Mental diseases: a public health problem. James Vance May
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New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington and Wisconsin. It is interesting, at least, to note the states not included in the registration area:—Alabama, Arkansas, Arizona, Georgia, Idaho, Iowa, Nevada, New Mexico, North Dakota, Oklahoma, South Dakota, Texas, West Virginia and Wyoming. The results obtained from a study of the reports from such an extensive district must be looked upon as thoroughly representative of the country at large. The last complete statistics available are those for 1920. Influenza was still an important factor at that time, it being responsible for a death rate of 71 per 100,000. The influenza rate was 98.8 in 1919, 302.1 in 1918, 17.3 in 1917, 26.5 in 1916, 16 in 1915, 9.1 in 1914 and 10.3 in 1912.
The important causes of death in 1920 were as follows:
| Rate per 100,000 | Percentage | |
|---|---|---|
| Typhoid fever | 7.8 | .6 |
| Malaria | 3.6 | .3 |
| Measles | 8.8 | .7 |
| Whooping cough | 12.5 | 1.0 |
| Diphtheria and croup | 15.3 | 1.2 |
| Influenza | 71.0 | 5.4 |
| Tuberculosis of the lungs | 100.8 | 7.7 |
| Other forms of tuberculosis | 7.8 | .6 |
| Cancer and other malignant tumors | 83.4 | 6.4 |
| Simple meningitis | 6.0 | .5 |
| Cerebral hemorrhage | 80.9 | 6.2 |
| Organic diseases of the heart | 141.9 | 10.9 |
| Pneumonia (all forms) | 137.3 | 10.5 |
| Other diseases of the respiratory system | ||
| (tuberculosis and pneumonia excepted) | 11.6 | .9 |
| Appendicitis and typhlitis | 13.4 | 1.0 |
| Hernia, intestinal obstruction | 10.6 | .8 |
| Cirrhosis of the liver | 7.1 | .5 |
| Acute nephritis and Bright's disease | 89.4 | 6.8 |
| Puerperal septicaemia | 6.6 | .5 |
| Other puerperal accidents of pregnancy and labor | 12.5 | 1.0 |
| Congenital debility and malformation | 69.8 | 5.3 |
| Violent deaths (suicide excepted) | 78.5 | 6.0 |
| Suicide | 10.2 | .8 |
| Unknown or ill-defined diseases | 17.7 | 1.4 |
The pneumonia rate (all forms) for 1920 was quite unusual, 137.3 per 100,000, as compared with 123.5 in 1919, 286.6 in 1918, 150.5 in 1917, 137.8 in 1916, 133.1 in 1915, 127.3 in 1914, 132.6 in 1913, 132.4 in 1912, etc.
The following table shows the average rate per 100,000 of some of the more important general diseases during a period of eight years (1912, 1913, 1914, 1915, 1916, 1917, 1918 and 1919):
| Typhoid fever | 13.86 |
| Measles | 9.01 |
| Scarlet fever | 4.87 |
| Whooping cough | 10.11 |
| Diphtheria and croup | 16.30 |
| Tuberculosis (all forms) | 144.52 |
| Cancer and other malignant tumors | 80.27 |
| Cerebral hemorrhage, apoplexy | 78.91 |
| Acute endocarditis and organic diseases of the heart | 153.65 |
| Pneumonia (all forms) | 152.98 |
| Acute nephritis and Bright's disease | 101.63 |
The death rate from diseases of the nervous system is of particular interest. The average annual rate per 100,000 of the population for the years 1916, 1917, 1918 and 1919 was as follows:
| Encephalitis | 1.0 |
| Meningitis (total) | 8.17 |
| Locomotor ataxia | 2.27 |
| Other diseases of the spinal cord (total) | 8.57 |
| Cerebral hemorrhage, apoplexy | 80.57 |
| Softening of the brain | 1.25 |
| Paralysis without specified cause | 7.65 |
| General paralysis of the insane | 6.77 |
| Other forms of mental alienation | 2.17 |
| Epilepsy | 4.07 |
| Chorea | .10 |
| Other diseases of the nervous system | 3.85 |
This shows a total death rate for nervous and mental diseases of 126.44 per 100,000. It is a fairly reasonable assumption that of the above, the following, at least, may be classified as having been definitely associated with psychoses:
| Rate per 100,000 | |
|---|---|
| Encephalitis | 1.0 |
| Meningitis | 8.17 |
| Softening of the brain | 1.25 |
| General paralysis of the insane | 6.77 |
| Other forms of mental alienation |
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