Mental diseases: a public health problem. James Vance May
8.1
The death rate for syphilis, locomotor ataxia and general paralysis of the insane, combined, was 14.3 per 100,000. The percentage of deaths due to diseases of the nervous system, many of which must be looked upon as probably having been associated with mental disturbances, is somewhat surprising, as shown by the following table:
| Encephalitis | 1.0 |
| Meningitis | 7.8 |
| Locomotor ataxia | 1.5 |
| Acute anterior poliomyelitis | 3.5 |
| Other diseases of the spinal cord | 4.0 |
| Cerebral hemorrhage (apoplexy) | 68.1 |
| Softening of the brain | .9 |
| Paralysis without specified cause | 5.2 |
| General paralysis of the insane | 4.1 |
| Other forms of mental alienation | 1.4 |
| Epilepsy | 3.5 |
| Convulsions (non-puerperal) | .2 |
| Chorea | .2 |
| Neuralgia and neuritis | .6 |
| Other diseases of the nervous system | 2.5 |
This shows a total rate of 104.5 per 100,000 due to diseases of the nervous system. If to this we add those dying of senility and the suicides as probably representing psychoses it would bring the total up to 123.2 per 100,000. It must be confessed, however, that such speculations mean comparatively little.
Practically the only other source of information at our disposal relative to the incidence of general diseases in the community is the tabulation of communicable diseases by Boards of Heath. The annual report of the United States Public Health Service for 1919 shows a case rate for diphtheria of 137 per 100,000 of the population based on the reports of thirty-seven states. The case rate for measles in thirty-seven states was 170. Poliomyelitis in thirty states showed a rate of 2.5 and scarlet fever a rate of 110 in thirty-seven states. The smallpox rate was sixty-eight and represented thirty-six states. The typhoid fever rate for thirty-seven states was only forty. The case rate for tuberculosis, all forms, was 346.7 in 1918. It was 274.2 in New York, 271.6 in the District of Columbia and 271.3 in New Jersey. These were the highest reported in the United States during that year. Unfortunately these statistics relate to communicable diseases only. This difficulty is due largely to the fact that comparatively few states have made attempts to keep elaborate records. The reports of Massachusetts are probably as comprehensive as any. The case rate per 100,000 of the population of all reportable diseases during the year 1920 was as follows:
| Influenza | 938.5 |
| Measles | 830.7 |
| Pneumonia, lobar | 143.6 |
| German measles | 12.5 |
| Pulmonary tuberculosis | 173.1 |
| Tuberculosis, other forms | 20.7 |
| Diphtheria | 194.2 |
| Gonorrhea | 186.7 |
| Whooping cough | 258.3 |
| Scarlet fever | 265.2 |
| Chicken pox | 138.4 |
| Mumps | 154.1 |
| Syphilis | 77.2 |
| Ophthalmia | 42.3 |
| Typhoid fever | 24.2 |
| Dysentery | 1.0 |
| Epidemic cerebrospinal meningitis | 4.7 |
| Malaria | 1.6 |
| Pellagra | .4 |
| Smallpox | .7 |
| Trachoma | 2.2 |
The case rates for influenza and pneumonia cannot be looked upon as representative, owing to the epidemic of 1919 and 1920. During 1917 the death rate from influenza was 12.9 per 100,000 and from pneumonia 163.8. The death rate from heart diseases (organic diseases of the heart and endocarditis) in Massachusetts in 1920 was 178 per 100,000 of the population, from apoplexy 108.4, cancer and other malignant diseases 116.7, Bright's disease and nephritis 92.4, diarrhea and enteritis 52.9, violence 76.3, automobile accidents and injuries 11.9 and suicides 10.1.
It must be admitted that it is exceedingly difficult to establish a definite basis for a comparison of our statistics relating to mental disorders and those dealing with the frequency of other diseases in the community. As has been shown, our information on the latter subject, such as it is, has to do only with communicable diseases and the reported death rates. In making an analysis of the reports of mental diseases we are limited almost entirely to the institution population. It is true that these statistics are much more reliable than the others, as we are dealing with a stable population entirely under control. The cases, furthermore, are almost invariably subject to a prolonged observation and careful study. The diagnosis in almost every instance is based on elaborate mental examinations and exhaustive personal and family histories. It is, of course, true that there are innumerable cases of mental diseases outside of institutions. There were 18,268 patients at home on visit from the state hospitals alone on January 1, 1920. Those not requiring hospital treatment or custody in an institution can, however, be eliminated for the purpose of comparative studies. The fact that an analysis of death rates alone does not throw any light whatever on the frequence of psychoses for reasons already given