For purposes of comparison we may contrast the admission rate of mental diseases per 100,000 of the population in Massachusetts in 1920 with the case rate of communicable diseases as follows:

Mental diseases101.7
Chicken pox138.4
Diphtheria194.2
German measles12.5
Gonorrhea186.7
Measles830.7
Mumps154.1
Scarlet fever265.2
Syphilis77.2
Tuberculosis, pulmonary173.1
Tuberculosis, other forms20.7
Typhoid fever24.2
Whooping cough258.3

The total institution population (mental cases) at the end of the year 1920 represented a rate of 395.49 per 100,000 of the population. It should be borne in mind that, with the exception of tuberculosis and syphilis, the communicable diseases reported above represent, as a rule, the total number of cases in the state during the year. Comparative studies should, therefore, be based not on the number of mental cases in the hospitals at any one given time, but on the total number under treatment during the year. This would indicate an incidence of mental diseases of 566.98 per 100,000 of the population.

On January 1, 1916, there were 147 state and federal institutions for the care and treatment of mental diseases in the United States, as shown by the Census Bureau reports. There were at this same time twenty-seven institutions for the feebleminded, nine for epileptics, three for inebriates, forty-five for tuberculosis, twenty-eight for the blind, thirty-three for the deaf, twelve for the blind and deaf and eighty-four for the dependent classes. [3]

The appropriations for the maintenance of these institutions for 1915 amounted to $33,557,058.29. This constituted 7.6 per cent of the appropriations made by those states for all purposes. In Massachusetts it represented 14.8 per cent, in New Hampshire 10.1, in New York 12.7, in Ohio 12, in Indiana 10.7, in Illinois 13.4, and in a number of other states over ten per cent of the appropriations for all purposes. It was equivalent to an average of $431.16 per million of the total assessed valuation of these states. In Massachusetts it was as high as $653.62 and in New York $567.37. This means thirty-three cents per capita for all states, eighty-four cents for Massachusetts and sixty-eight cents for New York.

The actual expenditure for the maintenance of these institutions was $36,312,662.20. For purposes of comparison, attention should be called to the fact that the maintenance of the tuberculosis hospitals of the United States for the same year cost $3,539,454.95, institutions for criminals $21,244,892.00, for the feebleminded $3,341,442.85, for epileptics $1,345,821.57, for the blind $1,066,973.14, for the deaf $1,893,490.09 and for the dependent classes $9,675,932.37.

The value of the property invested in the state and federal hospitals for mental diseases in 1916 was estimated at $187,028,728.00. The valuation of these institutions per 100,000 of the population was $184,795.81. This does not include establishments for mental defectives. The average value per patient was $938.43. In Massachusetts it was $1,097.85 and in New York $1,039.85. In Arkansas it was as high as $2,264.00. The total acreage of land was 109,503.2, an average of 744.9 acres per hospital. There were 33,124 persons employed, an average of 226.9 for each institution. This represented one employee for every six patients.

The census taken by the National Committee for Mental Hygiene [4] in 1920 shows 156 state hospitals for mental diseases, two federal institutions, 125 county or city hospitals and twenty-one institutions of a temporary care type. In the public and private hospitals for mental diseases on January 1, 1920, there were 232,680 patients under treatment. Of these, 200,109 were in public and 9,238 in private hospitals. This represented an increase of 8,723 in two years. It is interesting to note that city and county institutions cared for 21,584 persons.

The first authoritative information relative to the institution care of mental diseases was obtained from the federal census reports of 1880. In that year there were 40,942 patients in the public hospitals. In 1890 there were 74,028; in 1904, 150,151; in 1910, 187,791; in 1917, 232,873 and in 1918, 239,820. The rate per 100,000 of the population increased from 81.6 in 1880 to 229.6 in 1918. From 1910 to 1918 the general population increased 13.6 per cent and the hospital population 27.7 per cent. The rate per 100,000 of the population in institutions in Massachusetts[5] on January 1, 1920, was 373.8, in New York 374.6, in Connecticut 317.8, in Iowa 248.1, in Wisconsin 300.6, in California 297.2, in Pennsylvania 215.2, in Ohio 212.1, in Illinois 229.5 and in Michigan 210.8. The admission rate per 100,000 of the population in 1917 was 151.6 in Massachusetts, 109.2 in Illinois, 124.8 in Montana, 97.3 in New York, 80.9 in Connecticut and 85.7 in California.