MENTAL DISEASES
CHAPTER I
THE SOCIAL AND ECONOMIC IMPORTANCE OF MENTAL DISEASES
The importance of mental diseases as a factor in the social and economic welfare of the community has not been given adequate consideration, notwithstanding the remarkable progress of modern psychiatry. Nor is this influence, unfortunately, one which can be easily estimated or accurately determined. We have, as a matter of fact, no data at hand to show the prevalence of disease, either physical or mental, with any degree of exactness even under our most elaborately organized forms of government. There is no complete information available which will enable us to determine the frequency of such important conditions as appendicitis, cardiac or renal diseases, peritonitis, septic infections, diseases of the eye, ear, skin or nervous system. It is true that there are, in the majority of states, records of contagious or readily communicable diseases which are probably fairly reliable. Aside from this, the only information at our disposal is confined to mortality statistics.
This suggests a further consideration of the advisability, if not absolute necessity, of more extensive statistical studies of diseases, both mental and physical, if the welfare of the community is to be safeguarded and the future of medical science assured. Every physician should be required by law to make careful reports to the Board of Health of his state showing all medical conditions requiring treatment by him or coming to his professional notice. The value of such information to medical science would much more than compensate for the comparatively small cost of such an undertaking. Nor is this procedure more radical either in theory or practice than was the proposal to report all communicable diseases only a few years since. The data thus made available in the various states should be correlated and published by the Public Health Service.
The mortality statistics of the United States Census Bureau furnish us with a valuable index of the relative frequency of the various disease processes which determine the death rate of the community. They are based on the transcripts of death certificates received from the so-called registration area, which in 1920 had an estimated population of 87,486,713. The total number of deaths reported in 1920 was 1,142,558, a rate of 13.1 per 1,000 of the population. It is true that the epidemic of influenza was still a factor of some importance at that time. The rate for 1916, however, was fourteen, for 1917 fourteen and two-tenths, for 1918 eighteen and one-tenth and for 1919 twelve and nine-tenths per 1,000 of the population. The registration area now includes thirty-four states:—California, Colorado, Connecticut, Delaware, Florida, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, 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):