DISEASE The high death-rate of early infancy from con genital causes and intestinal infections is followed, as we have seen, by a relatively low death-rate in the years from five to twenty, though health has remained a prime object of solicitude at every period of life. From this point on mortality and morbidity increase.
Most tragic of all diseases of adult life are those which cause the alienation of the mind. Insanity does not often afflict youth, but from the beginning of maturity through old age it is one of the sinister influences operating to break up homes or to inter fere with their establishment. There were one hundred and eighty-eight thousand persons in the hospitals for the insane on January I, 191o, two thirds of them between the ages of twenty-five and fifty-five, with an average age for all of forty-five. The sixty-one thousand admitted during the year were somewhat younger, as would be expected, the bulk of them being from twenty to fifty, and their average age forty-one. In proportion to the popu lation of the same age, the number of patients admitted increases rapidly up to the age of fifty, and again after seventy, with a stationary or slightly lower ratio between fifty and seventy: i. e. except for these two decades, liability to insanity increases steadily with advancing years. Fortunately, over half of the insane men and over a third of the in sane women in hospitals are unmarried. Widows and widowers constitute a rather larger proportion of the insane than of the general population; and the proportion of divorced among the insane is twice as great for men and three times as great for women as it is in the population at large.
In the thirty years between 188o and 1910 the insane in hospitals increased more than fourfold in actual numbers, and their ratio to the population was more than doubled.* The greater part of this increase is only apparent and represents causes for congratulation: additions to hospital accommoda tions, improved methods of care, greater skill in detecting insanity, greater willingness to entrust to institutions persons formerly cared for at home. There probably has been, however, some real in crease in the relative amount of insanity, as there has been in suicides, along with the development of urban centers and other accompaniments of pro gress which have not yet been thoroughly adjusted to the needs of the normal life of man. This
tendency may be counteracted, and a further de crease effected after the increase has been checked, by establishing all along the line those normal con ditions of work and living which are desirable for many other reasons as well. For, as Dr. Nathan Allen, of Lowell, said at the second meeting of the National Conference of Charities in 1875: This cannot be the fruit or result of true civilization, but comes from something wrong— some artificial habits, some unnatural, un wholesome way of living, some false and cor rupt state of things in society.
By way of confirmation it may be mentioned that ten per cent of the patients admitted in 1910 were reported to be suffering from "alcoholic psychosis" and over six per cent from general paralysis, which is indicative of syphilis.
It will be necessary to enlarge still further our hospitals for the insane and to increase still more our expenditures for this, already the largest single item in some of our state budgets. Diagnosis, and curative and hygienic treatment based on the diagnosis, are the great needs. The interval be tween the recognition of the disease and admission to a hospital or a psychiatric clinic, already com paratively brief, must be made briefer; and the interval between its onset and its recognition must be cut down to a minimum by medical skill and enlightenment of the general public; oversight of the patients who leave the hospitals recovered or improved (eighty-two per cent of those discharged) must be provided for a probationary period, in or der that dangers of relapse may be warded off; and continuous oversight of those who are discharged unimproved, as long as there shall be any such. Above all, perhaps, or at any rate under all, is needed the patient education of nervous children and young people in habits of emotional control, and the protection of all from such a degree of stress and strain as the normal mind can not reason ably be expected to stand.