The following table shows the relative prominence of the principal definite causes among males and females as reported by the New York State hospitals.
State hospitals taken by psychoses on 1July 1917. As the patients of the New York State hospitals have been carefully classified with reference to psychoses for the past 10 years this census may be considered representative of the distribution of insane patients in institu tions in the various clinical groups. As the duration of hospital life of patients in some groups is much longer than in others the dis tribution of the patients in the hospitals with respect to psychoses varies considerably from that of the newly-admitted cases. This is shown clearly in the accompanying table.
Insane Classified with Reference to Psy No nation-wide census of the insane in the United States with reference to psy choses of mental diseases has ever been taken. The accompanying table gives the result of a census of the 36,357 patients in the New York Movement for Uniform Statistics of the Insane.— As previously pointed out, statistics of the insane until recent years dealt prin cipally with the number enumerated in various States and countries without regard to the kinds of mental disease with which they were afflicted. In fact, the absence of a generally accepted classification prior to 1917 prevented the collection of national statistics of mental diseases. The first bureau of statistics for the study of mental diseases was established in 1908 by the New York State Commission in Lunacy (now the State Hospital Commission). The Commission adopted a uniform classifica tion of mental diseases for use in its 13 State hospitals, and required the medical officers of each hospital to submit to the Commission's statistician a statistical card report concerning each case admitted, readmitted, discharged or deceased. From such cards yearly statistical reports have been prepared and published, and the cards have been filed according to identill= cation number and psychosis. The Commission stow (1918) has a file of uniform cardr of about 60,000 first admissions — the largest col lection of systematic data concerning mental diseases in the world. By combining the cards received from all the hospitals for a series of years, the bureau is able to make intensive studies of the separate mental diseases.
The success of New York's pioneer work led the American Medico-Psychological Asso ciation to undertake a movement for uniform statistics of the insane throughout the United States. At the meeting of the Association held in Niagara Falls in June 1913, a special committee was appointed to devise ways and means of securing uniform statistical reports from institutions for the insane. This com mittee, after prolonged conferences, submitted its final report to the Association at the annual meeting held in New York in May 1917. The
report recommended the adoption of a new classification of mental diseases and submitted outlines of 18 statistical tables for use in the annual reports of institutions for the insane. The committee stated that "the lack of uni formity in hospital reports at the present time makes it absolutely impossible to collect com parative statistics concerning mental diseases in. different states and countries, and extremely difficult to secure comparative data relative to the movement of patients, administration and cost of maintenance and additions); and that the "importance and need of such uniform data have been repeatedly emphasized by offi cers of the association, by statisticians of the United States Census Bureau, by editors of psychiatric journals and by administrative offi cers in various "Such data," the com mittee adds, "should serve as the basis for con structive work in raising the standard of care of, the insane, as a guide for preventive effort, and as an aid in the progress of The report of the committee was unanimously adopted and a standing committee on statistics was appointed to secure the adoption of the new classification and statistical system by Federal and State authorities. In February 1918, such standing committee affiliated with the National Committee for Mental Hygiene which had received a special gift for statistical work.
Through the co-operative work of the two organizations a uniform system of statistics of mental diseases was put into operation in'nearly all the State hospitals for the insane in the United States during the summer of 1918. The surgeon-general of the army, in September 1917, adopted practically the same system for use in the Division of Neurology and Psychiatry.
The Association's classification of mental diseases which forms the basis of the new statistical system consists of 22 groups of principal psychoses, some of which are sub divided into more or less distinct types. The classification is not regarded as final, but it constitutes the first successful attempt to secure uniformity in the designation of mental diseases in the United States.
Bibliography.— Census reports, Insane and -Feeble-minded in Institutions, 1904 and 1910; 'Insane, Feebleminded, Epileptics and Ine briates in Institutions in the United States, Jan. 1, 1917,' by Horatio M. Pollock, Ph.D., and Miss Edith M. 'Furlough, A.B4:B.,S; •brOw York. State Hospital Commission Reports 1908 to 1917; Report of Committee on Statistics of the American Medico-Psychological Associa: tion, 1917; Statistical Manual for use in Insti tutions for the Insane,. published by the Bureau of Statistics of the National Committee for Mental Hygiene, 1918; Statistical yearbooks of foreign countries.