CAUSES OF INSANITY 559 



were admitted for the first time to any hospital for the insane in 

 New York state; one in 1,600 of the whole population or one in 1,000 

 if only those above the age of sixteen are considered. Here, then, is 

 our problem in the prevention of insanity. Was it possible, by means 

 at our command to have saved any of these unfortunates from becom- 

 ing insane last year? Must an equal number, the population of a 

 large town, be admitted next year, another 5,000 in 1912 and so on in 

 the years to come? Are there facts at hand which point to practical 

 measures of prevention or are the causes of mental disease so little 

 understood or so deeply rooted that this sad toll of 5,000 new cases in 

 a single state must be paid each year without hope of reducing it in 

 the future? 



Those who are responsible for the care of the insane in the various 

 states are deeply impressed with the necessity of being able to give 

 definite answers to these questions. In preventive medicine accurate 

 knowledge must precede action and so statistics are being carefully 

 gathered and analyzed in order that reliable information may not be 

 wanting in this field of the prevention of disease. The New York 

 State Lunacy Commission, which is charged with the care of nearly 

 one fifth of all the insane in the United States, has recently adopted 

 a greatly improved method of obtaining statistical data regarding new 

 patients and already sufficient material is available to permit the accu- 

 rate statement of some conditions which could be presented previously 

 only in a general and rather unconvincing way. So, in this discussion 

 of two preventable causes of insanity, it is worth while to examine the 

 records of the 5,301 " first admissions " in New York state for the 

 year which ended September 30, 1908. 



At the very outset of any consideration of insanity, it is necessary 

 to make it plain that we have to do not with one disease, manifesting 

 itself in different ways, but with a number of diseases, differing very 

 greatly from each other in many important respects. What is true of 

 the causes or of the clinical characteristics of one mental disease may 

 be entirely untrue of another. Various mental diseases, or " insani- 

 ties " as it would be quite permissible to call them, are grouped to- 

 gether because of some similarity, and all these groups make up insan- 

 ity as that term is generally used. 



The mental diseases of one such group have the common character- 

 istic of depending upon a preceding infectious disease. Permanent or 

 transitory mental impairment may follow typhoid fever, influenza and 

 some other acute, infectious diseases and it is obvious that these mental 

 disorders are preventable in just the measure in which the diseases 

 upon which they depend are preventable. The number of these cases 

 is not large, and yet, when the cost of the needless prevalence of typhoid 

 fever is estimated, these more remote effects should be considered. 



