CAUSES OF INSANITY 561 



which led to their infection and have become responsible for the sup- 

 port of families and of economic value to their communities. It not 

 infrequently means that an innocent mother must be taken from her 

 home,, and even from the cradle of her baby, to pay, in mental dark- 

 ness, a dreadful penalty for her faith in the man who became her 

 husband. 



Turning again to the cases we have selected to examine for pre- 

 ventable causes, we find that there were a very large number of patients 

 in whom alcoholic intemperance was the cause of their mental disease. 

 There is no subject which needs to be discussed with so much conserva- 

 tism or with such scrupulous regard for accuracy as the effects of alco- 

 hol. So much in the relation of alcohol to social and bodily ills is the 

 subject of bitter controversy, and so much damage may be done a worthy 

 cause by careless or ambiguous statements that it seems desirable to 

 define very precisely what we mean when we speak of alcohol as a 

 cause of mental disease. Alcohol has been assigned as the cause, 

 directly or indirectly, of more than one half the admissions to hos- 

 pitals for the insane by Kraepelin of Munich, a very great leader in 

 psychiatry and perhaps the foremost worker in Europe in the cause of 

 temperance. In order to remain upon unassailable ground in this im- 

 portant matter, we will consider separately those cases in which alcohol 

 is directly responsible and those in which it was a controlling and 

 probably the only cause. So the facts relating to the " alcoholic in- 

 sanities," those in which to name the disease is to give the cause, will 

 be presented first. In our series of 5,301 first admissions there were 

 638 such cases, or about 12 per cent, of all. 



There were together, then, 664 cases of general paralysis (depend- 

 ing upon syphilis) and 638 cases of the alcoholic psychoses (all due to 

 intemperance) or more than one fourth of all first admissions due to 

 these two preventable causes. Before considering any measures of pre- 

 vention, it is desirable to examine a little in detail these 1,302 cases 

 because there are some matters of sex and environment which are 

 particularly significant. It is seen in the smaller chart that, as would 

 have been supposed, both these causes affected men to a much greater 

 extent than women. A factor which bears directly upon preventive 

 measures is shown in the larger chart, which indicates the residence, as 

 " rural " and " urban," of patients admitted with general paralysis 

 and of those with alcoholic psychoses. It is seen that in the case of 

 male admissions environment did not have a very marked influence 

 upon the prevalence of the alcoholic psychoses, but that the percentage 

 of cases of general paralysis in men was nearly three times as great in 

 the admissions from cities as in those from the country. For women, 

 this chart shows that the percentage of cases of general paralysis from 

 cities was twice that from rural communities, but that the percentage 

 of admissions with alcoholic psychoses was seven times as great for 



