CAUSES OF INSANITY 563 



cities as from rural communities. This is eloquent testimony to the 

 influence exerted by the back room and the " ladies' entrance " of the 

 city saloon. The most striking fact shown by these charts, however, is 

 that Jf2 per cent, of all the male admissions from cities were for gen- 

 eral paralysis and the alcoholic psychoses. Where are " the nervous 

 tension of the cities " and " the mad rush of modern life," of which 

 we speak so glibly, compared with syphilis and drunkenness as the 

 real dangers of city life? But for the undue prevalence of insanity 

 due to these two causes, the ratio of the insane to the population would 

 actually be greater in the quiet countryside than in the cities, in spite 

 of their congestion of population, their unequal share of immigrants 

 (an important factor in the prevalence of insanity) and their increased 

 economic stress. 



All through the etiology of other types of mental diseases than those 

 which we have considered, appears the trail of syphilis and intemper- 

 ance; sometimes unmistakable and sometimes faint but recognizable. 

 A considerable percentage of the 5,301 first admissions were for mental 

 diseases arising upon a basis of congenital mental defect or epilepsy. 

 Some of these psychoses are temporary attacks in epileptics and in 

 imbeciles and some are really terminal stages of such conditions. The 

 tremendous effect of alcohol in the parents as a cause of mental defi- 

 ciency has been pointed out by many competent observers and there 

 are many very interesting studies which could be mentioned if space 

 permitted. Alcoholism in parents has nearly as great an influence in 

 the causation of epilepsy as of mental defect in descendants. Dr. E. 

 E. Doran found that the parents of 257 of 1,300 epileptic children ad- 

 mitted to the Craig Colony had been confirmed alcoholics. A group 

 forming about one tenth of all admissions to state hospitals is made up 

 of patients with psychoses dependent upon gross disease of the brain. 

 In these mental diseases there is destruction of cells of the brain, re- 

 sulting from arterial changes, the effects of hemorrhages, the pressure 

 of new growths and similar causes. In a very large proportion of such 

 cases it was syphilis or alcohol which first attacked the integrity of 

 the blood vessels or in other ways laid the train which was destined 

 to lead finally to insanity. 



So, if we care to go beyond the field of what is demonstrable by 

 absolutely trustworthy statistics and can be shown by tables and charts, 

 we find that alcohol and syphilis are factors in the production of mental 

 diseases which have no equal. If we prefer to confine our attention to 

 general paralysis and the alcoholic psychoses, we find that these dis- 

 eases, due directly to syphilis and alcohol, are responsible for nearly 

 one fourth of the sad procession of new patients entering the hospitals 

 of a single state at the rate of more than a hundred a week. 



The lesson of these statistics is full of hope and encouragement. 



