246 PSYCHIATRY 



of those states in which statistics have been more carefully kept, as, 

 for example, in Massachusetts, New Hampshire, and New York, as 

 well as by the census statistics of this country and Great Britain. 

 We may say that in the last twenty-five years the ratio of sane to 

 insane has shown an apparent gradual increase from 1 to 450 to 1 to 

 300, and this latter seems to be about the ratio in those communities 

 of North America and Europe in which modern conditions of civiliza- 

 tion prevail. 1 This average has varied but little in the last few years; 

 the slight yearly increase probably will not change rapidly and prob- 

 ably not continue. For when the increase in the insane reaches 

 a certain point of excess, society will have to take notice of it and 

 correct it. 



For twenty-five years the explanation for this increase has been 

 that more cases were observed and more victims kept in institutions 

 than formerly; and this is still the explanation. It is my opinion, 

 however, that the increase is a real one, and it is one to be expected, 

 not only from the strenuousness of modern life and increase of city 

 population, but also because more feeble children are nursed to 

 maturity and more invalid adolescents are kept alive to propagate 

 weakly constitutions or to fall victims themselves to alienation; the 

 period of life susceptible to insanity is longer. 2 A fourth of the cases 

 of insanity are due to so-called moral causes: emotional strain, 

 shocks, and vicious indulgences. But moral causes are not sufficient 

 to cause insanity if the individual has a sound constitution. Insanity 

 is increasing in part, then, because we are saving too many lives 

 by the careful regulations of our health boards. Hence, those who 

 are working so enthusiastically, and nobly, and successfully in pre- 

 venting disease achieve results which carry serious responsibilities 

 for the state. 



1 The somewhat startling increase in suicide is corroborative of an increase in 

 psychopathic constitutions. 



2 The expectation of life is now 43.59 (Newsholme). The death-rate of children 

 under 5 has dropped from 68.6 to 64.5 in the years from 1865 to 1895 in Massachu- 

 setts. The drop in the death-rate, from 5 to 40, has been much greater, while the 

 death-rate above 40 has increased. (S. W. Abbott, Vital Statistics, Wood's Ref. 

 Handbook, vol. vm.) The period of life during which insanity most frequently 

 occurs is 30 to 40, and next, that between 20 and 30. The average age at death in 

 England was: 



Males. Females. 



1840 27.15 29.38 



1900 33.63 39.90 



/ Excluding to 4. % / Excluding to 54 > 

 Males. Females. Males. Females. 



1840 46.46 46.77 ^2.09 73.05 



1900 53.17 55.21 W0.41 71.92 



S. G. Warner. 

 Expectancy of life in Massachusetts : 



1880 44.64 



1900 46.05 



U. S. Census Bulletin, No. 15. 



The average age at death has increased from about 28 in 1840 to 34.5 in 1900, 

 thus bringing more people into the third decade, which is the one most fruitful in 

 insanity. 



