Mental Diseases: a Public Health Problem

Part I. General Considerations.

CHAPTER PAGE

I. THE SOCIAL AND ECONOMIC IMPORTANCE OF MENTAL DISEASES 15

II. THE EVOLUTION OF THE MODERN HOSPITAL 34

III. LEGISLATION AND METHODS OF ADMINISTRATION 50

IV. THE STATE HOSPITALS—THEIR ORGANIZATION AND FUNCTIONS 68

V. THE HOSPITAL TREATMENT OF MENTAL DISEASES 84

VI. THE DEVELOPMENT OF THE PSYCHOPATHIC HOSPITAL 104

VII. THE MENTAL HYGIENE MOVEMENT 121

VIII. THE ETIOLOGY OF MENTAL DISEASES 138

IX. IMMIGRATION AND MENTAL DISEASES 155

X. MENTAL DISEASES AND CRIMINAL RESPONSIBILITY 169

XI. THE PSYCHIATRY OF THE WAR 185

XII. ENDOCRINOLOGY AND PSYCHIATRY 202

XIII. THE MODERN PROGRESS OF PSYCHIATRY 217

XIV. THE CLASSIFICATION OF MENTAL DISEASES 234

Part Ii. the Psychoses

I. THE TRAUMATIC PSYCHOSES 253

II. THE SENILE PSYCHOSES 266

III. THE PSYCHOSES WITH CEREBRAL ARTERIOSCLEROSIS 280

IV. GENERAL PARALYSIS 293

V. THE PSYCHOSES WITH CEREBRAL SYPHILIS 308

VI. THE PSYCHOSES WITH HUNTINGTON'S CHOREA, BRAIN TUMOR AND OTHER BRAIN OR NERVOUS DISEASES 323

VII. THE ALCOHOLIC PSYCHOSES 344

VIII. THE PSYCHOSES DUE TO DRUGS AND OTHER EXOGENOUS TOXINS 363

IX. THE PSYCHOSES WITH PELLAGRA 378

X. THE PSYCHOSES WITH OTHER SOMATIC DISEASES 392

XI. THE MANIC-DEPRESSIVE PSYCHOSES 409

XII. INVOLUTION MELANCHOLIA 427

XIII. DEMENTIA PRÆCOX 440

XIV. PARANOIA AND THE PARANOID CONDITIONS 461

XV. THE EPILEPTIC PSYCHOSES 475

XVI. THE PSYCHONEUROSES AND NEUROSES 489

XVII. THE PSYCHOSES WITH PSYCHOPATHIC PERSONALITY 504

XVIII. THE PSYCHOSES WITH MENTAL DEFICIENCY 524

INDEX 537

AUTHOR'S PREFACE

In presenting a preliminary consideration of the subject of mental diseases as a public health problem the author is actuated by no other motive than that of stimulating the undertaking, at some future time, of a comprehensive investigation and survey of an important field which has never been systematically and adequately studied in the past. Under existing circumstances the facts necessary for an intelligent discussion of this question are unfortunately not obtainable. We have, as will be shown, practically no information whatever as to the incidence of mental diseases in the community. Hospital statistics are still in such a chaotic state that we are not even in a position to speak authoritatively of that part of the population which is entirely within our supervision and control in institutions. Before any progress can be hoped for we must at least have at our disposal accurate data relative to the patients within the walls of our hospitals. This presupposes a uniform scheme of statistical reports based upon some common viewpoint. Adequate preparations for this undertaking have been made by the American Psychiatric Association and the National Committee for Mental Hygiene. Every hospital for mental diseases in the country has been urged to cooperate in this movement. To show the necessity for more actively prosecuting this research has been one of the principal purposes of this book.

In elaborating somewhat briefly the conception of the various psychoses generally accepted by American psychiatrists, and for that reason included in the classification adopted by the Association, every effort has been made, as far as possible, to show the steps which have led up to present developments. The author has endeavored to confine himself to reflecting the views of others throughout and has used actual quotations from recognized authorities as far as was deemed advisable. In the discussion of the various psychoses frequent references will be noted to the description of the various clinical groups contained in the manual prepared by the Committee on Statistics for the American Psychiatric Association. As is shown in the manual, these definitions and explanatory notes were formulated by Dr. George H. Kirby.

Special reference should be made to the important contributions to the literature of psychiatry of such well-known American writers as Meyer, Hoch, Kirby, White, Barrett, Campbell, Southard, Peterson, Diefendorf, Jelliffe, Paton, Salmon, Russell, Buckley, Rosanoff, Orton, Singer and many others. The work of Kraepelin, Bleuler, Nissl, Alzheimer, Freud, Jung, Stekel, Janet and others abroad has exercised an influence on the psychiatry of the day which must be recognized. We are very largely indebted to Pollock and to Furbush for the available information relating to the incidence of the various psychoses in this country. To the American Psychiatric, for many years the American Medico-Psychological, Association we owe an exhaustive historical review of the institutional care and treatment of mental diseases in the United States and Canada.

Obviously this work was not intended as a textbook, nor was it designed to serve the purpose of one. It is an appeal to those who are already familiar with the fundamental principles of psychiatry. For that reason the interpretation of mental mechanisms given so much space in textbooks has been entirely omitted and no reference is made to the treatment of the individual psychoses. Such reliable statistical data as could be gathered from recent hospital reports and publications have been utilized in full. The following institutions were represented in this study:

1. MASSACHUSETTS—fourteen hospitals (1919-1920): Boston State Hospital, Boston; Bridgewater State Hospital, State Farm; Danvers State Hospital, Hathorne; Foxborough State Hospital, Foxborough; Gardner State Colony, Gardner; Grafton State Hospital, North Grafton; McLean Hospital, Waverley; Medfield State Hospital, Harding; Monson State Hospital, Palmer; Northampton State Hospital, Northampton; State Infirmary, Tewksbury (Mental Wards); Taunton State Hospital, Taunton; Westborough State Hospital, Westborough; Worcester State Hospital, Worcester.

2. NEW YORK—thirteen hospitals (1912-1919): Binghamton State Hospital, Binghamton; Brooklyn State Hospital, Brooklyn; Buffalo State Hospital, Buffalo; Central Islip State Hospital, Central Islip; Gowanda State Homeopathic Hospital, Collins; Hudson River State Hospital, Poughkeepsie; Kings Park State Hospital, Kings Park, L. I.; Manhattan State Hospital, Ward's Island, New York City; Middletown State Homeopathic Hospital, Middletown; Rochester State Hospital, Rochester; St. Lawrence State Hospital, Ogdensburg; Utica State Hospital, Utica; Willard State Hospital, Ovid.

3. Twenty-one hospitals in fourteen other states:

ARKANSAS—State Hospital for Nervous Diseases, Little Rock (1917-1918).

COLORADO—Colorado State Hospital, Pueblo (1917 and 1918).

CONNECTICUT—Connecticut State Hospital, Middletown (1917 and 1918); Norwich State Hospital, Norwich (1905-1918 inclusive).

MARYLAND—Springfield State Hospital, Sykesville, 1919; Spring Grove State Hospital, Catonsville, 1918 and 1919.

MICHIGAN—Pontiac State Hospital, Pontiac, 1917 and 1918; State Psychopathic Hospital, Ann Arbor, 1917 and 1918; Traverse City State Hospital, Traverse City, 1917 and 1918.

MONTANA—Montana State Hospital, Warm Springs, 1917 and 1918.

NEW JERSEY—Essex County Hospital, Overbrook, 1918.

PENNSYLVANIA—State Hospital Southeastern District of Pennsylvania, Norristown, 1919.

SOUTH CAROLINA—South Carolina State Hospital, Columbia, 1918.

UTAH—State Mental Hospital, Provo, 1918.

VERMONT—Vermont State Hospital, Waterbury, 1917 and 1918.

VIRGINIA—Central State Hospital, Petersburg, 1919; Western State Hospital, Staunton, 1919.

WASHINGTON—Eastern State Hospital, Medical Lake, 1917 and 1918; Northern State Hospital, Sedro Woolley, 1917 and 1918.

WEST VIRGINIA—Spencer State Hospital, 1917 and 1918; Weston State Hospital, Weston, 1917 and 1918.

These institutions may, I think, be looked upon as fairly representative of the hospitals of this country. Based on their official reports an analysis has been made of over seventy thousand consecutive first admissions.

There is no disposition on the part of the writer to overestimate the value of statistical studies. Our conclusions should, however, be based as fully as possible on facts rather than on abstract theories or individual observations alone. The social, economic and clinical aspects of mental diseases must all be given adequate consideration if psychiatry is to fulfill its obligation to the community and assume a dignified rôle in the advancement of modern medicine.

JAMES V. MAY.

Boston, Mass., December 15, 1921.

PART I. General Considerations

GENERAL CONSIDERATIONS

MENTAL DISEASES

CHAPTER I

THE SOCIAL AND ECONOMIC IMPORTANCE OF MENTAL DISEASES

The importance of mental diseases as a factor in the social and economic welfare of the community has not been given adequate consideration, notwithstanding the remarkable progress of modern psychiatry. Nor is this influence, unfortunately, one which can be easily estimated or accurately determined. We have, as a matter of fact, no data at hand to show the prevalence of disease, either physical or mental, with any degree of exactness even under our most elaborately organized forms of government. There is no complete information available which will enable us to determine the frequency of such important conditions as appendicitis, cardiac or renal diseases, peritonitis, septic infections, diseases of the eye, ear, skin or nervous system. It is true that there are, in the majority of states, records of contagious or readily communicable diseases which are probably fairly reliable. Aside from this, the only information at our disposal is confined to mortality statistics.

This suggests a further consideration of the advisability, if not absolute necessity, of more extensive statistical studies of diseases, both mental and physical, if the welfare of the community is to be safeguarded and the future of medical science assured. Every physician should be required by law to make careful reports to the Board of Health of his state showing all medical conditions requiring treatment by him or coming to his professional notice. The value of such information to medical science would much more than compensate for the comparatively small cost of such an undertaking. Nor is this procedure more radical either in theory or practice than was the proposal to report all communicable diseases only a few years since. The data thus made available in the various states should be correlated and published by the Public Health Service.

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