STATISTICAL STUDIES OF THE INSANE FOR THE FISCAL YEAR 1914.

BY WILLIAM J. NOLAN, A. M.,
Assistant Statistician.

In the past two months I have been frequently called upon by the Commission and others for certain very specific and definite statistics relating to the insane. By searching for answers to these inquiries which covered a period of ten or more years, I have learned that the State Hospital Commission has gradually increased the efficiency of its statistical work; that the statistical department, especially in the last few years has made great progress both in definiteness of classification and discrimination of material.

Prior to 1908 there was no distinction made between first admissions and readmissions neither was there a definite or adequate classification of patients according to psychoses nor a complete record of paroled patients; nor any definite information concerning the citizenship or race of patients in our State hospitals.

Improvements in classification and new discriminations have been gradually introduced until now the State of New York ranks first among the States in the accumulation and compilation of data concerning the insane.

Owing to recent movements toward the prohibition of the sale of alcoholic liquors and toward the prevention of diseases there has been a great demand for the collection and interpretation of statistical material relating to social problems of every description.

In the past six years the Commission has gathered together in the form of statistical cards a vast amount of valuable material which when tabulated will enable us to answer many important questions relating to causes and results of various mental diseases.

During the sessions of the legislature, there are frequent requests for data from which to shape financial policies. Sociologists and scientists are seeking definite information

and the Commission calls for data to answer perplexing questions, or for the purpose of achieving more efficiency in administration.

The data accumulated must be intelligently and accurately tabulated so that it is available for use. This is the work of the statistician, but it must not be forgotten that the value of the statistician's work depends upon the reliability of the original data with which he deals.

Since this material is so important to the State in shaping its financial policies, so necessary in dealing with sociological problems and so important in determining a method of procedure for the prevention of insanity and after-care of the insane, it is essential that each superintendent impress upon each person having a part in securing the various data, the importance of accurate, conscientious answers to every item. If there are unimportant items, they should be eliminated from the card.

We realize that it requires great tact, skill, patience and perseverance to secure the facts called for on the statistical cards, but with increased experience and facilities there should be more exact diagnosis of patients, more careful discrimination in marking cards and unascertained items should gradually diminish.

Owing to the introduction of the revised statistical cards in 1913, we have been able to tabulate some new and very interesting data for the fiscal year 1914. The additional tables relate to race, economic condition, and citizenship. In addition we have the new form of card for the alcoholic psychoses. Great credit is due the hospitals for the vast amount of attention and labor given to secure the information called for on this card. By accumulating these cards and by special studies that are being made, New York will soon have the largest fund of information concerning alcoholic insanity obtainable in the world.

ECONOMIC CONDITION.

The same is true of the new classification of economic condition of patients. Although there have been some general classifications of economic conditions, the State of

Unascertained..

New York was the first to get definite data along this line. The old classification of "poverty," "comfort," and "affluence" proved to be indefinite and inadequate. It submerged in the comfortable class, the great marginal class which constituted 52.4 per cent of the first admissions for the fiscal year 1914. Poverty is another term which is reluctantly applied and in no way delineates the great dependent class which constituted 21 per cent of the first admissions last year. In addition there are 2.5 per cent whose economic condition was unascertained, which without doubt belong to either the marginal or dependent class, making a total of 75.9 per cent for the two classes and leaving a comfortable class of 24.1 per cent. That only a small percentage of these can be classed as affluent, seems evident from the fact that less than 9 per cent of the admissions were reimbursing patients.

The following is a classification of the first admissions of 1914, classified according to economic condition:

Total.

1759 3283 45.6 60.1 52.4 i

825 683 1508 24.7 23.3 24.1

Further classifying these patients according to psychoses and choosing the five groups which contain the greatest number of patients, the following table is obtained:

3338 2927 6265 100.0 100.0 100.0

Comparing these five principal psychoses: senile, general paralysis, alcoholic, dementia præcox and manic-depressive, we find the largest percentage of dependents among the seniles and the smallest among the manic-depressives; there being relatively more than twice as many senile dependents as manic-depressive dependents.

The manic-depressive marginal class was relatively one and one half times as great as the senile marginal class and greater than that of any other psychoses; while the senile comfortable class was the greatest, and dementia præcox comfortable class the least.

RACE.

This is the first time that a general table of the race of first admissions has been possible as the statistical card which required this data did not come into general use until 1914.

The first admissions were distributed among the principal races as follows:

Although there were thirty-five races in the classification used, we find that six of these races; i. e. the English, German, Hebrew, Irish, Italian and Slavonic number 3,640, or 60.5 per cent, of the ascertained cases.

The Irish race exceeded all others and constituted 17.5 per cent; the German race 12.6 per cent; the Hebrew 10.5 per cent; the English race 6.9 per cent; the Italian race 5.9 per cent and the Slavonic 4.7 per cent.

RACE DISTRIBUTION OF FIRST ADMISSIONS TO THE CIVIL STATE HOSPITALS, YEAR ENDING SEPTEMBER 30, 1914.

With the exception of the African race there are no statistics available to show the distribution of the various races in the general population of the State. Assuming that since 1910 the African race in this State has increased at the same rate as the general population, the present population of the race would be 145,731. During the fiscal year 1914, there were 202 Africans among the first admissions to the civil State hospitals, or a rate of 138.5 per 100,000 of the population. The rate of first admissions among the general population of the State was 63.3. These figures seem to indicate that the rate of insanity among the negroes is approximately twice as great as among the general population.

Among the different races the frequency of different forms of mental disease varies greatly.

The following table shows the distribution of certain psychoses among the leading races:

B