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ART. VIII.-STATISTICS OF INSANITY IN THE UNITED STATES OF AMERICA.

BY RICHARD J. DUNGLISON, M.D.,

Physician to the Burd Orphan Asylum and to the Albion Society.*

STATISTICS of physical or mental infirmities interest the curious inquirer more often than they reward the zeal of the compiler. The reason is obvious; a few new facts of little consequence, or a few old ones with which he has been unfamiliar, become magnified as objects of importance in the eyes of the one, while the patience of the other receives but slight satisfaction in the paucity of useful materials separated from the confused mass of details. Matters of slight moment are dwelt upon, considered and reconsidered, while what is truly important is thrown aside, rejected as worthless, or left to the exploration of more careful observers. The latter must always, of course, in numerical strength, be the fewer, but the grand results so often obtained by patient investigation preserve the memories of their authors, when those who have devoted themselves to unimportant abstractions have been forgotten, and their results have passed away with them.

Perhaps statistics of infirmities of the organs of the senses furnish as striking an exemplification of this fact as any other sources of statistical information. The institutions devoted to the care and comfort of the blind, deaf-mute, and insane portions of the population, do not appear equally to appreciate the value of general information upon points on which professional and unprofessional are eager to acquire knowledge. How often are we told, as if they were almost the only points which could possess any interest to us, that the institution has expended so much in the course of the year for groceries and provisions, and has laid out its grounds in such a scientific and ornamental style of gardening as to excite the admiration of all beholders! To become truly useful sources of practical information, we need, rather than an advertisement of this kind, an enumeration of all the facts bearing upon the causes of predisposition to certain morbid affections of the senses, a personal history of the patient's condition, sex, and age, an account of the greater prevalence of mental disease in one district of country than another, the influence of marriage, sex, and constitution, on recovery or the reverse, and the numerous other channels through which lessons may be learned to guard us from the incursion of disease, or to assist us in relieving the infirmities to which we are subject.

If we could only bring home to our minds the consciousness of the fact that we are all exposed to most of the causes, of one kind or another, which predispose or excite to blindness, deaf-dumbness, or insanity, the world at large would be much less indifferent than it now is to considerations which seem at present to possess direct interest to compara

* From the North American Medico-Chirurgical Review. July, 1860.

tively a small proportion. It is not easy to impress this conviction upon the mind, and perhaps it may be as well that people generally should remain indifferent to it; the gloomy contemplation would assuredly not add much of happiness to the cares of every-day life. The truth is only mentioned to show how much wider the field of accurate statistical information might become, if more general interest were excited in such subjects of universal consequence.

We are, of course, dependent upon the accuracy and careful scrutiny of others for the mass of statistics through which we must search for the elimination of but few important details. If such authorities were unanimous in their mode of arrangement, and in their knowledge of what should be accepted as useful and what might be unhesitatingly rejected as worthless, if some uniform understanding of the wants of the professional and unprofessional could be arrived at, how greatly might the whole matter of statistics be simplified! It is by no means a grateful task, while aiming at unexceptionable accuracy, to discover how much disorder has been thrown into statistical records by the total carelessness, or only near approximation to accuracy, of those who should be the most worthy sources of information. If some system of classification were adopted which would furnish facilities for the collection of facts, and be uniformly applicable to every institution in which the blind, or the deaf-mute, or the insane are cared for, the slight additional trouble of registration would be amply compensated for by the grateful appreciation of those interested in human infirmities.

Insanity, in all its phases of mental and moral perversion, is fully described in works devoted to special and general pathology. The purpose of this article is to avoid all such points as refer to symptomatology, diagnosis, or treatment, and to adhere, as far as practicable, to facts which may be confirmed or established by the numerical records and the enlarged experience of those who have devoted special attention to the subject. A complete statistical history of insanity from European and American sources is almost impracticable. Continental authorities are often inaccessible, and from a few scattering details in countries whose language is unintelligible to the rest, we can make no inferences which are worth recording. Our own country is rich in the registered history of mental ailments, and from these channels it is proposed to make such deductions and collect such materials as may furnish a condensed history of insanity in the United States. As the reports of institutions for the insane are the most prolific records it is in our power to consult, we shall collect from them statistical information upon prominent points of interest connected with the insane, having previously considered such facts, meagre as they are, as have been furnished in the details of the United States Census of 1850. We may therefore appropriately touch first upon the statistics of the insane among the general population, and afterwards upon institutions devoted to their care. We shall refer merely to those cases of mental alienation which occur from perversion of intellectual and moral qualities, and exclude entirely all reference to congenital cases of defective mental development, embraced under the head of Idiocy.

I. STATISTICS OF THE INSANE AMONG THE GENERAL POPULATION.

Information on the number, &c., of the insane in this country can only be obtained through the details of an imperfect census. How little or how much reliance can be placed upon it, we cannot now argue; but adopting as our standard the results which it has furnished, we are able to make certain estimates of the influence of race, of the proportionate numbers of this class of unfortunates in different states, and other points of interest which may have some value to statisticians, however accurate or inaccurate the figures may be. In referring to census details we become involuntarily disbelievers in the idea that figures are infallible, and we condemn the laxity with which facts are collected, although we employ them almost as freely as if they were the most accurate results that census-takers could accomplish. The few facts obtained from the census of 1850 are embraced in the following tables. 1. Comparison of the Insane, Blind, Deaf, and Dumb, &c.-The following table, in an aggregate of 50,994 cases of infirmities of sense or the senses, exhibits the proportion of insane to the other classes in the general population :

The blind approximate closely the number of the deaf and dumb, while the insane and idiotic classes are not widely apart from each other. The insane are more than 60 per cent. more numerous, if we can place reliance on these estimates, than either the blind or deaf-mutes.

In every 100,000 of the Population (Census 1850) there are:

2. In a previous article upon deaf-muteism,* we referred to the greater prevalence of that infirmity among the native than among the foreign population. If we adopt a similar mode of classification with the insane, excluding slaves only, we shall find insanity far more prevalent among the foreign-born than among the native population.

PROPORTION OF INSANE IN THE NATIVE AND FOREIGN POPULATION.

12,865 17,498,550 1: 1360 2,049 2,175,999 1: 1061

* Observations on the Deaf and Dumb, reprinted from the North American Medico-Chirurgical Review. Philadelphia, 1858.

Change of mode of living, intemperance and dissipation, the frustration of fondly-indulged hopes of success, reverses of fortune, &c., are very often followed by insanity, and these, we imagine, operate powerfully among the foreign-born population. In the words of one of the New England Institutions: "Driven from their early homes by poverty, ignorance, and delusive hopes, they are thrown on our shores, and left to contend as they may with the new circumstances around them, until disappointment or sickness, or intemperance, or other form of vice, extinguishes the feeble light of reason, and consigns them to a lunatic hospital. They are unpromising patients. They do not recover in so large a proportion as others, and consequently contribute largely to swell the number of incurable cases which crowd the wards of our hospitals.'

We do not offer any explanation why mental alienation should attack the foreign-born in so large a proportion in some States, nor why they should be attacked in a proportion in the New England States no greater than exists among the native born. Reasons doubtless exist, which must be apparent to those familiar with the intimate domestic arrangements, habits, and feelings of each class.

3. Influence of Race. It will be seen, by the following table, that insanity is far more prevalent among the white and free coloured popu lation of the United States than among the slaves. It would be natural to suppose that absence of care and freedom from anxiety as to the future would tranquillize the mind, and ward off disturbing elements. The condition of a happy slave, thinking only of the present, and not dreaming of want in the future, would appear to be that which should give rise very unfrequently to causes of insanity. Intemperance, so fruitful a source of misery and unhappiness to the white and free coloured, is comparatively unknown among the slave population, every slaveholder striving to prohibit the use of alcoholic liquors, and dreading the proximity of taverns or drinking-places, which can supply unlimited indulgence to his slave. Hence, intemperance itself does not exist as a cause of mental alienation, nor can the thousand evils it always brings in its train-disease, exposure, excesses, &c.-be worthy of consideration as causes of insanity. Anxiety would be a far more productive source of mental disease to the free coloured population, from the fact that they have to contend at a disadvantage with the whites in many of their occupations and modes of earning a livelihood. It would be interesting to pursue these inquiries further than they have already been carried, to determine what causes are mainly at work to produce insanity among the coloured race, and why in some portions of the country-New England and Delaware, for example-the proportion should be so large. It may be remarked, however, that in a small population-in Maine, for instance the number of insane must be so small that no very reliable deductions can be founded upon such meagre statistics. Yet New England, which contains but about one-thirtieth of the free coloured population of the Union, had within her limits

* Third Annual Report of the State Lunatic Hospital at Northampton, Massachusetts, 1858, p. 31.

nearly an eighth of the free coloured insane. Ohio, with a larger free coloured population than that of all the New England States, had, in 1850, but one-third as many insane; while Maryland and Virginia had but two and a-half times as large an insane free coloured population as New England, although having more than five times the number of free coloured in the general population.

Influence of Race in the production of Insanity.

In inserting the above table, which has been carefully prepared from the census of 1850, we desire to correct an erroneous conclusion which has crept into a valuable statistical work-Boudin's Traité de Geographie et de Statistique Médicales, &c., Paris, 1857 (vol. ii. p. 143)