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rather that the insane as compared with the normal are less likely to marry." 1
An interesting relationship is also to be observed between certain psychoses and the state of widowhood, divorces and separations. Table 4, copied from statistics furnished by the New York State Hospital Commission,2 shows that the percentages of the widowed, divorced, and separated were highest in the general paresis and alcoholic groups; the table also shows that the groups of constitutional psychoses have the highest percentages of single persons.
21.3 6.7 5.5 23.1 6.6 9.7 6.6 2.2 3.3 9.2 2.1 3.1
Education. That the factor of education is in some manner related to the incidence of mental disorders is uniformly indicated by statistics representing the experience of every state in the country.
1 Insane and Feeble-Minded in Institutions. Bureau of the Census, Washington, 1914.
2 Twenty-fifth Annual Report, Albany, N. Y., 1914.
Thus on January 1, 1910, there were 881.8 persons in institutions for the insane per 100,000 of the white illiterate population 10 years of age or over in the United States and only 225.8 per 100,000 of the literate population. The constitutional psychoses, far more than others, contribute to this showing.
The conclusion could hardly be drawn from this that illiteracy is to any great extent a cause of mental disease, rather the reverse being true for the most part: the clinical histories of the illiterate insane show that most of them had been unable to learn to read and write owing to inherent mental defectiveness.
Immigration. Immigration in relation to insanity presents in this country a problem of great magnitude. Of all the insane in institutions in the United States according to the enumeration of the Thirteenth Census 29.3% were foreign born; of the native insane 30.7% were of foreign or mixed parentage. The figures given for the state of New York are even more striking: 41.4% were foreign born; of the native insane 51.0% were of foreign or mixed parentage.
Furthermore it has been shown that during the year ending September 30, 1911, the native population of the state of New York furnished 46.4 first admissions per 100,000 to the state hospitals, while the foreign born population furnished 100.3- relatively 2.19 times as many.1
1 H. M. Pollock. A Statistical Study of the Foreign-Born Insane in the N. Y. State Hospitals. N. Y. State Hosp. Bulletin, April,
This raises the important question whether the incidence of insanity is really greater among the immigrant races than in the older white population in this country or whether some other conditions are responsible for this showing.
A study of the available statistics has shown that the difference in age distribution which exists between the native and foreign-born parts of the population accounts largely, but not wholly, for the difference in the proportion of insane hospital admissions.
The difference is further, but still not wholly, accounted for by the greater proportion of town dwellers among the foreign-born than among the native population.
Upon eliminating the errors resulting from these disturbing factors there remains but a slight difference between the native and foreign-born parts of the population in the incidence of certified insanity.
It is thought that this remaining slight difference may be accounted for by the heavy stress entailed in the migration and in the subsequent process of adjustment to new conditions and more exacting standards of living, and, possibly, by other, less obvious, disturbing factors.
Incidentally, it was shown that the migration of native American masses of population from the eastern to the western coast has produced a similar effect in creating a seeming increase in the incidence of certified insanity; natives of the state of New York who have emigrated to California have contributed proportionately 2.60 times as many admissions to the
state hospitals there as the native Californians, a showing even more unfavorable than that made by the foreign-born population in the state of New York.
Owing to the practical impossibility of eliminating all sources of error in a direct comparison of the insanity rates in the native and foreign-born parts of the population, an attempt was made to make the comparison by an indirect method.
Insanity being, in large measure transmissible by heredity, any real difference in its incidence which may exist between the native and foreign-born parts of the population should be as patent in the offspring as in the parents; in other words, it should be as evident between native persons of native parentage and native persons of foreign parentage as it is between the native and foreign-born themselves.
Calculation shows that in the state of New York in the fiscal year ending September 30, 1911, the native of native parentage contributed 34.6 first admissions to the state hospitals per 100,000 of their general population, while the native of foreign parentage contributed 34.9 - practically the same proportion.1
The conclusion may, therefore, be drawn that there is no evidence to show that there is a greater proneness toward mental disease in the foreign-born than in the native population and that the excessive proportion of hospital admissions furnished by the foreign-born is due to other causes.
1 A. J. Rosanoff. Some Neglected Phases of Immigration in Relation to Insanity. Amer. Journ. of Insanity, Vol. LXXII, 1915.
SYMPTOMATOLOGY. — DISORDERS OF PERCEPTION.
INSUFFICIENCY OF PERCEPTION.—ILLUSIONS.—
"THE senses," says Jean Muller, "inform us of the various conditions of our body by the special sensations transmitted through the sensory nerves. They also enable us to recognize the qualities and the changes of the bodies which surround us, in so far as these determine the particular state of the nerves." The senses, in other words, are the means through which we obtain the knowledge of our own bodies and of the external world.
For the exercise of their function are necessary: (1) the reception of an internal or an external impression by a peripheral organ; (2) the transmission of this impression to the brain; (3) its elaboration by the cortical cells, which transform it into a phenomenon of consciousness: first sensation and then perception. Only. the latter operation is of interest to the alienist. We shall study successively:
I. Insufficiency of perception;
II. Illusions (inaccurate perceptions);
III. Hallucinations (imaginary perceptions). Halluci
1 Jean Muller. Manuel de Physiologie.