regeneration of the city and that the mortality from all diseases has been reduced to an unprecedented figure. We know that efforts for the public welfare often produce results where they were least expected, and so, the different fields of preventive medicine, special as some of them seem to be, are really inseparably related. Contrary to general belief, the prevention of insanity is not a matter which depends upon such special factors that it does not concern us all. It is, instead, only a phase of the general warfare against preventable disease; it has points of contact with many familiar problems of sanitation and, as will be shown, it bears a fundamental relation to two social questions which are occupying a very large place in the public attention at the present time.
The prevention of insanity is a matter well worthy of some consideration, for it is doubtful if any other human infliction can produce keener distress. A better conception of the nature of disorders of the mind and a kindlier attitude toward the insane have done a great deal to improve the lot of the sufferers themselves, but nothing can do much to lessen the unhappiness which insanity brings to others. It is difficult to tell exactly how prevalent insanity is. A few years ago some writers, who failed to take account of factors which greatly modified their statistics, startled the public in England by showing that the total number of the insane was increasing at a much more rapid rate than the general population, and one of the more gloomy of these writers did not hesitate to predict that insanity would ultimately engulf the race. It was, of course, absurd to ignore the effect, in increasing the aggregate number of insane persons under treatment, of an increasing readiness to seek institution treatment on account of the enormous advances in standards of care, of the earlier recognition of mental diseases and of the effect of building more hospitals, thus affording ready access for cases not often committed to distant institutions. At the close of 1908, there were 30,456 patients in the public and private institutions for the insane in New York state; about one in 280 of the general population of the state. This is approximately the ratio which exists in neighboring states and, it happens, exactly the same as the ratio in England. This number is not, fortunately, a satisfactory index of the prevalence of mental diseases, for the reason given and because the duration of some mental diseases is so great, in patients who do not recover, that the aggregate number under treatment at any given time represents, in large measure, the accumulation of unrecoverable cases admitted in former years. A patient died recently at the Utica State Hospital who had been admitted in 1843; she had been counted in 65 annual enumerations. The number of patients admitted for the first time to any hospital for the insane during a specified period is a much more trustworthy guide. Last year 5,301 patients
