cities as from rural communities. This is eloquent testimony to the influence exerted by the back room and the "ladies' entrance" of the city saloon. The most striking fact shown by these charts, however, is that 42 per cent, of all the male admissions from cities were for general paralysis and the alcoholic psychoses. Where are "the nervous tension of the cities" and "the mad rush of modern life," of which we speak so glibly, compared with syphilis and drunkenness as the real dangers of city life? But for the undue prevalence of insanity due to these two causes, the ratio of the insane to the population would actually be greater in the quiet countryside than in the cities, in spite of their congestion of population, their unequal share of immigrants (an important factor in the prevalence of insanity) and their increased economic stress.
All through the etiology of other types of mental diseases than those which we have considered, appears the trail of syphilis and intemperance; sometimes unmistakable and sometimes faint but recognizable. A considerable percentage of the 5,301 first admissions were for mental diseases arising upon a basis of congenital mental defect or epilepsy. Some of these psychoses are temporary attacks in epileptics and in imbeciles and some are really terminal stages of such conditions. The tremendous effect of alcohol in the parents as a cause of mental deficiency has been pointed out by many competent observers and there are many very interesting studies which could be mentioned if space permitted. Alcoholism in parents has nearly as great an influence in the causation of epilepsy as of mental defect in descendants. Dr. E. E. Doran found that the parents of 257 of 1,300 epileptic children admitted to the Craig Colony had been confirmed alcoholics. A group forming about one tenth of all admissions to state hospitals is made up of patients with psychoses dependent upon gross disease of the brain. In these mental diseases there is destruction of cells of the brain, resulting from arterial changes, the effects of hemorrhages, the pressure of new growths and similar causes. In a very large proportion of such cases it was syphilis or alcohol which first attacked the integrity of the blood vessels or in other ways laid the train which was destined to lead finally to insanity.
So, if we care to go beyond the field of what is demonstrable by absolutely trustworthy statistics and can be shown by tables and charts, we find that alcohol and syphilis are factors in the production of mental diseases which have no equal. If we prefer to confine our attention to general paralysis and the alcoholic psychoses, we find that these diseases, due directly to syphilis and alcohol, are responsible for nearly one fourth of the sad procession of new patients entering the hospitals of a single state at the rate of more than a hundred a week.
The lesson of these statistics is full of hope and encouragement.
