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ADMISSIONS OF INSANE TO PUBLIC AND PRIVATE HOSPITALS DURING 1904 AND NUMBER PER 100,000 OF POPULATION, FOR STATES

AND TERRITORIES.

STATE.

Number of

Insane
Admitted.

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Maine... New Hampshire Vermont... Massachusetts. Rhode Island. Connecticut. New York. New Jersey Pennsylvania. Delaware.. Maryland. District of Columbia. Virginia... West Virginia. North Carolina. South Carolina. Georgia.. Florida. Ohio. Indiana. Illinois. Michigan. Wisconsin. Minnesota. Iowa. Missouri.. North Dakota. South Dakota.. Nebraska.. Kansas.. Kentucky. Tennessee. Alabama.. Mississippi. Louisiana. Texas. Indian Territory. Oklahoma. Arkansas. Montana.. Wyoming Colorado... New Mexico. Arizona. Utah. Nevada. Idaho. Washington. Oregon.. California..

333
352

268
4,001

424

864 6,630 1,290 3,359

106 816 702 906 428 609 544 969

303 3,386 1,396 4,228 1,447 2,094 1,227 1,563 1,949

175 132 663 924 951 613 681 477 273 761

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236

89 165

37 503

26 113 115 31

94

496

General
Population.

706,427
424,150

347,660
3,008,304

458,314

966,528 7,722,443 2,040,882 6,676,216

190,556 1,240,236

296,035 1,925,208 1,029,035 1,992,661 1,408,100 2,352,132

577,677 4,331,414 2,632,582 5,178,163 2,518,659 2,203,671 1,909,459 2,346,361 3,259,845

365,070

420,550 1,067,606 1,485,683 2,250,567 2,111,310 1,941,678 1,645,035 1,475,880 3,340,100

467,982

512,946
1,377,265

279,308
103,272
585,011
207,861
135,361
300,388

42,335
188,010
575,749

447,876 1,582,396 80,651,957

Number per 100,000 of Population.

47.1 82.9 77.1 132.9 92.5 89.4 85.8 63.2 50.3 55.6 65.8 237.1 47.1 41.6 30.6 38.6 41.2 52.5 78.2 53.3 81.6 57.4 95.0 64.2 66.6 59.8 47.9 31.4 62.1 62.2 42.2 29.0 35.1 28.9 18.5 22.8

46.0

6.5 59.1 35.9 85.9 12.5 83.5 38.3 73.2 49.9 86.1 84.2 94.5

377 1,496 49,622

Continental United States .

61.5

MORTALITY AND ALCOHOLISM.

The available statistics of deaths from alcoholism have, on the whole, an uncertain meaning. Says the United States Census Report on Mortality Statistics for 1906, “The death rate from alcoholism in 1906 was 8.6 per 100,000 of population, the same as the rate for the year 1903;” but adds:

“It is not at all likely that there should be very definite returns of death due to this cause, especially those due to the indirect effects of alcohol. Many chronic degenerative diseases, such as cirrhosis of the liver, must be considered in estimating the total effect of alcoholism, and as the certificates of death from secondary effects of alcohol frequently make no reference to alcoholism as a primary cause, it is impossible to make a complete statement in this respect."

The following table exhibits the deaths from alcoholism per 100,000 population for a series of years. The figures are taken from the United States Census report. The "registration area" and "registration cities” referred to comprehend the area and the localities from which official mortality returns are received each year.

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NUMBER OF DEATHS FROM ALCOHOLISM PER 100,000 OF POPULATION.

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How alcoholism compares with other causes of death may be gleaned from the next table which likewise is taken from the latest census report.

Whether alcoholism is a more fruitful source of mortality than a few years ago cannot be determined from the statistics cited. The variations from year to year are so slight and may be wholly due to more or less perfect methods of reporting causes.

In European countries there is the same uncertainty. Dr. Printzing characterizes the existing statistics as “very inexact"

and says,

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"a comparison between different countries is not feasible,” as many cases of alcohol poisoning are entered under organic diseases. According to the best authorities, the death rate from chronic alcoholism per 100,000 population, was in Prussia 7.9; in Bavaria 7.4; in Baden 2.4; in Italy 1.7; in England 19.2; in Scotland 10.1. The Swiss mortality statistics are supposed to be particularly trustworthy. According to official returns for Switzerland, alcoholism was found to be a direct or contributory cause during the period 1891–1899 in 10.7 of each 100 deaths among males, and 1.9 in each 100 deaths among females. During the period 1900–1903 10.3 in 100 deaths among males and 1.9 in each 100 deaths among females were ascribed to the same cause.

In Denmark, where the consumption of intoxicants is particularly heavy, Westergaard says that 6.7 per cent. of the deaths among males and 0.8 per cent. among females are due directly or indirectly to drink.

It is well known that heavy drinkers show a particularly large morbidity and mortality rate. Certain diseases may be caused directly by the misuse of intoxicants; and in the case of other diseases, especially those connected with fever, the outcome is likely to be more dangerous, for the confirmed toper than for others. But how frequently such ailments as neuritis, amblyopie, cirrhosis of the liver, stomach catarrh, heart trouble, etc., are due to alcohol or spring from other causes cannot be stated statistically because there is no general agreement in the diagnosis made by different physicians. In this connection Dr. Printzing instances the fact that “cirrhosis of the liver occurs not infrequently without being preceded by over-indulgence in alcohol."

While no finality can be claimed for the statistics showing the death rate from alcoholism in the registration era of the United States, they afford some light on conditions in Maine. The next table shows the death rate per 100,000 of population in cities and rural districts of each registration State, from alcoholism, in 1906. The query arises at once, why has prohibition Maine a death rate from alcoholism exceeding that for Indiana, Maryland, Massachusetts, Michigan, New Hampshire (in cities), Pennsylvania, Rhode Island (in cities), and South Dakota? This excess is visible not only in the death rate from alcoholism in cities, but in that for rural districts as well. Five of the fifteen registration States show a lower death rate from alcoholism in rural districts than Maine and

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NUMBER OF DEATHS PER 100,000 OF POPULATION-1906.

CAUSE OF DEATH.

Total.

Cities.

Rural.

Typhoid fever.
Malarial fever.
Smallpox.
Measles..
Scarlet fever.
Whooping cough.
Diphtheria and croup.
Influenza.
Dysentery.

erculosis lungs.
Venereal diseases.
Cancer.
Rheumatism.
Diabetes.
Alcoholism..
Diseases of nervous system.

Meningitis..

Apoplexy and paralysis.
Diseases of circulatory system.

Heart disease.
Diseases of respiratory system.

Bronchitis..

Pneumonia (lobar or unqualified)
Diseases of digestive system..

Diarrhoea and enteritis..
Cirrhosis of liver..
Peritonitis..
Appendicitis.
Diseases of genito-urinary system.

Bright's disease and nephritis.
Violence...

A11 Causes.

22.2
2.6
0.1
11.8

7.4
14.6
26.0
10.1

8.4 153.8

4.1 74.4

8.0 14.9

6.4 179.1 27.6 97.1 187.3 143.3 205.0

31.2 111.5 205.8 120.7 14.7

7.7 10.5 120.9 103.7

106.9 1,604.0

21.6
2.2
0.1
15.3

9.7
15.9
33.1
7.4

6.4 177.3

5.5 77.7

8.0 15.4

8.2 175.2 33.4 88.4 187.8 138.6 245.8

36.1 129.4 231.3 142.2 17.7

7.0 13.0 139.5 121.0 115.6

23.0 3.0 0.1 6.9 4.1 12.7 16.0 14.0 11.3 120.5

2.2 69.8

8.1 14.2

4.0 184.6

19.2 109.6 186.6 149.9 146.9 24.2 86.2 169.6 90.1 10.4 8.7 6.9 94.4 79.0

94.6 1,408.3

1,741.8

DEATH RATE PER 100,000 OF POPULATION IN CITIES AND RURAL

DISTRICTS OF EACH REGISTRATION STATE, FROM ALCOHOLISM-1906

Cities.

Rural Districts.

California.....
Colorado.
Connecticut.
Indiana...
Maine..
Maryland.
Massachusetts.
Michigan..
New Hampshire.
New Jersey..
New York.
Pennsylvania.
Rhode Island.
South Dakota.
Vermont...

13.5
11.1
9.4
5.5
8.4
5.8
5.6
5.8
5.1
12.0
8.8
7.1
8.0
7.9
13.2

9.4 12.3 9.9 2.3 4.3 3.3 3.4 3.2 6.6 3.5 4.6 4.7 12.5 4.9 5.0

. . . .

among them Massachusetts, Maryland, Michigan, and New Jersey, while New York and Pennsylvania yield only a slightly higher rate. There is a variation between the rates for various localities which point to the uncertainty of the diagnosis. In Maine, physicians may possibly be inclined to give greater weight to alcoholism as a cause of death. Even so the rate in this State would have to be reduced several points, both for cities and rural districts, to bring it down to that of some of the most populous license States. Moreover, the death rate from alcoholism in Maine shows if anything an upward tendency. The ultimate significance of this fact cannot be determined. But at all events, the death rate from alcoholism in Maine must be accepted as one of the many evidences of the total ineffectiveness of State-wide prohibition to check one of the saddest results of intemperance.

MORTALITY AND OCCUPATION. The various studies of occupational mortality made in this country do not attempt to establish the death rate among persons engaged in the sale or manufacture of intoxicants. Indeed, no official classification of mortality by occupation has been made for the registration area.

In Europe this question has attracted greater attention, but the results of inquiries have been exceedingly meagre and not comparable as between different countries. The alleged statistics compiled simply to prove a thesis may be left out of consideration. Those bearing the stamp of credibility, notably those from Switzerland, appear to establish a higher death at the various age periods among persons engaged as workmen in breweries, or as bar keepers, waiters in saloons, etc., than among males of all occupations. Other evidence goes to confirm this conclusion; and it is perfectly natural. In the occupations specified the temptation to intemperance is particularly strong and nature revenges itself accordingly. The intemperate succumb first in the battle with disease and death. What constitutes intemperate indulgence is another question on which physiologists do not agree. How the sick rate and death rate in the occupations mentioned would compare with those for persons engaged in some of the several dangerous trades that have nothing to do with the sale or manufacture of intoxicants, is not known. It has been ascertained, however, that in several of these dangerous trades the death rate is much higher than the general death rate.

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