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OCT 8 1903 CAMBRIDGE,

THE GEOGRAPHICAL DISTRIBUTION OF INSANITY IN THE UNITED STATES*

BY DR WILLIAM A. WHITE,

SUPERINTENDENT GOVERNMENT HOSPITAL FOR THE INSANE,
WASHINGTON, D. C.

W

HEN I was invited by the National Geographic Society to address the Society on the geographical distribution of insanity in the United States, my ideas on the subject were extremely chaotic. I had vague notions of the possibility of formulating laws that would express the relationship between insanity and latitude and longitude, temperature, precipitation, &c., and I felt that a diligent study of statistics would be rewarded by the emergence of such laws. Similar ideas, I think, would quite naturally occur to any scientific man not especially acquainted with the statistical study of sociological phenomena. Confronted at the outset by the fact that the proportion of insanity varies. greatly in different regions of the United States, what more natural than to ascribe such variations directly to the difference in man's physical environment in these localities?

From time immemorial variations in

climate and in weather conditions have been supposed to produce profound effects upon man's conduct, and such expressions as the "depressing effects of heat" and the "stimulating effects of cold" are common in our every-day conversation, and I believe that all of us have a more or less clearly defined idea that the physical and mental characteristics of the different races of men are to some extent an expression of the effects of the climatic and geographic conditions under which they live. general conception was particularly fathered by that great English historian, Henry Thomas Buckle, who, in the opening chapters of his "History of Civilization in England" traces in detail the effects of the four great physical factors climate, food, soil, and the general aspect of nature-upon the characters of individuals and upon the growth of races and the progress of civilization.

This

There has consequently been fostered

* Read before the National Geographic Society, Washington, D. C., February 6, 1903.

a general tendency on the part of statisticians and those engaged in the study of abnormal mental conditions, to follow along these lines with a view to establishing relations of cause and effect.

If I am not able to present to you such laws as I originally dreamt of, clothed in all the beauty of mathematical formulæ and demonstrating beyond doubt the precise effects of each climatic and geographic factor upon the prevalence of mental disease, I at least hope to be able to show why it is not possible to do so, and I feel assured that my results may be just as valuable as if it were.

The social organism is extremely complex, and any effort to reason from the association of two or more conditions to the probable causative relations between them is always dangerous, and when figures are suborned for such purposes the results are notoriously inaccurate. With the elaborate means used of late years by the governments of all civilized nations for the collection

of statistics, it is but natural that the figures obtained should be applied to all sorts of social conditions, and thus we are treated by the authorities to elaborate tables which show the month, day, and hour when suicide is most prevalent in a certain country, the season of the year in which crimes of violence reach their maximum, the effects of temperature, barometric pressure, humidity, wind velocity, and precipitation upon various phases of conduct, such as attendance at school, infractions of discipline in prisons, clerical errors in banks, &c., &c.

In view of all these facts, it is my function tonight to inquire whether the prevalence of insanity in the various regions of the United States can be shown to have any definite relation to any one or more of these environmental conditions; whether insanity is more prevalent at certain elevations above sea-level or between certain degrees of latitude; whether it prevails more especially in regions of a certain average

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Outline Map No. I.-Ratio of Total Insane per Ico,000 Population, Census 1880

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Outline Map No. II.--Number Population for Each Insane Person, Census 1880

temperature and barometric pressure, or, on the other hand, where the mean humidity is high or low, and, further, if these conditions can not be shown to have a causative effect upon its distribution, what has?

Let us start our inquiry by a study of a map of the United States upon each state and territory of which the ratio of insane to 100,000 population is indicated, in accordance with the census returns for 1880 (see outline maps Nos. I and II). We are at once confronted with a condition of affairs which is so well marked that when I first saw it I was very much surprised. The greatest proportion of insanity is in the Northeast-in the New England and Middle States-of which New Hampshire, Vermont, Massachusetts, Connecticut, and New York all have one insane person to less than 400 of the population. If from this center of greatest prevalence of insanity we draw a line in

any direction-West, South, or Southwest-we see that no matter which way we go we find a steady decrease until we strike the Pacific slope. A slight interruption of the continuity of the decrease is noted in Michigan as we go west, but is, I think, of little consequence. As we go south along the coast Delaware appears as a marked exception. This is due to the fact that previous to the organization of the Delaware state hospital in 1889 no statistics of insanity were reliable. The insane were county charges and the care given them was so atrociously bad that every one took pains to conceal cases occurring in their families. Despite these minor variations the decrease of insanity as we go from the northeastern part of the United States-South, West, or Southwest-must strike you as being remarkably uniform and constant. This uniform decrease only takes place if we start from this northeastern center. If,

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for instance, we drop a line from any of the Northwestern States, as Idaho, Montana, or Minnesota, we find no uniform results, and if we go South from the Dakotas we will find that the proportion of the insane actually increases. The notable increase when we strike the Pacific slope I will speak of later.

If we now attempt to explain this condition of affairs by the topographical or the climatic conditions we are at once met by insuperable difficulties. If variation in temperature is alone responsible, why does not the proportion of insane diminish as we go south from the Dakotas as well as from the New England States? Or, on the other hand, why should Maine have a smaller proportion of insane than any other New England State? Montana, which is as far north as Maine, has a higher ratio than the states immediately south of it. If meteorological conditions are determining factors, why do we not find a marked variation in the proportion of the insane in the states bordering on the Great Lakes? Here we have conditions quite different from anywhere else in the United States. This region, a large area of which is occupied by these immense island seas, is directly in the course of the greater proportion of storms which come from the Northwest and pass through here on their way to the Atlantic coast; sudden variations in temperature, barometric pressure, and wind velocity are the rule, and with the immense areas of evaporation, fogs and rains are frequent and the percentage of cloudiness unusually high (66 per cent), still there is nothing in the proportion of the insane to call our special attention to this region.

I might continue in this wise, but it is only necessary for me to call your attention to the general results of such reasoning. They are these. The variation in the proportion of insanity in the different states is regular and uniform, while both geographic and climatic con

ditions are not, but, on the contrary, differ greatly in different parts of the United States, as, for instance, in the region of the Great Lakes just mentioned. If, therefore, we would explan these figures, we must seek a cause as uniform as its effects. This cause, or, more properly, these causes, are the same causes that make for civilization, the same that make for permanency and organization of social institutions, the same that make for concentration of population in great cities, the same, in short, that make for progress in its broadest sense.

Before proceeding to the elucidation of this proposition, let us for a moment return to the consideration of some first principles.

I did not intend to convey the idea by the remarks I just made about the influence of climate on conduct that no such influence could be demonstrated. On the contrary, I think it can be, and in fact has been. Dexter * has recently shown this in a most admirable and exhaustive study of the effects of climate on different phases of conduct. stance, his studies show that as humidity increases assaults, necessity for prison discipline, and the number of arrests for insanity decrease, while the data also show an increase in these same occurrences when the barometer is low.

For in

Granting for the nonce that these various meteorological conditions could actually produce insanity, they could not account for the uniform variation of the proportion of the insane in the different states to which I have called your attention. Weather changes are transitory, and conditions that are inimical to mental health are quickly followed by others that are highly beneficial. This is especially true of those regions of the United States where the proportion of insanity is high. The ratio of insane in

* Edwin Grant Dexter, A. M. : Conduct and the Weather. Psych. Rev., Vol. II, No 10, May, 1899.

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