of all proportion to the growth of the general population, would it not be superficial in the extreme to conclude, without further data, that insanity was on the increase? At present these statistics mean nothing more than that the number of patients in such institutions has considerably increased. But when we consider what great advances have been made in the diagnosis of mental diseases, and consider also that a great number of such cases, which were formerly treated unsuccessfully at home, are now treated in such institutions with good results, because there they are removed from the detrimental influences of familiar surroundings, while the proper means and methods for rational treatment are at hand, we shall find that the seemingly enormous increase of mental disturbances need not cause us uneasiness.
Other extensive statistical material for nervous diseases is afforded by the numerous dispensaries of the great cities; but no extended experience is required to teach that a large proportion of such cases would not appear if the patients had to pay fixed fees, and round ones, as they had to do in the good old times when physicians saw comparatively little of nervous diseases. Our grandmothers had their "headaches" and their "twitchings in the limbs" like the women of to-day; but they never dreamed of calling a doctor or going to the dispensary for such things, so that they were not "statistical material."
In the dispensaries for nervous diseases there are numerous chronical patients who, becoming discouraged in one place, think they would like to try another doctor; and some of them make a round of sojourns in different hospitals. Each of them is counted as many times over in the statistics as there are places where he is treated. This perceptibly increases the numbers.
These considerations give some idea, though but a slight one, of the extreme difficulty of making even rough approximate inferences from sanitary statistics. But certain observers tell us that exact enumeration is not required. Hysteria and degeneration of the race stare us, as they aver, daily in the face. In every department of human activity disorders of the nervous system are seen. The very style and methods of the art and literature of the day proclaim a general nervous prostration.
Max Nordau is the protagonist of this widespread opinion. In his eyes, mental degeneration has seized upon the majority of civilized men to such a degree that "the upper strata of urban population" form but a "suffering hospital." The art, the poetry, the fiction, the philosophy of the day present the most manifold embodiments of degeneration and of secular hysteria.
Nordau admits, of course, that degeneration and hysteria have always existed. "But," says he, "they were formerly sporadic and were of no importance for the whole life of society."