THE MORBIDITY INCIDENCE OF DEGENERATIVE SOMATIC DISEASES IN PSYCHOTICS IN COMPARISON WITH THE SAME TYPE OF DISEASE IN COMPARABLE AGE GROUPS IN CIVIL LIFE

1. The morbidity incidence of degenerative diseases among psychotic patients in our hospital, over a period of five years, was found to be less than the incidence of the same type of diseases in comparable age groups among non-psychotic patients in civil life.

2. Of a total of 7096 patients in the five year period, 1931-1935 inclusive, there were 558 cases of degenerative diseases (a ratio of approximately one to every 13 patients).

3. Of a total of 9304 patients discharged from the Presbyterian Hospital, New York City, in 1935, there were 833 cases of degenerative diseases (a ratio of one to every 11 patients).

4. Among 10,188 patients examined in the medical division of the John Sealy Hospital, Galveston, Texas, 1660 had a degenerative disease ( a ratio of one to every six patients.)¹

5.The largest percentage of degenerative disease among our psychotic patients occurred in the 40 to 49 age group.

6. In a statistical survey covering a period of 18 months from January 1, 1932, to June 30, 1933, of 95,629 patients admitted to the Cook County Hospital, Chicago, Illinois, Dr. Nathan Flaxman found that 54 per cent came under the age group of 40 to 6o.²

7. Of 558 cases of degenerative diseases among our psychotic patients, over the five year period, 56 died (1o per cent mortality).

8. Of 1646 patients with a degenerative disease among 4600 cases admitted with a cardiac diagnosis in the Cook County Hospital, Chicago, Illinois, over a period of 18 months from January 1, 1932, to June 30, 1933, Dr. Flaxman reports a mortality of 38 per cent.³

9. It is evident that a functional relationship exists between the heart, blood vessels and kidneys, responsible for the so-called cardiovascular renal syndrome. Thus we can see how, for example, the degenerative changes in the blood vessels produce similar pathological changes in the heart and kidneys. As man goes through the several decades of life gradual progressive pathological changes occur in the arteries. The onset and rapidity of this process is dependent upon the individual's resistance as well as his mode of living.

10. The longevity outlook of the hospitalized mental patient suffering from one of the degenerative diseases is considerably better than for the civilian ambulatory patient in the same age group because the former is spared the social and economic responsibilities that predispose to degenerative changes in the human body. He leads a sedentary routine institutional existence, deprived of strenuous physical exertion, receiving his meals at regular intervals and given ample amount, of sleep and rest, as well as recreational and occupational opportunities, all of which is conducive to physical and mental health.

11. Our records show that the average estimated period of hospitalization for a mental patient is four to five years; those cases with a more favorable prognosis recover usually within one year. While it has been difficult to determine accurately the exact date of onset of their somatic disability, it is gratifying to state that encouraging results have been obtained in the treatment of degenerative diseases during the five year period of hospitalization, a contributory factor, undoubtedly, in the recovery of a good percentage of our mental patients.

I wish to acknowledge my appreciation for the invaluable assistance received from Misses Esther Bowers, Clara Barton, Eleanora Jones and Louise Pfister, in gathering the necessary statistical data; and I also wish to express my indebtedness to Miss Dorothy Kurtz, Supervisor of Record Department, Presbyterian Hospital, New York City, New York, and to the Library Service of the American Medical Association, without whose cooperation this paper could not have been written.