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Dr. Malzberg's book offers an interesting compilation and critical analysis of the statistics of mental disease based upon the records of admissions to the New York state hospitals. To prevent erroneous conclusions, the author carefully uses only records of first admissions per 100,000 general population.
While the physical health of the public has improved in the last few decades, there has been an increase of mental disease. 'The ratio of the mentally ill to the total population has been steadily on the increase.' One important exception is the decrease in general paresis. The increase, according to Malzberg's thorough analysis of all arguments to the contrary, is a real one, no statistical artifact. Only a part of this upward trend can be attributed to the aging of the population.
An examination of the relationship between age and mental disease shows that 'the probability of a mental disorder is a direct function of age'.
Enlightening and of particular interest to the psychoanalyst is the comparison of mental disease in urban and rural populations, clearly establishing the greater incidence of mental disease in urban populations. 'There also appears to be, on the whole, a steady progression in the relative incidence of mental disease with increasing size of population.' In rural communities mental patients can be cared for at home more easily than in urban communities, but this explains only a part of the difference. It seems especially significant that 'the urban standardized rate of first admissions with dementia præcox exceeded the rural rate in the ratio of 1.8 to 1.0, being highest in the largest cities of the State'. This conclusion which Malzberg reaches only after thoroughgoing critical analysis of all relative factors is of unusual interest. The phenomenon of the 'big city', until now little investigated and understood in its psychological implications, seems to favor the development of psychoses. The same factors, the effect of which has her