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Mr. John Keren, the special expert agent of the census, concludes that making every allowance for other considerations, the census returns permit but one conclusion, namely, that the rate of increase is greater for the insane in the United States than it is for the general population. (138) Whether the increase is due to an actual increase in insanity, or to a greater accuracy in the enumeration, or to improved institutional facilities which tend to increased use, it coincides with the experience of foreign countries, and the best authorities agree that there is an actual increase of insanity.

As between different States, the variation in ratios indicates not so much the difference in the relative number of the insane as the extent to which they have been segregated from the rest of the population. New York, for instance, has 166.4 more insane persons per 100,000 of population than Pennsylvania. It may be that New York actually has more insane, but this figure probably means that New York provides for them much more fully than Pennsylvania. This conclusion is borne out by the fact that in 1904 there were 1888 insane persons in almshouses in Pennsylvania and only 304 in New York. (139)

Granting an increase, which experts seem to agree has actually taken place, not only in the number of persons classed as insane, but in the number actually suffering from a diseased mental condition of given severity, the explanations that are offered for this increase are many.

Mr. Koren says: --

"As the management of the public hospitals and the care afforded patients have reached a higher standard, popular prejudice against these institutions has diminished. Yet until comparatively recent times the deep-rooted and often too well founded aversion to hospitals for the insane was a sufficient factor to keep out of them all patients who could be cared for in some other manner. The popular conception of a hospital for the insane as a place of confinement for the abnormal is rapidly giving way to the modern idea of a curative establishment for the sick. Wise legislation has accelerated the influx to hospitals in many places by segregating the criminal, incurable, and epileptic in-sane and the feeble-minded from the others, by providing better safeguards in the matter of commitments, and in a few instances by prohibiting the admission of insane persons to almshouses."