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Am J Psychiatry 1949;106:185-189.
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The Chicago State Hospital, Chicago, Ill.

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In spite of the fact that the rate of admissions to the Chicago State Hospital has increased in 1945/47 as compared with 1935/37, the number of deaths during these two periods has not increased. The death rate, expressed as percentage of admissions, has essentially declined for 1945/47.There were more deaths of old age patients in 1945/47 than in 1935/37. This corresponds to an increased influx of senile patients.Deaths from exhaustion in the course of acute schizophrenia have markedly decreased. The same is true for deaths from general paresis. Delirium tremens has disappeared as cause of death, at least from the Chicago State Hospital.Malignant tumors seem to be rarer among mental patients than in the general population.The senile patients are becoming a special problem to the hospital, as they are admitted in increased numbers. Two points should be kept in mind. A considerable percentage of these old-agers die very soon after admission. It seems justified to ask, whether these patients (who, of course, are senile psychotics) could not have died at home as well as in the hospital. It is very likely that they did not benefit from the transport from home to the Psychopathic Hospital and from there to the State Hospital. It should be emphasized that this question involves social problems, as housing shortage and care and supervision by the family. On the other hand, there are quite a number of senile patients who survive in the mental hospital for several years. It is questionable whether for all of them the mental hospital is the right environment. The American Psychiatric Association, by setting different standards for "acute" and senile patients, has implicitly touched upon this question. increased life expectancy probably will allow more and more people to live up to the age of senile dementia, and society will have to face this problem sooner or later.

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