NERVOUS DISEASES:

By: Joseph Jacobs, Maurice Fishberg

Frequency of Hysteria Among Jews.

The Jews are more subject to diseases of the nervous system than the other races and peoples among which they dwell. Hysteria and neurasthenia appear to be most frequent. Some physicians of large experience among Jews have even gone so far as to state that most of them are neurasthenic and hysterical. Tobler claims that all the Jewish women in Palestine are hysterical; and Raymond says that in Warsaw, Poland, hysteria is very frequently met with among both Jewish men and Jewish women. The Jewish population of that city alone is almost exclusively the inexhaustible source for the supply of hysterical males for the clinics of the whole Continent ("L'Etude des Maladies du Système Nerveux en Russie," p. 71, Paris, 1889). As regards Austria and Germany the same neurotic taint of the Jews has been emphasized by Krafft Ebing, who states that nervous diseases, and especially neurasthenia, affect the Jews with exceptional severity ("Nervosität und Neurasthenische Zustände," p. 54, Vienna, 1895). Binswanger, Erb, Jolly, Möbius, Löwenfeld, Oppenheim Féré, Charcot, Bauveret, and most of the other specialists in nervous diseases, speak of this in their monographs on neurasthenia and hysteria, and point out that hysteria in the male, which is so rare in other races, is quite frequent among the Jews. In New York city it has been shown by Collins that, among 333 cases of neurasthenia which came under his observation, more than 40 per cent were of Jewish extraction, although his clientele was not conspicuously foreign ("Medical Record," March 25, 1899).

Causes.

The following causes are usually assigned for the nervousness of the Jews: (1) The fact that they are town-dwellers, and that diseases of this kind are most frequently observed in the populations of the modern large urban centers. (2) The peculiar occupations of the Jews: neurasthenia is seen most often among the commercial classes, bankers, and speculators. This view is not sustained by the fact that neurasthenia and hysteria are met with in the poorer classes of Jews, in laborers and artisans, just as often as in the richer classes. (3) Consanguineous marriages are also blamed by many physicians; but the modern view that such marriages, when contracted between healthy individuals, are not at all detrimental to the health of the offspring contradicts this theory. (4) The repeated persecutions and abuses to which the Jews were subjected during the two thousand years of the Diaspora are to be considered when speaking of their neurotic taint. Such massacres as occurred in Kishinef in 1903 were of frequent occurrence during the Middle Ages; and their effect on the nervous system of the Jews could not be other than an injurious one. Organic as well as functional derangements of the nervous system are transmitted hereditarily from one generation to another.

Education.

The education of the Jewish child in the eastern European ghettos must be recalled when speaking of the nervousness of the Jews. The ḥeder, in which he begins at a quite early age to spend the greater part of the day in studying Bible and Talmud, is also an important factor in the production of nervousness among the Jews. As is well known, the intellect of the Jewish child is very precocious, and on this account the nervous system suffers severely.

Mortality.

Hysteria and neurasthenia are only rarely, if at all, fatal, and consequently their extent can not be appreciated by a study of the causes of death among the Jews. But the case is different when the degenerative organic nervous diseases are considered. Minor and others insist that these diseases are less frequently met with among the Jews than among the rest of any given population; while other physicians claim that all the diseases of the nervous system, both functional and organic, are very prevalent amongJews. Thus from J. S. Billings' statistics of 60,630 Jews in the United States it is seen that the mortality from diseases of the nervous system was (per 1,000 deaths in which the cause was known) as follows:

	Jews.	General Population of the United States (1880).
Men	121.22	118.62
Women	120.62	108.61

These data show that, when compared with the general population of the United States, the Jews showed a much larger mortality from these diseases. The high mortality of the Jewish women, almost equaling that of the men, is striking. Similarly in Verona, Italy, Lombroso has found that the mortality of the Jews from nervous diseases is almost double that of the Catholic population of that city. In Körösi's statistics for Budapest, Hungary, however, quite the contrary is seen. The mortality from meningitis per 100,000 population during the period 1886-90 was as follows:

Catholics	114
Lutherans	120
Other Protestants	108
Jews	66

In Yew York.

Under meningitis Körösi includes tuberculous meningitis, epidemic cerebrospinal meningitis, and meningitis secondary to infectious diseases, new growths, etc. This may account for the lower mortality, because it is known that tuberculosis is observed less frequently among the Jews (see Consumption), as is the case with other infectious diseases (see Morbidity). Hydrocephalus also appears to be less frequently a cause of death among the Jews of Hungary than among their neighbors: only 67 per 100,000 Jewish children under five years of age, as against 145 among the Catholic children, died of this disease. Statistics obtained by the census bureau for New York city also tend to show that the mortality from nervous diseases is less among Jews than among others. Thus, during the six years ending May 31, 1890 ("Report on Vital Statistics of New York and Brooklyn," pp. 40-41, Washington, 1894), the mortality per 100,000 population was as follows, the cases being classified according to the birthplace of the subject's mother:

Bohemia	336.76
United States (whites)	293.48
Italy	258.73
Ireland	242.44
England and Wales	240.71
France	218.48
Germany	197.39
Hungary (mostly Jews)	192.13
Russia and Poland (mostly Jews)	117.68

From these and other available statistics it appears that the Jews are less predisposed than are other races to those forms of organic diseases of the brain and spinal cord which are liable to prove fatal. This has been pointed out by Minor of Moscow, who analyzed 3,214 cases of nervous diseases in his practise, including those of 1,480 Jews and 1,734 Christians. He concludes that, so far as he could discover, the Jews are not more predisposed than Christians to all nervous diseases. On the contrary, the most serious organic diseases of the brain and spinal cord, chronic inflammation of the cerebral blood-vessels, etc., are far more often met with among Christians than among Jews. Minor is satisfied that the main, if not the exclusive, reason lies in the facts that the Jews are not alcoholics and that they only rarely suffer from syphilis. The only disease from which Minor found the Jews to suffer more often than non-Jews was hysteria, particularly hysteria in the male.

Locomotor Ataxia.

Locomotor ataxia is one of the most important organic nervous diseases, and is usually attributed to syphilis. In eastern Europe physicians state that it is only very rarely observed in Jews. Stembo reported, at the Eleventh International Medical Congress, that it is very rare among the Jews in Wilna, Russia; at least it has been until now a very rare disease, as has syphilis. Among the 200 Jewish inmates under his care in the hospital at Wilna he has met with various nervous diseases, but not one of locomotor ataxia. Of the 40 cases he has seen in Jews all had syphilis (L. Stembo, "Atti dell XI. Congresso Medico Internationale," vol. iv., "Psychiatria," p. 119, Rome, 1898). Gajkiewicz also found among 400 Jewish patients with nervous diseases only 13 with locomotor ataxia—3 per cent, which is very low ("Syphilis du Système Nerveux," p. 158, Paris, 1892). Minor found that among his patients the proportion of locomotor ataxia to the total number of cases was: among Christians, 2.9 per cent; among Jews, 0.8 per cent—i.e., the disease was nearly four times as frequent in Christians as in Jews. In the Montefiore Home, New York city, on the other hand, there are many cases of locomotor ataxia. On examining the list of diseases in the reports of this institution, it will be observed that among the diseases of the nervous system locomotor ataxia appears more frequently than any other disease. This may be explained by the fact that patients affected with this disease remain in the institution for a long time, and consequently accumulate in large numbers, thus appearing on the reports annually for many years. It must be remembered also that the Jewish population of New York exceeds 500,000. Considering that every poor man affected with the disease is practically an invalid, and is likely to seek admission to the home, it may be concluded that the disease is really not very frequent, as in similar non-Jewish institutions the proportion of locomotor ataxia is much larger. At any rate this in connection with other evidence tends to show that syphilis is on the increase among the Jews of New York.

Paralysis Agitans.

Paralysis agitans or "shaking palsy" is a disease of the nervous system that is very frequent in Jews. Of 100 cases reported by Krafft-Ebing 65 were Christians and 32 Jews. He remarks that at the time when he observed these cases the Jewish population of Austria-Hungary was only 4 per cent of the total population. The morbidity of the Jews with respect to paralysis agitans was consequently eight times greater than their proper proportion (R. v. Krafft-Ebing, "Zur Aetiologie der Paralysis Agitans," in "Arbeiten aus dem Gesammtgebiet der Psychiatrie und Neuropathologie," part iii., p. 6). Minor alsofound that in Russia this disease is three times more frequent among Jews than among Christians.

In general it may be summarized that the Jews suffer chiefly from the functional nervous diseases, particularly from hysteria and neurasthenia, and that the organic nervous degenerations, such as locomotor ataxia, progressive paralysis of the insane (see Insanity), etc., are uncommon, commensurate with the infrequency of alcoholism and syphilis among them. Wherever the proportion of Jews affected with syphilis and alcoholism is larger, the number of persons affected with organic nervous diseases increases to a similar extent. This may be observed in the large cities of western Europe and in America. See Apoplexy; Diathesis; Idiocy; Insanity.

J. M. Fi.