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Statistical Report of 190 Cases of Insanity Admitted into the Retreat. Near Leeds, during TenYears, from 1830 to 1840 (Continued)Author(s): Samuel HareSource: Provincial Medical Journal and Retrospect of the Medical Sciences, Vol. 6, No. 142(Jun. 17, 1843), pp. 232-236Published by: BMJStable URL: http://www.jstor.org/stable/25492123 .

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232 STATISTICS OF INSANITY.

5. Creosote improves the urine and diminishes its quantity.

Dr. Marsh (Dub. Hosp. Rep., vol. iv, p. 432) ob serves " that in many of the cases whose histories are

recorded, the earliest disturbance in the general health could be distinctly traced to some cause acting on the skin; that every case is accompanied with a peculiarly morbid condition of the skin; that none of the remedies produced the slightest benefit till the skin began to relax and a sweat to appear on the surface."

Lastly, an interesting and elaborate case of diabetes is now publishing in the "Medical Gazette," by Dr. Percy, of Birmingham, accompanied with very accu rate details and experiments. It is well worthy of attentive perusal.

After reflecting upon the preceding case, and upon the experience of different observers in the treatment of this obscure and formidable affection, we would recommend the following plan to be pursued:

A diet of animal food, with eggs, beef tea, and the cruciferous vegetables, all farinaceous and other

articles to be strictly prohibited. The drink to con sist of beef tea, lime water, diluted mineral acids, distilled water, alum whey, or very weak brandy and water, as might be indicated; all to be taken tepid, and the patient recommended to restrain himself in quantity. Flannel clothing on the whole surface. Very moderate exercise. The regular use of vapor baths, in proportion to the patient's strength, and the state of the skin, followed by inunctions with oil or

lard; stimulating terebinthinate embrocations to the loins; opium in proportion to the diuresis and irrita bility; ammonia and magnesia in the early stages, and afterwards the free use of mineral and vegetable tonics and astringents. In the early and acute stage, one or two bleedings from the arm might be premised, and in many cases it is probable that occasional

local depletion to the loins and epigastrium would be desirable. The specific gravity, quantity, and other qualities of the urine should be very frequently, if not daily, ascertained. The effects of farinaceous food upon the local and general symptoms should also be occasionally tested.

STATISTICAL REPORT OF

190 CASES OF INSANITY ADMITTED INTO

THE RETREAT, NEAR LEEDS,

During Ten Years,from 1830 to 1840.

By SAMUEL HARE, Esq.

(Continued from p. 213.) III.-CAUSES OF INSANITY.

Even with the greatest care, this is a matter in which

it is extremely difficult, in many cases, to arrive at an accurate conclusion; the difficulty is much increased

when the patients come from a distance, so that written communications only can be obtained from their friends, for under such circumstances many causes are omitted, which by verbal questioning

might be elicited. Again, in other instances, causes obviously incorrect are assigned, a common error being to allege as a cause that which in reality was the com.

mencement or an effect of the disease; thus, in one

case the "supposed dishonesty of servants," was put down as a predisposing cause of insanity, while in reality this was only one of the early hallucinations under

which the patient labored. In comparatively few in

stances were predisposing causes assigned, excepting when these consisted in hereditary predisposition, a sub

ject which has been already mentioned; and as in seve

ral of the remaining cases, those given could not, for the

reason stated above, be depended on, I have thought it better, as the list must necessarily have been imper

fect, not to give the predisposing causes at all, and

have, therefore, confined myself to the exciting ones, which will be found in the accompanying Table, No.

XI.

They are here divided into the two classes of phy sical and moral, the larger number being included

in the latter division, since it contains 62'5 per cent.

of the cases where the causes were known, while only 37.5 per cent. of them are included in the former divi

sion. Among the males, the moral causes were

more productive of insanity than the physical ones, in the proportion of 41 to 27 cases, or 60-29 to 39-71

per cent.; the same observation is applicable to the

females, but with still more force as regards the moral

causes, which in them seem oftener to produce in

sanity than amongst the males, while the physical causes of insanity are of course proportionately less

common; thus, out of the 52 females in whom the causes

could be ascertained, the moral to the physical were

as 34 to 18, or as 65'38 to 34-62 percent. Looking at

the subject in another point of view-of the 75 cases

excited by moral causes, 41, or 54-66 per cent., were

males, and 34, or 45-34 per cent., were females; and

of the 45 produced by physical causes, 27, or 60 per

cent., were males, only 18, or 40 per cent., being females.

Amongst the physical causes, intemperance holds

by far the most prominent place, insanity being as

cribed to it in no less than 15 cases, out of which 13

were of the male and 2 of the female sex; it was a

cause, then, of 12'5 per cent. of the whole of the cases

whose causes were ascertained, and, if the males alone

be considered, to the extent of somewhat more than 19

per cent (13 cases out of 68). Four cases were as

cribed to falls on the head, accidents, &c., to which

males are obviously more liable than females. In 4

males insanity followed attacks of fever, to the effects of which it was ascribed; cerebral disease and epi

leptic fits each produced 2 cases, while inflammation of the brain and paralysis were each said to have

caused 1. Some cases arose from causes peculiar to females, such as the 3 puerperal ones, and the 4

from change of life and suppressed menstruation. Of the cases, amounting to 75, induced by moral causes, anxiety on pecuniary affairs, on commerce, or on

property, seems to have been the most fertile source; it numbered no less than 17 cases, all of which, with

one exception, were among males. Anxiety from other causes and jealousy, as far at least as they are

causes of insanity, seem confined to the female sex, while females, too, are oftener affected by grief and contrarieties in domestic affairs.

Hopes and fears on the subject of religion were stated as exciting causes in 14 persons, the proportion, being rather greater amongst the females than the

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STATISTICS OF INSANITY. 233

males. Of these, 6 belonged to the EstablishedChurch, 5 were Methodists, and 1 each to the Baptists, Cal vinists, and Society of Friends; amongst these, how ever, whose insanity is ascribed to religion, it is proper to state that 4 had relatives who were insane, and of

1 of them this was the case as respects both the father and mother, while another had manifested some peculiarity of manner during the whole of her life. In 3 instances excessive study was the ascribed cause.

TABLE XI.

Showing the Exciting Causes of Insanity, as assigned by the Relatives of the Patients.

Physical Causes. M. F. T. Moral Causes. M. F. T.

Intemperance 13 2 15 Excitement ofvariouskinds 3 1 4 Intemperance. ..... 13 2 15 -marriage, elections, &c.

Do. and prosperity . 1 1 Prosperity .. 1 1 2

Inflammation of the brain .1 1 Anxiety on money affairs, 16 1 commerce, or property.

Cerebral disease .... 1 1 2 Anxiety from other causes . 5

Paralysis ...... 1 1 Domestic affairs .... 3 5 8

Epileptic fits .... . 1 1 2 Private cause .... . 1

Delirium tremens .... 1 1 Disappointment . . . . 1 1

Fever, effects of .... 4 4 Jealousy .......3 3

Illness Do. 1 2 .Grief-from death of

friends 4 7 1 chiefly . . . ......

Do. and disappointment 1 1 Fear ....... .1 1

Weakness ...... 1 1 Fear of results from lues . 2 2

Watchfulness and weaning 1 1 Religion- hope and fears 7 7 14 a child . connected therewith .

I.. , ,,. . o o Do. Improper excitementon } Disordered digestive organs. 2 2 Do.Improper excitement n 1 1 during infiam. of the brain

Change of life ..... 2 2 Do. with losses in business . 1 1

Suppressed menstruation . 2 2 Excessive study ... . 2 1 3

Puerperal affections . . . 3 3 Solitary state .... 1 1

Accidents, falls, &c. . 4 Total moral causes . . 41 34 75

27 18 45 Total physical causes . 27 18 45

Totalexcitingcausesknown 68 52 120

Causes 'notany' or'notknown' 8 9 17

Causes not stated . . . 17 12 29

Grand total. . . 93 73 166

IV.-THE VARIOUS FORMS OF INSANITY UNDER WHICH THE PATIENTS SUFFERED ON THEIR FIRST ADMIS SION.

In the Retreat, as in almost all other institutions for the reception of the insane, far more both of the

males and of the females were affected with mania than with any of the other forms of mental derangement

(Table XII). Ofthe 166 patients, 75, or 45 18 per cent., were admitted with mania, more than 16 per cent. were cases of monomania, 1024 per cent. of melan

cholia, and about 6 per cent. labored under moral in sanity; while 22 per cent. were affected with various degrees of dementia, of wiech I in 4, or 5'42 per cent., of the whole were in a state of fatuity. The relative proportions, though not the absolute numbers, of the two sexes laboring under mania and monomania will be found to be remarkably similar, and, indeed, as regards monomania, they may be aid to be identical;

melancholia occurred more than twice as often among females as among the males, and the disproportion

was still more marked in the cases of moral insanity, for while only about 2 per cent. (2'15) of the males

were attacked with it, nearly 11 per cent. of the

females suffered under that form of the disease. The

relative number of cases of fatuity was the same in

the two sexes; but in the other forms of dementia

(incoherence and imbecility, especially the latter) the males predominated considerably. Four cases (2 males and 2 females) were well-marked instances

of what is termed religious monomania, while there

were 5 cases of religious melancholia, the whole of which occurred in females; 4 of the above belonged to the Established Church, 2 were Independents, 1 a Methodist, another a Roman Catholic, while, pre. vious to her insanity, another Ad not professed any religion in particular."

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234 STATISTICS OF INSANITY.

TABLE XII.

Showing the different Forms of Insanity on the First Admission of the Patients.

Actual Numbers. Per Centagc.

Forms of Insanity. I -

M. F. T. . F. T.

Mania .. . . . . . . . 43 32 75 46-23 43'83 45-18

Monomania ........... 15 12 27 i 16-12 16-43 16-26

Moral Insanity ........... 2 8 10 215 10-95 602

Melancholia ............ 6 11 17 645 15-06 10-24

Incoherence ............ 8 4 12 8 60 5'48 7-23

Imbecility . . . . . . . . . . . . 14 2 16 15-05 2 7,5 9,64

Fatuity . . ...... 5 .9 537 5-48 5'42

Total. ........ 93 73 166 100-00 100-00 100-00

Suicide.-All the cases in which suicide had been

attempted or threatened, could not properly be ar

ranged under the heads of either suicidal monomania

or melancholia; a large proportion, however, of both sexes had either a predisposition to or had actually

attempted self-destruction previous to admission: no information on this subject (Table XIII) was obtained in 14 cases; of the remainder, 29 males and 32 fe

males-i. e., 2 cases out of every 5, had a predisposition to or had attempted suicide; in the attempts, various

means had been adopted-laudanum, drowning, edged

instruments, and suspension, but the last was that which had been most frequently resorted to.

TABLE XIII.

Showing the Number of Cases in which there did, and in which there did not, exist a Suicidal Propensity.

M. F. T.

Predisposition to, or had ~29 61 attempted suicide . . 29 32 6

No predisposition to suicide 52 39 91

Total ... . 81 71 152

Not stated . . . 1. 2 2 14

Grand total . . 93 73 166

V.-ON THE DURATION OF RESIDENCE.

It must be obvious that, while a period of ten years is insufficient to give what would ultimately be a cor

rect average either of the general duration of residence, or the number of deaths of patients in this or in any other establishment, yet, from the numbers admitted, a result approximating to the truth may be obtained

as regards the recoveries. Many patients, whose dis

ease is incurable, remain of course to the end of their

lives in a Retreat, and as the period of residence may thus extend to ten, twenty, or more years, a far higher

average will be obtained than can possibly be the

result of an establishment during the first ten years of

its existence. The average duration of residence of the whole number of admissions (190) was nearly

eight months, but of those who had been discharged it amounted in the average of the two sexes, taken

together, to not quite five months. The average pe

riod of residence of the males remaining in the Re

treat was two years four and a half months; of the

females, three years seven and a half months; and of

the two sexes together, nearly two years ten and a

half months-34'38 months. The average period when the discharge took place of those whose recovery was

complete, amounted to less than four and a half

months; of those whose recovery had taken place, who to their friends appeared well, but of the per

manency of whose cure I was not so well satisfied (and

which class I have, therefore, thought it right to ar

range separately under the head of "recovery not

confirmed"), the period was about five and a halt

months; while those who were discharged " relieved,"

remained on the average six and a half months. The

mean time occupied in effecting recovery hasjust been

stated at a little less than four and a half months, nevertheless a much larger number recovered at or

before the end of the first three months (Table XV) than during any other similar period; for of the whole number of recoveries (74 + 9 = 83) 59'03 per cent. took place at or before the expiration of the three

months; 30'12 per cent. between three and six months

after admission; and but 8'43 per cent. between the

sixth and ninth months, while after this period only two

recovered, one at the end of a year and eight months, the other after a period of three years. The former of

these cases afterwards relapsed; the latter remained

well when last heard of, a few weeks ago, a period of

four and and a half years after she left the Retreat.

Most of the cases which were "not relieved"

were incurable ones, though this was by no means

the case with all of then, some being removed before

an opportunity of relieving them had been afforded; indeed, the average residence of those discharged "not relieved," was less than that found necessary

(on the average also) to procure recovery. When

death occurred, it was after a mean residence of three

months-a period which may appear short, but, as has been before remarked, ten years is too short a time

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STATISTICS OF INSANITY. 235

to give an exact average of the period when death

usually takes place after the admission of patients into an asylum. The causes of deaths will be fully en

tered into in the section relating to that subject. TABLE XIV.

Showing the Average Duration of Residence of the Patients who recovered, died, remained in the Re

treat, &ic., with the Average Residence of the whole Number of Patients; distinguishing the Sexes.

Residence in Months.

M. F. T.

Recovered (complete). . . 3'47 565 4'42

Do. recoverynot confirmed 6 5'35 5'44

Relieved . ...... 4'13 9-14 6-52

Not Relieved ..... 3-20 6-33 4'37

Died .. ..... 4 0-83 3'09

Average Residence of those 3- 627 4-83

who had left the Retreat 369

Remaining June 30, 1810 . 28'63 '43-42 34338

Average Residence of the) whole Number of the 6-26 9-42 7'64 Patients . . . . . .

VI.-or THE RECOVERIES.

There are several views under which we should

examine the number and proportion of recoveries

viz., as regards their aggregate numbers and propor tions, the mode in which they are influenced by the

form of insanity and its duration, and by the age and

sex of the patients. A.-Of the 172 patients who had left the Retreat,

74 were discharged recovered. This is in the pro

portion of 43-02 per cent.; but if, as may properly be done, the 9 who recovered, but whose recovery did not appear confirmed before they were removed

by their friends, be included, the number of those

who were cured will amount to 83, and the centesimal

proportion to 48'25; those relieved amounted to 44, or 25-58 per cent., while those who left unrelieved were 21 in number, or rather less than 14 per cent.

But of these two last classes, some of those who were relieved would, in all probability, have recovered had they remained longer in the Retreat, while the

condition of several of those who were not relieved

might certainly, by a longer residence, have been

ameliorated; for, as already stated, this last class of

patients was, on the average, removed in a less

period of time than was occupied in the cure of those

who recovered.

TABLE XV.

Showing the Number of Cases discharged, remaining in the Retreat, and the Total Number admitted, with the Result of Treatment in the whole of the Cases discharged; these being arranged so as to show the Period after admission when Recovery, 5c., took place.

Discharged.

I-------I-- --Remain-

JGrand Recovered. ing, June Total.

Not De. Ttl 30, 1840. Duration of Residence. Relieved. te e Died. Total. Relieved .

Recovery recovery complete. confirmed

M.F.T. M.F.T. M. F.T. M.F.T. M.F. T. M. F. T.M.F. T. M. F. T.

3 Monthsorless . . 27 17 44 5 5155 2010 5 1510 1662 38 100 2 3 564 41 105

From 3 to 6Months .13 9 2 2 3 4 7 11 5 1 6 2 225 19 44 2 227 19 46

6-9 ....2 4 6 2 4 6 2 2 4 10 14 4 10 14

9-12... . 1 2 3 1 12 2 41 13 2 5

1-2 Years .. 1 1 1 1 2 3 1 ] 2 ,t 2 3 5 8 2 2 5 5 10

2-3 .... 1 11 1 1 1 2

3-5 .... 1 1 1 2 2 3 3

5-10.... 3253 2 5

Total . .42 32 74 1 8 923 21 4415 9 2415 6 21 96 7617211 7 18107 83 190

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236 STATISTICS OF INSANITY.

B.-Influence of the Form of Insanity.-Not a

single recovery occurred out of the 23 patients (14 + 9) who had entered either in a state of imbe

cility or fatuity, and only 3 of them were even re

lieved. The proportion of cases of moral insanity was

greater than is usually met with, and they were also

more amenable to treatment than I had expected to

find them, no less than six out of eight having reco

vered, the appropriate moral and medical treatment

of a well-regulated asylum seeming, in several of the

instances, soon to produce a marked change in the

disorder. In one of these cases, however, I did not

venture to consider the patient as recovered until after a lapse of three years, since which period it is

satisfactory to know that she has kept quite well.

The other results arising from the influence of the form of insanity will be seen by referring to the fol

lowing Tables, XVI and XVII.*

TABLE XVI.

Exhibiting the Influence of the dierent Forms of Insanity upon the Recoveries, ?c.

Discharged.

Remain- Grand Recovered. ing, Jun Total.

Disease, Forms of e Re Relieved. Died. Total. 30, 1840

.....plReteie.o Died.not Recovery RoIY Relieved complete. confied______________________

M. F. T.JM. F. T. M. F. T. M. F. T. M. F. T. M.FF. T.M. . T.M. F. T.

Mania ...... 22 18 40 4 417 11 28 5 4 9 5 1 649 38 87 5 2 754 40 94

Monomania . ... 9 3 12' 1 3 4 2 3 5 2 1 3 1 114 11 25 1 2 315 13 28

Moral Insanity . . 1 5 6 1 1 1 1 7 8 1 2 2 8 10

Melancholia .... 4 4 8 2 5 7 2 2 1 7 11 18 1 1 7 12 19

Incoherence .... 6 2 8 1 1 2 2 8 3 11 2 1 3110 4 14

Imbecility .... . I 12 7 1 8 4 412 2 14 2 214 2 16

Fatuity . .... 1 1 1 3 4 7 5 4 9 5 4 9

Total 42 32 74 1 8 923 21 4415 9 2415 6 21,96 76 17211 7 18107 83 190

TABLE XVII.

Exhibiting the Duration of Residence in the Cases which were discharged Recovered, distinguishing the Sex

of the Patients, and the Variety of Insanity with which they were affected. M o n

Moral Mania. Monomania insanity Melancholia. Incoherence. Total.

Insanity. Duration of Residence. - -- ---

M. F. T . M. F. T . M. F . T. M. F. T . M . F T M F. T.

3 Months or less . 14 11 25 6 1 7 1 3 4 2 2 4 4 4 27 17 44

From 3 to 6 Months .8 6 14 1 2 3 2 1 3 2 2 13 9 22

6--9 .... 1 2 2 1 1 22 2 4 6

1-2 Yeara . . 1 1 1 1

2 - 3 .... 1 1 1 I

Total .. 22 18 40 9 3 12 1 5 6 4 4 8 6 2 8 42 32 74

[To be continued.]

* It may, however, be remarked that mania appears to have been the form of insanity from which restoration to health was most speedily effected, as only a single case out of the 40 recoveries was protracted beyond the period of six months, and the care in that ease took place before the expiration of a year from admission. The two cases alluded to as having been cure after the

lapse othirty-six and twenty months respectively, were, one of moral insanity (as has been already mentioned), and the other of eelaochlita.

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