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Statistical Report of 190 Cases of Insanity Admitted into the Retreat. Near Leeds, during TenYears, from 1830 to 1840 (Concluded)Author(s): Samuel HareSource: Provincial Medical Journal and Retrospect of the Medical Sciences, Vol. 6, No. 143(Jun. 24, 1843), pp. 250-255Published by: BMJStable URL: http://www.jstor.org/stable/25492142 .

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.250 STATISTICS OF INSANITY.

dorsal vertebra, were within the tumor, denuded, carious, and deeply excavated, the intcrvertcbral

substance remaining nearly entire. The tenth dorsal

vertebra was more deeply excavated than the rest.

The seventh, eighth, and ninth dorsal vertebra, were

in some degree protected by a mass of fibrine lying upon their anterior surfaces, and which materially

strengthened the walls of the tumor at this point. The ninth, tenth, eleventh, and twelfth ribs, were also

more or less absorbed. The ninth rib was denuded

and carious, and from it a plate of bone was detached, and pushed upwards. The tenth rib had nearly dis

appeared, two small portions only remaining, one attached to the cartilage, the other to the vertebra. The eleventh rib was only less injured than the tenth, the remaining portions being considerably displaced, and pushed downwards. The twelfth rib was com

pletely divided near the vertebra, but not otherwise

extensively diseased. The walls of the tumor were

at every point entire. The remaining viscera pre sented little remarkable.

STATISTICAL REPORT OF

190 CASES OF INSANITY ADMITTED INTO

THE RETREAT, NEAR LEEDS,

During Ten Years, from 1830 to 1840.

By SAMUEL HARE, Esq.

(Concluded from p. 236.)

C.-InRfuence of the Duration of the Disease.

Judging from the result of the cases, as exhibited in

Table XVIII, and without modifying circumstances being considered, it would seem that the previous

duration of insanity had less influence on the propor tionate number of recoveries than is usually believed,

because these did not, in the more recent cases, very

remarkably exceed those which took place in the cases of a more chronic kind. Nevertheless, I am

fully convinced that the former are far more under

the influence of treatment than the latter, and that the time required for their cure is also considerably less. The reason why the proportionate number of cures in the more recent cases does not appear greater is simply that, some of the patients being much relieved,

were removed by their friends before they could be con sidered completely well, and that they were, there

fore, put down in the report merely as relieved. That friends should be more anxious to remove patients from an establishment when the case is recent, is

easily comprehended, because, as in these cases, the

patients frequently becoming quite manageable in a short time, their friends often desire that the re

mainder of the recovery should take place at home.*

Of the more chronic cases, those whose insanity had existed more than twelve months, the recoveries, con

sidering this circumstance, were very numerous, amounting to no less than 39 out of 90. This circum

stance I attribute to the great pains taken to improve the general health, and the close attention paid to the state of the digestive organs; for I have often had the

evidence before me, and have been more and more

confirmed in the opinion by each succeeding case, that the first step to be attained in the cure of mental disorder is to put the chylopoietic viscera into as

sound and healthy a condition as possible, and that

the alleviation of the mental disease may usually be

dated from the period when this desirable object is

accomplished. TABLE XVIII.

Exhibiting the Influence of the Duration of the Disease upon the Recoveries, a'c.

Discharged.

Remain- Gran Recovered. ing, June Total

Duration of the Attack. RNoelievedtR e Died. Total 840 Recovery Recovery Relieved.

complete. confirm ied.

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

First attack of three) months' duration, or 9 5 14 1 1 6 5 11 2 22 1 317 14 31 1 1 18 14 32

less . . . . . ) I Do. of from three to

twelve months'dura- 7 7 14 l 7 1 8 5 3 8 3 1 422 12 34 1 1 23 12 35 tion . . . ..

Second attack of not more than twelvet 415 2 2 1 2 1 1 5 3 8 1 1 2! 6 4 10 months' duration . S

! , t

Attacks of more than twelve month's dura-2 139 1 7 8 9 11 20, 9 4 3 7 31046 44 90 8 614 54 50 104 tion . . . . . . j I

Attack and duration ot stated

d io 2 2 1 2 3 1 1 2 1 3 6 3 6 3 9

Total . . 412 32 74 1 8 923 21 44 15 9 2415 6 21 76 2 7 18107 83 0 Total .2... 1232 74 1 8 923 21 44'15 9 24'13 6 2196 76 172111 7 18107 83 190

* It may also be remarked, that some of the cases which were reported by the patients' friends as of only three mont!is' duration, were, probably, of considerably longer standing, the insidious approach of the disease being often, in its early stages, altogether overlooked.

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STATISTICS OF INSANITY. 251

D.-Influence of Age.-Generally speaking, and

other circumstances being equal, the chance of reco very from insanity diminishes with the advance of life, and especially in its latter stages. Thus, of the 104 patients not above 40 years of age, 44'24 per cent.

recovered; while of those above 40, the recoveries amounted to but 41'17 per cent. Again, dividing the

patients into those under and above 50, the recoveries amounted to 43-75 per cent. among the former, and

only to 39'28 among the latter; but the difference is

still more obvious when the patients are divided into

those who are under and those who are above 60, the

centesimal proportions in these classes being respec tively 43-82 and 30-00. The oldest individual ad

mitted was a male of 74, who recovered, and, when

last heard of, in May, 1841, had not had a relapse. The case, however, was a favorable one; he had no

hereditary predisposition to insanity, and it had only existed four months previous to his admission. Had

those cases of recovery whose permanency was con

sidered more doubtful, owing to the short period which the patients remained in the Retreat after it

had taken place, been included in the above estimate,

the per centage of recoveries under the age of 50

would have been augmented to 50 per cent., while,

for those above that age, it would still have remained

at 39-28-a difference between the two classes of

nearly 21u per cent.

TABLE XIX.

Exhibiting the Influence of Age upon the Recoveries, E'c. the arrangement being upon the same principle as some of theformer Tables.

Discharged.

Remain- Grand Recovered. ing, June Total

Not 30, 1840. Ages. Relieved Not Died. Total 30, 184 Recovery Recoveryo

Relieed. Relieved.

. Total. R not

complete. ~confirmed. ____ __

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

]5 to 20 Years . . .2 2 1311 22 2 7 6 13 1 1 7 7 14

21-30 .. . 8 6 14 33 7 4 11 5 3 8 3 1 423 17 40 6 2 8 29 19 48

31-40 .....17 9 26 1 2 3 2 6 8 4 2 6 7 1 831 20 51 2 2 4 3322 55

41- 50 . . 7 10 17 3 3 5 7 122 2 4 1 3 4115 25 40 15 25 40

51-60 . . 5 3 8 3 2 512 1 32 212 6 18 2 2 41 14 8 22

61 - 70 . . 2 4 1 5 1 11 7 2 91 1 8 2 10

71-80 . . .1 1' _ 1 l1 1

Total . . 42 3274 1 8 923 21415 9 215 62196 76 7211 7 18107 83 190

E.-Influence of Sex.-Some remarks have already

been made on the duration of residence, by which it

appeared that the females had, on the average, re

mained in the Retreat considerably longer than the

males. This assertion not only holds good with re

spect to the whole number discharged, but also as

regards those who were discharged " recovered;" for,

while the period averaged for the males only 3-47

months, it reached 5'65 months for the females, or,

without including the two very protracted cases

already referred to (and both of which occurred

among the females), it still amounted to 4-16 months,

thus exceeding the average for the males by two

thirds of a month.

The actual number of complete recoveries was 42

males and 32 females, giving a centesimal proportion of 43'75 recoveries in the former, and of 42'18 per cent. in the latter; and if, as we ought to do here, we

include those recoveries which, however, were "not confirmed," the result is, that the recoveries were 44'79 per cent. in the males, and 52'63 in the females. This shows that though the males recovered more

rapidly, yet that the total number of cures effected

was, in the complete recoveries, within a fraction of

being equal in the two sexes, and that it was in favor

of the females, if we include the cases which left the

Retreat before the permanency of the recovery could be depended on. This is a result similar to that

arrived at by most of those who have had extensive

experience in this disease.

VII.--TiE READMISSIONS.

Of the 190 admissions, 24, as was stated at the com

mencement of this paper, were readmissions; the

persons readmitted were, however, but 16; 11 having been readmitted once, 2 twice, and 3 three times; of

these 16 individuals, 11 (6 males and 5 females) were

cases of mania, 2 of incoherence (both males), and 1

was a case (in a female) of monomania. All the

cases which were readmitted more than once were

instances of mania. The periods after the previous

discharge, at which the readmissions took place, varied, as might be expected, very materially, 4 of them

(16'66 per cent.) taking place within six months, and

1 of them not until between six and seven years after

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252 STATISTICS OF INSANITY.

wards; these results will be more fully seen by refer ring to the accompanying Tables. The average interval between the previous discharge and the subsequent re admission was, for the males one year seven months and one-third, and for the females one year six and a half months. The whole of the cases which were readmitted had not been previously discharged re

covered; this was the case with but 21 of them, and of these, 3 were in the Retreat in June, 1840; and of

the 18 who were redischarged 14 (77'77 per cent.) were cured, 3 relieved, and 1 unrelieved. One of the

three who had previously only been relieved, was, on

his subsequent admission, discharged cured; another had received no benefit when again redischarged, and the third still remained in the house in June, 1840.

None of those who had left unrelieved again returned to the Retreat.

Of the 16 persons readmitted, 7 (4 males and 3 fe

males) had had one or more attacks prior to the one for

which they were first admitted, and 2 of the remainder were discharged relieved only; hence, there were 7 cases of first attack of insanity in which a recurrence of the disease took place. Now, supposing we consider as " first attacks of insanity," those which were really such, and were also of not more than twelve months'

duration, it is evident, by Table XVIII., that at least 28 such cases were discharged completely reco vered; the proportions of readmissions after first attacks would then be exactly 1 in 4: this is, how

ever, I am satisfied, very far below the actual lia

bility there is, under such circumstances, to relapses; because-lstly, two other cases of recurrence of the dis

ease have beenreadmittedsince the period at which this

report closes; 2ndly, recurrence of the disease may not take place until many years after the first attack, while of course all those which were readmitted must have been cases of subsequent attack occurring within

eight or nine years at the utmost, and most of them within far shorter periods; 3rdly, on a subsequent at tack the patients might be admitted into other asylums.

Hence, it is probable that at least 2 cases out of

every 5, if not indeed one half, of all those who are attacked wiih insanity, will have a recurrence of the

disease.

TABLB XX.

Showing the Number of Persons and CasesRe-admitted into the Retreat.

Re-admissions. M. F. T.

Re-admitted, once. . . 6 5 11

,, twice . . 1 1 2

three times . 2 1 3

Persons re-admitted . 9 7 16

Cases re-admitted . . 14 10 24

TABLE XXI.

Showing the Length of Time which elapsed between the previous Discharge and the Re-admission.

Period of Time be Recoveredwhen Reeed when tween the prv seve

d wheo tDiheen

te nprevis previously previously

Re.-dminsion. eDscharged. Discharged.

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

Under 3 Months . 3 1 4

From 3 to 6

,, 6 -12 . 3 1 4 2 2

1, --2Years 3 5 8 1 1

,, 2-3 . 1 2 3

,, 3-4 . . 1 1

6- 7 . . 1 1

Total . . 12 9 21 2 1 3

TABLE XXII.

Showing the Number of Cases Re-admitted, and their Condition (as regards Cure) when previously Discharged; also the Result of Treatment at the Period of their being Re.discharged.

State when Discharged.

State at previous Discharge ReTadtied.i Recovered. Relieved. Not In the Recovered

ReRelieved, Retreat.

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

Recovered. ... ..... 12 9 21 8 6 14 2 1 3 1 1 1 2 3

Relieved ......... . 2 1 3 1 1 1

Total .. . 14 10 24! 9 6 15 2 1 3 2 2 1 3 4

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STATISTICS OF INBANITY. 253

VIII.-DEATHS. In calculating the proportionate number of deaths,

they ought not to be compared with the number of admissions, but with the number of patients discharged, seeing that the result of treatment of those patients

who are at present in the Retreat cannot be accurately foretold. Of the 172 who were discharged, 21 (15

males and 6 females) had died; this gives the cente

simal proportion of 12'20 for the whole number of

cases discharged; of 15'62 for the males, and of 7'89

for the females. All cases of insanity, except idiotcy, being admitted,

and none being refused on account of ill health, seve

ral patients entered the Retreat with diseases which were not only incurable, but which were likely to prove very speedily fatal; thus not only augmenting materially the proportion of deaths and diminishing those of recovery, but also making the average dura

tion of residence of those cases which died extremely

short; hence, 4 out of the 6 deaths which occurred in

the females took place within a fortnight of admis

sion, and the average period for the whole 6 cases was

but twenty-five days. Of the men, too, 6 died within

three weeks of admission, and on the average after a

period of not more than four months' residence (Table

XXIII). The average age at which death occurred was 37'38

years; the men reaching the age of 34'33, and the

women that of 44'83 years, an average difference of more than ten years in favor of the females. (See also

Table XIX.) On referring to Table XXIV., it appears that of the

causes of death, 13 were affections of the nervous

system, either of a chronic or acute character; of

these, 2 patients were carried off by apoplexy, 2 fell victims to epilepsy (one of them during an epileptic fit), and 2 to paralysis; the 4 cases of phthisis died respectively a fortnight, a month, six weeks, and two

months after admission. The influence of the form of insanity, and of the

duration of the disease, will be seen on referring to col. 6 of Tables XV. and XVII.; it may, however, be here remarked, that while in the other forms of

insanity the deaths did not quite average 1 in 17 of

those who were discharged; in incoherence they amounted to nearly 1 in 5; in imbecility to 1 in 3 ; and in fatuity to 7 out of 9.

TABLE XXIII.

Showing the Periods after Admission when the Deaths took place; with the Sexes of the Patients, and the Forms of Insanity under which they suffered.

Meln. Inohe. Duration of Residence. a Monomania cholla. rece. Imbecility. Fatuity. Total.

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

2Weeks or leas. .1 I 1 1 2 3 54 4 8

2 Weeks to 1 Month, 3 3 1 1 4 4

1 Monthto2 . . . 1 1 12 1 2 2 4

3 ,, 6 ... 1 1 1 12 2

6 ,,12 . . 1 1 1

to 2 Years . . . 1 1 1 1 2 2

Total . . . 5 1 6 1 1 1 12 24 4 3 4 715 6 21 _ __ .I ._ _ _ _ _ ._ _ _ _ _ _ _ __._ _

IX.-SUBSEQUENT HISTORY OF THOSE PATIENTS WHO HAD LEFT THE RETREAT.

As this subject is one of much importance, I endea vo4red in May and June, 1841, to ascertain the then

condition of those patients who had been discharged "recovered;" and have also, within the last few

weeks, made renewed inquiries eencerning many of them: although information could not be procured as

respects the whole, yet that obtained posesses con siderable interest, and the following is a summary of the results which it affords. It may here be remarked

that any periods of time mentioned are always those between the last discharge of the patients from the Retreat, and that when information was last obtained

respecting them: Of the 74 patients who were discharged completely

recovered, no information has been afforded respecting 36; of the remaining 38, 33 when last heard of were living, and 5 had died. Of the former number, 21 had remained perfectly well since leaving the Retreat; the periods since their discharge up to the time when information was last obtained respecting them, vary ing from one to twelve years (Table XXV); 2 others presented some traces of their former disorder, or some peculiarity of manner, without, however, having had any decided attack of insanity, while 10 had had

a relapse since they left the Retreat, though 4 of this number had again recovered. Of those who were

dead, 3 had remained sane up to the period of their

disease, 1 presented some traces of, and another had

relapsed into, a state of insanity.

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254 STATISTICS OF INSANITY.

TABLE XXIV.

Showing the Causes of Death in those Cases which terminated Fatally in the Retreat.

Causes of Death. M. F. T.

Brain, Chronic Disease of . . . . . . . . . . . . . . . . . . . .. . 2 2 4

,, Acute Inflammation of (one of them Meningitis) .......... 2 2

,, Ramolissement of (Cerebellum) ................ 1 1

Apoplexy .................... ...... 1 1 2

Epilepsy . .. . . . . ...... . . . . . . . . . . . . . .. 2 2

Paralysis . ... . . .... . . . . . . . . . . . . . . 2

Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1

Cholera . . . . . . . . . . . . . . . . . . . . . . . ... 1 1

Phthisis . . . . . . . . . . . . . . . . . . . . . . . . . 2 2 4

Asthma . . . . . . . . . . . . . . . . . . . . 1 1

Accident, in attempting to escape ................. . 1 1

Total . . . . . . . . . . . . . 15 6 21

TABLE XXV.

Exhibiting the Permanency, or otherwise, of the Recovery of those Patients who, at their last Discharge from the Retreat, were cured.

Total Intervals since Recovery Presenting some Number

their last discharge Permanent. traces of insanity. Relapsed. discharged, to the period _I of whom

Condition when when information information last discharged. was last obtained Living. Dead. Living. Dead. Living. Dead. has been

respecting the obtained.

patients-or to that of death. M. F. T.M. F TM. F. T.M. F.T.M.F.T. M F. T M. F. T.

Recovered. Under one year. l 2 2

Recovery com- From 1 to 5 .. 3 3 6 1 1 2 21 235 9 6 15

plete .. . - 5 to10.. 6 7 13 1 33 6 11 17

-10 to 12 2 2 2 2 4 4

11 10 21 2 1 31 2 2 1 1 4 6 10 1 121 17 38

- 5tolO . I 11 2 2 Recovery not I

- 10 to 12. 1 2 2 22 1 3 4 confirmed . X _. _

Total . 12 12 24 2 1 1 2 21 1 4 9 131 1 1'22 22 44

14327 3 t 3- 914

14.13.27 3 3 5.9.14

In a former section I stated that those cases of the permanency of whose cure, when they left the establish mpnt, I did not feel satisfied (owing to the short time they remained after convalescence was established), ought nevertheless to be considered as " recovered;" of the propriety of this remark, it is satisfactory to be assured by knowing that one half of those, respecting

whom information has been obtained, have remained quite well during periods of from five to twelve years thus indicating a proportion of relapses but little greater than those occurring amongst the patients who were discharged quite recovered; hence, of the 44 from or of whom information has been obtained, and

who were discharged from the Retreat cured, 14 only

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ABUSE OF THE PHARMACEUTICAL SOCIETY. 255

had relapsed, 3 presented some traces of their disease and 27 either remained there perfectly well or had done so to the period of their death. Moreover, ii

may be remarked that several of those who are leav

ing the Retreat, at the request of their friends, before

they were cured, and who were consequently dis

charged only as relieved, have subsequently recovered entirely without further treatment.

In conclusion, as this report is offered merely as a

contribution to the statistics of insanity, it is quite

unnecessary, if indeed it would not be out of place, to enter into the minutia of the plan of treatment

adopted; yet from the paramount importance of which I deem it, I cannot refrain from reiterating the neces

sity there is of attending most closely in maniacal

cases to the state of the digestive organs, and by means

of steady perseverance in a judicious course of medicine,

dietetics, and other remedies, improving their condi tion and bringing up the health to the highest possible standard. With this object in view, and to have ac

curate daily reports of the progress'of each case, sepa rate books were kept for every patient, with columns for the different symptoms which might present them selves, for the state of the alvine and other secretions, the diet, and the medicines taken, &c., so that at a

glance the state of every patient on any given day could be referred to, with the Imedicines prescribed and their effect. This system, which at first sight may appear somewhat difficult, but which can be worked out with the greatest ease, I have found so useful in the treatment of those who were under my care, that I would venture earnestly to recommend it to all who

may have the management of the insane. But while I think thus highly of the value of medicine in these

cases, let it not for a moment be supposed that I undervalue the moral treatment in this disease, for it is most assuredly of vast importance in aiding the cure of insanity. By affording amusement and occu

pation to the mind, by the kindest and most concilia

tory treatment, and by encouraging the patients to

employ themselves in such ways and undertakings as are most congenial to their temperaments and former

habits, have I found the good effects of medical treat ment increased, the mind diverted from the hallucina tions which haunted it, and the recovery of its healthy functions materially accelerated.

PROVINCIAL MEDICAL JOURNAL

SATURDAY, JUNE 24, 1813.

There are few bounds or limits to the practice of

quackery in our profession; few and vague indeed as

the protections afforded to its members; constantly does it become our unpleasing task to record some new

illustration of this truth, or recount cases in which by the continuance, nay the increased number of im

postors, the medical profession is daily degraded and

the public as constantly deceived.

It has long been customary with the vulgar to re

ceive in the light of medical advisers the numerous

class of chemists and druggists, and apparently to

regard their large colored glass bottles as the evi dences of qualification equalling in value and import ance the license of the Royal College of Physicians or Apothecaries' Hall. Nothing loth to retain an

imaginary rank, thus to a certain extent thrust upon them, have a very large number of retail druggists, both in town and country, pursued with impunity a

system of dangerous, but nevertheless profitable impo sition, denominated" counter practice." Some,indeed (and these are by no means few), have overstepped the bounds of the counter, and visit, prescribe for, and physic their hapless patients with an amount of

unblushing effrontery which utter ignorance alone can create, regardless of their own incapacity to alleviate the sufferings of disease, and by their pecu niary extortions adding to sickness the kindred mise ries of poverty.

For many years past have a considerable proportion of these persons, more particularly those who reside in the more densely populated districts, continued to ensure to themselves a good annual income, derived from the speculations made upon the health and lives of their fellow-creatures. Within a comparatively recent period, either from the long-agitated question of medical reform, the increased growth of quackery, or other causes, the public have been occasionally induced to inquire into the qualifications of medical

practitioners, and have began at length to discover that a chemist and druggist is in no way connected

with medical practice; as a consequence of this, several practising druggists have lost a large portion of their patients, and would ere long have been pro bably driven back to their proper spheres, and, in

despair, have returned to their shops, preserving as some relic of their former course an occasional indul

gence in " counter prescribing :" when a light broke

in upon them, a new means of deceiving their patients

and the public was opened to them, and the " Phai'

maceutical Society," destined for a better purpose'

has become the means of affording an imaginary

qualification to aid the purposes of the practising

druggists, each of whom now hlastens to paint on

some conspicuous part of his house the attractive

announcement that Mr. - is a member of the

" Pharmaceutical Society of Great Britain;" and,

should a sceptical patient venture to question the

qualification of his soi-disant medical attendant, the

certificate of the Society, dignified with the name of

diploma, is produced, and the poor sufferer, probably never having seen or known anything about medical education or collegiate rank, is satisfied; he has seen

a paper with the name of Mr. - , to which signa tures are appended; all suspicion is lulled, and he remains the unconscious victim of combined ignorance ind fraud. This abuse of the Pharmaceutical Society s not an unreal one; would it were so. When the

society was first proposed, we were induced to believe

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