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On the Alleged Increase of Insanity in Ireland

Published online by Cambridge University Press:  19 February 2018

Thos. Drapes
Thos. Drapes*
Affiliation:
District Asylum, Ennis corthy
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Extract

The question of the increase of insanity in Ireland is, of course, but a part of the much larger question, the increase of insanity generally, all the world over. But there is one peculiarity about Ireland which has been repeatedly noticed, of which, as yet, no adequate explanation has been forthcoming, namely, that while in other countries insanity has increased along with, and in a higher ratio than an increasing population, Ireland alone of all civilized countries, so far as I am aware, possesses the unique and unenviable distinction of a continuously increasing amount of insanity with a continuously decreasing population; and, what would appear to be an almost necessary consequence, the proportional rate of increase in Ireland is far beyond what exists elsewhere. The aim of this discussion then, it seems to me, should be directed not so much towards explaining such increase in insanity as Ireland shares in common with other countries, as to an endeavour, if possible, to account for the preponderance, or the assumed preponderance, of insanity in Ireland over that of other countries.

Type
Part I.—The Transactions of the Fifty-Third Annual Meeting of the Medico-Psychological Association, held in Dublin, 12th to 15th June, 1894
Information
Journal of Mental Science , Volume 40 , Issue 171 , October 1894 , pp. 519 - 548
Copyright
Copyright © Royal College of Psychiatrists, 1894 

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References

∗ 47th Report of Commissioners in Lunacy, 1893, p. 11.Google Scholar
† Inspectors' Special Report on the “Alleged Increasing Prevalence of Insanity in Ireland,” Feb., 1894, p. 17.Google Scholar
∗ The number of insane in private asylums varies hardly at all. Twenty years ago, ten years ago, it was almost the same as it is to-day, and if anything it is decreasing. The admissions into private asylums have altered so little during the past twenty years that the average annual admissions during the first quinque$nnium were 0·34 per 10,000 of population, and during the last 0·33. I have thought it better, however, to include them, as they make a slight but perceptible difference in the proportion of admissions to population.Google Scholar
† As regards the idiot population there is one remarkable incident revealed in the census tables. In the year 1861 the number of idiots in asylums is stated to have been 403, and to have been 410 in 1871, a rise of only seven; but in 1881 the number had risen to 1,896, that is to say, it had more than quadrupled itself. During the same decade the idiots in workhouses nearly doubled in number, having risen from 1,183 to 2,195. The total increase in asylums and workhouses, in fact, from 1871 to 1881 amounted to 2,498, while the idiots at large were only reduced by 599, leaving a margin of just 1,900 idiots sent into asylums and workhouses, whose origin must, I fear, remain a matter for speculation. During the last decade they have been reduced by nearly one-half, 996 being returned as in asylums and 1,170 in workhouses. Such abrupt changes in the numbers can hardly, I think, be held to indicate a sudden outbreak of idiocy, or an equally sudden extinction of a large mass of existing idiocy, but rather an uncertainty in the application of the term idiot on the part of those who made the retains.Google Scholar
∗ “Brit. Med. Journ.,” 25th Nov., 1893.Google Scholar
∗ And this is, in reality, the case. Taking the average for the last five years (1888–1892) I find that in England the readmissions formed but 13 per cent. of the total admissions (excluding transfers), while in Ireland they were 22 per cent. And if we take the twenty years (1873 to 1892) and compare the last quinquennium with the first, we find that the total admissions increased by 34 per cent, first admissions by 27$f12 per cent., and readmissions by 61$f12 per cent.Google Scholar
∗ Going a step farther, we may ask why in two countries in such close proximity this disease should be so prevalent in one, so conspicuous by its absence in the other. There is some difference of opinion, even among our highest authorities, as to what factor plays the most important part in the etiology of general paralysis. But I think all are agreed that the agents which induce it are to be found within a small group of causes. These include sexual excesses, syphilis, and alcoholism, with, perhaps, strain of mind superadded. In other words it is a disease believed to be intimately connected with, if not the direct product of a dissolute life. Some consider that alcoholism alone is sufficient to cause the disease. Against this is the fact that in Ireland we have abundance of alcoholism, and a large number of cases of insanity due to it, but scarcely any general paralysis. On the other hand syphilis is a comparatively rare disease amongst the rural population of Ireland, whereas it is common enough in the numerous large towns and cities of England. I wish to speak cautiously here, but when we find a certain disease prevailing to a large extent in one country, and one of its admittedly potent causes existing with it side by side, and when we find a notable absence of both cause and disease in an adjacent country, it does seem as if there was some very intimate connection between the two. Of the 21 deaths assigned to this disease last year in Ireland, 13 hail from the Richmond Asylum and six from Belfast; but syphilis is a disease not unknown either in the northern or in the central metropolis. This leaves a balance of two deaths for the rest of Ireland. If the inference suggested by these facts be true, then, strange as it may appear, the apparent preponderance of insanity in this country may be said to be largely due to the virtue of its inhabitants.Google Scholar
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