Read at the Annual Meeting of the Medico-Psychological Association, London, 1896.
From the collective investigation of Tucker (Lunacy in Many Lands, 1887) it would appear that this is also occurring in other countries. This investigation, however, is based only upon the personal opinions of Superintendents unsupported by statistics. To the question addressed to the Superintendents of Asylums: “Has general paralysis increased?” 264 replies were received, in 165 instances in the affirmative, 62·5 per cent., and in 199 in the negative, 37·5 per cent. Arranged according to the country to which they apply the numbers of these answers are as follows:—England, affirmative 33, negative 23; Wales, affirmative 0, negative 3; Scotland, affirmative 5, negative 11; Ireland, affirmative 1, negative 14; France, affirmative 22, negative 6; Germany, affirmative 22, negative 3; Belgium, affirmative 1, negative 4; Netherlands, affirmative 5, negative 1; Denmark, affirmative 2, negative 1; Norway and Sweden, affirmative 3, negative 1; Russia, affirmative 3, negative 3; Italy, affirmative 13, negative 2; Spain, affirmative 2, negative 0; Portugal, affirmative 0, negative 2; Austria, affirmative 8, negative 3; Switzerland, affirmative 3, negative 8; United States of America, affirmative 36, negative 15; Canada, affirmative 6, negative 0. From the foregoing it will be observed that with the exception of six countries—Wales, Scotland, Ireland, Belgium, Portugal, and Switzerland—the prevailing impression indicates an increase of this disease among European and English-speaking races.
Scotland has apparently ceased to be one of the favoured nations, the average percentage of general paralysis as a cause of death, according to the Reports of the Commissioners in Lunacy, being, at least as regards males, a steadily increasing one of late years, as is shown in the following table:—
Average for 31 years ending 1888, males 18·3, females 4·5 per cent.
Average for 32 years ending 1889, males 18·5, females 4·7 per cent.
Average for 33 years ending 1890, males 18·6, females 4·7 per cent.
Average for 34 years ending 1891, males 18·7, females 4·7 per cent.
Average for 35 years ending 1892, males 18·8, females 4·7 per cent.
Average for 36 years ending 1893, males 19·0, females 4·8 per cent.
Average for 37 years ending 1894, males 19·2, females 4·7 per cent.
The increase in the Paris Asylum at Villejuif is shown in the following figures, giving the proportion per cent, of general paralytics to admissions:— 1882 13·03; 1883 14·75; 1884 11·00; 1885 14·60; 1886 15·45; 1887 19·50. (Arnaud, , Annales Medico-Psychologiques, July 1888, p. 86.) A very exhaustive paper by Kraft-Ebing (“Ueber die Zunahme der Progressiven Paralyse, im Hinblick auf die sociologischen Factoren”) has been published in Jahrbucher f. Psychiatrie, 1895, xiii. Bd., Heft 2 and 3, in which statistics are given that prove beyond question a very largely increased proportion of this disease in Austria, Germany, and Switzerland.
The total number of general paralytics admitted to establishments in England and Wales$: during the fifteen years 1878–92 was 18,438, and it is upon the statistics referring to these that this paper is based.
The argument that those who are ultimately responsible for the diagnosis are more adept of late years, and that more cases than formerly are therefore recognised, has very little, if any, weight; the personnel of the higher medical staff of English Asylums has undergone very little change in the period under consideration, and there is no reason to suppose that the diagnostic capacity has altered materially in such a short space of time as fifteen years. Again if diagnostic ability were greater, the increase ought to apply uniformly to all classes of patients, which is not so, as will be seen later on.
The disproportionate increase among males is brought out when the figures are given in another form. In the first quinquenniad the sex-proportion among admissions was 3·7 males to one female; in the last it was 4·1 males to one female. This is quite contrary to the conclusion arrived at by Krafft Ebing, whose statistics show an increasing proportion of women attacked.
The very great increase among private males is evidenced by the alteration of the sex-proportion, which in the first quinquenniad was 7·2 males to one female, and in the last 12·5 to one, the corresponding proportion for paupers being 3·5 to one and 3·7 to one.
Mickle, , General Paralysis of the Insane, second edition, p. 250, gives 33 as the average age at onset of the soldiers under his care.
Arnaud, (Annales Medico-Psychologiques, July, 1888, p. 86) observes that the mean age of general paralysis is lowered, and that the lowering is related to the greater frequency of the disease.
Mickle, (op. cit.) says, “Reading the older literature of the subject one is led to think that formerly general paralysis occurred somewhat later in life, on the average, than is nowadays the case.”
Krafft-Ebing, (op. cit.) gives statistics which point in the same direction.
Calmeil, (De la Paralysis considerée chez les Alienes, 1826, p. 371) gives the following figures for 45 general paralytics:—Age at onset: Up to 32, 4·4 per cent.; 32 to 40, 31·1 per cent.; 40 to 50, 44·4 per cent.; 50 to 60, 20·0 per cent.
The proportion of the offence of drunkenness per 10,000 population in 1893 was:—England and Wales$:, 582·46; Seaports, 1,387·72; Mining Counties, 963·15; Metropolis, 600·64; Manufacturing Towns, 457·90; Agricultural Counties 167·79.—Criminal Statistics, 1893, p. 91.
Inasmuch as in the etiological tables dealing with general paralysis no distinction is made between private and pauper cases, or between exciting and predisposing causes, it is necessary for purposes of comparison to take both classes of cases combined and the total causes.
Further and very powerful evidence of the diminishing power of resistance of the race is afforded by the disproportionate increase during the past twenty years of suicide, which to the extent of 98 per cent. is adjudged to be the outcome of insanity.—Criminal Statistics, 1893.
The average annual proportion of persons per 10,000 of population tried for the offence of drunkenness in England and Wales$: during the four quinquenniads ending 1893 was 812, 698, 636, 615. Here apparently is opportunity for congratulation. But are we justified in concluding that as a race we are becoming more “temperate?” Or is it that we are only a less drunken race? Custom has altered since the Pickwickian times, and to get drunk is now decidedly “indecent;” but are we in reality more temperate? Whether there is temperance or its opposite depends upon results. Drunkenness obviously implies excess; increasing general paralysis implies the same thing, not so obviously, but still none the less really. The significance of the replacement of drunkenness by general paralysis lies in the fact that it indicates a greatly increased tendency to race decay.