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Phthisis and Insanity: a Study based mainly on the Statistical Returns of Comparative Mortality in Ireland

  • Thomas Drapes (a1)

Is there any special connection or affinity between insanity and phthisis? In other words, is there a greater proclivity in the insane because of their insanity to develop pulmonary consumption than in the sane? That such is the case is, I think, an opinion which at least up till recently has been rather widely if somewhat vaguely held, and believed to be well grounded. The ablest contribution on this subject has, I need hardly say, come from the pen of Dr. Crookshank (Journal of Mental Science, October, 1899), and the facts and arguments adduced by him should go far to dispel this idea. In this paper no attempt will be made to treat the question fully, which, after all that has been written by others, would be quite superfluous, but I shall endeavour, mainly by an appeal to some statistics of Irish asylums, to see if from them corroboration is to be found for Dr. Crookshank's conclusion on this particular point. My paper is therefore to be regarded as in a small way supplementary to his.

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(1) Read at the Annual Meeting of the Medico-Psychological Association at Cork, July, 1901.—

(2) Prof. Brouardel in his address on the prevention of consumption at the British Congress on Tuberculosis held in London in July, states : ‘Laennec, Nat. Guillot, Letulle, proved that in more than half the necropsies made, old healed tuberculous lesions were to be found. … As for my personal experience at the Morgue in Paris, where I frequently make necropsies on accidental deaths, I can state that in half the cases, if the person on whom the necropsy is made has lived in Paris for about ten years, I find healed tuberculous lesions. … These lesions in the majority of cases are not phthisis in an early stage manifested by small disseminated foci, they are cicatrices of large foci, sometimes of wide cavities completely cicatrised. Phthisis, therefore, is curable even in its most advanced stages.’ (Brit. Med. Journ., 27th July, 1901, p. 196.) These statements show that in a large proportion of the sane population evidence of phthisis ‘even in its most advanced stages,’ but arrested, is found. Compare with this Sir J. Crichton Browne's remarks in the discussion on Dr. Eric France's paper (Journ. Ment. Sci., Jan., 1900, p. 19):—’ In 100 general paralytic patients dying in the West Riding Asylum, consecutive cases, in all of which general paralysis was the certified cause of death, tubercular disease of the lungs was found in 25 cases. In six of these only the remnants of past phthisical disease were noted, cretaceous nodules, cicatrices, etc. ; but there was no room for doubt that in 19 cases the disease had arisen during the course of the general paralysis. … In none of these had the disorganisation of the lungs spread to the extent which we are accustomed to find in patients who have died of phthisis.’ The bearing of these extracts is not without significance, and, if anything, lends support to the view that, as far as regards the discovery of phthisical lesions post mortem in sane and insane, they are very much on the same level.

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The British Journal of Psychiatry
  • ISSN: -
  • EISSN: 2514-9946
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Phthisis and Insanity: a Study based mainly on the Statistical Returns of Comparative Mortality in Ireland

  • Thomas Drapes (a1)
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