The Increase of General Paralysis in England and Wales: Its Carnation and Significance

Abstract

No Disproportionate Increase of Insanity.The increase of the total living insane in England and Wales during the intercensal period 1881–91 was 15·24 per cent., while the corresponding increase of population was only 11·7.SummaryI.—There is no evidence of increasing liability to insanity on the part of the English race.II.—There is evidence of an increasing tendency to general paralysis.III.—This is most pronounced among males, in whom the increase is nineteen times what it is in women.IV.—Among males the increase in private patients is more than twice that in pauper patients; in the former it is steadily progressive, in the latter it is a diminishing increase. Among females the increase in paupers is slight. In private female patients there is a steadily maintained diminution.V.—The age at which the increase of general paralysis attains its maximum is the decade 35 to 44; in other forms of insanity the increase occurs at ages over 45 and is greatest at ages over 55.VI.—The increase is greatest among married men, being five times that which occurs in unmarried men, and sixty times that in married women.VII.—The greatest increase is found in large urban centres, most so in sea-ports and in particular coal-exporting towns; the next greatest in coal-mining counties and manufacturing towns, while in agricultural counties there is a decrease. A close parallel, as regards geographical distribution, is to be traced between the increase of general paralysis and the occurrence of the offence of drunkenness.VIII.—The etiological factors most responsible for the increase are alcoholic intemperance, sexual excess, and venereal disease. The causes connected with the reproductive life of women are diminishing as factors in the production of general paralysis. The increase finds its origin in causes related to the self-regarding, not the altruistic, instinct.IX.—The increasing prevalence of general paralysis indicates a change in the type of insanity, a reversion to a lower form of brain disease, increasing moral and physical decadence, lessening power of resistance and diminishing vitality, and increasing tendency to premature and rapid racial decay.X.—The affection being absolutely fatal, and the causes being to a very large extent controllable, the only direction in which the remedy is to be sought is in that of prevention.