The bones of the insane

Abstract

This article examines alienist explanations for fracture among British asylum patients in the late nineteenth to early twentieth centuries. A series of deaths in asylums came to light in the 1870s which, in placing the blame for such incidents on asylum staff, called for a response from the psychiatric profession. This response drew upon other medical fields and employed novel pathological techniques to explain why fractures occurred among the insane, in many cases aligning bone fragility with particular forms of insanity (namely, General Paralysis of the Insane). Although such research aimed to provide a medical explanation for the ‘fracture death’, it also called into question the value of pathological research and the utility of quantitative measurement in understanding mental disease.

Statistics, Classification, and the Standardisation of Melancholia

“…This can at least in part be attributed to the context in which he worked; at West Riding there was a significant focus on cerebral post-mortem examinations and diagnostics were constituted within a solid biological framework. 118 His commitment to neurology and neurophysiology was in strong evidence in his textbook, which commenced with a substantial section on anatomy and histology, made up of several detailed chapters on the various parts of the brain and spinal cord. He went on to describe simple melancholia as 'forms of a purely emotional or affective insanity, where there is mental pain or emotional distress apart from obvious intellectual disturbance'.…”

‘Shrouded in a dark fog’: comparison of the diagnosis of pellagra in Venice and general paralysis of the insane in the United Kingdom, 1840–1900

“…However, Bucknill and Tuke (p. 285) maintain: 'General paralysis is very frequently caused by intemperate habits', thus agreeing with others who hypothesized that GPI could also be a consequence of 'a disease of nutrition affecting the whole nervous system' (p. 496). This hypothesis was based on the overall malfunctioning of the neuro-muscular system and on the numerous and suspect instances of fractures and even deaths due to patients' falls (Wallis, 2013). The idea of a possible dietary cause of GPI, postulated by Bucknill and Tuke, suggests a further affinity with pellagra, one that in actual fact did not exist.…”

On ‘The bones of the insane’ (letter received 23 December 2013)

“…While Macmillan states that he does not agree with my assessment of Campbell’s results as ‘inconclusive’, some of the points he raises in his letter suggest a similar conclusion – such as Campbell’s reluctance to offer ‘any definite answer’ (Campbell, 1895a: 256). As I stated in my conclusion, it is notable that, despite in-depth research like that undertaken by Campbell, the ‘responsibilities [of asylum staff] were unchanged by the suggestion that some patients were especially liable to fracture’ (Wallis, 2013: 208).…”

“…I do not state in the article that Campbell’s second study used an additional Rainhill sample, rather saying that it was a ‘larger sample’, but agree that this could have been made more explicit (Wallis, 2013: 204).…”