Appendicitis in Private and Public Hospitals for the Insane

The excuse for a discussion on this physical affection in association with the insane mind is an attempt to prove by its rarity in county and county-borough asylums, asylums for idiots, mental hospitals and licensed houses of England and Wales, that it is preventable. In ten years from 1902 to 1911 there are recorded by the English Commissioners in Lunacy seventy-five deaths from appendicitis, typhlitis or perityphlitis, ascertained in the majority of cases by post-mortem examination, as having occurred among the insane population of the above institutions. and of the seventy-five deaths it would be instructive to know how many of these had the relics of this disease upon them or were suffering at the time of admission from acute or chronic symptoms. In making the statement that appendicitis is a rare malady in private and public hospitals for the insane, I do so with the support of several practitioners of psychiatry. Not only do these clinical observers give me their assistance, but further I have the help of the pathologist to the London County Asylum at Claybury who states, “I do not believe there has been a single case of appendicitis on the post-mortem table at Claybury since I have been pathologist. Consequently in more than 2000 post-mortems there has been no case.” In comparing the Claybury Hospital for the insane with two general hospitals, St. Bartholomew's and Guy's, we can make a valuable contrast. For instance, at St. Bartholomew's Hospital 1645 autopsies were made between 1909 and 1911, and of these, 69 were recognised as appendicitis. At Guy's Hospital in the year 1900, of the first 500 post-mortems 12 were recorded as cases of appendicular disease. As regards the proportion of cases of appendicitis to the number of admissions I find that at the same hospital in 1890 there were 8588 admissions. Of these admissions, 306 were subjects of appendicitis, 187 being under the care of surgeons, while 119 were under the care of physicians. The death-rate from appendicitis recorded in the Registrar-General's Report for 1909 shows a slight gradual increase from 1901 to 1909. Referring to other parts of the Kingdom in this investigation I find the statistical tables from the Lunacy Board of Scotland show that formerly deaths from appendicitis were usually returned as deaths from peritonitis, that appendicitis had no separate heading in the Board's tables of causes of death, and is not yet separately notified. If a case of appendicitis were returned it would be placed in the table of Diseases of Digestive System; but it has been ascertained that no death in a Scottish asylum has been returned during the past five years as due to appendicitis. Again the Blue Book of the Inspectors of Lunatics for Ireland in the issue for 1911 gives typhlitis grouped among the causes of death, but the table gives no return of the complaint for that year. and in the table there are only eleven cases of peritonitis. Likewise the Secretary of the Office of Lunatic Asylums, Dublin Castle, sends me the returns for typhlitis for the period 1902 to 1910 as follows: 1902, o; 1903, 1 male; 1904, o; 1905, 1 female; 1906, o; 1907, 1 male; 1908, 2, male and female; 1909, o; 1910, o—viz. five in all. and the cause was ascertained, except in one case, by post-mortem examination. With these figures for your guidance I would remark that in experimental research and statistical calculations, extreme care and accuracy should survive comment. But with the greatest attention and thoroughness that any of us can spend on the subject matter of a professional inquiry in medicine, exception will be sure to prove the rule.