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Irish Journal of Medical Science

, Volume 178, Issue 1, pp 73–77 | Cite as

Syphilis, psychiatry and offending behaviour: clinical cases from nineteenth-century Ireland

  • B. D. Kelly
Original Article

Abstract

Background

Syphilis presented substantial challenges to nineteenth-century medical and psychiatric services.

Aims

To illustrate the clinical course and diagnostic challenges associated with neurosyphilis in nineteenth-century Ireland.

Method

This paper uses original archival material from the Central Criminal Lunatic Asylum, Dublin to present clinical cases and inform a discussion of related issues.

Results

Mr A, a 34-year-old banker convicted of “felonious entry”, demonstrated many psychiatric and neurological features of neurosyphilis (“general paralysis of the insane”); he soon became “feeble”, “paralytic” and “demented”, and died within 2 years. The case of Mr B, a 38-year-old game-keeper convicted of “attempting to upset trains”, illustrates diagnostic dilemmas associated with neurosyphilis, especially when complicated by evidence of tuberculosis (“scrofulous diathesis”).

Conclusions

The clinical and diagnostic challenges presented by syphilis have changed over the past century, but these cases, combined with recent evidence of syphilis outbreaks, highlight ongoing needs for clinical and epidemiological vigilance.

Keywords

Syphilis Mental disorders Forensic psychiatry Mercury History Nineteenth century Ireland 

Notes

Acknowledgment

The author is grateful for the support of Professor Harry Kennedy, National Forensic Psychiatry Service, Central Mental Hospital, Dundrum, Dublin, Ireland.

Conflict of interest statement

None.

References

  1. 1.
    Fleetwood JF (1983) The history of medicine in Ireland, 2nd edn. Skellig Press, DublinGoogle Scholar
  2. 2.
    Quetel C (1990) The history of syphilis. Polity Press, OxfordGoogle Scholar
  3. 3.
    Shorter E (1997) A history of psychiatry: from the era of the Asylum to the age of Prozac. Wiley, New YorkGoogle Scholar
  4. 4.
    Hutto B (2001) Syphilis in clinical psychiatry: a review. Psychosomatics 42:453–460. doi: 10.1176/appi.psy.42.6.453 PubMedCrossRefGoogle Scholar
  5. 5.
    Dayan L, Ooi C (2005) Syphilis treatment: old and new. Expert Opin Pharmacother 6:2271–2280. doi: 10.1517/14656566.6.13.2271 PubMedCrossRefGoogle Scholar
  6. 6.
    Rothschild BM (2005) History of syphilis. Clin Infect Dis 40:1454–1463. doi: 10.1086/429626 PubMedCrossRefGoogle Scholar
  7. 7.
    Prestwich PE (2003) Family strategies and medical power: ‘voluntary’ committal in a Parisian asylum, 1876–1914. In: Porter R, Wright D (eds) The confinement of the insane: international perspectives, 1800–1965. Cambridge University Press, Cambridge, pp 79–99Google Scholar
  8. 8.
    Dörries A, Beddies T (2003) The Wittenauer Heilstätten in Berlin: a case record study of psychiatric patients in Germany, 1919–1960. In: Porter R, Wright D (eds) The confinement of the insane: international perspectives, 1800–1965. Cambridge University Press, Cambridge, pp 149–172Google Scholar
  9. 9.
    Kelly BD (2007) Dr William Saunders Hallaran and psychiatric practice in nineteenth-century Ireland. Ir J Med Sci 27(June). Epub ahead of printGoogle Scholar
  10. 10.
    Hallaran WS (1818) Practical observations on the causes and cures of insanity, 2nd edn. Edwards and Savage, CorkGoogle Scholar
  11. 11.
    Finnane P (1981) Insanity and the insane in post-famine Ireland. Croon Helm, LondonGoogle Scholar
  12. 12.
    Torrey EF, Miller J (2001) The invisible plague: the rise of mental illness from 1750 to the present. Rutgers University Press, PiscatawayGoogle Scholar
  13. 13.
    Smith C The Central Mental Hospital, Dundrum, Dublin. In: Bluglass R, Bowden P (eds) Principles and practice of forensic psychiatry. Churchill Livingstone, Edinburgh, pp 1351–1353Google Scholar
  14. 14.
    Gibbons P, Mulryan N, O’Connor A (1997) Guilty but insane: the insanity defence in Ireland, 1850–1995. Br J Psychiatry 170:467–172PubMedCrossRefGoogle Scholar
  15. 15.
    Mulryan N, Gibbons P, O’Connor A (2002) Infanticide and child murder—admissions to the Central Mental Hospital, 1850–2000. Ir J Psychol Med 19:8–12Google Scholar
  16. 16.
    Farthing MJG, Jeffries DJ, Parkin JM (1994) Infectious diseases, tropical medicine and sexually transmitted diseases. In: Kumar P, Clark M (eds) Clinical medicine, 3rd edn. Baillière Tindall, London, pp 1–105Google Scholar
  17. 17.
    Clarke CRA (1994) Neurological diseases and diseases of voluntary muscle. In: Kumar P, Clark M (eds) Clinical medicine, 3rd edn. Baillière Tindall, London, pp 871–955Google Scholar
  18. 18.
    Ances BM, Shelhaus R, Brown MJ, Rios OV, Herman ST, French JA (2004) Neurosyphilis and status epilepticus: case report and literature review. Epilepsy Res 59:67–70. doi: 10.1016/j.eplepsyres.2004.03.007 PubMedCrossRefGoogle Scholar
  19. 19.
    Gürses C, Kürtüncü M, Jirsch J, Yeşilot N, Hanağasi H, Bebek N et al (2007) Neurosyphilis presenting with status epilepticus. Epileptic Disord 9:51–56PubMedGoogle Scholar
  20. 20.
    Kaplan HI, Saddock BJ (1996) Concise textbook of clinical psychiatry. Williams & Wilkins, BaltimoreGoogle Scholar
  21. 21.
    Walsh O (2004) Gender and insanity in nineteenth-century Ireland. Clio Med 73:69–93PubMedGoogle Scholar
  22. 22.
    Walsh D (1992) The ups and downs of schizophrenia in Ireland. Ir J Psychiatry 13:12–16Google Scholar
  23. 23.
    Jones G (1999) The campaign against tuberculosis in Ireland, 1899–1914. In: Malcolm E, Jones G (eds) Medicine, disease and the state in Ireland, 1650–1940. Cork University Press, Cork, pp 158–176Google Scholar
  24. 24.
    Kelly BD (2007) One hundred years ago: the Richmond Asylum, Dublin in 1907. Ir J Psychol Med 24:108–114Google Scholar
  25. 25.
    Guthrie D (1945) A history of medicine. Nelson, London, pp 383–384Google Scholar
  26. 26.
    Merrit HH, Adams R, Solomon HC (1946) Neurosyphilis. Oxford University Press, OxfordGoogle Scholar
  27. 27.
    Brown EM (2000) Why Wagner-Jauregg won the Nobel Prize for discovering malaria therapy for general paralysis of the insane. Hist Psychiatry 11:371–382. doi: 10.1177/0957154X0001104403 CrossRefGoogle Scholar
  28. 28.
    Kelly BD (2007) Murder, mercury and mental illness: infanticide in nineteenth-century Ireland. Ir J Med Sci 176:149–152. doi: 10.1007/s11845-007-0045-7 PubMedCrossRefGoogle Scholar
  29. 29.
    Malcolm E (1989) Swift’s Hospital: a history of St Patrick’s Hospital, Dublin, 1746–1989. Gill and Macmillan, DublinGoogle Scholar
  30. 30.
    Gordon AG (1998) Swift’s pocky queen. J R Soc Med 92:102Google Scholar
  31. 31.
    Bewley TH (1998) The health of Jonathan Swift. J R Soc Med 91:602–605PubMedGoogle Scholar
  32. 32.
    Bewley TH (1999) Swift’s pocky queen. J R Soc Med 92:216PubMedGoogle Scholar
  33. 33.
    Ferris K (1996) James Joyce and the burden of disease. University Press of Kentucky, LexingtonGoogle Scholar
  34. 34.
    Quin JD (1991) James Joyce: seronegative arthropathy or syphilis? J Hist Med All Sci 46:86–88. doi: 10.1093/jhmas/46.1.86 CrossRefGoogle Scholar
  35. 35.
    Carter R (1996) James Joyce (1882–1941): medical history, final illness and death. World J Surg 20:720–724PubMedGoogle Scholar
  36. 36.
    Lyons JB (2000) James Joyce: steps towards a diagnosis. J Hist Neurosci 9:294–306. doi: 10.1076/0964-704X(200012)9:3;1-#;FT294 PubMedCrossRefGoogle Scholar
  37. 37.
    Waisbren BA, Walzl FL (1974) Paresis and the priest. James Joyce’s symbolic use of syphilis in “The Sisters.”. Ann Intern Med 80:758–762PubMedGoogle Scholar
  38. 38.
    Hook EW, Peeling RW (2004) Syphilis control—a continuing challenge. N Engl J Med 351:122–124. doi: 10.1056/NEJMp048126 PubMedCrossRefGoogle Scholar
  39. 39.
    Doherty L, Fenton KA, Jones J, Paine TC, Higgins SP, Williams D et al (2002) Syphilis: old problem, new strategy. BMJ 325:153–156. doi: 10.1136/bmj.325.7356.153 PubMedCrossRefGoogle Scholar
  40. 40.
    Hopkins S, Lyons F, Mulcahy F, Bergin C (2001) The great pretender returns to Dublin, Ireland. Sex Transm Infect 77:316–318. doi: 10.1136/sti.77.5.316 PubMedCrossRefGoogle Scholar
  41. 41.
    Cronin M, Domegan L, Thornton L, Fitzgerald M, O’Lorcain P, Creamer E et al (2004) The epidemiology of infectious syphilis in the Republic of Ireland. Euro Surveill 9:14–17PubMedGoogle Scholar
  42. 42.
    Hopkins S, Lyons F, Coleman C, Courtney G, Bergin C, Mulcahy F (2004) Resurgence in infectious syphilis in Ireland: an epidemiological study. Sex Transm Dis 31:317–321. doi: 10.1097/01.OLQ.0000123653.84940.59 PubMedCrossRefGoogle Scholar
  43. 43.
    Gerbase AC, Rowley JT, Mertens TE (1998) Global epidemiology of sexually transmitted diseases. Lancet 351(Suppl 3):2–4. doi: 10.1016/S0140-6736(98)90001-0 PubMedCrossRefGoogle Scholar
  44. 44.
    Ashton M, Sopwith W, Clark P, McKelvey D, Lighton L, Mandal D (2003) An outbreak no longer: factors contributing to the return of syphilis in Greater Manchester. Sex Transm Infect 79:291–293. doi: 10.1136/sti.79.4.291 PubMedCrossRefGoogle Scholar
  45. 45.
    Singh AE, Sutherland K, Lee B, Robinson JL, Wong T (2007) Resurgence of congenital syphilis in Alberta. Can Med Assoc J 177:33–36. doi: 10.1503/cmaj.070495 CrossRefGoogle Scholar
  46. 46.
    Tikhonova L, Salakhov E, Southwick K, Shakarishvili A, Ryan C, Hillis S, Congenital Syphilis Investigation Team (2003) Congenital syphilis in the Russian Federation: magnitude, determinants, and consequences. Sex Transm Infect 79:106–110. doi: 10.1136/sti.79.2.106 PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2008

Authors and Affiliations

  1. 1.Department of Adult PsychiatryUniversity College Dublin, Mater Misericordiae University HospitalDublin 7Ireland

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