Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Irish Journal of Medical Science Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fleetwood JF (1983) The history of medicine in Ireland, 2nd edn. Skellig Press, Dublin

    Google Scholar 

  2. Quetel C (1990) The history of syphilis. Polity Press, Oxford

    Google Scholar 

  3. Shorter E (1997) A history of psychiatry: from the era of the Asylum to the age of Prozac. Wiley, New York

    Google Scholar 

  4. Hutto B (2001) Syphilis in clinical psychiatry: a review. Psychosomatics 42:453–460. doi:10.1176/appi.psy.42.6.453

    Article  PubMed  CAS  Google Scholar 

  5. Dayan L, Ooi C (2005) Syphilis treatment: old and new. Expert Opin Pharmacother 6:2271–2280. doi:10.1517/14656566.6.13.2271

    Article  PubMed  CAS  Google Scholar 

  6. Rothschild BM (2005) History of syphilis. Clin Infect Dis 40:1454–1463. doi:10.1086/429626

    Article  PubMed  Google Scholar 

  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 79–99

    Google Scholar 

  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 149–172

    Google Scholar 

  9. Kelly BD (2007) Dr William Saunders Hallaran and psychiatric practice in nineteenth-century Ireland. Ir J Med Sci 27(June). Epub ahead of print

  10. Hallaran WS (1818) Practical observations on the causes and cures of insanity, 2nd edn. Edwards and Savage, Cork

    Google Scholar 

  11. Finnane P (1981) Insanity and the insane in post-famine Ireland. Croon Helm, London

    Google Scholar 

  12. Torrey EF, Miller J (2001) The invisible plague: the rise of mental illness from 1750 to the present. Rutgers University Press, Piscataway

    Google Scholar 

  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 1351–1353

  14. Gibbons P, Mulryan N, O’Connor A (1997) Guilty but insane: the insanity defence in Ireland, 1850–1995. Br J Psychiatry 170:467–172

    Article  PubMed  CAS  Google Scholar 

  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 19:8–12

    Google Scholar 

  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 1–105

    Google Scholar 

  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 871–955

    Google Scholar 

  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

    Article  PubMed  Google Scholar 

  19. Gürses C, Kürtüncü M, Jirsch J, Yeşilot N, Hanağasi H, Bebek N et al (2007) Neurosyphilis presenting with status epilepticus. Epileptic Disord 9:51–56

    PubMed  Google Scholar 

  20. Kaplan HI, Saddock BJ (1996) Concise textbook of clinical psychiatry. Williams & Wilkins, Baltimore

    Google Scholar 

  21. Walsh O (2004) Gender and insanity in nineteenth-century Ireland. Clio Med 73:69–93

    PubMed  Google Scholar 

  22. Walsh D (1992) The ups and downs of schizophrenia in Ireland. Ir J Psychiatry 13:12–16

    Google Scholar 

  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 158–176

    Google Scholar 

  24. Kelly BD (2007) One hundred years ago: the Richmond Asylum, Dublin in 1907. Ir J Psychol Med 24:108–114

    Google Scholar 

  25. Guthrie D (1945) A history of medicine. Nelson, London, pp 383–384

    Google Scholar 

  26. Merrit HH, Adams R, Solomon HC (1946) Neurosyphilis. Oxford University Press, Oxford

    Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  29. Malcolm E (1989) Swift’s Hospital: a history of St Patrick’s Hospital, Dublin, 1746–1989. Gill and Macmillan, Dublin

    Google Scholar 

  30. Gordon AG (1998) Swift’s pocky queen. J R Soc Med 92:102

    Google Scholar 

  31. Bewley TH (1998) The health of Jonathan Swift. J R Soc Med 91:602–605

    PubMed  CAS  Google Scholar 

  32. Bewley TH (1999) Swift’s pocky queen. J R Soc Med 92:216

    PubMed  CAS  Google Scholar 

  33. Ferris K (1996) James Joyce and the burden of disease. University Press of Kentucky, Lexington

    Google Scholar 

  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

    Article  CAS  Google Scholar 

  35. Carter R (1996) James Joyce (1882–1941): medical history, final illness and death. World J Surg 20:720–724

    PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  37. Waisbren BA, Walzl FL (1974) Paresis and the priest. James Joyce’s symbolic use of syphilis in “The Sisters.”. Ann Intern Med 80:758–762

    PubMed  CAS  Google Scholar 

  38. Hook EW, Peeling RW (2004) Syphilis control—a continuing challenge. N Engl J Med 351:122–124. doi:10.1056/NEJMp048126

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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 9:14–17

    PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland

    B. D. Kelly

Authors
  1. B. D. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. D. Kelly.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kelly, B.D. Syphilis, psychiatry and offending behaviour: clinical cases from nineteenth-century Ireland. Ir J Med Sci 178, 73–77 (2009). https://doi.org/10.1007/s11845-008-0259-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-008-0259-3

Keywords

Search

Navigation