Murder, mercury, mental illness: infanticide in nineteenth-century Ireland

Another umbrella murder? - A rare case of Minamata disease

We report a rare case of fatal intoxication in a 40-year-old man caused by injection of a fluid containing organic mercury, allegedly in an attack with a syringe fixed to the tip of an umbrella. The man suffered from severe neurological symptoms and progressive multiorgan failure and died 10 months later in refractory status epilepticus. Autopsy revealed severe brain atrophy and non-specific kidney damage. Neuropathological examination showed neuronal loss especially in the occipital lobe, distinct granule cell necrosis in the cerebellum and Wallerian degeneration in the brainstem. Postmortem toxicological analysis revealed extremely increased levels of mercury in liver and kidney tissue as well as methylmercury levels in peripheral blood.

Regaining agency and autonomy: A grounded typology of concealed pregnancy

AIM

To explore and understand the experience of concealed pregnancy and develop a framework for practitioners.

BACKGROUND

Numerous cases of concealed pregnancy resulting in serious outcomes including maternal and perinatal death, newborn abandonment, and neonaticide are reported internationally. Historically concealed pregnancy is associated with oppressive religious cultures where premarital pregnancy was shunned. Concealed pregnancy has traditionally been viewed through a biomedical lens and associated with mental illness but this assertion remains unsubstantiated by robust evidence.

DESIGN

A Glaserian grounded theory study was undertaken.

DATA SOURCES

Thirty women were interviewed, between 2014 - 2016, on up to three occasions (46 interviews) and 22 cases of public interest were included as data.

METHODS

The constant comparative method and theoretical sampling which are the analytical strategies of grounded theory were used to analyse the data and generate the typology.

RESULTS

Concealed pregnancy is a fearful, life-altering, and traumatic experience. Women with a history of controlling and oppressive relationships characterized by fear respond to a crisis pregnancy by keeping it secret. Many women's relationships were characterized by emotional, mental, sexual, or physical violence. Fear for one's survival is common, may render women unable to access care or support and can be so extreme that a woman may end her own life or give birth alone.

CONCLUSIONS

This typology of concealed pregnancy is intended to aid understanding the fear, trauma, and complexities associated with concealed pregnancy which is vital if practitioners are to provide sensitive, responsive and non-judgemental care.

Searching for the patient's voice in the Irish asylums

The history of mental healthcare in Ireland ends to focus on the histories of institutions and development of mental health legislation. Attention has also been devoted to clinical records, with all of their interpretative and narrative complexities. In both the historiography and archives, however, patients themselves remain remarkably elusive, their voices astonishingly distant. In countries other than Ireland, there have been more extensive analyses of patients' letters, journals and first-person accounts of hospitalisation and treatment. In Ireland, there is real difficulty accessing such accounts, if they exist, especially from the 1800s. Asylum and hospital records offer some assistance in understanding patients' concerns and, arguably, the symptoms recorded in asylum records (eg, delusions) provide further windows into patients' minds. Methodological challenges abound, but while patients' voices may remain largely unknown at present, they are certainly not unknowable. This paper posits that we just need to listen harder and, perhaps, listen better.

Beyond the walls: the mentally ill in Ireland outside the institutions in 1901

Objectives

Ireland’s rates of psychiatric institutionalisation increased rapidly throughout the 1800s and early 1900s. This paper provides a systematic analysis of individuals with mental illness who were not resident in psychiatric hospitals, workhouses or other institutions in 1901.

Methods

We examined the online census records of all individuals described as ‘lunatics’ on the island of Ireland, not resident in psychiatric hospitals, workhouses or other institutions on census night, 1901.

Results

There were 482 individuals described as ‘lunatics’ and not resident in psychiatric hospitals, workhouses or other institutions on 31 March 1901, yielding a point prevalence of 10.6 per 100 000 population. The lowest prevalence (7.8) was in Leinster (possibly owing to provision of workhouses and asylums); the highest prevalence was in Connaught (17.5) (p=0.013). A majority of them (60.4%) were women. Mean age was 45.7 years. In addition, a majority were single (never married) (63.7%); 33.3% of women were married, compared with 14.1% of men (p<0.001). The most common relationship to the head of the household was child (32.8%), although some were boarders or lodgers. The majority were Roman Catholic (82.0%) and could ‘read and write’ (64.5%). Among those for whom ability to speak Irish was recorded, 74.4% spoke both Irish and English.

Conclusion

There were significant geographical and gender differences within the population recorded in the 1901 census as mentally ill and outside institutions. This group merits further study, especially with regard to their distribution in relation to asylum locations, and the extent to which they were cared for in communities, possibly prefiguring later models of community care.

Criminal insanity in 19th-century Ireland, Europe and the United States: cases, contexts and controversies

The insanity defence has a lengthy, complex history. This article provides a concise, comparative background to the evolution of criminal insanity legislation and institutions for the mentally ill in the nineteenth century, with particular reference to Ireland and the United States. Three key themes are identified and explored: (a) the emergence of the insanity defence in the nineteenth century (e.g. the McNaughtan Rules); (b) conditions in nineteenth-century asylums and institutions for the 'criminally insane' (with particular reference to overcrowding, physical illness and asylum deaths); and (c) nineteenth-century considerations of criminal responsibility in women with mental illness (with particular reference to medical and judicial views of the relevance of menstruation, pregnancy and child-birth). These themes are explored through review of historical literature (with particular reference to the work of Dr. Isaac Ray, founding father of forensic psychiatry in the United States) and examination of previously unpublished archival material from the Central Criminal Lunatic Asylum, Dublin.

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

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.