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Stories from psychiatry’s past: ‘between danger and disease’

April 19, 2013
Richard Bright's first case of Bright's disease

Richard Bright’s first case of Bright’s disease

Research is gradually uncovering the intracacies of the relationship between our bodies and our brains, and it is clear that the former has more sway over our minds and mental state than is commonly acknowledged. But in the nineteenth century there were some strong and startingly ideas about the effects of bodies and bacteria on the brain. Jen Wallis reveals more. 

In 1874, doctor Samuel Wilks described a trial that took place after a man, on his deathbed, made a will in favour of his wife, ‘a person beneath him in station, and to whom it was not known at the time that he was married’:

‘In an attempt to set aside the will, a post-mortem was made, in the description of which a hesitating opinion was given as to the healthiness of the kidneys; whereat the solicitor in the action gathered information relative to the existence of cerebral disturbance in connection with the diseases of these organs, and on which he tried to found an argument as to the soundness of the testator’s mind.’

What was being suggested here was that the failure of the kidneys could lead to an accumulation of waste products in the blood, causing mental disturbance. Mental symptoms were sometimes associated with Bright’s disease (a historical term referring to inflammatory kidney conditions), which the man had apparently suffered from. Called in to give his opinion, Wilks said that the symptoms of the man were not in line with such poisoning (common signs were ‘stupor, unconsciousness, or coma’ – not leaving property to one’s wife). He did concede though, that in such cases ‘certain aberrations of mind [were] occasionally found’.

Wilks’s testimony – that toxins in the body could cause mental disturbance – was not unusual. Other doctors had identified lead poisoning, pellagra, gout, and – most commonly – alcoholism as possible causes of insanity.

Turn-of-the-century auto-intoxication theory elaborated this idea of bacteria entering the bloodstream and affecting internal organs including the brain. The typical auto-intoxication theory, described by Richard Noll in ‘Kraepelin’s ‘Lost Biological Psychiatry’?’, identified the intestines as the centre of the infective process, but later evolved to focus on the teeth and tonsils as sites of ‘focal sepsis’ (leading to some startling surgical interventions, as related in Andrew Scull’s Madhouse).

By the early twentieth century, a whole host of bodily products were coming under closer scrutiny as microscopical analysis became easier. Edwin Goodall at Cardiff Asylum investigated the urine of patients for micro-organisms and declared that a large number of samples contained significant levels of bacteria. Together with his colleague E. Barton White, Goodall also examined the faeces of general paralytic (neurosyphilitic) patients, and found that ‘the number of total organisms per gramme of faeces … was above the average normal figure in a large proportion of [the] cases’. It was almost as if the body of the asylum patient had a natural affinity for germs.

The idea that an individual might have a heightened sensitivity to toxic influences paralleled the notion of predisposition – the idea that, in a person who already had some hereditary ‘weakness’, all that was needed was a catalyst to trigger insanity. As medical historian Charles Rosenberg has noted of the early nineteenth century,  ‘both learned physicians and the common man saw disease as the sum of one’s transactions with the environment … Hereditary constitutional endowment was one given, the peculiar pattern of life through which that original endowment passed, another’.

The predisposition model didn’t disappear at the end of the century in light of advancing bacteriological knowledge, however. Instead, the idea of innate susceptibility to mental disease was frequently co-opted into new frameworks that offered a more detailed explanation of the causes of mental disease.. Andrew Mendelsohn in ‘Medicine and the Making of Bodily Inequality in Twentieth-Century Europe’ describes how, though we may be inclined to draw a clear line between the late nineteenth and early twentieth century, ‘a continuous structure’ existed of ‘the predisposed body, the body between danger and disease’.

In the asylum, of course, this body might be positioned especially precariously. The bacteria found in Goodall and White’s patients could be linked to their mental state, but it could equally be attributed to the asylum environment: with large numbers of people living together in often outdated buildings, the asylum was an ideal breeding ground for germs.

Today, infection may still be implicated in mental disturbance, particularly amongst elderly patients. Though it remains difficult to pinpoint infection as the primary factor in a person’s mental state, a 1997 study of the causes of delirium in 171 elderly patients attributed 73 cases to infection, a large proportion of which was accounted for by urinary infection. We now know that, contrary to the earlier belief that toxins set in motion an irreversible decline into insanity, in these cases delirium is ordinarily a temporary state. But, whilst we are less likely to cite excess urine, gout, or alcohol as specific causes of insanity today, they do continue to feature in our modern understandings of the complex interplay of biological, social, and environmental factors which may give rise to mental illness. 

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