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17
The general death-rate, therefore, among mental patients is about three times
the normal so that when the phthisis deaths are stated as a percentage of the deaths
from all causes the proportion of phthisis deaths among male mental patients is
lower than would be expected from the normal relation, while among females it is
more than twice as great. The percentages for 1925-7 are as follows:—
Sex.
Actual.
Expected.
Male 5.9 per cent. 7.6 per cent.
Female 7.3 „ 3.1 „
Viewed therefore in the light of the deaths from all causes, the phthisis deaths
among male mental patients is found to be lower than the normal, but the female
deaths are in marked excess.
Closer examination of the data, available in greater detail for the four years
1911-14, shows that this conspicuous difference in relative sex incidence of phthisis
mortality is largely, though not entirely, eliminated when deaths from general
paralysis of the insane are omitted from both the County and the mental hospitals
deaths. Deaths from this cause form, of course, an overwhelmingly greater proportion
of the total deaths in mental cases than in the general population, and they
are also about six times as frequent among males as among females.
The effect of excluding deaths from general paralysis of the insane will appear
from the following figures, which show that the phthisis deaths as a percentage of
deaths from all causes in the period 1911-14 (i) including and (ii) excluding general
paralysis :
Sex.
(i.) Including general
paralysis.
(ii.) Excluding general
paralysis.
London.
Mental Hospitals.
London.
Mental Hospitals.
Males 15.9 per cent. 10.2 per cent. 16.1 per cent. 15.2 per cent.
Females 9.7 „ 11.2 „ 9.8 „ 12.2 „
The exclusion of general paralysis brings the percentages for the mental patients
into fairly close approximation to those for London as a whole, the male percentage
now being in excess of the female.
General
observations
It will be evident from what has been said that mere correction for differences
in age and sex distribution does not render the rates for the mental hospitals population
comparable with the normal. General paralysis is probably only one of a
number of factors causing the divergence of the proportional sex-incidence shown,
and certainly there are among female patients a not inconsiderable number whose
mental condition is associated with some functions of sex, for which there is no
equivalent among males.
Upon the general question of phthisis mortality in mental hospitals, it may be
observed that experience shows that where no marked differences in administration
are in question, the phthisis mortality of an institution is mainly governed by the
phthisis mortality of the area from, which the patients are drawn. The phthisis
mortality of the Council's institutions, in which there is a high percentage of paying
patients—i.e., patients of higher social class—appears to be lower than the
average.
An examination of some of the death certificates of mental patients shows
that the date of onset of phthisis is uncertain in a considerable proportion of the
cases. In the early detection of pulmonary tuberculosis, much help can be obtained
from the intelligent co-operation of the patient, a help which is not forthcoming
in some of the mental cases, with the result that on the average the stage of the disease
at detection may not be as early as in the normal case and this is an important