The comparative history of forensic psychiatry may help unravel relations between legal and administrative procedure, medical knowledge and expertise, and social interests, as they determine judgements about the criminal responsibility of the mentally disordered. But little has been done to compare the past or the present under different jurisdictions. This paper, therefore, suggests some points which would encourage such comparisons, and particularly a comparison between France and England in the nineteenth century, for both of which countries there is now a valuable historical literature. It also illustrates the complex interaction of procedure and medical expertise by reference to the case of George Victor Townley (1863).

The case histories of the patients newly admitted to the Retreat Asylum in York between 1880–1884 were examined. Most patients were aged under 50 years, single and non-Quaker, and a majority satisfied the Research Diagnostic Criteria for a diagnosis of schizophrenia or affective disorder. It was found that 72·9% of the patients were deluded, the most common delusions being of persecution, grandeur and guilt; in 34·9% of the deluded patients, the delusion had a religious content. Suicidal ideation was recorded in the case records of 31·4% of the patients. Drug therapy was commonly prescribed, a history of assault on other patients or asylum staff was recorded in 38·1% of the patients, and 11% of patients were force fed at some stage during their illness. Within a year of admission 49·1% of the patients were discharged, the prognosis being better for patients with an affective illness than for schizophrenia, but 31·4% remained in the asylum for five or more years.

The characteristics, alleged causes of mental illness, and treatment and outcome of the Retreat patients were compared with those of patients admitted during the same period to the two other York asylums which served different socio-economic groups of the population. Mortality rates were higher in the asylum admitting mainly pauper patients, and possible reasons for this are explored.

In June 1637 William Harvey petitioned the Court of Wards and Liveries, a legal incompetency court in early modern England, for a grant of the custody of his mentally disabled nephew, William Fowke. ‘Idiocy’ and ‘lunacy’ were the two medico-legal categories for insanity used by the Court and Harvey requested that his nephew be inspected for idiocy. However, the legal and administrative history of the Court indicates that in the 1630s idiocy (but not lunacy) grants were prejudicial to the assets and economic security of retarded persons. Since petitioners' wishes, more than clinical status, usually determined the diagnostic label assigned to referred individuals, idiocy grants were not sought by persons of some social standing. Harvey's idiocy referral probably reflects his allegiance to his own clinical observations in the face of opposing social norms and family advantage.

An English translation of Marcé's original description of anorexia nervosa is reproduced with a brief comment on the author and his work.

The relationship between schizophrenia and ‘mental handicap’* has been obscured by historical changes and varying diagnostic criteria. It has been generally accepted that there is an increased incidence of psychotic illness among people with intellectual retardation, but detailed community surveys are limited. Catatonia, severity of illness and research potential are all to be found in this ‘dual diagnosis’ group. The value of an historical analysis is underlined.

Twenty-six elderly (> 60 yrs) patients with DSM-III major depression were compared to 13 patients with NINCDS/ADRDA probable Alzheimer's disease (AD), and to 31 screened normal controls. Subjects were matched on age and sex. Fifteen of the 26 depressed patients were cognitively impaired on the Mini-Mental State Examination (MMSE) upon admission, but after treatment returned to the normal range. These 15 patients were defined as having the dementia syndrome of depression (DOD). The remaining 11 depressed patients were termed depressed, cognitively normal (DCN). All subjects received standardized cranial CT scans for assessment of ventricular brain ratio (VBR) and CT attenuation numbers. Subjects also received neuropsychological evaluation.

CT values for the 26 depressed patients lay between those of AD patients and normal controls. CT values for the DOD subgroup clustered near those of AD patients. Patterns of cognitive deficits and correlations of CT attenuation values with cognitive measures were also similar in AD and DOD. Most patients were reassessed at a mean of two years after initial testing; of the 11 of the 15 DOD re-examined, only one had undergone cognitive decline. By contrast, all AD patients retested had declined significantly. Episodes of DOD and DCN tended to ‘breed true’. This study suggests that while patients with DOD may have underlying structural brain abnormalities, obvious short-term progression to AD does not commonly occur.

Clinical analyses of 19th century psychiatric practice have been limited by the paucity of available records. Using the richly detailed casebooks of Ticehurst House Asylum, it was possible to study over 600 admissions and assess them using the Research Diagnostic Criteria. Over 80% of cases conformed to recognizable psychiatric illness, mainly schizophrenia and manicdepressive psychosis. Movement disorder, often equivalent to tardive dyskinesia, was noted in nearly one-third of schizophrenics. Violence, masturbation and severe psychopathology were also common features. The implications of these findings in terms of treatment, diagnosis and the rise of the asylum are discussed.

Leading articles or textbooks on anorexia nervosa generally give credit for its discovery to either the British physician William Withey Gull or to the French neuropsychiatrist Ernest Charles Lasègue. Although the major contributions of both men show a remarkable but independent coincidence around 1873, Gull is mostly given a slight priority because of a rather cryptic mention of an anorexia-like condition in a paper read in 1868. An analysis of the events, however, shows that the British physician from London does not really deserve this honour. For no clear-cut priority for either man can be established.