title: Distancing the mad: Jarvis's Law and the spatial distribution of admissions to the Hamilton Lunatic Asylum in Canada, 1876-1902.
abstract: The institutional confinement of the 'insane' in the nineteenth century constitutes one of the most controversial events in the social history of medicine. Within this scholarship there has emerged an important debate over the spatial determinants of institutionalization. Some studies uphold an historical postulate--Jarvis's Law--that contends there was a 'distance decay' effect in mental hospital utilization--that is, an inverse correlation between the distance from a medical institution and the likelihood of people to use its resources. Other scholars have challenged or modified this thesis, arguing that factors such as the local politics, urban living, or socio-economic status were more important determinants of institutional confinement. This article contributes to this ongoing debate by analysing over 4000 admissions to the Ontario Provincial Asylum in the city of Hamilton, Canada, between 1876 and 1902. The results confirm Jarvis' Law was applicable to the Hamilton context: there was an inverse statistical relationship between physical distance from the asylum and the likelihood of admission. However, this paper yields three additional dimensions to the literature: (1) it demonstrates that jails were much more likely to be utilized as temporary places of confinement for communities far from provincial mental hospitals; (2) the length of stay in the asylum was positively correlated with the distance travelled to the institution; and (3) an inverse relationship was found when correlating distance from the asylum and the likelihood of being readmitted to the same institution. These findings suggest an impact of 'distance' beyond the dimension of hospital utilization and imply that the broader asylum experience could be affected by the previous location of patients.
authors.affiliation: McMaster University, Hamilton, Ontario, Canada. chris.smith@mcmaster.ca
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Wright
authors.forename: Shawn
authors.initials: S
authors.lastname: Day
mesh_terms: D002391:Catchment Area, Health; D019992:Databases as Topic; D005260:Female; D049672:History, 19th Century; D049673:History, 20th Century; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D009864:Ontario; D010343:Patient Admission / Q000639:trends*; D012934:Social Isolation