139
Art. XI.?LUNACY IN SCOTLAND. The Eighteenth Annual Report of the General Board of Commissioners in Lunacy for Scotland, addressed to the Right Honourable Richard A. Cross, Her Majesty's Principal Secretary of State for the Home Department, has been duly presented to both Houses of Parliament, by command of Her Majesty, and thereafter published for the information of anyone inIt terested in the management and disposal of the insane. is, however, probably only by those to whom this Report was originally presented, or by persons accustomed to the perusal of Parliamentary returns, that this document, with the elaborate statistics which characterise it, will be fully appreciated. To the general reader the subject will appear dry and uninviting, and the tables bewildering; while to the medical reader ,it will be found deficient in many of those medical and scientific elements which might naturally be expected to present themselves, when it is kept in mind that the subject treated of is in reality a disease or morbid state. Nevertheless, the Report contains much and valuable information on the subject of the provision made for the treatment and management of the insane in Scotland, and an interesting summary of the most important changes which have taken place amongst this portion of the community during the year 1874. In plan and general outline, the present Report resembles those already given to the public. The number and distribution of the insane, their proportion to the population, and the relations of the population and pauperism in general to the existing amount of pauper lunacy, are first considered; the changes which have taken place in the population of the asylums, of the lunatic wards of poorhouses, and of private dwellings collectively, are next referred to: then follow a statistical account of the progressive history of patients placed in these establishments; a short notice of the escapes which have been made from them; a similar notice of the changes among the attendants; a full and detailed record of the accidents which have occurred in the different public institutions; a short summary of the results of treatment in each asylum, and of the condition of each asylum individually; and an account of the changes which have taken place among, and the condition of, patients boarded out in private dwellings; of the provisions made for the treatment and disposal of the insane in the
140
LUNACY IN
SCOTLAND.
various districts; of the expenditure for pauper lunatics during the year; of the number of dangerous lunatics sent to asylums at the instance of the Procurator Fiscal, and of the number of alien lunatics removed from Scotland. The Report closes with a few observations on the subject of lunatics mider judicial factors, and of the pressing necessity there* exists for some economical and effective procedure for the administration of their funds. The total number of the insane in Scotland, known to the Board, on January 1, 1875, amounted to 8,225. Of these we learn that 1,476 were maintained from private sources, 6,700 by parochial rates, and 49 by the State; the last being the criminal lunatics detained in the General Prison at Perth. Of the 1,476 private patients, 104 were imbeciles, inmates of various training schools or asylums for idiots; while of the 6,700 pauper patients, only 39 belong to this class. 8,003 of the above patients were disposed of as follows:?5,002 were registered in chartered and district asylums, 1,333 in parochial asylums and in the lunatic wards of poorhouses, and 1,472 in private dwellings. The total increase in the number of known lunatics during the year amounted to 156, and the changes in the population of the different establishments consisted in an increase of 285 patients in chartered and district asylums, a decrease of 112 in private asylums, and an increase of 20 in parochial asylums and lunatic wards of poorhouses. There was also a falling off in the number of patients residing in private dwellings to the extent of 45 in all. Whether this increase in the number of statutory lunatics represents an increased proportion of the insane to the sane part of the general community is a question for and against which many arguments might be advanced. If there be such an increase at all, it is certainly much less than these returns would indiTaken collectively, the apparent increase in the number cate. of the insane since the appointment of the Board of Lunacy is no doubt large, amounting as it does to 2,402 patients; but the increase during the year under consideration, namely 156, cannot be regarded with special apprehension, as it has been repeatedly exceeded in previous years, notably in 1868, 1869, 1870, and 1871, when the corresponding numbers were 167, do not con255, 261, and 158. The Commissioners themselves " sider these facts as necessarily indicating any greater production of insanity in the country. It is possible," they say, " that they only express what might be looked for as the result (1) of the increased facilities of obtaining gratuitous treatment and maintenance in asylums; (2) of the diminished dislike to resort to the treatment of insane persons in asylums; (3) of
141
LUNACY IN SCOTLAND.
the increased readiness to adopt the more costly forms of treatment, in consequence (a) of the greater wealth of the country, which affects the admissions both of private and pauper patients, and (b) of the relief to local taxation from imperial sources, which affects only the admission of paupers; (4) of the altered medical and public opinion as to what constitutes lunacy, especially as to what constitutes that degree or kind of Lunacy which can be certified as rendering the subject of it a fit and proper and treatment in an asylum." person to be placed under care It would be of considerable importance if it could be ascertained how far any increase in the admission of pauper patients into asylums was the result of the Government grant; but although the Board consider that this has to some extent already had effect, they cannot speak with any certainty of its extent. It is more probable that the increase, as yet, results from the same causes which have been in operation since 1862, namely, the greater facilities afforded for the transmission of both private and pauper patients to asylums by the Act of Parliament passed in that year. A much more important and instructive fact revealed by the above statistics is the decrease in the number of patients resident in private dwellings. In the year 1858, 1,784 pauper lunatics were disposed of in this manner. Since that time, with the exception of the year 1872, when there was an increase of 29 over the previous year, a steady annual decrease has been taking place, until the number now amounts to only 1,387. Considering the favour with which this mode of providing for the insane poor has for years been regarded by the Scotch Lunacy Commissioners, and which has so frequently been lauded as the peculiar feature of Scotch lunacy administration, this result must be considered as particularly discouraging, and all the more so when it is remembered that it is only by increasing the facilities in this direction for the disposal of the insane, that any hopes can be entertained of ultimately dispensing with the system of congregating lunatics in establishments, or even of materially lessening the number so congregated; an arrangement which this Board consider so unnatural, and, to judge from occasional remarks in their reports, view with no little distrust. Dr. Mitchell, now one of the Commissioners in Lunacy, in his work on "The Insane in Private Dwellings," published in 1864, " very properly observes that, from the very nature of asylum populations (when we remember that their increase is due to a steady accumulation of old cases), we may safely draw the inference that there must be included in them a certain proportion of incurable lunatics who do not absolutely require asylum care or treatment, and who could otherwise be provided for at less cost, >
142
LUNACY IN SCOTLAND.
and with no loss of comfort. The number of these ought to be kept down as much as possible, and there ought to be good and How, then, strong grounds for their prolonged detention. are we to dispose of this accumulation of chronic and manageable cases ? The answer I give to this," says Dr. Mitchell, is that, in a transference to private houses, under proper regulation and supervision, one excellent outlet for the accumulation may be found." Why, then, has this means of relief, so strongly recommended, borne so little fruit ? In the Report before us no explanation is given, although this is a question which might not be .
.
.
.
.
.
"
difficult to answer. Indeed, the zeal of the Board themselves the subject would appear to be rapidly abating ; for it must be admitted that but very meagre praise is accorded to the system, when they now say, in referring to the moderate death rate in patients so situated?namely 6*5 per cent, of the average number on their registers: "We accept this fact as evidence that the circumstances in which pauper patients in private dwellings are placed are not adverse to health, and that they include some influences which prove more than a compensation for the loss of orderliness, discipline, and better food which are secured We are not to be understood, however, as in establishments. holding that the condition of the pauper insane in private dwellings is in every respect satisfactory. That would be true neither of them nor of patients in asylums. But we believe that the condition of the vast majority of them is probably more satisfactory than that of patients in private dwellings in other any country." The information given in Table V. shows the development of pauper lunacy under another unfavourable aspect; for it is there stated that while the proportion of registered paupers to the general population has, on the whole, steadily decreased from 2,555, the proportion per 100,000 in the year 1861 to 1,958 in 1875, the corresponding proportion of pauper lunatics has annually increased from 171 to 191 during the same period; " a large decrease in the or, in other words, while there has been proportion of ordinary paupers to the population, a large increase has taken place in the proportion of lunatic paupers." The changes which have occurred in the population of establishments?under which term are included all chartered, district, and parochial asylums, the lunatic wards of poorhouses, training schools for imbecile children, and the Lunatic Department of the General Prison at Perth?have been the admission of 2,191 new cases, the discharge of 974 patients recovered, 490 of the new of 397 not recovered, and the death of 561. cases sent to these establishments were private cases, and 1,701 pauper lunatics. These numbers show a marked increase over on
LUNACY IN
SCOTLAND.
143
years, and may be accepted as indicating an on the part of those responsible for the the insane in this manner, in these institutions. of disposal The average rate of recovery would appear to be highest in parochial asylums?a circumstance which the Commissioners are inclined to attribute to the admission into these institutions of a large proportion of what they call ephemeral forms of insanity. The average annual mortality, however, would also appear to be greatest in parochial asylums, amounting to 10*2 per cent, on the number resident, as the average of ten years ending 1875; while the corresponding figures for private asylums are 9*5, for public and district asylums 8*5, and for lunatic wards of poorhouses 7*9. It is evident, however, that the condition and character of the patients in these establishments must vary so much, socially, physically, and mentally, as to render the above calculations unreliable as factors of any practical value. The chapter of accidents is a formidable one, and the record of them has evidently been drawn up with care?perhaps many will think with even unnecessary minuteness and detail, since it will be found to include a list not only of the more serious cases wherein the injuries have terminated fatally, but also of those slight bruises the result of sudden falls during epileptic fits. Of the former 19 cases are recorded. " In 34 instances " the accidents " were attended with broken bones, in 16 of these one or more ribs being fractured. In six instances they involved dislocation of the shoulder or of some other joint. Six of the fatal accidents were suicides. Four deaths occurred either from accidents before admission or from accidents occurring in previous years." Much as such occurrences are to be regretted, whether they happen in asylums or out of them, few, it is believed, who have paid any attention to the subject, will be found to agree with all the inferences the Commissioners seek In the present Report it is said: " A to deduce from them. statement of this kind shows that great difficulties and responsibilities attend the management of asylums; and that patients are not entirely secured from risk of accident and injury when they are placed in asylums. It is even possible that this risk may be increased by the congregating of lunatics in establishments?a system which is not natural, and which is chiefly recommended by convenience and economy, which, indeed, are the main recommendations of all hospital treatment." The idea which it is sought here to impress on the public mind is even more clearly put in former Reports, for it is not unworthy of remark that the above paragraph has been copied almost verbatim et literatim into every one of the Annual Reports for the last six years. In the 13th, 14th, 15th, and 16th Reports
those of
previous
increasing confidence,
LUNACY IN SCOTLAND.
144
additional observations will be found repeated in fashion: " Fatal or serious attacks by lunatics out of do occur they asylums are comparatively rare; but when they and a attract legitimate demand is at once public attention, raised for the protection of the public by the removal of the offenders to asylums. But fatal or serious attacks in asylums The attract comparatively little attention from the public fact of their frequent occurrence, however, remains; and the were unavoidable or were the result of question how far they the circumstances in which the patients were, perhaps unneceswhich is worthy of careful study! It would sarily, placed, is one that everyone who is responsible for the disposal of the be well not only to what risks they may be insane should consider of asylums, but also to what risks they may out J be exposed establishments." such in subjected Had these remarks been merely an expression of the crude theories of some unpractical enthusiast they might have been of notice; but when they are brought passed by as unworthy and authority of official statements the all with weight forward and are repeated, without change or variation, year after for their careful examiand in Report after Report, the necessity One must be apparent to everyone. consideration and nation however, need not detain us long; for that the of subject, part " fatal or serious attacks by lunatics out of asylums are compa"fatal or serious attacks in asylums ratively rare," or that attention from the public" are little attract comparatively to what must be the experience so opposed thoroughly statements literature of the present time that of all who peruse the current further comment. In fact it may be this point really needs no but that sensational accounts of a passes day said that scarcely and fatal attacks by persons serious of and accidents in asylums, in been have asylums, will be found prowho evidently should the columns of our daily newspapers. in minently reported be condensed into two The subject for consideration may the Scotch Lunacy Board, of the in opinion points. First, are occupying an unnatural lunatics, resident in lunatic asylums, of lunatics in such in consequence position; and secondly, are so numerous, that being are accidents establishments, maintenance of the insane, should think the for responsible these dangers. Had the Board well before exposing them to some better arrangement for recommend to been in a position of the more dangerous the disposal of the insane, and especially some excuse might have been in portion of them, than asylums, as is embodied here found for the expression of such an opinion The dispersion even hinted at. is but no such improved system cannot be dwellings evidently in lunatics of dangerous private
the the
following' same
year'
tliose?who
?
LUNACY
IN
145
SCOTLAND.
entertained, as the application of this plan to the wants of even harmless imbeciles and idiots has, as already noticed, proved, if not a failure, at least been found to come far short of what, at The truth is, the fact would one time, was expected from it. seem tc have been overlooked by the Commissioners that the original intention, and even now the primary object, sought, in sending the insane to asylums is not their treatment, but that they may be isolated from society for their own and the public safety. The treatment of the insane in asylums has always been, and still is, altogether a secondary consideration. How far this is to be regretted, or how it is to be remedied, are, howIt ever, questions beyond the scope of the present remarks. would be just as reasonable to argue that a prisoner is in an unnatural position in a prison, as to say that a lunatic is unnaturally situated in an institution specially provided with everything that can conduce to his care and comfort, as well as to the amelioration of his position while there. Indeed ever since the sentence was pronounced on the leper that " without the camp shall his habitation be," in all ages of civilisation, and in all states of society, the necessity of setting apart certain individuals for their own sake and the general weal, has been acknowledged and acted upon; and what was found necessary for the leper and slayer of old, experience has shown to be equally necessary for the vicious portion of society and for the dangerous insane of the present day. Whatever views the Scotch Lunacy Board may therefore entertain, the majority of the public will still, it is believed, conclude that a lunatic in an asylum is in a more natural position than he would be at large, probably endangering his own life and the lives of those around him, and will not be acting far wrong in continuing to send the insane to these establishments, until, at least, as some would fondly hope, mankind shall reach perfection, or, to use the amended language of a former Scotch Lunacy Report (slightly " of the Education until the state the Act), to suit present of the people, which is in process of instruction compulsory the way for a reform in the being accomplished, shall prepare mode and scope of education, and when scholastic teaching, by of the laws which including moral training and a knowledge shall mental and health, prove a real saferegulate the bodily and insanity ; a grand and glorious crime both guard against but we should think little to prospect for humanity in general, be desired by commissioners in lunacy. An analysis of the facts published by this Board will show also on what slight grounds their second inference is based. Of the 19 fatal cases, six were suicides, in whose case the fatal result can by no system of reasoning be ascribed to their PART I.
VOL. Ill?NEW SERIES.
K
146
LUNACY IN SCOTLAND.
residence in asylums; and of the remaining 13 cases terminating in death, one died of "asphyxia during the act of vomiting"; " one from haemorrhage and heart disease, brought on by " being pushed over by another patient"; two from suffocation face the the during by turning upon night" (one, and very " supposed probably both, being epileptic); one from burning, to have been caused accidentallyand one from " a fractured rib, supposed to have been caused by a fall out of bed"; all being accidents which might occur anywhere. Seven cases, therefore, can only be fairly credited to asylum influence, and of these two were from "fracture of ribs, causes unknown," two from "injuries inflicted by other patients," one "from a fall while trying to escape from attendant," and two from injuries received in struggling with attendants. Of 170 minor cases, 45 were the result of quarrels arising between patients, the majority of them being of a slight nature; 13 resulted from attendants endeavouring to control violent patients; and in nine instances were injuries inflicted by patients on their attendants ; 102 were of a nature that might have occurred although no establishments had been in existence, for it would be difficult for an ordinary mind to discover any relationship of the nature of cause and effect as existing between such places and accidents of the following character:?"Prostration from eating the buds and leaves of a yew tree," "injury caused " by the fall of a large stone," precipitation from a viaduct," " insensibility from swallowing an overdose of chloral," " slight accident from being knocked down by a cab," injuries caused " " by the fall of a heavy weight from a height," by the fall of roof plaster," etc. etc., to say nothing of the many unavoidable bruises and injuries to which epileptics are liable, from the nature of their malady, and not from that of the situation in which they may be placed. A much more satisfactory explanation of asylum accidents of the present day will be found in the greater freedom now everywhere allowed to the patients, and which is, in fact, but an illustration of the law that the increased benefit of the majority can only be obtained at the expense of the few. Repugnant as the system of restraint now appears to the minds of the present generation, this at least can be said in its favour, that many of the accidents now recorded in the Lunacy Reports could not, while it existed, possibly have occurred ; and many instances might be given of the relief afforded, not only to the minds of their guardians, but also to the feelings of the patients themselves, when by means of the camisole, or muff, they were rendered physically incapable of doing harm. In connection with this subject, one naturally examines the Report to see how it fares with patients
LUNACY IN SCOTLAND.
147
in the private dwellings; but the search proves in vain, for, however carefully the accidents in establishments are recorded, no list of those occurring in private dwellings would seem to be kept by the Board; at least none is laid before the public. The condensed summaries as to the state of the establishments give information on two things?their actual condition at the time of inspection, and the opinion of the Commissioners as to the best means to be adopted for their further improveThe space at our disposal will not allow us to refer to ment. each institution individually, but it will be sufficient to view All the reports indicate a steady improvethem collectively. ment in the direction of rendering these institutions less prison like, and of endeavouring to bring them as nearly as possible to the aspect of places of private residence; and the recommendations of the Commissioners appear judicious and worthy of every support, consisting as they do in suggestions for increasing the amount of land attached to some asylums, for remodelling the older portions of buildings in others, and generally for increasing those comforts and other home-like provisions which experience has shown to exercise so beneficial an influence on the insane, and not to be without effect on even the most clouded and impaired intellect. With few exceptions, all the asylums were found either crowded or fully occupied, but the general results for the year must, notwithstanding, be considered satisfactory, in so far as the average percentage of recoveries, calculated on the admissions, was found to be 34*1 for males, and 43-2 for females, while the percentage of deaths on the average numbers resident was 9*6 for males, and 6*6 for females. The average daily rate of maintenance for pauper lunatics in the different establishments is stated to be Is. 5\d. in royal, district, private, and parochial asylums, Is. 1 \d. in licensed wards of poorhouses, and 8d. in private dwellings. The rate in the royal, or chartered, asylums, charged for pauper patients varies greatly, being lowest in Dumfries?namely, 221, per annum and highest in Glasgow Eoyal Asylum, where the rates are 321. 14s. 4d. 351. 19s. 4d., and 381. 1 Is. 4d., the last-mentioned rate being charged against parishes sending only their worst In district asylums the rates charged for cases to that asylum. district paupers ranges from 221. 16s. 3d. in Banff, to 291. in Perth District Asylum; and for non-district paupers in Eoxthe rate for burgh it is as high as 361. In parochial asylums non-district patients varies from 22l. 2s. in Glasgow, to 291. 18s. in Abbey Parochial Asylum, and in the lunatic wards of poorhouses from 18I. 4s. in Wigton, to 231. 8s. in Liff and Benvie, and in Dumbarton poorhouses. The minimum rate for private 1C
2
148
LUNACY IN SCOTLAND.
patients in chartered and district asylums also varies much, being 231. 8s. in Argyll and Bute District Asylum (a rate, however, confined to private patients belonging to these districts), and 50l. in Murray's Eoyal Asylum, Perth. At the end of the year 1875, 286 persons were reported to the Board as under judicial factory, in consequence of "
mental unfitness for the management of their affairs," and were located as follows:?179 were in asylums in Scotland, 98 in private dwellings, and nine beyond the jurisdiction of the Board. The Commissioners' suggestion, in connection with these patients, " that in cases where the funds do not exceed 1,000^., the authority to appoint a curator, at present possessed exclusively by the Court of Session, should be extended to the sheriff," is one that cannot be too strongly endorsed, as such appointments would thereby be greatly facilitated, and the expenses, which at present in many instances prove a very heavy tax, would be considerably lessened. The appendices of this, as of former Reports, contain carefully prepared, extensive, and"minute information in regard to what the Board happily term the movement," and the expense of the maintenance of the insane poor, in every parish in Scotland, and also copies of all entries made by the Commissioners in the registers of the different asylums. These will, no doubt, of reference, but need not be prove invaluable for purposes farther referred to at present. Appendix F, however, tempts us to make a few remarks, as it contains the reports of the Deputy Commissioners. Dr. Paterson's report consists of three lines of printed matter, and a table showing that he had visited and reported on 597 patients in private dwellings, of whom 80 were private cases, and 517 were paupers. Of these, 146 were in special licensed houses. Dr. Paterson's patients were scattered over 14 counties. Dr. Sibbald's report is of a similar nature, and indicates that he visited 630 patients, of whom 44 were private situated in 19 counties. Dr. patients, and 586 paupers, " several patients within the district Sibbald also adds that usually visited by him have been left unvisited this year, owing to the time occupied in special enquiries which were ordered by the Boardbut " the cases in which no visits have been paid do not include such as afforded reason to doubt the satisfactoriness of the care and treatment bestowed on the patients." No one will doubt the attention bestowed by these gentlemen on their work, and the assiduity with which it is performed, nor will there be any general inclination to grudge them their salaries; but from a consideration of these reports and of the nature of the duties imposed upon the Deputy Commissioners, the question Le jeu, vaut-il la chandelle ? will at once present itself to the mind of
LUNACY IN
SCOTLAND.
149
anyone who considers this subject in an unbiassed manner. According to the estimates of the Civil Services for the year endingMarch 31, 1877, the salary of each Deputy Commissioner is given at 600/., and the travelling expenses of all the Commissioners at 900L, so that at the lowest possible estimate this would give considerably more than 21s. per visit per pauper as The official influence the expense incurred in this department. of an annual visit, and in some instances it would seem of one visit only in two years, must be small; but if this really be sufficient^ might not equally satisfactory results at less expense be secured, by arranging for the inspection of this portion of the insane by competent local authorities ? On the whole, one does not rise from a perusal of the Scotch Lunacy Blue Books with a feeling of entire satisfaction. As has been already said, much valuable matter is contained and given to the public in the carefully arranged and elaborated tables, but in the reports themselves there is often exhibited from year to year a painful and unnecessary repetition of the same facts, arguments, and ideas. This has been noticed in the observations on accidents, but the same thing considering occurs elsewhere. Thus, in referring to the admission of patients into asylums, we find this remark: " It is too apt to be forgotten that the statutory lunacy of a country is far from being a thing which ' human power cannot multiply and modify.' In our ' Fifteenth Report (p. 285) we pointed out that the existence of or required to be lunacy, in so far as it is officially recognised decided at is dealt with by the State, by the certificate present of two medical men : and indeed must always be determined in that or some similar manner. If there be persons who imagine that a uniform standard of mental soundness is accepted by all medical men, or by any one medical man in all circumstances, they must have little experience to guide them. Such certificates of the social as well as are always signed after a consideration the medical circumstances of each case, and it is scarcely open to doubt that in actual practice the source from which the required expenditure is to be obtained is, rightly or wrongly, a Of course no one common element in this consideration.' is not that it appears for matter the will deny this, and surprise in the Fifteenth, but that it did not appear in the Fifth Report. But is this a subject of so much importance that it should be gravely copied verbatim into the Seventeenth and again into the Eighteenth Reports ? Again, many clauses in these Reports would appear to indicate what may not improperly be called a want of harmony between the Scotch Lunacy Board and those practically engaged in the treatment and management of the insane, if not an actual
150
LUNACY IN SCOTLAND.
want of practical acquaintance with the disease itself. During the last twenty years the increase in our of the physio-
knowledge
of the brain and nervous system and of the principles of mental philosophy has not been slight, nor have investigations into the causes, pathology, and treatment of insanity been barren of results; yet the true scientific aspect of the subject is scarcely ever touched No doubt extensive upon in these returns. researches in this direction are restricted by the statutory clauses regulating the contents of such documents, and by which the duties of the Commissioners are confined chiefly to report" ing upon the condition and management of all public, private, and district asylums and houses in which any lunatic is kept and detained under an order of the sheriff"; but that these restrictions are not considered absolutely binding is seen from the investigations of a statistical nature which from time to time appear, but which do not always lead to very valuable or apReport, general parently reliable results. Thus, in last year's " principles were sought to be established on the influence of the seasons on deaths from diarrhoea," by comparing the mortality from this disease, as it had occuired m all the Scotch asylums during 10 years, with the mean deaths fioin diai rhuea or of 20 in London for five years, and persons above the age the attacks of diarrhoea occuring in one Scotch asylum for eight similar investigations have years; and in the present Report " the deaths from general paralysis of the been instituted on insane." This disease is chosen, we are told, as one " whose occurrence as a cause of death is least likely to be inaccurately recorded;" and yet a glance at the tables will satisfy anyone that they cannot refer to cases of genuine general paralysis of the insane at all?at least, as this disease used to be understood ?but that the returns employed were probably the records of all deaths among the insane occurring in consequence of, or during the progress of, all the many and protean forms of disease to which the human nervous system is liable, in which a more or less general paralytic condition was a prominent symptom during life. This, indeed, is to a certain extent admitted, as well as the insufficient nature of the data obtainable in the cases of private patients ; but, curiously enough, these objections are not considered as calculated to seriously vitiate the results. In such enquiries the Scotch Lunacy Board might benefit by the experience of their English brethren. In the Thirtieth Report " of the English Lunacy Board it is observed: At no time have we considered it our draw to but most plain and the any duty obvious deductions from the figures which the means at our disposal enable us to present; nor can we deem it advisable or justifiable to offer to the public any speculations or theories of
logy
LUNACY
IN
SCOTLAND.
151
At present we do not think our own, based on these statistics. that the recorded experience is sufficiently extensive to warrant many very certain conclusions to be drawn from it; and the official publication of conjectures, founded on confessedly imperfect data, and therefore liable to be falsified by the event, would not, we submit, be attended by any public advantage." Still, the accumulating' facts of physiology and pathology are at their use of these the Commissioners would disposal, and of their volumes not a attractiveness and increase the value of promoters of the to and position occupy little; by striving the scientific investigation and treatment of lunacy, and of the medical and intellectual study of insanity generally, in the different asylums, establishments, and houses under their jurisdiction?a position they might easily attain to, from the official status they already hold?and to be less contented with the attitude of mere domiciliary inspectors, they would soon acquire and be capable of exerting a greater influence over the welfare of the insane than they at present possess.
by"making
Art. XI.?LUNACY IN SCOTLAND. The Eighteenth Annual Report of the General Board of Commissioners in Lunacy for Scotland, addressed to the Right Honourable Richard A. Cross, Her Majesty's Principal Secretary of State for the Home Department, has been duly presented to both Houses of Parliament, by command of Her Majesty, and thereafter published for the information of anyone inIt terested in the management and disposal of the insane. is, however, probably only by those to whom this Report was originally presented, or by persons accustomed to the perusal of Parliamentary returns, that this document, with the elaborate statistics which characterise it, will be fully appreciated. To the general reader the subject will appear dry and uninviting, and the tables bewildering; while to the medical reader ,it will be found deficient in many of those medical and scientific elements which might naturally be expected to present themselves, when it is kept in mind that the subject treated of is in reality a disease or morbid state. Nevertheless, the Report contains much and valuable information on the subject of the provision made for the treatment and management of the insane in Scotland, and an interesting summary of the most important changes which have taken place amongst this portion of the community during the year 1874. In plan and general outline, the present Report resembles those already given to the public. The number and distribution of the insane, their proportion to the population, and the relations of the population and pauperism in general to the existing amount of pauper lunacy, are first considered; the changes which have taken place in the population of the asylums, of the lunatic wards of poorhouses, and of private dwellings collectively, are next referred to: then follow a statistical account of the progressive history of patients placed in these establishments; a short notice of the escapes which have been made from them; a similar notice of the changes among the attendants; a full and detailed record of the accidents which have occurred in the different public institutions; a short summary of the results of treatment in each asylum, and of the condition of each asylum individually; and an account of the changes which have taken place among, and the condition of, patients boarded out in private dwellings; of the provisions made for the treatment and disposal of the insane in the
140
LUNACY IN
SCOTLAND.
various districts; of the expenditure for pauper lunatics during the year; of the number of dangerous lunatics sent to asylums at the instance of the Procurator Fiscal, and of the number of alien lunatics removed from Scotland. The Report closes with a few observations on the subject of lunatics mider judicial factors, and of the pressing necessity there* exists for some economical and effective procedure for the administration of their funds. The total number of the insane in Scotland, known to the Board, on January 1, 1875, amounted to 8,225. Of these we learn that 1,476 were maintained from private sources, 6,700 by parochial rates, and 49 by the State; the last being the criminal lunatics detained in the General Prison at Perth. Of the 1,476 private patients, 104 were imbeciles, inmates of various training schools or asylums for idiots; while of the 6,700 pauper patients, only 39 belong to this class. 8,003 of the above patients were disposed of as follows:?5,002 were registered in chartered and district asylums, 1,333 in parochial asylums and in the lunatic wards of poorhouses, and 1,472 in private dwellings. The total increase in the number of known lunatics during the year amounted to 156, and the changes in the population of the different establishments consisted in an increase of 285 patients in chartered and district asylums, a decrease of 112 in private asylums, and an increase of 20 in parochial asylums and lunatic wards of poorhouses. There was also a falling off in the number of patients residing in private dwellings to the extent of 45 in all. Whether this increase in the number of statutory lunatics represents an increased proportion of the insane to the sane part of the general community is a question for and against which many arguments might be advanced. If there be such an increase at all, it is certainly much less than these returns would indiTaken collectively, the apparent increase in the number cate. of the insane since the appointment of the Board of Lunacy is no doubt large, amounting as it does to 2,402 patients; but the increase during the year under consideration, namely 156, cannot be regarded with special apprehension, as it has been repeatedly exceeded in previous years, notably in 1868, 1869, 1870, and 1871, when the corresponding numbers were 167, do not con255, 261, and 158. The Commissioners themselves " sider these facts as necessarily indicating any greater production of insanity in the country. It is possible," they say, " that they only express what might be looked for as the result (1) of the increased facilities of obtaining gratuitous treatment and maintenance in asylums; (2) of the diminished dislike to resort to the treatment of insane persons in asylums; (3) of
141
LUNACY IN SCOTLAND.
the increased readiness to adopt the more costly forms of treatment, in consequence (a) of the greater wealth of the country, which affects the admissions both of private and pauper patients, and (b) of the relief to local taxation from imperial sources, which affects only the admission of paupers; (4) of the altered medical and public opinion as to what constitutes lunacy, especially as to what constitutes that degree or kind of Lunacy which can be certified as rendering the subject of it a fit and proper and treatment in an asylum." person to be placed under care It would be of considerable importance if it could be ascertained how far any increase in the admission of pauper patients into asylums was the result of the Government grant; but although the Board consider that this has to some extent already had effect, they cannot speak with any certainty of its extent. It is more probable that the increase, as yet, results from the same causes which have been in operation since 1862, namely, the greater facilities afforded for the transmission of both private and pauper patients to asylums by the Act of Parliament passed in that year. A much more important and instructive fact revealed by the above statistics is the decrease in the number of patients resident in private dwellings. In the year 1858, 1,784 pauper lunatics were disposed of in this manner. Since that time, with the exception of the year 1872, when there was an increase of 29 over the previous year, a steady annual decrease has been taking place, until the number now amounts to only 1,387. Considering the favour with which this mode of providing for the insane poor has for years been regarded by the Scotch Lunacy Commissioners, and which has so frequently been lauded as the peculiar feature of Scotch lunacy administration, this result must be considered as particularly discouraging, and all the more so when it is remembered that it is only by increasing the facilities in this direction for the disposal of the insane, that any hopes can be entertained of ultimately dispensing with the system of congregating lunatics in establishments, or even of materially lessening the number so congregated; an arrangement which this Board consider so unnatural, and, to judge from occasional remarks in their reports, view with no little distrust. Dr. Mitchell, now one of the Commissioners in Lunacy, in his work on "The Insane in Private Dwellings," published in 1864, " very properly observes that, from the very nature of asylum populations (when we remember that their increase is due to a steady accumulation of old cases), we may safely draw the inference that there must be included in them a certain proportion of incurable lunatics who do not absolutely require asylum care or treatment, and who could otherwise be provided for at less cost, >
142
LUNACY IN SCOTLAND.
and with no loss of comfort. The number of these ought to be kept down as much as possible, and there ought to be good and How, then, strong grounds for their prolonged detention. are we to dispose of this accumulation of chronic and manageable cases ? The answer I give to this," says Dr. Mitchell, is that, in a transference to private houses, under proper regulation and supervision, one excellent outlet for the accumulation may be found." Why, then, has this means of relief, so strongly recommended, borne so little fruit ? In the Report before us no explanation is given, although this is a question which might not be .
.
.
.
.
.
"
difficult to answer. Indeed, the zeal of the Board themselves the subject would appear to be rapidly abating ; for it must be admitted that but very meagre praise is accorded to the system, when they now say, in referring to the moderate death rate in patients so situated?namely 6*5 per cent, of the average number on their registers: "We accept this fact as evidence that the circumstances in which pauper patients in private dwellings are placed are not adverse to health, and that they include some influences which prove more than a compensation for the loss of orderliness, discipline, and better food which are secured We are not to be understood, however, as in establishments. holding that the condition of the pauper insane in private dwellings is in every respect satisfactory. That would be true neither of them nor of patients in asylums. But we believe that the condition of the vast majority of them is probably more satisfactory than that of patients in private dwellings in other any country." The information given in Table V. shows the development of pauper lunacy under another unfavourable aspect; for it is there stated that while the proportion of registered paupers to the general population has, on the whole, steadily decreased from 2,555, the proportion per 100,000 in the year 1861 to 1,958 in 1875, the corresponding proportion of pauper lunatics has annually increased from 171 to 191 during the same period; " a large decrease in the or, in other words, while there has been proportion of ordinary paupers to the population, a large increase has taken place in the proportion of lunatic paupers." The changes which have occurred in the population of establishments?under which term are included all chartered, district, and parochial asylums, the lunatic wards of poorhouses, training schools for imbecile children, and the Lunatic Department of the General Prison at Perth?have been the admission of 2,191 new cases, the discharge of 974 patients recovered, 490 of the new of 397 not recovered, and the death of 561. cases sent to these establishments were private cases, and 1,701 pauper lunatics. These numbers show a marked increase over on
LUNACY IN
SCOTLAND.
143
years, and may be accepted as indicating an on the part of those responsible for the the insane in this manner, in these institutions. of disposal The average rate of recovery would appear to be highest in parochial asylums?a circumstance which the Commissioners are inclined to attribute to the admission into these institutions of a large proportion of what they call ephemeral forms of insanity. The average annual mortality, however, would also appear to be greatest in parochial asylums, amounting to 10*2 per cent, on the number resident, as the average of ten years ending 1875; while the corresponding figures for private asylums are 9*5, for public and district asylums 8*5, and for lunatic wards of poorhouses 7*9. It is evident, however, that the condition and character of the patients in these establishments must vary so much, socially, physically, and mentally, as to render the above calculations unreliable as factors of any practical value. The chapter of accidents is a formidable one, and the record of them has evidently been drawn up with care?perhaps many will think with even unnecessary minuteness and detail, since it will be found to include a list not only of the more serious cases wherein the injuries have terminated fatally, but also of those slight bruises the result of sudden falls during epileptic fits. Of the former 19 cases are recorded. " In 34 instances " the accidents " were attended with broken bones, in 16 of these one or more ribs being fractured. In six instances they involved dislocation of the shoulder or of some other joint. Six of the fatal accidents were suicides. Four deaths occurred either from accidents before admission or from accidents occurring in previous years." Much as such occurrences are to be regretted, whether they happen in asylums or out of them, few, it is believed, who have paid any attention to the subject, will be found to agree with all the inferences the Commissioners seek In the present Report it is said: " A to deduce from them. statement of this kind shows that great difficulties and responsibilities attend the management of asylums; and that patients are not entirely secured from risk of accident and injury when they are placed in asylums. It is even possible that this risk may be increased by the congregating of lunatics in establishments?a system which is not natural, and which is chiefly recommended by convenience and economy, which, indeed, are the main recommendations of all hospital treatment." The idea which it is sought here to impress on the public mind is even more clearly put in former Reports, for it is not unworthy of remark that the above paragraph has been copied almost verbatim et literatim into every one of the Annual Reports for the last six years. In the 13th, 14th, 15th, and 16th Reports
those of
previous
increasing confidence,
LUNACY IN SCOTLAND.
144
additional observations will be found repeated in fashion: " Fatal or serious attacks by lunatics out of do occur they asylums are comparatively rare; but when they and a attract legitimate demand is at once public attention, raised for the protection of the public by the removal of the offenders to asylums. But fatal or serious attacks in asylums The attract comparatively little attention from the public fact of their frequent occurrence, however, remains; and the were unavoidable or were the result of question how far they the circumstances in which the patients were, perhaps unneceswhich is worthy of careful study! It would sarily, placed, is one that everyone who is responsible for the disposal of the be well not only to what risks they may be insane should consider of asylums, but also to what risks they may out J be exposed establishments." such in subjected Had these remarks been merely an expression of the crude theories of some unpractical enthusiast they might have been of notice; but when they are brought passed by as unworthy and authority of official statements the all with weight forward and are repeated, without change or variation, year after for their careful examiand in Report after Report, the necessity One must be apparent to everyone. consideration and nation however, need not detain us long; for that the of subject, part " fatal or serious attacks by lunatics out of asylums are compa"fatal or serious attacks in asylums ratively rare," or that attention from the public" are little attract comparatively to what must be the experience so opposed thoroughly statements literature of the present time that of all who peruse the current further comment. In fact it may be this point really needs no but that sensational accounts of a passes day said that scarcely and fatal attacks by persons serious of and accidents in asylums, in been have asylums, will be found prowho evidently should the columns of our daily newspapers. in minently reported be condensed into two The subject for consideration may the Scotch Lunacy Board, of the in opinion points. First, are occupying an unnatural lunatics, resident in lunatic asylums, of lunatics in such in consequence position; and secondly, are so numerous, that being are accidents establishments, maintenance of the insane, should think the for responsible these dangers. Had the Board well before exposing them to some better arrangement for recommend to been in a position of the more dangerous the disposal of the insane, and especially some excuse might have been in portion of them, than asylums, as is embodied here found for the expression of such an opinion The dispersion even hinted at. is but no such improved system cannot be dwellings evidently in lunatics of dangerous private
the the
following' same
year'
tliose?who
?
LUNACY
IN
145
SCOTLAND.
entertained, as the application of this plan to the wants of even harmless imbeciles and idiots has, as already noticed, proved, if not a failure, at least been found to come far short of what, at The truth is, the fact would one time, was expected from it. seem tc have been overlooked by the Commissioners that the original intention, and even now the primary object, sought, in sending the insane to asylums is not their treatment, but that they may be isolated from society for their own and the public safety. The treatment of the insane in asylums has always been, and still is, altogether a secondary consideration. How far this is to be regretted, or how it is to be remedied, are, howIt ever, questions beyond the scope of the present remarks. would be just as reasonable to argue that a prisoner is in an unnatural position in a prison, as to say that a lunatic is unnaturally situated in an institution specially provided with everything that can conduce to his care and comfort, as well as to the amelioration of his position while there. Indeed ever since the sentence was pronounced on the leper that " without the camp shall his habitation be," in all ages of civilisation, and in all states of society, the necessity of setting apart certain individuals for their own sake and the general weal, has been acknowledged and acted upon; and what was found necessary for the leper and slayer of old, experience has shown to be equally necessary for the vicious portion of society and for the dangerous insane of the present day. Whatever views the Scotch Lunacy Board may therefore entertain, the majority of the public will still, it is believed, conclude that a lunatic in an asylum is in a more natural position than he would be at large, probably endangering his own life and the lives of those around him, and will not be acting far wrong in continuing to send the insane to these establishments, until, at least, as some would fondly hope, mankind shall reach perfection, or, to use the amended language of a former Scotch Lunacy Report (slightly " of the Education until the state the Act), to suit present of the people, which is in process of instruction compulsory the way for a reform in the being accomplished, shall prepare mode and scope of education, and when scholastic teaching, by of the laws which including moral training and a knowledge shall mental and health, prove a real saferegulate the bodily and insanity ; a grand and glorious crime both guard against but we should think little to prospect for humanity in general, be desired by commissioners in lunacy. An analysis of the facts published by this Board will show also on what slight grounds their second inference is based. Of the 19 fatal cases, six were suicides, in whose case the fatal result can by no system of reasoning be ascribed to their PART I.
VOL. Ill?NEW SERIES.
K
146
LUNACY IN SCOTLAND.
residence in asylums; and of the remaining 13 cases terminating in death, one died of "asphyxia during the act of vomiting"; " one from haemorrhage and heart disease, brought on by " being pushed over by another patient"; two from suffocation face the the during by turning upon night" (one, and very " supposed probably both, being epileptic); one from burning, to have been caused accidentallyand one from " a fractured rib, supposed to have been caused by a fall out of bed"; all being accidents which might occur anywhere. Seven cases, therefore, can only be fairly credited to asylum influence, and of these two were from "fracture of ribs, causes unknown," two from "injuries inflicted by other patients," one "from a fall while trying to escape from attendant," and two from injuries received in struggling with attendants. Of 170 minor cases, 45 were the result of quarrels arising between patients, the majority of them being of a slight nature; 13 resulted from attendants endeavouring to control violent patients; and in nine instances were injuries inflicted by patients on their attendants ; 102 were of a nature that might have occurred although no establishments had been in existence, for it would be difficult for an ordinary mind to discover any relationship of the nature of cause and effect as existing between such places and accidents of the following character:?"Prostration from eating the buds and leaves of a yew tree," "injury caused " by the fall of a large stone," precipitation from a viaduct," " insensibility from swallowing an overdose of chloral," " slight accident from being knocked down by a cab," injuries caused " " by the fall of a heavy weight from a height," by the fall of roof plaster," etc. etc., to say nothing of the many unavoidable bruises and injuries to which epileptics are liable, from the nature of their malady, and not from that of the situation in which they may be placed. A much more satisfactory explanation of asylum accidents of the present day will be found in the greater freedom now everywhere allowed to the patients, and which is, in fact, but an illustration of the law that the increased benefit of the majority can only be obtained at the expense of the few. Repugnant as the system of restraint now appears to the minds of the present generation, this at least can be said in its favour, that many of the accidents now recorded in the Lunacy Reports could not, while it existed, possibly have occurred ; and many instances might be given of the relief afforded, not only to the minds of their guardians, but also to the feelings of the patients themselves, when by means of the camisole, or muff, they were rendered physically incapable of doing harm. In connection with this subject, one naturally examines the Report to see how it fares with patients
LUNACY IN SCOTLAND.
147
in the private dwellings; but the search proves in vain, for, however carefully the accidents in establishments are recorded, no list of those occurring in private dwellings would seem to be kept by the Board; at least none is laid before the public. The condensed summaries as to the state of the establishments give information on two things?their actual condition at the time of inspection, and the opinion of the Commissioners as to the best means to be adopted for their further improveThe space at our disposal will not allow us to refer to ment. each institution individually, but it will be sufficient to view All the reports indicate a steady improvethem collectively. ment in the direction of rendering these institutions less prison like, and of endeavouring to bring them as nearly as possible to the aspect of places of private residence; and the recommendations of the Commissioners appear judicious and worthy of every support, consisting as they do in suggestions for increasing the amount of land attached to some asylums, for remodelling the older portions of buildings in others, and generally for increasing those comforts and other home-like provisions which experience has shown to exercise so beneficial an influence on the insane, and not to be without effect on even the most clouded and impaired intellect. With few exceptions, all the asylums were found either crowded or fully occupied, but the general results for the year must, notwithstanding, be considered satisfactory, in so far as the average percentage of recoveries, calculated on the admissions, was found to be 34*1 for males, and 43-2 for females, while the percentage of deaths on the average numbers resident was 9*6 for males, and 6*6 for females. The average daily rate of maintenance for pauper lunatics in the different establishments is stated to be Is. 5\d. in royal, district, private, and parochial asylums, Is. 1 \d. in licensed wards of poorhouses, and 8d. in private dwellings. The rate in the royal, or chartered, asylums, charged for pauper patients varies greatly, being lowest in Dumfries?namely, 221, per annum and highest in Glasgow Eoyal Asylum, where the rates are 321. 14s. 4d. 351. 19s. 4d., and 381. 1 Is. 4d., the last-mentioned rate being charged against parishes sending only their worst In district asylums the rates charged for cases to that asylum. district paupers ranges from 221. 16s. 3d. in Banff, to 291. in Perth District Asylum; and for non-district paupers in Eoxthe rate for burgh it is as high as 361. In parochial asylums non-district patients varies from 22l. 2s. in Glasgow, to 291. 18s. in Abbey Parochial Asylum, and in the lunatic wards of poorhouses from 18I. 4s. in Wigton, to 231. 8s. in Liff and Benvie, and in Dumbarton poorhouses. The minimum rate for private 1C
2
148
LUNACY IN SCOTLAND.
patients in chartered and district asylums also varies much, being 231. 8s. in Argyll and Bute District Asylum (a rate, however, confined to private patients belonging to these districts), and 50l. in Murray's Eoyal Asylum, Perth. At the end of the year 1875, 286 persons were reported to the Board as under judicial factory, in consequence of "
mental unfitness for the management of their affairs," and were located as follows:?179 were in asylums in Scotland, 98 in private dwellings, and nine beyond the jurisdiction of the Board. The Commissioners' suggestion, in connection with these patients, " that in cases where the funds do not exceed 1,000^., the authority to appoint a curator, at present possessed exclusively by the Court of Session, should be extended to the sheriff," is one that cannot be too strongly endorsed, as such appointments would thereby be greatly facilitated, and the expenses, which at present in many instances prove a very heavy tax, would be considerably lessened. The appendices of this, as of former Reports, contain carefully prepared, extensive, and"minute information in regard to what the Board happily term the movement," and the expense of the maintenance of the insane poor, in every parish in Scotland, and also copies of all entries made by the Commissioners in the registers of the different asylums. These will, no doubt, of reference, but need not be prove invaluable for purposes farther referred to at present. Appendix F, however, tempts us to make a few remarks, as it contains the reports of the Deputy Commissioners. Dr. Paterson's report consists of three lines of printed matter, and a table showing that he had visited and reported on 597 patients in private dwellings, of whom 80 were private cases, and 517 were paupers. Of these, 146 were in special licensed houses. Dr. Paterson's patients were scattered over 14 counties. Dr. Sibbald's report is of a similar nature, and indicates that he visited 630 patients, of whom 44 were private situated in 19 counties. Dr. patients, and 586 paupers, " several patients within the district Sibbald also adds that usually visited by him have been left unvisited this year, owing to the time occupied in special enquiries which were ordered by the Boardbut " the cases in which no visits have been paid do not include such as afforded reason to doubt the satisfactoriness of the care and treatment bestowed on the patients." No one will doubt the attention bestowed by these gentlemen on their work, and the assiduity with which it is performed, nor will there be any general inclination to grudge them their salaries; but from a consideration of these reports and of the nature of the duties imposed upon the Deputy Commissioners, the question Le jeu, vaut-il la chandelle ? will at once present itself to the mind of
LUNACY IN
SCOTLAND.
149
anyone who considers this subject in an unbiassed manner. According to the estimates of the Civil Services for the year endingMarch 31, 1877, the salary of each Deputy Commissioner is given at 600/., and the travelling expenses of all the Commissioners at 900L, so that at the lowest possible estimate this would give considerably more than 21s. per visit per pauper as The official influence the expense incurred in this department. of an annual visit, and in some instances it would seem of one visit only in two years, must be small; but if this really be sufficient^ might not equally satisfactory results at less expense be secured, by arranging for the inspection of this portion of the insane by competent local authorities ? On the whole, one does not rise from a perusal of the Scotch Lunacy Blue Books with a feeling of entire satisfaction. As has been already said, much valuable matter is contained and given to the public in the carefully arranged and elaborated tables, but in the reports themselves there is often exhibited from year to year a painful and unnecessary repetition of the same facts, arguments, and ideas. This has been noticed in the observations on accidents, but the same thing considering occurs elsewhere. Thus, in referring to the admission of patients into asylums, we find this remark: " It is too apt to be forgotten that the statutory lunacy of a country is far from being a thing which ' human power cannot multiply and modify.' In our ' Fifteenth Report (p. 285) we pointed out that the existence of or required to be lunacy, in so far as it is officially recognised decided at is dealt with by the State, by the certificate present of two medical men : and indeed must always be determined in that or some similar manner. If there be persons who imagine that a uniform standard of mental soundness is accepted by all medical men, or by any one medical man in all circumstances, they must have little experience to guide them. Such certificates of the social as well as are always signed after a consideration the medical circumstances of each case, and it is scarcely open to doubt that in actual practice the source from which the required expenditure is to be obtained is, rightly or wrongly, a Of course no one common element in this consideration.' is not that it appears for matter the will deny this, and surprise in the Fifteenth, but that it did not appear in the Fifth Report. But is this a subject of so much importance that it should be gravely copied verbatim into the Seventeenth and again into the Eighteenth Reports ? Again, many clauses in these Reports would appear to indicate what may not improperly be called a want of harmony between the Scotch Lunacy Board and those practically engaged in the treatment and management of the insane, if not an actual
150
LUNACY IN SCOTLAND.
want of practical acquaintance with the disease itself. During the last twenty years the increase in our of the physio-
knowledge
of the brain and nervous system and of the principles of mental philosophy has not been slight, nor have investigations into the causes, pathology, and treatment of insanity been barren of results; yet the true scientific aspect of the subject is scarcely ever touched No doubt extensive upon in these returns. researches in this direction are restricted by the statutory clauses regulating the contents of such documents, and by which the duties of the Commissioners are confined chiefly to report" ing upon the condition and management of all public, private, and district asylums and houses in which any lunatic is kept and detained under an order of the sheriff"; but that these restrictions are not considered absolutely binding is seen from the investigations of a statistical nature which from time to time appear, but which do not always lead to very valuable or apReport, general parently reliable results. Thus, in last year's " principles were sought to be established on the influence of the seasons on deaths from diarrhoea," by comparing the mortality from this disease, as it had occuired m all the Scotch asylums during 10 years, with the mean deaths fioin diai rhuea or of 20 in London for five years, and persons above the age the attacks of diarrhoea occuring in one Scotch asylum for eight similar investigations have years; and in the present Report " the deaths from general paralysis of the been instituted on insane." This disease is chosen, we are told, as one " whose occurrence as a cause of death is least likely to be inaccurately recorded;" and yet a glance at the tables will satisfy anyone that they cannot refer to cases of genuine general paralysis of the insane at all?at least, as this disease used to be understood ?but that the returns employed were probably the records of all deaths among the insane occurring in consequence of, or during the progress of, all the many and protean forms of disease to which the human nervous system is liable, in which a more or less general paralytic condition was a prominent symptom during life. This, indeed, is to a certain extent admitted, as well as the insufficient nature of the data obtainable in the cases of private patients ; but, curiously enough, these objections are not considered as calculated to seriously vitiate the results. In such enquiries the Scotch Lunacy Board might benefit by the experience of their English brethren. In the Thirtieth Report " of the English Lunacy Board it is observed: At no time have we considered it our draw to but most plain and the any duty obvious deductions from the figures which the means at our disposal enable us to present; nor can we deem it advisable or justifiable to offer to the public any speculations or theories of
logy
LUNACY
IN
SCOTLAND.
151
At present we do not think our own, based on these statistics. that the recorded experience is sufficiently extensive to warrant many very certain conclusions to be drawn from it; and the official publication of conjectures, founded on confessedly imperfect data, and therefore liable to be falsified by the event, would not, we submit, be attended by any public advantage." Still, the accumulating' facts of physiology and pathology are at their use of these the Commissioners would disposal, and of their volumes not a attractiveness and increase the value of promoters of the to and position occupy little; by striving the scientific investigation and treatment of lunacy, and of the medical and intellectual study of insanity generally, in the different asylums, establishments, and houses under their jurisdiction?a position they might easily attain to, from the official status they already hold?and to be less contented with the attitude of mere domiciliary inspectors, they would soon acquire and be capable of exerting a greater influence over the welfare of the insane than they at present possess.
by"making
