267
Art. IX.?LUNACY IN SCOTLAND.
There exist in Scotland at the present time 8,069 persons of unsound mind. Of this number, 3,760 are males, 4,309 females, 1,455 private patients, and 6,614 pauper lunatics. The population of Scotland is 3,462,879, and the proportion of lunatics to every 100,000 of the population is 228. Ten years ago it was only 203, so that there has been a considerable increase of insanity; but whether this indicates a real or apparent increase, we are unable to state. The probability is that more lunatics are now under the supervision of the law than formerly, and consequently appear on the Commissioners' books, and that there is no real increase of lunacy. This table shows the number of the insane placed in Establish1858, and in each of the ten years 1865-1874, distinguishing between males and females, and between private and pauper patients :? ments in
Table X.
Numbers
placed in Establishments, excluding Transfers
Years General Total
Pauper
1858 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874
Average of the 10 years 1865-74
Male
Female
Total
Male
I Female
Total
Male
Female
193 198 235 210 182 219 208 227 185 201 200
213 221 210 235 215 218 223 254 197 256 228
406 419 445 445 397 437 431 481 382 457 428
436 484 538 597 62S 666
1.042 1.043 1,123 1,260 1,319 1,466 1,357 1,355 1,484 1,642 1,577
629 682 773 807 810 885 815
819 780 795 898 906
749
606 559 585 663 691 ,800 750 708 7S3 902 828
886 941 949
1,158 1,056
206
226
432
636
727
1,363
842
953
It thus appears
every hundred pauper.
that,
patients
on an
607 647 701 740
874
1,018 973 962 980
Total
1,448 1,462 1,568 1,705 1,716 1,903 1,788 1,836 1,866 2,099 2,005
1,795
average of the ten years 1865?1874, of Asylums, 24*1 were private, and 75-9
sent to
u
2
LUNACY IN SCOTLAND.
268 With
regard
to the increase of
Commissioners say:?
lunacy
in
Scotland,
the
" The figures in the Table do not indicate any steady or appreciable increase in the admission of private patients into Asylums. On the contrary, in view of the increasing population, they may rather beheld
indicate a decrease. " As regards pauper patients, however, the Table shows a considerable and progressing increase in the number of admissions. In 1858 the number of pauper lunatics placed in establishments was 1042, while in 1874 it was 1577, being an increase of more than 50 per cent. During the same period, the increase of the general population to
about 14 per cent. It does not necessarily follow from these facts that there is any greater production of insanity in the country. It is possible that they only express what might be looked for as the result of the increased facilities for gratuitous treatment and maintenance in Asylums, which result from the operation of the Lunacy Laws. "We have reason indeed to believe that some of the lower class of private patients, the cost of whose support in Asylums was with difficulty defrayed by their friends, are now registered as paupers and supported in whole or in part out of the poor-rates. This of course reduces the admissions of private and increases those of pauper patients. Only a small part, however, of the increase which has taken place in A much the admission of paupers can be accounted for in this way. larger part of the increase is probably due to the placing of patients in public establishments who were formerly kept at home. Gratuitous treatment in Asylums is now obtained with greater ease ; our institutions are more scattered over the country, and patients entering them do not require to be removed so far from home and friends; the feeliri"of repugnance to treatment in Asylums has undergone a diminution since the principles which guide that treatment have become better known: the working classes have been busier, and the presence in the household of an insane member has been increasingly felt to interfere with the comfort and prosperity of the sane members; the trouble involved in satisfying the views of the Board as to what constitutes treatment in the case of pauper patients provided for proper care and in private dwellings has led parochial surgeons and inspectors of poor more frequently to recommend and resort to Asylum treatment, thus relieving themselves of trouble and responsibility ; the greater wealth of the country has weakened those obstacles to the adoption of the more costly form of treatment which operate in poor communities ;?to these and various other such causes, may fairly be attributed a considerable proportion of that increase in the number of pauper patients annually admitted into Asylums, which has taken place since 1858 when the Law came into operation. Lunacy " But these causes would probably have operated with less force if there had not grown up, during the same period, a change of medical and public opinion as to what constitutes lunacy, or at least as to what constitutes that degree and kind of lunacy which can be certified as rendering the subject of it a fit and proper person to be placed under was
only
"
LUNACY IN SCOTLAND.
269
and treatment in an Asylum. This last, as well as the mere existof lunacy, must be certified of every patient who is placed in a public establishment for the insane, and it is clear that considerations apart from the patient's condition are almost certain to influence the granting of 'such certificates. Our experience shows it to be a mistake to say that human power cannot multiply or modify the lunacy in the country;' for in practice it is found to do so easily and largely, at least as regards the lunacy which is brought into relations with the State. On this subject it was pointed out in our Fifteenth Report, that ' the existence of lunacy, in so far as it is officially recognised or required to be dealt with by the State, is at present decided by the certificate 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 are always signed after a consideration of the social as well as 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, * or rightly wrongly, a common element in this consideration.' " or of due to the of In addition to the change practice opinion of the the from circumstances operation resulting Lunacy changed Laws, there is probably also a deeper change in medical opinion as to what constitutes insanity, the tendency of which is to include among lunatics persons who formerly would not have been so included. In this way again an apparent increase in the number of the insane in the country may take place without any real increase in the amount or production of insanity. There is perhaps one beneficial effect of this change, which presents itself in the readiness with which Asylum treatment is extended to those labouring under the transitory forms of mental unsoundness. It is clearly a change, however, which in some of its effects may be injurious to the country, by unnecessarily increasing the burden which lunacy lays on it, and injurious also to some of those persons who exhibit the milder forms of mental unsoundness by subjecting them to discipline and restraints which they do not require, and which take away from the happiness they are capable of enjoying. " We are of opinion that in these ways we can account for a considerable proportion of the increase which has taken place in the number of patients annually admitted into our Asylums, without accepting it as evidence of a correspondingly increased rate in the production of insanity. On the other hand, there is certainly nothing in the figures of Table X. to show that the creation of Asylum accommodation in Scotland has tended to diminish either the amount or the production of insanity. Probably no such result should be expected. It appears indeed that so sharply defined a product of insanity as suicide is not appreciably controlled in its frequency by the existence of Asylums, even in communities where these are conveniently situated for use, where fiscal and poor-law are good, and Avhere medical advice is abuncare
ence
arrangements
*
Fifteenth Report of the Board.
Report by Dr. Sibbald, Appendix F., p. 285.
270
LUNACY IN SCOTLAND.
In London, for instance, if we take the proportion of suicides to 100,000 of the population for each of the 12 years from 1862 to 1873,
dant.
we find that the and that there is
tending
fluctuate considerably but quite irregularly, evidence in them of the working of any influence diminished frequency of suicide.
figures
no
to cause a
"It is impossible, nevertheless, to come to any other opinion than that insanity is to a large extent a preventable malady, and it appears to us that it is in the direction of preventing its occurrence, and not through the creation of institutions for its treatment, that any sensible diminution can be effected in its amount. Lunacy is always attended with some bodily defect or disorder, of which it may be regarded as one of the expressions or symptoms. We must therefore attempt to prevent its occurrence, in the same way as we attempt to prevent the occurrence of what are called ordinary bodily diseases; and if it be admitted that to a large extent preventable diseases exist among us in consequence of the ignorance of the people, it is clear that we can only convert the preventable into prevented by the removal of that ignorance through a sounder education. Much more, however, is necessary for this than ordinary scholastic training?more even than a mere discernment of the laws by which the universe is governed. Men must also be taught that it is their duty, and not merely their interest, to know those laws and to make them reverentially the rule of their conduct. In short, we can only hope that preventable insanity, like other preventable diseases, will be diminished in amount when the education of men is so conducted as to render them both intelligent and dutiful guardians of their own physical, intellectual, and moral health. To this, and not to any machinery, however good it may be, for the treatment and cure of the insanity which has actually arisen, can we reasonably look for a diminution in its amount. " Table XI. shows the number of Sheriffs' orders granted for private and pauper patients during the year 1874, and the whole number granted for private patients during the ten years 1865-74. The Table also shows whether the orders were granted for the admission of patients into Private or into Public Asylums. In 26 instances the orders were merely granted for the transfer of patients from one Asylum to
another."
The chief county in Scotland in which insanity is most prevalent is Argyllshire, with 46*4 lunatics to every 100,000 of the population. The Commissioners make some most interesting observations on the influence of the seasons on the various admissions, and on the deaths, which we here append:?
LUNACY IN
271
SCOTLAND.
Admissions, excluding
Recoveries
Death3
Tears 186-5-1874
Years 18G5-1S74
Transfers Month Years 1865-1874
M.
January
February March
*786
April May July August September October November December Totals Averages
Every
T.
F.
654 1,333 779 1,452 *817 1,506 *848 *1,634 *894 1,651 *904 *1,681 *868 *1,695 *836 1,522 804 *1,543 782 1,447
M.
F.
T.
239 256 289 292 285 *347
294 320
533 576 660 565 643 *694 *806 *738
*871 273
F.
T.
*227
*480
*253 208 *214 200 201 *212 205 185 187 207 *230
*507
*785
*253 *254 *241 *230 *221 191 188 160 175 170 208 *231
*449 *444 421 392 400 365 360
*340 *324 238 *343
358 347 *429 *401 *412 *370 351 *442
8,588
9,702 18,290 3,667
4,368
8,035
2,522
2,529
5,051
716
306
364
670
210
211
421
*757
June
*
679 673 689
*777 *827 686
*739 665 646 664
741 775
1,387 1,439
808
month which shows
1,524 a
*377 *337
*752 *694 589
number above the average has the
sign
*
357 415 *461
before it.
"As regards admissions, this Table shows that in each of the months of April, May, June, July, August,* and September, their number is considerably above the number in the different months of January, February, March, October, November, and December. This is true of both sexes. The admissions reach their maximum in July, the hottest month of the year. But they show a considerable rise in April, and go on rising steadily through May and June, till they reach their maximum in July, after which they fall with more or less steadiness from month to month till they reach their minimum in
January. "
The occurrence of insanity is in few cases immediately followed removal to an asylum. In most cases, indeed, a considerable interval elapses between the attack and the removal, which last must therefore stand in the relation of effect to some cause or causes which considerably precede it. In like manner, though probably in a much smaller degree, exacerbations of existing subdued states of insanity do not, as a rule, immediately involve removal to an asylum, some time being generally allowed to elapse 'before this step is resolved It is thus improbable that the maximum, which on as necessary. the admissions show in July, is an expression of what has occurred in that month, or that it can be due to July weather. Indeed, the fact that the number of admissions begins to decline rapidly in the months which immediately follow July, goes rather to show that the weather of that month has no special tendency to originate or intensify If such were the case the effect would, for the mental disorder.
by
* As regards men, August occupies a peculiar position. The great and sudden fall from July gave rise to tho suspicion that some orror existed in the figures, but no error has been detected.
272
LUNACY IN SCOTLAND.
which we have just assigned, be seen following the cause after appreciable interval. It is more probable that the high figures of June and July are the outcome of conditions which present themselves in the spring months. It appears, indeed, that some change takes place in January, February, and March, which converts a downward into an upward tendency of the figures, and that this change
reasons some
remains, an
and continues
increasingly
to
exercise
an
influence in the
direction through April and May. The effects are prolonged in intensified form through June and July, when conditions seem to
same
be encountered of an opposite character, checking the progressive rise in the figures, and converting it into a steady fall through the months of August, September, October, November, and December, till we arrive at the minimum in January. "We recognise, of course, that all this may occur without assuming that the results are in any way under the control of weather, and we are aware that at the very most we can only regard as under seasonal influences that small portion of the admissions which is represented by the range between the minimum and the maximum. There remains a steady mass of monthly admissions which cannot properly be associated with weather. It would greatly advance our knowledge of this question if the admissions of fresh cases of insanity, and of cases showing recent exacerbations, were tabulated separately from the admissions of old-standing cases. " It has been shown that in the general population deaths from diseases of the nervous centres have their maxima in the period from January to May inclusive; and between this fact and the number of admissions into asylums in the different months of the year, the relation is evident and interesting. We do not venture, however, to do more here than point out the facts; and such remarks as we have made are intended rather to show how the interpretation of the facts should be sought than to give the interpretation. " It is perhaps worthy of note that the progress of admissions into asylums from month to month over the year is substantially the same as the progress of deaths by suicide in the general community. " This of course might be held to indicate the existence of some special intensity of mental disorder in the months which show a maximum of suicides, and not, as already argued, in the preceding months. " Turning to the deaths in asylums, we find the maximum occurring in the cold months of December, January, February, March, and April, and the minimum in the warmer months of June, July, August, September, and October. Indeed the progress of the total mortality in asylums appears to obey the same influences as those which regulate the progress of deaths in the general population. " In former reports we pointed out that, while the number of deaths of both sexes is greatest in winter, the tendency to death is not so much reduced in summer, and not so much increased in winter, in the This is probably the appearcase of females as in the case of males. ance in asylum populations of the fact now ascertained, that women in the general population succumb more readily than men to the diseases which are specially fatal in the hot months, and that, on the other
273
LUNACY m SCOTLAND.
hand, men succumb specially fatal in only with adults. are
"
more readily than women to the diseases which the cold months. We are dealing here of course
The month of December 1874
was remarkable for great and and the following figures show, as the seeming result, that a considerable increase of the deaths in asylums took place both in the month of December itself and in the succeeding month of J
prolonged cold, anuary:??
"Winter of
1872-73
November December
January...
"Winter of 1873-74
39 53 48
37 36 44
Winter of 1874-75
33 69 59
"
It has been frequently asserted to us by a careful observer that deaths from diarrhoea in asylums follow a course which is different from that of deaths caused by the same affection in the general
In order to test this, Ave have prepared the following shows the deaths from diarrhoea in all the asylums of Scotland for the ten years 1864-1873, tabulated according to the fortnightly periods in which they occurred. We have also inserted in the same Table columns showing the mean fortnightly deaths from diarrhoea in London of persons above the age of 20*, for the five years 1869-1873, and the number of attaclcs of diarrhoea,f which occurred in the Montrose Asylum during each month for the eight years 1866? 1873. The information necessary for filling up the last column was to us by Dr. Howden. supplied " Though drawn from periods of considerable length, the absolute numbers in this Table are small, and therefore, in order to render their teaching more clear and sure, they have been treated according to the method recommended in such circumstances by Mr. Bloxam, "which consists in assuming the number for any particular period to be the mean of the actual number and of the numbers for the corresponding periods immediately preceding and following. In other words, it imparts to the number for each period a portion of the characteristics of the periods which precede and follow. " Before all the figures in each column which exceed the mean of that column, an asterisk is placed, so that the periods of maxima are
community. Table, which
readily
seen."
The report before us contains a careful description of the present condition of public and private asylums, with remarks for their improvement when necessary. There appear to us to be many more single patients residing under private care in Scotland than in our own country, and we find that on the 1st of January of this year 103 houses were so licensed, the *
It was necessary to make this column deal
only
with persons above this
age, in order to institute a fair comparison with the population of asylums, which consists almost entirely of persons above the age of twenty. t
Very
few of these
were
of course fatal.
274
LUNACY IN SCOTLAND.
enabling the proprietor to receive four persons of unsound mind in Ms house. The condition of the patients under private care is most
license
satisfactory.
During the year forty-three persons have availed themselves of the special clause in the Lunacy Act, and placed themselves under supervision in asylums of their own free will. The report before us contains highly instructive matter, and carefully-drawn-up statistical reports, and is in our opinion one of the most careful descriptions of the condition of insanity, and of the various lunatic asylums, published by the Lunacy Board of Scotland.
Art. IX.?LUNACY IN SCOTLAND.
There exist in Scotland at the present time 8,069 persons of unsound mind. Of this number, 3,760 are males, 4,309 females, 1,455 private patients, and 6,614 pauper lunatics. The population of Scotland is 3,462,879, and the proportion of lunatics to every 100,000 of the population is 228. Ten years ago it was only 203, so that there has been a considerable increase of insanity; but whether this indicates a real or apparent increase, we are unable to state. The probability is that more lunatics are now under the supervision of the law than formerly, and consequently appear on the Commissioners' books, and that there is no real increase of lunacy. This table shows the number of the insane placed in Establish1858, and in each of the ten years 1865-1874, distinguishing between males and females, and between private and pauper patients :? ments in
Table X.
Numbers
placed in Establishments, excluding Transfers
Years General Total
Pauper
1858 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874
Average of the 10 years 1865-74
Male
Female
Total
Male
I Female
Total
Male
Female
193 198 235 210 182 219 208 227 185 201 200
213 221 210 235 215 218 223 254 197 256 228
406 419 445 445 397 437 431 481 382 457 428
436 484 538 597 62S 666
1.042 1.043 1,123 1,260 1,319 1,466 1,357 1,355 1,484 1,642 1,577
629 682 773 807 810 885 815
819 780 795 898 906
749
606 559 585 663 691 ,800 750 708 7S3 902 828
886 941 949
1,158 1,056
206
226
432
636
727
1,363
842
953
It thus appears
every hundred pauper.
that,
patients
on an
607 647 701 740
874
1,018 973 962 980
Total
1,448 1,462 1,568 1,705 1,716 1,903 1,788 1,836 1,866 2,099 2,005
1,795
average of the ten years 1865?1874, of Asylums, 24*1 were private, and 75-9
sent to
u
2
LUNACY IN SCOTLAND.
268 With
regard
to the increase of
Commissioners say:?
lunacy
in
Scotland,
the
" The figures in the Table do not indicate any steady or appreciable increase in the admission of private patients into Asylums. On the contrary, in view of the increasing population, they may rather beheld
indicate a decrease. " As regards pauper patients, however, the Table shows a considerable and progressing increase in the number of admissions. In 1858 the number of pauper lunatics placed in establishments was 1042, while in 1874 it was 1577, being an increase of more than 50 per cent. During the same period, the increase of the general population to
about 14 per cent. It does not necessarily follow from these facts that there is any greater production of insanity in the country. It is possible that they only express what might be looked for as the result of the increased facilities for gratuitous treatment and maintenance in Asylums, which result from the operation of the Lunacy Laws. "We have reason indeed to believe that some of the lower class of private patients, the cost of whose support in Asylums was with difficulty defrayed by their friends, are now registered as paupers and supported in whole or in part out of the poor-rates. This of course reduces the admissions of private and increases those of pauper patients. Only a small part, however, of the increase which has taken place in A much the admission of paupers can be accounted for in this way. larger part of the increase is probably due to the placing of patients in public establishments who were formerly kept at home. Gratuitous treatment in Asylums is now obtained with greater ease ; our institutions are more scattered over the country, and patients entering them do not require to be removed so far from home and friends; the feeliri"of repugnance to treatment in Asylums has undergone a diminution since the principles which guide that treatment have become better known: the working classes have been busier, and the presence in the household of an insane member has been increasingly felt to interfere with the comfort and prosperity of the sane members; the trouble involved in satisfying the views of the Board as to what constitutes treatment in the case of pauper patients provided for proper care and in private dwellings has led parochial surgeons and inspectors of poor more frequently to recommend and resort to Asylum treatment, thus relieving themselves of trouble and responsibility ; the greater wealth of the country has weakened those obstacles to the adoption of the more costly form of treatment which operate in poor communities ;?to these and various other such causes, may fairly be attributed a considerable proportion of that increase in the number of pauper patients annually admitted into Asylums, which has taken place since 1858 when the Law came into operation. Lunacy " But these causes would probably have operated with less force if there had not grown up, during the same period, a change of medical and public opinion as to what constitutes lunacy, or at least as to what constitutes that degree and kind of lunacy which can be certified as rendering the subject of it a fit and proper person to be placed under was
only
"
LUNACY IN SCOTLAND.
269
and treatment in an Asylum. This last, as well as the mere existof lunacy, must be certified of every patient who is placed in a public establishment for the insane, and it is clear that considerations apart from the patient's condition are almost certain to influence the granting of 'such certificates. Our experience shows it to be a mistake to say that human power cannot multiply or modify the lunacy in the country;' for in practice it is found to do so easily and largely, at least as regards the lunacy which is brought into relations with the State. On this subject it was pointed out in our Fifteenth Report, that ' the existence of lunacy, in so far as it is officially recognised or required to be dealt with by the State, is at present decided by the certificate 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 are always signed after a consideration of the social as well as 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, * or rightly wrongly, a common element in this consideration.' " or of due to the of In addition to the change practice opinion of the the from circumstances operation resulting Lunacy changed Laws, there is probably also a deeper change in medical opinion as to what constitutes insanity, the tendency of which is to include among lunatics persons who formerly would not have been so included. In this way again an apparent increase in the number of the insane in the country may take place without any real increase in the amount or production of insanity. There is perhaps one beneficial effect of this change, which presents itself in the readiness with which Asylum treatment is extended to those labouring under the transitory forms of mental unsoundness. It is clearly a change, however, which in some of its effects may be injurious to the country, by unnecessarily increasing the burden which lunacy lays on it, and injurious also to some of those persons who exhibit the milder forms of mental unsoundness by subjecting them to discipline and restraints which they do not require, and which take away from the happiness they are capable of enjoying. " We are of opinion that in these ways we can account for a considerable proportion of the increase which has taken place in the number of patients annually admitted into our Asylums, without accepting it as evidence of a correspondingly increased rate in the production of insanity. On the other hand, there is certainly nothing in the figures of Table X. to show that the creation of Asylum accommodation in Scotland has tended to diminish either the amount or the production of insanity. Probably no such result should be expected. It appears indeed that so sharply defined a product of insanity as suicide is not appreciably controlled in its frequency by the existence of Asylums, even in communities where these are conveniently situated for use, where fiscal and poor-law are good, and Avhere medical advice is abuncare
ence
arrangements
*
Fifteenth Report of the Board.
Report by Dr. Sibbald, Appendix F., p. 285.
270
LUNACY IN SCOTLAND.
In London, for instance, if we take the proportion of suicides to 100,000 of the population for each of the 12 years from 1862 to 1873,
dant.
we find that the and that there is
tending
fluctuate considerably but quite irregularly, evidence in them of the working of any influence diminished frequency of suicide.
figures
no
to cause a
"It is impossible, nevertheless, to come to any other opinion than that insanity is to a large extent a preventable malady, and it appears to us that it is in the direction of preventing its occurrence, and not through the creation of institutions for its treatment, that any sensible diminution can be effected in its amount. Lunacy is always attended with some bodily defect or disorder, of which it may be regarded as one of the expressions or symptoms. We must therefore attempt to prevent its occurrence, in the same way as we attempt to prevent the occurrence of what are called ordinary bodily diseases; and if it be admitted that to a large extent preventable diseases exist among us in consequence of the ignorance of the people, it is clear that we can only convert the preventable into prevented by the removal of that ignorance through a sounder education. Much more, however, is necessary for this than ordinary scholastic training?more even than a mere discernment of the laws by which the universe is governed. Men must also be taught that it is their duty, and not merely their interest, to know those laws and to make them reverentially the rule of their conduct. In short, we can only hope that preventable insanity, like other preventable diseases, will be diminished in amount when the education of men is so conducted as to render them both intelligent and dutiful guardians of their own physical, intellectual, and moral health. To this, and not to any machinery, however good it may be, for the treatment and cure of the insanity which has actually arisen, can we reasonably look for a diminution in its amount. " Table XI. shows the number of Sheriffs' orders granted for private and pauper patients during the year 1874, and the whole number granted for private patients during the ten years 1865-74. The Table also shows whether the orders were granted for the admission of patients into Private or into Public Asylums. In 26 instances the orders were merely granted for the transfer of patients from one Asylum to
another."
The chief county in Scotland in which insanity is most prevalent is Argyllshire, with 46*4 lunatics to every 100,000 of the population. The Commissioners make some most interesting observations on the influence of the seasons on the various admissions, and on the deaths, which we here append:?
LUNACY IN
271
SCOTLAND.
Admissions, excluding
Recoveries
Death3
Tears 186-5-1874
Years 18G5-1S74
Transfers Month Years 1865-1874
M.
January
February March
*786
April May July August September October November December Totals Averages
Every
T.
F.
654 1,333 779 1,452 *817 1,506 *848 *1,634 *894 1,651 *904 *1,681 *868 *1,695 *836 1,522 804 *1,543 782 1,447
M.
F.
T.
239 256 289 292 285 *347
294 320
533 576 660 565 643 *694 *806 *738
*871 273
F.
T.
*227
*480
*253 208 *214 200 201 *212 205 185 187 207 *230
*507
*785
*253 *254 *241 *230 *221 191 188 160 175 170 208 *231
*449 *444 421 392 400 365 360
*340 *324 238 *343
358 347 *429 *401 *412 *370 351 *442
8,588
9,702 18,290 3,667
4,368
8,035
2,522
2,529
5,051
716
306
364
670
210
211
421
*757
June
*
679 673 689
*777 *827 686
*739 665 646 664
741 775
1,387 1,439
808
month which shows
1,524 a
*377 *337
*752 *694 589
number above the average has the
sign
*
357 415 *461
before it.
"As regards admissions, this Table shows that in each of the months of April, May, June, July, August,* and September, their number is considerably above the number in the different months of January, February, March, October, November, and December. This is true of both sexes. The admissions reach their maximum in July, the hottest month of the year. But they show a considerable rise in April, and go on rising steadily through May and June, till they reach their maximum in July, after which they fall with more or less steadiness from month to month till they reach their minimum in
January. "
The occurrence of insanity is in few cases immediately followed removal to an asylum. In most cases, indeed, a considerable interval elapses between the attack and the removal, which last must therefore stand in the relation of effect to some cause or causes which considerably precede it. In like manner, though probably in a much smaller degree, exacerbations of existing subdued states of insanity do not, as a rule, immediately involve removal to an asylum, some time being generally allowed to elapse 'before this step is resolved It is thus improbable that the maximum, which on as necessary. the admissions show in July, is an expression of what has occurred in that month, or that it can be due to July weather. Indeed, the fact that the number of admissions begins to decline rapidly in the months which immediately follow July, goes rather to show that the weather of that month has no special tendency to originate or intensify If such were the case the effect would, for the mental disorder.
by
* As regards men, August occupies a peculiar position. The great and sudden fall from July gave rise to tho suspicion that some orror existed in the figures, but no error has been detected.
272
LUNACY IN SCOTLAND.
which we have just assigned, be seen following the cause after appreciable interval. It is more probable that the high figures of June and July are the outcome of conditions which present themselves in the spring months. It appears, indeed, that some change takes place in January, February, and March, which converts a downward into an upward tendency of the figures, and that this change
reasons some
remains, an
and continues
increasingly
to
exercise
an
influence in the
direction through April and May. The effects are prolonged in intensified form through June and July, when conditions seem to
same
be encountered of an opposite character, checking the progressive rise in the figures, and converting it into a steady fall through the months of August, September, October, November, and December, till we arrive at the minimum in January. "We recognise, of course, that all this may occur without assuming that the results are in any way under the control of weather, and we are aware that at the very most we can only regard as under seasonal influences that small portion of the admissions which is represented by the range between the minimum and the maximum. There remains a steady mass of monthly admissions which cannot properly be associated with weather. It would greatly advance our knowledge of this question if the admissions of fresh cases of insanity, and of cases showing recent exacerbations, were tabulated separately from the admissions of old-standing cases. " It has been shown that in the general population deaths from diseases of the nervous centres have their maxima in the period from January to May inclusive; and between this fact and the number of admissions into asylums in the different months of the year, the relation is evident and interesting. We do not venture, however, to do more here than point out the facts; and such remarks as we have made are intended rather to show how the interpretation of the facts should be sought than to give the interpretation. " It is perhaps worthy of note that the progress of admissions into asylums from month to month over the year is substantially the same as the progress of deaths by suicide in the general community. " This of course might be held to indicate the existence of some special intensity of mental disorder in the months which show a maximum of suicides, and not, as already argued, in the preceding months. " Turning to the deaths in asylums, we find the maximum occurring in the cold months of December, January, February, March, and April, and the minimum in the warmer months of June, July, August, September, and October. Indeed the progress of the total mortality in asylums appears to obey the same influences as those which regulate the progress of deaths in the general population. " In former reports we pointed out that, while the number of deaths of both sexes is greatest in winter, the tendency to death is not so much reduced in summer, and not so much increased in winter, in the This is probably the appearcase of females as in the case of males. ance in asylum populations of the fact now ascertained, that women in the general population succumb more readily than men to the diseases which are specially fatal in the hot months, and that, on the other
273
LUNACY m SCOTLAND.
hand, men succumb specially fatal in only with adults. are
"
more readily than women to the diseases which the cold months. We are dealing here of course
The month of December 1874
was remarkable for great and and the following figures show, as the seeming result, that a considerable increase of the deaths in asylums took place both in the month of December itself and in the succeeding month of J
prolonged cold, anuary:??
"Winter of
1872-73
November December
January...
"Winter of 1873-74
39 53 48
37 36 44
Winter of 1874-75
33 69 59
"
It has been frequently asserted to us by a careful observer that deaths from diarrhoea in asylums follow a course which is different from that of deaths caused by the same affection in the general
In order to test this, Ave have prepared the following shows the deaths from diarrhoea in all the asylums of Scotland for the ten years 1864-1873, tabulated according to the fortnightly periods in which they occurred. We have also inserted in the same Table columns showing the mean fortnightly deaths from diarrhoea in London of persons above the age of 20*, for the five years 1869-1873, and the number of attaclcs of diarrhoea,f which occurred in the Montrose Asylum during each month for the eight years 1866? 1873. The information necessary for filling up the last column was to us by Dr. Howden. supplied " Though drawn from periods of considerable length, the absolute numbers in this Table are small, and therefore, in order to render their teaching more clear and sure, they have been treated according to the method recommended in such circumstances by Mr. Bloxam, "which consists in assuming the number for any particular period to be the mean of the actual number and of the numbers for the corresponding periods immediately preceding and following. In other words, it imparts to the number for each period a portion of the characteristics of the periods which precede and follow. " Before all the figures in each column which exceed the mean of that column, an asterisk is placed, so that the periods of maxima are
community. Table, which
readily
seen."
The report before us contains a careful description of the present condition of public and private asylums, with remarks for their improvement when necessary. There appear to us to be many more single patients residing under private care in Scotland than in our own country, and we find that on the 1st of January of this year 103 houses were so licensed, the *
It was necessary to make this column deal
only
with persons above this
age, in order to institute a fair comparison with the population of asylums, which consists almost entirely of persons above the age of twenty. t
Very
few of these
were
of course fatal.
274
LUNACY IN SCOTLAND.
enabling the proprietor to receive four persons of unsound mind in Ms house. The condition of the patients under private care is most
license
satisfactory.
During the year forty-three persons have availed themselves of the special clause in the Lunacy Act, and placed themselves under supervision in asylums of their own free will. The report before us contains highly instructive matter, and carefully-drawn-up statistical reports, and is in our opinion one of the most careful descriptions of the condition of insanity, and of the various lunatic asylums, published by the Lunacy Board of Scotland.
