Read Ebook: On the State of Lunacy and the Legal Provision for the Insane With Observations on the Construction and Organization of Asylums by Arlidge J T John Thomas

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PRELIMINARY OBSERVATIONS.

Importance of an inquiry relative to the number of the Insane, and the legal provision for them, 1.

Official returns imperfect, 3.--Divergence of returns of Lunacy Commissioners and of Poor-Law Board, 4.--Unreported 'private' lunatics, 5.--Criminal lunatics in prisons, 6.--Inadequate estimate of the number of the Insane, 7.--Illustration of the difficulty of discovering the true statistics of Lunacy, 7.--Number of pauper lunatics in workhouses, 9.--Paupers not enumerated in official returns, 9.--Estimate of the total number of the insane on 1st of January 1859, 10.--Causes of apparent increase, 10.

Materials for calculation unsatisfactory, 11.--Rate of accumulation of the insane in asylums, 12.--Estimate of increase made by the Commissioners, 12.--Table of number of lunatic paupers in workhouses, 13.--Calculation of their rate of increase, 14.--Increase of pauper lunatics not in workhouses or asylums, 14.--Total increase and accumulation of lunatics, 15.--Positive increase of insanity by new cases, 15.--Table of admissions in four years, 16.--Total number of new cases added yearly, 17.--Expenditure on account of the pauper insane, 18.--Proportion of the insane to the population, 18.--Cause of accumulation of the insane, 19.--Suggestions for obtaining improved statistics of pauper lunatics, 19.

Commissioners' calculation of asylum accommodation wanted, 20.--Their conclusion that the present provision is inadequate, 22.--On the accuracy of the Commissioners' conclusions, 22.--Pauper lunatics accommodated in workhouses, and boarded out, 23.--Their unsatisfactory condition, 23.--Colony of insane at Gheel, in Belgium, 24.--Character of lunatics in workhouses, 25.--Unfit cases of insanity in workhouses, 25.--Commissioners' estimate that one-half of lunatic inmates of workhouses are improperly detained, 26.--Estimate of asylum accommodation required, 26.

Insanity a very curable disorder, 27.--Experience of American physicians, 27.--Exceptional circumstances in American asylums, 28.--Experience of St. Luke's Hospital, London, 28.--Experience of the Derby County Asylum, 30.--Advantages of early treatment, 30.

Absence of all curative influences at home, 32.--Causes of delay in submitting patients to treatment, 33.--Impediments to transmission to county asylums, 34.--Evils of pauper test in public asylums, 34.--Characters of Continental asylums, 35.--Practice followed in America, 36.--Scheme of assessment of means of those applying for admission to public asylums, 36.--Failure of the pauper test to protect the rate-payers, 37.--Its demoralizing and degrading effects, 38.--Suggestion as to conditions and mode of admission into county asylums, 38.--Act in force to recover the costs of maintenance objectionable and inefficient, 39.

Detention practised on economical considerations, 40.--Examination of the value of such considerations, 41.--Estimated cost in asylums and in workhouses includes different items in the two, 41.--Illustration from the Devon Asylum Report, 42.--Children constitute above two-thirds of workhouse inmates, 42.--Material effect of this on the cost of maintenance, 42.--Inmates of asylums almost all adult, 42.--Fluctuations among inmates of workhouses greater than in asylums, 43.--Mode of estimating the rate per head of cost in workhouses, 43.--Population of workhouses, sane and insane mixed, 44;--that of asylums of insane especially, 44.--Those insane who involve increased cost rejected from workhouses, 44.--Remarks on this point by Dr. Bucknill, 44.--Economy of workhouses for the insane doubtful, 45.--Cost of asylums contrasted with that of workhouses, 46.--System of asylum structure hitherto adopted unnecessarily expensive, 47.--Workhouses and asylums not fairly comparable as to cost, 47.--Plan to diminish cost of asylums one-half, 48.--Chronic lunatics can be provided with asylum accommodation at a rate not exceeding that for workhouses, 48.--Internal cost of asylums and workhouses compared, 49.--Mistaken policy of constructing lunatic wards, 50.--Unfitness of workhouses for insane patients, 51, 75.--Evils attending presence of lunatics in workhouses, 52.--American experience in the matter, 52.--Workhouses unfit by structure and organization, 52, 75.--Workhouse detention especially prejudicial to recent cases, 53, 81.--Deficiency of medical care and of nursing in workhouses, 54, 78.--The dietary of workhouses insufficient for lunatics, 54, 77.--Injurious effects of workhouse wards upon lunatics, 56, 77.--Lunacy Commissioners' remarks thereon, 56.--Dr. Bucknill's remarks on the same subject, 57.--Characters of the lunatic inmates of workhouses, 58.--The majority of them imbecile and idiotic, 58.--Proportion especially claiming asylum care, 59.--Epileptics and paralytics unfit inmates of workhouses, 59.--Old demented cases badly provided for in workhouses, 59.--Imbecile patients are, as a rule, unfit inmates, 60.--Idiots improperly detained in workhouses, 61.--None but a few imbeciles permissible in workhouses, 61.--On the class of supposed 'harmless' lunatics, 61.--Remarks by Dr. Bucknill on this class, 62.--Experience of the Surrey magistrates on transferring 'harmless' patients to workhouses, 63.--Degradation of the patients' condition in workhouses, 64.--Legality of workhouse detention examined, 65.--Remarks on this subject by the Lunacy Commissioners, 66.--Clauses of the Lunacy Asylums Act bearing on the subject, 66.--Defects of the law in protecting the pauper insane, 68.--Remarks of the Lunacy Commissioners on the anomalies of the law, 68.--Objections to the powers conferred upon parochial officers, 68.--The law obscure, and open to evasion, 69.--Duties of the parish medical officers ill-defined, 69.--Proposal of a district medical officer, 70.--Contravention of the law by Boards of Guardians, 71, 81.--The further construction of lunatic wards should be stopped, 72.--Necessity for the supervision of the Lunacy Commissioners over workhouses, 72.--Several amendments of the Lunacy Laws suggested, 73.--Proposed regulations for supervision of workhouses containing lunatics, 73, 82.--Lunatics in workhouses should be under certificates, 73.--Proposal to increase powers of Lunacy Commissioners over workhouses, 74.--On the Supplement to the 'Twelfth Report' 'of the Commissioners in Lunacy,' on workhouses, 74.--Abstract of its contents:--unfitness of workhouses for lunatics, 75.--Workhouses in large towns most objectionable, 76.--Lunatic wards more objectionable than the intermixture of the insane with the other inmates, 76.--Miserable state of the insane in lunatic wards, 76, 79.--No efficient visitation of workhouse lunatics, 77.--Insufficiency of the dietary for insane inmates, 77.--Medical treatment and nursing most defective, 78.--Fearful abuse of mechanical restraint in workhouses, 78.--Wretched neglect and want in the internal arrangements for lunatics in workhouses, 79.--Abuse of seclusion in workhouses, 80.--Varieties of mechanical restraint employed, 80.--Absence of all means for exercise and occupation, 80.--Lunatics in workhouses committed to gaol, 80.--Neglect and contravention of the law by parish officers, 81.--Amendments in the law suggested by the Lunacy Commissioners, 81.--Proposal to erect asylums for chronic cases, 82, 126.--Visiting Justices of Asylums to supervise workhouse lunatic inmates, 73, 82.

Number of such lunatics, 83.--Neglect of their condition, 83.--Question of insanity should be left to the district medical officer, 84, 175.--This officer should visit and report on their condition, 85, 87.--Indications of the unsatisfactory state of this class of pauper lunatics, 85.--Evidence from Dr. Hitchman's Reports, 85.--Wretched state of 'single' pauper patients in Scotland, 87.--Neglect of Poor-law medical officers towards such patients, 87.--Objections to boarding pauper lunatics with strangers, 88.--District medical officer to select their residence, 89, 146.--Advantage of keeping them in lodgings near asylums, 89, 146.--Distribution of lunatics in cottage homes, 90, 145.--Notice of the colony of insane at Gheel, 90, 145.

Recklessness and cruelty in transmitting patients, 91.--Non-lunatic cases sent to asylums, 91.--Cases of very aged persons sent, 92.--Previous horrible neglect of patients, and their moribund state on admission, 93.--Extracts from Reports of asylum superintendents illustrative of the facts, 91-96.--Transfer of lunatics to asylums must be committed to some competent and independent officer, 97.--Want of instruction for medical men in insanity, 97;--Errors committed owing to the want of it, 98.--Neglect of psychological medicine in medical education, 98.--Law regulating transfer of weak cases to asylums, 99.--An amendment of the law requisite, 99.

Defective medical staff in large asylums, 102.--Efficient treatment impossible, 102, 121.--Degeneration of management into routine, 103.--Exclusive estimation of so-called 'moral treatment,' 103.--A very large asylum especially prejudicial to recent cases, 104.--Delegation of medical duties to attendants, 105.--Evils of absence of medical supervision over individual patients, 105.--Evils of large asylums upon character of attendants, 106.--Routine character of medical visits, 107, 143.--Necessity of medical supervision being complete, 107, 115, 121.--Distinction of asylum attendants into two classes--attendants proper, or nurses, and cleaners, 108.--Objections advanced by the Lunacy Commissioners to large lunatic asylums, 109.--The erection of large asylums supposed to be economical, 110.--The supposition fallacious, 110.--Commissioners' remarks on these topics, 111.--Rate of maintenance higher in the largest asylums, 112.--Inadequate remuneration of medical superintendents, 113.--Lord Shaftesbury's advocacy of improved salaries, 113.

Opinions of foreign physicians on the subject, 118.--Estimate of the medical staff requisite, 118.--Erroneous views prevalent in some asylums, 119.--Illustration furnished by the Middlesex asylums, 119.--Jacobi's views of asylum organization, 121.--Advantages of unity in the organization of asylums, 122.--Appointment of a chief physician, paramount in authority, 122.--Circumstances affecting the selection of asylum superintendents, 123.

Rapid extension in the demand for accommodation, 125.--Illustrated by reference to the Middlesex asylums, 125.

Objections to such separate establishments, 126.--Examination of the value of these objections, 127.--Cases to be transferred from one institution to the other, how determined, 128.--Mixture of recent with chronic cases undesirable, 128, 130.--Examination of the present relative position of acute and chronic cases, 129.--Separate treatment of recent cases desirable, 131.--Influence of distance on the utility of an asylum as a place of treatment, 131.--Borough asylums, 131.--Many chronic cases removable from asylums, 132.--Less expensive buildings needed for chronic cases, 132.--Views of the Lunacy Commissioners on these points, 132.--Evidence of Lord Shaftesbury, 134.--French system of dividing asylums into 'quarters,' 135.--Permissive power of Lunacy Act to build distinct asylums for chronic cases, 135.--On the powers of the Home Secretary to control asylum construction, 136.--Amendment of present Act proposed, 136.--On mixed asylums, for recent and chronic cases together, 137.--Conditions under which distinct institutions are desirable, 138.--Advantages of an hospital for recent cases, 138.--Number of inmates proper in such an hospital, 139.--Regulations required in it, 139.--Organization of asylums for chronic cases, 140.--Union of counties for the purpose of constructing joint asylums, 140.

German system of 'relative connexion' of asylums for recent and chronic cases, 141.--Proposition of Lunacy Commissioners to place industrial classes of patients in distinct wards, 142.--Advantages of separate sections, 143.--Objections to a purely 'industrial classification' of patients, 144.

Subdivision of asylums for chronic cases, 145.--Illustration of cottage provision for the insane at Gheel, 145.--The system at Gheel impracticable as a whole, 146.--The 'cottage system' deserving of trial under proper restrictions, 146.--Suggestions as to the arrangements required, 146.--'Cottage system' supplementary to asylums, 147.--Economy of 'cottage system,' 147.

Epileptics need separate provision, 148.--Idiots not fit inmates of lunatic asylums, 148.--Idiots require special asylum provision, 149.--Removal of idiots from workhouses, 150.

Necessity of registering the insane, 150.--Large number of insane at present unprotected, 151.--Legal advantages of registration, 151.--Desirability of correct statistics of insanity, 152.--Lord Shaftesbury's evidence on this point, 152.--Registration as a means of discovering the existence and condition of lunatics, 152.--Registration would promote early treatment, 153.--Should be accompanied by visitation, 153.--Enactment necessary to regulate the sending of lunatics abroad, 153.--Practice pursued in Sardinia, 154.--Suggestions offered, 155.--All patients removed uncured from asylums ought to have the place of their removal reported, 155.--Objections raised to registration, 156.--Their validity examined, 156.--Principle of a compulsory registration and visitation of all lunatics recognized in Belgium, 158.--English enactments respecting 'single' patients, 159.--Their failure, 159.--Lunatics secluded under the name of 'nervous' patients, 160.--Lord Shaftesbury's observations on defects in the Lunacy Laws respecting 'single' cases, 161.--Clauses to Act, proposed by his Lordship, to deal with 'nervous' patients, 161.--Clauses open to some objections, 162.--Lord Shaftesbury's proposal to report every 'nervous' patient, 163.--Compulsory powers of Lunacy Act defective, 164.--Suggestions made, 164.--Proposition to report all lunatics to a district medical officer, who should visit, 165.--Additional certificate granted by this officer, 165.--Lunatics well protected, 165.--Modification of present form of certificates of insanity, 166.--Objections to two forms of certificates, 166.--Determination of the nature of certificate to be given, 167.--Clause in Scotch Asylums Act respecting 'single' cases, 167.--Need of mitigated certificates and of intermediate asylums for certain cases of mental disturbance, 168.

Centralization dreaded as an evil, 187.--Importance of a central and independent body to the interests of the insane, 188, 192.--Want of power in the hands of Commissioners, 188.--Reasons for a central Board, 189.--More frequent visitation of asylums desired, 190.--Value of Commissioners' opinion on lunatic cases, 190.--Inquiries of Commissioners respecting the payment for patients, 190.--Divided authority of Commissioners and Magistrates in the case of private asylums, 191.--Anomaly of this state of things, 191.--Lunacy Commissioners too few, 192.--Magistrates not effectual as asylum visitors, 193.--Jurisdiction of the Commission should be the same throughout the country, 193.--Licensing powers of magistrates, 194.--Duties of office of Masters in Lunacy, 194.--Commissioners should visit all lunatics, whether Chancery or not, 195.--Proposed division of Lunacy Commission, 195, 198.--Advantages of the division proposed, 196.--Reasons for increasing Commission, 196.--Want of Commissioners' supervision of lunatics in gaols, 197.--Inadequacy of the present number of Commissioners, 197.--Appointment of Assistant Commissioners, 198.

Principles of construction in general use, 199.--Authorities on asylum construction, 200.--Examination of the 'ward system,' 200.--Sketch of the conditions of life in a 'ward,' 201.--Disadvantages of the arrangements, 201.--The arrangements of a ward vary widely from those of ordinary life, 202.--Day and night accommodation should be quite separate, 203.--Advantages of this plan, 204.--Salubrity, warming, and ventilation promoted, 205.--Economy resulting therefrom, 205.--Means of communication facilitated, 206.--Supervision facilitated, 207.--Classification improved, 207.--Domestic arrangements facilitated, 208.--Management facilitated, 209.--A smaller staff of attendants required, 210.--The cost of construction diminished, 210.--Objections to a third story removed, 211.

THE STATE OE LUNACY, AND THE LEGAL PROVISION FOR THE INSANE.

PRELIMINARY OBSERVATIONS.

The number of the Insane, and the legal provision requisite for their protection, care, and treatment, are subjects which will always recommend themselves to public attention and demand the interest alike of the political economist, the legislator, and the physician. To the first, the great questions of the prevalence of Insanity in the community, its increase or decrease, its hereditary character, and others of the same kind, possess importance in relation to the general prosperity and advance of the nation; to the second devolves the duty of devising measures to secure the protection both of the public and the lunatic, with due regard to the personal liberty, and the proper care and treatment, of the latter; to the last belongs the practical application of many of the provisions of the law, besides the exercise of professional skill in the management and treatment of the insane.

Moreover it will not be denied that, owing to the intimate manner in which he is concerned with all that relates to the lunatic, with all the details of the laws regulating his custody and general treatment, as well as with the institutions in which he is detained, with the features of his malady, and with all his wants, the physician devoted to the care of the Insane is well qualified to offer suggestions and recommendations to the legislator. Hence the present pages, in which the aim is to examine the present state of lunacy; the advantages to be gained by early treatment; and the adequacy of the existing legal provision for the Insane; and to offer some suggestions for improving the condition, and for amending the laws relating to the care and treatment, of this afflicted class of our fellow-creatures.

The whole subject of the efficiency of the Lunacy Laws and of their administration, occupies just now a prominent place in public attention, owing to the rapid multiplication of County Asylums and the constantly augmenting charges entailed by them; to the prevalent impression that Insanity is rapidly increasing; to recent agitation in our Law Courts respecting the legal responsibility of the Insane and the conditions under which they should be subjected to confinement, and still more to the proposed legislation on the matter during the present Session of Parliament. It would be a great desideratum could the Lunacy Laws be consolidated, and an arrest take place in the almost annual additions and amendments made to them by Parliament; but, perhaps, this is next to impracticable, owing to the attempts at any systematic, effectual, and satisfactory legislation for the Insane, being really of very recent date, and on that account subject to revisions enforced by experience of its defects and errors. However, the present time appears singularly suited to make the attempt at consolidation, so far as practicable, inasmuch as the appointment of a special committee of the House of Commons on the Lunacy Laws, furnishes the means for a complete investigation into existing defects, and for receiving information and suggestions from those practically acquainted with the requirements of the Insane, and with the operations of existing enactments.

To fulfil the objects taken in hand, and, in the first place, to sketch the present state of Lunacy in this country, it will be necessary to investigate the number of the Insane, and the annual rate of their increase; then to examine the extent of the present provision for them in asylums and of probable future wants. This done, after a brief essay on the curability of insanity, as a means of judging what may be done to mitigate the evil, we shall review the present provision for lunatics, point out its defects, and suggest various remedial measures, calculated in our opinion to improve the condition of the Insane, diminish the evil of the accumulation of chronic cases, and render asylums more serviceable and efficient.

In carrying out our design, we shall be found in some measure occupying ground already taken up by the Commissioners in Lunacy, and by some able essayists in the Medical Journals. We do not regret this, although it may deprive us somewhat of the merit of originality of conception and elucidation, as it will strengthen our positions and enhance the value of our remarks. Fortunately, too, we coincide generally with the opinions from time to time put forth by the Lunacy Commissioners, to whom so great merit is due for their labours in the interests of the insane, and for the character and position our County Asylums enjoy in the estimation of our own people and of foreign nations.

To attempt the character of a reformer when the affairs of Lunacy and Lunatic Asylums are in such good hands may be deemed somewhat ambitious; yet as sometimes an ordinary looker-on may catch sight of a matter which has eluded the diligent observer, and, as the views and suggestions advanced are the result of mature and independent thought, aided by experience of considerable length, and very varied, the undertaking may, we trust, be received with favour.

At all events, we flatter ourselves that the representation of the state of Lunacy in England and Wales; the estimate of its increase and of the provision made for it; the evils of workhouses as primary or permanent receptacles for the Insane; the ill consequences of large asylums, and some of the legal amendments proposed, are in themselves subjects calculated to enlist the attention of all interested in the general welfare of our lunatic population, and in the administration of the laws and institutions designed whether for its protection or for its care and treatment.

This inquiry must be preliminary to any consideration of the provision made or to be made for the Insane. In carrying it out, we have chiefly to rely upon the annual Reports of the Commissioners in Lunacy along with, so far as pauper lunatics are concerned, those of the Poor-Law Board. However, these reports do not furnish us with complete statistics, and the total number of our insane population can be only approximately ascertained. The Lunacy Commission is principally occupied with those confined in public asylums and hospitals, and in Licensed Houses, and publishes only occasional imperfect returns of patients detained in workhouses or singly in private dwellings. On the other hand, the Poor-Law Board charges itself simply with the enumeration of pauper lunatics supported out of poor-rates, whether in asylums or workhouses, or living with friends or elsewhere. Hence the returns of neither of these public Boards represent the whole case; and hence, too, the chief apparent discrepancies which occur when those returns are compared.

To show this, we may copy the tables presented in Appendix H of the Report of the Commissioners in Lunacy for 1857, p. 81.

"Increase of Lunatics of all classes during the last five years, according to Commissioners' Reports 3932

"According to returns published by Poor Law Board during same period 6535

No clue is given in the official documents to the cause of this discrepancy, and we are left in doubt which estimate of our lunatic population is the more correct. The excess occurs in the Commissioners' Returns; for on adding together, in each year in question, the numbers reported by the Poor-Law Board, as detained in County and Borough Asylums and in Licensed Houses, we find that the totals respectively are less than the whole number of paupers as calculated by the Lunacy Commissioners, by the precise difference we have made out, viz. 986 in 1852 and 1261 in 1857. Of the two returns before us, we accept that of the Lunacy Commission, viz. that there were, including those in workhouses, and with friends or elsewhere, 26,574 reported Lunatics in 1852, and 33,641 in 1857; and account for this larger total by the fact that the Poor-Law Board Returns apply only to Unions and omit the lunacy statistics of many single parishes, under local acts, and some rural parishes under 'Gilbert's Act,'--containing in them together above a million and a half people more than are found in unions. Moreover, the Poor-Law Board returns do not include County and Borough Patients. Looking to these facts, the excess of 986 in 1852, and of 1261 in 1857, over and above the totals quoted from the Summary of the Poor-Law Board, is not surprising; indeed, taking the average usually allowed of one lunatic in every 700, the number in one million and a half would be above 2000; that is, more than half as many again as 1261; a result, which would indicate the Commissioners' total to be within the truth.

We have just used the term 'reported lunatics,' for, besides those under certificates and those returned as chargeable to parishes, comprised in the foregoing numbers, there are very many of whom no public board has cognizance. Most such are private patients supported by their own means, disposed singly in the residences of private persons, throughout the length and breadth of the country, and, with few exceptions, without the supervision, in reference to their accommodation and treatment, of any public officer. The Lunacy Commissioners justly deplore this state of things; lament their inability, under existing Acts, to remedy it, and confess that not a tithe of such patients is reported to them, according to the intention of the law . It would appear that less than 200 such cases are known to them; and it would not be an extravagant or unwarrantable estimate to calculate their whole number at about half that of the inmates of Licensed Houses, viz. at 2000. This number would comprise those found lunatic by Inquisition, not enumerated in the Commissioners' summary, although under the inspection of the "Medical Visitors of Lunatics." According to the returns moved for by Mr. Tite "of the total number of Lunatics in respect of whom Commissions in Lunacy are now in force," there were, on the 27th July, 1858, 602 such lunatics, and 295 of them were, according to the Commissioners' tables, detained in asylums or Licensed Houses, leaving 347 not reckoned upon. In addition to this class of the insane there is an unascertained small number of persons of unsound mind in the horde of vagrant paupers, alluded to occasionally in the Lunacy Commissioners' Reports.

The number of Criminal Lunatics in asylums is noted in the returns, but that of those in jails is not reckoned. Although this is comparatively small, owing to the usual custom of transferring prisoners, when insane, to asylums, yet, at any one period, a proportion sufficient to figure in a calculation of the whole insane population of the country will always be found. Nay more, besides such scattered instances in County Prisons, there is a very appreciable number in the Government Jails and Reformatories, as appears from the returns presented to Parliament

The prisons included in these reports are:--Pentonville, Millbank, Portland, Portsmouth, Dartmoor, Parkhurst, Chatham, Brixton, Fulham Refuge, and Lewes. In the course of 1857, 216 persons of unsound mind were confined, some for a longer or shorter period, others for the whole of the year, in one or other of those prisons. Making allowance for those of the 216 who by removal from one prison to another , might be reckoned twice, it may be safely stated that at least 150 were in the prison-infirmaries in question the whole year. In fact, the Infirmary of Dartmoor Prison has wards specially appropriated to insane patients, and actually constitutes a criminal asylum of no insignificant magnitude. For instance, the report tells us that on the 1st of January, 1857, there remained in that prison 102 cases; that 41 were received during the year; 37 discharged ; and 106 remained on the 1st of January 1858.

It is also worth noting that in this Dartmoor Prison Infirmary, 38 epileptics remained on January 1st, 1857; 22 were admitted, 13 discharged, and 47 remained on January 1st, 1858. The total of epileptics coming under notice in the infirmaries of the several prisons in question, in the course of 1857, amounted to 135. The remarks on some of these cases of epilepsy by the medical officers, are sufficient to show that the convulsive malady has seriously affected the mental health, and that they might rightly be placed in the category of the insane.

However, having no wish to enhance the proportion of the subjects for Lunatic Asylums, we will deal only with those enumerated as mentally disordered. These amounted, according to the preceding calculations, in the Government Prisons, to 150, and it would seem no exaggerated estimate to assert that an equal number may be found in the various other prisons and reformatories throughout the country. To put the matter in another form, 300 lunatics are to be found in English prisons at any date that a census may be taken. Consequently this sum of 300 must be added in calculating the total of insane persons in this kingdom.

The average daily number resident in asylums would be a more correct representation of their insane population than the total taken on any one day, although it would fail to show the lunacy of the year.

Lastly, to illustrate the point discussed, to indicate how imperfect our present estimate of the prevalence of insanity most probably is, and to show the difficulties and defects of any ordinary census, we may appeal to the experience of the special commission charged by the legislature of Massachusetts to examine the statistics of Lunacy and the condition of Asylums in that State, as recorded in their report, published in 1855.

"In 1848" , "a committee of the Legislature, appointed to 'consider the whole subject connected with insanity within the commonwealth,' ascertained and reported the number of insane in this State to be 1512, of whom 291 were able to furnish the means of their own support, and 1156 were unable to do so, and the pecuniary condition of 65 was not ascertained.

"In making that survey in 1848, the Commissioners addressed their letters of inquiry 'to the municipal authorities of every city and town in the commonwealth.'

"These public officers had direct means of knowing the number and condition of the pauper insane, and probably this part of the report was complete; but they had no other facilities of knowing the condition of those lunatics who were in private families, and supported by their own property or by their friends, than other men not in office, and could only speak of those who were within their circle of personal acquaintance. Consequently the report included only a part of the independent insane who were then actually in, or belonged to, the State."

"In 1850 , the marshals, the agents of the national government who were appointed to take the census, visited every family; and, among other items of information, they asked for the insane and idiots in the household.

"Making all due allowance for the increase of population, and consequently of the insane and idiots, these figures undoubtedly show far less than the real amount of lunacy and idiotcy at that time, and render it extremely probable that many concealed the facts that the law required them to state to the marshals."

Thus the marshals discovered the number of insane to be in 1850 nearly double that returned in 1848, and from their apparently searching inquiry, it might have been presumed that they had made a near approximation to the truth in the figures they published. However, the most pains-taking and varied investigations of the Special Commissioners in 1854, prove the marshals to have much underrated the number, for the result arrived at was, that in the autumn of the year just named, there were 3719 lunatics, of whom 1087 were idiots, in the State of Massachusetts.

The partial explanation of the divergence in numbers, viz.:--"that it is probable that many of the families refused or neglected to report to the marshals the insane and idiots who were in their households,"--is of itself an indication of one of the impediments to a correct enumeration of the insane members of a community, even when such is attempted under favourable circumstances. It is one likewise which, however operative in the United States, where the public asylums are open to, and resorted to by, all classes of the community, must be still more so in this country, where family pride endeavours in every way to ignore and keep secret the mental affliction of a member, as though it were a plague spot. Besides this, in no English census yet taken, has the enumeration of the insane constituted a special subject of inquiry.

In their last Report , the English Commissioners in Lunacy state that, on January 1st, 1858, there were confined in asylums, hospitals, and Licensed Houses, 17,572 pauper, and 4738 private patients, exhibiting an increase of 915 pauper and of 51 private cases upon the returns of the year preceding.

Considering that the Poor Law Board obtain no record of the pauper insanity in one million and a half of the population of England and Wales, nor of the number of insane belonging to counties and boroughs,--for this reason, that their cost of maintenance is not directly defrayed out of the poor-rates, there must necessarily be a much greater number in workhouses at large than the 6947 mentioned, and no inconsiderable proportion of poor lunatics dispersed abroad in the country not enumerated in the 5500 counted as existing in January 1st, 1857. On these grounds, we assume 8000 as an approximative figure to represent the total of insane poor not under confinement in Asylums and Workhouses, believing fully that it will be found, on the publication of the returns for this year , within the mark.

Private patients not in Asylums, or Licensed Houses, often confined without certificates, and the majority unknown to the Lunacy Commissioners, we have put down, at a moderate estimate, at 2000. The present state of the law does not enable the Commissioners or others to discover these, often, we fear, neglected patients: and, on the other hand, the operation of the laws regulating asylums, and the feeling evoked by certain public trials of individuals confined in Licensed Houses, have, together, combined to render them more numerous, by inducing friends to keep them at home, to send them abroad to Continental institutions, or to place them under the care of private persons or attendants in lodgings.

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