specified, and others boarded with their friends or elsewhere. We, however, learn further, from the same excellent authority, that, owing to the imperfection of the periodical returns, only a comparatively small portion of the pauper insane confined in Asylums and Licensed Houses is included in that total. Indeed, the fact of its being very much smaller than that of the lunatics in Asylums and Licensed Houses, clearly enough shows that the latter are not reckoned in it except partially.
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 (1859), 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.
This completes our enumeration; and the figures stand thus, on the 1st of January, 1858: —
To extend the estimate to the commencement of the present year (1859), we require to add the gross increase of lunatics during 1858 to the total just arrived at: 39,557. What this increase may be cannot be decisively stated; but to anticipate the estimate of it, which we shall presently arrive at, viz. 1600 per annum, the result is, that on the 1st of January 1859 there were in England and Wales, in round numbers, 41,000 persons of unsound mind, or, to employ the legal phraseology, lunatics and idiots.
It perhaps should be explained, and more particularly with reference to those detained in workhouses or supported by their parishes at their own houses, that besides idiots, or those congenitally deficient, a very large proportion of them is composed of weak and imbecile folk, who would, in olden times, have been considered and called “fools,” and not lunatics, and been let mix with their fellow-men, serve as their sport or their dupes, and exhibit their hatred and revenge by malicious mischief and fiendish cruelty. But, thanks to modern civilization and benevolence, these poor creatures are rightly looked upon as proper objects for the supervision, tending and kindness of those whom Providence has favoured with a higher degree of intelligence. This act of philanthropy, effected at a great cost, elevates at the same time, very materially, the ratio of insane persons to the population, and thereby gives cause of alarm at the prevalence of mental disorder, and makes our sanitary statistics contrast unfavourably with those of foreign lands, where the same class of the sick poor has not been so diligently sought out and brought together with a view to their moral and material well-being.
Chap. II. – On the Increase of Insanity
The only data at hand to calculate the gross increase of the insane in this country, year by year, or over a series of years, are those contained in the Official Reports of the Commissioners in Lunacy and of the Poor-Law Board. These, as we have just shown in the preceding chapter, are incomplete as records of the state of lunacy, since they take no notice of numerous patients not in recognized asylums. Moreover, the annual summary of the returns made by the Commissioners of insane patients confined in Asylums and Licensed Houses, represents a compound quantity, made up of the increment by accumulation in past years, and of the fresh cases admitted in any particular year, and remaining at its close. The same is true of the figures supplied by the Poor-Law Board. Now, though these summaries are useful to show the rate of accumulation of the insane in the various receptacles for them, annually or over any fixed period, they do not tell us how many persons are attacked by madness in any year, or other space of time; or, in other words, they do not inform us whether there is an actual increase, or a decrease in the annual number of persons becoming insane.
This question of the simple increase or decrease of insanity cannot be correctly answered. It is elucidated in some measure, so far as licensed institutions for the insane are concerned, by the tables of admission for different years furnished by the Reports of the Lunacy Commissioners; and it may be assumed to be partially answered by the returns of the number of lunatics in workhouses published by the Poor-Law Board, after an allowance made for the diminution caused by deaths which have taken place in the twelvemonth; but no means whatever exist of discovering the number of persons annually attacked with mental disorder, who do not fall under the cognizance of the public boards.
With the materials in hand, let us in the first place examine the results which follow from a comparison of the Lunacy statistics of the Commissioners, instituted at intervals of more or fewer years. By this course we shall attain, not indeed an estimate of the progressive increase of our insane population, but a valuable comparative return of the number of those enjoying the advantages of asylum care and management in different years. The summary presented in each annual report shows that there were in
From these tables it therefore appears that the accumulation of insane persons in Asylums in the ten years between 1843 and 1853, equalled 6140; and in the five years between 1853 and 1858, 4898; or progressed at the rate of 614 per annum in the ten years, and of 979·6 (or in round numbers 980) per annum in the five years under review, or upwards of 50 per cent. faster in the latter space of time.
In their Twelfth Report (1858) the Commissioners in Lunacy attempt to calculate the probable demands for asylum accommodation on the 1st of January 1860, from the increased number of lunatics in the space of one year, from January 1st, 1857, to January 1st, 1858, amounting to 915. But as we have pointed out in a paper in the “Journal of Mental Science” (vol. v. 1859, p. 249), the conclusion drawn from such data must be fallacious. For instance, a calculation on the result of one year’s statistics is evidently worth little. There are many causes at work in asylums which materially affect the relative number of admissions and discharges, and consequently produce an inequality in the rate of increase viewed year by year. Moreover, where the same plan of calculation has been adopted in determining what asylum accommodation was necessary, experience has soon exhibited the fallacy, and both the admissions and the demands for admission have far exceeded the total reckoned upon. To arrive at a nearer approximation to the truth, the augmentation in the number of lunatics ought to be noted for a space of several years; and to make the deduction more satisfactory, the increase of the general population, the conditions of the period affecting the material prosperity of the people, and its political aspects; and, lastly, the mere circumstance of the opening of new asylums, – a circumstance always followed by an unexpected influx of patients, need be taken into account.
In the preceding considerations only the returns of lunatics in Asylums, Hospitals, and Licensed Houses are discussed; but, as we have seen, there is an almost equally large number detained in workhouses, or boarded with their relatives, or other persons, at the expense of their parishes, whose increase or decrease is a matter of kindred importance. On reviewing the returns of their numbers at periods when they have been taken cognizance of by the Lunacy Commission, we find that there were in workhouses and elsewhere, together, in
exhibiting an increase of 4342 in the ten years between 1847 and 1857,
