·1871.

VICTORIA.

REPORT

OF THE

INSPEOTOR OF ASYLUMS

,. ON

THE HOSPITALS \ FOR THE INSANE, . '

FO:a. THE YEAR

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PRESENTED TO BOTH HOUSES OF PARLIAMENT BY HIS EXCELLENCY'S COMMAND.

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till a utborit!1 :

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J?BN l<'ERRES, GOYERl'ClfENT PRINTER, lIfELBOUHNE.

No. 25.

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,Prepa,rlltl(}~-NQt given.

PrlnUng (825 copies)

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" , APPROXIl\1A~E COST OF REPORT.

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1£ S. d.

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REP 'OR ·T·. , ,

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HOSPITAL 'FOR TIlE' INSANE, , Yarra Bend, ; Melbourne; ,28th:' April 1871.

SIR, . .., \, In accordance' with 'the provisions of ,section 56 of, the Lun~cy Statute, I have the honor to lay before you my Annual Report "ofthe'state' and,' condition .of th~ Asylums" in Victoria, and ",of such oiher particulars" as seem "deserving of notice." Th.~ annexed tables furnish detailed information in reg aid ' to 'num bel!s . and results. I would now beg ,tq ~~bmit some general. considfrations, J7eg·arding the following particulars:- ,,' .. ' . , . <-

1. Increase of Lunacy l;ly accumulation., II. Rec'm:eries and Mortality. ..... ' I .'. .f .. ".,' •• ,

\. III. Proportjon of Insane to P9pulfttioiI:": ,-' ",'." .. ' ~ ., " . , IY. Mode' of providing for the Insi:!one i!i' Victori~:"','" !

V. Criminal ·Lu'ilatics.·" VI: Delirium Tremens. " ' ~ : , • t· • , • • • , . •

VII. Habitu:al Inebriates. ' . ' " j

VlI1. Fut~re Accommodation for the Insane. IX. Cailses' of Insanity in' Victoria: ., X. Chinese'Lunatics: " i

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XI. Victorian-born Insane. . XII. SuiCidal cases. >.

XIII. Re-a~1'11issions and Relapses. , ·XIV. Cost of Maintenance.' , ..,

I.-INCREASE OF LUNATICS. BY ACCUMULATION.

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On the 1St of January. 1870' the nu,rnber of insane under ca,re' inthe public , asylums was' 1705. During the year 566 :were admitted; 2'76 were discharged

recover'e9 or relieved; and 135 deaths occurred. On the 31st December the n1;lmber r~maining\' w~s 1849 ; leaving a total increase of 144 above the previous year. The ~'Umberl' of adrpjssions during' the past, yeardo.es not give any- ~ppreciable ,evidence of an incre~ed growth of insanity in the colony,at large.' There were only 31 persons more admitted in 1870 than in 1869, and this num,ber i~ alI!lost eptit.:e,ly a.ccount~d for, as will hereafter be seen, by the pl'oportionate, , increa)Se of the population. The augmentation, by 144, of the number of lunatics remaining under care in ,the asylums is due to the accumulation of chronic and for the most part incurable cas,es; a process t,hat has been iI]., operation since the establishmen~ of th(3 colony, and has ,caused ;-an ~ddition to .the'numbers in liach intervening year. ,-' "" '

_.' 11;1 the last Report an opinion was ~xpressed tb,at'.' during the present year (1870 ) some increase IDustu1;1doubtedly be anticipat~d, but it may. be less~than/that ~hich aCGrued during the 'past year, since the increase betweep '1868-69 has been of smaller amount than that ,between 1867-68.'" The jncrease durin 0', 1870 has -in, -fact been, numerically le!3s tha1;1 during 1869; Gonsiderably less w~en. the, increase of the population, estimated at 27,000, is taken' into account; and very much smaller than during 1868. .' , . 'j' '. -" ". , '

I It is again needful to' 'bear in mind that a gradual,incr<;>ase, for a certainpe.riod of years, of the total number of lunatics remaining under care is a result inevitable in any young colony. In this respect.Victorii:!- has only repeated the experience'of, all other colonies,an 'experience due to the conditions under "vhic4 they h~ve l?eell, formed. The col0ny was es;tablished chieflY.by the ,influx· of healthy ad~lts; only a very small nup.lber of in~al1e .persons, were landed among the.'iIp.llligrants'-the insane· members Qelonging to their generation being .l~ft _b~hjlld ..• , In)ts ,il,ifa:ncy. th,e. ;col.o:tlY therefore enjoyed an almost complete immunity from a burden which hangs 'on every Civilized

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cQmmunJty. But after 'a little while insanity cQmm'enc~d to. develQpe itself in thQse lia;ble to. its attack frQm 'whatever cause. Every year a number Qf new cases came under treatment; _ Qf these a certain prQPQrtiQn _ were discharged cured; in a certain p~QPQrtiQn a fatal, result Qccurred; b,ut a, balance' was always left, CQmpQsed Qf the

• uncured cases, which thus accumulated year by year. As,the insanity latent in the immigrant 'PQPulatiQn becQmes, so. to. speak, wQrked Qut, this prQc'ess Qf increase shick ens, and shQuld reach its natural limit at the expiry Qf a generatiQn. . Tfie prQPQrtiQn to. PQPulatiQn may then be expected, Qther things being equal, ,to. remain statiQnary; Qr, in Qther wQrds, the number Qf admissiQns shQuld be equalled by the discharges and deaths, with'the exceptiQn Qt any number due to. the grQwth Qf the PQPulatiQn ..

The statistics Qf lunacy}n Victoria frQm the 5th October 1848, when the asylum at Yarra Bend was Qpened, up to. the l~st day Qf 1870, may be'cQmpressed into. a very brief statement :- . I

Admitted from 1848 to 1870, inclusive ... Recovered or relieved Died ' Escaped or l:emoved .•.

Remaining in asylums 31st Dece1pher 1870' . . ... 1,849

'fhe number nQW under care jn the asylums -is, in shQrt, the surplus which remains after deducting the discharges an\l deaths frQm the admissiQns during the same periQd. It is cQmpQsed Qf a large sub-stratum Qf chrQnic cases, the result Qf'twenty- ,

'twO. years Qf accumulatiQn, mixed with a, flQating PQPulatiQn Qf curable patients W~Q have c,ome into. the asylums mQre rec.ently. The way in which tijis result CQmefj abQut cannQt be mQre. strikingly exemplified than in the table (p. 38) giving the leJ;lgth Qf time during w,hich the patients who. were cured in 1870 had resided in.the asylums. Out Qf 228'persQns who. recQvered, Qnly 8 had,been inmates fQr mQre than two. years; 16 had been inmates' between Qne and two. years; 204 had recQvered within twelve months frQm their admissiQQ.. These results are in accQrdance w:ith the general experience Qf asylums. NQW in the Yarra Bet;ld Asylum, at the end Qflast year, 749 patients Qut Qf a tQtal Qf 1043 had been resident there fQr mQre than twelve mQnths ; 614 fQr more than two. years. Xt will be seen hqw extremely small a PQrtiQn Qf this, number is likely to. reCQver. After two. years the expressiQ~s ," chrQnic" and "incurable".

, becQme almQst equivalent te~'ms. ,It is true that no. effQrt s4Quld be }ntermitted to Qbtain a favQrable res,!lt .... even when derangement has existed fQr many years, since recQveries d9 QCcur, thQugh rarely, in spi~ Qf thelQng cQn~inuance Qf mental aberratiQn. It is also. true that. the individual patients who. will resPQnd favQrably to. treatment cannot a1ways be singled Qut from thQse who. will remain pe:t;manently insane. But

. althQugh it may nQt be PQssible to. number the curable and incurable patients with perfect exactitude, it is Qnly too. evident that, in the mass, mQre than·twQ-thirds Qf the inmates Qf the Yaira Bend Asylum will-never be fit fQr restQratiQn to. the Qutside WQrld.

,Extending this inference to. the Qther asylums, the cQnclusiQn is' reached that Qut Qf the 1849 patients undei' care, 1200, in rQund numbers; belQng to. the ~hrQnic and ' permanent grQup. Ho.peless. and lamentable as are the prQspects o.f these men and WQmen, they canno.t all be eliminated fro.m lunatic asylums; many o.f them demand a

.large'r share o.f medical supervisiQn Qr attendance and o.f vigilant' watching, to. alleviate their sufferings and keep them in safety, than do. the curable patients; many Qf them are suicidal, ho.mici'dal, destructive, Qr afflicted with bQdily disease. To. the remainder, whQ'are harmless imbeciles, attentio.n will afterwards be directed. The Qnly measure Qf success that can be cQnfidently ainled at is,tQ mitigate the disease by making their Jives as safe, tranquil, ~nd cQmfQrtable at' po.ssible. These chro.nic cases are gradually thinned each year by the mQrtality; but each year also. there is an additiQn to. their ranks, and sQ'far the number carried Qver to them 'has been the greater o.ne. It i!? nQt u'nreasQnable . to. fix the limit Qf their increase at a generatiQn, which canp.o.t be quite'

, .,reached so. lo.ng as survivQrs linger fro.m the Qlder years. At present there are l~ving representatives frQm the admissiQns fQr every year since the first asylum was Qpened, thQugh the number grQws smaller as the enquiry travels farther back. 'SQme Qf them, have sUrvived every Qfficial who. was in the institutiQn at the. time o.f their admissiQJ;l. Tl~e extent, to' which life can be prQIQnged in'an asylum is'very remarkable. 1'he first , patient who. . was admitted to. the Yarra Bend Asylum died during the past year, after s.uffering frpm bQdily illne~s fQralQng periQd, andthere are still Qthers standing Qver

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rom the same year (1848). In the records of a Scottish asylum at Dundee (from 1820 to 1866) there are'instances of inmates who survived for thirty-three, thirty-six, and thirty-nine, years after their admission. >11' ' • •

In the sister colony of New South Wales the process of increase has been in -adval!ce of that which has/ occurred in Victoria, and has been traced to the same source. _ The Inspector of Lunacy in New South Wales (,where the proportion is higher than here), in the course of his valuable report on lunatic asylums, remarks, in speaking of the Australian Colonies ;_ I . !

"The ratio in the 'older settled colonies of Tasmania and New South Wales differs very little. In the newer colonies the mass of chronic insanity, with which all older countries are burdened, has not had time to accumulate. At leastjifty years are necessary for such accumulation."t

There scarcely seems to be sufficient reason for making the period so long as ,C

fifty years. Unless the rising generation of colonial-born show more liability to insanity than their parents, o{ which there is no evidence, or some other important change,

'" affecting the rate of insanity should occlir, the' accumulation ought to stop at an average generation from the arri~al of the bulk of the immigrants .. It is also to be hoped that the Victorian rate may continue permanently. lower than that of New South Wales. The latter coJO!lY was placed at a disadvantage by the existence of a convict element, amongst ,,,hom. imbecility and the lower forms of insanity are comparatively more freq'!lent. .

. A similar result, and from causes of the same kind, occurred in the United Kingdom after the. opening of the new county asylums .. 'When one of th~m was established in a district the lunatics from which had been previously provided fo, elsewhere, it was noticed that year by year the number remaining in the asylum became larger. 'l'he result was so universal, that at the first glance it was imagined to show a suqden and startling increase of insanity among the population, until it was made cle:;tr by further enquiry that the increase was in great part due to the accumulation of chronic cases. The present Chancery Visitor in Luna~y.for England, in his comments on the statistics of lunatic asylums, puts the explanation in a brief form :- . '

"The increase of the insane il1 asylums admits of a more simple explanation than the theory of the alleged increase of lunacy. ,Of every 100 patients admitted in a given period into an asylum, it is evident that a certain number must remain over to swell the nnmbers, viz., the difference over the discharges and the deaths."t ' '.

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The same authority very recently adduces the table presented in, my last Report as "another statistical illustration" of the apparent increase of lunacy, and presumes that "no advocate of the doctrine of the increase of insanity would argue from this table that the lunacy of Victoria had doubled itself in the decennium 1859-69'" II

It would be easy to multipy instances from other parts of the world where this 'conspicuous feature in the 'growth of lunatic asylums has been observed and its cause recognized. / / . . .

The history of gaols or penal establishments does not furnish an analogy from this' point of view with that of insanity. The number of offences against the laws, and the proportion of the offenders to the population, when the community is young, may be much greater than in its more mature state, when social order becomes fully: established and the machinery for preventing and punishing crime.is completely organized. For a time the prisons -may actually diminish ·in the number of their inmates, while the lunatic ftsylums become full. Insanity is a disease in which about 40, per cent., or rather less than one-h~f, of the cases are cured. . If it were allowable for one moment to imagine that in more than half the criminal convictions each year the punishment had been imprisonment for life, a large- class would thus have come­into existence who would have accumulated in the ga9ls and steadily increased .in numbers, corresponding, though only in this one point, to the class of, incurable lunatics who have accumulated in the asylums. But, as it is, the increase in the number of lunatics belongs more nearly to the same category as the accumulation of

I those afflicted :with loss of sight, old age, or physical infirmity of any kind. Although the community started with a population for the most part in the prime of life, sooner or later disease must overtake even 'the healthiest, and' hence the general hospitals,

... Forty-sixth Report of Dundee Roya.l Asylum, 1866, p, z9. t Dr, Manning: Report on JJunatic Asylums, N.S.W., 1868, p. HO. t On the Alleged Increase of Lunacy.-Journal of Mental Science, April 1869. p. 14. II Journal of Mental Science, J~!luarr 1871, p. 476.

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benev~lent. :asylu~s, orphaI)-' asylums,. asylums for the blind, asylums for the deaf and du~b", or . (when . t~e brilin': pl:ecedes . the othe,r' organs. in decay) :the lumltic asylums, enlarge in numher. . ._.' .,' , ': '" .. : ,: " , 'If "", -In,·this',<1;;planation of tl1e growth'of the number of the·insane~Wlder care it 'is -p.ot implied .. that there. is: any ,hidden necessity, which .has fixed the p'~rtici:t~ar amount of. increas~ during ~he.,past,: Ol~ tlu\>t .will force the numbers to rise to ,SQme particlilar staud~r.d,in the.futlll'e. '. OI?-.. ~he pontr!1ry, the increase:mayrbe 'more.rapid'·in .oll(t colony than in another, just as the rate of insanity varies,in.diff~rent countries. "And in this colony, if any large cause had been absent and.its place \iot'Suljplied by others, the :n,il,mber 9f}t:dmis'sions vv:o.uld' hav~ beens~aner; and there w'ou:ld ·15e fewer lunatics now in the asylums. 'l~heqriestion of. the <;.auses of insanity' in Victoria wWbe exarr,tined in a subsequent, portion of the'Report; but it is oniy intendeq now to shoW-

\ t.l~at tHe ,fact qf ~ncFease ;by' the aCCllmidt,tion of ~hl;onic cases gives ,no: ground' in itself ~or'coric~udingl that' the':co'l'ony' o,ccnpies'.' al position at, all ::pe!?uliar or unfavorable, since, .. 'at the very best,: 'some annual, iiicrease' nillst needs hav(t occu':d:'ed. ' Supposing that. in 4'i!new 'corrnr:tunity a'ny of th'e causes bf insanity, such 'as inteniperance; were suppressed oi' absent,an'd, in·:cons'e.quenC(~'the'n:illnbei'·Of ·persons':yeady'·beil'oming Insane :'hy, 'so I'nu?li, smaller';' SUPIfosil1g " 3;lso thaFthe:-' treatineut .,yas exceptionallysuccessful"stiJI' some 'patien,ts 'iIflist'arinually 'be'len' uncured; alid "bf these -not·an:.,,~olild "die. J: The remainder would of necessity accllmulate for a ter';ll of 'years. ' , ': =":.' ", ': ",'"

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'c'. J:' ,I I ;.,'~ "" ',' n.-RECOVERIES A~P ~ORTAL1~Y. , .'

,.', :, . ,'The,g~neral conditions' affecti~g the number Of the 'in~ane' ~r~ .6£ t,,~~'i~i~d'~-. The f!rstr ~re ,those whIch .~ct: outside the.' asylums and are beyond theil~ controL;,,:the ~eauses : pl~oduc.ing insanity ,among the people" which' 'result in a" larger or srualler ,'i1Umhel~'of annual adl'nissions.:, The second are: the influences at work in' theasylitms themsel'ves.' Looking for the present at :th~ latter, which concern the managenlentof

, ·the·' asylums" there are,. two points. directly.connected with, the increase' or. decrease of ,the,numbers. ',These are theTate:of cures and the'lrate ,0Ldeaths .. :· The,;'larger.lthe pro,portipn 9f ,<;,ures.aJIlong .thos.e. admitt,eq, and, the larger the, mortality ~mong the

.. patients ;resident,. the smalJer would he the, munber·left a,t the\ end of .each year to add to the ~ormer total. 'On the other hand, a small propoi-tion of cures; or. a s.mall,pro~ portion of deaths, would increase the number." It may be well to determine ,the posi~iQQ of. the V.i~tor.ia.n a~ylums in regard. to the~e points., " , ; " ' >:'., :, 'J.L "Rec(YI)erie.s~-' The :propolitipn.of the·recoveries',calculated on tpe. adlr!-issions is,. for '1;8.79" '49 per cent., or .48 per, cent;, ,includin.g th,e ·cases ,relieved,. a very similar rati~ tQ .th<tt . obtained. in .. l 869 (page 37). .In other words, out ofev,ery hundred persoJ).,s .. whoen~er ,the, as)' luros" {orty leave, them ~ntirely restored ,to reason, and eight :additio.Ila;l!are so far re,cov~:r:ed:as;to reside with their,:friends .. , Now the average dr.~wl1 from the data furnished hy the whole of the English asylums for a p.eriod of elfyeq. y~ars,. is:not q~nite.' .. thitty-four per, cent> (33'93')1:). In, this respect, therefore, the ;1sylums,oLthis C<2hmy occupy a highly· gratifying position .. -. .'

• " " , 2. 1v.Ior~f1tity.-A high rate ,of mortality obviously lessens .acculnulatipn ; but it. ought; to be the stre;tmou!3,ahn of a~ylUll1 ma~ag({ment, in ohe(1ience to t,he dictate$' pfhilUl:Hlity,~ t,O"pr,Q1ol+g ~~ far a&possible t'\Ie life of every pa1;.ient whether 'incuraN~~ 'or ,QUl;ableL.Tb.e fairest ~i1d Ippst unexceptionable tests of gen<;lrn.l efficiency that can 'be applied are a good rate of cures and a low, ~tandard of 1110rt~lity. In;:Victorian'

. asylums .the .rate of mOl:tality has been for some years past COrllp~fatively ,~m,aILrrhis fact, highly satisfactory in itself,. h!:1$ on' the, other sideliad .~ considerable share in contributing tb the~ '.numb~rs~they now·contl;l;in. The proportion of de:;t:ths, .in'!tlle English asylums" ~erived froQl the whole of them for a peri~d of elev:en years, ~s 16'·34 ' :per cent. ti ten, out of every' hu~(h'ed resident die each year. N ow if~ in the Ya~a 6&~nd:.AsyhHn" the,lIlort?;lity qnring ~he·r1ast five, .y.~ar~ 4ag,~q~1.9w~e(l.t!~e uS'!l;alE1p'gHs~ '.tate";there,,Would. ha;v~ .beQlh'497, death~ insteap, of .th~"~3.2/?::,t~::tt ,a~c~}l.~PY:Q,c<:~rr~~I; ltIl"ere;$Quld J~~iveJ,)een· £ewer.iinmates· ,1;>y ·17 L tha;l1 .. ther~, a~'<: a:t Er~~ent:" "Q~, t~~~g -·tlie .. :~p.t:;tl~~ furpishea bj,;th~ Y,ier.onan. ~Y.~llrps; fqf.l~~\3 'P~st'F~ar·loI:t.ly, i~.!Vm be .. ,s~~lll .that.,the . .,nl,l;lIlber ?f .. death.,$: .. ;W~$, .. 13:S:; .• ig!y'l!ng a ,pel1c,ent;:tge ,Q~-/'r7 3· (.pag~',3.'l).· " ¥. ;.ths ~.ngJ~sh}:ll:~_~~,4.e~!~~~ft,!.±I ~ore:would have died. In other wqrds, very nearly one­

, third of the increase fot 1870 -( 144) in"the 'number of 1'llna1ics' remaining -has' 'directly depended on the greater,.l~ngth.oOife e)1.joyedhy the.il}sane, in the Victorian asylums.

tv-f'onrth Report of 5·

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, IIT.-PROPORTION- OF INSANE "TO· f:OPULATI6~. . . <

The statistics ofluna:cy~in,V~ctoria, up to'i869, showed 'not bnly·that·t~e total number.of in'sai;I,e had gr~d;uany ihcreased, whi,ch was certain to occ:rr, ·but a~so t?at it was rising. in so .large a' degree as to approach the home proportIOn. ES~lillatmg the population of' the colony on fhe las~ day of 1870 at 738,200, the proportion now stands at I lunatic to every 397 'persons. , . .

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1861 ... 54~~800 1861, ... 555,744, 1863

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. . 1864 . - ... . 6°5,5°1 . 1865 ... 61,6,639 1866 ... 643,911, .. i8b7 ... 959,887 .. . 1868 . 684,3 16 • ...

.. .. _ ... _ .. ~ 8~9_ ........... ~~~. ,_. ».71.<:>,3)7 .. 1870 ... 73 8,1,00

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.. Total NU1;l1ber of Lunatics

on 31st December.

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1,001 1,051" 1, 189 1,1,80 1',559

.1,7.?L, 1,849

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Proportion to ,

Population. .,

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" 670

" 604

" 595 . " 541 ,

.. SIS "., 439 . ... 4155

" 397 .'

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" :,This,'rate for:Victoria is as nearly as· possible on a par witkthat recorded for England' and Wales. .' . ' .

At the close of 186:9 the English proportion was I in 403,* to which it had r~sen from I .in 41 I the previous year·; the)ncrease"being considered to be partly due 1;0 more complete. registration., ,An increase of a simi~ar amount from the same cause :will most likely be shown when ·the Report ·for 1870 an;iv.es. ,The colonial ratio for 1870 is ,therefore .slightly over, the English reported. ratio' for 1869; and probably slig4tly, undel; tpat . fer 1.870.; .. The numQ,ers. are so close' that .they are practically

. tdentical ; since a very small error in estimating the j population would- turn the scale in one way.or the other. If,the present cenSus shows, 'as it 'possibly may, that the estimate is' under ,the' actual numbe:r:s, the rate of lunacy must be con:espondingly lessened. . \ ..

But the English proportion does not represent the British proportion or the proportion f9rth~ United. Kingdom. < Victo!,ia compares more favourably with the other .divisions: : ,The ratio in Scotland and Irehind is much higher than in England and Wales '; not, it is I thought, because there is actually much mQre lunacy in the former· countries, but· because. the less perfect regiRtration, makes ,the proportion in 'Ellgland appear' to be smaller than it actually is. The ratio· for 1866 for Scotland is· calculated·: at-I. I· in 368.; for Irela;nd 'at I in 325.t . But it may, I think, be made evident that the :later rates for Ireland are· partly artificial, not the normal UIidis­turbed proportion. Ireland forms' in fact an illustration, but in reverse, of the process that has ·been described as· operating in the colonies. In the course of the large emigration ,th~t . has been draining that country for ma:p.yyears, the insane have had ~o be left. pehind, ·directly .causing a rise in the proportion they. bear to the remaining inhabitap.,ts. '. At the census of 186 I the number of lunatics was the same or slightly in excess 'of that r:egi~tert7d·tep. years before at the census of 1851. But the general population,.had meanwhile run down by more than thre~-quarters of a million.. J us~ as the ·new, communities formed by ~he ip.coming' tide would show a temporary freedoIp from ins~nity, so the· m9ther-country would exhibit a burden correspondingly increased. If then allowance. cou]d be maqe for ~he disturbing ~lements that affect the rates given for the different divis~ons of the United Kingdom, it would probably be found that the three countries were not far apart; the average

'for the United Kingdom would be.about I 'in 368, or the estimated Scottish ratio. It is therefore matt.er for congr~tuJ~,~i~n that the'proportion of insane is still considerably below the'standard of the U mted Kmgdom. ~ '.

It is essential to distinguish carefully between an increase in the total number of lunatics caused by the residue' Qf uncured case& from former' years, and an increased liability to insanity ·among the population at large. 'The two things' are

.. Twenty-fourth :fu:port of English Commissioners in Lunacy, p. 4, ta.ble z. .. .. ....... '- .... ··f ·Dr,·Manning's·Report"p,· I 09· . ,., . ~

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sometimes conful'ed under one phras~ when reference is made to 'the growth of lunacy in the colony; but one of them may exist without the other, ,The first has been already elucidated as a result tp some extent inherent in the growth 'of a youna. co:uptry, but which haS already begun to slacken in Victoria, The second is ~ phenomenon that would give rise to great anxiety for the future. It would be a subject for most serious alarm if the Victorian population were found to be marked by ,an i~creasing proclivity.to mental dis~ase. The proper measure of, the tendency to Insamty. among a people IS the proportIOnal munber of those attacked by insanity each year. The experience of Victoria for the last two years is 'furnished by placing the annual number of cases sent to the asylums side by side with the population amongst whom they originated. ,

Estimated Popu- , Number Proportion Year: of Admissions to 'to , lation. Asylums. Population. ,

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-1869 ... I ... 710,87,8 535 I in 1,328 , "

1870 .. . ... 738,200 566 " 1,304-

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There has been a numencal increase of only 31 in the admissions of the past year over 1869' Twenty out of this numJ)er are due to increase of population, for'if' the tendency to insanity had been identical in 1869 a:p.d 187o,.the number of admission,S during the }ast- year would have been 555 in place of 566. The' source of the remaining I I may be inferred from the table ,giving the ages of admissions. During the past year 93 persons above the age of 50 years were admitted (page'38, table y.); the 'number for the preceding year was 80. A sQmewhat larger number .probably of immigrants long resident· in the colony would seem to have been attacked by brain disease as they entered the decline of life. It is clear that no increasing tendency to insanity among the p,opulation at large can be detected during the past year. The distinction between a~ increase of insanity among the' population and a simple

,increase in the number of the insane by accumulation is well illustrated by an examina~6n of the female admissions during the past year. There were fewer women admitted ill' 1870 than iii. 18691'219 in place of 225 ; but at th,e end of 1870 there were 51 more female' patients remaining in the asylum.

" A great help in judging of' the future might be expected from / a comparison measured in this way between Victoria and other countries; but in trying to ' compare the yearly admissions to the lunatic asylums an obstacle is met with at. the. outset. It has just been seen that ~he proportion of insane of all Kinds is smaller in the colony t.hap. f,tt home. When we turn, to the annual numbers of those who are sent to the asylums in England and Vic~oria, a large discrepancy is manifested, caused by the different modes in which provision is made for the varions classes of the insane.

IV.-MoDE OF PROVIDING FOR THE INSANE IN VICTORIA. I

Notwithstanding the fact that the proportion 'of insane has always been and still remains distinctly below the level of the United Kingdom, the impression pr~valent

, among all who have not been led ,special~y to examine the subject is decidedly to the contrary effect. Such an impression cOlud indeed. scarcely fail to force itself on any one who after arriving in the colony should compare the growth of the lunatic asylums with the populatioll. The explanation ljes in the'different modes in which prQvision is made for the insane, which will be evident from a short abstract.

DISTRIBUTION 'PER CENT, 01<' THE IN~.A.NE IN ENGLAND AND VICTORIA.

, ,

Where maintained. England and Victoria. , Wales.'"

, , . . . ,.

In Lunatic Asylums 66 100 . ... ... ." , In Poorhouses ... , .. . .. 21 ... Boarded in Pri~ate Dwellings , ... ... 13 ...

~ -100 .100 -

'" from the Twenty-fourth Report of English Cominissioners in Lunacy 1869), pp. 4- a.nd 5·-

\ ,

, . In Victoria the whole of the insane population, with very trifling exceptions, has

been poured into the lunatic asylums. In the United Kingdom one-third are provided for in other ways that are thought to be equally suitable and more economical. In Victoria the number of asylum patients is identic:al with the total number 01 registered lunatics in the colony; in the mother-country: there, is a wide difference between the two" The immediate consequence is that "the insanity of Victoria is presented in a more striking and tangible form. Elsewhere the insane are distributed in lunatic asyhuns,. poorhouses, and private dwellings; in Victoria they are concentrated into lunatic asylums only. 1n round numpers there are half as ,many more' persons kept inlunatic asylums in the colony than there are in England; hence also the discrepancy previously noted -in the proportion horne 'by the admissions into lunatic asylums to the population at large. In England, during 1869, 1 person out of 1973 was sent to au asylum;* in Victoria, during the' past year, lout of 13°4. Just as the proportion of insane at present Jiving in asylums is one-third less in England than in Victoria, so the proportion of fresh cases sent there during t11e year differs ip precisely the same degree. One-third of the patients committed to t"Qe. Victorian asylums would in, England have been kept at hQme, with, if needful, a small allowance for,their support~ or have been placed in the local il}stitutions for th~ poor. .

Asylums and hospitals for the insane were established for the care and treatment of those who could not be properly managed without them. They are intended for,( 1 )

curable cases of all kinds, and (2) those who are suicidal, destructive, or dangerous, whether curable or not. ,For these the method of admission cannot be too prompt and easy, both for the good of the patients themselves and of society; and all appliances for their care or sa,fe-keeping should be ungrudgingly s~pp]ied. A large class remain who are marlied by !llental deficiency rather than mental aben-ation ; the mind being partially extinguished rather, ~han deranged. They would at .one time scarcely have been considered lunatics in the strict sense of. the' word. Amongst them are to he found idiotic children; semi-idiotic adults; the paralysed or infirm, in whom weakness of mind has followed weakness of body; old men or women in their dotage; . confirmed epileptics who are not violeut; vagrants worn out in body and mind; and the simply imbecile who have not sufficient sense' to look after themselves and earn their own livelihood. . These weal\: -minded persons may be briefly called the imbecile class of insane. They are essentially incurable, and with some degree of care usually harmless. Some of them are able to do a little ,,'ork, hut most need a certain amount of wat~hing, \ nursing, and medical attendance, as well as shelter and support. Nowhere but in - , Australia have they been maintained as a class in the lunatic asylums. Under the more modern and wider definitions they occupy a place in the enumerati9n of the insane population, described by the English Commissioners as consisting of "lunatics, idiots, and persons of unsound mind." A very important practical check to their being sent indiscrilninately to British lunatic asylums exists in the immediate responsibility of the parish for their maintenance at the current asylum rates. The custom of providing for this class in poorhouses is by no means a peculiarity dependent on the operations-;of the Poor Laws of the United Kingdom. In America they i'eside in large numbers in .institutions corresponiling to poorhouses or benevolent asylums. . It is estimated t,hat there are from 30,000 to 35,000 insane in the United States unprovided with accommoq,ation in the hospitals for the insane.t '

In Victoria .the lunatic asylums 'have gradually come to be the refuge for all . who can be declared lunatics, idiots, or of feeble or, unsound mind in . any shade or

degree; without discrimination as to .their suitability for asylum treatment. In the first Inspector's Report (for 1868) attention was directed to, the influx into the ~unatic asylums of a number of the imbecile class. Some of them had been previously maintained in benevolent asylums and general ho~pitals, but when the new Lunacy Statute came into operation advantage w~s taken of its facilities to transfer these iIJ.mates to the lunatic asylums. The forms of the Statute for the most part resembled the English precedents; but .there was no compensating Poor Law legislati9Il- in existence and no system of local responsibility, to prevent their receh .... ing a wider application. The, numbers in the public asylums rose in consequence from 1280 on the'last day of 1867 to r556 on the last day of 1868, giving the largest annual increase (276) that has hitherto .occurred. The process still continues. Imbeciles are sent to a less extent from charitable' institutions, but very largely from among the population

.. Calculated from the Twenty.fourth Report of English Commissioners in Lunacy, pp. 4- and $. t Pliny Earle: On the Insane Poor in the U¢ted States.-Journal of Mental Science, October IS6S, p. 366.

/

10

~~hrough! th~ .ni,~~UIl)., oC the p~oli'ce, c.:mrts or ,gaol;. ,I .When,~ for, example, ;a. -destitute 'j:;tnd: .w~ak~Jnii::tded though,.'inoffen'sive persop is brought l,lnder the notice:Qf t1;te po!i,ce, pi~ cOinmitta~ t.o, a lunatic asylum, i~ . the most direct and certain .mode, 0(i:il~6yidiI).g -:for .him .. ·Should there "be a local benevolent asylum 011, hospital, the,candid11tesJor adinission have to undergo::.), process of selection, in.which, an imbecile wo:uld g~nera1ly 'p~ ,excluded'. ,The, choice. seems, then to be. between, the 'g~ol al1d the lunatic aSy'i,um, ~nd. there ,~3:~ be ri.'9 hesitation in certifying that ,the, patient is' m@re ~uitabl~ for' car~ ~rid.treatme:t;lt i:p., an asylum ,t.hall .in a ,lock-up. ,It. is ch:;tritable,.,to' the p::.),ti~I).t,' ,arid practical.ly ,t1;t~ m.ost feasible course, to tran~mit him to an asylum. ·Once' withill:,the ~alls,t1:;I,ere ,is, . for' him" no: outlet., A . general , hosp!tal, . 11 benev.ole~t· asylup1, . or an '.jI)imigran,ts' ho.~e :~can iS~n~ !1 patient "to" a,lunatjq asyl~m" either, through: the ,poFG~' .. 9r·. by ::;t:priy::.),.t.e· .order. ~igJ;ied" by an officer .of the ipsti~ution· and. a,cco.mpanie~ . by

. ,gert~fi,Gates .. ,But- nO,OIle can b~, seIlUn 'a simiJar way,f'rorq a lunatic :;tsylum to o·l\e. of \ .tlie. other,institl:lti9:gS:' ',Sh@uld aI),inmate "be . found to. shpw 'np prQpensities, rendering his d~tention -in'~ lun"atj? ~sylum n~cessary, altho,~gh fro.p1 w~a~ness of body or ~d ~~!1rFIx?,~p~Ildent qn}he ~~lp of'others, ~h~re~~.noavail~lile'~ayj~·w.bich l':H~canJ¢a~e, It.·'. I lie b~,nevolent asylums"so far from reC~IV1,ng ,h:;trmless lp1beciles fro.m the h,matlC dsylums' (as 'do the POOi'ho'uses at home), or those who' . DecOl;ue' ,i~15,e.cil~ in' t~e surrounding·p.opula.tion, desire.,on the. ,contrary to. send any"imbecile'iriillates they:may 'h~pp~lli to 'have' 'to. the .lunatic . ~sYl1pi:ts.: It'is 0 bviolls also ,that, the local'institutio:t;ls, in d~qiding on Jthe apI)licarits for . admission, woUld give the p~'efereiic'e to the Siinp~y. irifirm 'over 'any who ~ere already housed in a Govern!1lent asylum, or might be sent to o-qe \)n ,the' gr,o'und: of weak'tess of mind. It. is, equal~y natural that ,they.should seek: to 'transfer, to the)unatic asylup1sa.ny inmates afflicted with paraly!,is or other incurable ,~disease:, 'foIl9,~~'(r by)l#be~ility, in' order to save, ·by Eassirig' it QV81;, 'to 'another ,iristit.ution~ ~he. incr~asea' 'exp~nse' and attendanc'e that these 'patiel1ts, eiltaj~.' 'There ,Is tlius nci';cpecK to 'the admission a,ud deterition ,in ,the, hmatic asYhJ.ins or'inaiiY who '~:olil,d 'iH)t,.el~'e~her~,15e'kept,in, ·the~. ,":".... : ". " , ., .. "" .";. '~" JUnder'thegen'eral'hea,d~of ",Lunatic Asylmlls." in the abstraot just given al~e 'i~Clu~~a private' asyiilUi~ (lice'used 'hQ~ses) as~ well as publl,G a~Yl,um~.,· 'O~t~C~h~ asylu~l'irin;i~les\i~Englilrid . .and Wales, '~y 'the last report, 27,98q wer~in Imblic,"a~a '4904 'iri'p:riv,~~easyhims:* The correspori~irig miillbers for Victoria are r849'and"i7, ,gi~ing}lie.f?I~R:'Yi~g 'pe~centag~ :~.. ,,',' '" .. ; ".', . .'.., I' '. • , .. ' ~ : ,:'" ',: , , ,

.' ' . ~,: " ' ~., n ... , ;';PERCENTAGE :DISTRIBUTION OF ASYLUM INMATES; .. ~ . ~ .... ,,-,i .' '~ .' . " ." I •. ,:' ,"'~ ,,. '\

o,J ". ',f' \.,i , .'. .. ;Wher,e Resident,. " .. , England, Victori~" ' i' '. ..~

. . ·Iii rublic AsyhuDs:' ' ... " .8;5' 99 , ... In·Private Asylums, .,: . 15 .' I .,:. ;_. t"

\' '.t",'L ... :. '. . ,', .

.' I . ~ ,

,100 , , ' ., I. , " ·t.,.

100 I , '

, .. <This great. d,ifi'erence should be .tak~n into - account' as \ adding still further' -to the impression of extent due·, to the almost ,comp]~t8' conceI;l;trationof lun~cy'· into ,the Government asylums. It is peedful to· remark that the' proportions ',do not quite represent the 'relative' numbers o{ paying patients ·ard of those maintained at the public 'expense. -A certain number of payi~g, patients reside in the public ,asylums. ' " .

It does not at,~mcefollow from this explanation of the different usage in regard to the,distributi,on of the insane tliat it is advisable or p(11cticable to,remodel the' present-,plan after the fashion of that adopted in, other countries. The ,history ·and:. circumstance~ of th,e e~lony' have uitavoidablyled to"mnny 'differences in its public: institutions. To bring alllunaiics under one'centralized lunacy 'department is at least a· siinple and uniform scheme with hone of the evils of divided lJ?anngement ,anq conflicting responsibility. It contmsts ho~ unfavourably with;-the 'multiplicity 'of " administration 'in England, The Lunatic Hospitals in that:.countryare ,institutions " founded o~ partly maintained ,by, private charity or munificeJ;l.'ce ;::the County.Asylum~ are:, iustitutibns locally governed', ·and· supported, as, to 'Irlaihtenance, from the lViion rates-· . as to buildings, from the county rates; the Poorhouses, 'coIitainingthe,imbecile, poor, are managed.,by the parishes; the Guardians of the'Poor ai'e partly responsible

.' , .. . . .1

.,,' t. ,~ .. ; r : 1

Twenty-fourth Report of English' Commissioners for 1869, p. 1. ", ,.;j. ,"',~ ~I 1- ,., .. ,: . ':':: :j'.! ,<~t' .i.. .. I.!~·

, -

1,1,'

for, 'the cases hoarded out; thePQor Law BOfl,rd ,h~s a ce~tain supervi~iop. over- the poorho,!!ses ; -and tlie Lunacy "'Board has large powers of visitation and criticism; but nbt of administration. There are·forty-one Acts'of-Parliament affecting the insane.:*' TIns varied and, often 'clashing machinery has been put together in fragments. under the pressure of the needs that have ,been felt ·from time to time. It can, scarcely be looked upon as final, or ,as offering a model which a new country should copy in all its details. Each scheme must be judged on its own merits. ' There is no plan which is absolutely best for all countries and under all circumstances; but -every country

, slIould seek. t9 frame' one that, is, for it, the best practi~able mode· of attaining the , humane end which all have in view. " ' ..,' " , ' ,

" Much the larger number of tho~e boarded in private' dw~llings, in England and Sc~tland- are-imbeciles living with their relatives. The arrangements are made 'by the parishes wh@' give what is needful to enable any poor family to keep at home some idiotic but'harmless member, and no difference.of opinion has arisen as to the .propriety or;economy. of the·custom .. It is worth consideration whether the practice of making a small' weekly allowance, where the relatives are anxious to have the patient with them in ord~r to attend ~pon' hiln-~hemselves but, are not'able to furnish the entire support, might· not' be applied' in suitable cases in this ·colonY:~" It would involve litVe if any alterati~n in existing legislati9n, which makes provision for patients leaving the asylum on :trial or' on bond; aild'some saving would be effected in all cases where it could be applied: . Still the' proportion of insane residing' with their relatives could not be expected for a long' time: to reach the home percentage, seeing that there are many more without available relatives to take charge of them 'in a colony than in a lpng­settled country~ The plan of boarding' lunatics 'with strangers stands on quite 'a different footing~ Any extension in this direction is stronglY' deprecated by the Englisk Commissioners. t WI,len a trial was'made in Dev~:mshire it .:was attended with great misery to some of the patients, and found 'by the' relieving officers to result in little, if a~y, saving t~, the poor . rates·.t . The 'Scottish Commissioners have encouraged the experiment of lodging certain p'atients with cotters in the country districts, only when l'endered safe by the supervision' of the guardians' of ,th'e poor, parish medical officers, and Deputy Commissioners specially appointed'to visit them. The 'number' provided for in this way throughout Scotland" at-, the close' of 186j§ was 384, 'or abo~t 7 per cent: of the total registered number of the insane poor. The cases are chiefly of the idiotic and'imbecile kind, some of whom are ,able, to do a little light work. It must be remembered that the asylum inmates who. are best able"to work are not included in th~s scheme; 'they are usu,ally .Q.ot imbeciles, but men liable t6 fits of violence, who' would be certain to escape from a private house and would be dangerous if interfered with '; tIie majority of the imbecile class ,need help instead of giving' any. Any person who would take pa!ients to board with him fora profit would only wish to accept those w:ho ;would give small trouble and might be made to work for him; those in fact who cost the least6f any in an aSyhun, so th~t there would be a.direct loss in farming them out,~ unless at a rate .considerably below the general average. There is also the obvious l,1.sk of ill-treatment where no' tie but, one of gain is pl'esent" unless with a~ amount of inspection' or when 'needful of medical 'attendance that in the absepce of the parochial 'system would.. add a good, deal to the cost. The number of patients-to ~hom the plan has be~n hitperto-appIied,is too small; and the difference of opipion as to its results even in Scotland where it. is most easv to ,york is too great, to 'permit any very positive conclusiqn as to its ~c9nomy or safety elsewhere. A specific instaqee, th~ latest of which there'is any record, will illustrate its working. II Thirty patie'nts, some of them. male idiots, but chiefly womell p'ast middl~, age who, had lapsed into it state of dementia or imb~cil.ity though cleanly and able to make themselves useful,~ wel~e "chosen from the City Parochial Asylum and the Gantnavel Asylum at ~la.sgow, {lnd boarded in approved dwellings, with 'frequent Inspection from local, s.ourc,es, 1l1"a. COJll~t~.y clistric~ nventy:, miles north.of·the- city. ~ifteen of them wel~e l~~gea, ~ith widows 'having~·a,little· pr}.vate means; The patients very rarely escaped, and are describe,d as sufficiently comfortaOlc, and 'w.ell, caredJor. They cost at' present, ;f.:. I 9; 'each pel- yeal~"vhich is £9 below the o,rdinary maintenance rate; and t,hus t4ere is ~n e~timated saving: on the w~o!e 'of £z.70:perannuul'., After a~ experience

. . . . . .. . . ': ":B,eport of English,d~nimissioners :(~~ I~67, page'90 ..

,. '., ~ ., ..... t-Iteport/of:English Commissioners-for ]860./',- • J.

. . t Report of l)evon County Lunatic Asylum, 1858, page IS, • § DI\. Mitchell (Deputy Commissioner in Lunacy for Scotland).-Journal of Mental Science, January 1868, page 487.

II Dr. A: Robertson (Glasgow): On Boar;Iing th,e Insane-Ibid, Oct, 1870, p. 4II.

~. '0 .,,+..... ':' L : , 144.

12

of seven years the system is considered to be applicable to about ,'10 per cent. ~f the, ,inmates. of lunatic asylums or lunacy wards of poorh.ouses. The success of tpis experiment is due to the very judicious manner in which it has been carried out. It is scarcely fair, however, to calculate the, amount of saving, on the average rate of maintenance, since 'these individual patients, when in an asylum, would actually cost much below it, Under the local circumstances there was a distinct economy, because

- if they had been sent to the, Gartnavel Asylum for want of room in the city asylum, the parish would have to pay the ordinary maintenance rate, which is calculated to include patients who cost more as well as those who cost less. It is clear that the economical 'success of,a simila~ experiment in this cQlony would depend on the existence of a class whose' time is not .of sufficient value to prevent them from employing it in watching their lunatic charges for a profit, of a few-shillings per week; and who are y~t householders of sufficiently respectable charact~r to be"trusted with the responsibility. It would be a great relief to asylums to have the patients who are, harmless but mentally incurable removed from them; and if this could be done .in any instance, in sufficiently large numbers to prevent the necessity of additional expense in building, the saving wou!d be larger than the simple economy of maintenance. . v

, \

Most of tge objections that are entertained to boarding lunatics with strangers-sometimes called the Cottage System-do not apply when it is their relatives who take charge of them. It may be adde~ that many aifferent things have received the name of the cottage ·system. ·Thus in the celebrated village of Gheel 'in Belgium, the patients are chiefly lodged in cottages, under the care of the inhabitants, who have devoted themselves for genetat~ons past to their guardianship; the commune being governe~ by special laws, ,and under a-complete system of medical administration by a superintendent and f!.ve resident medical officers. About 1060, or one-fifth of the iilsane in Belgium, have been sent there. Patients who are dangerous, likely to escape, or t~ disturb '.public tranquillity or decency, are excluded by section 27 of the regulations of 185 I, 'and any who become so are -generally sent,back or transferred to an Ol:dinary asylum. * The proportion of cures is low, as most of the admissions are transfers of chronic cases. The expeIjence of this peculiar village-asylum has shown­that certain classes of lunatics rna:}' enjoy with safety and happiness 'a larger amount of freedom than was otherwise thought possible; but the place is so unique in every way that it throws little light that can be of help elsewhere. Again, the erection Of cottages in conn~ction with l1>n asylum, either inside'its walls fts at Yarra Bend, or sufficiently neal' them, has been strongly recommended. The presence of ' the cottages and their ,gardens, so much more homelike and comfortable than large wards, is one of the great advantages of ,the Melbourne Asylum in hastening tpe, cure of convalescent patients. ' ,

, Passing now to th~ proportion of imhecile and idiotic :who are elsewhere supported in poorhouses or,con;esponding institutions, it must be remembered that no mat~rial harm or injury is inflicted on them by their residence in lunatic asylums. They must be maintained somewhere; and in opening the Government asylums to

- them, and il;l making full and lU~iform provision for the well-being of the unsound in mind of ,ev~ry degree, the colony has acted with almost unexampled generosity. In all the' points bearing on their welfare-such as agood scale of diet, supervision by trained attep.d. ants, medical attendance and comforts, protection against accidents, and the investiga-' tion by coroners' juries in 'every case of death-this particular class of patients are better treated and more care bestowed upon them) than in any other country as' to which I am able to obtain information. _ On tne other hand. there are one or two drawbacks to be" noted: ,the comfort derived by these weak-minded persons from mixing with their sane fellow-residents in the cqttage or the po?rhous~ ha~ been thought­to compensate for the absence of any of the material advantages of an abode where they _ are s,!!ITounded by lunatics only. A more immediate, objection is that whenever there is any pressure on asylum accommodation the imbecile .class hamper the resources for the cure and safe-keeping of the majority, and damage .the prospect~ of the acute cases without themselves gaining any commensurate advantag~. After all, the ques­tion is one of expense. Now, in the early years. of the colony, the number of insa~e was so small that the fact that some of them would Q,ot have been elsewhere kept. III

an asylum was n~t of ll!,uch ~oment. There ~vere no poorhouses !1t hand, already

.. Dr. Neuschler: On GheeL-Journal of M~nt~l Science, April 1867, p. 30. Dr. Webster, ibid., October 1866, p. 330,

.,

· . \

13

peopled With the destitute, in which the imbecile class could be retained at a smaller cost. There was no parochial system of out~door relief under which the weak-minde d co-q.ld be maintained at home. The benevolent asylums, in the very few places where they exist, have grown up under a special . sys~em quite apart from the lunatic, asylums, and have avoided the iJIlbecile class.as much as possible, thinking they were more appropriate to the latter. Gradually: the ,,,hole, or very nearly the whole, have been absorbed by the Government establishments. .

As a natural result, embarrassment was .felt from time to time for 'want of room; but the difficl,llties as they arose were fairly met and liberally provided for, ,especially by the foundation of the Ararat and Beechworth A:s'ylums for the outlying districts. ' At present the Yarra' Bend Asylum is again overcrowded. Th.e admissions seem to gravitate very strongly t9wards .the metropolis, not only from the immediate neigh­borhood, but fi'om the country distri!3ts, qoubtless on account of the easier access. Out of the 566 new cases during 1870, 27 went to Beechworth, 133 to Ararat, while

, 406 came to the Yarra Bend, bringing the numbers of this ~ast institution up to 1043 at the close.of tJ1e year. This asylum has been for some years past one of the largest in the world. 'There are, three in England w~ich have a distinctly greater population-those for the county of Middlesex at Colney-Hatch 'and Hanwell, 'and that, for the West Riding of York at Wakefield; there are three in France-the Bicctre, the Saltpetriere, and Clermont; but neither in Scotland nor Ireland, elsewhere on the continent of Europe, or in America, is there any so large, with the possible' exception of the New York City Asylum. And of the English asylums named, in none do the buildings cover so wide an extent of ground. It is riot therefore' to be wondered at that this asylum should create a strong impression in the mind of anyone visiting it

- of the prevalence of insanity in Victoria. These very large asylums are universally condemn~d as overgrown; the general opinion bei~[ that 5t is'next to. impossible t~at they can be smoothly managed, and extremely Idltticult for the patients to receIve individual treatment and supervision fi'om a limited medical staff. It is very rare that modern asylums have been planned for more than' 600 inmates. ' Portions of the Yar,ra Bend Asylum are well fitted for the residence of the insane; other portions are temporary structures no~ now adapted for their comfort; but as a whole too many inmates haye had to be provided for in it. For these disadvantages the completion of the new Metropolitan Asylum at Kew will furnish the needed remedy. 'With this additional accommodation there Will be sufficient room for the proper tI'eatment of a11 the insane now under care, and a margin left for some -increase in their. numbers. However desirable it may be to relieve the lunatic asylums of those patients-estimated at 460, or one-fourt~ of the total number-who might be managed in ordinary institu­tions for the poor (could proper arrangements be made 'for their reception, such as exist in the lunatic wards of poorhouses), it is difficult. to see how such a step is possible just: now, when the'charitable it.stitutions'are already full. , It may,be remarked that in point of economy only lunatic asylums appropriated

for the exclusive reception of the imbecile dass do not offer much advantage. That w:hich makes the maintenance less expensive at ,home or in a poorhouse is the substitution 'of a ])artly unpaid ,attendance. . Harmless imbe~iles can be kept most cheaply at home chiefly because the needful attendance is furnished without cost by the relatives; they can be kept more 'cheaply in a poorhouse than in a lunatic asylum because the sane inmates are able to furnish part of the needful care without payment or with a small reward .. - But in a lunatic . asylum-an institution with no admixture of sane inmates-, all care or nursing must proceed from ordinary paid attendants; for the insane, though often capable of doing many kinds of work, are peculiarly unfit to attend on each other, and, with rare exceptions, cannot be trusted to do so. The cost of a special asylum for imbeciles and of the lunatic asylum from which they were withdrawn, would in the aggregate be equal to that of it mixed asylum including all classes. The essential condition for economy seems to be that the imbeciles should be attached to·. institutions containing a considerable number of sane poor who, although unequal to heavy work, would be able to render personal service to the sick, infirm, ()r weak-minded, and thus be utilized iJ;!. a- desirable manner. If this condition does not exist or cannot be attained, the imbeciles would be kept as cheaply in a mixed asylum as in a special one. "

Some recommendations as to the futur~ disposal of imbeciles will be made under the head of Future Provision for the Insane.

,

, 14

H, ",:, ';' "., ' r' , ".v:-.8RIMINAL LL~A~GS. ;' :, , ,~ , ' : 1. "The class ,of criminal insane are, in thetJ~ited'Kingdom" ho.long~r,:~e'nt to-th~

public ,'lunatic ,asylums. In; Victoria it is still the practice to.' transfer thither from the gaols' ,and 'penal establishments .all,cnminals, of unsound mind -and all· priso.rrers who ~econ:le insane dunng the term of th'eir 'confinem€mt. An ~nquiry into, the resul~s o£ t;e.atin~nt in the ~ases 'admitted at the YalTa Bend during ~hepast three year:s ~~.

:exhlblted III a c,ondensed fOl:m':in the following tabl<;:- ' c, :'" '\ • .., • ." .-. ~" , , J

ANALY:flIS OF 'RESULTS, FRo:r.r INSANE PRISONERS ADMITTED Ifo THE MELBOURNE ASYLUM DURING

, ',~ , ' , ,: 1868, 1869, AND' ~ 870. '

" . ,

Year.

, 1868 ' 1869'

1876 .,'. \ .;

Admitted.,_ Discharged. ~ -x' Net Recoveries.

15' •. , r 20 "'; 2{

2' " I I '

. " '; I

'. . ~, . , .. "'

Died.

'2 ' r •• ,'

·5 ",' 4 "':

i'

__ ~~~~ __ ~~ __ ~_~_60 __ ~~~4_,~:_. _____ '2_,,~,~, ____ ~ _____ .,-'~i~ ... __ ~,J,_,_,_._, __ ~_ ''rhE\~e r~s~h~' ~r~ Y<;fY ~trikJng;," 'The propo~rti~,n ~f discliirrge~~abouJ 6 pei~ ce¥t,: ':o~ri the a,dniisslI;msl: ... :'-isextremely-low,'!1ud is reduced still further by ~n examination 'Of the indiVidual ca,s~s. Two of the p~tients who were;discharged came again a: short tiine afterwai'ds into, ,the h:;tnds o( the polic~: ,Out of the two who formed 'the ,net recoveries one wa(3 a y'out,l;t (D. M.) .W,ho had g~lloped away on' a horse no(belonging fohini,"and as the "l,t~t "seemed to be a boyish freak or escapade and was accompanied by some ' ecc~ntrj'city ,of niiP.cl, he' was sent to the asylum. The !Step was an'idvisable one; but'­~he' boy,. !3c~rG~Iy:ea:¢~under We 'ca~egory of jnsane l)risonei's although 'technically in~Jw;le.d -in th~ t~ble::, In the seC:o~d case, of recovery the subject,.< J. 'C.) was an old' cdminal, 'WhO' seemed to ha:ve a 'good deal of simUlated madness riiiied with' sOll}e t;eal ab~rra:tibn <If '!liind; ~he cha~,c¢s a:r:e,that ~e WIll soon' be once more',in custody:'" 'But, a:ccep,tinlg this last as a re~oye!y,;,t~e lpimber :is redtfced to' one, a propoIi(ion, of les~ tltan,' '2 per cent. on the adrW~siori·s. : :It'will' be l:emembel!ed that the g'eneral avei'age' of cures,.ill ,which these, insane prisoners ar~ included, and which they make lower than it oth~l-wise'"r(h:tlq be'iis?4-0 per,c¢~t. "Qut 'of the 11umber remaining, 'no hope ofrecoveri is ~qte$ined in- any instaqce.' :¥ y .1:i.eliefis that a ,true recovery is a rare event under any tr,Q3;tmeI!t.in ~hQs.e.eases;· ,a,lld t~~t,when it does, perchance' happ'en it would }lave' 'coqit?,~bo~t ~!l,l'!: )V.~ll~.ffeguIAted: l?-Il,atic wa;rd,of a,'gaol just 'as ,spop.~s in'an .. asyluin. Th~, li~gJi proportIOil of ',d,eaths IS also noticeable, and is due to those who have been ~ent tp, the asyl~m al~ea~y iii ,ah?p~{ess ~~n?ition ,froill physica~, : disease ,and' hav~ epgi!.ged more thap. theIr share of hospItal attendance; 'accommodatlOn, and 'expense;~-:

2 . I I

, From. this examina~ion the 'illf~rence can'scarcely be avoided that,'there:' are' peculiari.ties .in this 'cl.ass '-\Yhicli mark, it"nff ,from -the 'jnsa,ne ,gener~lly'; 'and~this inference .is confirmed by: tlie:,.'impression derived fl;6nifurther obs81.'vation ,of the, ' ch:;tracteristics of the criminal gl:0Up.· Somediscl<imil1ation must' alway~ -be exerciseq. in determinjng tp~ individuals who_ belong to it, fOJ.: whom a lunatic asylum is 'tho:ught to be an untit residenee., To j),man who,' of previously good '~haracter, has been ,hurried in,to. sOp:J.e~ crime by a manifest ~nd overpowering delusion, treatment in an asylum fOJ.' the insane might be both merciful' ,and beneficial, at least until it is seen whether the impl;llse is of a transi'€mt 'or recurrent character:.' 'Bl.l.t by crimimil lunatics are' chiefly: meant those of the habitually cl'~minal class, or ~onvict typ'ej as well as many idle, an,d, dhlorderly ! persons addic~ed' ,to the less ,penal giadesof crime who become insane while in pri~0l?-'" In tJ:ese 'ine'n t4e.irisa~ity is' often merely ap. e:x;aggeration of yicibus propensities." 'Th¢~e' may, be ,some. in,co~ierence ~f:'~hought, sonie -loss of memory, some liability to epileptic fits, 'and some ecci'entric delusions.' The' usualJ.y low fom of intell~Ct tluiy possess'has at least dipp~d below the level, 'of'denientia; biit the groundwork Qf the character is essentially crimInaL The insanity veils a little blit does not hi~€lt~e vice. Ma,ny of5tlieinnocently insane are extremely suicidal, dangerous'; and violent, put,' they respond ,to 'gentle treatrrient ,and to freedom froni:restrai;nt,:and they exert. no m.ora~ly ~egr~ding infl~'ence on' otlief~: ',The srimina!s':are daiigerous in a different' way :'they are cunning, 'treacherous, aird wm plot together,' and escape by devices that; they ,h3;V~ learned iJ? their pr<?vious career. I\1ed,ical t~'eatm'ent is df little avail, indulgehceis thrown away;' they~re conscious' of enJoying the imnilmities of 'a lunatic asylum. It is not often ·tHat:....t11ey 'are disi':loseclto -be suicidal Dr to'injul'e themselves. If quiet, they are mO,st freque~tly idle. The modern system, so successful

I • \. "

, , 15

in "its results, seems, t.o' be ineffective when the;e is n.othing left to w.ork' upon in 'a th.or.oughly. depraved n~ture. If to.o weak in body t.o be .otherwise than ~armless, t~ey are cases f.or a sic;k ward .or h.ospital. It must be added that the attitude.of. mmd acquired by' an attendant in dealing with these men is different fr.om that. WhICh he sh.ould cultivate t.owards the'.ordinary insane. Their presence tends, t.o alter an hospital f.or the insane in the direction .of a prison. They d,isanange ,the best principles of asylum management, in which pers.onal influence is substituted f.or restraint. And while their entrance is t.o themselves n.o real kindness, it appears1to be a direct hardship f.or, th.ose whose, insanity has come upon them. as an unf0reseen afflicti.on t.o be in any. way ,ass.ociated with them: It may be gathered from these,iterps th;1t though a sma~' ' class. ,they ~ar.e 'anexperisive one" Th~y, need;a larger proportio~,.of attendants, .than the' average, to prev.ent"thein:t~ing :;tdvantage of the' freedom .. tlieY enjoy~in .their p.osition, as lunatics;' or t.o isolate theni,as much as pO,ssi?le from .other pa~ients'; they destroy more and,work less than others. They inustdisprop.ortlOnatelymcrease the average ,maintenance"rate in any asylum where they are received. The table of maintenance'rates hereafter given (page, 30) will show that they, cost in England from 50 to 100 per cent. more than the average ,of patients in the county asylums. .

, At 'one ,time criminal lunatics were indiscriminately admitted .into the asylums 'of, Great Britain and' Ireland., It w.ould indeed seem at first sight that the l.oss .of reason should ab.olish all. distinCtio~s, and place, crimina:l and non-criminal .on, the s~e level. It was at least,'rIght that It sh.ould- be seen w4atc.ould be d.one f.or h,matic prisoners by assoGiating them with .others under the' new treatment bestowed upon the' insane in modern' asylums. The phrase " loss of reason H helped s.omewhat t.o this view. It:would'pE} nearer tl;le tnith t.o speak .of 'theni as usually affected bJ'a partial,deficiencj of intelligence while preserVing the rest .of their character. 'The disadvantages .of such a course so.on became o1{vious. In 1845 Dr. Thurnam wr.ote :~ ,

"~he whole subject indeed of the custody aitd treatment of !lriminal lunatics appears to call for the serious enquirY'and rev.ision of the Government. For reasons which have reference as well to c,riminal lunatics themselves as to . other 'inmates of these institutions, the propriety of confining such cases in county asylums, or even in .Qospitafs where, as at Bethlem, they have a separate department assigned them, seems, to say th!3least, very doubtful. For whilst, as regards the formeI', the· restoration of mental and moral

'health should never be lost sight of in their treatment, this would still properly be oCa stricter description than that adopted in general' asylums. From the geQeral ~haracter of the patients, ,the greater violence of their passions, and consequent greater necess!ty for security, the general economy of the establishment should of course approximate closer to that of a prison than would be at all proper in ordinary hospitals for the insane. On the other hand, the association 'of unfortunate and innocent insane persons :with criminal lunatics cannot but be attended wit}.! numerous evils ,to the former, some of which I am glad to see hav~ been recently pointed out by Dr. Julius of Berlin, ,and, still more recently by the Metropolitan yommissioners in Lunacy. In addition to that shock of the feelings which many patients, even of humble rank, mU,st experience, who, on recovering- from 'an attack of insanity, find themselves mix.ing with criminal lunatics, I would insist on

/ the importance of dissociating altog!;lther .the idea of a penal establishment from every institution having for its prip:tary object the,restOration to 'health of its inmates. • : . . The effects of confini!1g crim'ina} lunatics in the district asylums of Ireland having lately claimed the attention of a Committee of, the House of'L9r'ds, it is to be hoped that 'some ,comprehensive remedy will so'on be applied to this increasing evil."·

These remarks seemed, t.o express the 'unanimous ' jUdgment .of all who cO"\lld base it.on practical experience, and 'were seconded by public .opinion. In the following year, in SCQtland, a, p.orti9n .of the general 'prison at .Perth \vas assigned t.o criminal­luna~ics ;. ap.d all those c.onfined for life .or during pleasure as, ,well as insane prisoners under long sentences' were placed there. . It was afterwards pr.ovided that persons imprisoned for a short term could be detained in this 'part of the ga.ol after the expiry .of. their s~ntences, if their insanity was certified t.o be .of such a ki.nd as to render this step more advisable than sending them to lunatic asylums. rrisoners becoming insane are, sent .thither fi:om the l.ocal prisons; few, if any, are a:ll.owed to be sent t.o an o~dinary asylum wIlo haye cominitted grave or viol~t .offences. Criminal lunatics are c.olle~ted in Ireland into the Central Criminal Asyl1lll1 at Dundrum, and .others -remain i~ ~lie' :a~i.ous metrop.olitan: a~d c,.onnty gaols. ,'In ~ngland, With few exce~tions, they :t:~sld~ l~ *e ~r.oadmoo'r Crimmal Asylum and at FIsherton House .near Salisbury. S.o als.o m the Umted States; generally they remain in the ,State pris.ons, but in the more populous 'State 'of New Y.ork'li criminal,asylllIliadj.oining the, penal 'establishment at Aub"\lfn ~s appropn!1ted t.o them. In New Sci~th Wales they iare also sent t.o a se arate asylum. . The principle that criminal lunatics ought no~ t.o be placed in orrh·l'lO,. .... T

ho~pitals for the insane is recognized in all these instanqes~ th.ough there are differences / in the details thr.oug.h which it is applied., .. In Engla~d,. Her Ma:jesty's Secretary .of Stftte has p~we,!:"t() tr~sfer .t.o_ the c.ounty asylums any .1I~sane, pn~oners who may be deemed p;1.ore ,fit . .f.or a reSIdence there." The pres~nce ,'.or absence .of ,the criminal

, . '. ". ' ~ , . , I

.. Statistics of Insanity, 1845, pp. 45, 46, 49' . \ , , '

, ,

, 16

character and disposition is the best criterion. One of the instances of recovery' formerly noted illustrates the usefulness of this alternative. Not all prisoners who can be' descril)ed as insane are certified for the crimina~' asylums in' the United' Kingdom. -,Vhen there is merely deficiency of intemgence, imbecility, or epilepsy, but without very, marked aberratiOlr of. mind, they are retained in the local prisons and placed lmder care and treatment; Oft the grOlmd-'of their mental state just as others are for bodily illness.* Insatie prisoners no doubt disturb discipline, but this is also done by cases of sickness .whom it has ~ever been proposed to' !3end to general hospitals. In ~ prison the insane or half-insane are an in~onve.p:ience, because .their mailllgement 'is lTIOl'e difficult than that of the sa1J.e~ Increased uberty, increased comfort, some relaxation of rules, more special and individual attention may be neede,d for these inmates, as it is also needed for thos<; in the hospital ward of a gaol ; but the transfer of criminals to ordinary lunatic asylums inflicts more serions damage. '

By the sixtli section of the Lunacy Statute of Victoria (1'867), it is lawful for, the Honorable the Chief Secretary to direct that insane prisoners 1;>e re:t;noved "to' such asylulIl or. other proper receptacle for insane persons as th~ Chief SecretarY.l;nay judge proper and appoint." In the absence of a special criminal asylum or of a receptacle such as v!'Quld be furnished",by a lunacy ward attached', to a gaol, criminal

I lunatics and insane' prisoners generally are transferred to the public lunatic asylums. ~ Should it be deemed. expedient to contin~le ~le present pra;c~ce,. it may be sue,-gested

that some part of the asylum a,t Yana Bend capable of bemg Isolat;ed from the rest, such 'as B .and H wards, should be set apart for this class. The humber of prisoners sent from toe gaols to the Melbourne Asylum has peen ~uccessively greater in. each of the past three years, and the tendency, to increase by accurimlatio'n is strong, owing to the small number of cures. With the existing pressure on the. asylum' it h3:,8 been

.' impossible to effe~t a complete separation. ' ' I '. ,

/ '

VI. ~DELIRIUM TRE~rnNS AND TEMPORARY' INSANITY FRO~f . DRINK.

Delirium tremens stands on the border-ground between the ge'neral diseases comi~g, under the usual province of the l)hysicia~ or surgeon a.nd. insanity pr9per, yut practically belongs to \the class that should be treated a,t home or ll1 a general hospItal. Delirium from drink (mania a potu) is a symptom produced by the alcoh9lic poison just as delirium from fever is the result of typhoid poison. /But in Victoria~ cases al~e sent to the lunatic .asylums, owing to the unchecked facilities previously descrihed, from long dist!lnces and at great expense. The plea usually given is the unsuitapility of the lock-up for treatment; or, where there is a~ local hospital, the absence of a separate room in which a restless patient can be placed. These cases .are now and then accidentally admitted into the h?me asylums; but not nearly to such an extent as in this colony. In France also, ifan admission to the Rec9ption House for the Insane js found to be laboring under delirium tl'emens he is sent to' one of the general hospitals.t "When instances of temporary excitement from drink do perchance obtain entrance into an English asylum their' presence is protested against :-

/ "In other instances men are brought who should be regarded us offenders. against the laws and punished accordingly. It is an abuse' of' /tn asylum to send to it a man who, maddened by drink, assaults his wife or child; or commits some other vagary or act of violeuce. It may not bc easy in every cuse to discliminate the excitement of intoxication aeting on a yiblent temper find eoarse nature, from mania; but a day' or two would generally suffice to decide the question; , The journey to the asylum l}Jld the warm bath OIl. !t!Tival often suffice to disper the excitement; and, it is obvious, that in place of a residence!n our comfortable wards there are cases in which a month's discipline at the treadmill would in every respect be the more' appropriate treatmentl't , I

But what is elsewhere t~e exception is in' danger of becoming in Victoria the' rule; 'and in many instancGs the lunatic asylum is most improperly made 'use of as a free and pleasant refuge in which ,to recruit after a'debauch. These cases need usually very/ little medical attendance, and add to the percentage 'of recoveries, helping to ~ compensate, for the many' other influences that tend to depress' it. But none 'the less

I are they placed, iii a f~~lse position in.a .lunatic asylum. -All finer' feeling~ having usually heen worn away before ~their entrance, these patients show very little gratitude for the care bestowed upon them by the State. ~ 0 technical fault is to be 'found with the certificates, as their subjects have certainly spoken and acted in an iITational and,. incoherent manner previous to admis~ion: The term lunatic cannot be . so sJrictly defined.as to e~clude many cases who nevertheless are practically n9} lunatICS.

'" ,1, Bruce Thomson (Su;geon to the Genera.l Prison for Scotland), Joulnal of Mental Science, Oct. l870 , p. 333. . . t Dr. Manning's Report,·p. 153. t Nineteenth Report of Wilts Asylum, p. 2,6.

17

VII. HABITUAL INEBRIATES.

The experiment of placing inveterate drinkers under care in asylums was authorized by the Lunacy Statute of 1867, and has since been in process of trial. The 17th section of the Act may be briefly said to give power to the Master-in-Lunacy to commit inebriates to an asylum for any period up to twelve months, either on a )yritten application from the inebriate himself declaring his willingness to submit to treatment, or on the application of a relative or friend confirmed by sufficient proof that he is either laboring under or recovering fi'om -an attack of delirium tremens, had wasted his means by excessive drinking, had neglected to support his family, or threatened or used violence towards any of its members; provided that under both forms of application the payment of maintenance is secured. The fu'st of these methods is voluntary, though with a difference. The application expresses the desire at the time of the person who makes it; but so soon as force has been given to it by the issue of the order, the patient can be kept even against his will, and can be captured if he escape from the asylum. He binds himself in effect to his own detention for a certain period, although in the interval his desire to enter or stay in the asylum may have become displaced by a vehement wish to leave it. The order, unless rescinded by a judge of the Supreme- Court, is a sufficient authority for his detention. The second method is entirely compulsory, with the same proviso in regard to appeal.

These powers have been so far made use of in a small number of cases. The method of voluntary admission has been employed only once. A person subject to nervousness and melancholy, attributed by him to excessive use of stimulants, was committed on his own application for a period of six weeks. It was somewhat doubtful whether the patient was an inebriate or whether this was not one of many self-a~cusing delusions. He was discharged much improved in mental and bodily health. A few cases of both sexes have been sent in for lengthened periods, under the compulsory clauses, on the application of relatives or friends, who provided the maintenance. They became perfectly sane and sober in a few days, and strongly resented then: continued confinement amidst tbe insane as harsh and· cruel-more cruel than a short term of imprisonment with enforced labor. Under these circumstances most of them would not engage in any sort of useful employment, and could not be made to do so in a hospital for the insane. 4-ny medical treatment or reformatqry tendency was nullified by the depressing influence of an unemployed sojourn in a lunatic asylum. There was a constant temptation to devise stratagems for obtaining drink and make use of any freedom tbat was enjoyed to cany them into execution. They could not be trusted with the same amount of liberty as the really insane, on whom they exerted a hurtful influence. There was considerable truth in their protest. The power of self-control is not strengthened by such a residence without active duties and active responsi­bilities. So far the results are very decidedly against the committal of inebriates by a compulsory process to a public lunatic asylmn.

The question of the disposal of inebriates has received the largest share of attention in the United States. Cases of temporary insanity from excessive drinking can gain admission into at least some of the lunatic asylums, but under' certain essential conditions. At the Maryland Asylum at Baltimore surety must be given for the payment of board along with the application; and the certificates have a special form. Inebriates can also be received in the Government Hospital for the Insane at "Washington; but admissions of every kind in that asylum are guarded by the provision that-except when a patient is serit from a public department by order of the Secretary of the Interior-the consent of the physician-superintendent is needful. The superintendent, discussing the treatment of inebriates, speaks of a more efficient system of reformatory restraint as necessary.*

It is the special asylums for inebriates that are regarded as proper retreats for this class. The progress' of these institutions is almost identified with the name of Dr. Day, who had a large share in originating the first of the kind-the Washington Home at Boston-and became its superintendent when it was opened in 1857. At first it was self-supporting; when it afterwards obtained a vote from the State the annual sum never exceeded 5000 dollars. Meanwhile a more ambitious experiment was being made in the State of New York, where the Inebriate Asylum at Binghanlton was founded in 1858, and in 1864 at lea.st partially opened. In March J 86.5 an Act was

.. American Asylums.-Journal of Mental Science, April 1869, p. 68. ~o. 25. B

is

passed by the Legislature of the State giving power to any justice of the Supreme Court, or county judge to commit inebriates for any period up to a year; * similar' powers .in short to those ussigned by the Victorian Statute of' 1867 to the Master in Lunacy, but with the difference that in America the commitment was not. to a lunatic asylum, but to this special institution. In two 'years this asylum was closed. Afte~ costing the State and private charity about £250,000, it had ·so . far proved an· utter failute,chiefly in consequence of extreme mismanagement. It. commenced however.a' new and more useful existence when it was shortly after re-opened under Dr. Day, who had ;worked with great energy' and success at Boston. At the close of . 1868 the number of inmates was 82, all or most paying for their board at rates rangi.ng to thirty dollars per ,~eek. The place is practically a well-appointed retreat, furnished with every means of amusement and comfort, for the wealthier classes, but containing about IS per cent of "free" . .01' non-paying patients. The part of the Act relative .t,o. "committed patients" seems to have been found useless and is almo~t in abeyance. t. The patients submit themselv:es vQluntarily for periods .Of from three months to·a year, and are placed on their parole to remain within the grounds. Dr: Day reports that "to re,ceive invQlup.tary patients }VQuld be to introduce the element of confineIPen~ <?r restraint, ·and thus to degrade the .institution .from its true. character i,nto ,a mere, ~ouse of' correction or a gaol. . . . . The fundamental basis up.on which alL hopefl,ll treatment must rest, lies in .the desire of the patient himself to escape from the slavery that enthrals him. But little, if anyt~ing, can be accomplished. in oppositign to the wishes ~f the .persQn to. be treated. "t. Theessential point is that the patiel}-t should.l~~, conscious of his weakness, and have a real desire to overcome it; this granted,. sp..G~e~s, may be hoped for, and there is. little ground for doubt that a large measure h~s "beeD: attaineQ.. . In .about half th~ cases the hapit was cured or at least b;rqke~.,' .. ;. I

An. experiment of a still more instruc~ive kind,because, it embraces. a clll;SS,

larger and much more difficult tQ deal with, was made in the establishment .of the. :Ward Island Asylum at, New York.· I~ is mandatory on the city magistrates tQ fine, imprisQn, .Or commit .to the workhQuse any case of public into~ication. The Commissi~ners fQr the' new institution, while ·admitting the QhviQ~l,S propl:iety .Of thi~. step in the, instances, of habitual inebriate~, considered that a milder remfdyshQulcl be tried when the offence was merely Qccasi9nal .Or: accidental, and offered.!a. h9me for inebriates. able to pay, as well as for those who we:t;'e unable. to. dQ so, '''upon. the. condition that tpey perform such labQur as may be assigned to, them, and in this.way make the institution self-(mpPQrting." The institution was opened inl 868, and the majQrity .Of the inmates were non-paying or "charity patients." After the first. half-year the CQmmissioners repQrted to the State BQard :~-.' .

, "But few of these 'have experienced the practical results which the asylum is expected to· . bring forth, owing in many cases to the shortness of the time of commitment, .but mainly due to· the fact that,. belonging to the class of revolvers-men and women who ha-:e grown up in vice and poverty, and ~~e constantly placed under the care of your honorable board, either as objects of charity or correction; the' desire to. reform, a pre-requisite to its accomplishment, was wanted ;in them, and heyond the' temporary restraint, their residence in the asylum was of little benefit."§ ..

In the United Kingdom if a person is brought to an asylum with ,~eliriuiii produced by drink, he must be disc~larged.as soon as he becomes ratiQnal o:r·h~. can institute an action for false imprisonment: Inebriates have gained admission i~ some cases into ~the public asylums of Scotland ~n~er tlie general provisi.ons as tQ Y9111!itary, hoarders .Of the Scottish Lunacy Act fQr 1866; but nQ, one entermg by th~s method can be detained mQre, than three days after giv~ng notice of his iI?-tentiQn tQ leave·II The Habitual Drunkard's Bill,. introduced and withdrawn by' Dr. Dalrymple 'during' the last session .Of the Imperia] Parfiament, proPQsed tQ deal With tWQ Classes.·JPQ.wer was to be given tQ commit to private institutions, .Or at least to' institutiQns dependent .On vQluntary enterprise, thQse who eQuId pay. For the secQnd class-those without means-the Inf:igistrates were to' be enabled to establish special . Reformatories, .Or use a portion of a gaQI .Or workhQuse, to which an inebriate CQuid be committed IQng enough to blunt the taste for intoxication. . . .

. .These details seem to confirm the opinions already expr.essed. It appears to be hurtful to commit in it mandatQry form habitual inebriates, whether they pay .Or not, 0 public lunatic asylums. Their committal to private asylums .Or separate -

* London Medical Times and Gazette, 16th April 1870, t British and Foreign Med. Chir. Rev., January IS71, P.41~ . pp. 114. 109· •

t Dr. Manning's Report, p. ISO. § Brit,. ana For. Med. Chir. Rev .• ;Jany. 1871, p. uS· II Dr. Haynes: Voluntary Patients in AsylUIllS.-.Journal of Mental Science, January, 1870, p. 569.

19

institutions:'fs open to mri~h less objectIon, especiall; i~ th~ semi-;ol~ntary manller provided by the Victorian Statute. .This form of self-committal' applies to those who are really t~ be. pitied-w:ho' need some exterria.l· help' to' caiTY out· their. ()wn res?­lutions. But for the ordinary inebriate without compunction or shaI~le,~ a ]unatl~. asylum is most unfitap.d his support in.idlen~ss is an unfair burden .. Co'mpulsory labour, is an essential ingredient in the remedial treatment of' such cases. Dr. Day affirms that liis system'is not applicahle to those whom he 'terms '.'the, fo~ced con1mitments of a court, or the commqn seizures of the poli~~,"*, who should~e assigiled to, the house of correctio~. Many of those are the "revolvers" spoken of by the Ward Island Com­missioners, a term illustt*'ted by Dr. Dalrymple's description of ".tnatabounding nuisance and scandal, the 'habitual drunkard, wh!? isperp~tu~lly ~h;c;tlat~g betvveel~ the gin-shoi)"the gutter, the .police-cell, and thergapl."t ... j .. ;., ....... : .' ", '

The special mentio'!1 of delirium tremens and excessive, 4rinking Inoue pa~­ticular section of the Victorian Lunacy Statute, and the sRecific'.fourse there laid down for ~btaining admission and power for the detention of ine~riates, s~em t<;>' imply-that if such.cases wel'(~ sent to', an asylum it was i~tended that'they sho-.;tld come under tl,.ese provJsions.; .. but practic;tlly all difficulties~'e genel;~l1y aV,?ided .. by gaini~g ·e~sl. access' to the asy him WIthout payme,nt, under the orilinary forms of the pr,ecedmg sections. The safeguards surroundinO' the'fu elsewhere are not :present. In, England the fact of loca~ re~ponsibil~ty, and in A.merica the dis~retionary po~ev'~sto 'awnissions unless in certainniandato~y cases, lessen tlJ:e risk of abuse.' '. _ ': ..

In handling ~his subject the ~ord "dipsomania ", has been.hithertoavoided. That there is su~~ a dise·ase·.adtll}ts of:t.to do~ibt ; fo~ t40~g1.1 it l~~ay ~f~en' ~ehar?·,~o.'~eparate the malady from the VIce, Its typICal features are distmct. A m~n bOl'l?- WIth. a trans~ mitted disposition jf not .to in~ani~y at least. to n~~y~us~iso.r?ers,. has .. sudde~ and uncontrollable paroxysms of drmkmg, separated ~ften by m~el~v:als. durmg ,whICh he looks back on his fall with'horror and, remorse .. He will do anythi~g to . ward off ~ renewed attack. of th~ impulse. J'heeraving .is not tlteJe~lllt. of iridpJ~ence-not an acquired hahit, as in the ordinary inebri~~~e. W~,th~carc~ly: ~riy::ri~~ a~dprogress it comes on' c;tpriciousl:y, sometimes in yery' eal'~y youth.C()~plete' ~bstin~nce, aided by everythmg that can strengthen the voluntary power of self-control, IS the only remedy. But, out of the numbe~ of cases admitted to the Melbdurri.e Asylum; only tW? could be assigned to' this form' of mental disease. . vVhen the term· is made of general application to inebriates the result. is very mischievous. . It is a.' clpak for plainer and more accurate words. Calla drunkard a dipsomaniac, and .itseems at once to imply that he has some practical affinity with," .maniacs ;" that he should be maintnined at the public expense,·though idle and unshamed ; that he should be taught to look upon himself as the victim of an ilTesistible disease. So also there is a real disease-kleptomaI~ia; and anyone whose position. did not make the act of .appl~Q~ priationso entirely'motiveless that it could be seen at once' to be involuntary, would run a risk of being treated as responsible; But it would be a perversion of .the·t~rm to certify as coming under it all who had allowed thf;lmselves to fall ,into the.h.a:pj.:t of taking what did not .belong to .them. If a man i~ treated as incapahle of controlling some propt;)nsity, ~e will ta¥.e little trouble tocontrol it: The growing pra:ctice of sen,ding inebriates to 'the Victorian asylums appears to give no discouragement to 'the '\-ice. . ' .

VIII.--:FuTURE ACCOMMODATION FOR THE INSANE. "

From this review of the provisions for lunaciin.Victori~ it will be·.evident that every' circumstance has ·tended . in one direction, that' Df. op~ning the' doors .of the asy lurns·. wider than in any of the older countries;. When the' hOSi)itals for the insane of the colony have had to' perform functions .elsewhere discharged by poorho.uses, parochial out-door relief, general hospitals, inebriate. reformatories,. 'benevolent asylums, penal establishments, and gaols; when they have had practically to contain all the lunatics of the colony, and have had sent to them many who are not lunatics at all, except under a very strained interpretation of the word; it. cannot be matter for surprise that the Lunacy department should ~ppcar to be of disproportion-ately large dimensions. '. r: '

An important question remains. Assuming that all those under care at present are still retained, and that the present usage as toadmission.continues,.:is it likelj).that

.. London Medi6at'Tim~s ind Gazette, 16th April 18 76~ t British and Foreign Medlco-Chir'llrgica 1 Hev.; J an'nary 18]1, p. 103.

n2

20.

new accommodation ,"vill again be required .. alld. futher l?uilding be necessary? In an earlier part of this report it was shown that the number of admissions in proportion to the population ,differed very little between 1869 and 1870, and that the increase in numbers remaining under care-due to the process of accumulation-seemed to have passed its maximum and to be lessening. Still it cannot suddenly stop. _ During the present year the increase will, it is anticipated, be proportionately less than for the past one; but with the increase of population it cannot. be much less in absolute numbers; and if during the next five years the population should enlarge at the present r;:tte without any great change in the causes producing insanity amongst them, a total increase of at least 500 must be expected, unless some check is placed on. the tpo eas~ admission of all who can in any way be certified as lunatics a:t;ld relegated to #

the asylums. In this calculation it. is assumed that tHe high rate of cures (40 per cent. on the admissions) !1lready reached will be maint!;1ined, and that the mortality will remain equally low. The additional number may. be accommodated if spread over the asylums at Kew, Yarra Bend, Ararat, and Beechworth, with certain inex­pensive additions to the two last; but if the annual increase should not decline so l:apidly,or in any case in a few years more, there will be as great a pressure on the asylums, Kew included, as there is at. present. It is im},)ossible to refrain from' expressing a hope that if this be so, some step may be taken to prevent the need. of building new asylums or making any large additions to those already completed or approaching completion. The existing _;and immediately prospective- accommodation is,not only up to but in advance of the wants of tbose for whom it is a necessity or a real benefit. If no obviously unsuitable cases were admitted, and the hospitals for the insane reserved for those who really needed them, there would be abundant room for a long period of years to come.

An English critic, not connected with asylum management, in objecting to the constant and expensive extension of asylums already too large, expresses, though with unnecessary harshness, a strong public conviction that sequestration in asylums has been carried to too great an extreme.. If his remarks are applicable to England with only 66 per cent. of her insane in asylums-to Scotland with only 48-to Ireland with only 4 I-they must be much more true of Victoria, where the whole of the insane are so placed :-

" But what has been the policy of the last few years? To congregate all these helpless creatures in palatial buildings, where their comforts are attended to, and their condition otherwise greaLly improved. People outside have found this out, and there is no longer any attempt to keep such patients out of asylums, but rather to obtain admission for unsuitable cases; and it is to this gradually spreading knowledge and inclination that It considemble proportion of the increased applications for admission is due, Improv.ed sanit.ary arrangements have contributed probably to the patients' length of day~, nnd so, with a lower death 'rate and increased applications for admission, asylums, which onght to be hospitals for mental ilisease, have been choked up with improper cases, and have helped to give rise to the cry of the increased, prevalence of insanity, Were there no actual increase of insanity, in course of time the balance would be attained, The death rate and the admission rate would become equal, for even paup!3l" lunatics cannot live for.ever ; and from the reports before us this would seem ill certain parts of the country to be even now nearly the ease. Then of course no additional bnildings wonld be required except for the natural increase depending on inereased population. But the question still remains-Is this advisable ?"*

The preparations now making in some of the up-country towns (Sandhurst and Castlemaine) for_ the reception and treatment of person affected With delirium tremens, or cases of transient insanity, must meet ,vith warm commendation. Hitherto, as ah:eady remarked, these cases have been brought fi'om long distances to the asylum, the journey being as expensive "as harassing .. In a few days they have recovered, or, in lighter cases, have become almost well before arrival. The new arrangement will be . a relief in many ways. Thetpatient himself will not be subjected to the annoyance and exposure of a long journey, or to the disgrace which attaches itself, more or less, to having resided in a lunatic asylum; the expense to the local bo~rd wiJI be diminished, and the police will be spared the task of escort: It is to be hoped that steps may be taken to induce other hospitals to follow this example.

But the future disposal of imbeciles is of larger import:mce, since they are more numerous and must continue to accumulate with the growth of the colony. Should the recommendations contained in the recent report of the Royal Commission , on Charitable Institutions, in regard to the formation of districts each with its own Benevolent Asylum or conjoined Benevolent Asylum and Hospital, be carried into effect, a better way of providing for them would at once be opened. It would then be possible to exempt incurably weak~minded but inoffensive persons, as most of them

.. I;oqdon Medical Times and Gazette: the Insane and their Management, 30th April .1870, p. 469.

/

21

are elsewhere exempted, from a committal, in their case needless, to a lunatic asylum, followed by a life-long detention within its walls. Their reception into the local institutions would be a benefit to the curable or dangerous luuatics by moderating the indiscriminate pressure for 3,dmission to Hospitals for the Insane. Apart from the cost of maintenance, many expenses would be avoided, such as certificates, journeys, escorts, and the legal expenses attending deaths. Further economy would doubtless result from a local management with readier access to friends or relatives able to contribute, and many of the objections to boarding out the weak-minded with relatives or others lose their force in the presence of local supervision ; leaving any economical advantages to be reaped without the risk of abuse.

IX.-CAUSES OF INSANITY IN VICTORIA.

It is not always possible, even with a very full knowledge of the previous history of an insane,person, to refer the malady to anyone definite source. In every instance the cause is complex, and the disease is due to the meeting of several elements that share in its production. There is no single circumstance that will infallibly give rise to insanity. But sometimes, the task of enquiry is comparatively simple; one of the antecedents stands out so prominently that it catches the eye at once and may be selected from the rest. When the derangement has been preceded, for example, by unprecedented reverses of fortune, ovenvhelming grief or anxiety, over­work of the brain, sunstroke, mechanical injury to the head, intemperate habits, or various bodily states fostering insanity, any of these conditions may be accepted as at least the immediate cause. But in general many other things require to be considered along with the external circumstances, and the true antecedents lie further back. Some original difference in th~ brain,and nervous system, some latent peculiarity­whether derived or not from progenitors who have been insane-makes the individual susceptible to influences that would have passed harmlessly over others. With no more than common anxieties, no larger share in the excitements or calamities of life than falls to the lot of most, no vicious propensities degrading the power of self-control, the mind imperceptibly travels towards and finally oversteps the line between sanity and insanity, or passes it at a bound, propelled by some apparently trivial exciting cause.

It is still less easy to draw up a numerical statement of the causes of insanity among the yearly admissions to a lunatic asylum, owing to the scantiness and imper­fection of the information that can be obtained. Some of the home asylums, it is true, print annual tables which are merely summaries of the causes assigned when the patient is brought to the asylum. THe absolutely unknown has usually the largest share; and for the causes enumerated the superintendent frequently states that he is not responsible. A glance at some of the headings of the tables proves that there is often very good reason for such a disclaimer. Among them we find :-Anger, Adultery, Business, Bad education, Carbuncles, Calvinistic preaching, Cancer of the right eye, Drinking rum after parturition, Fancy, Fatuity, Giddiness, Love and over­study, Natural causes (one case only out of 678), Reading the Coming Struggle, Trouble, Want of sight and worldly circumstances, Witchcraft.· What is the value of a medley of symptoms, coincidences, and superstitions, tabulated without examination, as causes of insanity? They represent the popular opinion about madness in the particular district from which they are drawn, but they have scarcely any other value. Doubtless for these reasons many of the asylums refrain from publishing tables of supposed causes; nor do the Lunacy Commissioners of England, Ireland, or Scotland supply them among the statistics in their annual reports. Really valuable researches have been made when this important subject was studied either by a consulting physician in lunacy or in an asylum so circumstanced that full details were accessible and could be personally examined and tested. The tables of Dr. Thurnam regarding the Retreat at York and the Wilts Asylum are models of what can be done in this direction. In a colony like Victoria, all the obstacles to accuracy are largely increased. Nevertheless an endeavour has been made to arrive at some approximate conclusions, by an examination of the

- cases admitted during the past year at the Yarra Bend Asylum, and a comparison of all the information that could be gained respecting them. Much of it was obtained some time after the admission from the friends, or from the patient himself, when convalescent. .

l\l Reports of Dublin Asylum for ]862, Colney-Hatch (Middlesex) 1862, Ra.nweJl (Middlesex) 1865, Dundee 1866, Somerset 1858, Devon 1858, 1864.

•. ,,:1' "'tt l ::-:. ;', ", 't'. Causes. :Males, '"

, ,

--'~ I~ I • HERRDITl_RY~PR'EDISPOS1TION ASCERTAINED

.; l?REVIOBS',ATTaOKS KNOWN .. .:" .•••

.;; 3

t" 'I .• ' :t· " .. "1

, '" P.HYSICAL 'CAU81<;S- ' ',l " " coJg~rtital idi6CY'- '. ':! " '" ' • ',' : . ". \ 5

" "I: of'd age" I " • ~ , 3 Apoplexy or paralysis ' ::.' ' .. ~ 6 Epilepsy 14 Sunstroke 6 " Accident and injurfes'to IHiad"'- ,. 5' , ..

" <,' F:ever and qisease ?f!ivel' \>1' .stomach 4 ,~, '." :GeneriiJ iH-liealth "" ',1~: " "\;:.' "": .. :':;\'.:: '5"': '\ , .' 'J .• Puerperal (i.e: con~ected"with,cbild bearing)... ' .•• '. ", '.', . Uterine diseases \, .. : '.. ; ~;~~~~i~ ',: .. <"::: .. , I'.:;:!I, ',', ,',

." W". : In tClIIperance" : .. ~;" ~ :. "~""'''~'' ._.1 ..1_

. ·f I

. "53

MO~;\L . CAUSES-:. , .' • , 'f." . Fright. '., .... , ", '.'.," , . Grief'for loss' of relatives .. .

,,\; .. '." '" PO~'el:ti :und'want of employment ... . . ~ • "'.: :' Pe?lniial'Y- disappointment/or anxiety

, 3 2

... 6 , 4

10 !. '2

,. 2' .... '.

10

1 3

'8 : .17

7." ,

; . Total.· . : .,

"'1'5 .'

5 .:8' . 24

9 5

.... '1-, . '13"

1.7-. '7'.

4. ·7 6 . 8

.3 : 9" .4 '.: ' ',:8

" ~

!...:

:.

.... "

'In,

!;,,~ :,.~ j-:,1-•. ,J!)esel:~ion,j',·~·I.-,; ... ,t>lj' ! .... ,/!~J.. .... '3. " "; ".: 3" '. \. .- ~ ,-

','.'; " .. Religiolls excitement. '... : .. ~ _., . " ,OBsouriE ,qR,'COMPLEX, excludIng th€,l.above·

, ':'.'. '. , . . \

,

'," .'tJ nknow.n (no information)' ~,\ ll;~~~-:"',. ~<I '.' I"

'1"', 1"

I

89' 2 '.\ " 3 ...

.55;' It+·,· -------I---~--~I-------

',' •••• 1

209 33

,,'."1.52:;' :"':;61: 12' "45"'~ '.

. ", -Hereai:tar.Y predisposition.-· There is U'O doubt 'thata more pre~ise· knowledge would. have greatly increased the number of these instances, mal{ing clearer to.the same exteht'the :otigin of the doubtful' cases. The family history is precisely the point a,bout~wliich. it :1S' most. difficult to learn anything, from the naturally' strong reticenGe of the re~ativ:esiliackJiowledging 'what is ,felt to be a disgrace or stigma. The difficulty rises to)alniost-'an impossihility in. Victoria. "A husband knows little of his wife's. relatives in "tJ'Ie:"rnother :countl~y;: 01;' vice versa,; and, in the greater number of admissions,·tne 11ai'en-ts of' the .fJatient,~ or his. ullcles or aunts, are not in the colo,ny. In'.the ten cases given'the' existence of tIle predisposition was proved; but there were scar.!3ely. ten cases ,in' whidl';its:abs~l1ce'could be affirined. There is a striking' agr.eement iii the rGsuJts of investigation iIito',this cause'in :ill. places where there has been the bestc'hance for.a tel<;ra;1~ly cqlIiplete enquiry. A fairlily predisposition has been found both in Europe alld America i'n about' one-third, or. 33 per cent. of the admissions, and 't~le 'inQ~'e exhallstive the reseatch fthehigher is' the proportion. In the Crichton Instituti.6n at Drinlti'ies, '49 per ~cent. of the patiel!-tsi'were affected with hereditarypredi§position.* ,Since~ t~e peorile of Victoria of the ages in which mental diseases are inost rife are, ;with. a:small dedliction, 'natives of one or other of the divisions oLthe United.IGngdom or of some' European state;: they must he supposed to have. bro'ught with. them this average predisposition of their respective countries; so that unless their residence her.e ,has had some ,unique, inffuence' in: ,annulling the 'innate tendency, ,it must he. expected to manifest itself in about the. sam,e degree. It may be conjectured, without ,much· risk of error, thato,ut of the total 406 admissions ISO were subject'to this influence. :

Puer.pem,l ca:uses.-The' mimber under this head may be considered as. com­pletely accurate'- These cases-the most distressing during their continuance to the .husba:td· .. and: far¢ly of the patient, and demanding very constant attention: and ',treatment~fortunately resp'ond' in the majority of cases to the. care bestowed upon them ,by' making good recoveries .. " . .' \ . ' .. ,.;, lJbsGureor. complex causes.;..,-A large number of cases rqmained that could.not be placed, wi~hout drawing very forced conclusions, under any of the 'separate heads.

~Pr, Crjgl)ton Browne:' Etiology of Insal1ity,~Bri~. and For. Med.-Chh. Hev., July '1867; p. 175. " ,+ I _,.,' ,"# ,I": ' '. .

They might be called, spontaneous; not meaning causeless,. but that the Gauses were chiefly iimate or dependent on ordinary influences acting slowly and gradually. All that could be affirmed was that the p~tieJ?ts"though of ordinary health and good habits, had becoine insane 'without ~my prominent event to accoUlit for it. The existence of some original .organic peculiarity or defect may be inferred, which had at last been lighted up into actual disease by some circumstance in itself accidental, an occasion rather than a cause. Some of the cases about whom the ndlest ipformation (except in regard to hereditary predisposition) could be obtained came under: this head. It would have been easy, with a determination either to findor to make a cause, to fix upon any trivial event coincident with the attack and rank it as the cause. But it is in vain to seek for a greater simplicity than e~ists in nature, or to give undue prominence to one cause out of mimy of equal strength. ' .

. About eighteepof these cases were attributed in the information-papers to Religion. The patient had begun on a sudden to read the Bible or religious books, at the same'time showing signs Of insanity. In the absence' of anything remarkable in his circumstances or habits to explain the attack, religious excitement was supposed to be its origin. But in all except three cases this symptom was evidently one of the first effects of the malady. There had been little previous devoutness or religious feeling. Even the three cases in the table were very doubtful: " One of tlIem was a, male patient who had been a sti'eet-preacher, and it seemed that religious fervour might have had some share in disarranging the mental balance. But it was soon found that he was liable to epilepsy and consequent nervous disturbance about the time of a seizure. The two female patients yvere weak-minded,' arid one of them had suddenly changed her creed, very possibly from commencing aberration. .

Intemperance;-;-About 25 per cent. of the male adrriissions and 10 per cent. of \the female adluissions, or an average of"I9 per cent. of the total number regarding whom information could be obtained, were probably caused by intemperance. The habit is so widely recognized as a source ~f insanity that it was usually looked for by the magistrates or the. police when a patient was committed, and the results of the evidence of relatives or friends embodied in the police report transmitted to the asylum. When a patient came in under a private order, information was gained from the friends who, brouO'ht hini. In 40 male patients intemperance was, thus reported as the "supposed cause." Subsequent examination made, a few of these cases very doubtful, but on the whole' raised the n,umberto 53, chiefly by including instances of too constant thollgh not very excessive' drinking. As an aid to investigation an abstract ~as ll).ade of the previous habits of the patients in regard to intoxicating drinks :-

I Habits. Males. Females. 'Total.

.' . i

Temperate " 136 , 283 ... . .. Lj.] Intemperate ... ... 6z 16 78

" z09· ISZ 361 Unknown ... .. . 33 11. 45

. -,242 164 406

The heading'" Intemperate habits~' incl~de~ those' ~who wer.e habitually intemperate, occasionally intePlperate, or who had been so formerly.

~ _ . Out of the 53 male cases given in the Table 'of Causes, 30 presented very little dIfficulty. They weI:esuffering 'under delirium tremens or temporary excitement, stupidity, or hallucination, obviously due to drink, with no' other sign of insanity. A:fter a course of intoxication followed by confusion of mind, they had been forwarded to the asylum as the most convenient way of disposing of them; a method rendered p'p~sible,hy ~.Y~ry :wide,interpreta~ion of forms.common-to the English and Victorian S~!1~qte~, but,gu~J;"ded. ~t,ho.me by,Iocal .tesponsibility, ,and,in,~merica'by the needful consent of the asylum committee or -the superintendent.' ,'Fhese, 'cases have been previously discussed under the heads of "Delirium tremens" and" j-Iabitual inebriates."

The remaining 23 were examples of insanity proper, chiefly in the form of ~eneral paralysj~ of the insane-:-popularly called softening of the brain. To assign mtemperance ,as a cause was here to a ,much, greater degree a matter of inference. J:;he form of the mental disease does not, as delirium tremens does, reveal its own origin: precisely th~ same ,variety may exist}n~he most abstem\ous as in the most

24

intemperate man. When 'the habit of continuous dram-drinking, tho~gh stopping short of intoxication, : was di~covered to be tolerably recent, it was taken as certain that the disease depended on' the state of chronic alcoholism thus induced. It was harder to disentangle the cases where such habits, though formerly existin$' had quite ceased for some time prior to the patient's admission. No doubt they had often caused degradation of nerve-tissue, giving i'ise to imperceptibly advancing disease not checked by subsequent temperance, so that in general the cases were placed under the same head. It is possible that by.fixing, in almost all cases "'I'here it was one of the elements, on intemperance as the sole cause of the malady, the number assigned to it may be Isomewhat in excess. It wi!l be seen tha~ among th~ females the number of cases' assumed to be caused by mtemperance mclude all m whom intemperate habits had existed; and out of 62 men reported intemperate, in 53 that habit is concluded to have been 'the effective cause. But, on the other hand, it is very probable that if information had been obtainable concerning the unknown cases, the proportion due to intemperance would have been larger among them than among the ,others, because the very fact that little could be found out about them was often due to then' having le4 a wandering and probably dissipated life.

It is singular that among _the whole of the male admissions during the ye.'tr only two persons were to be found connected with the sale of intoxicating liquors; and both these have been discharged recovered. This fact would seem to show that even with a most potent agency in producing insanity there must also exist some predisposi­tion to nervous disturbance, rendering its action more powerful on one than another;

-habits and circumstances must not lead to the overlooking of original proclivity. Some men could not be made permanently insane by drinking ; other organs would suffer before the brain. Not the less is intemperance an, essenti!ll factor in many cases where the disposition to insanity would have lain dormant unless roused into activity by this cause. And it seems to me that the habit of pel1)etually drinking even small quantities of ardent spirits in a hot climate, fosters this tendency where it exists, and is more dangerous, because more insidious, than fits of excessive drinking with long intervals of sobriety.

But another point to be considered is that it would be very unsafe to pass to the other extreme and infer that in every patient who was found to have been more or less intemperate alcoholism was the cause of the disease. Amongst an extremely temperate people the, conclusion might be nearly correct. But, under other conditions, we must also bring into view the proportion outside the asylums affected by the same habit. Taking a_ hundred men at random-miners for example, on any goldfield-and counting those who were occasionally intemperate, the number would be appreciable­one man out of ten, Jet it be imagined, or any other proportion. Unless this habit were a direct preservative from ordinary causes of insanity, these men must be expected to come into the asylums at least in the proportion they bear to the rest, and apart from the question. of temperance or intemperance. If'then on making a similar enquiry among the same class in an asylum, the proportion who had been of intemperate habits were the same, it would be manifestly inaccurate to credit them all to intemperance as a cause. To find that a certain proportion of patients have previously been of more or less intemperate habits, does not furnish a warrant for saying thatif the habit had been non-existent the number would have been exactly so many less; because such a conclu­sion would hnply that whereas an abstemious man could become insane from a variety of causes, a drinker could not-that, in short, his intemperance saved him from every source of the disease except itself. But if we find an excess of intemperates in a lunatic asylum over the proportion in the same class outside, then it is open to assign the difference to the operation of the habit.

Among the female admissions intemperance was, "rjthout doubt, a very small cause, and the number assigned to it is probably slightly in excess. A sudden inclination for drink is sometimes an effect of insanity rather than a cause. Under the influence of commencing disorder of the brain, and the consequent change wrought in the character, among many other morbid propensities a craving for stimulants is suddenly acquired. Some of the cases probably came under this head. The rest were chiefly women who had led vicious and dissipated lives.

To the question whether intemperance is a more frequent cause in the colony than at home it is difficult to reply on account of the introduction into Victorian asylums of cases that would not in England find their way there. The best English and Irish tables yield a proportion varying between 12 per cent. and 18 per cent.

25

In this enquiry it has been sought to avoid .as much as possible any merely conjectmal tesults. A general impression is not to be trusted apart from an individual examination of a large number of cases. Intemperance is a cause so readily seized, so easily packed into one word; it comes so usually under the notice of a patient's family, his fiiends, or the public ; a long peIiod of years so often foreruns the ultimate fate ; that a few striking instances engross the mind and unconsciously count for more than a dozen others who, without any very obvious cause, enter unnoticed into the asylums. The one receives a semi-publicity; the many are passed by. The mind naturally prefers to dwell on tangible results, on which some direct moral may be hung. It is precisely the same with other circumstances connected with lunacy. Any two or three events occurIing together, although preceded and followed by long intervals in which they' are absent, cannot avoid giving the most dispassionate observer the notion of a higher average rate than when double the number happen to be distributed more evenly.

Intemperance, though by no means the most frequent, is thus one of the most prominent causes; because it is more isolated, definite, and preventible than the rest. A special interest attaches to it on the ground that it is directly under the control of the individual and almost the only source that can be affected by legislation. Nothing can be more distressing than the existence of an agent so purely gratuitous; as if the practically inevitable causes of the afRiction were not sufficiently numerous. But to suggest a remedy is beyond the province of this Report. The extent to which suppressive legislation should be carried involves civic and social considerations in

. regard to which no special value belongs to the opinion of an asylum physician. So much stress has been laid in the present Report on peculiar features in the

asylums and on exceptional causes in the production of insanity in the colony, that it is needful to remember that a minoIity only has been under discussion. Upon'the great majOlity of the male patients, and upon all the females with few exceptions, loss of reason has fallen as a calamity from natUTal causes and not as a result of any personal indulgence. Deep compassion for the heaviest loss that a human being can sustain is the only right feeling towards them; they are to be pitied, with no admixture of blame. Doubtless the attack might often have been averted if foreseen, but no one can predict the precise effect of events when acting upon himself, or can always avoid them when they happen. The alarm often excited on the approach of bodily disease leads to an escape from the causes that are producing it. But in mental disease the mind is often perfectly unconscious that it is going wrong; the half­paralysed will cannot move the man out of the fatal groove in which he is working, or change the conditions that are acting unfavomably upon him before it is too late.

GENERAL CAUSES.

In compaIing Victoria with England an observer might anticipate that the rate of insanity in the colony would be higher or lower than that in the mother-country, according as one set of -::onditions or their opposites were selected and dwelt upon. It might have been expected that as in this colony the bulk of the inhabitants enjoy without doubt a larO'er share of the comforts and luxuries of life than in England, with a more exhilarating climate and less c:powding in large cities, a smaller amount of mental disorder would be developed among them. But, on the other hand, causes of insanity of a different order would appear to have a much increased action. The vicissitudes of a miner's occupation, the constant change that has formed the colonial life of many men, alt~rnations of hope and disappointment replacing the level monotony of a labomer's existence at home, a restless vitality in the pursuit of pleasme as well as business, the solitary condition of shepherds on remote stations, the free use of ardent spirits in an atmosphere almost too stimulating in itself to the vascular and nervous systems, an enervating indulgence in tobacco, a general diet containing a large superabundance of animal food; all these things might easily have been anticipated as likely to prove strong incentives to insanity, So also it might be supposed that the emigrants, being healthy and in the prime of life, would enjoy a comparative exemption at least from those forms of mental disease that are favoured by poverty and debility. But this very constitution of tbe population, with a smaller proportion of children and the aged, would tend to give a greater ratio of insanity, since it is at the period of middle life that attacks most frequently OCCUl'. In truth every influence that can affect in any way the inhabitants of a country has some share in determining the liability to mental disease. Race, climate, education, social condition, diet, personal habits, occupations,

26 , "

al:e'J~11 factors' that enter in~o ,t~le product. But:no one previous to experience can so estima0 the e?Cact influence o~ external circmnstances acting .on imiate-menf?l qualities as. to tell, b~f~~~ehan~ ;whether on the, whole they will $lUll up to a 11igher' or lower total in one country than anQther. \Ve may find that some known cause of insanity is absent or of less force among a people, but we cannot assume that the prevalence of il1sanity "rill be exactly so much the lessi until it is discovered whether other causes have supplied its 'pl~ce.~. '.f.h~ same effect is. produced by a,variety of causes, which may l>~ substitut~d for, each <:Jther. St.'ttistics showed, some years ago; that in the north of France ins3:nity was m.ore frequent in the towns than in the comitry districts. Over­~!o",ding\ gre~~e:.; in,teinperp'l!ce, sede~~~ry, o~, unhealthy occup:iti?n~, warit of pure 'air a!l.d. ~exer,Cls~"c.9u~~l,be .readily suggested as the causes. But, turmng to England',) :" t,ljQ cro'rded··1ife of manufacturing towns ha&' no more striking contrast than the, slowly inov~ng ~ pop~!ation ,pf ,one of t~e southern agricultural counties. .If a phleg!l1atic character, country air,. 'and rural labour are any safegllards, they are to b~ fomia in Wihsliire. ,Now fn L~69 the proportion of indig~nt insane, to"the popuhitiC?n of ,t4at di!3trict ,had reached I'lin 327,,01', counting ,the private patients; 'about I in 312-' the highest proportion to. be found anywhere in England an~ Wales. SO,me . strong c~)Unteracting:.iQfhience ·must be at, work, . and this is probably the intense j)oveitj or t4e inhabita~ts ; 'thp highest rate of pauperisin there goes 'hand-In-hand with the high~st .~>at~-,'or,il!~anity."" I~ is therefore not' surprising to find an accomplished physi610gi~t ~3:~dng insanity-.' '. I', '" ,'"'' ",

"rather to 'be an- upshot, o,f ,extreme mental inactivitY';,but when the tenden<;y to it is pronounce'd, t,hellmfllltal., strlJ.in ,eX;citQs'tbe. ,!3Vil.., • " " • The picture thus pl'!,sented to me is that the origin 9f, insanity a~:!} co~crete fac.t is rathel' to be sought for in inactivity, hereditary aud individual, ina~tivity of brai'n, thau'in exel'eise of brain '; and that excessive exel'eise of brain is a cause not so much of mental as of physic~i derange~'en't;" Our uued~catea 'cloddi~h populatidns are in shor~; as' I venture to: assume, the, breeders of QUI' insanity, while our educated" ambitious, overstraining, untiring, mental WOl'ki;m; :are ,th,e breeders arid intensifiers of some of the worst forms of physical malady:-"* :. , ~ :.

:'.:~ ': j30,al~o,' 'but",~or~ c~iitiousij, ~he· supel~nte:tldent, of thG- Wilts ,AsyiVm concludes::.-,-,' ',~ ,', -'" -, ., " '.' . '-"!

. ,.':It would result from the whole of these' compariso~'s, that th~ position of tile' far~~lab~urer by no mean~ exen;ipts hi,~.ft;om that liabilitj' to , insanity .vhich is sometimes' regarded as the especial penalty .0f a mbr~ ~mbitious career."'t ~ I .•

-'''', , . SeekIng: now ,'f0r, a, di~trict, peo]:iled by' the same race, put differing mQ~t wi9.ely. i,n social 'condition· and ,general intelligence, scarcely,any could be foun4 more so' t~an th~ .State of M~~sacJws.etts.", ITh~r~ is a,due admixturc"of, to1vn, and ~~un.tr.y population, ::tnd of manufacturing and agricultural pursuits; the State has the well­founded reputation of being the best educated in the Union; there is no excessive proportion of crime, vice, or intemperance; the people are of good -moral diaracter, shrewd,. i~ven:tive,:,and: enterprising; and prosperity is tolerably diffused among all classes., A, State"(b~nSl~s, of th~ ·insane in 1854' resulted'in the proportion of I in ,J02, the ,v~ry' highest that ,has yet been recorded in any, part of'the world. The censlls w:as a v:cFy.exhaustive one il one, equally so,in Wiltshire'would perhaps make the rates equal: Struck too exclusively ,by this side of ~~e ,question some of the most careful observel;s and reasonE)i's arrive al)TIost at the pOSItIOn that the general advance of a peoplem~y b~:measur<?d by, th~nlUllbe!' Q( tllei!' ipBane. ' ,

" " "H,:M:odern civilization :teilds, c(£~eris paribus, to increase the amount of inental disease."t, , ' . : "An increa.se of insanity is a penalty which an increase of our present civilization necessarily pays.

},' " : ',' An increase, in the number of insane persons in a country does not necessarily mean the degeneracy of the people: the particular i't sacrificed to the' general."§" '.'

_, t, It is ~;t'that the, general: amou:nt, of dis~ase is la~'ger; it may'be smaller i: but tpe instrument that is most wodwd may weal' out soonest. Diseas~s of the l>r~ may nrep(,mderate, oyer those of the other organs. It must be remel1lbered tha~ by the' 1;>raill, is p1e~l)t~n9.t t11~ organ 9f ip.tellectual efiprt .only" but th~l. ch~nelof hop~, fea~,

'. di.~~pp()ip,tmeJ);t,.~nlbition,~alJ the emotiop.~ th~t ,1lJay be over:strained,in a man' of low: ~~tellig~n~e ·as ,mu(')~. !n.pr9portion ~s in one who i~ thoughtful ,and c.4-ltivat~d. . ... _ ' .

, Almost 'all aiscussions on the sources of insanity in Victoria have turned on' caus~s that affE:ct chiefly or exclusively the. mal,e sex. h is reasonable to think that ~ ,lifi;: of change, l-),nd turmoil, moral irregularities, intemperance III alcohol 91' i;n

.. Dr. W, : Physical Disease from Mental Strain.-Journal of Scien,ce, Oct. 1869, 'p. , ,t 'Report for 1869"P: 21. , "':j:Hucknill and Tuke,-Psychological Medicine, 1858, p, 43,' "

"I'\" '§ Dr:'l\:fau!lsley:-Physiol?gy,~nd Patholo~y of' Mind, I86~, pp, 729, 235. • -:",.',' ,;;,

~t

tobacco, have much to do with t4e production of ins~nity. This being so, will not the proportion among men be greatly in"excess' of that among women? Women are generally in a better, material condition here than in the mother-country; there are not so many mothers scarcely able to find food and clothing for their children; nor such uninterrilitting toil atlo)V, wages' of domestic servants or of girls engaged in manufactories. If poverty, and the anxiety and want following in its train, are essential elements in, the production of mental qisease, then should the female inhabitants of the colony be' more free n'om insanity than at home, unless new causes of an equal force make their appearance. It is diflhmlt to find any. Desertions are nO.t frequent as a cause of insariity, the, number of women who have led irregular lives is very small among the admissions, and the proportion due to intemperance is ,certainly very far below that31TIong men. The anticipation seems irresistible that insanity must prevail mllch more' 'among'men than among women, and this expectation is fortified by another consideration. ' The women of the colony have increased much more rapidly of late years than' the men, the excess of immi­gration over emigration being greater. Including the increase by births, there were about 72,000 males more in the 'colony at the close of 1870 than at the close of 1860; but the increase' of females was 117,000, although the addition was made to a population that contained proportionally more men. Many more men than women passed through the' exciting' vicissitiides of the' earlier years of the colony, which is now a younger one, so to speak, as to, its women than as to its men'; the former have entered it more freely since it became better established and its home life more comfortable. Further, this larger importation of women gives them the advantage that the tendency to insanity among them has not had so long a time to become developed, and the female patients in asyhuns to increase so much by the process of accumulation already described. The patients in European asylums are about equally divided between the sexes, just as among the general population; any cause acting among females, but not 'among' males, is' supplied by some other; and the resulting numbers are so much on a par that statisticians cannot fully decide which has the preponderance. With these anticipations we now turn to the facts. In 1859 there were, in proportion to the population, more insane women than men in the asylums. Since that time, and probably in consequence of the larger increase in female immigrants, the balance has turned the other way. Out of every 100 in the estimated population on the.last day of 1870, 56 were male,S. and 44 females; out of every 100 asylum inmates, 59 ,were, males and 41 females. There is thus a cert:;tin excess on the male side, but not nearly so large as might have been expected, and it is diminished or rendered doubtful by the facts regarding immigration. From this result it would seem to follow that' the force of special causes of insanity acting chiefly upon men, must- not, be exaggerated, and· cannot after·all be very excessive in this colony. It is hardly possible to avoid the .conclusion that wider influences affecting both sexes have been the chief sources.

The results of the c~nsus ",ill probably furnish on a future occasion material for comparison on such subjects" as the l'elative frequency of lunacy in various occupations, and on other points which would at present be only matter for speculation.

X.-" CHINESE LUNATICS.

. . Though nQt very many Chinese are to be found in anyone lunatic asylum, t~ere are sufficient in the department to make their enumeration of some interest.

NUMBER OF CHINESE LUNATICS IN ASYLUMS, 31ST DECE;\IBER 1870.

Asylum. Number. Melbourne Z 3 Carlton

"Ararat , 10

Beechwol'th I2

_ . It..!' the same' p~oportioJi" of insanity exists . amongst the Chinese residents ill

the colony· as among the general population, the total of 46 would correspond to 18,506 Chinese. The present census will enable this point to be ascertained. Should the numbers be under 18,500, the Chinese insane.will be by so much greater a burden. thaJi- those' appertaitting to th,e IPajority of' the 'pop~a~ion'. -

28

XL-INSANE BORN -IN VICTORIA.

No positive conclusion as to the relative liability to insanity in the colonia:I­born can be drawn until the colony is some years older. The period of life most favorable to attack is from thirty to forty, next in frequency from twenty to thirty, and thirdly from forty to fifty. An analysis has been made of the numbers and ages of the insane born in the colony at present in the Melbourne Asylum.

VICTORIAN-BORN IN MELBOURNE ASYLUM.

Ages. Males. Females. Total. -

From 5 to 10 years •.. ... 7 7 14

" 10 to 15 "

... ... 2 8 10

" 15 to 20 " ' ... ... .3 13 16

" 20 to 25

" ...

... I 7 I 8

" 25 to 28

" ... '" 3 1 4

I 22 30 52

Idiots ... . .. . .. 13 29 42 Othel~ forms of insanity ... 9 I 10

1 1-

-I 22 3 0 52

XII.-SUICIDAL CASES.

No death from suicide has taken place among the patients in the public asylums of the colony during the past year ( I 870); there had been two in 1869, and one in 1868, Considering the number under care, the proportion' is not a large one. When a patient has ~made an attempt upon his life, or shown a suicidal disposition previous to admission, the fact is stated in the papers brought with him to the asylum. The following is an abstract'of the number admitt~d' to the Melbourne Asylum during last year' who were thus reported suicidal, either in the police report or in the state­ment accompanying a private order :-

ADMISSIONS-MELBOURNE ASYLUM, 1870'

I Reported Not - Reported Total.

I

Suicidal. Suicidal.

Males '" ... I

37 205 242 ]<'emales ... ... 34 13° 164

71 335 4 06

The column "Not reported snicidal" includes those reported "Not suicidal" ·and those relwrted " Unknown."

XIII.-RE-ADMISSIONS ru'ID RELAPSES.

Like many other diseases, insanity is ,liable to recur, although many years of mental health may intervene between the attacks. On comparing the proportions of re-admissions to the total admissions, it will be found that it is smaller than that which is observed elsewhere. There was a total of 8 I 15 admissions in the English county and borough asylums during the year 1869; 1109 out of these were re-admissions, making a proportion of 14 per cent~ '*' In the Victorian asylums' there were 48

.. Twenty-fourth Report of English Commissioners, p. 86,

29

re-admissions out of a total of 566 (page 37), making a proportion of 8 per cent. It would, however, be very inaccurate to frame any general conclusion from these figures. The population of Victoria is, as a whole, much less stationary than that of England, and the country asylums have not been opened long enough to obtain their due proportion. As the asylum at the Yarra Bend has been much longer in existence, it presents a much higher percentage than the others. In the following table these cases have been classified according to the length of time that elapsed between their discharge as recovered and the next admission.

RE-ADMISSIONS-MELBOURNE ASYLmI, 1870'

Had been Discharged Recovered.

Length of time after Discharge.

Male. Female. Total.

Under [ month '" ... 4- . .. 4 From I to 3 months ... ... I I 2

" 3 to 6 months ... ... I 2 3

" 6 to 9 months ... ... [ I 2

" 9 to 12 months ... 1 '" I

" [ to 2 years ...... ... 3 4 7

" 2 to 3 years ... ... 3 5 8

" 3 to 4 years .. ... ... I I

" 4 to 5 years ... ... 1 , [ 2

" 5 to [0 years ••. ... 4 6 10

" [0 to 15 years ... 1 3 4

----2O 24 44-

Total admissions ... 242 164 406

XIV.-CoST OF MAL."iTTENANCE.

The following table gives the amount of expenditure in the Lunacy Department during I 870, with its distribution over the four asylums, and shows the average cost per week of each inmate. The gross total comprises every item which appertains to the department-salaries, provisions, clothing, stores, medicines and medical comforts, forage, fuel, light and water, removals, and incidentals. Building expenses belonging to the department of Public Works are not included.

EXPENDITURE OF HOSPITALS FOR THE INSANE, 1870'

Average Number Average Asylums. Expenditure. of Weekly Cost per

Patients Resident. Patient.

£ s. d. £ s. d. Melbourne ... . .. 34>3 58 10 6 1,002 ° 13 2 Carlton ... ... ... 5,202 14 7 145 ° 13 9 Ararat ... ... . .. 11,721 19 6 301 ° 14 II Beechworth ... . .. 10.353 5 ° 297 ° 13 4

61,636 9 7 1,745 o [3 7 General expenses •.. ... 1,524- 5 '4 1,745 0 0 4

£63,160 14 II 1,745 ° 13 II

There has been a reduction in the average cost of the insane during the past year. In 1869 the gross expenditure was £60,925 15s. lId., the average number resident was 1926, and their weekly cost 14S. 4d. each.

30 , '~'. "~

Some general expenses are included in this de tment which' are not dhargeaOle to asylums elsewhere; these are the' cost of offi ,visitors, inspector's 'office, and remova~ of patients. , In the .IT nited Kingdom the inspection falls en the Imperial Government, not on the local asylums, and indigent patient.s are removed or tranElferrep' by the uni~ns, to which .they belong. These items are therefore placed together. in the' table under one head included in the gross total and gross average, bnt. not in ,the net amounts for each asylum, to which 'they make a difference over the whole of 4d. a week each patient. '. ",

Certain sums have been collected from private funds for the maintenance of patients through the office of the Master'in Lunacy' at Melbomne, as shown in the followi.ng return fmnished by ~im :-

AMOUNTS COLLECTED FOR J\.iAlNl'ENANCE BY THE MAS'l'ER IN LUNACY DURING 1870 •

. Asylums. Amounts. £ s. d.

1:t:elboui'ne ... 1,506 i 6 '

C!1.rlton 286: 8 2 Ararat 161 4 6

. Beechworth. 51 3 , :

Total £2,005 5 " :'" "

The~e receipts, as they are paid into the general rev~nue, are entrrely independent of the accounts of this department; they are introduced in order to show the existence of a number of private 0'1' serni-private 'patients in the public asylums, more especially at Melbomne,for whi~h the receipts, in proportion to the numbers, are very much larger. . .. ... :, , .

,For pmposes of comparison, the' latest maintenance rates,from the highest to the lowest, at some lunatic' hospitals and borough or county asylums in England, and at all the American asylums of which the rates can be ascertained, are now subj oined.

The same principle of separation that exists in Victoria between building and maintenance is always observed ,in ,these 'rates. The first cost of asylums depends to so great a degree on accidental circumstances in various localities and countries, that it throws little light on, the' comj:larative' economy of management of'. the patients who afterw~rds reside in-them. The maintenance may be high in- a'cheap building"or ·it may, be low in a costly one .. The results of the labom of the patients are always used to lessen the maintenance ,v-hether the produce is consumed or sold. It is of most ~port:'1nce when there are many artizans among the population, or good agricul~ural labourers with a fertile soil surrounding the asylum~" - ..

WEEKLY. MAINTENANCE RATES PER PATIENT. ; , ~ , ' " t

ENGLAND. UNITED STATES.

State Asylums.t £, s. d .

L~tnatic HospitCfls." , 'Bor011gh or County AS.lIlums.* £ s. 'd; ... £ :s. 'd.-

Manchester 2 3 N ewcastle-oll-Tyne 0 13 6 Nott.ingham ' .

I 9 2 City of' London OIZ 61! " ... 'iI. . ~ ... 41 Bethlehem, London', 1 3 6 Bristol , 0 12

St. Luke's, LondOD I I~ Cam bridgeshire ' . 0 10 - 8

I Northampton 0 13 5~ Surrey '.:.. ' o '10 6 Northumberland < 0 10' 4!

Criminal Lunatic Asylums. Middlesex (Ihnwell) 0 10 31 4'

Bro!1.dmoort -Kent ... o .IO Ii

3 0 Derbyshire 0 9 10 Fisherton 0 17 0 Wilts - 0'8 I~

Dorset 0,6 10

Washingt.on o 10

New York o 18 8

New Jersey:.: 0 16 8 Massachusetts . b 15 0

Pimnsylvania 0 15 0 ,I ,;" VICTOlUA.

Hospitals for tlte Insane . £ s. d.

Ararat o 14 II

Carlton 0 13 9 Beechworth 0 13 4

. :. . Melbourne o 13 2

.. :Report of English Lunacy Commissioners for 1869, pp. IOO-II 3. t Journal 'of Mental SCience, January;' I 869,'P. 560. t Dr. Manning's Report, p. I U.

3i

The rat~ for pa~per lunatics in the city parish at Glasgow. was i os. 9d: in 1869;*' at some of the district asylums in Scotland it was lIS. IId. t For Ireland in :£ 866 the average of the disbict asylums was 9s.,t which has probably sirice risen coincidently with the diminution of' pauperism. , The public institutions for the insane in Victoria are named indifferently

hospitals for the insane or lunatic asylums, but in England and elsewhere there is a real difference between the two. The lunatic hospitals or hospitals for the insane, strictJy so cal1ed, in England, Ireland, and the United States, are charitable institutions,

, supported partly from bequests and subscriptions, partly by small sums paid by those able to do SQ' among t'he patients, who are usually respectable persons reduced to indigence by the malady. The cases selected are the acute and curable forms of mental disorder.' The rate of maintenance is, therefore, much. higher at' Bethlehem aild' St. Luke's hi' London than at Hanwell and Colney Hatch, which are not only purely pauper institutions, supplied largelY fi'om the workhouses, but also contain a much smaller proportion of. recent cases. These Middlesex c0l'!-nty asylums are rec~ptacles for an enoimous mass of chrenic cases who are kept at a correspondingly loW; rate. In Victoria ,the public asylums; as previously shown, contain within less than one per cent. the whole of the certified Innacy of the, colony, and therefore a much larger proportion of residents who, in England would be found in the lunatic hospitals or the cheaper kind of private, asylums. Many of those who in London would enter the hospitals just named, or in Dublin would be received into St. Patrick's (Swift's) or St. Vincent's, come in Melbourne at once to the public asylums. I:t;l the

I Hanwell Asylum for 'every 100 cases resident there on the first day of ,1869 a pro­portion of only, I 9 recent cases were received during ,the year.,§ . But in the Melbourne Asylum there were in 1870 a proportion of 41 new cases admitted', to every'lOo old ones. It is these recent cases that cost the most: they stand in need of the pest treatment that can be provided, in order, while there is the best chance of'success, to attain a cure. ' , '

T~e Northampton General Lunatic Hospital, as it is," essentially the pauper asylum for the' county,"11 but also contains a certain proportion of pIivate patients, seems to furnish the nearest analogy to the Victorian asylums~ It will be seen that the average rate (13s. S!d.) is about equal to tha.t of the 'Melbourne Asylum (I3s. 2d.). The. totals arenear,Iy the same, but the items :which compose them differ;, some are on a more economical scale in the colony. The average expenditure per patient in the Victorian a~ylums during 1870 on J1]edicines" medical comforts, wines, spirits; and malt liquors, waE! £2 per annum (9d. per week), all these articles being at higher prices than at lwme; but in Northampton it was £2 ,lOS. for wines, spirits, and malt liquors alone: Gfr ' The cures were 32, per cent. ; at Melbourne 40 per cC11t.

Turning' now to the borough and county asylums it must be remarked that the figutes represent' the' actual cost to the respective pal'ish or union poor rates of the lunatics who are chargeable to them. They represent the lowest safe point to which it is found practicable in each county to reduce the I;ates. .Some details concerning the Wiltshire Asylum, the lowest but one on the list,' will explain under what conditions so small a rate consistent with efficiency becomes possible. ** The female attendants commence at £5 a year, the male attendants at £18 a year; while in Victoria the fOrJ.ner begin ,with. £26 (£30 in the up-country asylums) and the latter with £65. The cook of the asylum has £15 a year. Clothing, including boots' and hats, is managed very cheaply, costing 26s. per year for each patient. The anlOun~ supplies' material; the attendant ,tailors who help,to mak,e it up are en ged at 8s. to lOS •. per week with rations. ' Now in the West Riding ,of York .~, the centre of cloth ,manufacture" the clothing at the asylum .cost 55s. 3d. f~r the sanie year, although a good' deal of material was wov.en in the asylum. tt At Melbourne this item amounted to £4 '138. per patient, including bedding, kept in the English accounts under a separate head. In one point of economy if in no other it ~ght be expected that the Victorian asylums would have the adyantage: the lower pTIC~ of meat. .,r~ Wiltshire the contra~t rate was 7d: p~r lb., at Melbourne it is 2id. But III the English asylum OZS. are gIven to each patIent and servant three a week, and 3. ozs. in stew on another day-a total slightly under I:t lbs., costing In the colomal"asylums meat is allowed once 'every day in rations of 12 ozs.,

, _ 1870, P.·4I 4. , § R!;port of English Lunacy Commissioners for 1869, p. 84. t IbId" Jan:rarl 18 / 1, p. .' : , " .. ' II IbId" p",36 . • J Dr. Mannmg,sRer.orp, P:·IU, .';, •. ,:. c .,~,,' .. , ,''1flbld"pp,:~,?8,,?~ .. : .•

Report of Wilts'Asylum for 1869; Financial Accounts. tt Ibid., pp. IOZ, ZII.

(

32

to 5*lbs. per week, costing IS. The rate of mortality is 10 per cent, * as against 7-t per cent. in Victoria; but this is attributed to the weak and under-fed condition in which many of the patients enter the asylum'. These details are an exponent of a general condition of the working community that is almost appalling. One out of every twelve of the, population of the coupty is a literal pauper, supported by the poor rates;t 20,000 out of a population of 246,856 are in this condition; the 755 insane are a mere fraction of a huge burden of pauperism, a burden that perpetuates itself by dragging down to the merest pittance the .wag!3s even of the best laborers and artizans, w40 are kept oscillating on the verge of starvation, Wages are at precisely the level that will keep a. man and his family off the parish, so lopg as he can obtain work. The pressure of poverty is so intense that respectable women will enter the asylum as attendants at the rate of two shillings per week, and suitable men for less than seven shillings. These details do not indicate cruelty or mismanagement; on the contrary, the asylum. has be,en under superintendence as good as could be wished. The Commissioners in Lmiacy specially report that the attendants "seem to be of a respectable class," though the sup~rintendent intimates that they leave the county as soon as they can.t When compared with the standard of subsistence outside,

_ the Wilts asylum ranks as high as any in Victoria. To enter it as a patient is a distinct rise in diet, clothing, and comfort; to enter it as an attendant places a man or woman 'in a better relative position than outside with wages at 9s. per week. But it is clear that no other locality unless in a state of poverty equally abject' could compete in point of economy. In a more prosperous district a rate of maintenance equally low would indicate maltreatment or neglect of the patients, The disadvantage. that a happie~ state of things has brought with it is, that it costs a little more to provide for watching and keeping the dependent insane. To imagine the population of Victoria in the same condition, would imply that a number of 60,000 were directly dependent on the State, and the laboring classes in general brought down nearly to the same level. Wiltshire has a much greater 'proportion of lunatics to its population than has Victoria; these lunatics are a fragment (5 per cent.) almost lost in the dark back­ground of general pauperism; the solitary advantage enjoyed is that this fraction costs not quite half as much as it would if the general burden were removed.

The social condition and the amount of pauperism is much the same in the neighbouring county of Dorset; -but ,the rate of the county asylum is even lower. In 1869 it was 6s. lod:, a 10'Yer rate than any public asylum in England or Scotland, and probably lower than any asylum in the British Empire. But the Dor~et Asylum has a contract, renewed every three years, to receive lunatics, generally hopeless cases,_ at the rate of I IS. and I2S. a week from out-county parishes in want of accommodation. AbOlit one-third (157 out of 478) of the inmates come under this head,§ and the profit helps to lessen the expense; so that the county is able to charge only 6s. IOd. to its own parishes. But this does not represent the real maintenance rate. Other county asylums also receive'in a similar manner out-county patients, generally at the rate of 14S.; the profit being often applied in lessening their own rate of maintenance. Many of the Middlesex poor are distributed in various county asylums at rates varying frbm 14S. to 17s. 6d. per week. II Another source of economy in the Dorset Asylum is indicated by an extract from the Report of the Commissioners in Lunacy:-

"We this day saw the patients at dinner, which consisted of soup and bread .only. We tasted the soup and found it thin and of poor quality; many of the patients refused it; and we suggest for consideration the propriety of substituting for this dinner meat in a solid form. The weekly allowance of meat, cooked and free from bone, is at present not more than 2 I ounces for the men and 19 ounces for the women.'"

The same remarks apply more or less to all the county asylums ; the patients in them are part of a large amount of pauperism which is supported from the same source. The general standard of living is lower, all or most manufactured articles are cheaper, and the rate of wages of good domestic servants an,d of industrious men offair education and trustworthy character is less than in Victoria or the United States. All these items have a direct bearing on the cost of the insane. . /

, The asylums in the United States furnish a more equal standard of comparison, since the general condition of the population corresponds more closely. It will be seen that the highest rate of maintenance for Victoria only touches the lowest for the United States; while in the Melbourne Asylum the inmates cost 5s. 8d. less per week than in

* Wilts Report for 1869, p, 32. t Ibid" p. 20.

. t Wilts Report for 1864, pp. 24, 20.

§ Report of Lunacy Commissioners for 1869, p. 136. II Ibid., p. 47. 'If Ibid., p. 139. /

..

33

the New York State Asylum. In the Cincinnati Asylum (for the State of Ohio) the salaries ,commence at IS, dollars per month for female attendants and 18 for male attendants. In the New York City Asylum female attendants are/paid 16 dollars and the male attendants 18 dollars. At the Pennsylvania AsyluIQ. the female attendants receive 12 dollars per month. ,Board is , always included in these rates. * In I 868 the bare cost bf patients for maintenance, exclusive of salaries, was 4 dollars per week -in the New York State Asylum. The dietary in American asylums is usually of a very liberal and varied kind.

A parallel can be more readily made between the lunatic asylums of different countries than ~between a lunatic asylum and an institution such as a poorhouse or

. workhouse containing sane inmates. The average cost Qf the insane is necessarily and invariably much higher; aln;wst every item is increased; the lunatic requires

. mQre fOQd, destroys and wears more clQthing and bedding, and nee~s much mQre , aUenda,nce and watching, and Qf a better ,class. Even when idiots and the quieter class

of 'lunatics are kept under Poor Law guardians in WQrkhouses, they. are much more expensive than the infirm but sane PQor under the same 111anagement. So. also the pauper rate Qf a lunatic asylum is, at its very IQwest, much higher than the general wQrkhQuse rate. In a year (1858) when the DevQn Co~nty Asylum was reduced to an ,extremely IQW rate (7s.7d. per week i~stead Qf 9s.6d. as at present), the rate of maintenance of the sane destitute (everything included except the first cost

. Qf the building) was 39. 6td. in the cQrresponding un~on wQrkhQuse. t ,"VithQut laying down an invariable rule, it would seem that the insane iIi lunatic asylums cost. twice as much, or nearly so., as the sane .in PQQrhQuses, when both are managed with equal eCQnQmy. - . , _

On the whQle, therefore, it WQuld appear that the Victorian hospitals 'fQr the insane stand midway in cost between the lunatic hospitals and the cQunty and

. borough asylums Qf England, being abQut equal to the lowest of the fOI'mer, and the highest Qf the latter ; and that their maintenance rate is IQwer, 'so far as known, than any Qf the State asylums of Ame'Hca. A cheap rate Qf maintenance is indeed far frQm being a test in itself Qf gOQd asylum management ;. it may be a sign Qf few cures, many deaths, much neglect, insufficient ,c1Qthing, and want of gQod attendance or of the comfQrts that conduce 'to recovery. But neither is a high rate in itself a sign of increased efficiency, as it may depend on mere want of econQmy. The best asylum is evidently that in which the standard of efficiency is kept high and a ~ue measure of comfort is secured to the patients, 'at the lQwest rate that is co~sistent with these Qbjects and with the cQnditions in which the asylum is placed. It can be safely said that the Victorian asylums, as to their results, hold a very gQQd place, and it may

,perhaps be now added that the cost of maintenance is, 'all things cQnsidered, very mQderate. It is the number of inmates daggregated. in the, asylums ih the manner previQusly described, rather than the individual 'CQst of each patient, that makes the tQtal a large one.' "

In cQnclusiQn I have'much pleasure in acknQwledging the very valuable help given me by Dr. Ba;yldQn in the preparation of 't his Report. .

I have the honor'to be, Sir,

/

Your most obedient servant,

E. PALEY,

Inspector QfLunatic Asylums,

'" Dr. Robertson (Glasgow): American AsyluUlS.-Joutnal of Mental Science, ,April 1869, pp. 62, 73. 78, 83. , ' t Thi~teeuth Report, l)evon County Asylum, p. 10:

No. 25. C

" 34

\ "

" pr··r, ',:', ,,;,,;,.), ,'MELBOURNE.iAND' CARLTON, LUNATIc:'!ASYL'lJ'MS~'/\ ";/ v :\

. :,' ," ';)jJiti'ng )ho' Y~ar "If~7-6 ~tliese' asyluiii~, h~ve,been, ~i~it~lby ,¥~; BO!1r'd 'Q(V:i~it9.i~~ con!3ist~ng'of the Honorab,Ie J: T, Smith, Esq:,-~~,L,A::;Ch'airinan'i'.arid p'o,Cto,rsJ'Bark~r, Thomas,', aIld Greeves', ,:~he~r:, ';reports" on, ~he stateal~9. ';co'Q.difion; of -the ,asylums were f<{rwa~de4t?~he" Honorable)he Chief 'S~cre~arj. ' 'No', oceurrenGe'des~rviilg:o£ speCiaF mention 'has t:ikei;t''place d!il~ing.the iear. :,,", ,,' t,',',.,,',!.. ,

"I ' ."". ,',., ~

ARARAT 'LUNATIC AsYLm.f,

': , :' ,F~)lirstatutoiy~isi~s we~rl nl~~e .to this' rasy'~uI~r: dui'i~g' 't~eyear-,-,;oh,:the;r9thl March;; 30th:' rru~e," 'Joth ''Septenipet, ;arrd 2:3rd, . December., " 'Ilhe war'ds)':d-arini tories~/ gall~d~s, attd' 'office~ were found;: in!eicell'ent:order,1 and! ~he patients fot;:th~r most': part tranquil 'an'd' wellbeh'ave:d.: ~ Tlle'Nredica! ;'u dUi'luil shcrwi-t Ithat: ~i'ttre' l'estraiQ.ti':oi:' seclusihn 'has:"been 'found nec~ssary. ·'e I; eiamiiied",the'prbviE!.lons' :in the 'sto:re~- tHey apperu;ed to ,be 0'£ gO,od ,q~~lity. I sa:" th~ qi~lllers ~erve~ to rea~ly .all the .p~tients.';' the food was good,;.wellcooked, and:fmrlydlsEnbuted: ,':[',,;,0 !,' "'I.','''; I

, , ,:'Or:e' of;~he: f~male;pati.ents~ L. C.;,who"hadbee'n,resjuent' for'tw.o;,y.e~rs;','w~ reported BJ'the, :MedlcalSl1p'enIltenden~i.qh theie'u7th" Febr.narx, to. be; pregn:an:t,r',: :':'FhIS reportf. was' mlme'diately" forwar.ded '.'and .,,·de:Ut ~ w.itH;: 1ly "th,(p l:'Iol1"0Table'i ~lre"'::;€l4i,ef Secretary; Who "directed 'tlia:t-th:eteg,uhttioris in -regard to :womeb,.':-leavirrg"trreh; part,@f

'the' asyl,u:ni shotUd':be' stringently ,adhere'd I ,to;l!' ,'Orto. the 'h~tli lMai'cli uF yisitea.' ,the' asylum and :'ma1;le:"'a pel'soiial":inyestigatioh int'o\the::case. <:'.Pliewolnah(.told;me'thatra' patient, J~' A.;·w~ldhe -callse\:of hel~ conditibnr'and evetJ"cireuITistam:~e:corrohorated\

, he:"ac~,oullt',:'~:'~~e'~ad:~been: pa,~ti~llY' ~~:ploy,ea ~,?uyi~~" .. t~~: ?:a!-~i~e'~~'assi~~tihg .the pI1vate serV3:J;lt <?f't~e' l\fedl9al E.'upermten'dept 1'n :.atten;dmg ,to'. hIS.; quartersi'and'\qre' male 'patient;")vhb \vas 'convalescent/ hi:l;d ·on"'several' 0C'casion'srcome ,'there 'Oil (Vari0U8'

'errands: The"Medical"Superin'ten'dent shlt'i3dthat li-e,?dtd'lro't: ima:gine:' that' ~ny evil could <}p'ossibly·'be anticinated", ,~hei1,th'e~ v.r0IQ~an',:;w3;S: in" his ',o,wn ',nduse '.a:rid,iri.'nder the. ,car~t of'hi~!'OWh' sGrvttiit." "~uc~ ,~ri,'evetit 'is not;\on!y~lextremelypa,infulrin\.ifself,'but~ a~qloug?·';happ~nlh:gt,luhdet;tl,tese'-v'erY','ex.c~p'~ional':cir(mmstances~,'is,'lia:ble to,:refiect

, dIsgrace on tltegeneral management;of·rarr asyh!L'm." ,""" , ''1'''- ,', "'1',"')",' -,'. ~'5:'::'~,,. The follo,Hng works appeal' to me to be urgently I;equired, viz, :-( I) Additional,

dormitory accommodation for 70 ~1ale and 50 female patients; (2) farm buildings; (3) workshops ;'(4rquartei;s()n'~he 'a;sylunr:reser,ve;forplale: attendallts.;,H ,S&i:ne'alt~rations . and repairs are also needed\vizqlpain'tin-g -arid 'distempering tn:roughout tIie 'asy luni;

-and alterations to laundry a,nd drying closets. ,The water supply is unsatisfactory as to quality, and during summer insufficient as to: quantity. It is highly important that steps should be, ,takel), to ,se.cure,a, permftnent and abundant supply of good water to the a~ylum. ' . , - ., ' . I

The amusements. h;wc been as heretofore, and an addition'has been'made by the erection of' 'a, movable stage in the ~ecreation hall, and a band is also in course of organization. Farm and garden operations have be~n caTI'iea on vigorously, ~nd have

'afforded means of occupation to a large number of patients. Considerable' progress has been made in the planting of fruit and ornamental, trees. A great quantify of firewood has been 'cut and gathered in, and a good piece' of road has been constructed.

BEECHWORTH LUNATIC ASYLUM.

Three statutory visits) of inspe~tion were made to this asylum during the year­on 31st March, 2nd ApdJ,a!1d.,BJh_,D,gg~.!l1.be1,', "The,whokJ?uil(Hng .-wa,sjJ1.ex,c~llQl~~ order; the stores,: 'offices, wards; 'dormitories, and. airing: "group:ds beingJ: wen ',kept. All the patients were clean and" neat ih perSOll and dress; no one was in restraint or

35

sech,l.sion, and one' only, on the occasion of my last visit, was in bed. This patient is bed-ridden and demented, and was transferred frpm the Beechworth Hospital. I am of. opinion that such a case should not be transferred from a hospItal for the, sick to an asylum for the insane, and ,the local charity be. thus relieved of the cost" at the expense-of the Gove~nment, on whom also will' fall the charges for a coroner's inquest at the patient's death.

The following additional buildings are required, viz. :-( I) Day-rooms and dormitories; (2) gardener'S house. Alterations and repairs :-( I) To warders' quarters ; '( 2) fencing; (3) converting present quarters of Medical Officer into sleeping and sitting rooms, and making provision for the Medical Officer in the main centre building. No permanent supply 0f water has yet been mage, and the tank 'which was lately constructed to increase water storage stands very much in need of repair. The water service would be hlOst effectually, and in the end most conveniently made, by taking it from a source of Sufficient elevation to admit of its being can'i~d by gravitation to the highest part of the building. tI

The amusePlents are as usual, and the fafp:l gardens and workrooms have afforded rpeans of occupation to a large number of patients.

LICENSED HOUSE FOR THE i:NSANE~ CREMORNE.

Four statutory visits 'of inspe~tio~ were made to this asylum during the year. On each occasion I saw aU the patients,' who appeared to 'ge comfortable and well cared for; the buildings were in good order, and well adapted to the requirements of the inmates. '

E. PALEY.

, .' "

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37

APPENDICES.

APPENDIX A.

HOSPITALS FOR THE INSANE. TABLE r;-Showing the Admissions, Re-admissions, Discharges, and Deaths during the Year 1870 in all

- the Asylums. \

, Males. Females. Total.

In the asylum on ut January 1870 ... ... ... ... .. . -. .. . .. 999 706 I,70S

:\Iales. Females. Tota.!. ---- ---- ----

{ For the first time - 324 194 518 Admitted ... ... ... ... Be-admitted .••• ... ... ... . .. 23 25 48

Transferred during the year ... ... ... . .. 54 41 95 Retaken ••• .•. ... ... ... ... .... 1 . .. I,

Total received ... ... ... ... ... . .. 402 260 662 ,

Total under care during the year .. /- ... '" ... 1,401 966 1.,367

Males. Females .. Total. Discharged, Removed, &c. ;- ---- --------

Recovered ... . ... ... ... ... ... Hg 109 228 Improved ... . .. ... ... . .. . .. 26 22 48 Transferred ... ... ... ... ... .. . 55 41 . 96 Escaped

, II , ... II ... ... ... ... ... .. .

Died .•. ... ... ... ... ... .. . 96 39 135

Total discharged, died, &c., during the year ... ... ... 3°7 2.Il . 5I S Remaining in the asylum on the 31St December 1870 (inclu~ive of ----

absent on 'trial, males and females) '" ... • •• 1,094 755 1,849 ----I-

, 'Averag~ numbers resident during the year ... ... ... 1,025 7'1,0 1,745

HOSPITALS FOR THE INSANE. TABLE 2.-Showing the Admissions, Discharges, and Deaths, ~ith the Mean Annual Mortality, and

Proportion of Recoveries, &c., per Cent. on the Admissions for the Years 1868 to 1870,

Admitted.

Recovered. Relieved. Transferred. I I Remaining on

-----,-------,----- DIed. • the ,1st December : ' • In each year.

Discharged. Average Numbers

Resident.

HOSPITALS FOR THE IN,SANE . •

Percentage of Cases Recovered

and ReUe'\'ed on Admissions.

TABLE 3.-Showing the Causes of Death during the Year 1870.

Cause of Death.

Cerebral or Spinal Diseases :­Apoplexy and ParalysIs •• Epilepsy and Convulsloll5 .,

• Genera! Paralysis. • . • • • Maniacal and Melancholic Elmaust!on or Decay . . •.

I Inflammation and otber Diseases of the BraIn, SoftenIng, Tumors, &c.

Thoracic Diseases Inflammation the Lungs, Pleurlll, and Bronchi,

~~;!:~a: J~~~:.rltion :: ' Abdominal Diseases I

Inflam!llll.tlon Ulceration of tbe StoIllllch, IntestineS, or Peritoneum \

Dysentery and Diarrhroa Bright's Disease .'.

E!'yslpelas Cancer General Debility and Old Age Accidents

Total

Melbeurne.

M, F. Total. M. 1-

5 5 , 4 1 ~l 16

6 6 12. 12.

1- 1 4 :z. 4 1 II

'I

4 4 9 10 1. :z.

:z. "-I .. 'I

- -55 ZS 80 16

Carlton. ,Ararat. Beechworth.

F. Total. M. F. Total. M. F. Total. --------

1- .. 1 6 :z. ..

13 9 u. • 1

:z. 4 S 1 :z.

.. I 1 1. :z.

I " .. I 'I-;;-~_"

. ... 17 19 IZ 31 6 I 1 7

Percentage of DeathS on the Average

M.

6 3

I~

~8

6 5 z

1

9 1. :z. .. 3

Numbers Resident.

Total.

]'. Total.

Ii S s Z ~I ~ 8

10 38

1 1 U 17 1.: 4

'4 1 10

:z. 1. 1. 3

I~I-;-z

96 39' 135

38

gOSPITALS' FOB. THE INSANE. TABLE {.-Showing the .Length of Residence of thos13 Discharged Recovered, and of those who have Died,

during the Year 1870.

Recovered. Length of Residence.

Mates, Females. Total, ~-------- -------------------''-1 Und'er I month _From I to 3 months

" 3 to.6 . '" ' ". 6 to 9 . " " 9 to 12 "

I to'2 years " 1.tO'3 " " 3 to 5 " " 5 to 7 ',,_

7 to 10 " " 10 to 12. " •• ,

" 12 to 15 " Over 15 years

.Total : ..

15 6 21

40 36 76 32 29 61

i , " 9 21 30

II 5 i6 .:,/ 8 -, 8 16.

... 2 2

2. 2 4

, I

.•. -,-I-J-9---·~I--~

H'OSPITALS J<'OR THE INSANE.

- I

Died.

lln1es. Females.

.9 4 13 5 14 I

9 2 10 2 2-1 II

7 8 5

2 2

2

39

TABLE 5.-Showing'the Ages of Admissions, Discharges, and Deaths .;luring the Year 1870,

Admissions. Ages. Recovered.

Discharges.

fumoved, ltel1evcd, or otherwise.

Deaths.

Total.

13 18 15 II _ 12

32

15 6 3 3

·4

2

135

I '- ' . ' , Males. Females. Total. Males. FEmales. Total, Males. Females. I Tot"l. Males. Females. I Total. -------~--~i~-- '-. /-----1------1------------From's to 10 years ... I. I'·...... ... ... .. . I I

• "-rotoI5.,, ••. 2 5' 7 ......... ,3 ... 3 . .. I I I I 2 3 4 . 7

29 15 44 28 8 36

" 15 to 20 " " ••• 10 1.1 3I 5 ,II 16. I

'_"" . 20 to .30.4 - ,i . ~"... ,,64 '" 69 -" 1 33 ""24 , 1.9 '" 53 dO

" 30 to 40,,' ... 101 76 177 ,39 31 70 30 " 40 to 50 " ••• 78 42 IZO 27 1.1. 49 1.5

-1. 3 ,

18 28

15 45 18 43

.19 5 24 4 ... 4 6 2 8 I ... I . ... ... .. .

-S 2 7

96 39 135

" 50 to 60" ... 58 17. 75 14 6 20 12

" 60 to 70 " ... 8 5 13 3 3 6 2 . r" . 70 to 80. " ••• 4'... 4... ... ... 1 " 80 t'o 90 " ... 1 J:... ... ... ."

< ,. 90 and upwards ; I ' Unknown - .~: -... "33 ·:"4 "( "37 :<"7 ",'7 ~ ";4:'''8 •• ; "'9

: ~ .... 1ill,~~I: 599 1~-.-I;-~I--;;I--6;_'~ -' ."""" .~-~-- 'l

II {{\~I !Total' lUll'

6 18 2 4 I 1.

... . ..

APPENDIX B.

< • ' •• ,.' ; HOSP-ITAL· 'FOR THE INSANE, MELBOURNE., TABt;E -'r :-'-'-8I:iowirlg . the Admissions, Re'-admi ssions, i Discharges, I an~ Deaths dur!Dg, the Year ending

. ""<'-.~. 31st December 1870' I I

I~~ - Fema.les . Tom!. . , In the asylum on 1St J anu~rJ7 187,0< ... ... ... ... ... ... .. . 587' 399 986

, . " " ., ;

' .. ',.' ,-,~ "j" "'"' .,"'« lIfales. Females. Toml.

Admitted for. the first time during the year 360 , ... ... 1.20 140

I Re-admittedduring the year. / ... ... ... .. , :1.2 24 46 I

',rm.nsferred during the year ... , ... ... ... . .. 2 1. \ I

Retaken ... ... ... ... . .. ... ... ... ... --_._ ... __ .... _._---,--------, , Total admitted ... . .. ... . .. ... .. . 1.42 166 408 - , ..

- , -, " I " Total under care during the year ... \ , , ... ... ... 8:1.9 565 1,394

Female:!. ! I

Males. Total.

Discharged, Removed, &c:;-- , 1-:-Recoyered ... ," ... ... .. . ... 62.. 1# Improved ... ... ... ... .. . .. . '15 II 26 Transferred ... '" ... ... ... ,55 39 94 ,;

Escaped ... ... '" ... .. . ... .. 7 .. . ·7 Died . ' . ,

.:55 25 80 ... ... ... ... ... -- -- \

Total discharged, died,&c., during the year .... ," ... 1.14 137 351 i Remaining in the asylum on the 31St December 1870 (inclushe of

absent on trial, males and femaJes) ... . .. ... 61 5 41.8 1,043 a ~ .' ----1-"

- A yerage numbers resident d:uring tj1e year ... ... ... 590 412 1,002

,

,-..,., HOSPITAL FOR THE INSANE. 'MEL130URNE.

- ':, ._----'

;TABLE z;-8howing the AdI;llissions; ,Dischul'g;s, ,and Deaths; with the Meft.ll Annual Mortality arid Proportion of Recoveries, &c., per Cent. on ~he 'Admi'ssions for the - ',:-; :.,'" , Years r848 to r870' , ;' ,

Admitted,

- , l , _ ._ , :, _ " , ~,

:: , " I I .~ ~Discha~ged. : 2 ,;.. : ;'<, 1 J Remaining

h---,-..,-----.... ----'·=~"'------;---:':'-,:-.• --','--_--- _ Di~d" ,011 the 31st Decembel'in

Recovered." Relieved... '" '" T.~ns!erred. ,'"t" ,,---~''- ~~Ch Year. .

--

Average Numbers Resident.

Percen't~e of c.:scs Recovered and lteiieved

. _, .: on Admisslons .. _ ..

Percentage of Deaths on the Average

Numbers Resident.

Males, Females, Total, 'Male's;- Females, Total. :Males, t'e~~les, Total, lI!al;S,';emales, .Total, lI!ales, Females, Tota( Males, Fe-:nales,[' T~'tal, ,L,,, Females, Tot<~l, l\~afes,1 FF~emal!lS' Total. lIrale., l'~e~"les, Total,

I __ I ___ I __ ~ __ ,_~ __ -- I I-+I~-?---I---'--_:: __ -= '.',1--::------I-'-I~-------'I-- --;------.,_1 __ ,_\ __

I8~~ ~I~ --2-5- --I-_-I~- 2 - i, I 2 .. : ,.. ' :.. I .. , I 9 'II' 2~" ~; 9. 1'1 1'6'66 16'00 14'28 ,'" 5'88,

22.

1850. 10 I:

1&5'I,!' 27.

1852.' I" 9 185}: 109

18541:' 79 185S~- I Il'

1856 'I' .. 100,

1857 74 160

1860 104 ,"

186~" 178 186i ;-,13'7

1863 158

1864, 2.08 . ,

1865 1866

1867' 1868 1869 1870

95

'42.

193

242.

,n ---,34

5 '19 '2.6

122.

'42-

: 132.

76

69

88

138

164

15 7

41 9'

35 2.

144 2.9

120 33 I,;

'15939:

,149 ,43;:'

139 2.2.

2.59 44,

'2.56 l 34

~~?"L.~4' , 274 49 21 3 2.5,

280 51

350 37

. ";3 10 37

156 2.6

164 IS

23 0 36

331,,, 52.

4061' 82.

2

11

8

15

117

2.0

"19,,

2.7

33 ,; 129

': 38 ,: 31

3 8

2.0 '''' 10 : 4

44 I

53 " j

59 4C

: 62 "I

49 6

77 5 _ 63 :: 6

77 ,II

--85",19

79 7

64 15

" II

f 8

15

3.

"3 6

-2.-" 6

5! 6

1- .,- 7

.,7,:,-' 12

12.

2'0

15 .. 24 ..

15 31

14' 2.5

24 - .. 43

;3

13

19

9 8

II

20

2.8

30

16

16

2.6

I

... i :: ::, ; .. , 3 ~I 4~. 26 17 _ , __ 4,L _~ xi I2 25 • _ '9'69 4 1'66 20',58 23;°7 l,g'33 16'00

= ... I ,I 2 ~ -27 ,', 20 4Z 25 IS 44 80'00 ,2.0'00 60'.0° 4'00,; 5'55 4'54 , .. "

' .... 4 :3 • 7;, 35" 24 5~;' ,33 26 59 ,40',90. 63'I5 51'2.1 12'12. ;1,1'53 1J'86

,;~ ;~:

c'- ,.,

...... ~

... "~ ;" ;;.

'-'>! ••

... -

1

15

I~ 2.3

;

2.7

'2 3', ,3 6 ,38 __ 7.4 I'" 3§ 29 66. ,66'66, 38'46 45'7 1 2.'77 ?'89 4'54 I: (: 4

} :5 .. :6

;4 16

'l:'9:~ 97 52 '14,9 69 43 113 27'SZ 48'57 32'63,21'73 ,9 '30 ; 16'81

'22' ~22 68, 190 103 56 160 45'56 48'78 46'66 15;53 7'14 12'50

i8'': 1'62 89 251 132- 74 2.06 38'73 <f5'83 40',88 17'41 6'75 13'59

3'3, 190 108' 298 167.' 97, 2.64- 44'00 4lkg.7- 45J;3 l6:16 ~'18 12'5°

~9, 2.08 141 349 194 121 316 37'83 43'07 -40',2.8 I2.'88 :3'30 9'1·7-

6;t-~ 267 : 184 451 ... ~ ,.. 412 30'62 40'40 34',!6 ';'; .;' 15'53 _

I ••• .~, :.:

25

4~. 55 42

12 \\ ?7~ 337 564 ... " '490 2.3'95 39'3 2 29~9 '.. _... 13'67 !

.-:~ ---. :: .. :

" ...

........... '.. 59 59

50 , 15 65

130 155 28 5

16 6 22

55! 39 I 94

46

49

5:1. 88

,79

5° 29

45

48

55

58,' ~-~I 245 596 347~; 244 '592 r:43'26 '58-02 49'72 12'10 .~f'55 979

59' 4 2,° 28 2 702 400~ 2.96667 :3 2'58 47'91 3T'95 11"?0 "4'88 8'84

~~3' 464 286 750 43f 285 722 ::29'92. 7/i'31 46'~7 II'23 ~~'91

, ~6 . :, 1'3 '.

64~' SOl ~56 49~; 326 825 -;39'24 3i '78 36'42 • 1<:1'44 3'68

2'6 :', 114; i SQ.2 398 96? 534\ 374 913,' U26'92 SC;,70 I 36':57 16:32. 6'95 12'48

£3 102 610 393 I,OO~ 387 397 984 :2471 41'66 31"93 I 1;;:44 5'79

'9 20

12

23

25

69 ~ 596 399 99?' 604 396 1,001;:~5 I'2.5

49 583 390 97~ 599 401 1,001: i' 30'52.

57 514 350 892 539 '347 886,' :',3°'28

71 587 399: 98f 550 369 920 3I'08 ,

80 615 428- i,i,04~ 590 412 1,002' 40'08 \' ,i'

6i:l0 60'86

4°'9° 59;00

58'!n 4n9

34'34

38'97

4I'~71

8'ln

4"84

8''34

8'.'72.

9:3 2

4'79

4'98

3'45

6'23

6'06

4'89

6'43

7'7 1

7'98

'. , 40

APPENDIX C.

HQ~PITAL FOR THE INSANE, CARLrON.

, , I,;

TABLE I.-Showing the Admissions, Re-admissions, Discharges, and Deaths during the Year ending 31st December 1870.

,

. Males • Females. Total.

. ----;--------II} the asylum on 1St January 1870 I

, '" ... ... ... ... .. . 85 55 140 -

, q

, :Males.~ Females. Total.

Admitted for the first time during the year ,

'" ... ... .., '" ... Re-admitted during the year ... '" ... ... ... .. . ... Transferred during the year ... '" ... . .. 41- 18 60 Retaken ... ... ... . .. '" '"

, ... ... ' .. ... ,

• Total admitted ,

18 60 ... ... .. ' .. , '" . .. 4'" . Total under care during the year I2.7 73 200 ... ... ... .. .

( ,

I?ischarged, Removed, &c, :-lIrales,. Females. Total.

Recovered ... Of' ... ... ... . .. 5 8 13 -Improved ... ... '" ... ... 1 3 4-Transferred /

I 2 2 '" . ,. ... '" , .. ." .., \

I~scaped .. ' .. ' .. , '" ... .. , 2 .., 2 Died , ... .. , ' .. '" .. , ... 16 , I 17 '"

Total discharged, died, &c., during-the year ... ... .. . 24- 14- 38 , '

Remaining in the asylum on the ,31St December 1870. (inclusive Of} absent on trial, males and females) ,

'103 59 162

Average numl;>ers resident during the year , .. , ... . .. 9° 55 145

, J

HOSPITAL FOR THE INSANE, CARLTON.

TABLE 2.-Showing the Admissions" Discl~al'ges,' and Deaths, with the Mean Annual Mortality, and Proportion of Recoveries, &e., per Cent, on the Admission's for the Years 1864 to'1870,

Ye"r.

1864 1865 1866 '1867 1868 1869 1870

Yell!",

1864 186, 1&66 [867 1868

, 1869 1870

I

Admitted,

Remaining' on the 3,st December in

each year,

41 ." 41 49 ... 49

133 - 61 194-79 '55 134 74 55 129 85 55 140

!O3 59 162 ;

Discharged.

9 "'3 IS 20

8

87 'i 5 7,8 14 44 ij 5" S 47 5 4[ 1

13 I

• Avemge Nllmhe1's I\esident,

27 19 - 46 46 ... 46 78 16 94

II9 53 172 74 53 127 80 56 136 90 55 . 145

3 S 8

,

,IO

14 16 16 13

I

4

3 6

15 8 2

Percentllge (;f Cuses Recovered and'Relieved

on Admissions.

21 '94 39'13 27'58 39'65 '" 39'65 29'62 15 '78 "5'21 5°'00 96'87 64'15 52'S5 53'48 53'09 .62'85 68'96 65'62 .. , '" .. ,

2 8 8

27 II

II 16

, Died,

1

5 I

, I

3 8

, 8 28 16 12 17

Percentage of Deaths on the Average

Numbers Resident.

7'40 5'26 6'52 17'39 ... 17'39 10'25 .. , 8'5[ 22'68 1'89. ; [6'27 14'86

9'43

1 [i' 59

13'75 I 1'78 \ g'82 17'77 I "llI II '72

41

APPENDIX D.

HOSPITAL FOR THE INSANE, ARARAT. I '

',fABLE I.-Showing the Admissions, Re-admissions, Discharges, and Deaths during the Year ending , '31st December 1870'

Males. Females, ,

Total. ----------In the asylum on 1St January 1870 ... ... ... ... ... ... . .. 156 12.5 281

l\Iales. Females, . Total.

dmitted for the first time during the year ... . .. ... 88 44- 132 e-admitted during the year

A R T R

... ... ... . .. I .. . I

ransferred during th~ year ... ... .. . ... 12 21 33 eta.ken ... ... . .. ... ... H' I .. . I

Total admitted ... ... ... ... ... '"

Total under care during thp, year ... ... ... ... ischarged, Removed, &c: :- :Males. I .Females. Total,

- - .. --'~~- --6-1-D Recovered ... Improved ... Transferred ... Escaped ... Died ... ...

... ... .. . ... ... 27 34 ... .,. ... '" ... 10 3 13

... ... ... ... .. . . .. ." .. .

... .. . ... H. . .. 2 .. . 2

... ... . .. ... .. . 19 12 . 31 Total dlscharged, dIed, &c., durmg the year Remaining in the asylum on the 31st December 1870 (inclusive of

absent on trial, males and females)

Average numbers resident during the year

HOSPITAL FOR THE INSANE, ARARAT.

102 65 167 ---------258 190 44-8

49 107 --------200 141. 341 ---1-174 127 301

TARLE 2.-Showing the Admissions, Discharges, and Deaths, with the Mean Annual Mortality, and Proportion of Recoveries, &c., per Cent. on the Admissions for the Years 1867 to 1870.

DlSCharg:d, i Remaining AYerage I Percentage of Cases Percentage of Deaths Admitted, I Died. ~e~~~n~~;t Numoors Recoy~red and on the A vera"e

Recovered. Reliev.d, TI"llUsferred,1 in each year. Resident, on !~~~~n., Numbers Resident, Ye"r·I_--;--:;:-_

~ ~1'~~ ~ I ~ ~ I ~ ~ I ~I~ i ~ ~ ~ ~ ~II ~ ~ 1 t ~ ~ ~ ~ )i:j~Eo<)i:j,,"Eo<)i:j"'Eo<~"'Eo<~"'Eo<);i~Eo<;:;;"'Eo< ~I'" Eo< )i:j ~ Eo< ----I -!--'--- __ -_________ - -,_ --_________ _

I, I I' . 1867 37 14 51 I... 1 2... z. ... ... "'1 1 ... I 85 17 102 64.. 8 72 S'10 ... 8'88 1'56 ... I'3~ 1868 82 53 135 27 11.2 49 7 3 10 .. , ...... 15 3 18 158112270127' 9021741'46 47'16 43'70 u'81 3'33 8'29 1~69 63 46 109 37 18 55 I 7 8 ......... ,26 8 34 156125281 154111727160'31154'34 5779 16'88 6'83 12'54 I870189 44 133 27 34 61 ,10 3 13 .. , ....... j 19 I2 31 200141341174,12730141'57 84'09 55'63 10'91 9'44 10'29

APPENDIX E;

HOSPITAL FOR THE INSANE, BEECHWORTH. TABLE I.-Showing the Admissions, Re-admissions, Discharges, and Deaths during the Year ending

31St December 1870.

In the asylum on 1St January 1870

Admitted for the first time during the year Be-admitted during the year .:. Transferred during the year Retaken .. , ... ."

Total admitted,

Total under care during the year Discharged, Removed, &c, :­

Recovered Improved Transferred Escaped Died ...

Malesa 'Females.' Total,

1 71 127

16 II

138

5

1 /.

Total,di.sch~rged, died, &c., during the year .. , ... "" 11 .\ II 1.2 Remammg m the asylum on the 31st December 1870 (inclusive of i.~-- ____ : __ ~_

absent on trial, males and females) ... ' ... '''~'~I~~

Average numbers resident during the year... ,.. • .. ) 171 I \ Iz6 I 297

No. 25. D

42

HOSPITAL FOR THE INSANE, BEECHWORTH.

TABLE 'z.-Showing the Admissions, J)ischargc_s,_ aE<i D;l,ltbs, with the Meau Annual Mortality, and Proportion of Recoveries, &c., per Cent. on the Admissions for the Years 1867 to 1870'

titl. ("':. ,\ ~~. ,~. I'.: ._~:~."~ '. ,'i"~" t r\' ',;' "r~'_~'",,~~r!,

Oats Barley Hay ,: .. ,i: r ."'", Straw, ... , Potatoes (small) 'Mangold".'; .' Green Food " ) , Potatoes' " ': 'Pork PoultrY, Butter Beef! Veal Eggs l· . .,.~

'~ ... :

Milk' .'.; 1 ::.: ! .•

~:~:~oo~~ '::::,',:: ;,~::,:: ~,:,:t::~'

;!: I

'i

Transierted.

,! 'Remaining , on thel'st

December ill eu.ch year.

APl?ENDIX F:

Carlton.

Quantity. Quantity.

60 bushels 54 ;, 50 tons' I .....

" ...

Av&rage;:' Numbers Resident.

';1 :.,1" .:":, i!' ;:f

Amrat.

Quantity.

,~.' ,

~ ... 15 tons ",,' .. ~.

, ,

HospiTALS FOR TIlE INSANE.

,.J

I Ileechworth.

Quantity.

TABLE 2 • .:....Return of Produce from'tlre ,Asylum:Gardens during the Year 1870' .,. . \ ~ ,.; ~

Asparag~s Beans Carrots Cabbage! Cauliflower Celery Cucumber ..• Lettuce, ;\1 arrows Onions I'eas Parsnips: Parsley Pumpkins Hadish Sage Thyme, Turnips, Tohmtoes Beet Artichokes Suup Vegetables

• !

. ," .. i *.'. ; ~ ... ,

J .... "

I .•••

I,eeks ... ... '" Fruit, Melons, and Rliubiirb;.&c.

, ..

I ...

flbs~ 1 t i. "I ',26

5,01" 16.335 17,821

,3,1'75 101 830

• (JOo ' I i;295 :

.10,589' 1,458

10,152 , , 162

, 516'

,767 , .. 15 .. ·45 2,067

583 - "---

f-'" Carlton.

~ QJ~ntity.j \' ., ,,', j,:

,"lb.: ~~ ~- ...

61 3 2,014 5,550 , 1,Q46

1,650,

544-354:,

1,783 2,15 8'

4 69 1,873" ,,'

32 7 398

" '."

575 0.,201

,

lb., ... 208 398

:9,9 .. °' 575 ... 997

2,9?,O .. 268'

"

,64 . ... ~ . ...... 3,Il I

; ...

I .....

\"1'

Beechworth.

Ibs,

1,254 277

": '" '16;8°7 .~,l' ;.' 3,363

" <" '1,094.'" ,',: ('" ". 749',

! 11.,885" 1.::'.084 ;; 2,250 1,000

r 5,141

~8;i'57 "1,157

1,408 178 .-

6,018

- » '. • , • < .,"' ~ ~ • '( i ~ ,w ~ •. -HOf;PITALS FOR "THE "):NSANE; . - "., .....

TABLE 3.-Retu'rn ~f Clothing Made up and Repaired'by M9Je Patients d~~g'the Year 1870.

Coats Trowsers Vests Jumpers ... Canvas Dresses, &c. ,_ I.eather Glov'es : :Mattresscs (Hair) Pillows (Hair) Men's Boots-

Soled and Heeled Soled : •• Patched

Women's Boots­Soled and Heeled Soled ! .. Patched

Melbourne.

lrci:de up.

to' ....

ltepaired.

755 1,880

316 593 742, '47

Carl ron.

Made up. Repaired.,

Ararat. Beechwortll.

Made up. Rep0.ire4. Madenp. Repaired.

~ ~ • .... .' J ••

.:';:" .J: ':H68PI'f,ALS ~OR' THE "INS4NE:" :L;. ': " ~.:. '," f, - . t

"

TAB~~ 4.-~eturp .. or: C~othing Ma<ie up and Repaired by Female Patients during the Year 1::170'

I '

,. I • I l_",",~ ..... ~'., " ... _ ... ! I~ ..1,'_ j __ " _.~

Melbourne. Carlron. :

I

Ararat. I

" , • Mad~ rip:;: ! Ilepalred.· Made up. I ~epal~ed.· : liiaJe np. -"o"-+! -.." •. !-, -'--=--'---";"""",,---;'~''-I ". '.7. i -;,'1' ". " " -e' i ,:' '/ ,,< I .-; , "' i ~ I ... I l .••

:Re~d.' I ro! I _~ !

~e;,p. ~- I • ~ ,

Coats Trowsers Vests • Jumpers .. : Canvas Dresses Apron-Serge Bonnets-Sun Blankets Chemises-Cotton

" Flannel Caps-Cotton

" Canvas Dresses-Linsey ••.

" PriIJt· Drawers-Serge' ; •• _ Gowns-Night Petticoats-Linsey

Pillo'~slips Rugs

Flannel

Sheets Shirts-Cotton

" Serge Stays .... Socks and Stockings Ticks-Bed

" Pi1lm~ Talllecloths Towels - ... Vests-Flannel

" Serge Wool Jackets

III

1.559 1',7.56 '

7.00

, ,.7.3 8 32.4 1 95 40 2,

.}. ~!l998 3,°56

.... 4-37 . ,5.2,5°

})~Oi3

15,599" , } 4,f2,0

848 66'6 .. ,

, .... ... ,

100

75 65

100

31°, 181 " 75

• .. 95

2, 67 "

376 2,7

l 889

f 1,'!IO

I?}

2,96

}.,4-38

1,1'59:'

} 358

4-3 3

46 I ....

12.".

2,68

34-8 zoo""

10 ....

12,0'·· ..

16o, 2,

ll2, 249 ...

• ,2,34" 12.4

400 574' . II4-

, ....

1,080

7.,839 1,7.34

631

379

9°0 32,

}'M3:S"

63

} ~,4~7 21

6 '. 12.8

} 3,~0'3' 4-

4,2,2,6

4

2,81 62

ISS" 1 31 :n'

, 45 80

143' 100

': . ......

8

40 80

2,67. I 1,13 1

2.7.6 868

10

} 1,345

50

44

-APPENDIX G.

LICENSED HOUSE FOR THE INSANE, CREMORNE.

TABLE ~.-Showixig the Admissions, Re.admissions, Discharges, and Deaths during the Year ending ,- 31st December 1870' .

I ,

In the asylum on 1St January 1870 I~~~ i 7 8 15

Males. Females. Total.

Admitted for the first time during the year Re·admitted during the year Transferred during the year ..•

Total admitted

Total under care during the year

Discharged, Removed, &c. ;-­Recovered Improved Transferred Died ...

31

3 Z

...

Males.

25 Z

4 2.

Total discharged, died, &c" during the year

13 Z

FellUlle •.

14

Z

44-5 2

Total.

39 Z

6 Z

36 15 51

43 z3 66

33 16 49

Remaining in the asylum on the 31st December 1870 (inclusive of absent on trial, males and females)

Average numbers resident during the year I~--;-+

LICENSED HOUSE FOR THE INSANE, CREMORNE.

TABLE 2.-Showing the Admissions, Discharges, and Deaths, with the Mean Annual Mortality, and Proportion of Recoveries, &c., per Cent. on the Admissions for the Years 1867 to 1870,

Discharged, Remaining Average Percentage of Cases Percentage

Admitted. Died. the Numbers Recovered and of De"ths On the

I JIst ReSIdent. Relieyed Average Numbers.

Recovered. Relieved. Transferred. In year. on Admissions. Resident. Year.

,; :Ii i ~ ~ ~ ~ :rl ~ -" I :Ii " 3 :Ii ~ ] ,;

" :g ,;

" ~ ,;

:S w " :S !i " ~ ~ "il -;i

* i3 $ S $ S ~ i3 " S S S S ~ OJ " 0 "il ," 0 " " " " " " 0 ~ <> '" ,;: '" " '" ~ I!! 0

~ '" '"" ::a "" E-! .;;j '" E-! :.. '" E-! ::a 1'0; E-! " '" E-! A '" E-! ::. '"' E-! ::a E-!

- - - i-I- - - - -.- - - - 1--- - --I- - - - 1--- --1867 1 4 7 J .1 , .. 1 I .. .. .. ., .. .. s n 78 6 73 79 100 50 71'4" .. .. . . 1868 15 10 35 .. 6 18 l 10 1J .. Sf 51 .. . . .. 5 6 II 5 13 18 88 60 80 .. .. ., ISIi9 3l 10 53 13 I, 38 I I 1 3 1 4 4 I 5 7 8 IS 7 7 '4 71'7 80 7,'40 "'f4 I4·:r.S )5'71

1870 J6 IS 51 ., 14 J9 :!. .. • 4 • 6 • • 10 7 17 8 7 15 87"5 87"5 87"; '5 .. ,u',

LICENSED HOUSE F9R THE INSANE, CREMORNE.

TABLE 3.-Showing the Causes of Death during the Year 1870'

Callse 01 Death. Males. Femnles. Total.

Inflammation and other Diseases of the Brain, Softening, Tumors, &c, :1.

LICE~SED HOUSE FOR THE INSANE, CREMORNE.

TABLE 4-.-Showing the Length of Residence of those Discharged Recovered, and of those who have Died during the Year 1870.

Recovered. DIed.

Length of Residence. Males.

I Females. Total. Males, Females. Total,

----- -----Under I month ... .oo ... ... !

I9 3 2:1. 2- oo • :1.

From I to 3 months ... . .. .. , n • 3 6 9 ... ~.'! ~

" 3 " 6 .. ... ... ... .. . 2. 2. 4- ... ... . ..

" 6

" 9 ,. ... ... ... .. . ... 2. Z ... • oo ... "

1 "

2. years .. , ... ... ... I I 2. ... ... . .. -------------

Total ... ... z5 14 39 2. ... Z

45

LICENSED HOUSE FOR THE INSANE, CREMORNE. ,

TABLE 5.-Showing the Ages of Adrriissions, Discllarges, and Deaths during the Year 1870'

Discharges.

Ages.

Admissions.

Reoovered. Removed, I«lHeved, or !

Otherwise.

Deaths.

i . Total. . Males. Females Total.

-----~----------·I-------~.,-----,-------

Males. 'Females TotaJ. Males'IF.mulesi Total.

From 5 to 10 years " 10 " IS " " IS" 20 "

" 20" 30 " " 3

0" 4

0 "

" 40" 50 " " 50 " 60 " " 60 u 70 " " 70 ,,80 " " 80" 90 " " 90 and upwards

Unknown

Total

.. -.

7 2 9 4 5 z 3 8 9 17 ~ 10 16 2 3

16 z 18 II 2 13 4 2 6 3 I 4

I'

I I----i·~--·----I---!-----------

15 I 51 25 14! 39, 6 2 8 2 I ... 2

APPENDIX H.

TABI.E showing the Number of Patients Visited and the Number of Miles Travelled by the Inspector of Asylums during the Year 1870.

Number of Patients Visited. Number of Miles Travelled.

Place ViBited. Date of Ylalt. -. -Number. Tot.~I. Number. Total.

Melbourne Asylum .. ... . .. ... .. . . .. ... .. . . ..

···1 26th March ... ... 130 4

Carlton Asylum 14th June .... ... ... 149 4 ... 3rd September 153 4 ... ... . 29th December ... '" 161 4 593 ------ 16

r 19th March ... ... 288 I 328

Ararat Asylum "'1 30th June ... ... ... 304 328 ... 30th September 312 328 ... ... 23rd December ... ... 336 3z8

1,240 ---- 1,3Iz

... { 31st March .•• ... ... 297 } 388 Beechworth Asylum znd .April ... ... 297 8th December ... ... 30Z 388

---- 896 -------- 776

... j 25th March ... ... 13 6 Cremorne Licensed House z3rd June ... ... . .. n 6

5th October ... ... 14 6 4th November ... ... I2 6

---- 51 ------- Z4 ---- ------Total ••• ... ... . .. ... .. . 2,780

\ ... 2,n8

.. Vlsited by OJllcilll Ylsitors-J. T. Sm.th, Esq., M.L.A.,alld Doctors Barker, Grooves, nnd Thomas.

By Authority: JOHN FERRES, Government Printer, Melbourne. No. 25. E