Lunacy for Scotland
200 Art. VIII.? Twenty-fourth Annual Report of the Commissioners in Lunacy for Scotland.
One of the most striking features brought out in the Report of the Commissioners in Lunacy for Scotland is the very considerable increase in the number of pauper lunatics registered during the past year. This increase exceeds that during any year since the establishment of the Board, and amounted to 333, the numbers being 337 pauper patients over and 4 private patients under the numbers for 1880. The distribution also of pauper patients in private dwellings continues to show considerable increase, the number for the period under review being 52 ; it should be remembered, however, in this connection that in Scotland no pauper lunatics are accommodated in private asylums, the public establishments alone receiving them. The admission of voluntary patients in the year amounted to 38, this number 11 less than in 1880, and the same figure under the average admission between 1875?7 9. The names of and particulars respecting these patients are preserved in a separate record, and of the system according to which they are admitted the Commissioners say :?
” We have for some years been able to state that nothing has occurred to indicate any difficulty or disadvantage traceable to the presence of this class of patients in asylums ; and we continue to be of opinion that it is a useful provision of the law which permits persons who desire to place themselves under care in an asylum to do so in a way which does not require them to go through forms from winch they naturally shrink, and yet affords sufficient guarantee against abuse. At the visits of the Medical Commissioners to asylums all voluntary inmates are seen, and they have then an opportunity of making statements in regard to their position, should they desire to make any. Where there is reason to suppose that they in any way fail to understand the conditions of their residence, we consider it proper to explain these conditions ; but we have never found that the nature of their position has been intentionally concealed from them.”
Discharges numbered, among recovered patients, no fewer than 1,188, 206 private and 982 pauper. These figures are both higher in respect to annual rates and to averages ; and it is curious that a precisely similar relation exists also between the deaths recorded in 1881 and in previous years. Thus during the year there were, among private patients, 206 recoveries, or 39 in excess of the previous year, and 12 above the average for the five years 1875-79; of paupers, 982 recoveries, 41 more than 1880, and 121 over the average for the quinquennial named above. One hundred private patients died during 1881, or 8 more than in 1880, and 1 above the average for 1875-79; and of paupers, 539 removed by death, 21 more than in 1881, and 57 above the average. Of course the figures quoted above must be regarded throughout in connection with the population movements already noticed, and especially with regard to the increase in pauper lunacy; but even then the disproportion is a considerable one, and when reduced to a percentage comparison, still shows decided increase on the preceding year. In 1880, the total rate among private patients was 6*6 ; in 1881 it rose to 7*1 ; among paupers it amounted to 8*0 per cent, in both years.
The Commissioners devote a good deal of attention to consideration of the causes which have operated to increase the amount of pauper lunacy so considerably, and are able to show very conclusively that the rise is mainly attributable to the Government grant in aid of pauper lunatics. This grant was first given in 1875, and was immediately followed by a large increase in the class of insane it was designed to relieve. The questions involved in this greater outlay of public money have presented themselves to the Commissioners, who declare a belief that ” To some extent the increase in the number of persons treated in private dwellings as pauper lunatics is an advantage both to them and to the public. But,” they add, ” in so far as it is a placing upon the State of burdens, which individuals are capable of bearing and which it is their duty to bear, it cannot be productive of benefit. The persistent and rapid increase in the number of persons placed as pauper lunatics in establishments is, however, unless it can be shown to be necessary, an evil of great magnitude. The unnecessary detention of any patient in an asylum is to be deprecated as in itself an evil. But when it is considered that, according to the average cost of asylums, such an increase in the number of pauper inmates in district asylums as has taken place last year involves, for the mere ccst of land and building, an addition ot from ?30,000 to ?50,000 to the burdens on the county rates, besides the expense incurred by the parishes in maintaining them, it becomes evident that even on financial grounds it is important that the increase should not be greater than the welfare of the insane and the interests of the public will justify.”
It would seem that the consequence of the grant his been to ameliorate the condition of the poorer classes of lunatics in Scotland, and, so far, even though at no small expense, it must be held’ to have produced satisfactory results. No doubt the steady increase in yearly expenditure occasioned by it will demand very careful consideration, but the conclusion of the Commissioners already points to the direction it must have for the future. After fully considering the various ways in which the influences due to the grants have been exerted, and the effects observed, brought about, they sum up the whole question thus :?” Both of the objects of the grant, or reasons for giving it, are to a large extent not fulfilled, and it does not appear that the extent of the fulfilment will be increased by increasing the grant. It has now reached an amount which may be considered a fair contribution from the State to a local tax over the expenditure of which the State exercises a certain control, and it seems probable that all the objects of the grant would be as fully attained as heretofore if it were fixed for the next five or more years at the amount expended lest year?the administration of it remaining substantially as at present.” During 1881 the lurge number of 310 escapes from Scotch asylums took place. Of these, 206 were brought back within 24 hour?, 61 in less than a week, and 21 after more than seven days. The remaining 22 were not returned during the course of the authority on which they were originally detained. They are accounted for thus: 3 recovered, 1 improved; 7 were relieved, 9 were unimproved, 2 were reported as still insane. The number (310) of escapes was the largest ever occurring in a single year, but did not represent the highest percentage proportion on the whole number of lunatics under control, this having been attained in 1876 of the present decade, when 272 patients, or 39 per 1,000, escaped; the proportion for 1881 reaches 37 per 1,000.
Accidents during 1881 numbered 141, 11 ending fatally. In several instances there is tolerably certain proof of selfdestruction ; but, as the Commissioners point out, it is always a difficult matter to prove the actual suicidal purpose in many instances. The deaths recorded were brought about under various circumstances. One male patient cut his throat in a very determined manner; another was choked through oesophageal obstruction by food, and consequent pressure on the trachea; a woman died from the effect of a burn ; a man was poisoned by accidentally drinking a liquor intended for dipping sheep ; a woman was killed through having a tooth thrust down her gullet; and two patients, one male and one female, were found drowned. Two fatalities were caused by violence, one resulting from injuries inflicted by one patient on another with a spade ; the other was due to violent treatment at the hands of attendants, but in only a minor degree. An attendant was killed by a patient he was bringing in from the grounds, and who retained possession of a spade he had been working with. The last accidental death was that of an epileptic patient who fractured his skull by falling while in a fit.
There were five cases of attempted suicide, resulting mostly in slight injury, and in no case terminating fatally. In 45 cases the accidents involved fractured bones or dislocated joints. These were occasioned in 22 cases by falls, in 7 cases by assaults made by fellow-patients, in 5 by struggling with fellow-patients or attendants, and in 10 cases the cau?e was not ascertained. The remaining accidents consisted of 17 injuries to the head by falls, by assaults by patients, or by acts of the sufferers themselves ; 21 flesh wounds, abrasions, burns, and scalds; and 42 injuries of unimportant character. A considerable number of the accidents as usual occurred in the cases of epileptics. The Report speaks most favourably of the present condition of the asylums under the Commissioners’ supervision, and gives a good account of the progress made in treatment during the year dealt with ; it is enriched with many admirable and laboriouslyprepared tables, which afford abundant useful information on the subject of lunacy in Scotland ; and in every respect the Report is fully deserving of the earnest attention of every practical alienist.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.