their elders, and with child-like simplicity suggest that the increase is due, "at any rate, to the increased number of lunatics in asylums." This decade then commenced in 1862 with a stock of 55,525 insane in the three countries; it ends in 1872 with an aggregate of 77,013, showing the enormous increase of 21,472 in ten years. The official Reports for the next decade, like their predecessors, teem with reiterated demands for and accounts of further accommodation, enlargements, additions, and so forth, thus testifying to the stern reality of that increase which the Commissioners, although they chronicle it, seem determined to ignore. The numbers of insane in England under official cognizance exceed now by 33,943 the numbers similarly circumstanced in 1862. The Commissioners assert that this is not a real but a seeming increase, simply a discovery of previously existing cases, mainly due to extended accommodation and improved methods of obtaining returns. This statement reads remarkably like the passage in which the Scotch Commissioners ascribed the increased numbers of lunatics in Scotland, if not to the growth of insanity, "at any rate to the increased number of lunatics in asylums."

With regard to the qualification inserted by the Commissioners to the effect that the annual production of fresh insanity is not "disproportionate to the yearly increase of the population," that is not a matter of opinion, but is purely a question of figures. Tried by this test what appears? According to a table given in their twentyseventh Report the insane in 1859 numbered 36,762, and the population then being 19,686,701, was at a ratio of 1.86 for every 1,000 of the sane. Now in January, 1882, the number of insane all told is put at 75,072, while the population according to the census returns was 25,798,922. Thus while the latter increased by less than a third, we find that the insane had more than doubled, and the ratio per 1,000 was now 2.90. I think these figures settle the question as to whether the annual production of fresh insanity is disproportionate to the yearly increase of the population or not.

In the last decennial period in Scotland the increase has been very substantial in proportion to its population, the numbers having risen from 7,606 in 1872 to 10,355 in 1882. These numbers are, the Commissioners state, "exclusive of unreported lunatics maintained in private dwellings from private sources." They add that (1) "the increase of the number of pauper lunatics in asylums and other establishments during the past year exceeds the increase during any year since the establishment of the Board; (2) there is again an increase, though not so great as last year, in the number of pauper lunatics accommodated in private dwellings." The Report proceeds: "The increase of the number of pauper lunatics in establishments during the past year is greater than it has been in any previous year. During the quinqueniad" (the word is, I presume, a Scotticism)

"1876-80 the average yearly increase was 238. During last year it was 248, and this year it has exceeded that number by 37. . . . This rise in the rate of increase it is shown by the figures which have just been given has continued to characterize the statistics since the year 1875, and during the last two years the rate has shown no symptoms of declining."

The Commissioners, having shown the effects of the grant from Imperial sources on the expenditure for pauper lunatics, state: "It is difficult to estimate the degree to which the rise from an annual increase of 238, and latterly to an increase of 285, is due to the operation of the grant, but circumstances frequently come under our observation which show that the rise is to a very appreciable extent due to that cause.” They have now for some time abandoned their attitude of cautious candour and adopted the development theory in its entirety.

I have already pointed to the morbid desire so often exhibited by the officials to minimise if not to make light of the increased numbers, as if they fear they may somehow be accused of having themselves caused the mischief. The elaborateness of argument in the last Scotch Report is so striking, and its ingenuity so great, that it deserves quotation in full. They say: "It has often been shown in the Annual Reports of the Board that the great increase of the number of pauper lunatics since 1857, when the first of the present Lunacy Acts (Scotland) was passed, is not due to an increased production of insanity, or, in other words, to a greater liability to insanity in the community. The benevolent operation of the lunacy laws during the first twelve or thirteen years after 1857 caused a large increase of the persons who are registered and officially recognised as pauper lunatics." This is intelligible enough, though why it should take the relatives of poor lunatics twelve or thirteen years to find out how they could relieve themselves of their burden seems strange. But the stock of undeveloped lunacy is, in the opinion of the Scotch Commissioners, not yet exhausted, for the benevolent operation of the lunacy laws" continues to have the same influence, though to a smaller degree."

There is another cause: "During the last seven or eight years, again, the contribution from the State towards the maintenance of pauper lunatics has had a manifest effect in increasing their number." Where were these undiscovered pauper lunatics all the previous years, and what were the Commissioners about that they knew nothing of them? If the increase is not due to a larger production of insanity or to a greater liability to insanity-if, in other words, two, three, or four thousand cases of pauper lunacy existed unprovided

for in Scotland-it should not have taken the authorities as many months as it appears to have taken years to find them out. Alluding

to the foregoing cases, the Commissioners assert: "The total increase is largely, or rather almost entirely, due to these and other such influences" (the italics are mine). There are indeed other influences at work, but clearly not in the direction thought of by the Commissioners, who repeat: "There is no evidence that it results from an increased tendency to mental disorder; but a certain part of the increase is of course the result of the increased population of the country, and no doubt another part is due to the increased tendency of the people to live in cities or towns, in which the lunacy rate, like the general disease and death rates, is higher than it is in rural or sparsely peopled districts."

The last two reasons contain, no doubt, a certain modicum of substance; let us test their sufficiency by calculation. During the last ten years the annual increase of population in Scotland has averaged, in round numbers, 30,000, while the insane have increased by 2,637, or at the rate of 260 a year. An allowance, therefore, of 2.50 as the normal ratio of insane per 1,000 gives us just 75 per annum to be added on the score of increased population, or 750 in the ten years, leaving a balance of 1,887 still to be accounted for. Set apart the odd 387 as " due to the increased tendency of the people to live in cities and towns," and 1,500 yet remain to be put down to other influences than those indicated by the Commissioners. But even if the latter's arguments were perfectly sound, they in no way dispose of the fact that, be the causes what they may, a substantial and progressive annual increase has prevailed in Scotland as well as in England and Ireland for a long series of years.

We are now in a position to combine our information in a table of figures:

It is singular to note that, save that the ratio of insane to sane is greatest in England and least in Ireland, the conditions throughout are so alike as to be almost identical. The actual growth of numbers is continuous and regular, as if influenced by some inscrutable law; there is a steady unchecked current of increase, in accommodation, expenditure, numbers, and, strangest of all, in "cures." It would be only wearisome to enter more fully into statistical details; any one who wishes and has leisure can scrutinise them for himself. The plain fact stands out, however others may try to disguise it in words, that in the brief course of two decades the insane in the three kingdoms have nearly doubled in number, in spite of the most elaborate and costly means provided to cure them. There is, moreover, another alarming feature, in that we evidently do not yet know the worst. The ominous words, "inadequate accommodation" and "increase of provision," run through the whole series of Reports from beginning to end. Yet the Commissioners strive, no doubt with perfect sincerity, to convince themselves and others that the enormous increase of numbers is not a dread reality but a phantom; their opinions, indeed, are calculated to give confidence, but their facts and figures and forecasts cannot but excite alarm and dismay. How they can maintain their position in the face of such an array of testimony is incomprehensible. No one accuses them or lays the mischief at their door; as well condemn the Conservators of the River Thames for an excessive rainfall as to hold the Lunacy Commissioners accountable for the increased numbers of the insane. No special pleading or ingenious argument can get rid of the facts, and we submit that we have shown that no theory yet propounded or admitted by the Commissioners adequately explains or accounts for them.

Again, if we turn to the records of admissions, discharges, and deaths, it will be seen that these keep increasing in proportion to the numbers resident. On this point the English Reports contain a valuable set of tables, which will suffice for the present purpose, without wading through the Scotch and Irish Reports to extract the corresponding information. In England, then, the admissions, which in 1871 were 10,528, not including poor-houses, increased steadily each year, until in 1881 they reach 13,504, or a total during the decade of 135,040. The number under treatment advanced from 48,839 at the commencement to 63,293 at the end of the same period. The discharges similarly rose from 7,298 to 8,255, while the total number discharged in the ten years amounted to 83,463, of whom 49,402 were reported recovered and 34,061 not recovered. The deaths during the same period numbered 44,245, or an average 4,424 per annum, having risen from 3,547 in 1872. The significance of these figures is that the floating mass of the insane, exclusive of

of

workhouse lunatics, under the cognizance of the authorities increased enormously, as well as the fixed stock, in a single decade. In other words, as the fixed stock increased from year to year the annual turnover increased in proportion.

Yet another proof may be adduced still more striking to plain practical people, who are neither statisticians nor scientists, namely, the financial side of the question. The English Lunacy Commissioners, in their Report for 1847, estimated the sums expended in building, furnishing, &c., up to that period at £2,000,000, and thus went on to say: "On a rough estimate it may be stated that the aggregate amount of money expended every year for the maintenance of lunatics or administered on their behalf exceeds £750,000;" and further on, in summing up, they put the annual expenditure on all lunatics at £1,000,000. That sum, however, includes £280,000 for private cases found lunatic by inquisition, and £12,000 for single private patients, and this would give a net sum of £710,000 as the annual expenditure for maintenance at that time. I cannot state exactly what is the present expenditure for maintenance in England, for although many details and averages are given in the Reports, the total cost does not appear; but as the numbers have quadrupled since 1847 it may be set down approximately, and certainly without exaggeration, at £2,500,000. As to the outlay on land and buildings, a Parliamentary return made in 1878 gives a total up to that year of £7,245,829, and this does not include the cost of Broadmoor. In Ireland and Scotland the burden is the same. As to the former, the Irish Lunacy Report, 1845, states £209,085 to be the expenditure on asylums up to that time, and £35,989 as the annual cost of maintenance. The Parliamentary paper just quoted gives £1,201,305 and £205,053 as the corresponding items for 1878. So in Scotland the annual expenditure from 1859 to 1863 averaged £95,244; in 1881 it amounted to £201,068. Surely enough has been said to show that the increase of expenditure has at least kept pace with the increase of patients.

The question now arises, are there any causes in operation tending to an increased annual production of insanity, and if so, what are they? It is to be regretted that the statistical information supplied by the Lunacy Departments in the three kingdoms is not formulated on a common plan and uniformly summarised. Taking the assigned causes of insanity from the last Report of the English Commissioners, it appears that of a total of 13,504 admitted in the year 1881 into regular asylums, the number of cases put down to dissipation and depraved habits is 2,020, including 1,730 due to intemperance in drink. In 2,647 cases hereditary influence is the assigned cause. Both combined reach about a third of the admissions. The Irish Commissioners have not printed a parallel table, but they have given