As ten years had elapsed since the first attempt of any value to present the numbers of the insane in England (see [page 211]), it is of interest to compare with the table referred to, the following statement of the numbers on the 1st of January, 1854:—
| Where confined. | Private patients. | Paupers. | Total. | ||||||
|---|---|---|---|---|---|---|---|---|---|
| M. | F. | Total. | M. | F. | Total. | M. | F. | Total. | |
| 33 county and borough asylums | 147 | 146 | 293 | 5,791 | 6,878 | 12,669 | 5,938 | 7,024 | 12,962 |
| 2 military and naval hospitals | 199 | 5 | 204 | — | — | — | 199 | 5 | 204 |
| 2 Bethlem and St. Luke's Hospitals | 235 | 239 | 474 | 4 | 7 | 11 | 239 | 246 | 485 |
| 22 other public asylums | 467 | 456 | 923 | 102 | 103 | 205 | 569 | 559 | 1,128 |
| Licensed houses— | |||||||||
| 42 metropolitan | 608 | 598 | 1,206 | 418 | 723 | 1,141 | 1,026 | 1,321 | 2,347 |
| 88 provincial | 795 | 738 | 1,533 | 593 | 407 | 1,000 | 1,388 | 1,145 | 2,533 |
| Workhouses and elsewhere | — | — | — | 5,326 | 5,327 | 10,653 | 5,326 | 5,327 | 10,653 |
| Total | 2,451 | 2,182 | 4,633 | 12,234 | 13,445 | 25,679 | 14,685 | 15,627 | 30,312 |
In their ninth Report the Commissioners speak of continued progress, and to show the beneficial effects of good and kind treatment, record the case of a lady visited by them in a private asylum, where they found her in a room by herself, in a sadly neglected condition, and very frequently placed under mechanical restraint. Her habits were dirty, and her opportunities of taking exercise few. In consequence of her unsatisfactory condition the Commissioners ordered her removal to another asylum (the York Retreat), and about twelve months afterwards saw her there, and made an entry to the effect that since her admission she had never been in restraint or seclusion; that her destructive and dirty habits had been corrected by constant attention, exercise out of doors, and association with other patients. The Commissioners found her quiet, orderly, clean, well-dressed, and so much improved in appearance that they had some difficulty at first in recognizing her.
It was inevitable, as a result of the attention directed to the condition of the insane, and the greatly increased provision made for them in consequence, that there should be an alarming apparent increase of lunacy in the kingdom. In point of fact, the number of pauper lunatics had increased sixty-four per cent. in the eight years ending 1855.
At this period there were 13,579 patients in county and borough asylums, 1689 in registered hospitals, 2523 in metropolitan and 2588 in provincial licensed houses, and 114 in the Royal Naval Hospital.
The number of insane poor not in asylums was estimated at 10,500, of whom about half were inmates of workhouses, and the remainder with relations and strangers on an allowance from the parish.
There were various obvious explanations for the apparent increase of lunacy, viz. the greatly enlarged accommodation; the prolongation of life in consequence of kind care; the parochial authorities being required to take immediate proceedings for placing violent and recent cases under treatment; medical practitioners recognizing the nature of cases of insanity better; facilities of post-office, railway, and press bringing cases to light; medical officers being required to make quarterly returns under 17 and 18 Vict., c. 97, s. 66; and the efforts of the Commissioners to impress on guardians the importance of sending recent cases to asylums.
The increase of private patients during eight years had been at the rate of only fifteen per cent.; but the Commissioners point out that this conveys an imperfect view of the relative increase of pauper and private cases, inasmuch as a practice had sprung up by which persons who had never been themselves in receipt of relief, and who are not infrequently tradesmen or thriving artisans, had been permitted to place lunatic relatives in the county asylums as pauper patients, under an arrangement with the guardians for afterwards reimbursing to the parish the whole or part of the charge for their maintenance.
"Indeed, it may be said with truth that, except among what are termed the opulent classes, any protracted attack of insanity, from the heavy expenses which its treatment entails, and the fatal interruption which it causes to everything like active industry, seldom fails to reduce its immediate victims, and generally also their families with them, to poverty, and ultimately to pauperism."