On the next page will be found the general distribution and numbers of the insane, January 1, 1881. A more detailed statement will be given, in the Appendix ([K I.]), of the county asylums and lunatic hospitals now existing for the care and cure of the insane, with the numbers confined therein.
On the 1st of January, 1881, the proportion per cent. maintained in asylums, hospitals, and licensed houses was 64.91; in workhouses, 25.72; and as outdoor paupers, 9.37.
As some of the tables of the Commissioners extend back twenty-three years, exhibiting the number, sex, classification, and distribution of all registered lunatics, January 1, 1859-1881, as also the ratio of the total insane to the total population, we may derive much valuable information for the purpose of our historical review.
Thus there were in England and Wales:—
| Location. | Patients. 1859. | Patients. 1881. | ||
|---|---|---|---|---|
| In county and borough asylums | 15,844 | 41,355 | ||
| In registered hospitals | 1,855 | 2,948 | ||
| In metropolitan private asylums | 2,551 | 2,511 | ||
| In provincial „ „ | 2,465 | 2,115 | ||
| In naval and military hospitals and Royal India Asylum | 164 | 307 | ||
| In Broadmoor Asylum for criminal lunatics | Not opened till 1863 | 491 | ||
| In workhouses— | ||||
| Ordinary workhouses | 7,963 | 12,093 | ||
| Metropolitan district asylums | Not opened till 1870 | 4,718 | ||
| Residing with relatives or others (pauper and private) | 5,920 | 6,575 | ||
| Total | M. 16,756 F. 20,006 | 36,762 | M. 32,973 F. 40,140 | 73,113 |
Of the 36,762 in 1859, 4980 were in private and 31,782 pauper patients. Of the 73,113, in 1881, 7741 were private and 65,372 pauper patients. In 1859 the ratio of the total registered lunatics to the population (per 10,000) was 18.67, the ratio of private lunatics to population being 2.53, and of pauper lunatics to population 16.14. In 1881 the ratio of the total lunatics of the population was 28.34, the ratio of private lunatics to 25.34. These figures bring out very distinctly the fact that the great increase of lunatics during the period between 1859 and 1881 is among the poor. It must, however, be repeated that insanity itself brings with it pauperism to many who have once been independent and educated, but who fall, through the misfortune entailed by the malady, into the category of paupers.
An important table, introduced for the first time into the last Report of the Commissioners, shows the annual ratio of fresh admissions to the population; hence the transfers and the admissions into idiot asylums are excluded. The value of this table consists in this—that, although the gross admissions into asylums have increased, due in part to the capitation grant of four shillings introduced in 1874, the ratio of the yearly increase of the fresh admissions to the population has been slight, showing, as the Commissioners observe, that the total number of the insane under care during the twelve years embraced by the table is "mainly due to accumulation, and not to a greater annual production of insanity."[208] This table does not include workhouses.
Thus:—