| Males. | Females. | Totals. | |
| England and Wales | 57,176 | 66,812 | 123,988 |
| Scotland | 8,594 | 8,999 | 17,593 |
| Ireland | 12,254 | 11,300 | 23,554 |
| Gross total | 78,024 | 87,111 | 165,135 |
These figures show the ratio of lunatics to 100,000 of the population to be 354 in England and Wales, 312 in Scotland, and 538 in Ireland.
Numbers of Lunatics on the 1st of January of the years 1857-1907 inclusive, according to Returns made to the Offices of the Commissioners in Lunacy for England and Wales, Scotland and Ireland.
There is thus an increased ratio in England and Wales of lunatics to the population (which in 1859 was 19,686,701, and in 1907 was estimated at 34,945,600) of 186.8 per 100,000 as against 354.8, and in Scotland of 157 as against 312 per 100,000. The Irish figures on the same basis have increased from 130.9 in 1862 to 538.1 in 1907. The publication of these figures has given rise to the question whether lunacy has actually become more prevalent during the last twenty years, whether there is real increase of the disease. There is a pretty general consent of all authorities that if there has been an increase it is very slight, and that the apparent increase is due, first to the improved systems of registration, and secondly (a far more powerful reason) to the increasing tendency among all classes, and especially among the poorer class, to recognize the less pronounced forms of mental disorder as being of the nature of insanity. Thirdly, the grant of four shillings per week which in 1876 was made by parliament from imperial sources for the maintenance of pauper lunatics has induced parochial authorities to regard as lunatics a large number of weak-minded paupers, and to force them into asylums in order to obtain the benefit of the grant and to relieve the rates. These views receive support from the fact that the increase of private patients, i.e. patients who are provided for out of their own funds or those of the family, has advanced in a vastly smaller ratio. In their case the increase, small as it is, can be accounted for by the growing disinclination on the part of the community to tolerate irregularities of conduct due to mental disease. And again, careful inquiry has failed to show a proportional increase of admissions into asylums of such well-marked forms as general paralysis, puerperal mania, &c. The main cause of the registered increase of lunatics is thus to be sought for in the improved registration, and parochial and family convenience. If there is an actual increase, and there is reason for believing that there is a slight actual increase, it is due to the tendency of the population to gravitate towards towns and cities, where the conditions of health are inferior to those of rural life, and where there is therefore a greater disposition to disease of all kinds.
The futility of seeking for accurate figures bearing on the relative number of lunatics in other countries is illustrated by the tables set forth in a report by the United States Census Bureau. They show that the number of registered lunatics in 1903 was 150,151; in 1890, 74,028; and in 1880, 40,942. An attempt was made in 1890 to estimate the number of insane persons outside of hospitals, which was stated to be 32,457. In 1903 no such attempt was made, as it was admitted that so many sources of fallacy existed as to render it useless. Thus the mere statement that of every 100,000 of the population (calculated at 80,000,000) 186.2 were registered as insane is of no value.
Bibliography.—The following are systematic works: Bucknill and Tuke, Psychological Medicine (4th edition, 1879); Griesinger, On Mental Diseases (New Sydenham Society, 1867); Maudsley, The Pathology of Mind (1895); Bevan Lewis, A Text-Book of Mental Diseases (1899); Clouston, Clinical Lectures on Mental Diseases (1892); Kraepelin, Psychiatrie (1893); Krafft-Ebing, Lehrbuch der Psychiatrie (1893); Regis, A Practical Manual of Mental Medicine (London, 1895); Magnan, Leçons cliniques sur les maladies mentales (1897); Mendil, Leitfaden der Psychiatrie (1902); Mercier, A Text-Book of Insanity (1902); Lewis C. Bruce, Studies in Clinical Psychiatry (1906); Macpherson, Mental Affections (1899); Brower-Bannister, Practical Manual of Insanity (1902); Ford Robertson, Text-Book of Pathology in Relation to Mental Diseases (1900).
(J. B. T.; J. Mn.; L. C. B.)
II. Legal Aspects
The effect of insanity upon responsibility and civil capacity has been recognized at an early period in every system of law.