9 



registerable insanity in London the same as it will in rural and urban 

 districts where the housing conditions are more favourable for the retention 

 at home of old-age pensioners suffering from senile decay. Twenty per 

 cent, of the admissions to the London asylums are old people, most of them 

 suffering with senile decay. The great increase of insanity, in my opinion, 

 is apparent rather than real, and for the following three reasons : 



Firstly, the standard of sanity has been raised ; a great number of 

 harmless idiots and feeble-minded persons who were formerly allowed to 

 roam at large are now gathered into the London asylums through the agency 

 of the Special Schools. The increase of accommodation for the insane has 

 been doubled in the county of London during the last 12 years. There 

 is not the slightest reason for supposing that insanity has doubled in a 

 stationary population ; no doubt numbers were formerly discharged as re- 

 covered on account of pressure of new cases. Correlated with the provision 

 of adequate accommodation by the authorities, the necessity of discharging 

 patients to make room for urgent admissions has steadily diminished in 

 recent years ; and probably this explains the fact that the number of 

 patients- discharged as recovered shows a constant and continuous diminution 

 of numbers. According to the report of the Clerk of the Asylums 

 Committee, out of the large mass of registered lunacy in London only 2*9 

 per cent, according to the medical superintendents have a favourable prospect 

 of recovery, 5*42 per cent, are doubtful, and 92*19 per cent, are unfavour- 

 able. By thus providing such increased accommodation for the permanent 

 segregation of incurable insanity the London County Council have been 

 practical Eugenists^ for as I shall show you, heredity isjthe most potent^ 

 cause ofjjasaoity. 



lother and very important cause of increase of asylum accommodation 

 is a diminishing death rate in asylums from tuberculosis, dysentery, 

 pneumonia, and other microbial infectious diseases. There is, therefore, a 

 constant tendency to silt up the asylums with chronic incurable cases. 

 That this is so, is shown by the fact, that at the present time nearly one- 

 half of the inmates of the London County Asylums have been resident in 

 asylums more than ten years. Again, at the end of 1910 no less than 4,238 

 patients, known to have been insane more than twenty years, were in the 

 London asylums ; moreover, such long standing cases have been accumu- 

 lating during the last four years at rates varying from 125-200 per annum. 



The third cause of the increase of registered insanity rests with those 

 who certify paupers. The degree of mental unsoundness necessitating 

 asylum treatment depends largely upon the provision obtainable for nursing 

 and taking care of incipient cases of insanity and aged persons who are 

 suffering from senile decay. In the report of the Asylums Committee, 

 1910, p. no, it is stated that as many as 4,762, or 23 per cent, of the 

 inmates of the London County Asylums were suffering from dementia, 

 senile and secondary ; this indicates that a number of these aged persons 



