October 12, 1906.] 



SCIENCE. 



475 



627, than in 1904. This shrinkage in the in- 

 crease of pauper and criminal insanity, small 

 though it may be, is highly satisfactory, and 

 this is supported by the fact that in county 

 and borough asylums the proportion of private 

 patients to the total number therein has risen 

 from 2.7 to 2.8 per cent, during the year. As 

 to the fluctuations of pauper insanity in coun- 

 ties and boroughs the commissioners say that, 

 as compared with the previous year, there has 

 been in the 63 administrative counties a net 

 increase in 40 counties amounting to 1,360 in 

 all. In 20 counties there has been a net de- 

 crease amounting to 166, and in three counties 

 — Hereford, Eutland and Somerset — neither 

 increase nor decrease. London County shows 

 by far the largest increase, amounting to 305. 

 Middlesex, Essex, Kent, Surrey and the West 

 Riding of Yorkshire, also show considerable 

 increases. Of the 72 county boroughs an in- 

 crease, amounting to 769 in all, occurred in 

 54, a decrease amounting to 109 in 14, and in 

 3 — Chester, Hastings and South Shields — 

 neither increase nor decrease. Of the 19 bor- 

 oughs 11 showed an increase, amounting to 

 70 in all; in 7 there was a decrease, amount- 

 ing in all to 31, and in 1 borough there was 

 neither increase nor decrease. 



Turning to the general question of the in- 

 crease of insanity since 1859, the total number 

 of certified insane has risen from 36,762 to 

 121,979, a rate of increase equivalent to 231.8 

 per cent., the general population having in- 

 creased during the same interval at the rate 

 of 75.4 per cent. Taking only the past ten 

 years, there has been during that period a 

 total increase of the certified insane of 26.5 

 per cent. This increase, however, is, as is 

 shown by a table furnished by the commis- 

 sioners, not only variable, but steadily de- 

 clining — that is, the increase has been mount- 

 ing more slowly for some years. Correspond- 

 ing to this absolute increase, the ratio of the 

 insane to population is increasing at a les- 

 sened rate. On January 1, 1906, the total 

 certified insane in England and Wales stood 

 to the estimated population in the proportion 

 of 1 to 283, as contrasted with 1 to 285 of last 

 year, 1 to 288 of 1903 and 1 to 314 of ten 



years ago — that is, the proportion of insane 

 persons to the community, per 10,000, has 

 risen from 31.89 to 35.31 during the decade. 

 The increase in population during this period 

 has been 10.8 per cent., and in the total num- 

 ber of insane under care 22.7 per cent. Thus, 

 the number of insane persons under care, both 

 numerically and relatively to population, is 

 still steadily increasing, though, of course, 

 this is not necessarily indicative of an in- 

 creasing growth of actual occurring insanity. 

 To this point we shall refer later. From the 

 point of view of the ratepayers, however, this 

 increase may be taken as an actual increase 

 of insanity, particularly as the increase is 

 practically confined to the pauper class. This 

 is clearly brought out by Chart II., facing 

 p. 6, showing the comparative variations in 

 the proportion of the insane to total popula- 

 tion from 1859 to 1906. In 1859 the ratio of 

 private patients per 10,000 population was 

 2.38. This rose in 1879 to 2.97, then fell to 

 2.67 per 10,000 in 1897, since when it has risen 

 slowly, and — ^with the exception of last year, 

 when, there was a drop of 0.01 per 10,000 — 

 steadily, to the present proportion of 2.84 per 

 10,000. The ratio of pauper lunatics, on the 

 other hand, has risen without intermission 

 from the 15.95 per 10,000 of 1859 to the pres- 

 ent figure, for January 1, 1906, of 32.20 per 

 10,000, Doubtless the question of an actual 

 increase of insanity is insoluble by purely 

 statistical methods; but of these latter, the 

 occurrence of insanity, as shown by the ratio 

 of first admissions to population, furnishes the 

 most reliable index. The commissioners' re- 

 port does not contain information respecting 

 this ratio for the years prior to 1898; but 

 Table III., Appendix A, shows that in 1898 

 this ratio per 10,000 population was 4.92. This 

 increased steadily to 5.76 in 1902, and since 

 then has declined to 5.21, the ratio for 1905. 

 Thus, so far as statistical evidence goes, these 

 figures tend to show that for the last four 

 years occurring insanity has not been on the 

 increase relatively to population, and that the 

 considerable absolute and relative increase of 

 insane persons under care is to be explained 

 by accumulation consequent on increasing 



