4c6Section IV.F. W. Mott,
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'g
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 is the most potent
cause of insanity.
Another and very important cause of increase of asylum accommodation
is a diminishing death rate in asylums from tuberculosis, dysentry,
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. 110, 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
who were formerly treated in the infirmaries are now sent to the asylums
where they can be better cared for. An inducement to send these cases by
the Guardians is the fact that the Government pays the Guardians 4s. per
week for each pauper lunatic. It is hardly fair, however, to cast the stigma
of insanity on a stock in the case of simple senile decay.
The Correlation of Pauperism, Insanity, and, Feeble-Mindedness.
The registered insane in London is 5 per 1,000, whereas in England and
