H.—B.

8

known, that would not afford the means of making a comparison between the extent to which insanity prevailed in it and in other countries. The nearest approach to an exact index of the comparative prevalence of insanity would be found in the annual admissions to Asylums. But even this is an extremely defective datum from which to draw conclusions, because the extent to which the annual admissions are a measure of the amount of insanity in a country will be influenced very much by the circumstances of the country, and may be supposed, for example, to be very different in England and New Zealand. It will be affected by the amount and kind of Asylum provision that exists, and the facilities on the one hand for conveying insane persons to Asylums, and the possibility on the other hand of avoiding Asylum treatment and managing them at home. Besides this, many cases of mental aberration occur which may or may not contribute to swell the list of Asylum admissions, according to the views which may be entertained by the practitioners in attendance as to what amount of aberration constitutes insanity; thus, delirium tremens is regarded by many modical men in this country as insanity, and many cases of it are sent to Asylums, but such cases are rarely sent to Asylums in England, even by mistake. Again, the transfers, and the re-admissions, which are sometimes relapsed cases, and sometimes cases which had been discharged un-recovered, would require to he eliminated from the number of annual admissions, to make it a fair test of the prevalence of insanity, especially iv New Zealand, where, from tho want of Asylum accommodation and from other causes, many un-recovered patients are discharged, and afterwards admitted, sometimes into the same Asylum from which they had been discharged, sometimes into a different one. But the information regarding the re-admissioiis is extremely unreliable. Taking such figures as can be got, and comparing the ratio of the admissions to the population in this country with that which obtains in others, by no means brings out such a flattering account of the lesser prevalence of insanity in New Zealand as is given by simply taking the ratio of the numbers in Asylums to the population. The ratio of admissions to population in New South Wales iv 1876 was 1 in 1,749 ;in England, in 1875, it was lin 1,693 ;in Victoria, lin 1,427; in South Australia (1876), lin 1,366; and in New Zealand, lin 1,180. The proportion of annual admissions to the average resident population of the Asylums is also comparatively high in New Zealand; in New South Wales last year it was 29 per cent, in England (1874) it was 30 per cent, and in New Zealand last year it was 45 per cent. From this it would appear that insanity is very common in New Zealand ; and as the number of admissions falls short of being a full "measure of the number of persons going insane, and is to a great degree regulated by the amount and accessibility of Asylum accommodation, one can hardly doubt that insanity prevails in New Zealand to even a greater comparative degree than is brought out by these figures. But it must be remembered that this insanity includes delirium tremens, aud that the number of cases of insanity occurring in the country, but not sent to Asylums, may be fully couutorbalanced by the number of old and relapsing cases which are sent from other countries. It is noteworthy that there is not only a much larger number of insane men than insane women in the colony, but that the amount of insanity is relatively much greater among men than among women, the proportion of insane men to the male population being one in 434, and that of women to the female population 1 in 656. Despite tho many disadvantages under which New Zealand Asylums labour, their statistics compare favourably with those of Asylums in other countries. Tho ratio of recoveries to admissions iv the Colonial Asylums is 13 per cent, higher than in Scotch and Irish Asylums, and 23 per cent, higher than in English County and Borough Asylums. The deaths in the Colonial Asylums are at the rate of 6"70 per cent, on the average number resident, and of 4"49 on the total number under treatment. In England, these death rates are respectively 1136 and 870; in Scotland, 66 and 53.* The high rate of recovery and the low death rate of the Colonial Asylums are in all probability largely due to the nature of the cases admitted, and to the insufficiency and inaccessibility of Asylum accommodation, which preclude the admission of many weak or dying patients unable to stand the fatigues of a long rough journey, and of many incurable and harmless insane persons who are not sufficiently troublesome to render their removal from home imperative. In England, the rate of recovery was higher twenty years ago, before the non-restraint system was established, than it is now in the best managed County Asylums. This falling off in spite of better treatment is obviously the result of a difference in the kind of cases now sent to Asylums, in consequence of the great increase of Asylums, the facilities for sending patients to them, and the alterations of opinion as to the degree and nature of mental affections which require Asylum treatment. No doubt, many cases which would not recover if treated with ignorance and neglect, are now cured in good Asylums; but the increase of recoveries thus obtained is obscured by the great number of demented and incurable patients now sent to Asylums; and, judging from the experience of other countries, probably no safer prophecy could be made than that an increase aud improvement in the provision for the insane in this country will be followed by a large apparent increase in the number of the insane, and by a real increase in the death rate, and a falling off in the rate of recoveries in Asylums. Apart from these considerations, it may be doubted if tho number of recoveries among the insane in the colony is really so great as it seems. I have known several patients discharged as recovered who certainly would not be considered recovered in England. The manner, too, of reckoning the recoveries in the Auckland Asylum is not very reliable. Patients are there discharged under clause 63 of the Lunacy Act, relieved or convalescent, and those who do not return within the year are concluded to have recovered. The plan of sending un-recovered patients out on trial is an excellent one, which by the way would be almost completely put a stop to by a central Asylum, but un-recovered patients who do not return are not a fair subject of comparison with those who are discharged recovered on medical authority. The list of recoveries in the Colonial Asylums is also considerably swollen by cases of delirium tremens, which yield almost as a matter of course to proper treatment. But even bearing these things in mind, the recovery rate and the death rate of the Colonial Asylums are very satisfactory, especially when the great difficulties which bave to be contended against are taken into consideration. * These figures are taken from the Journal of Mental Science, January number, 1877, the Lunacy Eeports not being to hand yet.