H.—7.

2

Ratio to Population. —On the 31st December the number of the patients on the register etood in the following ratio to the estimated general population: — The proportion of the total insane to the total population was, — Exclusive of Maoris ... ... ... ... 3447 per 10,000, or lin 290 Inclusive of Maoris ... ... ... ... 3315 „ lin 302 The proportion of the male insane to the male population, — Exclusive of Maoris ... ... ... ... 3825 „ lin 261 Inclusive of Maoris ... ... ... ... 3685 „ lin 271 The proportion of the female insane to the female population,— Exclusive of Maoris ... ... ... ... 30-19 „ lin 331 Inclusive of Maoris ... ... ... ... 2899 „ lin 345 For a ratio as low as the present, one has to go back to some period during the year 1900 when the proportion of insane to population (exclusive of Maoris) rose from 1 in 296 at the beginning to 1 in 288 at the end of the year. The highest proportion was in 1903—viz., 1 in 284. These ratios are practically the same as those in Great Britain (that of England and Wales on the Ist January, 1907, was 1 to 282), but it was pointed out in my last report that the ratio is very low among native-born New-Zealanders of European stock forming that section of our population which, conceding an excess of younger persons in its age-distribution, is at all comparable with the population of an older country. One finds the significance of these statistics misunderstood by so many that, at the risk of repetition becoming tedious to the few, it must be pointed out that the above ratios relate to the insane accumulated in our institutions over a number of years, and are misleading if used as a measure of the growth of the malady. The figures hereunder dealing with the ratio of admissions to population, even of first admissions, though furnishing a better are not a trustworthy measure; for, in addition to the sources of error which we share with other countries, there is one peculiar to communities whose expansion is largely by accretion. Last year I showed that these accretions were relatively unstable elements, being chiefly adult persons whose ratio of insanity was higher than that among adults in their country of origin, and how in the general statistics this neutralised the low ratio of insanity among the native-born population of European stock. It is not my intention to repeat the figures and deductions, but only to ask that the fact be kept in mind when inferences are drawn from our statistics. Admissions. —The annual return of immigrants who became insane within a year of landing in the Dominion may be placed here conveniently: —

The total number of patients received into our hospitals in 1907 was 700; but, as 100 of these were transfers, the admissions proper numbered 600. 472 of the 600 were admitted for the first time, 105 were readmitted into a hospital where they had been previously treated, and 23 had been discharged from a hospital other than the one into which they were subsequently admitted. Six of the patients were Maoris, three being received as first admissions and three as readmissions. Ratio of Admission to Population. —Excluding the Native race and patients transferred from one institution to another, the proportion of total admissions to the estimated population at the end of the year was 639 to 10,000; a sharp fall after an apparently progressive rise, the ratio for the previous ten years being 6 - 56, for the previous five 676, and in the previous year 716. As a matter of fact the progress has not been altogether orderly and unbroken; but, apart from the low ratio in 1907, for a parallel to which one has to go to 1900, there has been an advance. How far this is due to increased immigration, how far to a more sympathetic conception of mental hospitals ns places rather for treatment than incarceration, and how far, if at all, to increased insanity, it is impossible to state with any degree of accuracy. Having regard to the fact that in the general population there are persons who have had attacks of insanity often necessitating their detention in a mental hospital in the past, and that such persons at one time largely augment the proportion of insane and at another time contribute an almost negligible increment to the general population, it is clear that these figures cannot be accepted without qualification. Our knowledge of occurring insanity is confined to persons in whose case a reception order is granted, and we have not therefore sufficient information to make of any value a comparative return of " first attacks " whether treated within or without a mental hospital, but hereunder is one, compiled from the Department's general register, differentiating between total and first admissions, which shows that readmissions are a significant factor. Calculated over the period included

Native of Stated to be First Attack. Previous Attack before ooming to Dominion. Total. United Kingdom Australia ... Elsewhere ... 8 5 0 8 0 0 16 5 0 Total for 1907 13 21 Total for 1906 26 31