H.—7

in the table, 1 to 4 is about the proportion of readmissions to admissions; but be it remembered that readmission is not synonymous with second admission: —

It may be mentioned incidentally that the average number of persons within the radius of practice of a doctor in this country is 1,180, and it is therefore obvious that among his patients the average practitioner has only every fifteen months or thereabouts one insane person requiring control. This patient and others in the same oategory are collected together in special hospitals and the recurring necessity of providing accommodation for those who do not recover or die dram public attention to their number, whereas the public knows little or nothing of the numerous patients labouring under acute and chronic maladies which the practitioner has treated during the same fifteen months. 1 quote this passage from the Morison lecture for 1907: "Imagine the popular outcry if the unrecovered persons discharged from general hospitals had to be kept for life in those institutions, and the resulting dread of national degeneration I" Dischargee and Deaths. —The total number of persons discharged from the mental hospitals during 1907 was 134 (m., 244; f., 190), of which 299 (in., 160; f., 139) were discharged as recovered, and 135 (m., 84; f., 51) as not recovered. The second group included 100 (m., 62; f .,38) transferred patients whose technical discharge from one hospital coincided with their technical admission into another. The percentage of recoveries on admissions in 1907 was 4967 (m., 4429; f., 5768) against 4294 (m., 3975; f., 4773) in the previous year. One (male) transferred patient who recovered has been omitted from the calculation. The recovery-rate in 1907 is the highest since 1888, when our record was reached —namely, 57*62 per cent. Previous to that year there had been three higher percentages tFian the present —those for the years 1876, 1877, and 1878, the rates being 5756 per cent., 4972 per cent., and 50 per cent, respectively. The recovery-rate, satisfactory though it be, is but a rough-and-ready estimate of the value of treatment because its fluctuations depend largely upon the class of patients admitted. Thus, in addition to the curable cases, there are many admitted with disease which will prove fatal within a more or less definite period, in many the alienation is of an incurable type, in many admission has been so long delayed that the mental disorder has become well-nigh intractable, and in some the prognosis is unfavourable because of age. It is the way of statistics that such factors are from year to year found in varying proportions. By eliminating the error.of human judgment in regard to prognosis, the result of treatment could be gauged by calculating recoveries on those patients resident during the year whose malady was deemed to be curable, the prognosis to be set down on admission and reviewed annually; but the recovery of patients in whom the prognosis was unfavourable —an experience which most, if not all, alienists have had—would greatly interfere with any such deduction. One factor, however, speaks well for the maintenance of our relatively high recovery-rate, and that is the steadily increasing number of persons admitted in whom the prognosis is unfavourable beoause of advancing years. In the quinquennium 1882-86 the percentage of persons of sixty years and over admitted was 607, while in 1902-6 it was 1579. These figures have a double interest because they tend to reduce Ihe recovery-rate and increase the deathrate: but it must be pointed out and kept in mind that the increase of such admissions is not out of proportion to the increase of persons of that age in the general population. In the census of 1881 those of sixty-five years of age and upwards were I'4l per cent, of the total population, whereas in the census of 1906 they represented 460 per cent. The percentage of deaths on the average number resident during the year was 739. The percentage for the previous ten years was 642; for the previous five, 6"65; and for the previous year,

3

Ratio to 10,000 of Population of Number ol Persons in Population contributing Year. Almissionc. First Admissions. One Admission. One First Admission. 1897 L898 1899 1900 1901 6-31 614 5-93 6-39 6-83 4-98 507 471 502 5-61 1,585 1,627 1,685 1,565 1,464 2,008 1,972 2,119 1,990 1,774 Quinquennial average 636 509 1,580 1,964 1902 1903 1904 1905 1906 648 6-78 6-55 6-76 716 507 560 5-42 5-59 5-82 1,542 1,473 1,526 1,478 1,396 1,971 1,783 1,844 1,786 1,718 Quinquennial average 6-76 5-51 1,479 1,814 Decennial average ... 6-56 5-31 1,525 1,881 1907 6-39 5-04 1,567 1,982