H.-7

4

Diteharget ami Deaths. Omitting transfers, where discharge from one institution is coincident with admission into another, the number of cases discharged From the mental hospitals was 426 (m., 211; f., 215), and the deaths numbered 307 (in., 196; f., 111). The total number under care 'luring the year, deducting transfers, was 4,697 (m., 2,739; f., 1,958). The corresponding figures for the previous year were 402, 280, and 4,595 respectively. Had the previous year's relation of discharges and deaths to the total number under care been maintained in 1913, there would have been 15 fewer discharges and 21 fewer deaths. Of the patients discharged, 337 (in., 175; f., 102) were classed us recovered. In I!II2 the number discharged as recovered was 325 (in., 184; I., 141). The percentage of recoveries calculated upon admissions was 42"98 (m., 37*55; f., 50"94), as against .'W'74 (m., 4017; f., 37"01) in the previous year. In the summary of total admissions since 1876 the percentage of recovery works out at 39"87 (m., 3739; f., 43-58). In England and Wales (exclusive of idiot establishments) the rate for 1912 was 3476. The recovery rate is above our average. A lower may well have been anticipated under the Aci of 1911 on account of a larger proportion of mentally deficient and mentally infirm admissions, on account of a certain proportion of persons coming as voluntary boarders and recovering as such, instead of as patients, and because previously when a patient was discharged on probation it was often taken for granted that lie had recovered; bill under the new Act such persons have to be regarded as unreeovered unless there is medical evidence of recovery at the end of the probationary period. Unfortunately, people get careless about sending reports after they have left the institution, and their recovery is lost to statistics. For some years a prognosis has been made upon the admission of each patient, and at the end of the year the ease of every patient is reviewed, and his further detention depends upon the granting of a certificate that it is necessary for his own good or in the public interest. Incidental to this review is a reconsideration of the prognosis. The first stage is to set aside those whose malady is definitely incurable, and then to separate from the remainder the more hopeful cases. The results for 1913 are shown in the table hereunder :—

This table is sufficiently established to pass over without explanation. It is perhaps necessary to repeat that transfers ait included, and that the figures are not comparable with the return of recoveries on admission. Of the patients on the register at the beginning of the year, S7'2 per cent, were incurable, and 499 per cent, were expected to recover, but in as main as 12"8 per cent, there was deemed to l>e a chance of recovery. These arc average proportions, and it is mainly upon this margin that the medical work of the institution is focussed. The factor of expense should not be considered in providing what is adequate, The cost of the necessary treatment, even if the patient could be retained in private care, is beyond the ordinary private purse. It is a matter for gratification that proper admission buildings are going up. and ii must be understood that the maintenance of patients in these buildings will cost considerably above the average, if for no other reason than the larger proportion of nursing staff necessary for supervision ami to give individual attention. The percentage of deaths calculated on the average number resident was 798 (in.. 8"70; f., 696), in 1912 the proportion was 7■ 57 (m., 8"99j f., 5 , (>1); calculated on the total number under care (less transfers) the proportion per cent, in 1913 was 6"53 (in. 717; f., 567), and in the previous year 609 (m., 720; f., 4"54). In England and Wales the percentage, in 1912, calculated on the daily average number resident, was 970 (m., 1096; f., 861). , A Coroner's inquest is held in every ease of death in an institution, irrespective of the cause. Analysing Table XII in the appendix one finds that about 55 per cent, of those who died were over sixty years of age. and in 34 - 53 per cent, senile decay was the cause of death. Death resulted from diseases of the nervous system in 2."r08 per cent., general paralysis among males contributing 1122 pei , cent. Consumption and other forms of tuberculosis contributed 879 per cent. None

Of 3,913 Patients resident on 1st January, 1913. Of 892 Patients admitted during 1913. Totals. Showing as on 31st December, 1913, the Discharges, Deaths, and Length of Residence of those remaining, after the Exclusion of all Cases deemed incurable on 1st January, 1913, or on Admission in Cases admitted during the Year. uass A . ri. h (lass C. Th '• *»?& Remainder, d » as: dSs. 88 fiSa. Of Classes Of Classes n-.-, ■ A and C. B and D. General. 1 : M. J F. T. M. J F. I T. M. F. I T. M. F. T. M. F. j T. M. F. T. M. F. j T. 95J 100J 19b| 150 155 ; 305J 129 135 264! 82J 79 161 224 235| 459 J 232 234 4lili 466 469 B26 Discharged recovered .. 49 „ unrecovered .. 14 Died .. .. .. ..2 Remaining, residence 1 month or less j .. Ditto, over 1 and under 3 months .. „ 3 to 6 months „ 6 to 9 „ „ 9 to 12 „ .. .... „ over 12 „ .. .. 30 Total remaining .. .. 30 61 17 I i;o 3. 3 li 1 30 23 1 65 34 2 75 3 61 7 3 136 7 6 16 3 3 10 6 2 2(i (I 5 121 14 5 122 24 4 24(i 38 9 51 14 4 40 29 :( 91 43 7 175 28 9 162 53 7 3.(7 81 16 17 12 9 8 4 1 1-1 23 li Id 5 1 31 35 20 18 9 2 6 10 13 14 15 2 10 11 14 11 12 3 li; 21 27 25 27 5 17 12 9 S 4 31 14 23 11 Id 5 22 31 35 20 18 9 r>3 8 10 13 14 15 105 10 11 14 11 12 104 16 21 27 2.") 27 209 23 22 22 22 111 i:iii 24 34 L>.-, 2! 17 126 47 56 47 13 30 262 21 51 103 !(')' 204 21 51 10 204 51 64 lie 60 12 , 81 s.-, 166 163 32.-1 244 247 191 io:s li! 162