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قراءة كتاب Insanity: Its Causes and Prevention
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also accurate, would go far toward a solution of the problem, but this has hitherto not been practicable in this country. Owing largely to the migratory character of large portions of the populations, the great extent of the country, and the sparseness of population in many sections, and for other reasons, any conclusions from it can be only proximate.
But, while we do not at present possess the data requisite to determine the question with accuracy in this country, we may refer to the statistics which have been yearly published since 1858, by the Boards of Commissioners in Lunacy for England and Scotland; and do so with the assurance that what may be found to be true there, will, at least, be good evidence as to what exists with us.
Both these countries have vastly greater facilities for accurately determining the number of insane persons living at any one time within their borders, than are possible in the United States. The population is much more homogeneous; it is greatly more dense, there being about 25,000,000 of people on a number of square miles less than are contained in some of our single States. The people are not accustomed to frequent change of residence from one portion of the country to another, and all classes are readily reached and their conditions of health determined.
In these countries, so favorably constituted in these respects, there have existed Boards of Commissioners in Lunacy, for many years, whose duties are concerned solely with the insane, and their system of inspection appears to be wellnigh perfect. I therefore propose to introduce some of the statistics furnished by these Boards, from which we may learn in what direction has been the tendency of insanity there. In this procedure I shall divide those which I use from both Boards into periods of ten years each, the first, from 1859 to 1868, inclusive, and the second, from 1869 to 1878, inclusive; giving the numbers of increase and decrease of both private and pauper patients, as they appear in the reports, distributed in asylums, licensed dwellings, and with relatives and friends.
From the report of the Commissioners for England: first, as to private patients, the whole number was, in 1859, four thousand nine hundred and eighty (4,980): and there was an increase of this class in registered hospitals, during the first decade, to the number of two hundred and thirty (230); and in licensed houses, to three hundred and twenty-six (326).
Of this class of patients residing with relatives and others, there has been an increase of one hundred and fifty-two (152); and in naval and military hospitals, of eighteen (18).
Of this class of patients in county and borough asylums, there was a decrease of eight (8).
Second, as to pauper patients;[1] there has been an increase of these, in county and borough asylums, amounting to nine thousand eight hundred and forty-four (9,844); and in registered hospitals, of one hundred and ninety-six (196); and in workhouses, of twenty-seven hundred and twenty-one (2,721); and residing with relatives and others, of one thousand and thirty-one (1,031).
There has been a decrease of this class residing in licensed houses, of six hundred and ninety-eight (698).
By adding together the several sums of increase which have occurred in both classes, and the increase in the number of criminal lunatics, three hundred and forty-two (342), who have been provided for, since 1864, in a special asylum at Broadmoor; and deducting the sums of decrease which have occurred by removals and redistribution of patients among the several asylums and registered houses, we have, as a grand total of increase during the ten years, fourteen thousand two hundred and thirty-eight (14,238).
I have presented the above statistics somewhat in detail, in order that it may be more apparent among what classes of society this large increase has mainly occurred. It will accordingly be observed that, while it has been only seventeen (17) per cent. among the private patients, it has been about seventy (70) per cent. among the pauper class.
It is apparent that the above statistics present only the total number of increase, without relation to the increase of the population. To enable us to appreciate their full significance, another statement, therefore, becomes necessary.
The ratio of the insane to the sane, the total number of the population being estimated at the middle of the year, for the several years of the decade, was as follows:
In | 1859 | one in | 535 |
" | 1860 | "" | 523 |
" | 1861 | "" | 507 |
" | 1862 | "" | 495 |
" | 1863 | "" | 478 |
" | 1864 | "" | 466 |
" | 1865 | "" | 460 |
" | 1866 | "" | 449 |
" | 1867 | "" | 441 |
" | 1868 | "" | 430 |
exhibiting a higher ratio of the insane to the sane for every year of the decade.
I now introduce the statistics of the second decade, viz., from 1869 to 1878 inclusive; and perhaps it is fair to assume that these will be more nearly perfect than those of the former period, as the system employed had been longer in operation, and the conditions of the problem somewhat simplified, as the result of previous labors. For convenience, I shall group together the private and pauper patients.
In 1869, there were of both private and pauper patients in the county and borough asylums twenty-six thousand eight hundred and sixty-seven (26,867); in 1878, there were of the same classes of persons, thirty-seven thousand seven hundred and sixty-three (37,763): exhibiting an increase of ten thousand eight hundred and ninety-six (10,896).
There were in registered hospitals, in 1869, of both private and pauper patients, twenty-three hundred and fifty-two (2,352); and in 1878, twenty-seven hundred and seventy-eight (2,778): showing an increase of four hundred and twenty-six (426).
In licensed houses, there were, in 1869, four thousand seven hundred and ninety-six (4,796); and in 1878, there were four thousand two hundred and two (4,202): exhibiting a decrease of five hundred and ninety-four (594).
In naval and military hospitals, in 1869, there were two hundred and nine (209); and in 1878, three hundred and sixty (360): an increase of one hundred and fifty-one (151).
In the Criminal Lunatic Asylum at Broadmoor, in 1869, there were four hundred and sixty-one (461); and in 1878, four hundred and eighty-two (482): an increase of twenty-one (21).
In the workhouses there were, in 1869, eleven thousand one