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  Chap. IV.—ON THE CURABILITY OF INSANITY. Insanity a very curable disorder, 27.—Experience of American physicians, 27.—Exceptional circumstances in American asylums, 28.—Experience of St. Luke’s Hospital, London, 28.—Experience of the Derby County Asylum, 30.—Advantages of early treatment, 30.   Chap. V.—ON THE CAUSES DIMINISHING THE CURABILITY OF INSANITY, AND INVOLVING THE MULTIPLICATION OF CHRONIC A. Causes external to Asylums. § Detention of Patients in their own homes. Absence of all curative influences at home, 32.—Causes of delay in submitting patients to treatment, 33.—Impediments to transmission to county asylums, 34.—Evils of pauper test in public asylums, 34.—Characters of Continental asylums, 35.—Practice followed in America, 36.—Scheme of assessment of means of those applying for admission to public asylums, 36.—Failure of the pauper test to protect the rate-payers, 37.—Its demoralizing and degrading effects, 38.—Suggestion as to conditions and mode of admission into county asylums, 38.—Act in force to recover the costs of maintenance objectionable and inefficient, 39.   § Detention of Patients in Workhouses. Detention practised on economical considerations, 40.—Examination of the value of such considerations, 41.—Estimated cost in asylums and in workhouses includes different items in the two, 41.—Illustration from the Devon Asylum Report, 42.—Children constitute above two-thirds of workhouse inmates, 42.—Material effect of this on the cost of maintenance, 42.—Inmates of asylums almost all adult, 42.—Fluctuations among inmates of workhouses greater than in asylums, 43.—Mode of estimating the rate per head of cost in workhouses, 43.—Population of workhouses, sane and insane mixed, 44;—that of asylums of insane especially, 44.—Those insane who involve increased cost rejected from workhouses, 44.—Remarks on this point by Dr. Bucknill, 44.—Economy of workhouses for the insane doubtful, 45.—Cost of asylums contrasted with that of workhouses, 46.—System of asylum structure hitherto adopted unnecessarily expensive, 47.—Workhouses and asylums not fairly comparable as to cost, 47.—Plan to diminish cost of asylums one-half, 48.—Chronic lunatics can be provided with asylum accommodation at a rate not exceeding that for workhouses, 48.—Internal cost of asylums and workhouses compared, 49.—Mistaken policy of constructing lunatic wards, 50.—Unfitness of workhouses for insane patients, 51, 75.—Evils attending presence of lunatics in workhouses, 52.—American experience in the matter, 52.—Workhouses unfit by structure and organization, 52, 75.—Workhouse detention especially prejudicial to recent cases, 53, 81.—Deficiency of medical care and of nursing in workhouses, 54, 78.—The dietary of workhouses insufficient for lunatics, 54, 77.—Injurious effects of workhouse wards upon lunatics, 56, 77.—Lunacy Commissioners’ remarks thereon, 56.—Dr. Bucknill’s remarks on the same subject, 57.—Characters of the lunatic inmates of workhouses, 58.—The majority of them imbecile and idiotic, 58.—Proportion especially claiming asylum care, 59.—Epileptics and paralytics unfit inmates of workhouses, 59.—Old demented cases badly provided for in workhouses, 59.—Imbecile patients are, as a rule, unfit inmates, 60.—Idiots improperly detained in workhouses, 61.—None but a few imbeciles permissible in workhouses, 61.—On the class of supposed ‘harmless’ lunatics, 61.—Remarks by Dr. Bucknill on this class, 62.—Experience of the Surrey magistrates on transferring ‘harmless’ patients to workhouses, 63.—Degradation of the patients’ condition in workhouses, 64.—Legality of workhouse detention examined, 65.—Remarks on this subject by the Lunacy Commissioners, 66.—Clauses of the Lunacy Asylums Act bearing on the subject, 66.—Defects of the law in protecting the pauper insane, 68.—Remarks of the Lunacy Commissioners on the anomalies of the law, 68.—Objections to the powers conferred upon parochial officers, 68.—The law obscure, and open to evasion, 69.—Duties of the parish medical officers ill-defined, 69.—Proposal of a district medical officer, 70.—Contravention of the law