The extra accommodation referred to in the last report has not yet been started but the plans have been approved. It is to be hoped that the recommendation with regard to the water supply will be given effect to as the pressure of water, particularly in summer, is insufficient.

The laundry is too small for the amount of washing to be done in an Institution of this kind. As a result of this the mangle has to be kept in the drying house, situated at the top of a very steep hill, and heavy baskets of clothes have to be carried up and down this hill in order to be mangled. In wet and frost the hill is very slippery, and, therefore, dangerous. When structural alterations are in progress it might be possible, at little cost, to increase the size of the present laundry by a corrugated iron building in which the mangle could be kept.

The majority of the inmates are employed at useful occupations. The recommendation to board out suitable patients has been considered but suitable guardians have not been found, their own relatives not wishing to have them at home.

Lunatic Wards, Old Monkland Poorhouse.

Inspected 23rd February and 22nd July, 1926.

(Average number of patients resident during year, 48.5.)

The care of the inmates is of a very satisfactory description. Their surroundings are homely and comfortable and they work at agreeable occupations under kindly supervision. They have excellent food.

At the first visit, the patients were looking forward to a concert which was being held in the evening and given by the members of the Poorhouse Committee.

Lunatic Wards, Paisley Poorhouse.

Inspected 6th January and 20th July, 1926.

(Average number of patients resident during year, 105·0)

The patients were all found to be very contented. They are neatly clad and show evidence of being well cared for in all respects. They are well fed and ample attention is given to open air exercise and employment.

The wards were found in good order, clean, comfortable and hygienic in all respects.

The nursing and medical care continue to be very efficient.

The wards are managed with much kindly forethought and in an active and able manner.

All the inmates who were physically and mentally fitted were taken on a picnic excursion to the beautiful grounds of Broadfield and from the conversation of several of them it was obvious that this outing was much enjoyed.

Lunatic Wards, Perth Poorhouse.

Inspected 4th February and 13th December, 1926.

(Average number of patients resident during year, 38-5.)

Beds and bedding were found in a satisfactory state, the wards clean and attractive, and the care and condition of the patients created a favourable impression.

A three course dinner is given daily, with fish in lieu of butcher meat on Fridays.

Inquiry was made concerning dental treatment and the arrangements seem to be satisfactory, namely, that the services of a qualified dentist are requisitioned at any time when necessary.

A few patients were confined to bed on account of senile infirmity and were found located in the ordinary sick ward of the Poorhouse. This arrangement cannot be criticised in cases of temporary illness as the lunatic wards are not staffed or equipped for the treatment of acute physical states. These patients, however, cannot properly be looked upon as inmates of the lunatic wards as they are not likely to return to them. This is a matter that will have to be kept in mind in choosing the type of patient to be sent to these wards which meantime. house a suitable number of the surplus population of the Edinburgh District Asylum. It is not expedient now to remove these patients but any patient in the future who shows signs of senile or other permanent disability should be returned to the Asylum.

Lunatic Wards, Wigtown Poorhouse.

Inspected 17th June and 12th November, 1926.

(Average number of patients resident during year, 37·0.)

The patients are all very contented. Most of them are actively employed.

The dayrooms and dormitories are clean and tidy. The condition of the male wards shows that careful attention has been paid to the criticism in a previous report. The patients are neatly and suitably clad and generally bear evidence of being adequately cared for.

The management is characterised by a very kindly concern for the welfare and happiness of the patïents.

(e) ESTABLISHMENT FOR STATE AND CRIMINAL LUNATICS.

Perth Prison.

Inspected 5th February and 29th September, 1926.

(Average number of patients resident during year, 69·5.)

This department was found in excellent order and the medical care of the inmates is informed and satisfactory.

There was a noticeable absence of excitement, and there were no complaints affecting the administration.

The inmates were found in good bodily health and they are agreeably employed. All of them showed that their needs in this respect, and as to outdoor exercise generally, are well attended to.

At the second visit the inmates were seen at a substantial dinner, which was well served, well cooked and appetising. The dinner consisted of broth, stew, potatoes and bread, and such of the inmates as were asked expressed themselves as being satisfied with the food given to them.

IV. LUNATICS IN PRIVATE DWELLINGS.

NUMBERS OF PRIVATE AND PAUPER LUNATICS.

The number of lunatics other than paupers who were provided for in private dwellings, with the sanction of the Board, on 1st Of these, 31 were persons whose means have January, 1927, was 80. been placed under curatory by the Court of Session or by a Sheriff Court. Of the whole number, 35* were in houses which possessed special licences for the reception of not more than four patients, and 45 were placed singly in houses which, having only one patient, require no licence. The number of houses possessing special licences for the reception of private patients was 36 on 1st January.

All pauper lunatics, wherever placed, come upon the register of the Board, and we are fully informed by visitation or otherwise as to the mode in which they are provided for, and of every important fact concerning them. The relation of the central authority to every individual member of the pauper class of the insane is peculiar to Scotland. In no other country is every lunatic whose maintenance is contributed to from public sources under the direct supervision of the central authority. The number of pauper patients provided for with the sanction of the Board in private dwellings on 1st January, 1927, was 1638, showing a decrease of 53 compared with the preceding year. The number admitted during the year to the roll of pauper patients in private dwellings was 94, which is 29 less than last year. Of these, 31, or one more than last year, were resident in private dwellings when first reported to the Board and remained with our sanction under private care, and 63, or 30 less than last year, were removed from asylums. Of the total number of pauper patients in private dwellings, 9 were certified sane during the year, 13 were removed from the poor-roll by their friends, 69 were removed to asylums, and 56 died the death rate being equal to 33 per 1000.

During the year 1926, lunatics and mental defectives in private dwellings were visited by the officers of the Board, many being visited twice in the course of the year.

General Reports on the Visitation of Patients.

Dr. H. Ferguson Watson reports as follows:-In the districts visited one is glad to be able to report that generally the care and comfort of the patients reach a high standard. As a rule they receive an excellent and varied dietary, are well nourished and above the average in general health. As a rule they are suitably clad and have at least one complete change of clothing, and they are kept very clean.

In the Highland areas the effects of the shortage of coal were little felt. Peat and wood are generally plentiful, and with excellent weather conditions an unusual quantity of peat was cut. Difficulties in transport during the industrial crisis made eggs, butter and milk not only plentiful In the Lowlands-especially in the but cheap in the Highland areas. mining districts there was much hardship. Some of the parishes were prompt in realising the position in which the Board's patients were placed and most considerately increased the aliment- some by as much as 2s. per week.

* Includes 6 private patients resident in houses licensed for pauper patients.

Last year the Superintendent of a Swedish Mental Hospital made a visit to acquire first-hand knowledge of the boarding-out system in Scotland, with a view to recommending the incorporation of some of its best features. He was shown over a wide area and expressed his appreciation of what he saw, making special comment on the great freedom which the patients enjoy. A few years ago a Norwegian State Officer in charge of the Lunacy Department made similar remarks.

Dr. Gibson reports:-In the licensed houses which I have visited during the last twelve months, the care of the patients has been very satisfactory. I have found the local authorities generous in regard to the question of aliment and ready in supplying the patients requirements of clothing.

The patients living in these licensed houses seem to have been selected judiciously, and the number that has been found to be unsuitable is negligible. There is no doubt that those patients who have the good fortune to be "boarded-out" appreciate the change from the routine of institution life, and very few requests are received to be permitted to return to the Mental Hospital.

There is always a certain difficulty attending the boarding-out of defectives, and the more intelligent the patient is the greater becomes the difficulty. As they become settled down and find that they are able to perform the various tasks assigned to them capably and effectively, they are apt to become discontented. This discontent is gradually increased, if they are associated with normal people who are earning wages, when they are not.

Medical Officers and Inspectors of Poor pay their Statutory visits regularly, and the result is reflected in the cleanliness and orderliness of the homes. Medical Officers have also been assiduous in their attendance on patients suffering from intercurrent ailments.

Parish Councils have been ready to adopt any suggestions made with a view to benefiting the patients' health or increasing their comfort. In many instances vision has been tested and suitable glasses provided, while the comfort of other patients has been greatly added to by the gift of artificial dentures.

Dr. Kate Fraser reports:Recently the "boarding-out" of certified defectives has been subjected to some adverse criticism, such criticism being based on one or two outstanding failures in this method of dealing with the mentally defective. Owing to the lack of sufficient institutional accommodation for cases requiring care and treatment in institutions it has been necessary in many instances to "board-out" doubtful cases rather than leave them in unsuitable home conditions. And considering the number of such cases at present under guardianship, it says much for the care and supervision exercised that so few failures do occur. To be properly carried out the boarding-out of defectives should form a necessary part of a national system for their care, a system which includes special schools, institutional treatment, home care and care under guardianship, and both patients and guardians must be carefully selected.

On the whole I have been satisfied with the care and supervision exercised, although in many instances more might be done. to interest and occupy the patient during leisure. One guardian spends much time in the evenings teaching his patient to read and write, another plays dominoes with his patient, and many have taught their female

patients to knit. One elderly female guardian who has two imbecile boys under her care has presented both with mouth organs on which they have learned to play hymns and simple tunes, and when they are not occupied in this way in the evenings she reads aloud to them. In this connection I should like to emphasise the importance of education and training in early life of all defectives. A defective so trained may have many interests which help to occupy his leisure and make his life under guardianship more like the home life of the normal members of the household, as well as making him a more efficient and useful member of society.

V.-EXPENDITURE FOR MAINTENANCE OF

PAUPER LUNATICS.

The expenditure of Local Authorities, on the maintenance of pauper lunatics, for the year ended 15th May, 1926, was as follows:- For the maintenance of pauper lunatics, who were under care for longer or shorter periods during the year, in asylums, lunatic wards of poorhouses, and private dwellings, and for other expenses connected with them, a total sum of £771,858 was paid; of which £667,310 was for maintenance in asylums (including Institutions for Imbecile Children*), £37,187 was for maintenance in lunatic wards of poorhouses, £53,223 was for maintenance in private dwellings, and £14,138 was for certification, transport, and other expenses. Of this expenditure, £46,202 was repaid by relatives and others, and £115,703 was contributed from the Local Taxation Account, in terms of Section 22 of the Local Government (Scotland) Act, 1889, and of Section 2 of the Education and Local Taxation Account (Scotland) Act, 1892. The net expenditure by Local Authorities on the maintenance of patients was thus £609,953, which is £2,428 less than the expenditure of last year.

COST OF MAINTENANCE.

As regards asylums, the average weekly cost per head is 19s. 11d., which, calculated for the year, is £51 18s. 6d.

In licensed wards of poorhouses, the weekly cost is 16s. 8d., or £43 9s. 1d. per annum.

As regards private dwellings, the average weekly cost is 12s. Id., or £31 10s. 1d. per annum.

VI. DANGEROUS LUNATICS.

The following statement shows the number of persons sent to asylums as dangerous lunatics in each of the ten years 1917-1926, at the instance of the Procurator-Fiscal, under the provisions of the 15th Section 25 and 26 Vict. cap. 54:

*For pupils in Baldovan and Larbert Institutions not certified under the Mental Deficiency and Lunacy (Scotland) Act 1913.