Tables showing (i) Classification of all recorded Causes of Death of Private Patients who Died in Asylums and other Establishments in the year 1926, and (ii) Classification of all recorded Causes of Death of Pauper Patients who died in Asylums and other Establishments Table showing the Average Weekly Cost of Maintenance of Pauper Lunatics in the different classes of Establishments, and in Private Table showing the Weekly Rates of Maintenance for each mode of providing for Pauper Lunatics in each Lunacy District during the Table showing the present Weekly Rates of Board in Royal and District Asylums, and the estimated Weekly Cost of Patients in Parochial Table showing the Expenditure of District Boards of Control on the Table showing the Quantity per Inmate of various Articles of Dietary, Table showing the Quantities and Estimated Values of Articles supplied to District Asylums from Asylum Farms and Gardens during the Financial year 1925-26, and Prices at which the Produce supplied Table showing the Acreage of Farms attached to District Asylums; Table showing the Expenditure by District Boards of Control during the Financial year 1925 26 in Providing, Building, Repairing, Fitting-up, and Furnishing District Asylums; and the amount of Monies Borrowed and Assessed for by District Boards of Control under the provisions of the Act 20 and 21 Vict. c. 71 Table showing the Number of Defectives on the Register at 1st January of each year, and the numbers placed on and removed from the Table showing the Number on the Register of Rate-Aided Mental Defectives of each sex chargeable to each Lunacy District in Scotland on 1st January, 1927, and the manner of their distribution, also the numbers per 100,000 of the population Table showing the Number of Private and Rate-Aided Defectives of each sex in each of the Certified Institutions on 1st January, 1927, and the changes which have taken place during the year 1926, List of Scottish Lunacy Districts, and Names and Addresses of Clerks to the District Boards of Control, the Asylums serving these Lunacy Districts, with Postal Addresses and Names of Superin- tendents - Circular issued to Clerks and Treasurers to District Boards of Control regarding the method of calculating proportionate parts of Pension 43 45 Thirteenth Annual Report. TO THE RIGHT HONOURABLE Sir JOHN GILMOUR, Baronet, D.S.O., M.P., One of His Majesty's Principal Secretaries of State. GENERAL BOARD OF CONTROL FOR SCOTLAND, EDINBURGH. SIR, We, the General Board of Control for Scotland, have the honour to lay before you our Thirteenth Annual Report on the Condition and Management of Lunatics and Lunatic Asylums, and on the Protection and Control of Mental Defectives in Scotland. The Lunacy Act of 1857 and the subsequent amending Acts of 1862 and 1866 did not include in their scope the power of dealing with any class of the feeble-minded who were not. insane, excepting that of idiots. This omission was remedied by the passing of the Mental Deficiency and Lunacy (Scotland) Act, 1913, which improved the existing machinery of the Lunacy Acts. The term "idiot " has been retained in the Lunacy Acts as well as in the Mental Deficiency Act and accordingly many of those who are obviously mentally defective persons still pass into Asylums, and will do so until legislation limits the admission of this class to Mental Defective Institutions alone. With respect to the care and treatment of the mentally defective, the experience of 13 years' working of the Mental Deficiency Act has confirmed our view that mental defectives must be treated in a different manner from lunatics. While no very clear line can be drawn between lunacy and mental deficiency, experience of both types of cases in the several Asylums and Defective Institutions has made possible their division into two distinct groups for all practical purposes. Lunacy presupposes a mental condition originally normal, but which, after the evolution of the mental faculties in childhood, say from birth to 5 or 7 years, is subsequently deranged by disease. 66 The word defective on the other hand connotes a condition of mind which has never been normal and can never be expected to reach that condition. In practice, the Asylum is a hospital for the care of persons suffering from mental disorder. On the other hand the Certified Institution for Mental Defectives is in essence an educational and training establishment from which, however, only limited though useful results can be obtained. The mentally defective being ill endowed with powers of resistance to the stress and strain of social conditions and physical diseases are specially liable to temporary attacks of mental disorders. As a rule they can be dealt with in Institutions for Defectives, but when insanity supervenes, and the patient is troublesome, it has hitherto been the practice to send such cases to Asylums. Such transference in our view should, at most, be temporary and when the scheme of treatment of the mentally defective of all ages has become more completely evolved there should be no necessity for even the temporary transference of defectives to Asylums. Until recently the number of patients certified as insane under the age of 16 years has been negligible but owing to the prevalence of Encephalitis Lethargica or sleepy sickness in epidemic form a relatively large number of juvenile patients have developed mental symptoms of an uncontrollable and dangerous nature. No special provision has been made in Asylums for the juvenile insane but it may be necessary to provide such special accommodation in some of our larger centres. It is not as a rule desirable to place insane young people under 16 years of age with the adult insane, for insanity is, too often, associated with a change in the moral character which so distorts the individual that he is an undesirable associate for young and susceptible persons. The Board have been watching the present condition of those mentally affected through Encephalitis Lethargica, whether young or old, and by arrangement with the Board of Health a large number of such cases from all parts of Scotland are accommodated in the General Hospital at Stobhill, where ideal Observation Wards exist for the care and treatment of incipient and temporary forms of mental disorder. Where juveniles under 16 years of age exhibit mental symptoms associated with Encephalitis Lethargica, the Board have been reluctant to advise certification, the affection being regarded by many as of microbic origin and if this surmise is confirmed by the researches which are now being actively carried on remedial measures may reasonably be hoped for. Some juvenile and adult patients affected with Encephalitis Lethargica have been placed in Defective Institutions and Asylums, they having been certified as suffering from mental defect of a post-encephalitic nature. In the present state of our knowledge of the affection it is, however, doubtful if the term "post-encephalitic" can be properly applied to any of these cases, for it may be that they are suffering from the actual disease in a chronic and lingering form and have the prospect of regaining complete mental health. As has been pointed out in previous Reports, mental defectives require protection and supervision throughout their lives, and their education, whether given to them in Special Schools or Classes or in Institutions for Defectives must be continued even after the age of adolescence is reached. This generally takes the form of instruction in various arts and crafts and also in domestic and agricultural occupations any work, in fact, which will occupy them in a useful, healthy and interesting manner. It would appear that the Colony System is the most suitable for supplying the kind of care and treatment indicated above, and it is satisfying to note that the authorities of many existing Institutions are contemplating suitable provision for the further education and care of adult defectives. In the development of this system the Board think it desirable that there should be as far as possible no break in the continuity of the training such as is caused by transferring patients from one Institution to another. Such continuous supervision should not, however, be confused with the idea of permanent care at the instance of Public Authorities. The expression "permanent care as applied to mental defectives who are admitted to Institutions certified by the Board in terms of the Mental Deficiency and Lunacy (Scotland) Act, 1913, is liable to convey a wrong impression to the Public. The Act itself does not employ the expression and it is also inaccurate and misleading. The idea of the Colony System is by no means a new one, for the Institution for 110 girls at Waverley Park, which was established before the passing of the Mental Deficiency Act through voluntary agency in Glasgow, has from its origin taken the form of a Colony from which, daily, inmates have been sent to responsible householders in the district to learn, and to occupy themselves in, domestic work. With the exception of certain cases dealt with at the instance of Education Authorities, the authority to detain a certified mental defective who is placed in a Certified Institution under the Act remains in force for one year only, unless it is continued for another year by order of the General Board of Control after such enquiries as they may consider necessary. If at the end of this second year the Board consider that the patient still requires Institutional care they may order his continued detention for a further period of three years and thereafter for successive periods of three years. Where, however, a defective child has been placed in an institution by an Education Authority with the consent of the parent or guardian, the case does not require to be reviewed periodically, but the authority for detention expires at the age of 16. The patient may, however, be further dealt with under the Act by the parent or guardian or by the Parish Council. |