the Education Authority or in the special training Institutions for juvenile and adult defectives under the Board, has for its object the evolution of the capabilities of the mentally defective to their greatest extent so as to fit them at least to take care of themselves and to live useful lives under the care of others.

The benefits of education, in the broadest sense of the term, in the majority of the mentally defective will ultimately fit them for home life under the care of parents and relatives, and when these conditions are wanting or where the home care is unsuitable they can most satisfactorily be dealt with by being boarded out in circumstances which most closely approach ideal home conditions.

The treatment of the insane, on the other hand, is wholly of a medical nature. It limits itself to the recognition and cure of recoverable mental illnesses and to the care and amelioration of chronic mental disorders and diseases.

The Board have directed their attention to a class of patients entering Asylums a class which represents almost 20 per cent. of the admissions; they are patients labouring under the mental states incidental to old age. It is a problem worthy of serious application whether these old people could not, with advantage to themselves, be cared for in circumstances more approaching the nature of Cottage Hospitals and Homes rather than the elaborate and expen ve Institutions such as the modern Asylums are.

In the Ninth Annual Report extensive reference was made to the Observation Wards established at the General Hospital at Stobhill and the Eastern District Hospital at Duke Street, Glasgow.

The value of these Wards has been greatly increased by the arrangement whereby patients entering into them may be permitted to stay for a period of six months. Observation Wards exist in Glasgow, Govan, Paisley and Dundee, and they undoubtedly subserve the needs of many patients suffering from early unconfirmed or temporary functional nervous diseases and mental disorders.

As was expressed in the previous report, the much needed rest these Wards afford, the efficient nursing and special care and treatment given to patients in the early stages of the disease prevent a complete mental breakdown, obviate the need for certification and remove that mental anxiety and fear which often prevent a patient seeking admission to an Asylum of his own free will.

It is a peculiarity of mental disorder in its early stages that the patient and his relatives are reluctant to consult even the family practitioner, and the mental condition develops until it reaches the stage when it is necessary to call in a specialist. Consequently, early cases of nervous and functional mental disorder seek relief for their condition in ordinary Nursing Homes and often have not the services. of the family practitioner.

By Statute the Board are empowered to inspect and visit any house where a lunatic is kept for gain provided the lunatic in question shall be in the house for the purpose of temporary residence and his mental disorder is not confirmed. Unfortunately while the Lunacy Acts provide a form to be filled up in all such cases a copy of this form need not be sent to the Board. The Board, therefore, have no official information of all patients placed in homes. Consequently such houses are only visited when information reaches the Board, as sometimes happens, that there is occasion for the Board's intervention. The Board are of opinion that it is desirable that their position in this respect should be strengthened by legislation.

The experience that has been gained as the result of the treatment of early cases of mental disorder under circumstances which are exactly similar to the general hospitals throughout the country reveal that the divorce between patients suffering from physical disorder and patients suffering from mental disorder is entirely artificial.

In the treatment of all such cases the Board have come to the conclusion that District Boards, either individually or in combination, and the Authorities of Royal Asylums should be empowered to establish, Nursing Homes, Hospitals, Outdoor and Indoor Clinics, particularly by arrangement with the Managers of General Hospitals throughout the country where anyone desiring advice, care and treatment may receive it as a voluntary patient. It is felt that such on arrangement would tend to dispel the natural fear that the person seeking advice, care and treatment might at any time be certified as insane and detained against his own free will.

Such legislative proposals, if carried out. would involve expense. If the Grant given from the Local Taxation Account for lunacy purposes could be utilised in helping towards the establishment of the several agencies referred to for the treatment of early cases of functional nervous diseases and mental disorders and investigations into the causes of mental disorders, any such expenditure would, the Board are convinced, be ultimately of economic value in obviating the necessity for the extension of large Asylums and in diminishing the number of permanent lunatics.

1. NUMBER AND DISTRIBUTION OF THE INSANE AT

1ST JANUARY, 1924.

On 1st January of the present year, exclusive of insane persons maintained at home by their natural guardians, there were in Scotland 18,389 insane persons, of whom we had official cognisance, including the inmates of Training Schools for Imbecile Children who have not been certified under the Mental Deficiency Act and of the Criminal Lunatic Department of Perth Prison. Of these 2,928 were maintained from private sources, 15,392 by parochial rates, and 69 at the expense of the State. As the total number at 1st January, 1923, was 18,248, an increase of 141 has taken place during the past year.

MODE OF DISTRIBUTION.

Male.

Female. Total.

PRIVATE.

PAUPER.

The following table shows the number and distribution of the insane of each sex in the different classes of establishments and in private dwellings at 1st January, 1924, distinguishing between private and pauper patients.

* New Saughton Hall Private Asylum is now the only Asylum of this class.

+ Greenock Parochial Asylum is now the only Asylum of this class.

In addition to these there were 723 Inmates certified under the Mental Deficiency Act.

The general results during 1923, as compared with 1922, are, in regard to registered* lunatics, as follows:-(1) There was a total increase of 144, due to an increase of private patients by 51, and an increase of pauper patients by 93. (2) The total increase of 144 arose from an increase of the number in establishments by 182, and by a decrease of

*The Inmates of Training Schools for Imbeciles and of the Criminal Lunatic Department of Perth Prison are recorded in separate books, and, not being on the Board's General Register of Lunatics, are not included in this statement.

the number in private dwellings by 38.

(3) The increased number of 182 in establishments arose from an increase of 60 private patients and an increase of 122 pauper patients.

CHANGES FROM THE PAUPER TO THE PRIVATE CLASS,
AND vice versa.

It must be kept in view, in connection with the statistical tables giving the number of lunatics classified into private and pauper patients, that each patient does not necessarily continue till his discharge in the class to which he belonged on being placed on the Board's register. The results shown depend partly on the number of persons who, while continuing on the Board's register, cease to be private patients and become paupers, and vice versa.

II. STATISTICS OF ESTABLISHMENTS

FOR LUNATICS.

(See Tables on Pages 1 to 12 of Appendix to Report.

ADMISSIONS TO ESTABLISHMENTS.

(1) Admissions directly under a Sheriff's Order, the Sanction of the Board or other Statutory Authority.

In arriving at the number of persons admitted to establishments who thereby add to the gross number of asylum patients, the number of admissions which refer to a mere transfer from one establishment to another must be deducted.

(a) The total number of patients admitted to establishments (excluding transfers) during 1923 was 3418, which is 420 less than in the previous year, and 19 less than the average for the quinquennium

1915-19.

(b) The number of private patients admitted last year was 559, which is 54 less than in the preceding year, and 95 less than the average for the quinquennium 1915-19. The pauper patients admitted to establishments numbered 2859, which is 366 less than in the preceding year, and 76 more than the average for the quinquennium 1915-19.

The number of patients who had never previously been registered, and who were admitted for the first time to establishments for the insane in Scotland during 1923 was 2593-470 private patients and 2123 pauper patients.

The number of private patients admitted for the first time is 72 less than in the preceding year. The number of pauper patients who had never previously been registered is 261 less than in 1922.

(2) Admissions by Transfer.

The number of patients transferred from one establishment to another during 1923 was 751, which is 168 less than the previous year and 347 more than the average for the five years 1915-19,

case.

(3) Admission of Voluntary Patients.

Voluntary patients are persons who, with the sanction of the Board, granted on a simple application signed by the patient, voluntarily enter asylums for treatment of mental disorder, but whose mental condition is not such as to render it legal to grant certificates of insanity in their They cannot be detained for more than three days after giving notice of their intention or desire to leave. They are not registered as lunatics, but a record is made of their names and other particulars regarding them. The whole number of such persons admitted into asylums in 1923 was 381. The average number admitted for the ten years 1914-23 was 255. The number resident at 1st January, 1924, was 487.

DISCHARGES FROM ESTABLISHMENTS.

(1) Discharges of the Recovered.

There were 211 private patients discharged recovered during 1923, which is 38 less than the number in the preceding year, and 29 more than the average of the five years 1915-19. The number of pauper patients discharged recovered was 1020, which is 39 less than in the preceding year, and 36 more than the average for the five years 1915-19.

(2) Discharges of the Unrecovered.

The number of private patients discharged unrecovered, excluding transfers, during 1923, was 150, which is 46 less than last year, and 5 more than the average of the five years 1915-19. The number of pauper patients discharged unrecovered was 319, which is 60 more than the number so discharged in the preceding year, and is 21 less than the average for the five years 1915-19.

DEATHS IN ESTABLISHMENTS.

The number of private patients who died in establishments during 1923 is 254, which is 39 less than last year, and 41 less than the average of the five years 1915-19. The number of pauper patients who died was 1282, which is 178 less than last year, and 346 below the average of the five years 1915-19.

The death-rate for private and pauper patients in establishments per cent. of the average number resident for the year 1923 was 94, as compared with 10-9 in the previous year.

REMOVALS FROM ESTABLISHMENTS ON STATUTORY PROBATION.

At 1st January, 1923, 54 patients were absent from asylums on probation, with the sanction of the Board. Of these 25 have been finally discharged as recovered, 11 were sent back, 18 remained, on the expiry of the period, under the care of friends, and none died. In the course of 1923, 95 patients were discharged on probation. Of these, 12 have been finally discharged as recovered, 4 whose period of probation has expired, remain under the care of friends, 25 have been returned to asylums, and 1 died. The number still on probation at the close of the year was 53.