into the fire. The provision of dentures has meant that patients both enjoy and digest their meals with a resulting benefit to their general health.

It is a pleasure to report a continuance of the excellent relations which I have always noticed between visiting deputy commissioners and the medical officers and inspectors of poor whom I have visited during my tour of duty. Everywhere these visits appear to be welcomed and an earnest desire to co-operate is shown by the generous spirit in which suggestions are sympathetically received.

Dr. Kate Fraser reports:-The care and supervision of pauper lunatics and certified defectives under guardianship in private dwellings, and specially licensed houses continues to be of a high standard. This is particularly so in country districts and especially in small farms and crofts where suitable employment is obtained by the patient under the direct supervision of the guardian and where he shares the home life of the family in every respect. The difficulty of placing defectives, particularly young women, is becoming increasingly great. Boys who have been sent to a small farm in the country have with few exceptions done well. Where this has failed it has generally been due to the fact that the boy has run away and found his way back to his own home, The cases that have done best have been those placed in homes in Islands or isolated places, and those so placed at an early age.

It should be pointed out with reference to the discharge of certified defectives that all the cases discharged were high grade feeble-minded between the ages of 15 and 25, the ages when supervision is most necessary in this group of cases. The fact that most were capable of working and that 7 were employed at the time of discharge makes the danger of removing these cases from supervision rather greater than less. Although no longer "aided" defectives they should be kept on the roll for supervision unless their home conditions are very exceptional.

Unfortunately until more institutional accommodation is available the majority of defectives have to be cared for in their own homes, frequently in the cities. Considering the dangers and difficulties involved the results are highly gratifying and reflect great credit on the vigilance and consideration of the Authorities responsible for their care.

VI. EXPENDITURE FOR MAINTENANCE OF

PAUPER LUNATICS.

The expenditure of Local Authorities, on the maintenance of pauper lunatics, for the year ended 15th May, 1923, 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 £852,596 was paid; of which £737,080 was for maintenance in asylums (including Institutions for Imbecile Children*), £39,506 was for maintenance in lunatic wards of poorhouses, £62,211 was for maintenance in private dwellings, and £13,799 was for certification, transport, and other expenses. Of this expenditure, £52,968 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

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

(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 £683,925, which is £88,931 less than the expenditure of last year.

COST OF MAINTENANCE.

As regards asylums, the average weekly cost per head is 22s. 4d., which, calculated for the year, is £58 1s. 4d.

In licensed wards of poorhouses, the weekly cost is 17s. 10d., or £46 7s. 4d. per annum.

As regards private dwellings, the average weekly cost is 13s. 4d., or £34 13s. 4d. per annum.

VII. DANGEROUS LUNATICS.

The following statement shows the number of persons sent to asylums as dangerous lunatics in each of the ten years 1914-1923, at the instance of the Procurator-Fiscal, under the provisions of the 15th Section 25 & 26 Vict. cap. 54:—

During 1923, 4 pauper lunatics were removed from Scotland as having no settlement in that country. Of these patients, all of whom were removed from asylums, 3 were sent to England and 1 to Ireland.

IX. LUNATICS UNDER JUDICIAL FACTORS.

At the end of December, 1923, there were 1194 persons reported to us by the Accountant of the Court of Session. as under Judicial Factory in consequence of mental unfitness for the management of their affairs. This number is exclusive of some of the cases in which the means of the wards have been exhausted, though the Factory has not beeu formally discharged by the Court.

These persons were disposed of in the following way:

844 were in asylums in Scotland;

267 were in private dwellings in Scotland under the care either of relatives or unrelated guardians; and

83 were resident either in asylums or private dwellings beyond the direct jurisdiction of the Board.

All patients resident in Scotland whose estates are under the management of Judicial Factors were visited by our officers during the year, except some whose position and circumstances were otherwise satisfactorily known, and in whose cases visitation was thought

undesirable.

X. THE NUMBER AND DISTRIBUTION OF MENTAL
DEFECTIVES AT 1ST JANUARY, 1924.

The number and distribution of certified mental defectives on the Register of the Board at 1st January, 1924, were as follows;—

The following table shows the institutions which were certified up to 31st December, 1923, with their accommodation, the changes which have taken place during the year, and the number of certified defectives resident in each at 1st January, 1924:

XI. PRESENT CONDITION OF ESTABLISHMENTS FOR MENTAL DEFECTIVES.

Baldovan Certified Institution.

Inspected 20th April and 14th September, 1923.

The medical care of the inmates in this institution is referred to in the highest terms of praise. The condition of each patient is well known to the Medical Superintendent and the appropriate care and treatment are carried out with knowledge and skill.

Occupational treatment of much variety and practical education in the school-100ms and wards were seen at both visits. The capacities of each child are carefully studied and brought out to the fullest extent, and it is obvious that the most assiduous care is applied towards making the children happy and contented as well as useful. It is interesting to note that the institution now has officially recognised companies of Boy Scouts and Cubs. These companies are trained by three Scouts from a Dundee Company who voluntarily give their services once weekly in providing a diversion for the boys which is not only an eagerly looked forward to treat for them but is warmly recommended by the Medical Superintendent as a most useful adjunct to their training.

The introduction of electric light into the old building is a great improvement and the new lavatory and bathroom accommodation in process of installation will, when completed, remedy conditions which have always been slightly defective, especially since the more extensive housing of nurses has been inaugurated.

Barnhill Certified Institution.

Inspected 4th January and 24th July, 1923.

The female patients previously resident in this institution have been transferred to Blinkbonny Home, Falkirk, and in appropriating the total licence of the institution for the accommodation of male patients only, it was impossible to make use of that portion of the buildings formerly occupied by the women. It has been expedient to remove the location of the institution to an old building known as the Cottages situated at the extreme east-end of Barnhill grounds. This one-storeyed building consists of a series of end-to-end Hospital Wards, four of which have been converted to the needs of the patients.

The number of patients in residence permits of the wards so converted being regarded as dormitories only and it is understood that alterations are in contemplation to provide the necessary day-room and dining-room space and to bring the buildings up to a more adequate standard of efficiency in respect of lavatory and other accommodation. The institution is separated from the main buildings by a considerable piece of land, part of which is being laid out as a bowling green, the remainder being garden ground for the occupation of the patients. This separation allows of the patients in the institution moving about with greater freedom and better supervision.

The personal clothing of all the patients was good, clean and serviceable, and their healthy and happy appearance were indications that their welfare is the chief and first consideration of the management.

The attention paid to the employment of the patients is of a satisfactory nature. A few are employed in garden work but large

numbers are physically unfit for outdoor work. A separate building has been set aside under the direction of an experienced attendant for the instruction of patients in making baskets, strand mats, rugs and carpets and the work which was seen was of a most interesting and promising description.

Bridge-of-Weir Certified Institution.

Inspected 16th April and 18th October, 1923.

In June last fire broke out in the dormitory floor of the Women's Villa, fortunately at a time when the patients were all downstairs. During the process of reconstruction, which is approaching completion, the patients are adequately accommodated in one of the homes in the village.

The patients are all in good general health. They are comfortably provided for in every respect, and their care is carried on in conditions which combine the best features of a home and a hospital.

Everything possible seems to be done to fit them in some varying degree for doing suitable, productive work. They are all extremely happy and contented.

It was most pleasing to notice how happy epileptic patients-for the majority of the patients suffer from this affliction-can be made in conditions most nearly resembling a good home life. Those in charge of them are most assiduous and devoted to their care, and the response of the patients was evident in the willingness shown by several of them to be helpful to the staff.

Craiglockhart Certified Institution.

Inspected 5th January and 17th July, 1923.

The care of all the patients in this institution is kindly and considerate, and in general they enjoy good health. At both visits they gave every appearance that their bodily welfare was adequately attended to.

Such patients as are physically fitted to work are usefully employed and many of the male patients have proved themselves to be excellent garden workers.

The wards and dormitories are clean and tidy.

Govan Poorhouse Certified Institution.

Inspected 16th February and 9th August, 1923.

The licence of this institution has recently been extended to allow of a total of 68 female defectives being accommodated. The building is well adapted for the purpose. The large room on the ground floor which formerly was the dormitory has been converted into a commodious and comfortable dayroom. Adjoining it is a dining-room, while the dormitory accommodation is provided on the two upper floors.

The inmates at both visits appeared bright and contented. The situation of the building allows them to have a considerable amount of freedom, and practically all have parole within the grounds of the villa. They were neatly dressed, and in this respect their individual tastes are tactfully indulged. It is obvious that their care and training are in the hands of a capable and kindly staff.