Taking the actual number of the insane in detention during the same years shows a very different result, for accumulation is here included, and swells the returns.
-------+-------------+------------------- | | Ratio per 10,000 Year. | Under care. | of number in | | detention to the | | population. -------+-------------+------------------- 1869 | 53,117 | 23.93 1870 | 54,713 | 24.31 1871 | 56,755 | 24.91 1872 | 58,640 | 25.42 1873 | 60,296 | 25.82 1874 | 62,027 | 26.23 1875 | 63,793 | 26.64 1876 | 64,916 | 26.78 1877 | 66,636 | 27.14 1878 | 68,538 | 27.57 1879 | 69,885 | 27.77 1880 | 71,191 | 27.94 -------+-------------+-------------------
In other words, there were eight more patients under care for every 20,000 of the population in 1880 than in 1869. Had there been no increase in the number in detention, after allowing for increase of population, the number in 1880 would have been 53,177. It was, in fact, 71,191, _i.e._ 18,014 more.
We have now traced step by step the remarkable progress effected in the asylum care of our lunacy population. In concluding this chapter I would, however, observe that it would be a grave and mischievous mistake to suppose that, most valuable as is the provision for the insane by asylums, there are not many cases which may be treated outside these institutions with the greatest advantage. Some patients are best cared for in their own homes, others in lodgings, and others in the houses of medical men. The extent to which non-asylum treatment can be carried out will be seen when we speak of Chancery patients. It will be observed that the number of single private patients is 448.
In regard to the location of pauper lunatics in private dwellings, it appears that while in England 6799, or 9.29 per cent., of their number live with their relatives or are boarded in private dwellings, nearly fifteen per cent. of insane paupers in Scotland are in private dwellings, inspected by the Lunacy Board.
Dr. Lockhart Robertson has expressed the opinion that "the utmost limits within which the county asylum can benefit, or is needed for the treatment of the insane poor, is fifty per cent. of their number, and that a further accumulation of lunatics there serve no practical purpose, and hence is an unjustifiable waste of public money."[209] After pointing out the success of the metropolitan district asylums at Leavesden and Caterham, where upwards of four thousand chronic lunatics are maintained at the rate of seven shillings a week, he expresses his opinion that, if these arrangements were properly carried out, another fourteen per cent., or forty per cent. of the incurable and harmless pauper lunatics and idiots, might be placed in workhouses; his ideal standard for the distribution of pauper lunatics being--in county asylums, fifty per cent.; in workhouse wards, forty per cent.; leaving ten per cent. for care in private dwellings.