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given of the chief pathological changes of structure observed on the dissection of seventy-two insane patients which have been recently performed in that hospital.
Tabular documents of the kind alluded to, when obtained from authentic sources, cannot prove otherwise than useful; and as the records of the above institution are replete with valuable information, I have thought it might be advantageous to lay the present communication before the Royal Medical and Chirurgical Society, where I trust it will be received, not as a paper containing much that is new upon the subject under discussion, but rather as an attempt to contribute a few data respecting the prevalence of insanity in the metropolis, its curability, and pathology; believing that the facts stated will assist, as well those actually engaged in the study and treatment of mental diseases, as also the investigations of physicians only taking a general interest in questions of that description.
With the view of promoting these objects, I would therefore beg to bring under the notice of the Fellows several tables recently compiled from the registers kept at Bethlem Hospital. Before, however, doing so, it is but just towards Mr. Nicholls, the present efficient Steward of the establishment, to state, that I have received great assistance from that officer, when drawing up the tables accompanying the statements, upon which many of the deductions in the present paper are virtually founded. Indeed, without his co-operation in supplying the requisite official returns, I should scarcely have been able to accomplish the task I have now undertaken, which I fear may still seem somewhat diffuse, from the different numerical calculations it contains.
According to the ancient records fortunately still preserved in the archives of Bethlem Hospital, it appears that 22,897 insane patients, exclusive of incurable and criminal lunatics, have been admitted into the above asylum since the year 1683. But as it would prove tedious, if not superfluous, to include so extensive a field of inquiry in the present remarks, they will be confined to the detail of the principal occurrences met with in that charity during the last hundred years. In pursuing this investigation, the number of patients received into Bethlem Hospital, with the total amount of cures, and the actual deaths reported, as also the per centage calculated on each, will be enumerated under separate heads; embracing, however, different periods of twenty years in each division ; the first commencing the 1st of January, 1743, and the last terminating the 31st of December, 1842. It is, nevertheless, right to mention, that, owing to defects in some of the official registers of the institution, the exact number of patients discharged cured from Old Bedlam, and the amount of deaths which took place in one or two of the years prior to 1748, could not be accurately ascertained, and are therefore given from a comparison with the results of subsequent years. Still, the number of admissions reported are correct, as well as every other particular in these tables ;
and as the returns are all taken from authentic public documents, and drawn up without reference to any preconceived theory, they become the more valuable.
Table exhibiting the Total Number of Lunatic Patients
admitted into Bethlem Hospital, discharged cured, or died, during five different periods of twenty years each, ending the 31st December respectively.
6,975 or 393 per cent. 1,812 or 102 per cent.
By the preceding statement, the number of insane patients received into Bethlem Hospital during the latter half of the eighteenth century appears to have varied very little from the previous average, although, during the early part of the present century, the actual numbers admitted, from various causes, which it is now unnecessary to particularize, indicate a material diminution ; in fact, the total admissions during the twenty years ending the 31st December, 1822, scarcely exceed half the amount of patients treated in Bethlem Hospital during the same series of years immediately preceding; whilst the aggre
gate number of curable lunatics received into that charity, for the twenty years terminating the 31st December, 1842, was more than doubled; being 4,404 in the latter, and only 2,149 in the former period. Nevertheless, this remarkable decrease in the amount of insane patients admitted at this asylum, during the early part of the current century, compared with the number received during the last, and also the twenty years just terminated, was temporary, and confined to this institution; since, at the time when this considerable defalcation in the admissions was noticed at Bethlem Hospital, so great an increase, compared with the amount of insane patients previously received into the wards of St. Luke's, then took place, that the augmented number at the latter, almost counterbalance the decrease reported at the former institution.
According to an authentic statement now in my possession, the total number of lunatic patients received into St. Luke's Hospital for the twenty years ending the 31st December, 1802, appears to have been 3,987, whilst the admissions increased to 5,346 during the twenty years ending the 31st December, 1822 ; although from that date to the 31st December, 1842, they again fell to 4,044. From these varied and conclusive facts, it cannot therefore be asserted, that mental alienation prevailed less frequently in London, during the early part of the present century than it did previously, or has done more recently; notwithstanding fewer insane patients were admitted into the most extensive of
the only two public lunatic asylums situated in the metropolis.
The uniformly increasing proportion of patients discharged cured from Bethlem Hospital, as well as the diminished ratio of mortality likewise met with in cases of mental disease in that establishment, are points which well deserve attention ; more particularly, as it appears by the above tables, that the annual amount of cures have not only steadily advanced, but the comparative number of deaths reported have also remarkably diminished, since the middle of the last century. For instance, the ratio of recoveries during the first twenty years embraced in the preceding statement, was only 321 per cent. on the admissions, whilst it rose to 511 in every hundred patients admitted during a similar number of years ending the 31st December, 1842 ; at the same time that the amount of deaths actually decreased from 213 per cent. to 514 per cent., or less than onefourth the previous average, after an interval of nearly a century. The difference will, however, appear even more marked, when the results met with during three years in the middle of the last century, are compared with similar results reported to have occurred in the three years just terminated. In illustration of this point, it is only necessary to refer to the official tables already quoted, which show that the number of insane patients received into Bethlem Hospital, discharged cured, or died, during the specified period, were as follows :