H.—6

2

The proportion which the annual admissions bear to the population is generally taken as the most accurate measure of the prevalence of insanity; but this must be also admitted to be, for many reasons, far from trustworthy; and there can be little doubt that, in this colony at any rate, persons suffering from transient and comparatively trifling affections of the mind are sent to asylums who would not be treated so in other countries. The admissions were to the general population in the proportion of lin 1,162. The proportion in England in 1878 was lin 1,854 ; in Victoria, it was lin 1,324 ;in New South Wales, lin 1,,636: so that this comparison does not tell in favour of New Zealand. The causes of insanity in the admissions, so far as they could be ascertained by the Medical Officers of the asylums, are shown in Table XVIII. In 98 of the whole number the cause was not known. With reference to the causes in the remaining cases, it is of course to be understood that they are given only with approximate correctness, and that, in addition to the physical or moral disturbance alleged to have been the cause of insanity, there was, in most cases, a predisposing peculiarity of constitution or insane temperament, which, after all, played the chief if not the most conspicuous part in the production of mental derangement. Intemperance in the use of alcohol figures very largely in the table, being assigned as a cause in 84 of the admissions. It is right to point out, however, that (as can be gathered from the returns from the Dunedin Asylum, which are given with unusual minuteness) this dreadfully prominent cause of insanity was, in many instances, combined with others equally powerful, and was often itself an inherited malady or symptom of disease. In the report of the English Commissioners for 1878 intemperance in drink appears as a cause, exciting or predisposing, in 21'8 per cent, of the male, and 7*9 per cent, of the female, and 14'0 per cent, of the total admissions into asylums for the year. It undoubtedly has a much larger share in the production of insanity in this country, having been a cause in 27 per cent, of the male, 11 per cent, of the female, and 21 per cent, for the total admissions for the year. As regards individual districts, whatever may be the explanation of the fact, it seems to be a much more frequent cause of insanity in some than in others. Thus, in Auckland (where, however, as at Christchurch, no cause was ascertained in large numbers of cases) it was the cause iu 8 per cent, of the males, and in none of the females admitted ; whereas the percentage of cases among the male admissions due to this cause in Wellington was 24, in Christchurch 27, in Dunedin 32, m Nelson 40, and in Hokitika over 50. Parturition or the puerpural state was the " cause "in 19 cases, or 12 per cent, of the women admitted, which also is a large proportion. No less than 12 cases are ascribed b} r the Medical Officer of the Dunedin Asylum to " emigration and congenital weakness." In 18 cases the disease was congenital. That hereditary predisposition was only ascertained to exist in 40 cases is rather a proof of the difficulty of getting information than a reason for supposing that it was not present in a great many more. As will be seen from Table IV., by far the greater number of the patients admitted belong to the most curable class of cases —that is to say, that they had not previously been insane, and their disease had not lasted for more than three months ; while comparatively few belonged to the fourth or least promising class, consisting of those who had suffered one or more previous attacks, and had been insane for more than a year on admission; but, compared with the admissions of the previous year, there was a smaller proportion of first- and second-class cases, and a larger one of third and fourth. Six of the admissions were under 10 years of age, and 15 were over 60. When people are sent to asylums at these ages it is often quite as much because they are poor and friendless, as because of their insanity, which is not always of such a nature as to require or benefit by treatment in a lunatic asylum ; and this, indeed, might be said of many others. Included among the admissions are 4 males and 6 females committed as habitual drunkards to tho asylums at Christchurch and Dunedin by order of Judges of the Supreme Court, under the provisions of the 21st section of " The Lunatics Act, 1568." /Discharges and Deaths. —The total number under care during the year was 1,354; of these, 188 were discharged as recovered, 31 as not recovered, and 7.1 died. The recovery rate, calculated as is usual on the admissions, is 47*11 per cent., being higher, as the nature of the cases would lead one to expect, than that in county and borough asylums in England, which for 1878 was 40'3, and which averaged 39'98 for the ten years ending 1878. The proportion of recoveries varied very greatly in the different asylums,, and ranged from 72'22 at Christchurch to 28'80 at Dunedin, where it has hitherto been fully twice as high. The difference is almost entirely explained by the nature of the cases admitted, and by the strictness with which the term " recovered "is applied. Most of those discharged as recovered had been resident for less than six months, and 46 had been resident for less than one. The fact that so many recovered within such very short periods, after having for the most part been" treated on principles which are chiefly remarkable for their extreme simplicity, naturally suggests the idea that some of them at least might have recovered equally well without having been removed to an asylum at all. And no doubt this is true to a very considerable extent; but, unfortunately, however simple may be the treatment of ordinary insanity, it implies such formidable expense that it cannot generally be secured, except by comparatively rich people, anywhere but in a special institution such as an asylum. The death rate was 7'09, or slightly lower than it was the previous year, and lower than the average rate, for the ten years ending with 1878, in county and borough asylums in England, which was 10'63. Out of the 71 deaths, 38 were caused by diseases of the nervous system, 12 by diseases of the lungs, and 5 by the decay of old age; the remainder were due to various other causes, as shown in Table XII. Eortunately there were no violent deaths, although some exceedingly suicidal patients were under treatment. Thirteen of those who died were 60 years of age ; twelve had been resident for upwards of 5 years, and 11 for less than a month. The ages and nationalities of the 1,056 patients left at the end of the year are shown in Tables X. and XL: 6 of them were children under 10 years of age, and 54 were over 60; 48 were born in New Zealand, and 92 were natives of foreign countries. Expenditueb. The total expenditure on the management and maintenance of the insane for the year 1879 was, as shown in Table XVI., £35,360 6s. 5d., which is £93 Is. 10Jd- more than that of the previous year. J3ut the amount received for the maintenance of patients and from the sale of asylum produce >vas