stances into which our limits forbid us to enter, account for the greater part of this alarming apparent increase, is certain. Whether, however, there is not also an actual increase, unaccounted for by population, or by accumulation, remains an open question, which statistics do not absolutely determine. At the same time we think that it is quite probable that there has been some real increase.
To what social class do the great mass of our lunatics belong, and to what grade of society does the striking apparent increase of the insane point? The large majority of lunatics under legal restraint undoubtedly belong to the pauper population. On the 1st of January, 1877, of the total number of patients in asylums and elsewhere (in round numbers 66,600), about 59,000 were pauper, and only 7,600 private patients. These figures, however, fail to convey a correct statement of the relative amount of insanity existing among the class of the originally poor and uneducated masses and the class above them, because in a considerable number of instances members of the middle and still higher classes have become paupers. Again, the wealthy insane remain very frequently at home, and do not appear in the official returns. We believe this class to be very large. Probably we get a glimpse of it from the census of 1871, which contained 69,000 lunatics, idiots, and imbeciles (and we have good reasons for knowing that this return was very far short of the truth), yet it exceeded the number given by the Lunacy Commissioners in the same year by 12,000! A large number no doubt lived with their families because these could well afford to keep them at home. None would be in receipt of relief, or they would have appeared in the Commissioners' Report. Another most important qualifying consideration remains—the relative numbers of the classes of society from which the poor and the well-to-do lunatics are derived. Several years ago the Scotch commissioners estimated the classes from which private patients are derived at only about an eighth of the entire population of Scotland; a proportion which would make them at least as relatively numerous as the pauper lunatics. No doubt in England the corresponding class of society is a larger one; but whatever it may be, a calculation based upon the relative proportion of different social strata in this country would vastly reduce the apparent enormously different liability to insanity among the well-to-do and the poorer sections of the community, although, with this correction, the pauper lunatics would still be relatively in the majority.
The disparity between the absolute number of pauper and private
- We are informed by Dr. Fair that the proportion between the upper and middle classes on the one hand, and the lower classes on the other, is as 15 to 85. Calculated on this basis, the proportion of private and pauper lunatics to their respective populations would be one in 484 for the former, and one in 353 for the latter—a very different result from that obtained by the usual method of calculating the ratio of private and pauper lunatics to the whole population, viz., one in 3,231, and one in 415.