lunacy since 1858, which gives the figures for four separate years. They refer only to the pauper lunatics, and show the cost, according to the kind of provision, to have been as follows:

If we omit the sums given in the fourth column for transport, certificates, &c., which are shared by all modes of treatment, it appears that of the total expense of providing for the paupers in each of the four years, the family treatment cost in the first year 18.8, per cent. then 15.3, then 14-3, and lastly 12.4 per cent. The proportion of patients disposed of in this manner, however, is much larger than is represented by the proportion of cost. Thus there were in 1858, of all pauper lunatics, 37.6 per cent. placed in private households; in 1862 there were 31.9; in 1866-28.1; and in 1871-23.5 per cent. The cost, therefore, of patients so placed, is found to be considerably less than that of patients in asylums. This becomes still more evident if we calculate the amount which is paid per head for each day, according to the several modes of provision. I shall select from a table in the Scottish Report the numbers applicable to 1871. It only relates to the various modes of providing for the pauper class of patients. The average daily cost was respectively, in public asylums, 1s. 74d.; in private asylums, 1s. 44d.; in parochial asylums, 1s. 2d.; in lunatic wards of poorhouses, 114d.; and in families, 74d. Thus in regular asylums a lunatic costs in Scotland each day from between 13 and 14 to 17 silver groschen; in poorhouses, about 10 groschen; and in private households only a little over 6 groschen. Let us look also at the average cost over the whole country. The expense is somewhat higher in some districts and lower in others, than

what has just been given. In the poorest parts of Scotland, in the islands, the daily average amounts to only 44d.; in the highlands to 64d; in the agricultural districts to 74d.; and in the opulent manufacturing districts to 7ąd. The highest sum paid in certain counties, as is the case for instance at Kennoway, is 104d. a day. The kind and cost of family treat. ment depend on the material well-being of the inhabitants. The lunatics in the Shetland Islands live in the same miserable huts as their sane fellow-countrymen, and partake of the same simple fare; the patients found in the well-to-do southern parts of the country reside in the better built and more comfortable houses of their native places, and receive correspondingly better fare. For the just appreciation of these figures there is this further to be considered. The sums which are given as the cost of maintenance are only what is paid by the parishes for the support of their paupers. And in the cases of those who are kept with their own relatives, a portion of the burden will naturally be borne by the families, so that what is received from the parishes can only be regarded as a supplement. In the other cases, where they are placed with strangers, the whole cost of maintenance is borne by the parishes. There is here illustrated one of the advantages of the family system, that it can be adapted to the peculiarities of each case; and the burden thrown upon the public rates is only what the relatives cannot support. When patients are sent to a public institution of any kind, the parish is required to pay the entire cost, and it is very seldom able to recoup itself, even to the smallest extent, from the relations who belong to the aid-receiving class.

We have thus seen that a certain class of patients in Scotland are provided for far cheaper in private households than could be done in asylums; and it must be believed that a similar financial result would also be obtained in other countries as well, where it is wished to follow that example in carrying out a general supervision of the insane.

Against this view Cyon brings forward a national-economical consideration which appears very generally to prejudice the financial aspect of the family system. We have seen already that the only other form of free treatment, which decidedly surpasses the asylums in regard to economy, is not applicable to our class of patients. But, according to Cyon, the asylums also surpass the family system. His most forcible argument is this. If one were to lay the question before an architect, whether for a certain number of patients it would be cheaper

to build a large establishment for all, or to build many small separate establishments, there could be no doubt that he would give the preference to the former. And this is undeniably true, just as the further statement that it is cheaper per head to board a large collected number than to provide for them separately. If, indeed, we had only to do with family treatment, as understood when so-called cottages are built in England, or if Mundy's plan were adopted according to which every house set apart for family treatment is provided with its seclusion room, its padded-room, its bath-room, etc., so as really to represent a small asylum-if such experiments in family treatment as these are what are thought of, it is unnecessary to say that they have no bearing on what has been discussed here. We have here to do rather with the utilisation of existing dwellings, to avail ourselves of habitations which have more accommodation than is required for their present occupants; and thus, as it were, to render productive certain capital which would otherwise lie dormant. Even if it were necessary in order to make them thoroughly satisfactory to add a story or build a room, our architect would, without doubt, regard this as cheaper than to purchase an extensive site, and then build an asylum on it. Cyon, indeed, remarks justly that many asylums have been erected in too splendid a style, and are maintained too luxuriously. But it may be doubted whether the least expensive asylums could compete with the simple form of family treatment. And it will not do to compare in this respect the asylums of different countries, which differ in social and economical conditions; if we wish fairly to investigate the cost of the two forms of treatment, we must make our comparisons between them as they are found in the same country.

The result of our inquiry seems on the whole to be, that we must recognise in the organisation of the family system, as it exists in Scotland, an advance in lunacy administration; and we must conclude that a similar organisation is desirable for other countries. What has been attained--the bringing of lunatics not in asylums under professional supervision-is an object which has scarcely been approached elsewhere, but which cannot long be anywhere delayed. As regards the supervision of asylums, public opinion is already prepared to demand the utmost. No regulation seems to be severe enough to allay that public terror, illegal incarceration in asylums. The evils to which this feeling leads when

it is embodied in legislation, are shown in the French lunacy law, whose disadvantages have lately received their due condemnation from Pelman.* The admission of patients has been surrounded by such difficulties that they generally arrive at the asylum much too late; but, on the other hand, it is not less difficult at present to get incurable patients out after they have been once received. It seems to occur to no one to require any supervision over the public when they have to do with the insane. It is here, however, that real dangers exist which are wholly ignored by the law. Cases are kept in concealment, and not sent to asylums till they have become incurable; and instead of care they often receive the roughest treatment. The public hears nothing of these except when by accident collateral circumstances drag such a case as that of Barbara Ubryk into the light of day. The results of such negleet are matters of daily observation in asylums.

These remarks are applicable in different degrees to different parts of our fatherland. Attempts are being made in many places by enlightening the public and the authorities to have patients brought early to the asylums. And it is endeavoured in many asylums to exert a certain amount of supervision over discharged patients as long as possible. But the object cannot be completely attained until a special law is passed, and a suitable authority constituted with power to see it carried out. What is required is a lunacy law, but a law founded on principles diametrically opposed to those of the French law. Whether the Scottish pattern should be exactly copied-whether the inspecting authority, which would, of course, have also to undertake the supervision of asylums, should be similarly constituted-does not require immediate discussion here. The fundamental principles may, however, be adopted with confidence from Scotland.

Strasburg, June, 1874.

* Ueber Irrengesetzgebung und das französische Irrengesetz. Allgem. Zeitschrift f. Psych. 31 Bd., Heft. 1.

An Illustration of Local Differences in the Distribution of Insanity. By P. MAURY DEAS, M.B., M.S., Lond., Medical Superintendent of the Parkside County Asylum, Macclesfield.

(Read at a Quarterly Meeting of the Medico-Psychological Association, held at Glasgow, April, 1873.)

That the amount and types of insanity vary in different countries, and even in different portions of the same country, has long been a recognised fact; but my object in this short paper is, by means of an illustration drawn from one district, to show within what narrow limits, as regards locality, great differences may be observed in the distribution of insanity.

Our district, comprising the eastern and north-eastern portions of Cheshire, embraces five Unions, with a total population at last census of 267,000. The population of the respective Unions, which, for convenience, I shall designate A, B, C, D, E, is as follows:

A is mainly agricultural, with small townships.

In B, the staple industry is cotton, but it contains a number of small townships, scattered over a hilly, rugged country.

C is partly manufacturing (silk); partly rural and country townships.

D is devoted to silk, and consists mainly of a large town, situated in a deep valley, on the banks of a small and much polluted river.

E consists of a large township, devoted to cotton; the chief town being again in a valley, with a highly polluted river running through it.

I mention these points to show that there are marked differences, physically and socially, between the various Unions.

The first thing that drew my attention to this subject was the large excess of male admissions during last year (1873), the men exceeding the women by no less than 50 per cent.

As a rule, the number of female admissions slightly exceeds that of the males, though even a cursory glace at the statistics