* Poorhouse will be used in this communication instead of workhouse. There is something unpleasant in speaking of providing for the insane in a workhouse.Google Scholar

* The italics are not Dr. Robertson's.Google Scholar

† Journal of Mental Science, vol. xi, p. 279.Google Scholar

“* * * * The forms of disease which, in my experience, have been found to be most suitable for care in private dwellings are idiocy, imbecility, and dementia; and of the existing single patients more than 80 per cent. labour under these forms of insanity—60 or 70 per cent. being idiotic or imbecile. The class sometimes spoken of as the “semi-insane” do not as a rule prove easily managed in private dwellings, nor do those patients labouring under “delusional insanity,” especially if the delusions be those of suspicion. In the class of cases which I have found to be most suitable, the unsoundness of mind is well marked, but in the direction of weakness or destruction rather than of perversion of the mental faculties. Their mental state should be one of defect rather than of disease, and should be a settled and well-established condition, and not a progressive or changing one. So far as mind goes, their condition should as much as possible be one simply of loss, or want, or void; and such patients are to be found among idiots, imbeciles, and dements, that is, among the fatuous; for idiocy and imbecility may properly be regarded as the fatuity of infancy or youth.Google Scholar

“What I have said neither supposes that all the fatuous can be properly managed in private dwellings, nor does it entirely exclude other forms of mental disease from such a mode of care and treatment. There are idiots, imbeciles, and dements, who require an asylum for their proper care, and others who do not; and so also of the other forms of insanity. But the number of idiots, imbeciles, and dements, who do not require this care, who can be comfortably and satisfactorily provided for in private dwellings, and whose state is permanent and irremediable, will always be and is considerable; while of those labouring under the other forms of insanity the number so situated will always be and is comparatively small.Google Scholar

“The class, therefore, which my experience has shown to do best in private dwellings is that class which it is often desirable to remove from asylums, either to obtain space or to check excessive accumulations. * * * *”—Eighth Annual Report of Scotch Commissioners in Lunacy, Appendix, p. 240.Google Scholar

* Journal of Mental Science, January, 1865, p. 478.Google Scholar

* In the very next parish, out of five patients in private dwellings four were removed by the Board to an asylum.Google Scholar

* Ninth Report of Scotch Board, xxix.Google Scholar

* The difference between the discharges of unrecovered private patients and unrecovered pauper patients is always exceedingly great, so great as to force us to the conclusion either that many private patients are improperly discharged, or many pauper patients unnecessarily detained. This point is one of much practical importance, and deserves careful investigation.Google Scholar

* Dr. Robertson, op. cit., p. 6.Google Scholar

* It is desirable always, but difficult sometimes, to avoid the use of such words as detention, confinement, &c., with reference to patients in asylums, because, as regards some cases Dr. Robertson refers to, they are, perhaps, the proper words.Google Scholar

* The proportions existing on 1st January, 1864, are here taken, as no other figures are accessible. Since no influence has been at work to change the proportions, they may be assumed to be substantially correct.Google Scholar

* Journal of Mental Science, No. lii, p. 479.Google Scholar

† Ibid., p. 482.Google Scholar

* Sixth Report of the Medical Officer of the Privy Council.Google Scholar

* The moderation of this estimate will be evident from what follows, On the 1st of January, 1867, there were 24,748 pauper patients in the county and borough asylums of England, of whom 22,257 are declared incurable, and 2491 curable. Of the incurable, 14,620 are declared excitable, violent, or dangerous, and 7637 are declared quiet and harmless. My large estimate, therefore, only deals with about one seventh of the incurable, quiet, and harmless. Google Scholar

It is worth remark here that of the 7637 who are incurable, and quiet, and harmless, 4743 consist of the idiotic and demented. Google Scholar

Sussex asylum, however, shows 495 incurables in a population of 537; in other words, it contains only 42 patients treated with the hope of cure. Of the 495 incurable, only 28 are regarded as quiet and harmless, and of these, 8 are idiots, imbeciles, or dements.Google Scholar

* Journal of Mental Science, No. xlvii, p. 362.Google Scholar