Lunacy Numbers, 1857-1913

The total number of insane in Scotland resident in an institution recorded in the First Annual Report of the General Board, excluding private single patients, as their number could not be correctly measured is shown in Table 1. As the figures show, the number of pauper lunatics uncovered by the Commissioners during their investigation was 4,737,[1] which was almost 6 per cent of the overall pauper population in Scotland of that year. At this time there were nearly four times more persons registered as pauper rather than as private insane, with the majority of these pauper lunatics situated in either royal asylums, or private dwellings, with smaller numbers housed in private asylums or poorhouses.

 

Institution	Male	Female	Private	Pauper	Total
Royal Asylums	1226	1154	786	1594	2380
Private Asylums	330	415	219	526	745
Poorhouses	352	487	6	833	839
Private Dwellings	810	974	—	1784	1784
Total	2718	3030	1011	4737	5748

Table 1 – Distribution of insane in each type of accommodation, 1858 (SCL, 1859).

What these figures do not revel, however, was that the Commissioners discovered great discrepancies in the proportions across Scotland, which they argued were dependent:

(1) on differences in the constitution of the inhabitants, (2) on differences in their education and mental culture, (3) on different degrees of social intercourse, and in the amount and nature of their occupations, and (4) on differences in the pecuniary position. (SCL, 1868:xii)

The discrepancies were so great, however, that they found it difficult to conclude which circumstances caused pauper lunacy to be more prevalent: a manufacturing or agricultural population, or in people of a Saxon or Celtic race. They supposed there to be, as a general rule, “a greater degree of mental activity among an urban and manufacturing population, than among one which is chiefly agricultural, and to this fact may possibly be ascribed the more frequent occurrence of insanity among the former” (SCL, 1868:xii). The Commissioners stated that, taking the country as a whole, it must be recognised that it was typically the lower classes of the population where insanity prevailed, drawn from the fact there were more pauper lunatics recorded. They argued that this was due to their low display of mental activities, with the urban and manufacturing environment having an increased impact on the levels of insanity compared to rural agricultural communities as a result of “overcrowding, impure air, exhausting labour, insufficient diet, abuse of stimulants, and contagious diseases” (SCL, 1868:xii). That said, high numbers of pauper patients were later sent to the rurally situated asylums in both Argyllshire and Perthshire, despite the overall population of both districts being in decline. It was generally assumed that such districts, which had a poor and sparse population, would have placed the majority of their patients in private dwellings, but, due to the poor standard of such dwellings and the small allowance available from the parochial boards to substitute home treatment, numbers sent to asylums were nonetheless accumulating.

By the concluding year of the General Board, the insane were distributed as follows:

Institution	Male	Female	Private	Pauper	Total
Royal Asylums	1774	2006	1964	1816	3789
District Asylums	5553	5253	319	10487	10806
Private Asylums	29	42	71	0	71
Parochial Asylums	126	100	0	226	226
Lunatic Wards of Poorhouses	441	415	0	856	856
Private Dwellings	1289	1654	110	2833	2943
Total	9212	9470	2464	16218	18632

Table 2 – Distribution of insane in each type of accommodation, 1913 (SCL, 1914).

The figures in Table 2 show that, as well as a massive rise in the overall number of pauper lunatics since the first report in 1859, by 1913 the majority of pauper patients were, unsurprisingly, distributed around the district asylums. Although one fifth of the pauper patients were accommodated in royal asylums, which would have included patients from counties such as Orkney and Caithness, who had agreements with the REA and Montrose Royal Asylum, the main energy of the General Board was focused on providing state-run district asylum accommodation for pauper patients, ideally through the expansion of the district asylum network.

As well as the concerted effort to provide each district with its own institution, which ultimately increased the pauper patient numbers as patients were moved out of private dwellings, the accumulation of this class in asylums was also exaggerated due to families taking advantage of the parish contributions towards maintenance costs, and an increasing willingness more generally for the poorer classes to accept pauper relief. The Commissioners recognised the increases as being due to the following:

1. The erection of new asylums for pauper lunatics – especially affecting localities in which no asylum accommodation for pauper lunatics previously existed.
2. The readier means of access to asylums due to increased facilities for travelling.
3. The gradual dying out among the public of feelings of dislike and suspicion towards asylums, a change which has resulted from an increasing recognition on the part of the community of the humane and enlightened methods of modern treatment, and of the protection, comforts, medical treatment, and curative influences generally which modern asylums afford.
4. The greater readiness among the poorer classes to send relatives to asylums as pauper lunatics, which is due in part to the cause just mentioned, but also in part to a strengthened conviction of the difference which exists between the acceptance of parochial relief in cases of insanity and its acceptance under other conditions.
5. The growing unwillingness of the poorer classes to submit to all that is involved in keeping an insane relative at home – the discomfort which usually results from the presence of an insane person in a small house, the expense of supporting a member of the family who is unable either to earn wages or to do housework, and the diminution of the earnings of the healthy which the care of an insane relative often involves.
6. The greater willingness of parochial authorities to recognise claims to parochial relief on the ground of insanity.
7. The stimulus, both to the readiness to seek relief and to the willingness to afford it, which has resulted from the giving of a State Grant-in-aid towards the cost of maintenance of pauper lunatics [see below].
8. The widening of medical and public opinion as to the degree of mental unsoundness which may be certified to be lunacy. (SCL, 1892:lvii)

Unlike private patients, who were often removed from institutions after a much shorter period of time to save the family money (either once the hope of recovery was passed or the patient had become more manageable), the pauper patient was more likely to be left in the asylum. As such, the total number of private lunatics enumerated in 1858 and 1913 less than tripled, whereas the pauper lunatic population rose from 4,737 to 16,218; a near four-fold increase.[2] Through their institutionalisation, the pauper family and the inspector of poor were “relieved of all trouble and responsibility in connection with the case” (SCL, 1870:v). Revealingly, only thirteen years after the passing of the 1857 Act, the General Board warned that the consequences of these factors “were every day assuming an aspect of greater gravity” (SCL, 1870:v), as the growth of pauper patient numbers fast outgrew the provision of accommodation.

[1] The number of pauper lunatics returned by the Royal Commissioners during the 1855 inquiry was only 3,904, but it appears they omitted a large number of pauper lunatics.

[2] This could, of course, also be due to pauper patients moving from private houses to district asylums.