A Survey of the Patients in a Large Mental Hospital.

ALTHOUGH, from the legal points of view, all individuals certified as of unsound inind have the same designation, every large mental institution contains a great variety of different types of patient, especially since the passing of the 1930 Mental Treatment Act. In Part I of the Annual Report of the Board of Controlfor 1933, for example, it was stated that at least 12-2 per cent. of patients, certified under the Lunacy Acts, in general mental hospitals were mentally defective but not insane. As the years go by, an institutional population becomes saturated with chronic types, for many of the acute cases are discharged recovered. It is interesting and of some practical importance to know exactly what types of patients inhabit a mental hospital at a given time and how the resident population differs in composition from a sample of admissions. The present communication gives an account of a survey, the object of which was to obtain full information about the incidence, in Severalls Mental Hospital, of the various types of mentally disordered and mentally defective patients. Every resident patient was seen by the writers, and the records of each case were examined; a diagnosis of the type of mental disorder was made and also an estimate of the patient's initial mental capacity. Naturally, in some instances when the mental disorder had caused dementia, the estimate of the patient's initial mental capacity had to be made upon historical evidence rather than from direct examination. While recognizing that, according to existing knowledge, any classification of mental disorders must be incomplete, the writers felt that the schedules 'Forms of Insanity ' and ' Causes and Associated Factors of Insanity ' in the Rules of the Commissioners in Lunacy could not offer a satisfactory basis for the proposed survey. The diagnosis recorded in the hospital registers is often made at a time too early in the observation of the patient to be accurate and complete. In many cases the restrictions of the Commissioners' Schedules actually compel the recording of a diagnosis known to be inaccurate. A frequent example of this is the case of a patient whose certification has been necessitated by symptoms of mental deficiency 'not amounting to imbecility '; the medical officer must then either register the patient as an imbecile, or coright.