Sir: I read with pleasure Henry Rollin's Psychiatry at 2000 (Psychiatric Bulletin, January 2000, 24, 11-15). I shall recommend it to trainees.

To add a footnote, I have the Annual Report for the Cumberland and Westmorland Lunatic Asylum for 1892, written by the Medical Superintendent, Dr J. A. Campbell. That year the Asylum had 580 inmates and a total of 52 attendants.

Dr Campbell includes a summary of the Asylum's work between 1882 and 1892. There had been 1537 admissions of whom 679 were discharged recovered and 503 (33%) had died. There were two suicides and three ‘fatal casualties’. Most of the deaths (29%) were due to physical causes. One hundred and eighty-eight had cerebral or spinal disease, 113 had ‘senile exhaustion’, 77 were diagnosed with general paralysis of the insane and 62 died of tuberculosis.

These figures suggest that the asylums unintentionally provided chronic or terminal care for non-mental disorders. The social value of this activity deserves remembrance in accounts of 19th century mental health provision. If these deaths are excluded then the average discharge rate was 62% in spite of the lack of effective treatments.