Throughout the history of the hospital, local social institutions, formal and informal, tended to perform casualty and receiving functions so that the Royal Derwent has always served as institution of last resort. Case books show that both illnesses and treatment conformed to those familiar elsewhere in the British Empire and developed no local peculiarities. The records provide epidemiological evidence of a dramatic decline in incidence of first admission for psychosis after the period when convict transportation created a high rate of social dependency.
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