I know for sure that a person I have been researching was certified to an Asylum in Surrey. She was changed to a 'voluntary' category and was in and out of the hospital (mostly in) for years. She died in the Asylum. On her death certificate the cause of death was kidney failure or something like it. I shouldn't think that 'insanity' or 'mentally ill' is normally recorded as a cause of death. My father had severe dementia but the cause of death was kidney failure. Diana G'day Jan ! I have no detailed medical knowledge whatsoever ! - but if you put "Mitral Disease" into Google you will get over 9,000 hits ! - I only looked at the 10 on the first page, but I think you will find it is a heart disease connected with the mitral valve ! I don't think there is any mental illness implied here at all; I think the word 'Asylum' is being used in an old sense of a hospital or place to rest and recover ?? Perhaps any Listers with medical knowledge may care to comment on my "diagnosis" ? Best Wishes ! Roger.