32
STATISTICAL RETURNS OF THE LUNATIC ASYLUMS.
fifth of its kind opened in England, which does not record a single case of dysen-
tery in the same ten years.
It must not be considered that the conditions in the ten years under review
were in any sense exceptional. A study of Dr. H. S. Getting's history of dysentery
in the Wakefield Asylum (Yorkshire, W.R.)(4) will show that dysentery has
existed in that institution since Thomas Umpleby of Leathly was admitted on
November 30th, 1818, with dysentery on him, one week after the asylum was
opened. Since then it has waxed and waned, waned and waxed again. Dysentery
cases occurred in 86 years out of 95, and in 1912 there were 78 cases and 35
deaths. The records of other English asylums could doubtless tell similar tales.
Dr. Getting's concluding paragraphs are as follows:—
" This article is not brought forward merely as a historical recital, but because I believe
the lessons it teaches are of value, as the lessons of history always are.
" For it shows that no amount of sanitation will stamp the disease out. It is no question
of unsanitariness or overcrowding, of water-supply, or of the other factors that have been
proposed. They are only side issues, important in their way, but side issues, all the same.
It is the actual infection that matters ; it is the chronic cases, the ' carriers', who keep the
asylum infection going, who originate fresh cases and epidemics. They form the keystone
of the problem, and must be detected, and isolated before any permanent good can be done.
" It is with the infective person that we must deal and not merely the aiding condition.
It is difficult matter to detect them, I know, but it has to be done if the disease is to be eradi-
cated. Much can be done by a strict segregation of all patients who have dysentery, or by a
routine examination of the stools.
" But the real hope lies in the laboratory, and I believe that, if the problem were investi-
gated, it would not be long before the pathologist would be able to detect these carriers to-day,
as he detects the typhoid or the syphilitic. And if this could be done, dysentery would soon
be as much a thing past in our asylums, as it is amongst the population."
In the Scottish and Irish Institutions, dysentery, although present, would
appear to be by no means so common. The number of deaths from dysentery and
diarrhœa amongst the pauper patients in the Scottish Asylums, for the five years
1902 to 1906, is stated to have been 71 all told, or about 14 deaths a year, a
proportion of about .008 per 1,000 patients resident. The number of deaths from
the same causes in the Irish asylums in 1912 worked out at about 24 (out of
21,000), or .008 per 1,000 patients resident, a figure identical with that of the
Scottish asylums.
The writer of this note believes that these figures give a wrong idea of the
prevalence of the disease, at least as far as Ireland is concerned. In Clonmel
asylum, from 1902 to 1905, when the writer was Assistant Medical Officer, dysen-
tery was a prevalent disease, but was very mild in type, and the death-rate
therefrom was practically nil. Saline treatment was invariably employed.
From the stool of one of the few cases which terminated fatally during this
period, McWeeny(5) isolated a mannite-fermenting bacillus, which, unlike the
typical Flexner, did not produce indol. It was agglutinated by the patient's blood
serum, and was extremely toxic to rabbits.
Coming to Indian asylums, one is faced with the difficulty that no table of
diseases for which patients are admitted and die, is included in the asylum reports
for each province, and one has to depend on the remarks in each report to learn
whether dysentery, colitis, and diarrhœa were prevalent in the asylums during the
year under review. Even from the meagre information so afforded, however, the
prevalence of dysentery in Indian asylums is sufficiently indicated.
In the report on the Bengal asylums, for example, we find that there were 52
admissions for dysentery in Dacca asylum in 1912, and that dysentery accounted
for 11.96 per cent. of the total deaths in the lunatic asylums of the premier pro-
vince for that year. In the Agra and Oudh asylums, there were 41 admissions
for dysentery and ten for diarrhoea during the same year. The figures for the
Lahore asylums for 1912 are not available to the writer, but dysentery and
diarrhœa were stated to be very prevalent in 1909,13 patients dying from diarrhœa
and nine from dysentery. In the Naupada asylum, Bombay, in 1912, 42 deaths
out of 76 were due to dysentery and diarrhœa. In Nagpur asylum, Central
Provinces, five deaths out of 29 in 1912 were due to dysentery. In the Patna
lunatic asylum, in the same year, there were 26 admissions for dysentery and