STATISTICAL RETURNS OF THE LUNATIC ASYLUMS.
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ASYLUM DYSENTERY, BY P. HEFFERNAN, CAPTAIN, I.M.S.,
SUPERINTENDENT, MADRAS LUNATIC ASYLUM.
[Reprinted from Indian Medical Gazette, Vol. XLIX (No. 11, November, 1914).]
Fourteen years ago, after Manson(1) had written scathingly of " that very
fatal type of dysentery, euphemistically termed ' Colitis,' which is the scourge
and disgrace of more than one of our English Lunatic Asylums," a commission was
appointed to investigate dysentery in the English Asylums, and, as a result of its
labours, asylum dysentery came to be attributed in the most advance circles, to
the Micrococcus of Durham and Mott.(2) Since then much water has flown
beneath the bridges, and dysenteries have been split into two great classes—the
amœbic and the non-amœbic. Thanks to the labours of Sir Leonard Rogers and
other physicians in this country—the problems of the etiology, treatment, and
prophylaxis of the former variety of dysentery and its complications may be
regarded as solved. There is every reason to hope that, in the near future,
serious cases of amoebic dysentery and liver abscess will be as rare as cases of
typhus fever.
Unfortunately we cannot as yet hold out hopes of similar success in the non-
amœbic or " bacillary dysenteries," of which asylum dysentery is the type. In
the lunatic asylums of every country in the world, as far as the writer is aware,
without exception, this disease still exacts toll, and does so in despite of the
glazed walls and marble floors, water carriage sewage systems, and high-pressure
supplies of germ free water that are to be found in some of the latest institutions
for the care of the insane. Nor is the use of the euphemism " Colitis " confined
to the statistics of lunatic asylums. Indeed most asylums have discarded the term
altogether.
But there is reason to believe that this and similar misleading expressions
have found their way into statistics other than those of asylums, and that the
importance of the various dysentery bacilli in the causation of disease of the
alimentary canal all parts of the world, but particularly in the tropics, has been
considerably underestimated.
At the quarterly meeting of the Medico-psychological Association, held in
London on 25th November, 1913, Dr. Sidney Coupland presented a chart (3) of
the dysentery incidence and mortality in the 95 lunatic asylums existing in
England for each year of the decade 1903—12. The following is a verbatim
quotation from his paper:—
" It will be seen that out of the 86 asylums which existed in 1903, there are 84 in which
cases of dysentery are reported in each year of the decade, 35 in which cases occurred in
from 5 to 9 of these years, and 13 in which cases occurred in only from 4 to 1 of these years,
there being five asylums in the last category. . . . Lastly in four asylums, no cases were
reported in any year. Of the remaining nine asylums, one was opened in each of the three
year , 1904,1905 and 1909 ; and two in 1906,1907 and 1908, respectively. Cases of dysentery
were reported from the year of opening in three ; in every year but the first in one ; and in
seven out of nine years in one."
*****
" Selecting from the list only those institutions in which the average annual dysenteric
incidence was not less than 20 per 1,000 (or 2 per cent.) of the total number of inmates, we
find these amount to 27, of which number, 20 had cases in each year of the decade, and two
were asylums opened subsequent to 1903."
According to this chart, the dysentery incidence rate reached 125 per l,000
(or 12½ per cent.) in Cardiff Asylum in 1911 (this asylum was opened in 1908),
105 per 1,000 (or 10.5 per cent.) in Hellingly in 1911 (an asylum opened in 1903),
110 per 1,000, or 11 per cent. in Bexley in 1906 (an asylum opened in 1898). In
other words, three of the newest and presumably most up-to-date and sanitary
asylums in England and Wales recorded dysentery incidence rates of over 10 per
cent. on the total number of patients, in one year or other of the decade. At the
other end of the scale comes Cornwall Asylum, an institution opened in 1820, the
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