( 2 )
Of the 30 cases at Agra on account of tubercle of lung there were 18 deaths.
Of these 30 cases 10 were admitted into the asylum during the year of which
8 died. The increase over the previous year cannot be laid to any neglect on
the part of the staff but rather to a more careful search for such cases. The
difficulty of diagnosing this malady is great among the inmates of an asylum,
and it is satisfactory to note that every case at Agra had been diagnosed and
admitted to hospital prior to death, and in every case the diagnosis was con-
firmed to have been correct at the post mortem. Of the 15 cases at Bareilly
7 died, but of these 7 three were among admissions of less than a year who
were in a very indifferent and poor state of health. Of the 7 cases at Benares
5 died ; of these 5 one was admitted into the asylum during the year in an
advanced stage of the disease. At Bareilly there is a tuberculous ward but none
at Agra and Benares which renders it difficult to segregate tubercle cases.
Plans for two tubercle sheds at Agra have been drawn out. I should like to see
the same provided at Benares.
During the year a microscope was sanctioned for Agra and a laboratory of a
rough but serviceable type arranged. Much useful work is being done as well as
ordinary bacteriological work connected with the asylum hospital. The fall in the
number of dysentery cases (16 as compared with 40) is probably due to the micros-
copic examination of stools which proved many cases to be really a colitis due to
entozoa, &c. No deaths occurred at Agra from dysentery. The number of dysentery
cases at Benares fell from 41 to 22 and there were only 4 deaths as against 19 in the
previous year from this cause. In the report for last year allusion is made to
inflammation of the bowels being intimately associated with the complication of
round worms. Microscopical examination of the stools during the year has shown that
some of the dysentery is amœbic in origin. The ova of round worms have been fre-
quently noted, anchylostoma being conspicuous by their absence. The low death
rate from this latter cause during the year is attributed largely to the periodical
dosing of the inmates with santonine followed by a course of thymol. During
November two dysentery cases of a severe type were treated with hypodermic
injections of emetine with marked benefit. In one of these cases there was marked
oedema of the lower extremities which entirely disappeared within a week from
the date of the commencement of the treatment.
6. The asylums are in good order and the patients well cared for. A new
barrack, main gate and garden well have been constructed at Benares at a cost
of Rs. 17,520. The settlement of the question of the supply by the Municipality
of water to the asylum for ablutionary as well as for drinking purposes is pending
the receipt of an estimate for the extension of the pipe line. When Sir John
Hewett, the late Lieutenant-Governor, inspected the Agra asylum in July last he
agreed with the report made last year as to the accommodation for the European
patients being both inadequate and unsatisfactory and directed the preparation
of plans and estimates for the improvement of the block. The project has been
drawn up but before further action is taken in the matter it will be necessary to
ascertain from the Government of India whether the construction of the European
Central Asylum at Ranchi will be completed in the near future as it is the
intention of Government that all European lunatics should be transferred to it.
The question of a revised scale of charges for European and Indian civil lunatics
admitted to lunatic asylums, and a scheme for an electric light installation at
Agra is under the consideration of Government. The proposals for the revision
of the scale of pay, &c. of the staff attached to the lunatic asylums which were
submitted in April 1912, and for the entertainment of a weaver at the Agra asylum,
have been provisionally approved by Government pending the provision of funds.
In order to avoid considerable inconvenience to the staff of the asylums owing to
lunatics arriving at the institutions at night district authorities have been asked
to arrange as far as possible for the lunatics to arrive at the asylum during the
course of the day.
LUCKNOW :
3rd March 1913.
C. C. MANIFOLD, M.B., COL., I.M.S.,
Inspector-General of Civil Hospitals, United Provinces.