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indulged in. In the month of September the whole Asylum, with the exception of
a few delicate individuals who were considered unfit to undergo the treatment,
was dosed with santonine. Three hundred persons were dosed and the number of
worms collected as a result of the treatment was 482. I think there must have
been many immature parasites which were overlooked in making the collections.
I hope the prophylactic use of santonine or thymol, with careful incineration of the
stools of those affected, will effectually check the disease." The attention of the
Superintendent will be drawn to my remarks on anchylostomia infection at Agra
in the note on the returns for the year 1910, regarding the close supervision to the
cleaning of utensils, the administration of thymol repeatedly, the isolation of all
mud eaters and the microscopical examination of blood and fæces for purposes of
diagnosis.
Ten deaths are returned under anaemia, debility and old age. These, with
the exception of one case, occurred among inmates over 50 years of age who had
mostly been many years in the asylum. The 5 under epilepsy were among hopeless
epileptics, death in each case taking place during an epileptic seizure. One death
was due to diarrhœa and another to maniacal excitement, while diseases of the
nervous system, respiratory system (an old man of 58 from asthma), digestive
system, urinary system and of connective tissue accounted for one each. There
were 22 admissions to hospital on account of malaria fever but no deaths. Tubercle
was conspicuous by its absence.
Of those who died 14 were in bad health on admission to the asylum, 9 in
indifferent health and 22 in good health. Two had been in the asylum for more than
30 years, ten for more than 20 years and four for 3 months or less. Many
of the patients on admission are in a miserable state through want of proper food
and clothing, and one died on the fourth day after his admission. Of the 45 who
died 2 were over 70 years of age, 8 over 60 and 15 over 50 years of age.
Agra.—The triennium on the whole has been a healthy one for the inmates
of this asylum except in the early portion of 1909 when the effects of the severe
malaria epidemic of 1908 were still apparent in the institution. The fever was
of a very intractable type and in many cases hypodermic medication of quinine
bi-hydrochloride had to be resorted to. Although no patient died while suffering
from fever the Superintendent considered at the time that malaria fever was
more or less directly responsible for 43 of the 87 deaths in 1908, as dysentery
anæmia and pneumonia followed carrying off many. The consequent debility
was very marked, weighments made in November and December 1908 showed
that the majority of the inmates had lost weight. The general health of the
inmates at the close of 1908 was very poor with a daily average sick in hospital
for December of 117.35. The insane patient is unable to convalesce rapidly. Up
to August 1909, there had occurred 36 deaths, 15 of which were from pneumonia
during the first quarter of the year. The Superintendent considered that in all
these cases the severe epidemic of malaria fever the preceding year had undermined
the constitution and powers of resistance. Deducting even the 15 deaths from
pneumonia the mortality incidence for 1909 stands at 42 which is on a level with
that for the years 1910, (43) and 1911 (44). The death rate of 8.25 in 1911, is the
lowest during the last six years, and it is satisfactory to note that although
the daily average strength rose in 1911 to 533.30 from 511.90 in 1910 and 512.87
in 1909 the number of deaths was only one more than in the previous years. Of the
44 deaths in 1911 pneumonia and senility accounted for 6 each, dysentery for 5,
anæmia, epilepsy and phthisis for 4 each, mania 3, diarrhœa and heat stroke
2 each, and malaria fever, septicæmia, cerebral hemorrhage, hydrocephalus
congenital, dementia, general paralysis of the insane and anchylostomiasis for 1
each. Anchylostomiasis though prevalent in the beginning of the triennium is
practically stamped out now owing to the prophylactic use of thymol in 1910, and
eucalyptus chloroform and santonine in 1911. Quinine was issued as a prophylactic
during the months of malaria prevalence throughout the triennium in 10 grain
doses on two consecutive days in each week, and the results were satisfactory.
5. In 1909 a death at Agra was due to an accident; an excited patient
climbed a tree from which he fell and ruptured his liver and intestines. In 1910,
a lunatic died from injuries received at the hands of another lunatic, the aggressor
being, under the orders of the Government, treated as a criminal lunatic. In 1911
a lunatic named Gurdin, an inmate of the asylum for the past 5 years and who