Part I.]
AGRA LUNATIC ASYLUM.
29
siderable number have died of debility, or simple want of vital power,—in many cases the
result of intermittent fever, in others of obscure disease of the brain, while in not a few the
bodily weakness has been aggravated by obstinate refusal to take food. The other principal
causes of mortality have been diarrhœa (15 cases), dysentery (5), intermittent fever (4),
epilepsy (4), albumenuria (4). Diarrhœa and dysentery have always been remarkably preva-
lent in the Lahore asylum. The reason of this we have never been able to fathom. The
small number of deaths under the head of fever is remarkable, but this is made up for by
the large number under the head of debility, plainly indicating the chronic nature of the malady
that has lingered amongst us since 1872. Epilepsy, of course, is a common cause of death
amongst lunatics all over the world, forming a part of the cerebral disturbance which shows
itself during life in ever varying forms. Little need be said about albumenuria; it is
common to all classes, but it generally leads, amongst natives, to the disease most prevalent in
the lunatic asylum, viz., diarrhœa, which in the majority of instances is the immediate cause
of death. No cases of cholera have occurred during the year.
Mortality.
The deaths numbered 53 against 93 in 1872, but then cholera had paid a
very fatal visit to the asylum. The mortality rates of this institution have
occasionally been truly terrible; for instance, in 1866 it was 43.7 per cent. of
strength, in 1867, 40.17, in 1869, 43.63, and in 1872, 36.21 ; but with the excep-
tion of the year 1866, these results were due to cholera. In that year, fever,
diarrhœa and dysentery were the fatal diseases.
Dr. Scriven goes on to remark :—
There is little doubt that the most effective way to reduce the mortality would be to build
a new asylum, as proposed in my letter No. 132 of 15th July 1872. Nevertheless, I believe
that even in the present building the increasing comfort and purer water-supply will, in a suc-
cession of years, manifest their influence, not only in diminished mortality, but in a smaller
sick list, and perhaps also in a more rapid and satisfactory recovery of the lunatics from their
mental maladies.
Conservancy.
The night soil is utilized for the garden, and the system is most success-
fully worked, whilst the waste water is employed to irrigate the ground.
Extra clothing dur-
ing the cold months.
Each patient was supplied with six blankets during the winter months, and
fires were provided in the wards. These measures would seem to have been at-
tended with great benefit, for in January only one person died, in February two, and
in March three. The number for November and December was, however, very
high as above noted. Special servants had to be employed to watch the fires.
Health on admission.
Mechanical restraint.
Of those admitted during the year, 67 were in good, 27 in indifferent, and
10 in bad health; of the deaths, 29 were in good, 18 in indifferent, and 5 in
bad health when they entered the asylum. Records of weight are unfortu-
nately not preserved in the asylum, nor is there any account of the number
of occasions upon which mechanical restraint was resorted to.
Finances.
The total cost of the asylum for the year was Rs. 17,966-2-2. The esti-
mated value of lunatic labour was Rs. 2,942-13-9.
Inspection.
Deputy Surgeon-General T. Hastings inspected the asylum on 22nd Nov-
ember and found everything in a satisfactory state. He writes :—
The quarters are clean, the beds are clean, sufficiently far apart, and the bedding is suffi-
cient. The latrines are clean and dry-earth is used. The food is very good; meat is given three
times a week with chuppaties, vegetables and dhal. The remaining four days' food is the
same without the meat. The Christian lunatics get meat every day. The water is good and is
filtered. It is procured from a well near the railway station.
Diarrhœa has caused many of the deaths, and Dr. Scriven thinks that the effects of fever
and cholera last year upon the general health of the inmates of the asylum may to some ex-
tent account for the great prevalence of bowel disorders this year. The deaths from debility
are wasting cases, in which diseases of the brain exists, but which is not easily recognised
during life, and many of the lunatics refuse to take sufficient food to maintain health.
AGRA ASYLUM.
Charge.
Health on admission.
Causes of mortality.
Surgeon-Major A. Chrstison, M. D., the Superintendent, furnished the report.
This new asylum, which was only opened in August 1872, has become
rapidly populated. The admissions reached 111 against 86 in 1872. The
death-rate has been moderate. The daily average number of sick was only
1.70, and 35 inmates contributed to this result. A total of 15 criminal luna-
tics were treated, and the daily average number of this class was 10.46. Of the
nine who died, 5 were in bad, 3 in indifferent, and 1 in good health at the time
of their admission into the asylum, and of the 53 discharged, no less than 50
were in good health on admission, and only one in inferior health when dis-
charged. Of the 111 admissions, 61 were in good and 50 in inferior health
when they entered the asylum. Fever caused two of the deaths, bowel com-
p laint two, debility three, delirium tremens one, and rupture of the bowel one,
but in one-half of these cases there was no hope from the beginning.
h