NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
3
The mortality at Nagpur was twice as great as in 1885 and greater than
it has been since 1874 : at Jubbulpore it was higher than it has been in any
of the previous 10 years. Dysentery and diarrhœa were the chief causes at
Nagpur, whilst at Jubbulpore there was not a single case of either disease.
There was a single sporadic case of cholera in the Jubbulpore Asylum, the
only case in the district throughout the year. The victim, a woman, had been
six years in the Asylum and had never, so far as is known, been outside it.
The chief causes of the great mortality at Nagpur are said to have been
(a) advanced age and bad health on admission, (b) accumulation of elderly
patients, (c) bowel disease.
Finance.
6. The average cost of each lunatic per head fell from Rs. 70-10-8 in
1885 to Rs. 68-14-0 in 1886. The cost per patient at each
of the Asylums was—
Nagpur ...
Jubbulpore ...
1885.
Rs.
75
59
a.
5
13
p.
8 ...
8 ...
1886.
Rs.
72
64
a.
2
14
p.
7
9
so that whilst the expenditure at Nagpur has decreased, that at Jubbulpore
has increased. The chief cause appears to have been that food-grains were
cheaper at Nagpur and dearer at Jubbulpore than in 1885.
As compared with those of 1885 the profits at both Asylums have
increased—-especially at Nagpur, where they have been hitherto relatively small.
The nets profits for the two years were—
Nagpur ...
Jubbulpore ...
1885.
Rs.
498
817
a.
1
4
p.
10 ...
9
...
1886.
Rs.
677
847
a.
13
9
p.
9
11
7. Some minor repairs have been carried out at both Asylums during the
year: at Nagpur 8 cells for male patients have been built by the Public
Works Department. The acknowledgments of the Chief Commissioner are due
to the Superintendents of both Asylums for their zealous administration dur-
ing a specially trying year.
ORDER.—Ordered that a copy of this Resolution be forwarded to the
Deputy Surgeon-General for information and guidance ; and that copies, bound
with the Report, be distributed as usual.
(True Extract.)
A. C. DUFF,
Offg. Under-Secretary.
No. 764 L. A.
FROM
JAMES H. LOCH, ESQ., M. D.,
DEPUTY SURGEON-GENERAL,
Central Provinces,
To
THE SECRETARY TO THE CHIEF COMMISSIONER,
Central Provinces,
Dated Nagpur, the 20th May 1887.
SIR,
I have the honour to forward for submission to the Chief Commis-
sioner the Annual Reports and Statements of the Nagpur and Jubbulpore
Lunatic Asylums for the year 1886.
2.At Nagpur 8 cells for male patients and a house for wheat grinding
in the women's enclosure have been built by the Public Works Department,
while the improvements in the grounds continue to be carried out by the inmates.
The building of the house for wheat grinding meets a much felt want, as until
its erection the wheat had to be ground in part of a dormitory. At Jubbul-
pore the dilapidated and unsightly wooden palings have been replaced by iron
railings, and the reservoir water was brought inside the asylum.
3. The admissions at Nagpur were very much fewer than in 1885, while
at Jubbulpore they were only 1 less.
The number discharged from the Nagpur Asylum was also less (by ¼)
than in 1885, and the number from the Jubbulpore Asylum was only half of
what it was in the previous year. With reference to the remark by Dr. Rice
that the smaller number of admissions at Jubbulpore is due to supposed luna-
tics being subjected to a longer period of observation than formerly before
admission to the Asylum, I find that of 9 such persons reported on at Jubbul-
pore only 5 were declared insane and sent to the Asylum, while at Nagpur of
the same number 8 were reported insane. I have not any explanation to offer
of the unusually large number of admissions at Nagpur in 1885 or the much
smaller number in 1886.
The daily average strength was practically the same for the two past
years at both the Asylums.
4. There was not any over-crowding at either of the Asylums, but at
Nagpur the number of inmates on one or more days reached to within 9 (4 for
males and 5 for females) of the full number that can be accommodated in
the Asylum.
5. At both Nagpur and Jubbulpore the percentage of cured to daily
average strength was rather less than in 1885. The following table shows
that in 1885. as in previous years the percentage of cures in the Asylums of
the Central Provinces is considerably less than that returned by Asylums of
2
other Provinces. I would add, with reference to this table and to the remark
in your letter No. 4993-A,—233, reviewing last year's report on the working
of the Central Provinces institutions, that the figures are taken from the same
columns in the statements of the various Provinces and of the Central Pro-
vinces, and that the ratios do, as far as the reports enable me to judge, admit
of comparison.
TABLE I.
Province.
Bengal ...
Bombay ...
Madras ...
Punjab ...
Rangoon ...
Tezpur ...
Central Provinces ...
Central Provinces ...
Year.
1885
„
„
„
„
„
„
1886
Total popula-
tion during
the year
1885.
1,151
899
707
495
254
78
348
343
Cured during
the year
1885.
93
63
91
48
15
8
18
15
Percentage of
cured to total
population.
8.08
7.01
12.87
9.70
5.91
10.26
5.17
4.38
Percentage to
daily average
strength
cured.
9.89
9.6
17 46
15.02
7.8
13.4
6.1
5.14
6. The number of patients discharged" improved" from the Nagpur
Asylum was very much less than in 1885, and (instead of being far above
the average of former years as in 1885) is considerably below it. No patient
was discharged " improved" from the Jubbulpore Asylum. I consider this
reduction in the number of patients discharged while only partially recovered
as very satisfactory, for it must always be doubtful what effect a return to the
irritation, annoyances and cares of a free life will have on such persons.
In connection with this it is satisfactory to find that at neither of the
asylums was there any re-admission, showing that care has been exercised in
the discharging of patients.
7. The number of patients discharged "otherwise" from the Nagpur
Asylum is unusually large—4 escapes accounting for this.
There were altogether 9 escapes from the Nagpur Asylum during the
year, but in 5 of the cases the lunatics were brought back almost immediately.
Of the 9 escapes, 5 took place from the gangs employed on field or farm labour,
1 escaped over the wall of the men's enclosure, 1 from the hospital, 1 from
the cook-house, and 1 from the women's enclosure. There was not any escape
from the Jubbulpore Asylum.
8. The death ratio was very much higher at both the asylums than in
1885, or in any of the 10 previous years.
STATEMENT II.
9. It will be noticed that at Jubbulpore during the last 2 and at Nagpur
during the last 3 years there has not been any criminal lunatic re-admitted,
indicating as in the case of the non-criminals care in the discharging of
3
patients. The daily average strength of the criminal population of the two
asylums did not differ to any marked extent from that of 1885, but while it
was slightly lower at Nagpur it was higher at Jubbulpore.
STATEMENT III.
10. The "residence" given in this table is, at least in the case of the
Nagpur Asylum, the district from which the lunatic was received; but in many
cases this is not the previous place of abode, which I find from an examination
of the papers of the 29 patients admitted at Nagpur to be
Nagpur ... ...
Raipur ... ...
Bhandara ... ...
Jubbulpore
... ...
Chanda ... ...
Hyderabad Assigned Districts ...
Unknown or not stated ...
11
2
3
1
2
6
4
Of the 16 admitted from the Nagpur district, 6 were sent in by the Can-
tonment Magistrate, Kamptee, and 4 came from the Central Jail.
The presence of a Military Cantonment with its strict rules and of a Cen-
tral Jail would thus seem to explain partly at least the large number of admis-
sions from the Nagpur district.
STATEMENT IV.
11. Does not call for any remark.
STATEMENT V.
12. Presents nothing unusual or worthy of note.
STATEMENT VI.
13. As in previous years the large majority of the lunatics admitted at
Nagpur were suffering from acute mania or acute dementia, and at Jubbulpore
from acute mania. The proportion of cases of melancholia is larger, and of
acute dementia smaller, at Jubbulpore than at Nagpur. I made a careful exam-
ination during the year of each case in the asylums, with a view to discover-
ing if it were possible to bring the classification of the two institutions more
into unison. In by far the greater number of the cases I had no difficulty in
accepting the type entered by the Superintendent as correct, but at each insti-
tution there were a few cases that I would have entered under a different type
from that under which the Superintendent had classed them; in these, however,
the symptoms were not sufficiently distinct to justify my setting aside the diag-
nosis of the Superintendents, formed after a lengthened observation of the
patients.
On taking out the percentages (on total patients) in the two asylums of
each type of insanity for the past and the previous 5 years, I find that the dif-
ferences are much less than they were, and that in the case of acute mania,
melancholia and acute dementia the difference does not in any exceed 2.4 per
cent in either 1885 or 1886.
4
STATEMENT VII.
14. Ganja smoking was very markedly the most common cause, as far as
it could be ascertained, of the insanity of the patients admitted in 1886.
STATEMENT VIII.
15. The daily average sick at both the Asylums is considerably larger
than for several years past: at Nagpur the ratio is higher than in any of the
previous 10 years, and at Jubbulpore it has not been so high since 1881. There
is the same difference in the ratio of sick in the two Asylums, as has existed in
former years, the ratio percentage of average daily strength being—
Nagpur ... ...
Jubbulpore ... ...
9.2
1.8
In the Chief Commissioner's Review of last year's report it was suggested
that this difference is possibly due to some difference in the system of record-
ing admissions to hospital or to medical treatment, but from special enquiry
made on this point I learn that the system is the same in both institutions, viz.,
that all cases of sickness under treatment, no matter how trivial, are returned.
The diseases that caused the highest number of admissions to hospital were
at Nagpur fever and bowel complaints, and at Jubbulpore fever.
As usual, fever caused many more admissions at Nagpur than at Jubbul-
pore, the percentage on average daily strength being at the former just double
what it was at the latter.
While dysentery and diarrhœa yielded a large number of cases with a very
heavy mortality at Nagpur, there was not a single case of either disease treated
at Jubbulpore. One cause that may, I think, partly at least account for this
continued marked difference in the health of the inmates of the two institu-
tions, is the difference of employment; but I have not the figures to enable me
to say if the proportion of sick at Nagpur is greater among the inmates
employed on out-door labour than among those engaged in grinding wheat,
spinning and other in-door employments, whose circumstances correspond in
this respect more closely with those of the Jubbulpore lunatics.
The mortality at Nagpur with almost the same strength was twice as heavy
as in 1885 and was heavier than it has been since 1874. At Jubbulpore it was
higher than in any of the previous 10 years. At Nagpur 3 and at Jubbulpore
4 of the deaths were due to causes in no way connected with residence in the
asylum. The ratio of deaths to sick from dysentery and diarrhœa was very
large at Nagpur.
Dr. Barter in his report states the causes to which he thinks the increased
mortality is due, but he does not offer any explanation of the increased sickness.
5
The table inserted below shows that in spite of the increase of sickness
during the year in the asylums, the ratios for the Central Provinces institutions
do not compare very unfavorably with those of the asylums of other Provinces,
but the rate of mortality is higher than that of any of the others.
TABLE II.
Province.
Bengal ...
Bombay ...
Punjab ...
Tezpur ...
Rangoon ...
Madras ...
Central Provinces.
Central Provinces.
Year.
1885
1886.
Per-
cent-
age of
sick to
strength.
3.77
11.22
9.30
7.45
5.90
3.48
4.39
5.95
Per-
cent-
age of
death
to
strength.
7.77
7.35
11.00
1.70
6.27
6.72
5.43
11.23
Percentage of total deaths from
Fever.
6.85
4.17
11.90
...
16.67
...
6.25
6.06
Dysen-
tery.
9.59
2.08
2.38
...
16.67
11.43
6.25
33.33
Diarr-
hœa.
10.96
22.92
16.66
...
8.33
25.71
...
9.09
Phthi-
sis.
15.07
2.08
...
...
...
17.14
6.25
...
Chest
affec-
tions
5.48
2.08
21.43
...
...
2.86
6.25
9.09
Anœ-
mia.
6.85
2.08
4.76
...
...
...
12.50
6.06
Other
dis-
eases.
45.20
64.58
42.86
100.00
58.33
42.86
62.50
36.36
STATEMENT IX., X. & XI.
16. An examination of the accounts for the past 2 years shows that for
both of 1885 and 1886 the cost per head at Nagpur was greater than at Jubbulpore
under all the items of expenditure except Superintendence, the total excess cost
per head being in 1885 Rs. 15.8-1 and in 1886 Rs. 7-3-10.
The items in which the excess at Nagpur was greatest were in 1885 diet,
establishment and contingencies, and in 1886 establishment, contingencies,
clothing and Europe medicines.
The excess cost of diet at Nagpur fell from Rs. 10-11-3 in 1885 to
Rs. 0-13-5 in 1886, in consequence of a change in the relative price of food
grains.
With reference to the higher cost in certain items at Nagpur I would
observe : —
(1). As regards establishment that a much larger proportion of the working
patients being employed on field and farm labour in an unenclosed country, it
is necessary to employ a larger staff of keepers to watch the patients.
(2). The higher cost of diet at Nagpur is chiefly due to the diet scale being
more liberal than that in use at Jubbulpore.
(3). The difference in cost of clothing is probably due to that used in Nagpur
being Jail made, while at Jubbulpore it is manufactured in the asylum.
6
(4.) The higher cost of contingencies is chiefly due to a difference in the
heading under which articles are included in the bills of the two asylums.
(5.) Europe medicines cost more at Nagpur because the Superintendent
entered the sum which the Comptroller charged to the institution under the rules
in force, while Doctor Rice appears to have debited the asylum with the value
of the drugs actually received: if the same course had been followed at Nagpur
the cost for medicines per head would have been only Rs. 0-9-4 instead of
Rs. 1-1-9.
The total cost per head at Nagpur was Rs. 3-3-1 less in 1886 than in 1885,
the decrease being due to the cheaper price of food grains by which the cost per
head for this item was reduced by Rs. 4-15-0. Establishment also cost rather less.
On the other hand, clothing, contingencies, repairs and Europe medicines
each cost more than in 1886, but, as already said, the sum entered under the last
heading is more than the real cost.
At Jubbulpore each patient cost Rs. 5-5-1 more in 1886 than in 1885, in
consequence chiefly of the dearness of food which raised the cost per head for
diet by Rs, 4-14-10. There was also an increase in the cost of contingencies.
The following table gives the average cost per head for each item of expendi-
ture in the asylums of the Central Provinces and in those of other Provinces,
and shows that with the exception of superintendence (the cost per head of
which depends on the number of patients), the charges in the asylums of the
Central Provinces compare very favorably with those in the institutions of
other Provinces and that the total cost per head in the Central Provinces, both
for the previous 5 years and for 1886, is lower than elsewhere :—
TABLE III.
Years.
2
2
1
1
1
4
5
Province.
Bengal ...
Bombay ...
Madras ...
Tezpur ...
Rangoon ...
Punjab ...
Central Provinces ...
do. 1886. ...
Mean cost per head of
Superin-
tendent.
Rs.
19
29
20
30
15
13
23
26
a.
15
1
10
5
11
1
4
6
p.
3
11
3
8
1
5
1
10
Establish-
ment.
Rs.
21
37
49
34
34
33
16
14
a.
7
3
6
5
9
1
5
13
p.
7
7
7
4
5
3
3
8
Diet.
Rs.
34
89
68
43
42
36
25
26
a.
13
0
4
13
9
10
3
4
p.
11
9
5
8
10
5
5
11
Cloth-
ing.
Rs.
3
9
4
3
1
7
2
2
a.
0
12
15
11
1
12
2
7
p.
10
11
9
4
2
8
6
6
Building
and
repair.
Rs.
2
2
1
0
a.
8
13
7
0
p.
11
6
7
4
...
...
0
0
7
9
3
2
Bazaar
medicine
Rs.
0
0
5
1
0
0
0
a.
0
2
0
7
6
3
0
p.
8
3
2
6
3
0
1
...
Contin-
gent
proper.
Rs
5
9
3
2
4
6
2
3
a.
1
11
7
2
7
4
15
9
p.
5
6
1
11
6
6
9
7
English
medicine
Rs
0
1
1
0
2
0
0
0
a.
6
10
0
8
13
15
4
10
p.
0
4
3
4
1
9
4
2
Total.
Rs.
87
179
154
116
101
98
70
68
a.
6
8
3
6
10
1
10
14
p.
8
9
6
9
4
3
8
0
The net profits were larger at Jubbulpore than at Nagpur in both 1885
and 1886, the difference in 1886 being nearly Rs. 10 per individual employed.
7
As compared with those of 1885 the profits at both Asylums have increased,
the increase being much larger at Nagpur than at Jubbulpore. The net profits
were:—
Nagpur ...
Jubbulpore ...
1885.
498
817
1
4
10
9
1886.
677
847
13
9
9
11
and the average for each individual employed:—
Nagpur ...
Jubbulpore ...
1885.
3
6
11
15
9
9
1886.
5
7
0
8
8
1
The labour on which the patients were employed was at Jubbulpore mostly
manufactures, while at Nagpur it was field and farm labour and levelling and
improving the grounds near the barracks, work for which no credit is taken in
the accounts.
The cost per patient is as under : —
Nagpur ...
Jubbulpore ...
1885.
75
59
5
13
8
8
1886.
72
64
2
14
7
9
or, after deducting the money received from paying patients and net profits :
Nagpur ...
Jubbulpore ...
1885.
70
51
3
5
5
6
1886.
66
56
9
6
6
2
I have the honour to be,
Sir,
Your most obedient Servant,
JAMES H. LOCH, M. D.,
Deputy Surg -Genl. and Sany. Commr.,
Central Provinces.
9
Report on the Nagpur Lunatic Asylum for the year 1886.
A row of eight cells for male patients was built by the Department Public
Works, they are suitable and secure. A room for wheat grinding was construct-
ed at small cost in the female enclosure, the cross walls and the foundation of
one long wall of other buildings having been utilized for the purpose: formerly
wheat for the entire asylum was ground in one of the dormitories, this is now
remedied. The female wards and enclosure with the out-offices as cells, grind-
ing room and latrine are now complete, in excellent order, and will require
no more alterations or additions.
2. Tidying of the environs still goes on; the lunatics have done much to
make the place trim during the year, but they are very capricious, and as
hard toil is in no case exacted, the work judged by the number employed may
seem trifling in quantity, still it is I think fair; there was much to be done
and a good deal still remains to be carried out. The more hardy are employed
on farming and on gardening, which they seem to like and understand; they
are not pressed at work yet they perform the whole of the out door-labour :
many of them belong to the agricultural classes.
A few additions and alterations as keepers' quarters, remodelling the
Deputy Superintendent's house, and another latrine for males are still required
with some minor works to make wards secure.
STATEMENT I.
3. It is very difficult to account for the large number of admissions dur-
ing the past two years, viz. 46 and 29 ; nor is it easy to state the cause of the
difference between the admissions in both years, viz. 17. No clue is given in
the papers sent in by Magistrates with lunatics nor does the condition of the
patients throw light on it, and so I refrain from offering an opinion on the
subject.
All admissions of the year except one were proper subjects for an asylum,
the exception being an epileptic and not an insane; he was soon released.
For the first time during the eleven years shown in this return there were
no re-admissions; only one was registered in 1885 : this would indicate care
and caution in ordering releases in previous years. During that under report
twenty left the asylum or—1885 excepted—a higher number than in any year
since 1878: of these, 11 were cured, 1 was improved, 1 was not improved, and 7
were disposed of under the term "otherwise."
4. Of the 11 cured, seven suffered from acute mania, their residence in
the asylum varying from four months to four years; the most unmanageable by
far on admission they are the most promising cases. Three cases of acute
dementia went out practically cured, their residence varying from ten to twenty-
six months; and one is returned as cured, but the man showed no symptoms
of insanity during his short stay of two and half months in the asylum
although subject to epilepsy.
11
STATEMENT III.
11. Nagpur and Kamptee sent in more than half the admissions ; it
may be that the police there are more keenly alive to the necessity for
sending such people up than the rural police, or it may be that a larger num-
ber are to be found in large centres than elsewhere.
STATEMENT VI.
12. The differences in the types of insanity as returned by both asylums in
former years have been noticed in the Chief Commissioner's reviews on their
working, and again in paragraph 5 of the review on the reports for 1885. The
Deputy Surgeon-General therefore visited this asylum in 1886 when every
lunatic there was separately brought before him and their cases and histories
read out : the result of this minute and lengthy examination was that whilst
the diagnosis in three or four cases was considered open to doubt, in none was
the type changed. Except in those unmistakeable cases of acute mania the
type is not registered until the lunatic has been some time in the asylum
under observation, the lunatic's history is then considered with reference to
known rules of classification aided by the principles laid down for guidance
in such standard works as that by Bucknill and Tuke. No little care is taken
in determining the classification, but it must be remembered that the symptoms
of types in some cases are so indistinct that even specialists may differ regard-
ing diagnosis. The following alterations were made in the classification of the
remaining of the previous year: two males and one female were changed from
acute to chronic mania, one male from chronic mania to chronic dementia, and
one from chronic mania to melancholia.
13. As during the previous year acute mania and acute dementia
formed the majority of the admissions or 24 out of 29: the first class contained
some very violent lunatics ; thus a priest's chela followed his superior to
Nagpur where they separated ; the young man gave himself up to dissipation
including ganja and was brought in so violent that it was difficult to do any
thing with him : food, medicine, clothing, every thing was spurned in the most
savage manner, yet he rapidly recovered and escaped three months afterwards.
In trying to account for the large number of acute as against chronic cases,
melancholia and so forth, it may be that the majority of those suffering from.
the latter forms and who are either friendless or so troublesome as to warrant
their being sent to an asylum have already been sent there, whereas all acute
cases would naturally be sent in at once.
STATEMENT IX.
14. Receipts from the Treasury were less than in 1885, cheaper provi-
sions and fewer patients caused this.
Public Works charges which appear in column 4 were also less : the item
Rs. 5,740-0-4 is made up thus : —
Garden and farm produce ...
Jail clothing ... ...
Medicine ... ...
Printed forms ... ...
D. P. W. work ...
Total Rs.
Rs.
867
494
178
4
4,195
5,740
a.
5
12
4
10
0
0
p.
5
0
11
0
0
4
12
The amount set against medicine is the sum intimated by the Comptroller
as the proportion of the cost of drugs supplied from Provincial funds to be borne
by the Asylum under the orders of Government; the actual value of drugs
received however was only Rs. 93, the cost of drugs set against the Civil station,
the Police and the Asylum under these orders falls in the case of Nagpur very
unequally ; perhaps the matter would bear looking into and re-consideration.
Diet cost Rs. 26-11-3 per head or Rs. 4-12-8 less than during the pre-
vious year, due to cheaper prices : supplies are bought in the open market,
which is the most favourable method of purchase.
The farm produced larger returns in 1886, and the net profit stands at
Rs. 677-13-9 as against Rs. 498-1-10.
NAGPUR:
April 1st, 1887.
J. F. BARTER, Brigade-Surgeon,
Superintendent Lunatic Asylum.