3
addicted to these habits or who have not been able to indulge in them for a
considerable time, will induce attacks of most acute mania; and that prolonged
indulgence unquestionably will cause chronic mania. The extent to which those
habits prevail among the general population is small. The difficulty of placing
restrictions on the manufacture of these preparations is enhanced by the fact that
the plants grow wild all over the country and the deleterious products can be
simply concocted.
Sickness.
III—GENERAL
11. The diseases contributing most largely to the sickness rate are fevers,
chiefly malarial, and intestinal disorders, such as diarrhœa
and dysentery. The ingestion of earth and filth by chronic
maniacs induces a state of enteritis which is intermittently acute : consequent on
this a profound anæmia results, but contrary to what one would expect, it is
apparently not, as far as researches have gone at present, associated with
ankylostomiasis or with any particular degree of helminthiasis. These cases of
anæmia are very intractable : the habit of eating mud, once formed, is exceedingly
difficult to curb; the patient thus affected rapidly succumbs as a rule to any such
intercurrent affection as pneumonia.*
Mortality.
12. Dysentery, pneumonia and tuberculosis of the lungs have been respon-
sible for the larger number of the deaths. Tuberculosis is not
uncommon : it begins insidiously and it is only by carefully
checking the patients' weights every month that its early presence can be
detected; once the patient is definitely attacked, the progress of the disease is
rapid. Special provision for the isolation of tuberculous patients is one of the
features of the contemplated extension.
During 1905 the mortality was higher than in the two previous years.
The unusual meteorological conditions, which prevailed in the course of that year,
are, to a certain extent, answerable for this; much sickness and several deaths
were directly duo to the intense cold which provailed in January at night, while
the unusually high night and day temperatures from 1st June to 1st September
affected the health of most of the patients, especially the epileptics, and were the
actual cause of sudden fatalities in two or three instances. But apart from these
unavoidable causes, the asylum was particularly unfortunate during the year by
some deaths which may be termed incidental. A European alcoholic died suddenly
within half an hour of entering the asylum. A native patient brought in from
the Lahore city in a state of wild delirium was found to be suffering from acute
bubonic plague to which he shortly succumbed. Another patient was admitted
suffering from acute pneumonia and died within three days. A patient, transferred
from the Singapore asylum, contracted cholera on the journey from Calcutta and
died in the asylum of this disease. One patient died of " traumatic pneumonia,"
consequent on injuries received in a scuffle with some of the other inmates.
lnfectious disorders.
13. Beyond the attacks of plague and cholera above noted, there were no
other cases of infectious disease. Parasitic skin affections are
very common and very troublesome. A part of the miscella-
neous section has been temporarily set apart for patients suffering from scabies, &c.
During the triennuim there were no suicides and only one patient was
discovered in a feeble attempt at self-destruction. A patient, admitted in Decem-
ber 1904, was found one day shortly after admission in a dying condition in a
corner of the criminal section of the asylum, with injuries indicating that he had
been brutally assaulted. The evidence of a patient (who will not speak) given by
signs and by writing, pointed to a criminal lunatic being the culprit: this man
had previously committed murder and has since this occurrence been kept under
especial supervision. In July 1905 another patient, as remarked above, received
injuries to his ribs while fighting with some of the other patients ; pneumonia
supervened, to which the unfortunate man succumbed. Both occurrences were
judicially investigated,
Escapes.
14. There were no fewer than six escapes in 1905. In three instances the
patients were traced to their homes and were brought back
to the asylum; in each of those cases the patient had been
working in the garden, and taking advantage of the keeper's negligence had run
* Quinine as a prophylactic was issued during the months of August and September with excellent result.