3
Sickness.
11. The usual most frequent causes of sickness are malarial fever,
dysentery, and chronic diarrhœa. Dysentery is a peculiarly
frequent disease in the asylum and it is not easy to
thoroughly account for the way in which the infection is carried, even after
allowing for many of the inmates, who, despite of all care, wander and pass
their excreta on the floor and in any part, and remembering that many habi-
tually eat mud, others soil their food and persist in eating it on the earth and
that others will persist in drinking from the latrine ablution troughs !! while
some few habitually devour excrement. Still, allowing for all these, a pro-
portion remains for the incidence of the disease in whom it is difficult to account
for. The amount of malarial fever is certainly less than that among the
ordinary population of the vicinity, and prophylactic issues of quinine are
administered annually. Pneumonia, despite the number of old and feeble
inmates, and of others who habitually discard their clothing and expose them-
selves even in winter, is not very common, though when it occurs is very fatal;
but very stringent precautions are taken in this respect, and the result this year
has been very satisfactory. When the asylum was first opened tubercular disease
was brought in among the patients and began to spread, but in view of the
possibility of the infection being carried by the constant dust prevalent, the
hospital enclosure was at once grassed, and the disease has now practically
ceased.
12. Plague has fortunately not yet visited the asylum, and the remain-
ing diseases call for no special comment. Taking the sickness as a whole,
the amount is relatively not great. It must be remembered that insanes
have little idea of self-protection, and expose themselves to many risks, so that
the sick rate is always larger than among a sane population. With the
sick, however, must always be collected a number of convalescent and feeble
members who require quite as much supervision, as well as those needing
forcible feeding. The whole, with sick attendants, &c., make up quite 20 per cent.
of the population, and the hospital accommodation being only half that, it is this
section which has been always overcrowded, and will remain so until the com-
pletion of the new buildings.
Sanitation.
13. Sanitation in an asylum is necessarily of great importance, and
a work of much difficulty and labour, and a matter of con-
stant supervision to ensure. The most scrupulous cleanliness
is insisted on. The very numerous filthy patients are cleansed and changed as
often as they are found to be so. No filth is allowed to remain for an instant
anywhere after being seen, but is at once removed to the trenches. The
buildings are kept open during the day and ventilated at night, and fully
cleansed before anything else is done in the early morning. The clothing of
all is washed regularly weekly and the patients bathed daily. The excreta is
treated with dry earth and the sweepings are removed outside and buried super-
ficially in the garden on the Allahabad system, one which has been found
here most successful, both in giving the minimum of odour or offence in any way
and the maximum of benefit to the land. From the habits of the patients the
major part of the urine cannot be collected at the same time, but passes with
the fouled bathing water and surface water, by excellent pucca drains, to an
impervious reservoir in the garden from which it is used as liquid manure and
found to be of high value.
Water supply.
14. The water supply is derived from a new deep well sufficiently far
removed as to avoid all risk of contamination, and pumped
from there by steam power to a high reservoir in the
centre of the asylum. Fifteen thousand gallons have been provided daily, giving
twenty-two gallons per head, and more is available. The water is of good
quality and has been found, whenever examined, free from any sign of con-
tamination. The tanks in which it is stored are frequently cleansed. Two cases
of typhoid certainly did occur among the patients, but considering the filthy
habits of so many of them, the same relative suspicion does not rest in the water
supply as would be the case in other places.
Clothing.
15. A very ample supply of good clothing is provided, and is entirely
manufactured in the asylum. That for winter use is most
excellent, and to the ample provision of this and the great