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pensable in every case of death in a lunatic asylum. The tendency to phthisis
among lunatics was long ago established in Europe.
11. For the sake of completing the enquiry, I will deal with the possi-
bility of weak or sickly persons becoming phthisical at Dullunda, who might have
escaped the disease elsewhere, and consider all the life-circumstances which
have been from time to time supposed to tend to its production, viz. the influ-
ence of air, food, clothing, and the state of the soil.
As to pure air and breathing-space there is not much to be said. Of the
atmosphere the lunatics have full benefit. Their lives are spent, by day, prac-
tically in the open air. At night they sleep in rooms well raised on arches, well
ventilated and dry, having floors of asphalt. The space is ample. Ventilation,
though good, is less perfect in the female wards, but here phthisis is com-
paratively rare.
Food has been good and sufficient throughout. In 1879 it was better
adapted than before to the habits of the people, if increase of flesh be evidence.
The diet scale, however, had little to do with the fatal cases, of which
the majority had been fed on extras as weak persons, when not in
hospital.
Clothing is extravagantly good. Home-made blankets, of weight and
substance unknown in the market, are supplied in any number that may be
required, and made into coats that the people may wear them at work in damp
or chilly weather.
12. The soil is, as to its surface, perfectly drained. There is not a
puddle to be seen half an hour after the heaviest rain; but of the subsoil I
cannot give so good an account and this is very important if there be a
tendency to phthisis at Dullunda. Among the evidences of causation advanced
from time to time concerning phthisis, none has been seen to meet so many
of the facts, and none has received such wide subsequent confirmation and
acceptance, as the conclusion which followed the enquiry of the Privy Council
into the results of main-drainage in 25 English towns in 1866. It was placed
beyond doubt that towns notorious for the prevalence of phthisis became com-
paratively free from it when their subsoil water was withdrawn. Many years
ago, when searching for a reason for high mortality at Dullunda, while the
Presidency Jail close at hand was very healthy, I could discover nothing but
a great difference in the level of the subsoil water. The relation of this to
phthisis was not then known; but it may now be mentioned, as an interesting
difference between the two situations, that in the jail the sub-soil
water is very low at times when, in Dullunda, it is within a few feet of
the surface. The proximity of the two places does not prevent this difference,
for the same may be seen in other parts of Calcutta. Of course actual mea-
surements, carried on through an entire year, would be necessary to establish
the fact of this difference as otherwise than accidental. The evidence, however,
as it stands, is quite as good as that of the local production of phthisis at
Dullunda. The occurrence of the disease in the two places, apart from its
production, may be examined here in order to leave nothing unsaid.
13. In the Presidency Jail in 1879 there were admitted into hospital 8
natives on account of phthisis. There had been 9 in 1878 and 20 in 1877.
There were no deaths in 1879 or in 1878 from phthisis, but 4 in 1877. Short-
term prisoners do not remain in jail to die of chronic illness. The figures
only show that there was no increase of phthisis here in 1879. At Alipore the
admissions did not differ materially in the three years, but the deaths in 1879,
were 10 only against 15 in each of the earlier years. The course of other
pulmonary diseases appears in curious contrast. It was as follows:—
Alipore Jail ...
Presidency Jail (natives)...
Admissions.
1877.
150
50
1878.
125
78
1879.
144
142
Deaths.
1877.
9
4
1878.
17
9
1879.
29
17
I must leave these figures to carry with them such significance as they may.
They do, at least, suggest a reason why three old asthmatics should have suc-
cumbed at Dullunda in 1879, and why the year should have proved fatal to
chronic phthisical invalids ; but they will give no clue to the production of
phthisis, if there should hereafter be reason to suppose that the disease is
produced in the Asylum.