34
LUNATIC ASYLUMS IN BENGAL.
Sickness and
mortality.
13. Since the asylum was opened there were 181 admissions into hospital, or at the
rate of 88.72 per cent. of mean strength. Of these 18 patients died, or at the rate of 8.82
per cent. of mean strength and 9.94 per cent of total treated. The daily average number
sick was 22.1, or at the rate of 10.83 per cent. of mean strength. Mr. Birch offers the
following explanation regarding the high rate of sickness:—“ This is a high figure, I admit,
but we have a number of old cases and old men, many of whom are anæmic, to deal with;
and in treating insanity, such a large latitude is attainable as to the definition of bodily sick-
ness that it is difficult to institute trustworthy comparison. I make it a rule to admit any
patient into hospital who seems at all anæmic, or who shows the slightest signs of trivial
fever, as by so doing he is kept under stricter observation, even though his illness amounts
to but indisposition. Thus it will be seen that no less than 62 cases of ague are entered out
of a total of 181 treated, and 16 of anæmia. Diarrhoea gave 27 admissions, but I shall
have more to say concerning this item presently.”
Diseases which
caused the
principal sickness
and mortality.
14. The following table exhibits those diseases by which the admissions into hospital
and deaths were caused:—
DISEASES.
Fevers
...
...
...
...
...
...
Of nervous system
...
...
...
...
Bronchitis and pneumonia
...
...
...
Dysentery ... ... ... ... ... ...
Diarrhœa
...
...
...
...
...
...
Anæmia, splenitis, and debility
...
...
Other diseases ... ... ... ... ...
Total
...
...
Admitted.
62
3
10
2
27
21
56
181
Per cent. of
total
admissions.
34.3
1.7
5.5
l.l
14.9
11.6
30.9
100
Deaths.
4
......
......
......
7
4
3
18
DIED.
Per cent. of
total deaths.
22.22
......
......
......
38.89
22.22
16.67
100
Per cent. of
admissions.
6.45
......
......
......
25.92
19.05
5.35
9.94
Prevalence of
intestinal worms.
15. It appears that a thorough post-mortem examination was made of the bodies of 15
of the fatal cases, and Mr. Birch records the pathological appearances observed by him in
the following terms:—“ I have now to relate the astonishing fact that of these 15 in no less
than 13 were found round intestinal worms. From one corpse 65 of these parasites were
removed. Without hesitation I state that some of the deaths were due wholly to these
worms, and further I believe them to have been the chief cause of our mortality. To me a
wholly new set of symptoms was presented,—a new disease seen, in fact so closely resembling
cholera, that during my absence from the station one case was actually returned as cholera.”'
The four deaths attributed to ague were actually caused, the superintendent states, by
secondary diseases, such as diarrhœa, pneumonia, and hœemorrhage from the bowels. In five
of the patients who died from diarrhœa, the intestines were infested with round worms.
Mr. Birch's remarks tend to prove that intestinal worms (the large round worm) were very
prevalent amongst the insane patients, and caused a considerable number of the deaths;
the symptoms due to their presence very much resembling those of cholera. The adminis-
tration of santonine had most undoubtedly, Mr. Birch remarks, saved many lives in the
asylum, as had also the careful daily inspections of the native doctor for the detection of
any patients suffering from these parasites. Of 23 of the worm cases referred to by
Mr. Birch, it was found that eleven of them came from Berhampore, three from Patna, and
nine from Dullunda. The presence of these parasites was first detected in June, but they did
not become prevalent until October, and in November had apparently disappeared.
Cause assigned for
the prevalence of
the intestinal
worms.
Buildings.
16. The prevalence of these intestinal worms was due, the superintendent considers, to
the disgustingly filthy habits of the lunatics, who were in the habit of drinking the water
supplied for the ablution of their persons after using the latrine.
17. There are eight wards in this asylum, which can accommodate 342 persons and
allow each 60 superficial feet and 1,018 cubic feet of breathing space. The hospital affords
accommodation for 25 patients, and each one in it will have 72 superficial feet and 1,188
cubic feet of breathing space. There are besides 10 pucca rooms, each one for the reception
of a single patient, and of a superficial area of 100 feet, and containing 1,150 cubic feet of air.
There are also six kutcha rooms, each intended for one person, and of 144 feet of super-
ficial area and containing 2,160 cubic feet of breathing space. With the exception of the
ten single rooms already mentioned, all the buildings are of kutcha construction, and are
raised on a plinth of about two feet in height, with verandahs supported by common
wooden posts. An isolation ward was in course of construction, and there is also a workshed.
The ventilation of these buildings is considered to be satisfactory.
Single rooms.
“ The pucca single rooms are built on the standard plan of jail solitary cells, save that the
little yard in front of each has been demolished, leaving a common yard 112 feet by 30 feet.
It is, however, intended, on the suggestion of the Deputy Surgeon-General, to re-arrange these
cells, two of them being converted into dark chambers, others to be provided with large