LUNATIC ASYLUMS IN BENGAL.
31
" But in addition to this a very large quantity of milk has been consumed
by the patients, aggregating for the year 276 maunds, being at the rate of 2.18
chittacks for each individual per day. We use 7.1 oz. of vegetables daily per man,
against 4oz. used in the jail dietary. We give a chittack less of rice and half a
chittack more of dall to the insanes than the prisoners get, more salt and milk
as above stated. I contemplate adding 1½ chittacks of dahi per diem to the
dietary above quoted and stopping the issue of milk as an extra, save to those
who are in hospital. I think then we shall have a tolerably perfect diet,
viewed either as to its alimentary principles or as to the practical point of its
being agreeable, and satisfying the natural instincts of the appetite.
" The question of diet is one of the most important which the Superintend-
ent of an institution for the care of natives has to concern himself with, and it
is one of the most difficult to manage, for the system of ' peculation by subor-
dinates ' to which the Bengal Government calls attention in its resolution upon
the asylum report for 1876 is concentrated upon the cook-house, and thereby,
notwithstanding all our care, even now I am sure the lunatics are sometimes
' unscrupulously deprived of their proper allowance of food.' I know of no
way of preventing this other than by constructing a cook-house, as the Deputy
Surgeon-General has recommended, within which the cooks are to be locked
during working hours. The present unsightly, large, kutcha cook-house,
open at all sides, affords every facility for peculation ; nor do heavy fines,
dismissal, or legal prosecution check it."
Overcrowding.
9. There has been no overcrowding. The maximum number confined
has been 223 males and 25 females. There were only 10 admissions during
the year, viz. .five ordered by the Magistrate of Hazareebagh, four by the
Magistrate of Lohardugga, and one by the Magistrate of Manbhoom. " It
would seem," remarks Mr. Birch, " that insanity does not prevail in this region."
Percentage of
cures.
10. The percentage of cures has been 8.04 of males, calculated on the
average strength. This seems a highly satisfactory result, when it is considered
that nearly all the inmates of the asylum have been cases of chronic insanity.
Escapes.
11. There were 13 escapes during the year. Most of these were speedily
recaptured, but one man was absent for 10 months and another has not yet
been retaken. There is nothing but an aloe hedge and deep ditch to prevent
lunatics getting away. Doubtless the keepers will, by experience, become
more watchful and more careful.
Death-rate.
12. The death-rate, calculated on the mean strength, was 5.20 for males,
and no females died ; so that the mortality for the two sexes was at the rate
of 4.95 per cent. Mr. Birch attributes this low mortality to the comparative
coolness of the climate, to the fact of the patients being allowed milk and
meat as part of the diet, and to the large quantity of vegetables allowed ; to
the men being taken into hospital before they actually manifest bodily sickness;
and " certainly not least because of the assiduity with which the Overseer
has worked for the welfare of those under his charge, and the painstaking
way the Native Doctor has performed his important part of the duties."
Sickness.
13. The daily average number of sick was 21.77 (20.23 males and 1.54
females), or 9.8 per cent. of strength. This, as Mr. Birch remarks, is a high
figure, though it does not indicate any sanitary defects, but is the result of
the system followed of admitting into hospital the most trivial cases of indis-
position.
Criminal lunatics.
14. When the asylum was instituted it was ordered by Government that
no criminal lunatics should be sent to it. However, under a recent notice
(No. 3657, of 4th August 1877) a man was sent from the central jail. It is
hoped that this is an exceptional instance, as the asylum at Hazareebagh is
insecure and unsuitable for the reception of criminal lunatics.
Intestinal worms.
15. Mr. Birch alludes to the presence of intestinal worms as giving rise to
diarrhœa and symptoms resembling those of cholera, viz. a state of semi-
collapse accompanied by evacuations of large quantities of clear mucus, and
partial or total suppression of urine. In such cases the symptoms entirely
disappeared on the expulsion of the worms. At present it is possible for the
patients to drink the water with which they have washed themselves ; but this
very shortly they will not be able to do, as the waste water will pass through
an iron grating into a covered drain beneath.