( 3 )
four asylums shewed increase of deaths from 52 to 119, a difference of 67
whereof 27, or the sum of the foregoing differences, were contributed by new
admissions. Separating these new admissions, we obtain the following figures
for the older residents :—
Dullunda ... ... ... ...
Patna ... ... ... ...
Dacca ... ... ... ...
Berhampore ... ... ...
Total treated.
201
199
188
180
Deaths.
28
22
16
12
General indications go no further than this. They show that of the incre-
ment of deaths in 1879, nearly one-half were among the admissions of the year,
and they dispose entirely of the increment in the Berhampore Asylum ; for the
excess of fatal illness there was more than covered by that of the new
comers.
7. I will now examine the special facts of mortality in the several asylums.
It must be remembered that, in all these asylums, the deaths were exceptionally
few in 1878. If it were possible to determine a normal death-rate, it would
probably be as much above the rate of 1878 as below that of 1879. With great
variation of season, averages of years are insufficient for this purpose. So far as
averages shew, Bengal Asylums compare very favourably with other asylums both
in India and elsewhere. This introduces the question of the deaths of a year as a
measure of the sickness of the year; which, however, cannot be fully discussed on
the returns. These show, not the duration of illness, but the duration of the last
sojourn in hospital, and the full history of the large number of sickly men, who
are treated as out-patients for months, or are properly allowed to live in the
wards and take light employment, does not appear. The returns, nevertheless,
give some useful indications on this point, as will be seen below. Asylum diaries
should give all that is needed. I drew attention to this matter in the 23rd
paragraph of my report with reference to table No. 11, intending to intimate
that the number of deaths occurring among persons admitted in a given period,
does not, by any means, represent the full effect of imported disease on asylum
mortality ; inasmuch as chronic illness, present on admission, is protracted from
year to year in many instances. Neither do the deaths show the production
of primary sickness in the given period, though they may shew the effects of
season on chronic invalids, both new and old residents. No tabular statement
could be a sufficient guide to full knowledge on these points.
8. Of the deaths in 1879 at Dullunda, three were due to anæmia. Two of
these were chronic invalids of over two years' residence. One brought his
condition to the asylum and partially recovered for a time. The other was
a sufferer from chronic fever on admission. Neither contracted his illness
in 1879. The third came from Hazareebagh fatally ill, and lived 29 days.
This third case represented the increase of anæmic death at Dullunda in 1879.
The death from asthma was in a very old man, a drunkard, several times
admitted and discharged. His disease affected his heart in the course of years,
as it commonly does, and death was a question only of time.
The death ascribed to emphysema was from the same condition, except
that the man had been 25 years in the asylum and was not a drunkard. Clearly
these two cases do not point to original sickness of 1879.
Cirrhosis of the liver was fatal to three persons, all of them chronic
invalids, one a hill man. This organic condition is not common among natives.
It is commonest among drunkards elsewhere, and has no connection with season
or other general cause. The death from debility should rather have been
entered as due to old age. The date of the man's admission is unknown. It
was before the earliest records. Old age, without disease, accounts for two
deaths in 1879, and for one only in 1878. The year is not responsible for
this difference.
Diarrhea and dysentery caused six deaths in 1879, and none in 1878.
Four of these cases were ill from admission, with the disease. Two represent
asylum sickness of 1879.
This increase of dysentery may bring to the Lieutenant-Governor's re-
collection some remarks submitted in my report on the Medical Institutions of
Calcutta for the past year. I pointed out that, with general improvement in
the public health, there had been unusual prevalence of fatal dysentery in the