LUNATIC ASYLUMS IN BENGAL.
3
6. On the several bases of reckoning, table 2 exhibits the proportions to
per cent. of discharges :—
TABLE No. 2.
Discharges.
1875 to 1884
... ...
1885
...
...
...
RATE PER CENT.
CALCULATED ON AVERAGE
STRENGTH—
Of
recoveries.
11.29
9.89
Of those
improved.
5.05
2.66
Of
total.
16.34
12.55
CALCULATED ON TOTAL—
TREATED—
Of
recoveries.
8.96
8.08
Of those
improved.
4.
2.17
Of
total.
12.96
10.25
CALCULATED ON ADMISSION —
Of
recoveries.
43.14
40.08
Of those
improved.
19.27
10.77
Of
total.
62.41
50.85
7. The percentage of recoveries in 1885, calculated on the mean daily
population, was 9.89, against 9.77 in 1884 and 11.29 the average of the
previous decade. The decrease from the average has been explained in previous
reports by "the reduction in the admissions" and " the greater proportion
which chronic cases bear to the total as admissions become less numerous, &c."
In my last year's report I entered very fully into this subject. It is
unnecessary therefore to do more than allude to it here. On the question
of the nomenclature and the difficulties in the classification of some forms
of mental diseases, the following careful note occurs in Dr. Crombie's
report:—" Every year references are made to the uncertainty of nomenclature
in the hands of different Superintendents. As a matter of fact, there is room
for difference of practice. The prevailing type of insanity in this part of
India is that which is manifested by eccentricity, loquacity, and general joyful-
ness and absurdity of demeanour, generally without delusions and with no
loss of intelligence. These cases I class as chronic mania, as they exhibit
exaltation of the emotional faculties. But they often pass into a condition of
chronic dementia when the emotional excitement becomes combined with
diminished mental power. It is possible that one observer may classify such
a case as one of chronic dementia, while another noticing the exaltation of
emotion would enter it as one of chronic mania. The diagnosis between
melancholia and dementia is not always easy. In both there is the same
abstraction and disregard of surroundings, similar solitary habits, and silence
or reluctance to speak, and perhaps similar disregard of decency and personal
cleanliness; but in one case, these symptoms are due to the mind being so
completely occupied by one thought of fear or misfortune or sorrow that
it leaves no room for any other consideration, and in the other case the mental
faculties are so degraded as to be incapable of being roused to an appreciation
of what is taking place. On the other hand, the distinction between
dementia and imbecility is dependent on the history of the case. If the
mental degradation has occurred after the full development of the mental
faculties, it is a case of dementia; if it is due to arrest of development of the
mental power in infancy it is a case of imbecility. The descriptive rolls on
which the diagnosis depends are generally altogether worthless: they either
contain no information whatever or are quite untrustworthy. Again, recurrent
acute mania, whether that which follows epileptic attacks, or some unknown
cause might, by one who regards chiefly the chronicity of the cause, which
often lasts many years,be entered as chronic mania; while another having
regard only to the acuteness of each individual attack would return it as
acute mania. I myself follow the latter course as being more consonant with
medical practice in other diseases, as for instance in acute rheumatism and
acute gout, which are exactly analogous. In nature the several types of
insanity are not clearly defined: they dovetail, overlap, and merge into
one another, and as the case progresses the type of insanity often changes
altogether." The diversity in the practice of some Superintendents is,
however, in my opinion, chiefly due to want of experience in the manage-
ment and treatment of the insanes. Accuracy, or as near an approach
to accuracy as can be attained in this direction, comes with a mature knowledge
of, and familiarity with, the various forms and progress of mental diseases.