8
LUNATIC ASYLUMS IN BENGAL.
accounted for four. Three were due to dropsy with contracted liver (cirrhosis)—
a rare affection in Bengal, and indeed throughout India, among natives.
Anæmia and debility were fatal to five persons, of whom two were admitted in
that condition and one suffering from chronic fever. In one worms appeared
to be the cause. There were three deaths from exhaustion of mania, one
from old age simply, one from chronic leprosy, one from epilepsy, one from
disease of liver and spleen before admission, one from enteritis. There was
no case of fatal injury during the year. To the total number of deaths old age
contributed in five instances, and in eighteen cases the disease which caused
death was brought to the asylum.
" It will be seen that of this long list seven cases only—viz. six of bowel
disease and one of the sequelæ of fever—were due to zymotic or preventible
disease, and of these seven persons five were ill on admission. No case of
cholera occurred, nor of severe fever, in the institution. Eight deaths took
place among the lunatics transferred from Hazaribagh. It would be idle to
attempt explanation of mortality from a variety of organic diseases none of
which are etiologically known to us with sufficient exactness for specification of
causes. It is not a little curious that three neighbouring institutions—viz the
two jails and the asylum which passed with small mortality through two pre-
ceding years of great general insalubrity—should all in 1879 have exceeded
their former death-rates. In both jails cholera was present, and accounted for
a part, but not for all, of the excess. In the asylum there was no cholera
and the excess of mortality was the greatest of all. The people transferred from
Hazaribagh were very unhealthy, as I understand were those received into the
Berhampore Asylum from the same place, but here their death-rate, though
high, was less than that of the total population of the place. There was no
question of crowding, for though numbers increased they remained well below
the capacity of the asylum. The diet was altered during the year with a view
to better adjustment to individual wants, and the effect of the alteration was
seen in a continuous rise in the weight of the people. Improved diet, however,
could no more have prevented the organic diseases which have appeared than
general insanitary conditions in the asylum, if they had existed, could have
brought such disease from outside or created them within. It is observable with
regard to pulmonary affections that simple acute diseases of the lungs are very
rarely fatal here."
18. The change in diet was introduced with the object of providing a fuller
diet in closer accordance with the habits of the people. The general issue of
meat was discontinued, as some of the people did not use it ; a partial issue
of meat was maintained for those who seemed to require and were willing to
take it. Dâl and oil were increased throughout the asylum. The people
gained flesh after the change. Pulmonary disease prevailed among the servants
at Dullunda in 1879.
19. In the Dacca Asylum there were twenty deaths in 1879, against eight in
1878, and nine in 1877. The increase is marked here also in pulmonary
diseases, from which one death only occurred in 1877, one in 1878, and seven in
1879. Diarrhœa was fatal to seven persons in 1879, to two in 1878, and to
three in 1877. Dr. Crombie shows that half the total number of deaths
occurred within a month of admission. One death only is recorded among
35 women in confinement. Notwithstanding the increase of deaths from
diarrhœa in 1879, there is satisfactory evidence of great improvement in the
sanitary condition of the Dacca Asylum during the past five years.
Dr. Crombie presents the following statement regarding zymotic disease :—
Admissions into hospital.
Fevers ... ...
Diarrhœa ... ...
Dysentery ... ...
1875.
128
64
47
1876.
113
67
40
1877.
53
44
37
1878.
49
40
15
1879.
30
14
8
20. At Patna there were 35 deaths in 1879, against 13 in 1878, and 21 in
1877. Pulmonary disease was present in excess of former quantities, as was
cholera, concerning which a special report has been received. Debility is charged