( 3 )
6. Dr. Payne submits a very thorough and interesting examination of
the statistics of mortality in the different asylums during the year. The
death-rate per cent fell from 14.7 in 1879 to 12.3 in 1880. The average of
the ten previous years was 11.5. There was a decrease in the number of
deaths from 42 to 38 at Dullunda, from 20 to 10 at Dacca, and from 22 to 15
at Berhampore, while there was a rise from 35 to 42 at Patna and from 3 to
4 at Cuttack. In the report for 1879, allusion was made to the influence
of the distribution of the lunatics from the abandoned asylum of Haza-
ribagh on the mortality at the other asylums. The disease conveyed from
this asylum was still fatal during 1880. Of the 163 persons received from
Hazaribagh, 25 died in the nine months of 1879 following their transfer, and
22 died in 1880. Of the 22 who died in 1880, it is reported that only one
was in good health on admission. In estimating the significance of the
mortality at the different asylums, it is important to bear in mind the
influence of newly admitted cases. It is established that mortality is
much greater among newly admitted patients than among old residents.
In Dullunda the percentages were 21 and 12 respectively, in Patna 23 and 12,
and in Dacca 14 and 2½. As the number of persons admitted to Dullunda and
Patna is much larger than the number admitted to any other asylum, a greater
number of deaths is to be expected. It is quite clear that diet had no connec-
tion with the mortality. In Dullunda meat rations were introduced with no
effect whatever on sickness. In Patna, where the scale was unaltered,
mortality increased. In Dacca, where one-third of the animal food was
re-placed by vegetables, the mortality decreased. The condition of the water-
supply at Patna and Berhampore will be enquired into under the Surgeon-
General's orders. Beyond this no evidence can be discovered of special
unhealthiness in the local conditions at any asylum. A detailed examination
of the deaths under the different heads leaves no doubt that the mortality
was largely affected by importation of disease from outside. Of 6 persons
who died from ague and its consequences, 3 were new admissions. From
anæmia, anasarca, debility and dropsy, 14 died in 1880 against 16 in 1879.
Of the 14, just half were new admissions. Of 3 persons who died from
remittent fever, 2 were new-comers who were admitted into hospital on arrival.
There were 23 recorded deaths from phthisis against 21 in 1879. At Dullunda
there occurred 11, at Dacca 1, at Patna 9, at Cuttack 2. Of the 11 who
died at Dullunda 3 were new-comers, 4 were from Hazaribagh where phthisis
had markedly developed before the asylum was closed, and 4 were chronic
invalids. Only one case could be shown to have originated locally. Of the
9 who died at Patna, 5 were from Hazaribagh, and all were noted as received in
weak condition. Of the two who died at Cuttack, one had been recently
admitted. In addition to these circumstances, Dr. Payne shows that, as the
post-mortem examinations are more regularly made, the Asylum authorities are
enabled to determine as phthisis a larger and larger number of cases which, had
examination not been held, might have been ascribed to other causes. Post-
mortem examinations are now made in every case in which no objection is raised
by the relatives of the deceased lunatic. It is certain that, under this practice,
the number of phthisis cases will, as a rule, appear large in comparison with
that reported in former years, while there will probably be a corresponding
reduction under the heads of anæmia and debility. Thus while the number of
deaths recorded under phthisis at Patna rose from 2 to 9, the number recorded
under debility fell from 5 to 2. On the whole, it seems quite clear that, while
lunatics generally are known to be liable to phthisis, there is no reason to
believe that the condition of any of the Bengal asylums contribute specially
to the promotion of this disease.
7. The total expenditure on the asylums during the year was Rs. 81,412-6-11
with a daily average of 881.74 inmates. The net expenditure, after deduction
of Rs. 1,524-12-8, realized from friends of patients, and Rs. 7,486-13-3, the
actual profit on manufactures, was Rs. 72,400-13. In 1879 the gross expendi-
ture, with a daily average of 889.96, was Rs. 96,648-9-2, and the net expendi-
ture Rs. 85,319-7-7. It is to be observed, however, that the gross figures
include the value of articles received from asylum manufactures and consumed in
the asylum. This has been differently calculated in the two years. In 1879
it was taken as the cost price of the actuals plus the value added to them in
the process of manufacture. In accordance, however, with the orders issued