LUNATIC ASYLUMS IN BENGAL.
3
TABLE No. 2.
Discharges.
YEARS.
1874 to 1883
...
...
1884
...
...
RATE PER CENT.
CALCULATED ON AVERAGE
STRENGTH.
Of
recoveries.
12.47
9.77
Of those
improved.
5.17
3.91
Of.
total.
17.64
13.68
CALCULATED ON TOTAL TREATED.
Of
recoveries.
9.63
7.9
Of those
improved.
4.
3.16
Of
total.
13.63
11.06
CALCULATED ON ADMISSIONS.
Of
recoveries.
43.24
38.79
Of those
improved.
17.94
15.52
Of
total.
61.18
54.31
8. If we take the proportion of the recoveries in 1884, calculated on
admissions, the figures are the same as those of the previous year. The
percentage of recoveries in the same twelve months, reckoned on the mean
daily population, was 9.77 against 10.24 in 1883, and 12.47, the average
of the previous ten years, including the year 1883. The decrease from
the average hitherto has been explained by the reduction in the admis-
sions, falling off in the " admissions under the head of acute mania," " un-
certainty of nomenclature in the hands of different Superintendents," and
to " changes in the Superintendents of Asylums," which " affected the
nomenclature of diseases, " &c., &c. This is all very plausible, but I am not
prepared to admit that such changes—no new element in the management
of our asylums—can possibly have had anything whatever to do with the
decrease noted. Had there been any diversity of practice—Superintendents
following different classifications—I could understand the nomenclature present-
ing very complicated results. The types or various forms of mental dis-
order adopted in our asylums, and laid down in this table, are eight only.
" Monomania" has been expunged, and very rightly. The only possible
heading, therefore, under which a medical officer might have entered his
acute or chronic mania-patients is " melancholia; " but, marvellous to relate,
there has been a steady decrease of admissions under this heading, in 1882,
1883, and 1884, the figures being 12, 9, and 3, respectively.
9. During the year 90 patients, males 74 and females 16, were cured, or
at the rate of 9.77 per cent., males 10.16 and females 8.27. This rate of
recoveries is a low one, and is below the average of preceding years, save that
of 1880 and 1882. Undoubtedly, the longer chronic cases are kept in the
asylums, the lower the rate per cent. of recoveries. Again, a certain number
of criminal lunatics is a fixed quantity, and these together tend to vitiate
statistics. The rate should be reckoned on admissions only, the usual method
followed in British, American, and Continental asylums.
10. The fallacy running through these figures for statistical purposes is that,
first admissions are mixed up with recurrent insanity. Unfortunately we have
no means of ascertaining the history of each patient on admission, and our
cures are simply the number of persons who have recovered after attacks of
mental diseases. That some of them may have suffered for various periods, or
even been discharged from the same or some other asylum anteriority is probable.
I think the very low percentage of known readmissions is sufficient to
corroborate this. The fallacy will be better understood, when it is remembered
that, recurrent mania is by no means rare, and a patient may have recovered and
relapsed a great many times previous to admission, yet he is discharged cured
from our asylums as a separate and distinct individual each time.
11. It would be highly interesting could we ascertain what becomes of the
discharged, cured and relieved. Do these recovered and improved lunatics re-
turn to their occupations ? How many die at their homes, and what time elapses
between the dates of discharge and the fatal issue in each case?