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Priced Publications of the Government of Bihar,
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—IN INDIA.
The Superintendent, Government Printing, Bihar,
Gulzarbagh, P. O.
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IN EUROPE AND AMERICA.
THE OFFICE OF THE HIGH COMMISSIONER FOR INDIA,Public
Department, India
House, Aldwych, London, W. C 2.
No 1028\
H-263-37
FROM
H. STOTT, O.B.E., M.D., F.R.C.P., D.P.H.,
LT.-COL., I.M.S.,
INSPECTOR-GENERAL OF CIVIL HOSPITALS,
BIHAR,
To
THE SECRETARY TO THE GOVERNMENT OF
BIHAR, LOCAL SELF-GOVERNMENT
DEPARTMENT.
Dated Patna, the 25th January 1938.
SUBJECT.—Annual report on the working of the Ranchi Indian Mental
Hospital, Kanke, for the year 1936.
SIR,
I HAVE the honour to submit, for the information of
Government, the Superintendent's report on the working of
the Ranchi Indian Mental Hospital during the year 1936,
together with the returns in the prescribed forms. The institu-
tion has maintained its reputation for efficiency as in times
past.
I have the honour to be,
SIR,
Your most obedient servant,
H STOTT, O.B. E., M.D., F.R.
LT -COL., I.M.S.,
Inspector-General of Civil Hospitals, Bihar.
ANNUAL REPORT
ON THE
Working of the Ranchi Indian
Mental Hospital, Kanke in
Bihar for the year 1936.
1. Administration.—On my return from leave ex-India, I
took over charge on the 17th February 1936 from Dr. J. N. J.
Pacheco, I.M.D., who officiated for me from 1st January 1936,
to 16th February 1936. I then continued till the end of the
year under review.
2. Provinces served.—The hospital continues to receive
patients from the Provinces of Bengal, Bihar and Orissa. On
the separation of Orissa from Bihar from 1st April 1936, the
sanctioned beds of this hospital were allocated as under :—
Bengal 75 per cent
Bihar 20 per cent
Orissa 5 per cent
Total ..
Male.
831
222
55
1,108
Female.
204
55
13
272
Total.
1,035
277
68
1,380
3. Accommodation.—The sanctioned accommodation of the
hospital is for 1,014 males and 272 females. The 50 additional
emergency beds, sanctioned by Government in 1929 to relieve
overcongestion in the Male Section, having been found insuffici-
ent to meet the constant demand for beds, it was proposed to
Government to increase the accommodation by another 44 beds,
without prejudice to the health of the inmates, and the Govern-
ment were pleased to sanction the increase in the accommoda-
tion by another 44 beds from the 1st October 1936.
4. Statement no. I—Patients.—The number of patients resi-
dent in the hospital on 1st January 1936 and the two previous
years is shown below :—
Year
1936 ..
1935 ..
1934 ..
Male.
1,053
1,044
1,049
Female.
249
239
234
Total.
1,302
1,283
1,283
2
5. The maximum number of residents in the hospital on any
one night during 1936 and the two previous years was as
follows :—
Year.
1936 ..
1935 ..
1934 ..
Male.
1,061
1,055
1,053
Female.
262
251
242
Total.
1,323
1,306
1,295
6. Total admission.—The following table shows the admis-
sions during the year 1936 and the two previous years :—
Year.
1936 ..
1935 ..
1934 ..
Male.
104
110
89
Female.
43
35
37
Total.
147
145
126
All the new cases were certified insanes and were admitted
under Reception Orders, either from Jails or the Mental Obser-
vation Ward, Bhowanipore, or from their homes.
Many applications for voluntary admission in the Male
Section have to be refused for want of accommodation.
7. The total population of the hospital as per statement 1
during 1936, and the two previous years was as follows : —
Year.
1936 ..
1935 ..
1934 ..
Male.
1,157
1,154
1,138
Female.
292
274
271
Total.
1,449
1,428
1,409
8. The daily average strength of patients during 1936 com-
pared with the two previous years was as under :—
Year.
1936 ..
1935 ..
1934 ..
Male.
1055.51
1047.38
1048.51
Female.
252.33
241.14
238.36
Total.
1307.84
1288.52
1286.87
9. The ratio per cent of cases recovered to the daily average
strength during the year 1936 and that of the two previous years
is shown below :—
Year.
1936 .. ..
1935
..
..
1934
..
..
Male.
5.02
5.25
5.34
Female.
8.72
4.15
7.56
Total.
5.73
5.04
5.75
3
10. The following is the ratio per cent of cases recovered to
total admissions for the year 1936 and the two previous
years :—
Year.
1936 .. ..
1935 .. ..
1934 .. ..
Male.
21.15
19.80
30.34
Female.
25.58
11.43
27.03
Total.
22.42
17.81
29.36
On reviewing the histories of patients admitted during: the
year as so-called " new admissions " one cannot fail to be struck
by the fact that many of them are recorded as hopeless chronic
insanes beyond recovery, and that many suffer from extreme
physical disability and anæmia. This state of affairs will conti-
nue so long as our mental hospitals remain congested and no
facilities exist for the treatment of early mental cases in the
wards of general hospitals of the large cities. It is a matter of
great satisfaction to note here that the Government of Bombay
have already made a welcome move in this direction by appoint-
ing a trained Psychiatrist on the staff of the Grant Medical
College, Bombay, who will be in charge of the Psychiatric Clinic
and Psychopathic Ward shortly to be opened in the Medical
College Hospital for the treatment of early mental diseases both
of adults and children. The Psychiatric Clinics and the attached
Psychopathic Wards should be as necessary a part of the general
hospitals all over India as a children's clinic or a maternity
ward are now. Besides, there are equally other advantages from
the patients' point of view in being in a general hospital for
early mental treatment with all its facilities for investigations
and treatment. Moreover, from the aspect of medical education
the advantages are equally obvious. From the scientific stand-
point it is in a close association of this kind that the hope lies of
raising the standard of the Psychological Medicine in India to
the level of the rest of the civilised world. Moreover, providing
facilities for treatment alone will not solve the problem. It also
requires the public mind in India to be sufficiently educated as
to the advantages of early treatment of mental diseases. In the
statement no. 1, attached to this report the word " cured " in
columns 6 A and 11 A, C should in my opinion be replaced by
the word " recovered " for obvious reasons. The word " recove-
red " seems to be more appropriate and in fitness of things with
mental disorders and all that it connotes, and is used in the
mental hospital returns all over the United Kingdom, Europe
and America.
4
11. Death-rate.—The percentage of deaths to daily average
strength during the year 1936 and the two previous years was as
under.—
Year.
1936 .. ..
1935 .. ..
1934 .. ..
Male.
2.56
3.25
2.29
Female.
2.38
4.56
2.94
Total.
2.52
3.49
2.41
12. The chief causes of deaths during the year under report
were as follows :—
Tuberculosis of lungs.
General debility and senility.
Heart failure.
Ankylostomiasis.
Pneumonia.
Cerebral Malaria.
Leprosy.
General Paralysis of Insanes.
Malignant growth.
13. Duration of hospital life of those who died during the
year is shown in the table appended below :—
Months.
Under 6 months .. .. ..
Over 6 months and under 1
year .. .. ..
Over 1 year and under 2 years
Over 2 years and under 3 years ..
Over 3 years and under 5 years ..
Over 5 years and under 7 years ..
Over 7 years and under 10 years ..
Over 10 years and under 15 years ..
Over 15 years and under 20 years ...
Over 20 years and under 25 years ..
Over 25 years and under 30 years ..
Over 30 years and under 35 years ..
Over 35 years and under 45 years ..
Over 45 years .. ..
Total ..
Male.
..
..
1
..
4
1
2
1
3
3
3
3
6
..
27
Female.
..
..
..
..
3
..
..
1
..
..
..
1
..
1
6
Total.
..
..
1
..
7
1
2
2
3
3
3
4
6
1
33
5
The above table shows that more than 50 per cent of deaths
occurred amongst old chronic patients who had been in the hos-
pital for 20 years and over.
14. The ages of patients died are shown below :—
Under 20 years of age .. ..
Between 20 and 40 years ..
Between 40 years and 60 years ..
60 years and upwards .. ..
Male.
..
3
15
9
27
Female.
..
1
4
1
6
Total.
..
4
19
10
33
15. Health of patients.—The health of patients was good
throughout the year under report.
16. Sickness.—The daily average number of sick treated for
physical ailments during the year 1936 and the two preceding
years is shown below :—
Year.
1936 .. ..
1935 .. ..
1934 .. ..
Male.
62.57
56.92
54.30
Female.
11.0
11.40
10.80
Total.
73.57
68.32
65.10
The following were the main types of physical disorders
treated in the Infirmaries during the year under report:—
Influenza, Malaria, Ankylostomiasis, Dysentery (i) Amoebic,
(ii) Bacillary, Diseases of the Digestive system, Senile
and other Debilities, Ulcers and Inflammations,
Diseases of the connective tissues, Diseases of the
respiratory system, Rheumatic affections, Diseases of
the skin, Pneumonia, Tuberculosis of lungs, General
Paralysis of Insanes, Malignant growth.
6,912 patients were treated at the outdoor department for
minor ailments during the year under report.
The apparent increase in the daily average number of sick
patients treated during the year 1936 as compared to 1935 and
1934 is due to the general increase in the hospital population
during the year under review and not due to any increase of
illness.
In the month of August, influenza broke out in a mild
epidemic form in the Male Section of the hospital and nearly
300 patients were attacked but all had an uneventful recovery
6
and its further spread was checked by stringent sanitary
measures.
Small-pox and Chicken-pox in mild epidemic form appeared
to be almost endemic amongst staff children in the staff line
throughout the year under review and stringent sanitary
measures with timely vaccination and segregation of contacts
just enabled us to keep the infection away from the patients as
well as the staff.
17. Statement no. II—Cases under observation.—The total
number of patients held under remand for brief periods of obser-
vations was 5 (4 males and 1 female) of which 3 (2 males and
1 female) were certified and admitted and two males were certi-
fied as non-violent insanes and were ultimately discharged by
the committing Magistrates for want of accommodation.
18. Statement no. III—Criminal patients—The daily average
strength of criminal patients for the year 1936 and the two
previous years is shown below :—
Year.
1936 .. ..
1935 .. ..
1934 .. ..
Male.
432.71
438.83
433.02
Female.
41.03
42.51
36.79
Total.
473.74
481.34
469.81
The following table shows the number of criminal patients
admitted during the year under report and a classification of
the crimes committed by them :—
Murder .. .. ..
Culpable homicide .. ..
Hurt and grievous hurt .. ..
Petty offences .. ..
Waging war against the King ..
Male.
17
3
3
7
1
31
Female.
2
1
..
4
..
7
Total.
19
4
3
11
1
38
19. Statement no. IV—shows the religion, sex and residence
of the patients admitted during the year under report and is
self-explanatory.
20. Statement no. V—shows the ages of patients admitted
during the year.
As in the past, the largest number of patients admitted
during the year was between the ages of 20 and 40 which doubt-
less proves that insanity is more prevalent within the second and
fourth decade of life irrespective of sex.
7
21. Statement no. VI—shows the forms of mental disorder
of those admitted during the year 1936.
The number of mentally defective children is steadily going
up and in the absence of a separate children's ward it is becom-
ing increasingly difficult for the administration to house and
treat such children. During the year under review a very
inexpensive scheme for the conversion of one of the existing
spare occupational therapy buildings in the Female Section into
a children's ward was placed before the Managing Committee of
the hospital for approval. It was unanimously accepted by the
Committee and the final sanction of the Government to the
scheme is now awaited. A mental hospital is not a fit place
for treatment of certified mentally defective children and in the
absence of proper homes for mentally defective children as well
as of the Mental Deficiency Act for India, the Magistrates have
no other alternative but to admit them for treatment in the
mental hospitals. It is therefore very clear that some measure
of reform is badly needed in this direction and the sooner it is
taken up the better.
22. Statement no. VII—shows the probable cause of
insanity in those admitted during the year.
23. Paying patients.—The following number of paying
patients were treated during the year under report and the two
previous years:—
Year.
1936 .. ..
1935 .. ..
1934 .. ..
Male.
70
72
63
Female.
26
24
22
Total.
96
96
85
The number of paying patients appears to be very small as
compared to the size of the hospital and this is due to want of
proper accommodation for such class of patients, The present
number of paying patients would probably treble itself if proper
increased accommodation is provided for paying patients in this
hospital. The construction of special blocks for paying patients
was again held up during the year under review as in the past
for want of funds. A scheme for building cottages for border-
line cases (12 beds) which was approved by the joint conference
of the representatives of the Governments of Bihar and Orissa
and Bengal in 1926 was re-submitted in detail for the considera-
tion of the Managing Committee of the hospital during the year
under review. The border-line blocks are built outside the
hospital where patients suffering from early mental diseases
8
are treated without certification. The Committee after great
deliberation passed the following resolution :—
"The Committee while approving generally the scheme
consider that it is rather one for private enterprise than for one
to be financed by public money. They recommend that Govern-
ments of Bengal and Bihar should give all assistance possible in
the way of publicity and giving facilities by provision of a site ''.
24. Suicide, injuries and absconding.—During the year
under review with the exception of a few minor injuries and
accidents there were no cases of serious accidents or injuries
amongst the patients. Similarly there was no case of suicide or
absconding.
25. Autopsy.—Post-mortem examinations were held on 25
cases during the year under report.
26. Conservancy and sanitation.—The sanitary condition of
the hospital as well as that of the staff lines was kept satisfactory
throughout the year under report.
27. Methods and treatment of insane.—The care and treat-
ment of insane to-day in a modern mental hospital can only be
fully appreciated by a comparison with conditions which existed
in the one time old asylums of India. A visit to the Ranchi
Indian Mental Hospital cannot fail to convince an unbiased person
of the complete hygienic and favourable conditions which exist.
A modern mental hospital is a self-contained unit and in its
communal life the patients find everything they need and no
effort is spared to make their daily lives as happy, comfortable
and contented as is possible having regard to the distressing
mental conditions from which many of them suffer. Where
recovery from mental illness is possible, the progress is slow and
the methods which have to be adopted are painstaking and diffi-
cult. A modern mental hospital represents a highly specialised
development where Psychiatry is best studied. One gets in-
numerable opportunities to study the life histories of great many
patients as they live 20, 30, 40 years and sometimes more, and to
follow them by the pathological findings after the end has come.
Modern mental hospital offer outstanding opportunities for
medical research. The armamentarium of medicine in-general
and of Psychiatry in particular has enormously increased and it
has become one of the functions of the Ranchi Indian Mental
Hospital to bring all these various diagnostic and therapeutic
agencies which have been developed through the years to the
service of its patients.
9
In the Reception Unit of the Hospital all patients on admis-
sion are subjected to a thorough systematic examination both
physical and psychological and later they are suitably classified
and treated accordingly.
1. Occupational Therapy.—Occupation is recognised as an
important therapeutic agent and has been defined as the orga-
nisation of suitable employment for the purpose of combating
idleness. The scope of "Occupational Therapy" is almost
unlimited and its usefulness is hard to exaggerate. The principle
involved in any intensive system of " Occupational Therapy"
must be that no patient who lacks initiative should be allowed to
remain idle because of this alone and left gazing at the walls of
his room. It has now been amply demonstrated in all modern
mental hospitals as well as in the Ranchi Indian Mental Hospi-
tal that those who are least expected can be occupied for a
regular number of hours daily under special supervision, even
though in certain cases they may only mean tearing coir for
mattresses as a contrast to tearing up their own clothing. As
stated in my previous reports " Occupational Therapy " is and
always will remain a sheet anchor of our treatment. Under its
beneficial influence noisy and turbulent wards of the Hospital are
fast disappearing and a number of hypnotic draughts given at
night is considerably reduced. " Occupational Therapy " breaks
up the routine institutional life of the Hospital and relieves
monotony and includes a busy activity with resulting cheer-
fulness and hope of recovery. Patients are selected for " Occu-
pational Therapy " departments in this Hospital by the Medical
staff according to their capacity and nearly 80 per cent of
patients of this hospital are daily so occupied. A brief outline
of work done in Occupational Therapy Classes of this hospital is
given below :—
Weaving, Carpentry, Smithy, Cane and bamboo work,
Painting, Tailoring, Rug-making, Knitting, Em-
broidery and lace work, Mattress and pillow-
making, Gardening, Shoe-making and mending,
Joss stick-making, etc.
Besides several patients are employed in the kitchens of
both the sections and wards to help in cooking and general ward
work.
At the local industrial exhibition in 1936 the Occupational
Therapy Departments were awarded three first class certificates
for the following :—
1. Furniture,
2. Lace work, and
3. Needle work.
10
My visit to the famous occupational therapy centres in Europe
and England during 1935-36.—In 1929-30 1 twice visited all the
best known occupational centres in America.
Last year also when on leave I visited all the best known
centres on the Continent and England. In England I was
informed that the Devon Mental Hospital at Exminister had
a great name for occupational therapy and I visited the hospital
in September 1935. On the Continent I visited the famous
Santpoort Hospital in Holland and in Germany the famous
hospital at Gutersloh. I must say that I acquired information
and experience by going round these hospitals which will form
an invaluable background for further development of the
Occupational Therapy Departments of the Ranchi Indian Mental
Hospital. The patients in these hospitals are carefully graded
and grouped by the medical staff according to their capacity and
nearly 90 per cent were genuinely occupied. I am glad to be
able to state here that the "Occupational Therapy" classes of the
Ranchi Indian Mental Hospital can stand a fair comparison with
those of the hospitals I visited although our departments are not
equipped with modern appliances and machinery and not staffed
by highly trained Occupational Therapy officers. I express my
indebtedness to all the Superintendents, Officers and staff of
these renowned hospitals for the facilities which I was afforded.
Reward to good workers.—During the year under report
a sum of Rs. 600 was spent in distributing rewards to the hard-
working patients over and above the daily extra gifts of
cigarettes, tobacco and other comforts.
II. Hydrotherapy.—An institution well equipped with
means for the various forms of Hydrotherapy is well on the road
to practically complete abolishment of the use of sedatives for
highly excited patients. This most useful form of therapy was
given to several patients throughout the year under report.
Altogether 176 male and 44 female patients were given this
treatment with very gratifying results. The average number of
hours of immersion of patients was 104.88.
III. Drugs—(a) Sulfosin Therapy.—During the year under
report as many as 83 patients were treated with sulphur injec-
tions and the results are shown in the table appended below :—
Stationary or no improve-
ment.
M.
10
F.
8
T.
18
Improved.
M.
38
F.
17
T.
55
Recovered.
M.
4
F.
6
T.
10
11
From the figures given above it will be seen that the results
were very good as the treatment affected recovery in 12.05 per
cent and improvement in 66.27 per cent of cases.
Use of Sulphur Injections in skin diseases.—During the year
under report, 20 patients suffering from the following skin affec-
tions were treated with sulphur injections and as in the past our
results were very encouraging as all the cases improved after 5
or 6 injections :—
(1) Scabies .. .. .. ..
(2) Eczemav .. .. .. ..
(3) Ringworm .. .. ..
(4) Impetigo .. .. ..
Total ..
12
5
2
1
20
(b) Evipan Sodium.—This drug was tried in a few cases of
acute excitement where other drugs failed to quieten the patients
and to induce sleep. In some it worked like a charm and the
patients remained quiet from 24 to 48 hours after an injection
of Sodium Evipan. It is given intramuscularly in the gluteal
region. The dose is 1 gram of Sodium Evipan dissolved in 10
c. c. of distilled water. Only one injection is given in 24 hours.
I strongly recommend the use of this drug when other ordinary
hypnotics have failed to produce the desired effects in refractory
cases.
(b) I. Narco-analysis by Sodium Evipan.—The treatment is
still under trial and our results will be published in our next
report.
(c) Bowolfia Serpentina.—A further supply of an alcoholic
extract of this drug (Hindi—Chota chand—or what is popularly
known as Hassan Imam's root) was received during the year
under report from the Calcutta School of Tropical Medicine and
was tried on patients, but the results were rather disappointing ;
apart from its mild hypnotic effects the drug did not produce
any beneficial results and same results could be achieved by any
other hypnotic drugs.
(d) Bacillicum Citratum or Subji leaf (Biswa Tulsi).—The
leaves of this plant contain yellowish green essential oil and 5 to
6 drops of this oil after pressing of the leaves if poured in each
nostril of an excited patient allays excitement and serves at
times as a powerful hypnotic. A further experiment on a larger
scale was made with this drug during the year under report and