( 4 )
town and suburbs. The neighbouring jails repeat the evidence. The deaths
from bowel disorders have been as follows:—
Alipore Jail
...
...
...
Presidency Jail (natives) ... ...
1877.
32
10
1878.
52
8
1879.
55
23
Enteritis caused one death. The man came from Hazareebagh, but his
illness was acute, unconnected with his state on admission.
The epileptic person brought his disease with him, two and half years
before his death. The year was not responsible for this.
Exhaustion of mania caused three deaths. One was nearly three years in
the place with recurrent seizures; in wretched condition on admission and
throughout. The others were admitted in 1879. One was kept alive by artificial
feeding for some months; the other for a few days only. These three deaths
are in excess of 1878. How far they belong to the asylum, and to the year
1879, may be inferred from what I have said.
Hepatitis. This name has been given to an old case of enlarged liver
and spleen which originated in the asylum. Leprosy was fatal to an old man
of 22 years' residence. It originated in the asylum but not in 1879.
Meningitis occurred in a case of long standing debility and old age.
The death from pleurisy was from illness contracted in 1879. That
from pulmonary apoplexy occurred in an old asthmatic, ill on admission.
Thus, of the four pulmonary non-phthisical deaths, three resulted from old
asthma dating long before 1879. There occur in countries where pulmonary
diseases abound, years which are peculiarly unfavourable to sufferers from
such disorders. Some curious evidence regarding 1879 in the neighbourhood
will presently be adduced.
I would here draw attention to the mortality among lunatics transferred
from Cuttack to Dullunda. Of 17 persons so transferred since November 1876,
no less than six died in 1879, and since the arrival of the party no less than
nine have died. All were chronic invalids, and six were more or less ill from
their admission.
9. It would seem that a sufficient account has now been given of the
events of the year at Dullunda in relation to ordinary diseases. It remains to
consider more fully the prevalence of pulmonary consumption and its apparent
increase in 1879. There were five deaths from the disease in 1878, and 16
in 1879. Some of this difference is due to the method of annual grouping.
The deaths of the year, as I have said, do not represent the sickness of the
year in chronic disease. Of these 16 fatal cases no less than five came forward
from 1878 and previous years and, of these five, three were ill on admission to the
asylum. Similarly, cases belonging to 1879 will have passed on to 1880, and
one year will commonly be on equal terms with another in this respect; but the
question now is one of apparent increase in 1879, and the point to be observed is
that the fatal cases, protracted into 1879, equalled in number the whole of the
phthisical deaths in 1878. Of the remaining 11, eight were among the new
arrivals of the year, all ill on admission. Of these last, four came with their
disease from Hazareebagh, and it is remarkable that these four were originally
sent to Hazareebagh in good health from Dullunda; where one had lived upwards
of 30 years. So far, therefore, as sickness originating at Dullunda is concerned,
there is, in the remaining three cases, nothing to show large or exceptional
production of phthisis there in 1879.
10. But this does not exhaust the subject. Of the chronic cases described
as ill from admission it is not proved that all were phthisically ill from
admission. Most of them were so undoubtedly; some are believed to have
been so on good technical grounds, from the subsequent development which
their illness took. Physical examination of the lungs of lunatics is often quite
impossible, and still oftener inconclusive. Phthisis in India is, among sane
people, very insidious in its approach and, among lunatics, early evidence
is in many cases unobtainable. A slight fever recurring, or progressive loss
of weight at Dullunda, draws attention to the lungs and they are examined;
sometimes with results, sometimes with none; and often a man is treated
as an invalid, or by special means, on mere suspicion. On the other hand
post mortem examination not unfrequently reveals a phthiscal condition which
could not be known with certainty before. Examination post mortem is indis-