NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
10
In 1935 three elderly patients sustained a fracture of the leg
as the result of accidental falls In the case of one, a female
suffering from a psychoses of the M. D. type of long standing,
it resulted in a marked improvement in her mental condition.
A male patient, whose general behaviour was exemplary, one
day suddenly inflicted several wounds on his legs while working
in the kitchen.
With the exception of the above, there were no serious
accidents among patients.
27. Autopsy.—Post-mortem examination was held on 70
cases during the triennium and specimens of pathological interest
were preserved in the laboratory.
28. Conservancy and Sanitation.—Throughout
the trien-
nium under report the sanitary condition of the hospital and
grounds as well as that of the lines of the staff were constantly
supervised by a special conservancy staff and kept satisfactory.
During the hot season, the fly nuisance which is greatest then,
was kept down as much as possible by attacking all breeding
grounds. The outfalls from the septic tanks, especialy that
which flows through the vegetable garden, were constantly
treated with a solution of phenyle and kerosene oil. Although
every attempt was made to control the increase of mosquitoes
during the rainy season, the results were not appreciable.
29. Treatment of mental conditions.—As a large majority
of the patients are in an advanced state of chronic mental
disorder and have been resident over a number of years but
who have not progressed in spite of all attention bestowed from
every aspect of therapy, physical, psychological and sociological,
for most of them institutional treatment as a routine is mainly
custodial and occupational.
The chronicity of some mental disorders is inevitable in
spite of the many forward strides of modern mental science,
and it is not surprising therefore that a fair majority of patients
in most mental institutions are in a state of advanced dementia.
An important factor is that, too frequently admission is delayed
by friends or relatives of the patient as long as possible till
management of him (or her) at home becomes intolerable or
impossible. By then the patient is already in an advanced
state of the disease and the chances of recovery remote. Even
among the educated classes it is regrettable to note that the
value of early treatment in mental hospitals is not fully
recognised.
11
However, every patient is on admission subjected to a
thorough systematic examination physically and psychologically.
After a period of observation in the Infirmary during which
he (or she) is daily interviewed, his (or her) case is treated
according to the diagnosis arrived at. The various forms of
therapy adopted is summarized below.
(a) Sulfosin injections.—During the triennium 243 patients
were treated and the results were :—
Year.
1935
..
..
1934 .. ..
1933 .. ..
Recovered.
3
16
18
Improved.
50
35
38
Stationary
or not
improved.
35
29
19
A wide selection of cases was taken and it was found most
beneficial in cases of acute excitement. In several such cases
early restoration to normal speech and behaviour was almost
dramatic.
(b) Sulfosin Therapy in skin diseases.—Forty-two cases
(16 in 1933, 21 in 1934 and 5 in 1935) of skin affections were
treated and all responded readily to this form of treatment.
(c) Rawolfia Serpentina.—A supply of an alcoholic extract
of this drug (Hindi—Chota Chand) was received from the
School of Tropical Medicine, Calcutta, who requested us to try
this medicine as it is renowned as a specific for insanity. The
drug was given both orally and by injections and it is found
that as a hypnotic it is very efficacious specially in allaying
restlessness of excited patients.
Twenty-six male patients and 14 female patients were tried.
Cases of acute excitement, either of Mania or Katatonia, were
selected and the results are as follows : —
Cured .. .. .. ..
Improved .. .. ..
Unimproved .. .. ..
Total ..
Male.
6
1
19
26
Female.
1
4
9
14
12
(d) Hydrotherapy. —During the triennium 829 (1933—308,
1934—299 and 1935—222) were treated. This mode of therapy
has been especially beneficial in cases of maniacal excitement,
to overcome mental and physical restlessness.
(e) Dentistry.—The care of the teeth of patients has
received greater attention since the appointment of a visiting
dentist to this hospital from the beginning of 1935. The
dentist visits the hospital three times weekly and during the
year 1935 treated 1,095 (812 males and 283 females) patients
both paying and non-paying.
(f) Treatment of neurosyphilis.—As a routine measure the
blood and cerebro-spinal fluid of all patients on admission is
sent to the Bacteriologist, Patna Medical College, for the
Wassermann reaction. The following table shows the number
of specimens of blood and specimens of Cerebrospinal fluid .
examined during the triennium under report. The results
were :—
—
Blood .. ..
C.S. F.
..
..
Negative.
1935.
46
12
1934.
27
7
1933.
51
9
Positive.
1935.
155
41
1934.
198
32
1933.
176
21
The Wasserman reaction of the cerebrospinal fluid is, I
consider, of greater importance in the diagnosis of neurosyphilitic
conditions, especially general paralysis of the insane.
The general belief in medical circles, that general paralysis
of the insane is a comparatively rare disease in Indians, still holds,
with the result that the diagnosis of general paralysis of the
insane is often overlooked. This disease is, I am of opinion, by
no means rare, and if the cerebro-spinal fluid is examined as
a routine measure, the more frequent will a proper diagnosis of
general paralysis of the insane be evident. The treatment of
neurosyphilitic states by the usual methods adopted universally,
i.e., injections of arsenical preparations and a course of malarial
therapy, has been shown by reaseach workers in Europe recently
13
to be somewhat disappointing and uncertain
During 1935 how-
ever another mode of direct attack, known as the Swift-Ellis
methods was carried out in cases of general paralysis. It consists
in the injection of the patient's own serum which has been salvar-
sanized, into the spinal canal, so that the drug reaches the brain
and its tissues directly. The results obtained were more
favourable. In this form of therapy, malaria need not be used
and its attendant risks thus avoided.
(g) Endocrine Therapy.—Various
endocrine preparations
were tried in selected cases but the results were disappointing
Evidence however is at hand that cases of schizophrenia whose
basis is endocrine dyscracia can be effectively improved by
a course of gonadal hor ones plus aphrodisiacs.
(h) Radium Therapy.—Following
the lead of continental
workers in the use of Radium with success in psychiatry, an
attempt was made to test the efficacy of Radium in the treatment
of the psychoses, by giving injections of Radio Active Water in
certain cases.
In 1935, I purchased at my own cost a Radium emanation
apparatus and tested it on several cases. The supply of Radio
Active Water is unlimited as the efficacy of the Radium element
is constant and continuous. The experiment is still in course of
trial and no definite deductions can be drawn but so far it is
gratifying to note that two cases of acute mania have shown
considerable improvement with this element alone. Another
case of ringworm that had been chronic and resisted every other
form of treatment, markedly improved after a few injections.
The results in cases of epilepsy however were disappointing.
(i) Occupational Therapy.—This department was enlarged
during the year by the conversion of a large store room into
a work shed. As the number of patients who are taking to
industrial handicrafts and occupations increases, the need for more
room is felt.
A high standard of efficiency was maintained in all sections
and many indolent and truant patients were revived to activity.
The following are some of the occupations prescribed to patients
who are selected for them according to their aptitudes or interests:-
Weaving, carpentry, smithy, cane and basket work,
painting, tailoring, rug-making, knitting, embroidery
and lace work, mattress and pillow makings gardening,
etc.
A number of others are occupied in the several kitchens of
both sections and each ward has a batch who help in general
ward work.
14
The need for a trained occupational instructress for the
female section is keenly felt as without a qualified and enthusi-
astic worker it is very difficult to train patients or stimulate
their interests from lethargy and indolence to useful and helpful
occupation with a view to rehabilitation. It is hoped that next
year this need will be met.
At local industrial exhibitions held in 1934 and 1935 in
which some of our products from the occupation department as
well as the garden were shown, 9 first prizes and a silver medal
were secured.
(j) Habit formation.—Psychotics in general have, as a result
of their mental disruption and loss of instincts, a tendency to
abnormal modes of behaviour, which is expressed variously as
destructiveness, viciousness, filthiness, nudism, grotesqueness, etc.,
and if not corrected from the start rapidly progress. Steps were
taken to eradicate, as far as possible, such traits by constant
correction and greater personal contact and attention on the part
of the attendant staff. As a result, the general behaviour and
habits of patients improved considerably. To quote one case in
point, a patient, who used to destroy a blanket nightly to
fashion a head-dress therewith, finally stopped his destructiveness
when supplied with a Turkey cap.
(k) Gardening and Poultry.—The aspect of this work should
be considered not in terms of mere manual labour and production,
but as an essential part of Occupational Therapy, the prime
object being the physical and mental uplift of the patient. Even
though a large number of the patients are agriculturists to whom
this work is suited, those who are not, are also sent, and it has
been found that out-door work is useful even in allaying mild
states of excitement. On an average about 250 patients work
daily in the main vegetable garden which is about 100 acres in
area. The following table shows the total value of the produce
in the year 1935 and also the two years preceding : —
Details.
Supply of variety of
good vegetables,
fruits,
spices,
paddy, etc., to the
hospital.
Supply of fodder for
hospital cattle.
Sale of
surplus
vegetable, etc., to
the public.
1935.
Rs.
30,580
274
1,410
a.
9
4
3
p.
9
0
9
1934
Rs.
22,636
287
1,581
a.
14
11
9
p.
0
0
0
1933.
Rs.
22,884
236
1,255
a.
3
0
10
p.
9
0
9
15
During 1935, 20 acres more were brought under cultivation
for growing paddy of which 89 maunds were produced.
The flower beds and hedges of both sections within the
hospital were tended entirely by patients and thereby a sum
of Rs 200 that had been sanctioned for the cutting of hedges
was entirely saved as this work was done by patients alone and
quite efficiently too.
Several patients were also engaged in tending a small
poultry yard that was stocked with fowls and ducks. A large
poultry shed was also erected by the patients. During the year
1935, 2,942 eggs were supplied to the hospital and 170 chicken
were hatched.
At the height of the hot season when the large tanks began
to dry, the stock of fish had to be removed and 3 maunds 36
seers of fish were supplied to the hospital.
30. Finance—(a)
Receipts,—The total receipts from all
sources amounted to Rs. 26,173-0-8 during 1935, Rs. 23,727-14-3
during 1934 and Rs. 24,011-10-6 in 1933. The following table
shows the sources of income, maintenance charges of paying
patients, sale of vegetable and manufactured articles and car
hire :—
Heads.
Receipts from paying
patients.
Miscellaneous
1985.
Rs.
24,164
2,008
a.
4
12
p.
2
6
1934.
Rs.
21,156
2,571
a.
4
10
p.
0
3
1933.
Rs.
22,078
1,933
a.
8
2
p.
0
6
(b) Expenditure.—The total expenditure, exclusive of the
receipts totalled above, amounted to Rs. 4,69,192-8-0 in 1935,
Rs. 4,70,895-8-10 in 1934 and Rs. 4,83,573-1-8 in 1933.
Annual average cost per patient.
Year.
1935 .. ..
1934 .. ..
1933
..
..
Annual cost per head
including Public Works
Department charges.
Rs.
364
365
375
a.
2
14
9
p.
0
9
2
Annual cost per head
excluding Public Works
Department charges.
Rs.
330
330
339
a.
5
7
1
p.
8
3
7
16
31. Games and amusement.—Under
the supervision of
a games master, who is also the Assistant Weaving Instructor,
this department showed much progress. The attendance of
patients at daily out-door games increased and more new games
were provided. The two amusement halls were also fully
attended each evening for music, indoor games, cinemas or
theatricals, and the hospital band was in attendance daily.
The present ward which is used in the female section
Infirmary as an amusement hall is wholly inadequate for the
female patients, who crowd into it in the evening. It might
be expanded by the inclusion of the next ward to make one
large hall.
The proposal for constructing a new amusement hall for
the male patients at a cost of about Rs. 35,000 has recently
been under the consideration of Government but the project
has to be postponed as the Government of Bengal who are to
share three-quarters of its cost, are unable in their present state
of finances to provide funds in the next year's budget.
Several hockey and football matches were played during
the triennium in local tournaments in which our side acquitted
itself very favourably. Cricket was also introduced for the
first time in 1935 and now we have a fairly efficient team.
Three matches were played of which one was lost, one draw and
one a win.
Cinemas were held regularly throughout the triennium
under report for the patients who take a great interest in and
look forward to this diversion.
During the triennium several theatrical entertainments,
magical performances, physical feats, comic sketches, etc., were
given by visiting companies. The patients themselves staged
eight dramatic performances with a high standard of histrionic
ability.
I am grateful to the final-year students of the Prince
of Wales Medical College, Patna, who whilst on a course of
training here, usually give a fine theatrical performance every
year which is highly appreciated by all.
32. Drives.—Both male and female patients are taken out
for drives to Ranchi on alternate days, and those who can do
their own shopping in the town, are allowed to do so.
33. Special entertainments.—On the occasion of important
religious festivals, such as Bakr-id, Durga Puja, Holy and X-mas,
etc., patients were provided with special diet and sweets.
17
During the X-mas holidays a long performance of entertain-
ments was provided and on New Year's Day the annual sports
were held. On these occasions the entire staff assisted in
entertaining the patients and I am grateful for their co-operation
in making these functions a success.
34. Staff.—In 1935 the Government of Bengal deputed
one assistant surgeon and two sub-assistant surgeons for duty
at this hospital to undergo training in Psychiatry for a period
of two years.
Bi-weekly conferences of the medical staff were held at
which I lectured on Psychiatry and Psychology. To co-ordinate
the administration of the hospital, weekly conferences of the
heads of all departments were held. The First Assistant Super-
intendent and the Matron delivered a course of lectures on
First-Aid and General Nursing to the attendant staff of the
Infirmaries of the male and female sections respectively.
The nursing of sick in the male Infirmary could, I feel,
be improved if qualified female nurses could be employed to
supervise the orderlies. The employment of at least three
additional female nurses is essential and would be a great boon.
35. Religious service.—Throughout the year each of the
main religious communities had weekly services or instructions
imparted to them, and patients of each denomination were
always keen on and regular in attendance. I am grateful to
each of the spiritual leaders who gave their services so zealously.
During the Durga Puja festival batches of Hindu patients
were allowed outside to attend the local celebrations.
36. Jubilee celebration.—On the occasion of Their Majesties'
Jubilee the hospital buildings and lines were beflagged and
decorated and were well illuminated at night. The patients
were also given a special diet and batches were taken to see the
illuminations in the town.
37. Committee of visitors.—The members of the Committee
of Visitors, both male and female, held 12 meetings each, during
the year 1935. I take this opportunity to express my thanks to
them for their keen interest in the welfare of the patients
throughout the triennium under report. Numerous patients
were also visited by their friends and relatives and for their
convenience a room was specially set apart and furnished in
both male and female sections where they can now meet in quiet
and privacy.
18
The hospital was visited by the following officials and other
distinguished persons during the year 1935:—
1. The Hon'ble Sir Ganesh Dutta Singh, Kt.
2. The Hon'ble Mr. N. N. Sinha.
3. The Inspector-General of Civil Hospitals, Bihar and
Orissa.
4. The Inspector-General of Prisons, Bihar and Orissa.
5. The Inspector-General of Prisons, Bengal.
6. The Raja of Kharsawan.
38. Donations—A sum of Rs. 1,155 was paid into the
Donation boxes of both sections during the year 1935 for the
comforts for patients by many kind and generous persons who
visited the institution.
A sum of Rs. 208 was contributed by friends and relatives of
patients and other well wishers of the hospital at X'mas time
in 1935 and this amount was expended for their amusements,
presents, and sports at this season. I am greatly indebted to all
who contributed so liberally and readily.
I wish to express my thanks to the publishers of the
following papers and magazines which were supplied gratis to
our patients throughout the triennium under review :—
The Statesman
..
..
Amrita Bazar Patrika..
..
Biswamitra .. ..
The Searchlight .. ..
Patna Times
..
..
Basumati .. .. ..
Illustrated Times of India ..
Illustrated India
..
..
Bharatbarsha
..
..
..
Prabasi .. .. ..
Daily.
Tri-weekly.
Weekly.
Monthly.
39. Lectures.—The final-year medical students of the
Prince of Wales Medical College, Patna, attended in two batches
as in previous years for a course of instruction in Mental Science.
Twenty-four lectures were given by me at each session.
19
Lectures were also given by me to the medical staff in 1935 at
our bi-weekly meetings. The post-graduate students of the
Department of Psychology and Philosophy of the University of
Dacca visited the hospital, during the Puja holidays as in the
previous years and on this occasion I delivered a lecture to them.
The Medical students of the University of Calcutta have
a course of training at the Bhowanipur Mental Observation
Ward, to which the hospital has to send a batch of about
12 patients with the classifical signs and symptoms of various
Psychoses for demonstration purposes each year. To my mind
this system does not appear to be to the best interest of the
students concerned, and I think the practice followed by the
University of Patna might well be followed.
During the year 1935 I published a book entitled " Modern
Methods in Psychiatry " for the use of medical students and
practitioners in India.
In the years 1933 and 1934 Major Dhunjibhoy, I.M.S., was
invited to read the following papers with demonstration of cases
at the Indian Science Congress which met in Patna and
Calcutta respectively : —
1. Conquest of Senility by Steinachand Voronoff methods
in selected cases (in 1933).
2. An experimental study of Steinach Rejuvenation
operation of patients for a period of three years
(in 1934).
During 1935, Major J. E. Dhunjibhoy, I.M.S., was deputed
by the Secretary of State for India in Council to represent India
at the meeting of the General Council of the International
Relief Union at Geneva on the 2nd December, 1935.
J. N. J. PACHECO,
M.R.C.S., L.R.C.P., I.M.D.,
Offg. Superintendent,
Indian Mental Hospital,
Kanke (Ranchi).
20
STATEMENT
Showing the admissions, discharges, etc., of patients in the Ranchi Indian
1
Years.
1935 ... ... ...
1934 ... ... ...
1933 ... ... ...
2
Remained on 1st
January.
Males.
1,041
1,049
1,041
Females.
239
234
239
Total.
1,283
1,283
1,280
3
Admitted.
Males.
107
82
103
Females.
24
31
21
Total.
141
113
124
4
Re-admitted.
Males.
3
7
13
Females.
1
6
7
Total.
4
13
20
5
Total population.
Males.
1,154
1,138
1,157
Females.
274
271
267
Total.
1,428
1,409
1,424
1
Year.
1935 ... ... ...
1934 ... ... ...
1933 ... ... ...
7
Died.
Males.
34
24
23
Females.
11
7
5
Total.
45
31
28
8
Remaining on
31st December.
Males.
1,053
1,044
1,049
Females.
249
239
234
Total.
1,302
1,283
1,283
9
Daily average strength.
Males.
1047.38
1048.51
1047.12
Females.
241.14
238.36
240.44
Total.
1288.52
1286.87
1287.56
10
Daily average sick
Males.
56.92
54.30
59.93
Females.
11.40
10.80
8.10
Total.
68.32
65.10
68.03
* Escaped but not
NOTE.—Observation cases are
The capacity of the Ranchi Indian Mental Hospital is at 50 superficial feet per patient,
The maximum number of lunatics confined on any one night was
21
No. I.
Mental Hospital, Kanke, during the year 1935, and the two previous year.
6
Discharged.
A
Cured.
Males.
5t
56
59
Females.
10
18
19
Total.
65
74
78
B
Transferred to friends.
Improved.
Males.
9
12
22
Females.
3
6
9
Total.
12
18
31
Not improved.
Males.
2
2
4
Females.
1
1
...
Total.
3
3
4
C
Otherwise.
Males.
1*
...
...
Females.
...
...
...
Total.
1
...
...
D
Total.
Males.
67
70
85
Females.
14
25
28
Total.
81
95
113
11
Percentage to—
Daily average strength.
A
Cured.
Males.
5.25
5.34
5.63
Females.
4.15
7.56
7.90
Total.
5.04
6.75
6.66
B
Died.
Males.
3.25
2.29
2.20
Females.
4.56
2.94
2.08
Total.
3.49
2.41
2.17
Admissions.
C
Cured.
Males.
19.80
30.34
26.72
Females.
11.43
27.03
35.71
Total.
17.81
29.36
27.78
D
Died.
Males.
1.80
3.48
2.59
Females.
5.71
...
...
Total.
2.73
2.38
2.08
yet recaptured.
excluded from this statement.
1,014 for males, 272 for females =Total 1,286.
1,055 males, 251 females=Total 1,306.
22
STATEMENT II.
Showing cases admitted for observation in the Ranchi Indian Mental Hospital, Kanke, during the year 1935,
and the two previous years.
Name of Hospital.
Indian
Mental
Hospital,
Kanke
(Ranchi).
Year.
1935 ...
1934 ...
1933 ...
Remaining on 1st January
1935.
M.
...
...
...
F.
1
...
...
T.
1
...
...
Admitted during 1935.
M.
1
2
3
F.
...
4
2
T.
1
6
5
Re-admitted.
M.
...
1
1
F.
...
...
...
T.
...
1
1
Certified and admitted into the
Hospital.
M.
...
1
2
F.
1
3
2
T.
1
4
4
Certified and released under
section 14 of Act IV of 1912.
M.
...
...
...
F.
...
...
...
T.
...
...
...
Released as uncertified.
M.
...
2
2
F.
...
...
...
T.
...
2
2*
Died.
M.
...
...
...
F.
...
...
...
T.
...
...
...
Remaining on 31st December
1935.
M.
1
...
...
F.
...
1
...
T.
1
1
...
Remarks.
* 2 male patients were certified to be non-
violent insanes but were not admitted for
want of accommodation and were discharged
by committing Magistrates.
23
STATEMENT III.
Return of criminal patients in the Ranchi Indian Mental Hospital, Kanke, during the year 1935, and the two previous years.
1
Years.
1935 ...
1934 ...
1933 ...
2
Remaining on 1st
January.
Males.
433
436
433
Females.
43
38
39
Total.
476
474
472
3
Admitted.
Males.
48
24
41
Females.
10
8
2
Total.
58
32
43
4
Re-admitted.
Males.
2
3
2
Females.
...
1
...
Total.
2
4
2
5
Total.
Males.
483
463
476
Females.
53
47
41
Total.
536
510
517
6
Discharged, trans-
ferred, etc.
Males.
22
26
29
Females.
1
3
3
Total.
(a)
23
(b)
29
(c)
32
7
Died.
Males.
11
4
11
Females.
1
1
...
Total.
12
5
11
8
Remaining on 31st
December.
Males.
450
433
436
Females.
51
43
38
Total.
501
476
474
9
Daily average
strength.
Males.
438.83
433.02
435.83
Females.
42.51
36.79
33.71
Total.
481.34
469.81
469.54
(a) Of which 11 male patients were transferred to the non-criminal class, and 1 male patient escaped and is still at large.
(b) Do.
10
ditto
ditto.
(c) Do.
14 male and 1 female patients were transferred to the non-criminal class.