LUNATIC ASYLUMS IN BENGAL.
7
TABLE No. 8.
Percentage of Recoveries on total treated.
Acute mania
...
...
...
...
...
...
...
...
...
Chronic mania
...
...
...
...
...
...
...
...
...
Melancholia
...
...
...
...
...
...
...
...
...
Acute dementia
...
...
...
...
...
...
...
...
...
Chronic dementia
...
...
...
...
...
...
...
...
...
1881.
17.37
8.66
1.28
5.12
1.18
1882.
17.5
4.08
5.06
8.33
5.35
1883.
16.81
6.22
4.
5.71
1.43
1884.
15.65
5.14
8.45
2.74
1.56
18. From this table it will be observed that the increase of admissions
from acute mania—especially when we remember that ganja is its chief cause in
this country—was not accompanied, as might have been expected, by a corres-
ponding increase in the recoveries. In 1884 the percentage of recoveries was
15.65, against 16.81 in 1883. There were, however, twice as many recoveries
under the head of melancholia in the same period. The difficulty we have
to contend with is this, what is a "first attack" of acute mania and
what is not, for it is among " first" or "primary" attacks that we look
for the larger portion of curable cases. The trouble is to eliminate the
recurrent insanity. Who is to say on the admission of a patient suffering
from the acute form of the disease, whether it is a fresh or an old case of
mania ? It is very little to the purpose endeavouring to tide over the difficulty
by declaring that the nomenclature is at fault, or that the change in the
superintendence of the asylums led to a divergence in the classification of the
several types of mental diseases on admission. The fact remains that we have
to be satisfied with the imperfect information furnished us by illiterate relatives
and friends, and police records; while we know full well that the larger propor-
tion of the admissions must be chronic incurable cases, or recurrent insanity.
19. The more simple our classification, the less chance of confusion, as
the subject is approached from different stand-points. I presume the nomen-
clature adopted in our asylums, was so adjusted, to frustrate the tendency to
divide and subdivide the classes of mental disorders into a multitude of
varieties, until the principal divisional types are lost in a labyrinth of scientific
expressions, which in their grouping, to the initiated, may mean a great deal,
but, which, for all useful or statistical purposes, possess no practical value. The
results shew that the arrangement was a wise forethought, and that, as a rule,
the classification has been carefully and intelligently followed.
20. It is thoroughly well understood that the chances of cure are much
greater in " first" or " primary " cases, and especially when the treatment is
undertaken early. Now, as a rule, we may take it, that a larger proportion
of acute mania reach the asylums than any of the other forms of mental
disease, in the first onset of the attack. Still this does not help us, as the
record or "medical history" of each patient, is very imperfect; and, in the
majority of cases, on admission, it is impossible to ascertain, or rather to
separate, the "first" or " primary " cases from the recurrent mania. Again,
the mortality from mania is as a rule the highest, and table 7 exhibits both
these facts very distinctly. Criminal lunatics when they recover are not
all " discharged." They remain in the asylums, and thus lessen the percentage
of " recoveries," i.e., bonâ fide discharges from the institutions which are alone
shewn in these returns. In 1884 the recoveries from acute mania were 44 and
chronic 23, or 48.8 and 25.55 per cent., respectively, of the total recoveries in
the same period. The deaths in the same year were from acute mania 22 and
chronic 36, or 25.29 and 41.38 per cent. of the total deaths registered in the
twelve months.
21. Causes of insanity.— Vide statement VII. Of the total treated viz.,
1,139, 448 were said to have been due to physical, 134 to moral causes, and
that in 557, or 48.9 per cent., the " cause" had not been ascertained. The
information furnished in the statement cannot be relied upon as carrying with it
any great degree of accuracy. The great causes would appear to be the abuse
of ganja and spirits. Of the former there were altogether 268 cases, including
19 criminal fresh admissions and 43 non-criminal; and of the latter 54, includ-
ing 3 criminal and 9 non-criminal fresh admissions. Opium is said to have
led to 8 cases of insanity, although the class or type is not given; epilepsy
has remained stationary. In 36 the origin of the disease was assigned to
hereditary predisposition. One case is set down to the effects of hydrophobia—