MUNICIPAL DEPARTMENT.
MEDICAL.
DARJEELING, THE 25TH AUGUST 1885.
RESOLUTION.
READ—
The Report on the Lunatic Asylums in Bengal for 1884.
Read again—
The Report for 1883, and the Resolution recorded upon it.
The report which was due on the 1st May was not submitted to Govern-
ment till the 10th July. The Lieutenant-Governor trusts that greater punc-
tuality will be observed in the submission of future reports.
There has been little or no fluctuation in the number of primary admis-
sions and re-admissions into the asylums during the year under review as
compared with the figures of the previous year. The number of admissions
was 208 against 209, and of re-admissions 24 against 23. The daily average
population of the asylums was 920.96 against 878.67, while the lunatics who
remained in the asylums at the close of the year numbered 919, of whom
730 were males and 189 were females.
2. The number of persons treated for insanity was 1,139, of whom 90
were discharged cured during the year, which was precisely the figure in 1883.
The percentage of recoveries in 1884 reckoned on the mean daily population
was 9.77 against 12.47, the average of the previous ten years. The Inspector-
General of Hospitals makes the following pertinent remarks:—
The decrease from the average hitherto has been explained by the reduction in the
" admissions under the head of acute mania," " uncertainty 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 under-
stand the nomenclature presenting very complicated results. The types or various forms of
mental disorder 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. * * *
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.
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 anteriorly 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 asylums as a
separate and distinct individual each time.
It would be highly interesting could we ascertain what becomes of the discharged
cured and relieved. Do these recovered and improved lunatics return 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 ?
3. Both in the Dacca and Cuttack Asylums the number of inmates
exceeded the estimated capacity of the buildings. As in previous years,
there was no real overcrowding during the year in either of these institu-
tions, as harmless lunatics were allowed to sleep in the verandahs, which were
not included in the estimate of capacity. The Inspector-General of Hospitals,