NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
ANNUAL REPORT
ON THE
Working of the Ranchi Indian
Mental Hospital, Kanke, in
Bihar and Orissa for the year
1933.
1. Provinces served.—During the year under report this
hospital continued to receive patients as in the previous years
from the Provinces of Bengal and Bihar and Orissa.
2. Administration.—I held charge of the hospital through-
out the year except for a short period of absence on leave
from 15th March 1933 to 27th March 1933 when the First
Assistant Superintendent officiated for me.
3. Accommodation.—The accommodation of the hospital
remained the same as in the previous years, viz., 1,014 for males
and 272 for females, total 1,286. The 50 extra emergency beds
sanctioned by Government in 1929 to relieve congestion in the
male section were in demand throughout the year.
The daily average strength of the male patients during the
year was 1047.12.
Many improvement and expansion projects could not be
taken up during the year under review as in the previous years
owing to financial reasons.
There was no over crowding in the female section.
2
4. Patients.—The following table shows the number of
patients resident in the hospital on the 1st January 1933 and
two previous years:—
Year.
1933
...
...
...
1932 ... ... ...
1931
...
...
...
Male.
1,041
1,045
1,034
Female.
239
227
222
Total.
1,280
1,272
1,256
5. The maximum number resident in the hospital on any
one night during the period under report as compared with two
previous years was as follows :—
Year.
1933
...
...
...
1932
...
...
...
1931
...
...
...
Male.
1,059
1,049
1,051
Female.
239
236
229
Total.
1,298
1,285
1,280
G. Total admission.—The following table shows the admis-
sions (including re-admissions) during 1933 and two previous
years :—
Year.
1933
...
...
...
1932
...
...
...
1931
...
...
...
Male.
116
97
97
Female.
28
39
35
Total.
144
136
132
3
7. The total population of the hospital during the year
under report as compared with two previous years is shown in
the following table :—
Year.
1933 ... ... ...
1932 ... ... ...
1931 ... ... ...
Male.
1,157
1,142
1,131
Female.
267
266
257
Total.
1,424
1,408
1,388
8. The daily average strength of patients resident in the
hospital in 1933 was 1287.56 (1047.12 males and 240.44 females)
as compared with 1272.75 (1043.53 males and 229.22 females)
in 1932 and 1259.41 (1033.34 males and 226.07 females) in
1931.
Birth.—A pregnant female patient was admitted on 7th
March 1933, and gave birth to a bonny baby girl on 23rd
August 1933. It was a case of difficult labour (Persistent
Occipito Posterior) but fortunately ended well with forcep deli-
very. As there is no one to take charge of the baby outside,
the baby is still in the hospital and is a great favourite
amongst the staff of the female section.
The birth is excluded from calculation.
9. The ratio per cent of cases cured to the daily average
strength during the year as compared with two previous years
is shown below :—
Year.
1933 ... ... ...
1932 ... ... ...
1931 ... ... ...
Male.
5.63
5.75
4.16
Female.
7.90
6.98
6.19
Total.
6.06
5.97
4.53
4
10. The ratio per cent of cases cured to the total admission
for the year and two previous years is appended below :—
Year.
1933
...
...
...
1932
...
...
...
1931
...
...
...
Male.
26.72
25.77
13.40
Female.
35.71
23.08
17.14
Total.
27.78
25.00
14.39
A considerable number of the so-called new admissions were
not really new admissions in the true sense of that expression,
but were cases of long standing mental disorder who, in default
of proper mental hospital accommodation and other reasons had
been detained for shorter or longer periods in jails or at home.
Taking into consideration the above state of affairs the figure
27.78 showing the ratio per cent of cases cured to the so-called
total new admissions in the year 1933 can be rightly looked upon
as extremely satisfactory and serves as a direct incitement to
the staff who devote every possible care to the employment of the
modern methods of treatment to the newly-admitted patients in
the reception wards of this modern mental hospital of
India.
11. Death-rate.—The percentage of deaths to the daily
average strength for the year 1933 as well as two previous years
is given below :—
Year.
1933
...
...
...
1931
...
...
...
1931
...
...
...
Male.
2.20
1.82
2.03
Female.
2.08
0.87
3.10
Total.
2.17
1.65
2.30
It is again very gratifying to note that this largest mental
hospital of India has continued to maintain the lowest death-rate
of all the other mental hospitals in India.
5
12. The chief causes of deaths among the patients resident
in the hospital are shown in the following table :—
Causes of death.
Malaria
...
... ...
Pneumonia ... ... ...
Tuberculosis (lungs) ... ...
Diabetes ... ... ...
All other general diseases ... ...
Diseases of the nervous system of which
Pathological basis is not known.
Diseases of the nervous system of which
Pathological basis is known.
Diseases of the Circulatory system ...
Diseases of the Respiratory system ...
All other diseases of the digestive system
Acute or Chronic Nephritis ... ...
Injury, general or local ... ...
Dysentery ... ... ...
Leprosy ... ... ...
Abscess of the Liver ... ...
All other diseases of the Liver ...
All other diseases of the Urinary system ...
Diseases of the stomach
...
...
Anæmia ... ... ...
New Growth—Malignant
...
...
Diseases of the Intestine
...
...
Total ...
1933
M.
...
3
5
...
2
...
2
3
1
...
...
...
2
...
...
1
...
2
...
1
1
23
F.
...
...
...
...
2
...
1
...
...
...
...
...
...
...
...
...
...
...
1
...
1
5
T.
3
5
...
4
...
3
3
1
...
...
...
2
...
...
1
...
2
1
1
2
28
1932
M.
...
4
3
...
3
...
2
2
...
...
...
1
...
1
1
1
1
...
...
...
...
19
F.
...
...
...
...
1
...
...
...
1
...
...
...
...
...
...
...
...
...
...
...
...
2
T.
...
4
3
...
4
...
2
2
1
...
...
1
...
1
1
1
1
...
...
...
...
21
1931
M.
2
2
2
1
7
1
...
...
1
3
2
1
...
...
...
...
...
...
...
...
...
22
F.
...
...
...
...
5
...
...
1
...
1
...
...
...
...
...
...
...
...
...
...
...
7
T.
2
2
2
1
12
1
...
1
1
4
2
1
...
...
...
...
...
...
...
...
...
29
6
13. Duration of hospital life of those who died during the
year under report.
Period.
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.
3
1
...
...
...
2
...
5
3
4
1
1
2
1
23
Female.
...
...
1
...
2
...
1
...
...
1
...
...
...
...
5
Total.
3
1
1
...
2
2
1
5
3
5
1
1
2
1
28
14. The ages of the patients died are shown below :—
Ages.
Under 20 years of age ... ...
Between 20 and 40 years ... ...
Between 40 and 60 years ... ...
60 years and upwards ... ...
Total ...
Male.
...
4
13
6
23
Female.
...
3
1
1
5
Total.
...
7
14
7
28
7
15. Health of patients.—The general physical health of the
patients has been good throughout the year. It is satisfactory
to note that there was no epidemic disease of any kind during
the year.
16. Sickness.—The daily average number of sick treated in
the Infirmaries for physical ailments was 68.03 (59.93 males
and 8.10 females) in 1933 ; 55.91 (52.21 males and 3.70 females)
in 1932 and 60.46 (57.62 males and 2.84 females) in 1931.
The important admissions in the Infirmaries are shown in
the subjoined table :—
Name of disease.
Dysentery ... ... ...
Leprosy ... ... ...
Malaria (a) ... ... ...
Influenza ... ... ...
Pneumonia ... ... ...
Tuberculosis of lungs (b) ... ...
Animal Parasites—Ankylostomiasis ... ...
Round worms ... ...
New growth—Non-malignant ... ...
Malignant ... ...
All other general diseases ... ...
Diseases of the eye ... ... ...
Number.
Male.
13
6
133
7
4
10
39
8
2
1
47
16
Female
...
...
8
31
...
1
2
1
...
...
4
5
Total.
13
6
141
38
4
11
41
9
2
1
51
21
(a) Out of 141 cases of Malaria—114 cases were bacteriologically positive (65-B.T.
42-M.T., 7-B.T. & M.T.) and 27 cases were clinically positive.
(b) Out of 11 cases of T.B. 8 were bacterbiogically positive and three were clinieally
positive.
8
Name of disease.
Diseases of the respiratory system ... ...
Diseases of the stomach ... ... ...
Diseases of the intestine ... ...
All other diseases of the liver ... ...
All other diseases of the digestive system ...
Acute or chronic Nephritis ... ...
Diseases of the areolar tissue ... ...
Inflammation, ulcerative ... ...
Other diseases of the skin ... ...
Injury, general or local ... ...
Number.
Male.
45
13
9
4
47
8
56
48
38
70
Female.
7
3
1
...
9
...
9
4
...
22
Total.
52
16
10
4
56
8
65
52
38
92
It will be seen from the above table that, as in the previous
years, Malaria has been responsible for a large number of cases
of sickness during the year under review. All practicable
measures were adopted to prevent the breeding of mosquitoes
inside as well as outside the hospital area by the sanitary
squads of the hospital under the direct supervision of the Second
Assistant Superintendent and myself. In spite of all stringent
sanitary measures to prevent the breeding of mosquitoes, no
satisfactory results were achieved on account of the vastness of
the breeding grounds (paddy-fields) in the immediate vicinity
of the hospital which always remained a source of danger.
Moreover, a small area within the male enclosure also proved
a great menace to the health of the patients of the blocks
situated in close proximity of this insanitary area. On account
of the deficient drainage in this area, the water stagnates and it
helps the breeding of mosquitoes. The managing committee
9
have recommended to Government to rectify this insanitary
defect and have passed a scheme costing Rs. 1,180 to provide
adequate drainage in this area. Statistics show that nearly 50
per cent of the positive Malaria cases of the year under review
were contributed by this insanitary area in the male enclosure.
About 10,895 patients were treated as outdoor patients in
the hospital for minor ailments such as ulcers, slight injuries,
headaches, constipation, etc.
17. Cases under observation.—The total number of cases held
under remand for brief periods of observation was 6 (4 males and
2 females) against 53 (36 males and 17 females) in the previous
year.
The decrease in the number of observation cases is due to
the fact that the local Magistrates exercised stricter restriction
in issuing detention orders under section 16 of the Indian
Lunacy Act, 1912, on account of overcrowding of the hospital.
Of the six cases, two males and two females were certified
and admitted and two male cases were certified as harmless
insanes and were therefore not admitted for want of accommoda-
tion and released by the committing Magistrates.
18. Statement no. II.—Criminal patients.—The annexed
table shows the daily average strength of criminal patients :—
Year.
1933
...
...
...
1932 ... ... ...
1931 ... ... ...
Male.
435.83
434.58
433.47
Female.
33.71
34.25
34.22
Total.
469.54
438.83
467.69
Forty-five (43 males and 2 females) criminal patients were
admitted during the year against 51 (40 males and 11 females)
10
in 1932, and an analysis of the crimes committed by them is
shown in the subjoined table : —
Crimes committed.
Murder ... ... ...
Culpable homicide ... ...
Hurt and grievous hurt ... ...
Attempt to commit suicide ... ...
Dacoity with murder ... ...
Petty offences ... ... ...
Total ...
Male.
20
7
7
1
1
7
43
Female.
2
...
...
...
...
...
2
Total.
22
7
7
1
1
7
45
19. Statement no. III shows the religion, sex and residence
of the patients admitted into the hospital during the year and is
self-explanatory.
20. Statement no. IV shows the previous occupations of
patients admitted and needs no comment.
21. Statement no. V shows the ages of patients admitted
during the year under report.
It will be noticed from the figures given below that the
largest number of patients admitted every year was between the
ages of 20 to 40 and the ages between 40 to 60 claim the next
place in order of frequency.
Ages.
Under 20 years ... ...
Between 20 to 40 years ...
Between 40 to 60 years ...
Upwards of 60 years ...
1933
9
98
36
1
1932
12
98
25
1
1931
12
98
21
1
1930
7
69
19
4
11
22. Statement no. VI shows the types of insanity of the
patients admitted. The following were the principal forms
treated :—
(1) Manic Depressive Psychosis.
(2) Dementia Præcox.
(3) Confusional Insanity.
(4) Toxic Insanity.
(5) Mental Defectives.
(6) Epileptic Insanity.
(7) Recurrent Mania.
(8) Senile Dementia.
(9) Secondary Dementia.
(10) Psycho-neurosis.
23. Statement no. VII shows the ætiological factors and
associated conditions in the patients admitted and is self-
explanatory.
Moreover, in my last Triennial Report I have fully dealt
with this subject, and no further comment is required.
24. Paying patients.—During the year 91 patients (62 males
and 29 females) were treated as compared with 83 (57 males
and 26 females) in 1932 and 86 (61 males and 25 females) in
1931.
The popularity of the hospital with this class of patient
is fast growing and every year we are obliged to refuse
admission to several paying patients for want of accommodation.
The scheme of building separate wards for paying patients
could not be considered owing to continued financial stringency.
25. Suicide.—It is very gratifying to note that there was no
case of suicide during the year under report in spite of the fact
that there were more than 81 suicidal cases and many of them were
potential suicides and made frequent attempts at suicide which
were timely prevented by the vigilance of the attendant staff
on duty to whom I offer my very best thanks. I am again
happy to be able to record that suicide is practically unknown
in this largest mental hospital of India for the last seven years.
26. Escapes—There was no escape although a considerable
amount of freedom was enjoyed by the patients.
12
27. Accidents and injuries.—There have been no assaults
or accidents worthy of note among the patients except the
following :—
A. dependable epileptic patient suddenly ran amok and
caused serious injury on the head of the first patient he met
before he could be caught and overpowered by the staff. Although
the injury was serious I am happy to be able to record that
the patient made a speedy recovery under adequate care and
treatment.
28. Autopsy.—Twenty-four post-mortems were performed
and interesting specimens were preserved in the laboratory.
29. Conservancy and sanitation.—The supervision of the
conservancy and sanitation of the hospital inside and outside
was strictly maintained. The general sanitation of the whole
area of the hospital was satisfactory throughout the year and
there was no epidemic disease of any kind. Besides, utmost
attention and care were paid to the cleanliness of the wards and
the disinfection of the patients, clothing and bedding was carried
out by means of Thresh Disinfector.
30. Treatment of mental conditions.—The question of treat-
ment of mental conditions of patients received our careful
consideration as in the previous years and we continued
to make as much progress as possible in this direction.
(i) Drugs.—The following drugs were tried during the
year under report in addition to those already mentioned in the
Triennial Report for the year 1930—32 :—
(1) Nembutal.
(2) Soneryl.
(3) Somnifene.
(4) Hypnol.
All the above drugs were found useful and gave encouraging
results in some cases of excitement and insomnia, and they are
worth trying where other ordinary drugs fail to allay excitement
and bring about sleep in highly refractory cases.
Sabji leaf.—Basillicum Citratum (Bisva
Tulasi).—This
small shrub indigenous to Persia and Sind is cultivated in
India. The leaves contain a yellowish green essential oil
and if 5 or 6 drops of this oil are poured into each nostril of
a highly excited patient, it allays the excitement and serves as
13
a powerful hypnotic. We have so far obtained encouraging
results with this shrub and it is now grown in my garden for
the purpose of further experiment and the results will be given
in our next annual report.
Sulphur injections in mental disorders.—As the sulphur
therapy proved very satisfactory in the previous years the results
of which were fully incorporated in my Annual Report of 1931
and Triennial Report of 1930—32, this treatment was continued
during the year under report with the results shown below :—
Number
of
patients.
M.
11
22
1
1
2
2
3
1
...
...
43
F.
20
6
1
2
...
...
1
1
1
32
T.
31
28
2
3
2
2
4
1
1
1
75
Types of mental diseases.
Manic Depressive Psychosis ...
Dementia Præcox ...
Paranoia and Paranoid Reac-
tions.
Psycho-neurosis
...
...
Epilepsy ... ...
Toxic Insanity ... ...
Exhaustion Psychosis ...
Syphilitic Insanity ...
Imbecility ... ...
Anxiety States ... ...
Stationary
or no
improvement.
M.
...
2
...
...
1
...
1
...
...
...
4
F.
11
3
...
...
...
...
1
...
...
...
15
T.
11
5
...
...
1
...
2
...
...
...
10
Improved.
M.
7
15
1
...
1
1
2
1
...
...
28
F.
6
2
1
...
...
...
...
...
1
...
10
T.
13
17
2
...
1
1
2
1
1
...
38
Recovered.
M.
4
5
...
1
...
1
...
...
...
...
11
F.
3
1
...
2
...
...
...
...
...
1
7
T.
7
6
...
3
...
1
...
...
...
1
18*
* Out of the 18 cases recovered, 15 returned home after discharge as cured. One of the improved cases also
returned home and was discharged. The rest of the 3 recovered cases could not be discharged as they were
ciminal patients and had to undergo their probationary period.
I have been experimenting with sulphur injections since
1930 and up to the end of 1933 I have tried this very useful
therapy in 215 cases suffering from various mental disorders
with very satisfactory results. Out of 215 cases, 85 remained
stationary, 85 improved in their mental health and 35 completely
recovered. It is very gratifying to record that since our publi-
cation of the good results of our pioneer work with sulphur
injections in India many private practitioners have adopted this
treatment with encouraging results. One of the practitioners,
Dr. K. K. Sen, published an article on the success achieved by
sulphur injections in one of his cases which appeared in the
Indian Medical Gazette of September 1933. We are also
glad to note from the last Triennial Report of the European
Mental Hospital that they also now adopted this treatment with
encouraging results.
14
Use of sulphur injections in skin diseases.—As stated in
our last Triennial Report of 1930-32, we continued the experi-
ment of sulphur injections in skin diseases throughout the year
with satisfactory results as shown in the sub-joined table : —
Number
of
cases.
M.
1
2
10
2
15
F.
...
...
...
1
1
T.
1
2
10
3
16
Kind of skin diseases.
Eczema ...
Pityriasis Versicolor
Scabies ...
Ringworm ...
Stationary or
no
improvement.
M.
...
2
...
...
2
F.
...
...
...
...
...
T.
...
2
...
...
2
Improved.
M.
...
...
...
...
...
F.
...
...
...
...
...
T.
...
...
...
...
...
Recovered.
M.
1
...
10
2
13
F.
...
...
...
1
1
T.
1
...
10
3
14
It will be seen from the above table that sulphur injections
were very efficacious in scabies, eczema and ringworm but had
no effect on Pityriasis Versicolor. In 5 or 6 injections the
patients made wonderful recovery from the abovestated skin
diseases which were not amenable to ordinary routine treatment.
(ii) Rorschach test.—These
tests were invented by
Dr. Hermann Rorschach and are known as Psychodiagnostik
Tests of Rorschach. It helps in exploring the patients' uncon-
scious mind and at times gives a clue to their complexes and
thus renders a unique assistance in the diagnosis of cases. I had
seen Rorschach tests usefully employed as " Psychodiagnostik "
in many modern mental hospitals of Europe and America. The
tests are well under trial and the results will be given in our
next annual report.
(iii) Organotherapy.—Various glandular preparations were
prescribed in cases where necessary but the results were not very
enouraging.
15
Raw liver was prescribed in anæmic cases with satisfactory
results. Moreover, the following medicines were tried in weak
and anæmic cases with encouraging results :—
(1) Colloidal Calcium with Ostelin D.
(2) Metatone.
(3) Incretone.
(4) Haliverol.
(5) Calcinol.
(6) Calcium Gluconate.
Use of raw brain in stuporous cases.— The treatment of
stuporous cases with raw brains was reported to be very efficacious
by some of the hospitals in England and during the year under
review I tried this treatment on 4 stuporous cases. Raw brain
(4 oz. to 8 oz.) mixed with curry was given to stuporous
patients for a period of few months but so far no appreciable
improvement is noted in their mental condition. The experi-
ment is, however, still under trial and the results will be reported
in our next Annual Report.
(iv) Physiotherapy.—Throughout the year our attention
was paid to physical examination of all patients on admission
and a great care was bestowed to correct the physical defects
which are now held responsible as contributory factors to the
causation of mental disorders.
The following number of specimens were examined in the
hospital laboratory : —
Kind of specimen.
Blood ... ... ...
Urine ... ... ...
Stool ... ... ...
Sputum ... ...
1933
929
850
669
216
1932
355
610
496
167
1931
306
474
730
123
Twenty bacteriologically positive cases of Malaria were
treated with Atebrin and Plasmoquine Simplex with excellent
16
results. All the cases were found to be bacteriologically negative
after the second course. We would have liked to use these
drugs in all Malaria cases for obvious reasons, but such was not
possible due to the prohibitive cost of these drugs.
Teeth.—Patients suffering from oral sepsis requiring imme-
diate treatment were attended to as in the previous years by the
medical staff of the hospital.
The proposal of appointing a Dentist on a monthly payment
of honorarium has been recommended by the Managing Com-
mittee of this hospital to the Government and the matter is
under their consideration. The appointment when sanctioned,
will remove a long-felt want of this hospital.
Syphilis.—The blood of all patients, newly admitted and
the Cerebro-spinal Fluid in some special cases, were sent to the
Prince of Wales' Medical College, Patna, for Wassermann test.
During the year under report 227 specimens of blood and 30
specimens of C. S. F. were sent for W. R. test, out of which
51 of the former and 9 of the latter were positive. All positive
cases were given full course of Anti-syphilitic treatment.
There is no doubt that the great improvement in the
general health of patients in the mental hospitals and the
decrease in the epidemic and endemic diseases is due to the
introduction of hospital methods of treatment and greatly
improved hygienic conditions. The improvement in the physical
health of the patients of this hospital has undoubtedly done
much to bring about improvement in their mental condition as
is shown by the steadily maintained high recovery rate and low
death-rate.
Cataract operations.—During the year under review cataracts
were successfully removed from 9 patients under local
anæsthesia and thus their sights were restored.
(v) Hydrotherapy.—As continuous baths are used extensively
in this hospital for various psychotic conditions especially to
allay excitement, it is necessary that some reference should be
made here to the results which were obtained from this form of
hydrotherapy. During the year under report 308 cases were
given hydrotherapy and the average number of hours of immer-
sion of patients was 34.25 and in good many cases the results
were astonishing.