( 7 )
The public health in the town and district of Dacca shewed marked im-
provement. Bowel disorders were reduced ; pulmonary diseases are not distin-
guished in the Sanitary Returns. In probable accordance with this general
improvement, nothing is said in the Asylum Report of the condition of lunatics
on admission.
17. At Berhampore the additional deaths were due as follows:—To dropsy
3 ; to bowel disorders 2. There were 12 deaths from the latter in 1879, and
10 in 1878; from the former there were none in 1878. Of the 12 cases 7 brought
their illness from Hazareebagh, and one of the other three. The increase
of mortality at Berhampore being more than explained by the state of the
lunatics from Hazareebagh it is unnecessary to enquire further. The health of
town and district was good, bowel disorders being greatly reduced. There was
increase of death from bowel disease in the jail but none from phthisis or
other respiratory disorders.
18. As summary conclusions from the foregoing facts and figures, I submit
the following:—
Having regard to the very low death numbers of 1877 and 1878 an
aggregate increase of 31 on the latter has not necessarily any pointed signifi-
cance.
The health of the lunatics confined at Hazareebagh had become very bad,
particularly in respect of pulmonary disease. Their return to the plains,
though beneficial to themselves, largely increased mortality in the asylums
which received them, in three out of four instances.
That where the entire mortality was largest, it corresponded closely with
the public health of the neighbourhood. At Patna the asylum shared the
general sickness from zymotic disease. At Calcutta the asylum suffered from
those special diseases which had shewn increased fatality outside, amid
general improvement in the public health. At Berhampore the public health
was good, as was that of the lunatics locally received. At Dacca there was
unexplained increase of death from bowel affections, while, in increase of
pulmonary disease, the vicinity corresponded. Where mortality was large,
chronic invalids felt severely the special influence of the season, both new
comers and old residents. Although there is no proof of increased production
of constitutional phthisis, those persons in whom this had become a pulmonary
disease suffered from a season which was notably unfavorable to pulmonary
invalids in general.
The method of grouping facts for annual reports is more or less artificial.
A record of deaths within a given period is not evidence of production of
disease within the period where chronic maladies are concerned ; although in
regard of most zymotic and acute diseases a year is a natural unit of time.
Nowhere was there such original production of sickness in the year 1879
as would point to any removable cause within the walls of an asylum, either of
a general or special character.
19. I am unable to offer any suggestion for improvement, and
propose only to provide that examination post mortem be made an invariable
practice when death takes place in an asylum, with a view to closer com-
parison in respect of conditions which may be variously named, and with
exception only of the rare cases in which friends of the deceased may rain
objection.
I have the honor to be,
SIR,
Your most obedient servant,
A. J. PAYNE, M.D.,
Surgeon- General, Bengal.
N. T W.—Res. No. 2043J.—251—26-5-80.