16
LUNATIC ASYLUMS IN BENGAL.
months, during the whole of which time he behaved in the most quiet and
sober manner, conversed rationally on all subjects, worked hard in the garden
and gained weight, and had only a confused recollection of the period he had
spent in the asylum in the exalted state I have described. He had been a
ganja-smoker and spirit-drinker, and his insanity had lasted only 25 days
before his admission. His exaltation continued without abatement till he
was taken into the hospital on the 13th March 1877 with the symptoms
mentioned, and he was discharged from the asylum on the 31st October 1877
'clothed and in his right mind.'"
The greatest number of recoveries and improvements took place among
cases of acute mania, and the least among those of chronic dementia.
Assigned
causes
of insanity.
10. Among the assigned causes, ganja was the commonest, and it was also
found that the greatest number of recoveries occurred in cases in which the
use of this drug was the assigned cause. In two cases the abuse of ardent
spirits was given as the cause. The disease was said to have been hereditary
in four cases. It is said that the lunatics are put to out-door work, and
Dr. Crombie suspects that occasionally when so employed they get ganja from
their relatives or friends.
Sickness.
11. Sickness.—During the year the total number of cases of sickness
treated was 268 (243 males and 25 females). The daily average number of
sick was 18.6, or 9.1 per cent. of the daily average strength. The diseases most
common were fevers, next diarrhœa and dysentery. In the year 1877 37.9
per cent. of the inmates of the asylum were attacked with bowel complaints,
against 51.9 in 1876 and 49 in 1875. Dr. Crombie thinks that the lower rate
of admissions from bowel complaints is justly to be attributed to the " great
care that has been taken with regard to the quantity and quality of the food
which has been supplied to the lunatics." He adds—" I, moreover, have
each man weighed from time to time, and require an explanation from the asylum
servants if I find any man losing weight. I may here remark, though I cannot
state the exact gain in weight during the year, that a very large majority of
the inmates have gained flesh during the time I have carried out this system."
Local injuries caused 32, or 12.9 per cent., of the total admissions. They
were all males, and nine were scalp wounds, and 12 were contusions or wounds
of the upper extremity and nine of the lower. Two were fractures of the forearm.
All of these were slight injuries, and were in nearly every case the result of
quarrels between lunatics at work.
Cholera.
There were seven cases of cholera, with three deaths. " With regard to the
cause of cholera," writes Dr. Crombie, " occurring in this asylum, I can only
remark that these are the cholera months in Dacca,* and the neighbouring institu-
tion, the jail, is invariably affected at, or immediately before or after, the occur-
rence of cases in the lunatic asylum. The two institutions are without anything
in common except their situation in the same locality. The jail derives its water
from wells within the jail premises; the water for the asylum is brought daily
in a cart from the river. The food is supplied by a different contractor.
Though there is a door of communication from one to the other, it is solely
used by the medical officer, who is never brought into contact with the prisoners
except those in hospital (who escape cholera) and at the weekly . inspections,
when he walks in front of them. None of the jail officials or warders ever
enter the lunatic asylum. They have virtually no more in connection than
they would have were they one hundred miles apart, and yet cholera invari-
ably occurs in the two institutions almost simultaneously, and that only at times
when it is occurring all over the district in almost every village. It would be
strange if cholera did not occur in the lunatic asylum and jail at the same time
also, for they really constitute largish villages."
Solitary
confinement.
12. Solitary confinement and restraint.—Hitherto no regular register of the
number of patients in confinement was maintained previous to Dr. Crombie's
assuming charge; but such a record has been kept since September, and the number
since then has varied from five to ten, and latterly five or six. Solitary confinement
is had recourse to in order to prevent patients injuring themselves or others, and
occasionally as a " punishment for mischief or other misconduct on the part of
the inmates, whose behaviour I think will be influenced by such a procedure.
This is done, however, with great discrimination and care, lest it should act
* March, April, May, and December.