NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
iii
the absence of proper care, treatment and supervision of people
suffering from mental defects in these two provinces is leading to
any serious mental deterioration of the people.
10. The problem is one which has hitherto affected a people
the majority of whom live under primitive conditions, but with
the advent of education amongst the masses, the conditions
visualised by the Superintendent, viz., an accelerated tempo of
living, may be productive eventually of greater mental strain and
an increase of mental disorders.
11. Whether this epoch is advancing slowly or rapidly, the
effective repercussions of the administration to meet such a situa-
tion will, as at present, depend on financial considerations.
12. The question to be decided is whether India should
follow the policy of other countries and erect more mental hospitals
or the alternative policy of allowing the care of the mental cases
to devolve upon the. communities where they reside. It is again
the problem of decentralisation and whether it is wise to develop
the Policy of Self Help Associations at the periphery, rather than
attempt to overcome a complicated and enormous problem by
central organisations.
One cannot visualise a mental hospital being erected in every
district in a province, similar to the county asylums in England,
and the alternative method would appear to be one for serious
consideration. This alternative method implies that the care of
the mental cases should be the responsibility of the community in
which they live—an opportunity for the philanthropist and the
cultivation of the spirit of civic responsibility. In this respect
one may add that the institution of the Private Mental Home, the
absence of which the Superintendent deplores, is not irrelevant.
13. The question of whether it is wise to herd a large
number of people of unsound mind together in one institution
with the intention of effecting a return to the normal mental
state, is not a controversial one, but one of expediency and prin-
ciple. Expediency in that the relations of the patient are not in
a position to take care of him; principle, in that the services of
a mental expert are not available It would therefore follow
that if the community is to be responsible for its own insanes,
the medical men who are available in the vicinity should have
a practical knowledge of the modern methods of psychiatry and
be available for advice.
14. In this respect this country is very much below standard
and the suggestion of a higher training for medical graduates
iv
and the institution of mental clinics in all large hospitals is
a necessary preliminary to the decentralisation method of
treatment of mental patients.
15. The present advance to reorientate the views of the medical
profession on disease with the modern methods of psychological
work is one of great importance in the treatment of mental con-
ditions in the early stages, and is obviously an endeavour to
prevent complete breakdowns ; and this preventive work is the
responsibility not of the mental expert, but of the general
practitioner.
16. How many persons of unsound mind there are at present
in the two provinces is one for conjecture. According to the
last Census return, 1931 the following figures are given :—
BENGAL.
Total population.
British Territory ... ... ...
British States ... ... ...
Total ...
Number of insanes—
British Territory ... ... ...
British States ... ... ...
Total ...
Ratio of insanes to population—4.4 per 10,000.
50,114,002
973,336
51,087,338
21,705
697
22,402
BIHAR AND ORISSA.
Total population.
British Territory...
...
...
Feudatory States...
...
...
Total ...
37,677,576
4,652,007
42,329,583
NUMBER OF INSANES.
British
Territory...
...
...
Feudatory
States...
...
...
Total ...
Ratio of insanes to population—2.1 per 10,000.
8,264
781
9,045
These figures when compared with the record of the number
of insanes in England and Wales as given in the 1911
Census, viz., 44.9 per 10,000, would appear to indicate that
v
insanity is less prevalent in India than in the West. But it is
not improbable that the figures given in the Indian Census
return do not include all the half-witted or feeble-minded
that would be included in the census for England and Wales.
Otherwise one might infer from these comparative figures that
the majority of the population is not yet subjected to the strain
of living which is extant in the West, and that if a large number
of feeble-minded have not been included in the Census figures,
that these feeble-minded are perhaps the result of hereditary
defects rather than any acceleration in the tempo of living.
17. How far consanguinity in marriages is responsible for
the village idiot or half wit is a matter which has never been
made the subject for investigation, but that village life in India
lends itself to such marriages, may be accepted as a probability.
18. Until the actual conditions prevailing in India of mental
deficiency are made known by an authoritative official enquiry,
it is premature to suggest any measures for its prevention, either
by segregation, sterilisation or imposing restrictions on the
relatives or guardians of such cases.
19. Major J. E. Dhunjibhoy, I.M.S., continues to administer
the institution with the self-confidence and acumen which
characterises this officer.
I have the honour to be,
SIR,
Your most obedient servant,
L. COOK, COL., I.M.S.,
Inspector-General of Civil Hospitals,
Bihar and Orissa.
TRIENNIAL REPORT
ON THE
Working of the Ranchi Indian
Mental Hospital, Kanke, in
Bihar and Orissa for the years
1930-32.
1. Provinces served.—During the triennium under review
this hospital continued to receive patients as in the previous
years from the provinces of Bengal and Bihar and Orissa.
2. Administration.—During the early part of the triennium
under report, namely from 1st January 1930 to 8th August 1930,
Dr. P. C. Das, M.B., First Assistant Superintendent, held charge
of the hospital as I was on leave ex-India. On return from
leave I assumed charge of the hospital on the 9th August 1930
and continued till the end of the triennium under review except
for a short period of one month and seven days, when I was
away on leave for reasons of health, making over charge to the
First Assistant Superintendent.
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 bed accommodation is
distributed in the proportion of three-fourth to Bengal and
one-forth to Bihar and Orissa. The male section of the hospital
remained congested throughout the triennium and 50 emergency
beds sanctioned by Government for this section in 1929 were in
great demand throughout the period under report. Owing to
financial stringency none of the badly needed additional buildings
included in the scheme of expansion of this hospital could be
constructed.
4. Patients.—The following table shows the number of
patients resident in the hospital on the 1st January of the three
years of the triennium under report:—
Year.
1932... ... ...
1931
...
...
...
1930
...
...
...
Male.
1,045
1,034
1,049
Female.
227
222
215
Total.
1,272
1,256
1,264
2
Special efforts were made to discharge 43 chronic and
harmless patients to the care of their relatives who could be
traced out by the Magistrates of their districts. As a result,
18 patients were discharged and in 14 cases no friends or relatives
could be found in spite of vigorous enquiries instituted by the
Magistrates concerned. In 11 cases inability for financial
reasons to take charge of the patients was accepted by the
enquiring Magistrates and they were, therefore, not discharged.
5. The maximum number of patients resident in the
hospital on any one night was 1,285 (1,049 males and 236
females) in 1932 against 1,280 (1,051 males and 229 females) in
1931, and 1,464 (1,049 males and 215 females) in 1930.
6. Total admissions.—The following table shows the admis-
sions (including readmissions) :—
Year.
1932...
...
...
1931
...
...
...
1930...
...
...
Male.
97
97
63
Female.
39
35
36
Total.
136
132
99
7. Total population.—The total population of the hospital
was 1,408 (1,142 males and 266 females) in 1932, 1,388 (1,131
males and 257 females) in 1931, and 1,363 (1,112 males and 251
females) in 1930.
8. Daily average strength.—The daily average strength of
the hospital is shown in the following table :—
Year.
1932
...
...
...
1931
...
...
...
1930
...
...
...
Male.
1043.53
1033.34
1040.05
Female.
229.22
226.07
218.08
Total.
1272.75
1259.41
1258.13
9. (a) The ratio per cent of cases cured to the daily average
strength was 5.97 (5.75 males and 6.98 females) in 1932 as
compared with 4.53 (4.16 males and 6.19 females) in 1931 and
4.69 (3.94 males and 8.71 females) in 1930.
(b) The ratio per cent of cases cured to the total admission
was 25.00 (25.77 males and 23.08 females) in 1932 as compared
with 14.39 (13.40 males and 17.14 females) in 1931 and 24.24
(23.49 males and 22.22 females) in 1930.
3
10. Total duration of hospital life of patients discharged is
shown in the sub-joined table :—
Period.
Under 2 months ... ... ...
Over 2 months and under 4 months ... ...
Over 4 months and under 6 months ... ...
Over 6 months and under 8 months ... ...
Over 8 months and under 1 year ... ...
Over 1 year and under 3 years ... ...
Over 3 years and under 5 years ... ...
Over 5 years and under 10 years ... ...
Over 10 years and under 15 years ... ...
Over 15 years and under 20 years ... ...
Over 20 years ... ... ...
1932.
1
17
12
9
28
19
7
10
1
2
1
107
1931.
3
13
7
5
6
10
10
17
9
5
2
87
1930.
2
18
8
10
8
14
8
7
1
2
3
81
11. Death rate.—The percentage of deaths to daily average
strength is shown in the following table :—
Year.
1932
...
...
...
1931
...
...
...
1930
...
...
...
Male.
1.82
2.03
2.02
Female.
0.87
3.10
2.29
Total.
1.65
2.30
2.07
It is very gratifying to note that this largest mental
Hospital of India has still continued to maintain the lowest
death rate of all the other Indian Mental Hospitals of India.
A comparative statement showing percentage of deaths in
different Indian Mental Hospitals in India as well as the Ranchi
European Mental Hospital at Kanke is appended below :—
Names of the Indian Mental Hospitals.
Ranchi Indian Mental Hospital ... ...
Lahore Mental Hospital ... ...
Yeravda Mental Hospital ... ...
Madras Mental Hospital ... ...
Rangoon Mental Hospital ... ...
Nagpur Mental Hospital ... ...
Tezpur Mental Hospital ... ...
Agra Mental Hospital ... ...
Ranchi European Mental Hospital ... ...
1932.
1.65
7.68
5.3
6.40
5.06
6.01
7.91
12.40
1.50
1931.
2.30
12.28
9.6
6.60
5.29
5.42
7.15
8.62
8.14
1930.
2.07
9.02
6.1
7.41
6.42
8.49
3.94
6.46
6.92
4
12. The chief causes of deaths among patients resident in
the hospital are shown in the following table :—
Causes of deaths.
Malaria ... ...
Pneumonia ...
Tuberculosis (lungs) ...
Diabetes ...
...
All other general diseases
Diseases of the nervous
system of
which
pathological basis is
not known.
Ditto
do.
it known.
Diseases of the circula-
tory system.
Diseases of respiratory
system.
All other diseases of the
digestive system.
Acute or Chronic Neph-
ritis.
Injury, general or local
Dysentery...
Leprosy ...
Abscess of the Liver ...
All other diseases of the
Liver.
All other diseases of the
Urinary system.
Pyrexia of uncertain
origin.
Diseases of the stomach
1932.
Males.
..
4
3
...
3
...
2
2
...
...
...
1
...
1
1
1
1
...
...
Females.
...
...
...
...
1
...
...
...
1
...
...
...
...
...
...
...
...
...
...
Total.
...
4
3
...
4
...
2
2
1
...
...
1
...
1
1
1
1
...
...
1931.
Males.
2
2
2
1
7
1
...
...
1
3
2
1
...
...
...
...
...
...
...
Females.
...
...
...
...
5
...
...
1
...
1
...
...
...
...
...
...
...
...
...
Total.
2
2
2
1
12
1
...
1
1
4
2
1
...
...
...
...
...
...
...
1930.
Males.
...
2
5
1
6
3
...
2
...
...
1
...
...
...
...
...
1
...
1
Females.
...
...
1
...
1
...
...
1
...
...
...
...
1
...
...
...
...
1
...
Total.
...
2
6
1
7
3
...
3
...
...
1
...
1
...
...
...
1
1
1
5
13. Duration of hospital life of those who died is shown in
the annexed table :—
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
6 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 ...
1932.
Males.
4
2
...
...
...
5
...
2
4
1
1
...
...
...
19
Females.
...
...
2
...
...
...
...
...
...
...
...
...
...
...
2
Total.
4
2
2
...
...
5
...
2
4
1
1
...
...
...
21
1931.
Males.
3
2
...
1
2
3
1
6
2
3
...
...
...
22
Females.
2
...
...
...
1
3
...
...
...
...
...
...
1
...
7
Total.
5
2
...
1
1
5
3
1
6
2
3
...
1
...
29
1930.
Males.
2
...
3
...
2
1
2
4
...
1
1
1
3
...
21
Females.
1
...
...
...
2
...
...
1
...
1
...
...
...
...
5
Total.
3
...
3
...
4
1
2
5
1
2
1
1
3
...
26
6
The ages of the patients who died are shown below:—
Ages.
1
Under 20 years of age
Between 20 and 40 years
Between 40 and 60 years
60 years and upwards
Total ...
1932.
Males.
2
...
4
12
3
19
Females.
3
1
1
...
...
2
Total.
4
1
5
12
3
21
1931.
Males.
5
...
7
13
2
22
Females.
6
...
4
1
2
7
Total.
7
...
11
14
4
29
1930.
Males.
8
...
7
8
6
21
Females.
9
...
4
...
1
5
Total.
10
...
11
8
7
26
14. Health of patients.—The general health of patients
remained good throughout the triennium under report except
for about two months in the year 1931 when influenza broke
out in a mild epidemic form. The daily average number of sick
treated in the infirmaries for bodily ailments was 55 91 (52.21
males and 3.70 females) in 1932; 60.46 (57.62 males and 2.84
females) in 1931 and 61.60 (59.93 males and 1.67 females)
in 1930.
The important admissions in the infirmaries are shown in
the subjoined table :—
Diseases.
1
Ankylostomiasis
...
Dysentery ...
(a) Malaria ...
Kala-azar ...
Influenza
...
Pneumonia ...
1932.
Males.
2
22
5
84
...
64
6
Females.
3
2
...
1
...
4
...
Total.
4
24
5
85
...
68
6
1931.
Males.
5
16
6
71
1
314
2
Females.
6
5
1
14
...
26
...
Total.
7
21
7
85
1
340
2
1930.
Males.
8
...
6
40
...
85
3
Females.
9
...
4
13
...
10
...
Total.
10
...
10
53
...
95
3
(a) In 1932—25 cases, 1931—19 cases and 1930—13 cases were bacteriologically positive and all the rest were
clinically positive.
7
Diseases.
1
(b) Tuberculosis of Lungs
All other general diseases
Diseases of the eye ...
Diseases of the respira-
tory system.
Diseases of intestine ...
All other diseases of the
disgestive system.
Other diseases of the
generative system.
Diseases of Organ of
Locomotion.
Inflammation Ulcerative
Other diseases of the
skin.
Injuries general or local
Nervous
system—
diseases of which the
pathological basis is
not known.
Nevrous
system—
diseases of which the
pathological basis is
known.
Acute or
chronic
Nephritis.
Acute or suppurative
inflammation of lym-
phatic glands.
All other diseases of the
Urinary system.
Diseases of the Areolar
tissue.
Diseases of the circula-
tory system.
1932.
Males.
2
2
35
7
9
13
42
12
2
48
14
55
...
7
...
1
12
50
2
Females.
3
1
3
1
6
7
1
...
1
4
...
4
...
...
...
1
...
2
1
Total.
4
3
38
8
15
20
43
12
3
52
14
59
...
7
...
2
12
52
3
1931.
Males.
5
4
38
17
15
36
37
3
2
33
36
74
4
4
1
1
3
37
...
Females.
6
1
7
...
3
3
3
...
...
3
...
7
...
...
...
...
1
4
1
Total.
7
5
45
17
18
39
40
3
2
36
36
81
4
4
1
1
4
41
1
1930.
Males.
8
4
50
10
89
80
82
7
10
28
31
63
...
...
...
...
...
...
...
Females.
9
1
14
1
7
4
2
...
...
2
1
...
...
...
...
...
...
...
...
Total.
10
5
64
11
96
84
84
7
10
30
32
63
...
...
...
...
...
...
...
(b) In 1932—all three were bacteriologically positive, in 1931—out of 5, 4 were bacteriologically and 1
linically positive and in, 1930 all the five cases were bacteriologically positive.
8
15. Cases under observation.—The total number of cases
held under remand for brief periods of observation was 53
(36 males and 17 females), viz. 4 (1 male and 3 females) in 1932,
25 (16 males and 9 females) in 1931 and 24 (19 males and 5
females) in 1930. Of the 53 cases, 23 (6 males and 17 females)
were certified and admitted ; 12 males were discharged as
uncertifiable ; 17 males were certified as non-violent and easily
manageable at homes and were released by the committing
Magistrates and 1 male patient died of Uraemia (Diabetes)
during his period of observation.
16. Statement II.—Criminal patients.—The annexed table
shows the daily average strength of criminal patients :—
Year.
1932
...
...
...
1931
...
...
...
1930
...
...
...
Male.
434.58
433.47
450.63
Female.
34.25
34.22
34.13
Total.
468.83
467.69
484.76
The following table shows the analysis of offences committed
by the criminal population of this hospital.
—
Class I
...
...
...
Class II
...
...
...
Class III ... ... ...
Total
Murder.
M.
97
117
43
257
F.
8
14
3
25
T.
105
131
46
282
Cupable homicide.
M.
30
19
7
56
F.
3
3
...
6
T.
33
22
7
62
Grievious hurt.
M.
52
16
1
69
F.
1
...
...
1
T.
53
16
1
70
Rape.
M.
2
...
...
2
F.
...
...
...
...
T.
2
...
...
2
Mishief by fire.
M.
6
4
...
10
F.
...
...
...
...
T.
6
4
...
10
Attempt to
commit suicide.
M.
2
1
...
3
F.
1
...
...
1
T.
3
1
...
4
Exposure and aban-
donment of child.
M.
...
...
...
...
F.
1
1
1
3
T.
1
1
1
3
Petty offences.
M.
25
10
1
36
F.
1
1
1
3
T.
26
11
2
39
Total.
M.
214
167
52
433
F.
15
19
5
39
T.
229
186
57
472
9
The above table speaks for itself and needs no explanation.
More than 50 per cent of the criminal population are murderers ;
some of whom have more than one murder to their credit. It is
a very grave responsibility thrown upon the administration of
this institution to house and guard these acute homicidal insanes
with limited staff. This difficulty has been realised by the
Government and the extension of the present Refractory Block
as included in the scheme of expansion of this hospital has
been administratively approved by Government.
17. Statement no. III.—Shows the religion, sex and residence
of the patients admitted into the hospital during the period
under report and is self-explanatory.
18. Statement no. IV.—Shows the previous occupation of
patients admitted during the triennium under review.
19. Statement no. V.—Shows the ages of patients admitted
into this hospital during the period under report. It will appear
from the statement given below that the largest number of
patients admitted every year is between the ages of 20 and 40.
The ages between 40 and 60 claim the next best place in order
of frequency :—
Ages.
Under 20 ... ... ... ...
Between 20 and 40 ... ... ...
Between 40 and 60 ... ... ...
Upwards 60 ... ... ... ...
1932.
12
98
25
1
1931.
12
98
21
1
1930.
7
69
19
4
20. Statement no VI—Shows the types of insanity of the
patients admitted into the hospital.
The following were the principal forms of mental diseases
in patients treated in the hospital throughout the triennium
under report:—
1. Manic depressive psychosis.
2. Schizophrenia (dementia praecox).
3. Confusional insanity.
4. Toxic insanity (chiefly ganja and alcohol).
5. Mental defective.
6. Epileptic insanity.
7. Senile psychosis.
8. Secondary dementia.
9. Psycho-Neuroses (anxiety states and hysterias.)
10. Encephalitis lethargica (apache types).
10
21. Statement no. VII—The causes and outcome of mental
disorders.—As in the other departments of medicine, so in
psychological medicine we find two classes of causes operative—
predisposing and exciting. The predisposing causes are made
up of those conditions existing within the individual and which
render him liable to the development of mental disorder under
favourable circumstances. The exciting causes are those circum-
stances and conditions which produce the actual attack of mental
disturbance operating usually upon predisposing soil.
Statement no. VII shows the Ætiological factors and
associated conditions in the patients admitted during the year
1932, and is self-explanatory. In majority of the cases no cause
could be ascertained due to practically no information being
supplied by the police in the descriptive rolls of patients. In
the Western countries, where statistics are reliable an inherited
predisposition to mental disorders is found at an average in 60
to 70 per cent of cases admitted into mental hospitals. But any
one who is at all familiar with the collection of statistics in India
must know how impossible it is for them to fully represent the
facts in such a matter. If one were to take up an annual
report of any institution for the insane and turn to the table
giving the causes of insanity in the several patients under treat-
ment one will find assigned such causes as the following:—
Business and domestic worries, loss of property, disappoint-
ment in love, domestic troubles, excessive study, loss of near
relatives, political excitement, sexual frigidity or starvation,
tyranny by mother-in-laws, cruelty and neglect by husbands,
excessive religious tendency, etc.
How many of us must have suffered at sometime or other
from some or perhaps all of these so-called above stated exciting
causes of insanity and yet despite this fact we find that sanity is
the rule—insanity the exception.
It therefore proves beyond doubt that whatever the exciting
cause of insanity may be, undoubtedly the chief predisposing
cause is unstable mental heredity. The term " hereditory predis-
position " here has a wider application than to those born of
insane parents only.
It includes such defects as extreme nervousness, eccentricity,
alcoholism, epilepsy, vagrancy, child-marriage, faulty up-
bringings, lack of moral training and any want of balance
in mental development. In addition to this, the offspring of
syphilytic, gouty, rheumatic and phthisical parents are infinitely
more liable to suffer from mental disorders than those sprung
from healthy stocks.
11
A great deal of what heretofore has been regarded as here-
ditary predisposition is now regarded by the psycho-analysts as
" quite possibly individual " and due to causes which almost
are preventible. In a certain sense a large number, if not all
of the psychoses, can be considered as life reactions. That is,
a defect of adjustment only develops upon the basis of some
weak point in the personality make up and that weak point can
be traced to its developmental beginnings in the early life.
The presence of unconscious complexes cause reactions such as
anxiety and obsessional neurosis, hysteria, etc., which seem to
be constitutional only because the real causes are buried from
sight.
22. Paying patients.—The
following table shows the
number of patients treated in the hospital:—
Year.
1932 ...
1931 ...
1930 ...
Male.
57
61
60
Female.
26
25
19
Total.
83
86
79
Owing to financial stringency the construction of paying
patients' blocks by Government could not be taken up and
this class of patients as in the previous years was treated in
a dormitory specially reserved for this purpose in one of the
hospital blocks. This makeshift arrangement to house the
paying patients being limited, several applications from this
class of patients for admission had to be refused. It is a regret-
table fact that in a vast country like India there is not a single
private mental nursing home or hospital of repute where this
class of patients can seek admission.
In all civilized countries in the West the States provide
limited accommodation for their mentally afflicted population
and the rest of the demand is supplemented by the local bodies,
such as the corporations, municipalities and various charity
organizations whether communal or otherwise. Although
there is no dearth of private mental nursing homes and hospitals
in the Western countries as in India yet the corporations
and municipalities run their own mental hospitals, homes,
mental clinics and child guidance clinics. Moreover, the
majority of the municipalities launch a complete mental hygiene
programme for the benefit of their rate-payers and carry it out
to its fullest extent.
Modern civilization and mental strain.—We live in an age
dominated by machinery and this has increased the speed at
which we work and play and carry on many other activities to