NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
No. 11697/11—121-1/35
FROM
LT.-COL. P. S. MILLS, I.M.S.,
INSPECTOR-GENERAL OF CIVIL HOSPITALS,
BIHAR AND ORISSA,
To
THE SECRETARY TO THE GOVERNMENT OF
BIHAR AND ORISSA, LOCAL SELF-GOVERNMENT
DEPARTMENT.
Dated Patna, the 27th August 1935.
SUBJECT—Annual report on the working of the Ranchi Indian Mental
Hospital, Kanke, for the year 1934,
SIR,
I HAVE the honour to submit, for the information of
Government, the Superintendent's report on the working of the
Ranchi Indian Mental Hospital during the year 1934, together
with the returns in the prescribed forms.
2. The institution has maintained the high level of efficiency
which has characterized it in the past.
I have the honour to be,
SIR,
Your most obedient servant,
P. S. MILLS,
LT.-COL., I.M.S.,
Inspector-General of Civil Hospitals,
Bihar and Orissa.
ANNUAL REPORT
ON THE
Working of the Ranchi Indian
Mental Hospital, Kanke, in
Bihar and Orissa for the year
1934.
1. Provinces served.—During the year under report the
Ranchi Indian Mental 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 throughout
the year under report.
3. Accommodation.—The accommodation of the hospital
remained the same as in the previous years, viz., 1,014 for males,
272 for females, total 1,286. The 50 emergency beds sanctioned
by Government in 1929 to relieve overcrowding in the male
section were in demand throughout the year.
There was no overcrowding in the female section.
As reported in the previous years, none of the expansion
projects could be taken up during the year under review, owing to
continued financial difficulties.
4. Patients. —The following table shows the number of
patients resident in the hospital on 1st January 1934 and two
previous years:—
Year.
1934 ... ... ...
1933 ... ... ...
1932 ... ... ...
Male.
1,049
1,041
1,045
Female.
234
239
227
Total.
1,283
1,280
1,272
2
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.
1934
... ... ...
1933
...
...
...
1932
... ... ...
Male.
1,053
1,059
1,049
Female.
242
239
236
Total.
1,295
1,298
1,285
6. Total admission.—The following table shows the
admissions (including re-admissions) during 1934 and two
previous years :—
Year.
1934
...
...
...
1933
...
...
...
1932
...
...
...
Male.
89
116
97
Female.
37
28
39
Total.
126
144
136
7. The total population of the hospital, during the year
1934 as compared with two previous years, is shown in the
following table :—
Year.
1934
...
...
...
1933
...
...
...
1932 ... ... ...
Male.
1,138
1,157
1,142
Female.
271
267
266
Total.
1,409
1,424
1,408
3
8. The daily average strength of patients resident in the
hospital in 1934 as compared with two previous years was as
follows :—
Year.
1934 ... ... ...
1933 ... ... ...
1932
... ... ...
Male.
1048.51
1047.12
1033.34
Female.
238.36
240.44
226.07
Total.
1286.87
1287.56
1259.41
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.
1934
... ... ...
1933 ... ... ...
1932 ... ... ...
Male.
5.34
5.63
5.75
Female.
7.56
7.90
6.98
Total.
5.75
6.06
5.97
10. The ratio per cent of cases cured to the total admission
for the year 1934 and two previous years is appended below :—
Year.
1934 ... ... ...
1933 ... ... ...
1932 ... ... ...
Male.
30.34
26.72
25.77
Female.
27.03
35.71
23.08
Total
29.36
27.78
25.00
As pointed out in my last report, the so-called new
admissions during 1934, which number 126, were by no means
early cases. In theory the advantage of treatment in the early
and hopeful stage is not disputed ; indeed, it is indisputable.
It seems that we shall never be able to see early cases in this
4
hospital for treatment in large numbers amongst our newly-
admitted patients until such time the public mind is sufficiently
educated in India as to the advantages of early treatment in
modern mental hospitals. No matter how much we may
deplore it, a strong odium is still attached to mental disease, and
the relations desire to keep secret the fact that no one in their
family is so affected. In my private practice I have been
often requested by relatives to visit the patients after sun¬
set so that I may not be spotted by neighbours and the fact may
not become public. The problem of encouraging early treat-
ment cannot be solved without securing the confidence of the
patient and of his family and any measure which will conduce
to this end is worthy of careful consideration. It will not be
out of place to report below the words of His Majesty the King
Emperor, while opening the Shenley Mental Hospital in
England on 31st May 1934 : " I note with satisfaction that, in
designing this hospital, you have paid special regard to the
treatment of the mental illness in its early stages by the addi-
tion of a Reception Hospital which I look forward to seeing
to-day. " Moreover, 40 per cent of this so-called new admissions
were not only suffering from chronic mental diseases but were
equally bad in their physical health. Good many were admitted
in a very low state of health, markedly anæmic with conse-
quent debility. Some were treated as suspected cases of Tuber-
culosis of Lungs. In fact, tubercle bacilli were detected in the
sputum of two newly admitted cases, and one of them subse-
quently died. In spite of the above difficulties, 29.36 the ratio
per cent of cases cured to the so-called new admissions should
be considered as extremely satisfactory and justifies the expense
on a modern mental hospital.
11. Death-rates.—The percentage of deaths to the daily
average strength for the year 1934, as well as that of the two
previous years, is given below :—
Tear.
1934
..
..
..
1933
..
..
..
1932
..
..
..
Male.
2.29
2.20
1.82
Female.
2.94
2.08
0.87
Total.
2.41
2.17
1.65
I am happy to be able to record that the death-rate of this
largest mental hospital has again been the lowest of all the
other mental hospitals of India,
5
12, The chief causes of deaths among the patients resident
in the hospital during the year 1934 are shown below :—
Tuberculosis of Lungs.
Heart failure.
Ankylostomiasis.
Gangrene of Lungs.
General debility and senility.
13. Duration of hospital life of those who died during the
year 1934 :—
Period.
Under 6 months .. ..
Over 6 months and under one 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
..
..
..
1
3
3
6
1
3
1
1
1
24
Female.
3
..
1
..
1
..
1
1
..
1
1
1
..
..
7
Total.
..
1
1
..
1
1
4
4
6
2
4
2
1
1
31
6
14. The ages of the patients died are shown below :—
Age.
Under 20 years of age .. ..
Between 20 and 40 years .. ..
Between 40 and 60 years .. ..
60 years and upwards .. ..
Total .. ..
Male.
1
7
11
5
24
Female.
..
1
3
3
7
Total.
1
8
14
8
31
15. Health of patients.—The general physical health of
patients has been good throughout the year under report. It is
very satisfactory to note that there has been no outbreak of any
kind of epidemic diseases during the year 1934.
16. Sickness.—The daily average number of sick treated in
the Infirmaries for physical ailments for the year 1934 and two
previous years is given in the subjoined table :—
Year.
1934 .. .. ..
1933
..
..
..
1932
..
..
..
Male.
54.3
59.93
52.21
Female.
10.8
8.10
3.70
Total.
65.1
68.03
55.91
7
The important admissions in the Infirmaries are shown in
the table below :—
Name of: disease.
Dysentery (a) .. .. ..
Leprosy .. .. .. ..
Malaria (b) .. .. ..
Influenza .. .. .. ..
Pneumonia .. .. .. ..
Tuberculosis of the Lungs (c) .. ..
Animal Parasites—Ankylostomiasis .. ..
Round worms .. ..
New growth—Non-Malignant .. ..
Malignant .. ..
All other general diseases .. ..
Diseases of the eye .. .. ..
Diseases of the stomach .. ..
Diseases of the intestine .. ..
All other diseases of the liver .. ..
All other diseases of the digestive system ..
Diseases of the Areolar Tissue .. ..
Inflammation, ulcerative .. ..
Other diseases of the skin .. ..
Injury, general or local .. ..
Enteric fever .. .. ..
Male.
22
1
119
..
2
12
65
21
..
1
63
6
2
32
3
165
52
31
28
95
..
Female.
4
..
21
4
..
1
25
2
1
..
3
..
..
7
..
13
5
1
..
10
1
Total.
26
1
140
4
2
13
90
23
1
1
66
6
2
39
3
178
57
32
28
105
1
(a) Out of 26 cases, 6 were of Amœbic type and the rest were of Bacillary type.
(b) Out of 140 cases, 126 cases (105 males and 21 females) were Bacteriologically posi-
tive (B. T.-74, M. T.-43 and B. T. and VI. T.-9-126).
(c) Out of 13 cases (12 males and 1 female), 8 (7 males and 1 female) were
Bacteriologically positive and the rest 5 males were clinically positive.
It is very gratifying to note that the insanitary area within
the male enclosure as pointed out in my last Annual Report,
has since been reclaimed at a cost of Rs. 1,180. This work was
sanctioned by Government on the recommendation of the
Managing Committee and I have every reason to believe that
this heavy outbreak of malaria in the male enclosure will now be
generally lessened.
About 9,725 patients were treated as outdoor patients in
the Infirmaries for minor ailments such as ulcers, slight injuries,
headaches, constipation, etc.
8
17. Cases under observation.—The total number of patients
held under remand for brief periods of observation was 7(3
males and 4 females) against 6 (4 males and 2 females) in 1933
and 53 (36 males and 17 females) in 1932.
Of the 7 cases, 1 male and 3 females were certified and
admitted and two male patients were released as uncertifiable.
One female patient remained under observation up to the 31st
December 1934.
18. Statement no. II—Criminal patients.—The annexed
table shows the daily average strength of criminal patients.
Year.
1934
..
..
..
1933
..
..
..
1932
..
..
..
Male.
433.02
435.83
434.58
Female.
36.79
33.71
34.25
Total.
469.81
469.54
468.83
Thirty-six (27 males and 9 females) criminal patients were
admitted during the year 1934 against 45 (43 males and 2
females) in 1933 and 51(10 males and 11 females) in 1932 and
an analysis of the crimes committed by them is shown in the
table appended below : —
Crime committed.
Murder .. .. ..
Culpable homicide .. ..
Hurt and Grievous Hurt .. ..
Attempt at suicide .. ..
Dacoity with murder .. ..
Petty offences .. ..
Harbouring an offender .. ..
Total ..
Male.
6
2
5
1
2
11
..
27
Female.
3
1
..
1
..
3
1
9
Total.
9
3
5
2
2
14
1
36
9
19. Statement no. III.—Shows the religion, sex and resi¬
dence of the patients admitted into the hospital during the year
1934 and is self-explanatory,
20. Statement no. IV.—Shows the ages of patients admitted
during the year under report.
As in the previous years it will be observed from the figures
given in the table annexed below, that the largest number of
patients admitted was between the ages of 20 and 40 and the
ages between 40 and 60 comes the next in order of frequency.
Ages.
Under 20 years ...
Between 20 and 40 years
„ 40 and 60 „
Upwards of 60 years ...
1934.
Male.
9
67
12
1
Female
6
24
7
...
Total.
15
91
19
1
1033.
Male.
8
81
23
1
Female.
1
14
13
...
Total.
9
38
36
1
1932.
Male.
8
73
15
1
Female.
4
25
10
...
Total,
12
98
25
1
21. Statement no. V.—-Shows the type of insanity of the
patients admitted. The following were the principal forms
treated.
Manic Depressive Insanity.
Mania.
Schizophrenia including D. P.
Epilepsy and Epileptic Insanity.
Acute Confusional Insanity.
Alcoholic Psychosis.
Canabis Indica Psychosis.
General Paralysis of the Insanes.
Neurosis and Psycho-neurosis.
22. Statement no. VI.—-Shows the probable causes of insanity
in the patients admitted during the year and needs no comment.
23. Paying patients.—Eighty-five (63 males and 22 females)
patients were treated in the hospital during the year 1934 as
10
compared with 91 (62 males and 29 females) in 1933 and 83
(57 males and 26 females) in 1932.
The scheme of building separate wards for paying patients
could not be considered owing to continued financial stringency.
Several paying patients had to be refused admission for want of
proper accommodation.
24. Suicide.—I regret to have to report that a very depend¬
able and well behaved patient, who had hitherto never shown
any suicidal tendency, suddenly committed suicide by hanging
during the year under review. The patient was perfectly sane
and took part in a theatrical performance got up by patients
and retired to his bed in a very jovial mood after the play was
over, and committed suicide towards the latter part of the night
in the night-latrine of the Dormitory in which he lived.
The above unfortunate incident once more very forcibly
brings to the fore the fact that in the light of our present
knowledge of " Suicide and its Vagaries" it is practically im-
possible for any human agency to prognosticate or prevent
persons with such sudden impulse at suicide, the exhibition of
which is never betrayed nor the barest suspicion thrown during
life time of the person. However this regrettable incident
which, as stated above, is beyond human control, will not
refrain me from expressing my deepest debt of gratitude to
those attendants who guard the suicidal wards of this largest
hospital in India day and night and it is due to their strict
vigilance that I am happy to be able to record that we have
had no suicides in our Suicidal Wards for the last 8 years
although we have a population of 82 potential suicides who
often make attempts at suicide.
25. Escapes.— Although a considerable amount of freedom
was enjoyed by the patients I am happy to be able to record
that there was no case of escape during the year under report.
26. Accidents and injuries.—There have been no assaults or
injuries or accidents worthy of note among the patients except
the following regrettable injuries to the staff.
A hitherto dependable hypochondriac patient who had
borne some secret grudge against one of the Sub-Assistant
Surgeons, a not very uncommon occurrence with this class of
patients, suddenly got excited and attacked this Sub-Assistant
Surgeon with a improvised knife made of tin and after inflicting
11
a few injuries on his person with it ho immediately ran after
the Second Assistant Superintendent and also attacked him and
assaulted him with the knife causing severe injury on his head
before he could be caught and overpowered by the staff. Both
the officers, I am glad to. say, made a speedy recovery, under
adequate care and treatment.
27. Autopsy.—Twenty-seven
post-mortems were performed
during the year under report and interesting specimens were
preserved in the Laboratory, as usual.
28. Conservancy and Sanitation. — As in the previous years
the supervision of the conservancy and sanitation of the Hospi-
tal, both inside and outside, was strictly maintained. The
general sanitation of the whole area of the Hospital was satisfac-
tory throughout the year under report and as already stated,
there was no outbreak of any kind of epidemic diseases. Besides,
utmost care and attention were paid to the cleanliness of the
Wards and the Thresh Disinfector of the Hospital worked at full
steam throughout for the disinfection of the patients' clothing
and bedding.
29. Treatment of Mental conditions. The treatment of any
mental disorder demands much time and patience. Only extreme
patience and forbearance on the part of every one in contact
with the patient can ensure that consistency and continuity of
treatment that are so essential to success. In the mental disor-
ders it is the patient himself who is being treated and not so
much other parts of his body, and that is why the personal factor
is so important. The secret lies in a proper understanding of
the situation in which the patient finds himself. It is essential
to try and see the world as the patient sees it, to accept for the
time being the reality of his abnormal experience and
to stand along side him in his difficulties. The reason why
Hospital treatment is very desirable and most soothing in many
mental disorders is that the trained staff of the Hospital know
bow to approach the patient properly and the patient feels that
at last he is understood and has some one to rely upon and by
making the most of his confidence it is often possible to avoid
many difficulties and eventually to lead him back to mental
health. As usual strict watch was kept over the latest mental
and medical journals for anything likely to influence in a direct
or indirect way the course of the malady, and neither expense
nor trouble is ever allowed to stand in the way of the employ-
ment of the latest discoveries if thereby the patient can in any
way be benefited.
12
(i) Sulphur injections in mental disorders.—Eighty patients
were given this treatment during the year with the following
results :—
Stationary or no
improvement.
29
Improved.
35
Recovered.
16
Hitherto we have tried this most useful therapy in 295
cases with the following gratifying results :—
Stationary or no
improvement.
114
Improved.
120
Recovered.
51
The above table shows that we have affected 17.3 per cent
recovery and 40.7 per cent improvement in our patients by this
method and we feel more happy over these results as we were
the first in India to experiment with Sulphur injections since
1930. Dr. Knud Shroeder of Demark, the originator of Sulphur
treatment in mental disorders, sent us a letter of congratulation
on our success with this therapy on the publication of my first
article on the subject in Lancet of 1931.
(ii) Use of Sulphur injections in skin diseases.—As stated
in my previous report, during the year 21 patients suffering
from the following skin diseases were treated by Sulphur
injection :—
Impetigo .. .. .. .. ..
Scabies .. .. .. .. ..
Eczema .. .. .. .. ..
1
18
2
21
All the above stated skin diseases marvellously disappeared after
four or five injections in each case.
13
(iii) Rorschach test.—We tried this test on one patient only
as no other suitable cases were available and the result was
satisfactory. I also tried this treatment in two of my private
patients with equally good results. The Rorschach Tests are
very complex and require a lot of time and patience both of the
Doctor and the patient and can only be usefully employed in
those border line cases which are well educated and are willing
to co-operate.
(iv) Hypno analysis.—During the year two early cases of
Psychoneurosis were treated by me by this method. One patient
was discharged during the year as recovered and the other
patient will be fit for discharge in early part of 1935.
(v) Utility of intravenous iodine injections in P. U. O.—
During the year under review 13 cases suffered from Pyrexia of
uncertain origin. We tried many recognized methods to bring,
the fever down but met with disappointment. Eventually we
tried intravenous Iodine injection (dose 5 to 8 minim) and the
fever came to normal after. 3 or 4 such injections, in each case,
and the patients recovered. Similarly this treatment was tried
in one obstinate case of Pyaemic abscess and in two cases of
Arthritis of the knee joints with satisfactory results.
(vi) Use of raw brain in stuporous cases.—This treatment as
stated in my last report was continued during the year and the,
results were disappointing. and we finally abandoned the.
treatment,
(vii) Physiotherapy.—It is a strict routine of this Hospital
to make a thorough physical examination of all patients after
their admission and utmost care is taken to remove any physical
defect noticed in them.
The following number of specimens were examined in the
Hospital Laboratory during the year under report :—
Kind of specimen.
Blood ... ...
Urine ... ...
Stool ... ...
Sputum ... ...
1934.
1,073
786
713
199
1933.
929
850
669
216
1932.
355
610
496
167
14
(viii) Teeth.—As in the previous years, patients suffering
from oral sepsis and requiring immediate treatment were
attended to throughout the year under report by the Medical
staff of this Hospital as far as practicable in the absence of
a Dentist.
I am happy to be able to record that the proposal of
appointing a Dentist submitted by me and recommended by the
Managing Committee of this Hospital was at last sanctioned by
Government in November 1934 and the Dentist has been
appointed from 1st January 1935,
(ix) Syphilis,—As usual the blood serum of all newly
admitted patients and C. S. F. of some special cases were
sent to the Prince of Wales Medical College, Patna, for
Wassermann Test. During the year under report 225 specimens
of blood and 39 specimens of C. S. F. were sent for W. R test
out of which 27 of the former and 7 of the latter were positive.
All the positive cases were given Antisypfyilitic treatment. The
Neurosyphilis cases were treated with Tryparsamide. I have
found this drug very helpful in General Paralysis of the Insane
and other Neurosyphilitic cases in combination with Salversan or
Malaria.
(x) Hydrotherapy:.—This most useful form of therapy now
extensively employed in all the modern mental hospitals is
largely used in this Hospital for various mental diseases, specially
in Refractory cases to allay excitement. During the year 268
male and 31 female patients were given this treatment with
gratifying results. The average number of hours of immersion
of patients was 60.77.
(xi) Occupation therapy.—In my opinion an idle patient
ought to be regarded as a reproach to the hospital. The Occupa-
tion therapy is and will always remain a sheet anchor of our
treatment, for we have always seen enough of the results of
Occupation therapy to feel sure that it leads to the amelioration
of conditions in patients which hitherto have not been successfully
dealt with in other way. The Occupation therapy is a valuable
means of developing the mind, and, where the mind has already
developed, of maintaining interests in life and happiness. As
stated in my last Annual Report we continued the experiment
of employing the highly refractory patients of the hospital on
active garden work and the results obtained were very encour-
aging and our only regret is that we did not try this treatment
earlier. The whole atmosphere of our ward no. 11 wherein
highly excited patients of the hospital are kept is now completely
15
changed. This was a noisy, dirty and destructive ward before
and since the introduction of active outdoor garden work every
patient on an average has put on 2 to 3 lbs. in weight, they sleep
better, there is no noise in the night or day and no sleeping
draughts are now required.
A brief outline of works done in the Occupation Therapy
classes of this hospital is given below :—
Weaving, Cane and bamboo work, Smithy, Carpentry,
Tailoring, Cobbling, Mending clothes, Mattress and
pillow making, Lace making, Knitting, Embroidery
work, Durree making, Gardening, Joss stick making
and various miscellaneous and domestic works.
In the last Industrial Exhibition the Occupation Therapy
Departments were awarded 4 First Class Certificates for the best
exhibits of the following ;—
1 Lace,
2. Basket.
3. Durries.
4. Galichas and Asnies.
30. Reward to good workers.—As usual the annual grant of
Rs. 600 was divided amongst hardworking patients during the
year under report over and above the daily extra gifts of
cigarettes, tobacco and other comforts of life. Some of the
patients were permitted to send the whole or a portion of the
reward to their family at home.
31. Sports and amusements.—I
consider well organised
congenial amusements as adjunct to treatment of mental diseases.
With this view attempts were made throughout the year to
provide for patients as many and as varied amusements as
possible.
Band.—As heretofore the Hospital Band had continued to
give great pleasure to the patients.
Games.—Out-door
and in-door games were kept up to
a standard throughout the year and were played daily by the
patients in both sections of the Hospital. 19 football and
10 hockey matches were played with outside teams of Kanke and
Ranchi and the Hospital team won several matches. The
Amusement Halls of both sections were largely attended by
patients and in addition to the daily amusements the following