LUNATIC ASYLUMS IN BENGAL.
13
lunatics in the manner required for the detection of phthisis, which I have
myself experienced, and to the frequency with which disease had been dis-
covered post mortem which I had not known to exist during life, it appeared
among the results of last year's enquiry that if, in other asylums, examination
post mortem had not been made as a matter of course, as it was not formerly at
the Presidency, it might very well happen that the late predominance of phthisis
in the Dullunda records and apparent increase elsewhere, would become intelli-
gible. I called accordingly for statements from all the asylums showing the total
number of deaths, the number of post mortem examinations, and the number
of phthisical deaths, from the year 1865 to date. The record is very
impressive. Wherever the number of examinations has borne high propor-
tion to the total number of deaths, the proportion of deaths ascribed to phthisis
has been also high. At the Presidency Asylum between 1865 and 1869 there
were 271 deaths in all and 31 examinations, with 8 deaths from phthisis.
From 1870 to 1874 there were 253 deaths, 42 examinations, and 26 deaths from
phthisis. From 1875 to 1878 there were 122 deaths, 72 examinations, and 32
deaths from phthisis. In 1879 and 1880 there were 80 deaths, 77 examinations,
and 27 deaths from phthisis.
52. At Dacca, between 1865 and 1876, examination was usual. There
were in this period 467 deaths, 409 examinations, and 71 deaths from phthisis—
an average of 6 per annum. In 1877 and 1878 there were 17 deaths and
7 examinations, with only 1 death from phthisis in the two years. In
1879 there were 20 deaths, 9 examinations, and 3 deaths from phthisis.
In 1880 there were 10 deaths, 8 examinations, and 1 death from phthisis.
For four years there has been great improvement in asylum mortality at Dacca,
which the figures of 1880 show to have been fully marked in the deaths from
phthisis; but it is by no means proved on the returns that more deaths were
due to phthisis in former years at Dacca than elsewhere.
53. At Patna from 1865 to 1873—that is in nine years—there were 157
deaths, 4 examinations, and 5 deaths from phthisis. From 1874 to 1877
there were 87 deaths in all, 75 examinations, and 16 deaths from phthisis,
that is in four years. In 1878 and 1879 there were 48 deaths and 7 examin-
ations, with 3 deaths from phthisis in two years. In 1880 there were
42 deaths with 35 examinations, and 9 deaths from phthisis in a single
year. This increase of specific death accompanies considerable reduction
under the heads of anæmia and debility.
54. At Berhampore, between 1865 and 1880, there have been 145 deaths,
18 examinations, and 3 deaths from phthisis in the entire period of sixteen
years. Here asylum mortality has increased largely since 1874, and it seems
probable that phthisis has existed in larger quantity also, though no increase is
recorded. Thirty-two lunatics were received from Hazaribagh. There were
15 deaths at Berhampore, with 6 examinations only in 1880, before examination
was made compulsory.
55. At Cuttack, between 1865 and 1879—that is in fifteen years—there
were 65 deaths in all, 25 examinations, and 4 deaths from phthisis. In 1880
there were 4 deaths in all, 4 examinations, and 2 deaths from phthisis.
56. The foregoing figures have, in my judgment, a very pointed mean-
ing, and show the necessity for the order issued last year, to the effect that post
mortem examination should be made in every case of death in a lunatic asylum,
provided that no objections were raised by relatives. They offer such an inter-
pretation of the late increase of phthisis that, if the cases from Hazaribagh
be withdrawn, there will be evidence of no real increase whatever. There is
no reason to suppose that the lunatics of Bengal are exempt from that liability
to phthisis which marks the history of asylum life in other countries; neither
is there reason to suppose that any existing asylum of Bengal is especially
guilty of producing the disease. Examination post mortem is now, and for the
future will be, very rarely omitted. It will therefore be no matter for surprise
if, setting aside the influence of Hazaribagh, apparent increase over the
mortality of former years from phthisis, elsewhere than at Dacca, shall be fully
maintained; nor will there be therein any indication of recent unfavourable
change in the conditions of asylum life.