NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
9
(4) Provision of adequate facilities for the training of the
whole personnel required for this work such as Psychiatrists,
Psychologists, nurses, social workers and teachers.
(5) Education of public opinion to a recognition of the
racial dangers underlying the unchecked increase of mental
deficiency.
(6) Eugenic sterilization of all known adult defectives of
both sexes.
Life segregation in large Central Provincial Institutions
and sterilization held out the greatest hope of most immediate
and effective results. Sterilization is adopted by a number of
civilised countries all over the world and it is a means of ridding
the race of its defective germ plasm. Sterilization must supple-
ment segregation as a measure of control to prevent procreation
because no State, however rich, can ever afford institutional
facilities for all their defectives.
Sterilization therefore relieves the State of a heavy financial
burden and as such it should be indispensable for India.
23. Statement no. VII shows the probable causes of
insanity in those admitted during the year.
The question of causation is the outstanding problem of
psychiatry. There are so many causes which may contribute to
a mental break-down that in most cases one cannot specify any
one in particular. The patient must be considered as a biological
problem. Toxic agents, epilepsy, various bodily illnesses and
life's stresses of various kinds must be regarded as in the main
contributory and the cause of mental disorders does not lie in
any one of the above stated ætiological factors alone, but is the
resultant of many such factors. " Heredity " and " Environ-
ment " are also factors of considerable ætiological importance and
prognostic significance. The " Heredity " of mental disease is
rather that of Tuberculosis. The child does not inherit the
disease itself but certainly inherits a predisposition to contract
the disease under suitable conditions. Next in importance to
" Heredity " are "Environmental factors". Some Psychiatrists
attach great importance to " Environmental factors" than
"Heredity". But I for one feel convinced that " Heredity"
does play an important role in the causation in majority of the
cases combined with the anxieties and increased stresses of
modern every-day life.
10
In support of my views I append below a list showing
preponderance of inherited taints in major Psychosis and
defects:—
(1) Manic Depressive Psychosis has the greatest inherited
taint.
(2) Schizophrenia and Dementia Præcox have inherited
abnormalities in about 50 per cent of cases.
(3) Epilepsy has an inherited taint in 80 per cent and
transmission is frequently direct.
(4) A very high percentage of forebears of mental defectives
are alcoholics or the subjects of nervous disease.
24. Paying patients.—The following number of paying
patients were treated during the year under report and the two
previous years:—
Year.
1937 ..
1936 ..
1935 ..
Male.
78
70
72
Female.
24
26
24
Total.
102
96
96
A large number of applications for the admission of paying
patients had again to be refused during the year under report,
for want of proper accommodation.
25. Injuries and suicide.—With the exception of two
fracture cases and a few minor injuries and accidents, there were
no cases of serious accidents or injuries amongst the patients
during the year under report. The two cases of fracture soon
recovered after adequate treatment. Similarly, there was no
case of suicide.
That there should be a number of accidents in a Mental
Hospital of the size of the Ranchi Indian Mental Hospital is
inevitable where a large number of certified highly dangerous
patients are treated and a maximum amount of freedom is
allowed for therapeutic reasons. However, it is a matter of
great satisfaction to note that during the year under review with
the exception of a few injuries and accidents there were no
cases of fatal accidents or injuries amongst the patients.
Similarly, I am happy to be able to record that there was
no case of suicide during the period under report although many
definite attempts were made by the potential suicides of the
hospital and were timely prevented by the vigilance of the staff
11
on duty. The Attendant Staff of the Suicidal Wards of the
hospital seldom appear in the limelight although on their
shoulders rests the heavy responsibility of watching so many
potential suicides day and night ; to all of them I owe a deep
debt of gratitude and I wish to record my appreciation and
sincere thanks for their good work. All potential suicides are
constantly on the watch for an opportunity as their life is
devoted to counting death. The ingenuity of such patients at
times is very great. One female potential suicide, who has
apparently made up her mind to drown herself, twice jumped
down the hospital well whilst employed on watering the plants
in the garden and twice she was rescued by the staff on duty at
the well at the risk of their lives. The third time she jumped
down a cauldron full of water which was kept on one of the
ovens of the kitchen for boiling but fortunately had not reached
the boiling point. She was again rescued by the staff on duty.
Another patient, a Marwari from Calcutta, has a strong desire
to end his life but he wants someone to take his life. Ever
since his admission he is asking whoever goes near him to kill
him but his wish is not yet fulfilled. Finding that no one
seems to oblige him in this direction he hit upon a novel way of
killing himself by refusing food and drink, what is in present day
known as " hunger strike ", until such time as he is fed by the
Governor of Bengal. We induced some friends to impersonate
His Excellency in order to make him eat but to no avail, and
I am sure even if His Excellency the Governor of Bengal comes
to feed him his request to him would be to kill him and he
would refuse food. He has been fed nasally twice a day by the
staff for the last five years to keep him alive. Many times we
stopped his nasal feed for a day or two and induced him to take
his food but he flatly refused and fervently requested us to
allow him to die of starvation. He is a case of " Involutional
Melancholia" and most melancholics are potential suicides.
These and other potential suicides of the hospital are watched day
and night, yet they must be given certain facilities and freedom
on humanitarian as well as therapeutic grounds. In a modern
mental hospital where too much freedom is given to all patients
the suicides also have their fair share of it and are not locked up
day and night as was the case in the old asylums, and some-
times they take advantage of this and let down the administra-
tion of the hospital who are doing their best for them. But this
should not deter a conscientious Medical Superintendent in
discharging his duties to his unfortunate suicidal patients, for
such accidents must
happen even in the best regulated
institutions.
12
26. Absconding.—There were no cases of escape during the
year 1937 although a considerable amount of freedom was
afforded to the patients.
A feature of the modern mental hospital is the friendly
and homely atmosphere and absence of any real evidence of the
detention and this is the very reason why we have few escapes
now a days from modern mental hospitals as compared to olden-
days asylums. Often we come across patients who on discharge
show great unwillingness to go home as they anticipate an
unpleasant home situation. Such patients I have often noticed
return very soon to the hospital as relapsed cases.
27. Autopsy.— Post-mortem examinations were held on 25
cases during the year under report.
28. Conservancy and sanitation.—The general sanitation of
the whole area of the hospital as well as that of the staff lines
was satisfactory throughout the period under report.
29. Methods and treatment of insanes.—The question of
treatment has always engaged our serious attention and whenever
possible we introduced all the latest approved Western methods of
treatment in this hospital with due regard to Eastern conditions.
(1) Occupational therapy.— During the year "occupational
therapy " has been carried out on the same intensive system
as in the past and an average employment of 80 per cent has
been maintained. The occupational therapy is primarily for
the benefit of the patients. Its object is to give those of any
introspective type some other interest, and, even though con-
siderable difficulties have to be overcome in persuading some to
do anything I am confident that " picking threads " out of rags;
is much better for them than sitting about and " day-dreaming "
Occupation is considered as one of the essentials in treatment,
and every effort is made to provide various occupations for the
patients in this hospital, and patients are allowed to choose
their own occupations as far as possible with due regard to their
mental and physical health. In the 1936 Report detailed list
of the works carried out in the Occupational Therapy Depart-
ment was fully dealt with and a repetition is therefore avoided.
At the local Industrial Exhibition during 1937 the hospital
won the following three First Class Certificates for the Occupa-
tional Therapy Department:—
(1) Furniture.
(2) Needle work.
(3) Lace work.
13
As usual Rs. 600 was spent in distributing rewards to hard-
working patients over and above the daily gifts of cigarettes,
tobacco and other comforts.
(2) Hydrotherapy.—This department was kept busy through-
out the year under review. 75 male and 35 female patients
were given this treatment with gratifying results. The
average hours of immersion per patient were 766.26. There is
a great need for a proper Hydrotherapy Ward for this large
hospital and a scheme for such a ward is already with the
Government but no funds are available for its construction due
to financial stringency.
(3) Drugs—(a) Cardiazol.—As stated in my last report
I brought this treatment from Budapest and we continued our
experiment with Cardiazol throughout the year under report.
Cardiazol when injected in Schizophrenic patients in large doses
(0.5 to 1 gm.) produces typical epileptic fits simulating major
epilepsy and such 20 to 30 epileptic shocks prove very benefi-
cial in some Schizophrenic cases. Some recover, others put on
great improvement and on some it has no effect. This treat-
ment was evolved by Dr. Meduna of Budapest. During 1937
I tried this treatment on 42 cases of Schizophrenia (31 males
and 11 females). The sub-joined table shows the results of our
experiment with 42 cases of Cardiazol.
No. of
cases.
15
17
8
2
Types of Schizophrenics.
Katatonic .. ..
Hebephrenic .. ..
Dementia Paranoides ..
Simple Dementia ..
Full
remission.
7
5
1
..
Improved.
4
9
2
..
Stationary.
4
3
5
2
The thirteen cases which attained full remissions were
subsequently discharged by the Board of Visitors of the hospital
as fully recovered, three of whom wrote to me that they had
re-joined their services and the remaining 10 patients have so
far maintained the improvement. The results of the experi-
ment can be called encouraging and the results in percentages
are as follows :—
Full remission (complete recovery)
Improved .. .. .. ..
Stationary .. .. .. ..
31 per cent.
36 „
33 „
Besides, the Cardiazol treatment appears to be safe in
selected cases and is well worth a trial in all types of Schizo-
phrenia and more so in Katatonic and Hebephrenic varieties.
14
It is free from any dangerous complication and does not require
such constant medical and nursing supervision nor involve any
grave risk as in the case of Insulin treatment of Schizophrenia.
I would certainly give this treatment preference over the Insulin
Therapy.
Acknowledgments.—We are highly indebted to Messrs. A. G.
Knoll, Chemische Fabriken—Ludwigshafen am Rhein, for the
free supply of Cardiazol powder for our experiment. Cardiazol
is a very expensive drug but on my request Messrs. A. G. Knoll
have specially reduced their prices to enable us to give this
treatment to a large number of patients. Even with such
drastic reduction in the price the full course of this treatment
would cost Rs. 15 per patient—a cost which appears to be
almost prohibitive for a hospital of our size. Cardiazol is now
available in India in ready-made injection form specially
prepared by Messrs. A. G. Knoll and Company, to facilitate its
easy administration by the profession in Schizophrenic cases.
It is also available in powder form in India. As we were the
first to introduce this treatment in India and to carry out
experiment with this drug on such a large scale, I wrote two
papers on the subject during the year under review—one in the
Lancent and one in the Indian Medical Gazette—for the informa-
tion of the medical profession in India.
(b) Photodyne.—During the year under review six patients
with marked endogenous depressions were treated with this drug
but the results were not very encouraging. Only one female
patient showed some improvement. I also tried this drug in my
private practice but there also the results were not encouraging.
(c) Benzederine.—This drug is found very useful in cases of
mild depression either of exogenous or endogenous origin.
(d) Narco-Analysis.—We tried Narco-analysis with Sodium
Evipan but the results were poor and treatment has not come up
to our expectation.
(e) Paraldehyde.—This drug is much too universally used as
a hypnotic and this is no doubt due to its cheapness and the
fact that it has no depressing effect on heart.
Use of Paraldehyde per rectum and by intra-muscular injec-
tions. — Paraldehyde is one of the most useful sleep producing
drug at our disposal and in acute cases of maniacal excitement it
acts like a charm in some cases when given deep intra-muscu-
larly in the gluteal region for 12 consecutive days at a rate of
15
one drachm per day. Similarly Paraldehyde can be used as
" prolonged continuous narcosis " in highly intractible maniacal
cases when given per rectum. The dose in such cases should be
one drachm per stone of patient's total body-weight. Say, for
example, if the patient's total body-weight is 8 stone the
Paraldehyde dose should be 8 drachm mixed with 8 ounces of Saline.
This method is largely used in general practice all over the world
by Surgeons to remove the pre-operative frights in nervous
patients before undergoing major operations. One of our highly
excited patients, who showed no signs of improvement or abate-
ment of excitement in spite of vigorous treatment by all the
known hypnotics and sedatives at our command, showed marked
improvement by this method. After the first-day treatment the
patient remained quiet for three consecutive days and slept at
a rate of 14 to 16 hours a day. This treatment can be given
twice or three times a week with due regard to patient's general
health.
(4) Sulfosin therapy.—This very useful therapy was given
to 86 patients during the year under report and the results were
as follows :—
Recovered.
11
Improved.
28
Stationary.
47
We now give Sulfosin in three strengths—1, 2 and 3 per cent
solutions. I brought this treatment from Denmark in 1930 and
since then we are treating our patients with Sulfosin and the
record shows that so far we have treated more than 500 cases
with very encouraging results which were published every year in
our Annual Reports. Sulfosin is useful in all highly excited and
non-co-operating types of cases of Schizophrenia, Manic Depressive
Psychosis and other forms of mental diseases. Sulfosin as a fever
creating agent is equal to other active and passive (Physical)
methods but holds the advantage of being safe, easy to measure
and employ, and above all most inexpensive. We prepare fresh
solution for our work in the hospital and it costs less than 1/12th
of an anna per dose. At the International Fever Therapy
Conference which met in New York on March 29th, 1937,
Sulfosin treatment was fully discussed along with other forms
of fever therapy and the trend of the discussion was in favour
of this therapy specially as it was considered the cheapest and
the safest form of fever therapy. Sulfosin is a sheet anchor of
treatment in this hospital for highly excited and non-co-operat-
ing types of patients.
16
USE OF SULFOSIN IN SKIN DISEASES.
During the year under report 36 patients suffering from
skin diseases were treated with Sulfosin and the results were as
follows :—
Scabies ..
Eczema ..
Ringworm ..
Pityriasis ..
Urticaria ..
Cured.
M.
25
5
..
..
..
F.
1
..
1
..
..
Improved.
M.
..
..
..
..
..
F.
..
..
..
..
..
Stationary.
M.
..
..
1
2
1
F.
..
..
..
..
..
(5) Dr. Hermann
Rorschach Psycho-diagnostic
test.—
During the year under report two educated patients suffering
from Schizophrenia were tried with Rorschach test and the
results were very encouraging and gave some clue as to their
submerged complexes. This test can only be used in cases
of recovered or semi-recovered educated patients. The tests
are largely used on the Continent as an aid to diagnosis.
(6) Physiotherapy.—A thorough physical examination is
absolutely essential in every mental case and this routine is
strictly followed in all cases on admission before the examination
of their mental condition.
The number of specimens examined in the hospital laboratory
during the year under review is shown in the following table :—
Blood ..
..
..
..
Urine .. .. .. ..
Stool ..
.. .. ..
Sputum .. .. .. ..
Other examination ..
..
..
1,051
1,053
1,653
182
67
Besides, 182 specimens of blood and 35 specimens of Cerebro
Spinal Fluid were sent for Wassermann test in the Pathological
Department of the Prince of Wales Medical College, Patna,
of which 35 of the former and 9 of the latter were positive and
were given antisyphilitic treatment,
Trypersamide combined
with Salversan was found much more effective in the treatment
of General Paralysis of Insanes than Malarial Therapy.
Operations.—3 major and 42 minor operations were per-
formed during the year under report.
17
Dentistry.—2,043 patients received dental treatment during
the year under report.
Nasal Feeding.—During the year under report 1,940 nasal
feeds were given to those patients who persistently refused to eat
or drink. One patient is on nasal feed for the last five years
without any detriment to his physical health.
(7) Diversional Therapy (Games and
Amusements).—Games
and entertainments are of the greatest therapeutic value as
adjunct to treatment of mental diseases. The full list of events
of this description is given below which shows that there was
no slacking off in this department during the year under review.
(a) Football.—19
football matches of the local League
Cup and Shield competitions were played by the hospital team
during the year under report of which won 6, lost 9 and drew 4.
Besides, 6 friendly matches were also played of which won 4,
lost 1 and drew 1.
Besides, the patients play daily Tennis, Badminton, Basket"
ball, Coits and various other outdoor games.
(b) Special
Entertainments.—
1. The Annual Hospital Sports.
2. Thought-reading, Ventriloquism and Comic Sketches by Professor
Mukherji.
3. Magic performance by Mr. Bakar Husain.
4. Two Theatrical performances given by the students of the Prince
of Wales Medical College, Patna.
5. Magic performance by Professor Das.
6. Theatrical performance by the Children of the Indian Sunday
School Union, Ranchi.
7. Magic performance by Mr. S. Bose.
8. Physical Feats and Dancing by Mr. Ispahani and Party.
9. Instrumental Music by Mr. Lingamma Derappa.
10. Magic performance by Mr. Syed Husain.
11. Conjuring tricks by Prof. Naug.
12. Theatrical performances by the Parsee Crown Theatre.
13. Humorous performance by Mr. R. M. Ghosal.
14. Four Theatrical performances by the staff,
18
(c) Cinema.—43 Cinema shows were held during the year
under report. It is now practically impossible to secure silent
picture programmes for the hospital, and the proposal for
replacing the Silent Machine by a Talkie is under the considera-
tion of the Government and the sanction for its purchase may
be accorded as early as possible. The usefulness of the Cinema
Therapy is hard to exaggerate for it not only provides a pleasant
amusement but it also helps enormously towards socialisation
and rehabilitation of patients.
(d) Band.—The Hospital Band under the conductorship of
Naik Shib Charan continued to entertain the patients through-
out the year under report.
(e) Outings.—Parole.—Many patients were granted local as
well as Ranchi parole with or without attendants—it all depended
on his or her mental condition—and none of them abused the
privilege so granted.
Motor Drives.—Batches of patients of both sexes were taken
out for motor drives round about Ranchi on every alternate day
in the hospital cars and those who were dependable and willing
were allowed to shop at Ranchi under the supervision of the
staff.
(f) Annual picnics.—In the month of March 250 male and
100 female patients were taken to the village of Borea for
a whole-day picnic. They were treated at a sumptuous lunch
and high tea and all games and sport gears were carted to keep
the patients amused and occupied. The Hospital Band also
entertained and the patients thoroughly enjoyed the picnic.
(g) Absence on trial.— During the year under report 3
patients were sent to their homes on trial for two months under
section 20, Part V of the Bihar and Orissa Indian Lunacy Act
Manual, 1934. They behaved very well at home during the
period of their trials and were finally discharged as recovered
on request of their relatives,
(8) Religious therapy.—Divine Services for the Christians,
Kirtans and Bhajans for the Hindus and Milad Sharif for the
Muhammadans including religious discourses and songs were
held regularly throughout the year under report. Besides, the
patients were allowed to fast on religious grounds.
I express my very best thanks to the Pandit and the Maulavi
Saheb for giving religious therapy to my patients on a very
nominal honorarium and to all the Christian Padris for giving
19
similar services without any remuneration. During Durga Puja
festival batches of patients were sent to visit the local celebra-
tions held outside the hospital.
30. Feasts.—On the occasion of religious festivals, such
as Pujas, Ids, Holi and Christmas, patients were treated with
special feasts.
31. Libraries.—(1) Patients'.—Several new books were
purchased during the year under report and added to the Patients'
Library. The following newspapers and monthly magazines
were continued to be supplied to the hospital free of cost, and
I take this opportunity of expressing my thanks to their
respective proprietors :—
1. Statesman.
2. Amrita Bazar Patrika.
3. Biswamitra.
4. Advance.
5. Searchlight.
6. Sentinel.
7. Illustrated Times of India.
8. Basumati.
9. Bharatbarsha.
10. Prabasi.
(2) Medical.—The Medical Library was also replenished
by a few new books and the usual supply of medical and mental
journals was continued.
32. Gardening.—The average number of patients employed
in the hospital Horticultural Garden daily throughout the year
under report was 250. The garden is run entirely with the
patients' labour. It is the greatest Occupational Therapy Centre
we have, and undoubtedly the best as it helps to better mental
and physical health of so many patients. The hospital is
entirely self-supporting in respect of its vegetable supply. The
Poultry Farm has now made considerable progress and supplied
7,711 eggs and 35 fowls to the hospital during 1937. The
success of the Poultry Farm has encouraged its extension and
two new poultry houses are being built by patients' labour
under the guidance and supervision of the Garden Manager.