LUNATIC ASYLUMS IN BENGAL.
3
vary in the different asylums in Bengal and probably also in other provinces.
This point shall be enquired into at once.
9. Types of Insanity.—Although the patients suffering from the different
types of insanity are now arranged according to the system adopted by the
Royal College of Physicians in the new nomenclature of diseases, the change
does not appear to have produced as much uniformity in the returns as might
be desired, and it is probable that until some authoritative definition is obtained
of the various forms of mental disease, not much progress in this direction will
be made.
10. In order to understand this, it is only necessary to refer to two varieties
of mental disease, viz., epileptic insanity and toxic insanity, which are not now
incorporated with the more common types, such as mania, dementia, &c. The
question at once arises, what is epileptic insanity ? and what toxic insanity ?
Some medical officers of asylums classify under the former all cases of insanity
associated with epileptic fits, while others regard the term as including only
those forms which can clearly be traced to, and are caused by, epilepsy. Again
with regard to toxic insanity, cases of temporary excitement due to intoxication
are regarded by some as instances of toxic insanity, while other medical men
restrict the term to permanent mental disease produced by a prolonged course
of indulgence in bhang, spirits, &c. Even in the standard text-books on the
subject much difference is found in the definition of the forms I have men-
tioned, and until some general agreement can be come to among experts, it
is hopeless to look for anything but confusion in the returns of the Bengal
asylums. It would be easy to lay down some hard-and-fast rules on the sub-
ject, but unless they were observed throughout the whole of India, the Bengal
returns would be useless for purposes of comparison with those of other provin-
ces, and even then a comparison with the returns of England would be
impossible. The matter does not seem to me to be of much importance, and
little good would be derived from a discussion of it at present. From what
I have said it will be evident that it is impossible to prevent the entries in
statement VI differing in some instances from those in statement VII.
11. Causes of Insanity.—Statement No. VII shows that ganja smoking is
by far the most prolific cause of insanity in Bengal, and it would seem that
when the drug is not smoked it is comparatively innocuous. It seems also that
spirit drinking gives rise to more mental disease at Patna than in any other
asylum of the province. Among the moral causes grief is the chief.
12. Sickness.—Sickness has diminished generally owing in a great measure
to the healthiness of the year. At Dullunda the in-door patients decreased
from 226 to 97, chiefly attributable to less fever and dysentery and chicken-
pox. The out-door patients also fell from 212 to 128—a state of things which
indicates a considerable improvement in the health of this asylum. At Dacca
there were 135 in-door patients and 43 out-door in contrast with 131 and 46,
respectively, in the previous year. At Patna the corresponding figures are 91
and 16, against 60 and 4 in 1887. At Cuttack 17 and 15, against 19 and 19
in 1887, and at Berhampore 50 and 113 as compared with 65 and 116. It will
thus be seen that while the diminution of sickness has been most pronounced
at Dullunda, there has been an increase at the Patna Asylum, but not to such an
extent as to deprive it of the reputation of being the healthiest in the province,
13. The fluctuations in the health of the asylums correspond in a
great measure with those of the jail and general population in the same
districts, the only marked exception being found at Cuttack, where there was
increased sickness in the jail with an improvement in the health of the lunatics.
14. Fever as usual was the cause of most of the sickness at nearly all
the asylums. Only at Dullunda was there any cholera, six cases, two of which
proved fatal, having occurred in November. No cause could be assigned for
the outbreak which was preceded a short time previously by the appearance
of the disease in the Station Hospital adjoining the asylum. It was confined
entirely to the female lunatics which leads to the suspicion that some undis-
covered local cause was in operation within the asylum. In future I propose
to discontinue the registration of indoor and outdoor patients separately, and
to include them all in one return, because the present system only produces
confusion and difficulty of comparison without any compensating advantage.