22
DULLUNDA ASYLUM.
5. Mortality.—The death-rate of the year, reckoned on the mean daily population, is
12.6 per cent. against 16.4 in 1869. In the latter year, however, there were nine cases of
cholera, and none in 1870. The past year, moreover, has been particularly healthful in
Calcutta, and lunatics share with their neighbours the physical influences of season. Duly
criticised, the mortality of 1870 takes in a gradually declining scale a place less well marked,
I fear, than that of 1869. A higher mean daily number of inmates of the classes least prone
to die is one cause of the ratio declining year by year, and is in peculiar force this year.
Excluding cholera from the history of 1869, its death-rate becomes 13.3, which shews a greater
improvement on the rate of 1868 than can be claimed for 1870 over its predecessor. Thus
the reduction of mortality given in the abstract table is more apparent than real. The
detailed account of fatal cases exhibits as large a number of deaths among the dying class
as the last three years have presented; and, as is seen year after year, this class is divided by
so sharp a line from the rest of the institution, that its separate consideration is essential to a
right understanding of the mortality. In the twelfth return there is a brief statement of the
facts of each fatal case. No less than 22 are the cases which, out of the larger number of
persons brought in dangerously ill, it was found impossible to restore. There are five cases of
acute inflammatory affection, three of phthisis, two from accidental causes, eight from exhaus-
tion of mania. There were nine cases of the old anæmic cachectic state without organic disease
to account for it. Four of them were admitted in this state; and of the five in which it
appeared during their residence, one had been 17 years in the place, one 15 years, one 11½
years, one over 7, and one over 5 years; in the last there was increasing maniacal excitement
as a cause. In neither of these can it be reasonably said that diet or any other element
of asylum life contributed to the result.
6. These figures tell a very plain tale. It is the same that has been told year after year
for a long time past in the asylum records, viz. that the number of cases admitted fatally ill
is large, and apparently must be always large in a town where the habits of the poorer classes
are as they are in Calcutta. Notwithstanding that the asylum itself has undergone perpetual
change in the hope of improvement from the year 1860 till now, and has for years defied the
efforts of the most fastidious sanitarian to discover a defect (except in space), it was not until
the Government, on my earnest representation, forbade the despatch from a distance of
lunatics physically unfit to travel, that there was any appreciable decrease of mortality.
From that time a lower figure has been shewn—not very much lower—because the principal
source of fatal cases, Calcutta, remains; and for such cases the asylum becomes a place of first
reception. But a figure has been reached, below which I have no expectation of seeing
mortality fall, unless it be by those accessory events which cause apparent diminution. If
only the mortality for which the asylum may be considered responsible be laid to its charge,
there will be little ground for concern in the death-list.
7. The utmost care has been taken during the year to secure to the patients the full
benefit of the liberal diet scale adopted in 1869, both as to quality of provisions, full quantity
in issue, and fair distribution to individuals. Those who are unable to consume or digest the
heavier food are provided with other kinds of nourishment and stimulants in ample quantity.
Any man who shews a symptom of debility, a pallor, or a loss of flesh, is fed, in addition to,
or substitution for, his diet with milk, arrow-root, soup, rum, all of the best quality. There
is now a permanent list of these persons, numbering 20 to 25. There is no question of their
getting what is ordered for them. Nothing is taken on trust. The rum is from the
commissariat; the milk is from cows on the spot; the meat, of the kind used by the natives of
the better classes, is cut up and weighed before the overseer; even each man's wheaten cake
is weighed before it goes into the oven. Every article is seen by myself every day. The
cook-room and the eating-house are now so constructed and situated that pilfering is impossible,
either in the preparation or the issue of food, for nothing can be done unobserved by the
overseer. Even in the midst of abundance one lunatic is occasionally seen to snatch another's