38
REPORT ON THE
Greater facilities of
transit to Dul-
1undah.
In the transmission of lunatics to the Dullunda Asylum I presume the railway is
ordinarily made use of, and that only in rare instances are mad people exposed to such
exciting causes of disease for such a length of time as those of Eastern Bengal are. On these
points, however, the available information is meagre.
Admissions from
Assam
more
numerous.
It may be suggested that this cannot be the real cause of the permanent high rate of
mortality of this asylum, as lunatics have always been sent from Assam to the Dacca Asylum,
and that they probably took as long ten years ago to reach their destination as now. This,
however, I find was not the case. Between 1859 and 1865 the admissions from that division
only amounted to 24, while from 1866 to 1871 they rose to 62.
Increase of death-
rate directly as
the
distance
travelled.
In the report forwarded to Government in December last, it was shown that the death-
rate increased nearly in proportion to the distance come, and that lunatics sent from Assam
died at the rate of 42.3 per cent. within a year of their arrival; from Tipperah at 25.7 per
cent.; from Cachar at 22 per cent. ; from Cooch Behar at 20 per cent.; while from Dacca the
proportion was only 11.05 per cent.
Duration of resi-
dence of fatal
cases diminish-
ing.
That some such cause is contributing to the high mortality rate is strengthened by the
following return of the average number of days passed in the asylum by each lunatic who
died during the past five years.
In 1867 the average period was
2,082 days.
1868
„
„
„
1869
„
„
„
1870
„
„
„
1871
„
„
„
1,419
„
1,321 „
982 „
961 „
Health of lunatics
on admission.
In table 10 the state of health of lunatics admitted during the year is noted. Of 80
admissions only 26, or 32.5 per cent., were in good health; 24, or 30 per cent., were
in indifferent health; and 30, or 37.5 per cent., were in bad health. Of the males in
bad health, 8 out of 22 died; while of the females, 5 out of 8 died.
Cold as a cause of
mortality.
Of cold and insufficient accommodation as causes of mortality I need not dwell now, as
it has been conclusively shown in the annual reports of 1868 and 1870, as well as in the
special report of December last, that they seriously influence the healthiness of the inmates.
Reform needed in
the system of
transmitting lu-
natics.
At your visit to the asylum in September last I particularly directed your attention to
the state of health of the sick then in hospital, and to the impossibility in most instances of
doing more than prolonging life. Your intimate knowledge of the internal economy of the
asylum, of the attention that is paid to the sanitary arrangements, and to the clothing,
dieting, and comfort of the inmates, will enable you to point out to Government what are
defects in the present system of transmitting and lodging lunatics. That these are the main
points on which reform is required is undeniable, and until some change is introduced there
is little hope of amendment in the health of the lunatics or of reduction of the present
high rate of mortality.
Special cases re-
lated.
Foreign
body in
the
œsophagus.
Two deaths during the year were due to exceptional causes, which deserve to be recorded.
1. Kumaldee, a criminal lunatic charged with murder, was admitted from Backergunge
on the 30th October 1870 in an acute state of mania. This subsequently passed into demen-
tia, characterised by great timidity and habitual silence. Towards the end of June he was
transferred to the sick list. Fever, disinclination for food, profuse salivation, and slight
hæmorrhage from the mouth, were the prominent symptoms. He usually sat with his head
sunk on his chest. No satisfactory explanation of these symptoms presented itself. He died
suddenly, great emaciation having previously set in. On opening the stomach about a
pound of dark coagulated blood was found, and the mucous membrane was marked with
patches of congestion. In the œsophagus an irregular sharp-edged piece of mutton bone,
1½ inches long and 1 broad, was found firmly impacted at the level of the sternum. The
mucous membrane around was in an ulcerated state, and the hæmorrhage had been caused
by the rupture of a small blood vessel.