12
LUNATIC ASYLUMS IN BENGAL.
The greatest number due to any one cause is entered under debility. This term expresses
the same truth which in former returns appeared under the terms asthenia, cachexia, anæmia,
exhaustion, &c., namely the dissolution caused in brain disease by simple impairment of the vital
energies and wasting of the organism. Its central feature is innutrition; tissue waste is not
supplied, and from the absence of palpable brain lesion sufficient to account for death, no more
specific account of it can be given; but there are important varieties of this wasting and
exhaustion. There are the wasting and exhaustion of acute brain disease, of paralysis, and of
chronic brain disease. The first it may be possible to control; the last two are not amenable
to remedy. Food is, in these conditions, of minor value. In acute insanity, if the brain
disorder can be by time, or artfully applied calmatives, restored to order, nutrition is
re-established; but in cases of the latter sort, though aliment is often largely and eagerly
consumed, it avails not to build up the frame or restore the vital force. This class of
causes will always rank high in statements of asylum mortality, and is one of the best
exponents of the dependence of the proper nutrition of the body on the soundness of
that central organ which co-ordinates all its actions. The depraved nutrition is in
many cases associated with dropsy, local or general, and this may be thrown into the
same category of causes. Taking them all together—asthenia, cachexia, anæmia, exhaustion,
debility, and dropsy—about 33 per cent. of all the deaths which have occurred during the
six years 1865-70 have fallen under this class. In 1869 and 1870 the proportion assigned is
rather less; but this is owing to many deaths in the Dacca asylum being attributed, not
to the simple exhaustion, which was the only palpable disease during life, but to the physical
evidences of brain disorder detected after death.
Next in order comes dysentery, which, with diarrhœa, account for 27 casualties. These
diseases have always contributed a large share of the asylum mortality,—about 20 per cent. of
that of the six years in question. In 1870 the percentage is greater,—25. It is hard to
conjecture how much of this is a mere expression or feature of the general wasting and depraved
nutrition, and how much a consequence of the specific causes producing these diseases in the
sane population; but the fact remains that "bowel complaints" rank second in the scale of
fatal conditions.
Brain disease—that is, palpable organic brain disease—comes next in order as a factor
of death, contributing 11 per cent. to the mortality of the six years 1865-70, and 17 per cent.
to 1870. As pathological discovery advances, this class of causes will increase at the expense
of " exhaustion," &c.; but much remains to be done ere the true nature and value of changes
observed in the brain, as conditioning bodily or mental disease, can be stated with precision.
Cholera—accounts for 7.5 of the deaths of 1865-70, and 9.3 of those of 1870. It is the
least constant cause of death.
Phthisis—contributes 4.8 per cent. to the mortality of 1865-70, and 5.6 to that of 1870.
This disease has always been thought to affect insane communities to a greater extent than sane.
The average death-rate per thousand from this cause on daily average strength in 1865-70 is
12.8. The same ratio among the prison population of this province for the five years 1865-69
is 3.92, and the percentage of phthisis among deaths is 4.95. The significance of the last
ratio is disturbed by the number of deaths among the insane occurring from causes which do
not affect the sane.
Acute diseases of the lungs—bronchitis, pneumonia, and pleurisy—contribute a consider-
able proportion to the asylum mortality, constituting 4.9 of the mortality of the six years
1865-70, and 3.7 of 1870. The remaining causes cannot be brought under a distinct category.
A few deaths are due to violence and suicide, a few to age, and the others to common
diseases, mostly of the degenerative kind.
It would be most interesting to be able to state accurately (1) what diseases the
patients brought with them into the asylums, and what supervened after their admission;