16
DACCA ASYLUM.
all punishment, and become, as lunatics, burdens on the State. Whenever it is possible, the
cost of their maintenance is recovered from them or their friends; but justice seems to demand
something more than this, even though the difficulties of the law may stand in the way.
IV. Table No. 5 shows the castes and sexes of the patients admitted during the
year, and the zillahs from which they were received. 38 were from Dacca, 12 from Tipperah,
and 15 from Sylhet; 15 from the Assam Provinces, and the remainder from the other districts.
V. Table No. 6 shows the trades or occupations of those who were admitted into the
asylum. The agricultural class, as usual, stands highest in its numbers.
VI. Table No. 7 shows the ages of the patients admitted during the year. In the
decennial period 30 to 40, forty patients, or 40.40 per cent. of the whole number, and between
the years 20 to 30, twenty-nine, or 29.29 per cent., were admitted.
VII. Table No. 8 shows the causes of mortality and the duration of confinement at
the period of death. The total number of deaths was 41, or 13.14 per cent. of strength.
Last year 45 died, or 14.01 per cent. of strength. The average period of residence
of each lunatic that died in 1869 was 3 years, 7 months, and 16.58 days. But as
I wish to make some remarks on the subject of mortality in the Dacca Lunatic
Asylum, I have had table No. 10 prepared with a view to show at a glance the causes of
death, the total per cent. of deaths to strength, the mean average temperature of each month
in the year, and the accommodation which the asylum has been capable of affording. I
have endeavoured to make this return conform as nearly as possible to the arrangement in
the new nomenclature. Pathologically considered, however, there is in the question of
causation of death much that is, to say the least of it, very coarse. First, I would premise
that the causes herein noted make no reference to the insanity of the individual, which, how-
ever, is an actual condition of disease, and one, too, that is often sufficiently potent to determine
a fatal issue from an ailment which, so far as the local or pathological conditions are concerned,
would in a sane person most probably end in recovery. In scrofulous affections there was
observed to be a peculiarly strong pre-disposition towards death. In diseases of the nervous
system, 11 cases are entered as meningitis, because altered conditions of the membranes of
the brain were the only well marked or extensive pathological changes perceptible by the
naked eye. That altered conditions of nutrition existed in the minute structure of the brain,
and that microscopical researches could demonstrate wide deviations from the natural arrange-
ment or condition of the intricate cells or fibres of the nervous centres, is beyond all doubt.
But then we have no names in our nomenclature for these microscopic appearances, and so it
has appeared to me better to state, in the coarse language of our present system, merely what
was apparent to unaided vision. In many of these cases the life of the patients simply ebbed
away. They had once been raving maniacs and then had become poor demented creatures, whose
intellects gradually faded till they were little else than tottering helpless animals, whose lives
were kept agoing by food; that they had neither the sense to take, nor the appetite to desire.
Death was but one of the phenomena to be expected in the course of a disease which during
life we call dementia, and after death, meningitis. It would be perhaps more rational
to say that death resulted from exhaustion, or syncope and coma combined, as it certainly did;
but in saying so we have said very little more than that the patient died because he could
not live, and at most we should attempt to state the mode of dying rather than the cause of
death. In time, no doubt, we shall be able to describe the causes of the death of lunatics
with greater precision; meanwhile, there is much to be learnt from the present arrangement
or classification of diseases. Every case was actually dissected, and therefore the disease,
whatever it may have been, that could be detected by the scalpel, has been placed under its
own proper heading or sub-division. Grouped under headings which refer to the several
physiological systems, the diseases are well placed for an analytical examination of their
primary causes. The case returned as intermittent fever occurred before I came to the