20
LUNATIC ASYLUMS IN BENGAL.
REMARKS ON THE SEVERAL ASYLUMS.
DULLUNDA
ASYLUM.
Superintendents.
No. 13.
YEARS.
1868
...
...
...
1869
...
...
...
1870
...
...
...
1871
...
...
...
1872
...
...
...
Average ...
1873 ...
Daily
average
strength.
268
279
309
335
354
309
369
PER CENT. OF AVERAGE STRENGH.
Admitted.
73.1
63.8
59.5
52.5
61.9
62.2
55.3
Discharged.
Cured.
38.1
27.2
28.8
27.4
19.8
28.3
37.4
Improved.
10.1
11.4
9.7
6.2
11.6
9.8
9.7
Other-
wise.
......
......
......
3.5
3.4
1.4
.81
Deaths.
17.9
16.4
12.6
12.8
12.4
14.4
10.8
Total
discharges
and deaths.
66.1
55
51.1
49.9
47.2
53.9
58.8
37. Dullunda.—This asylum was under the superintendence of Surgeon-Major
R. Bird, M.D., during the
first quarter of the year,
and of Surgeon-Major
A. J. Payne, M.D., during
the last three.
Dr.
Payne's report and the
tables annexed to it
exhibit fully and clearly
the events of the year.
Those tables which have
been summarized in the
statements embodied in
this report have not been
reproduced.
Summary of
statistics.
38. Statement No. 13
gives a view of the prin-
cipal statistical events of
the year in relation to population, and in comparison with similarly prepared figures for the
five preceding years. The resident population is, it will be observed, still increasing ; the
admissions, though comparatively numerous, bear a smaller ratio to a growing strength of
inmates; the recoveries were, both absolutely and relatively, unprecedentedly high; the number
of persons discharged improved was absolutely above the average of former years, and
relatively about the average. Only two escapes took place, and fewer deaths occurred than in
any of the previous ten years, save two; the death-rate being considerably lower than in any.
Overcrowding.
39. Dr. Payne records some strong observations on the overcrowded state of the asylum,
and his opinion on this subject is supported by Deputy Surgeon-General H. B. Buckle, C.B.,
who is an official visitor of the institution, and whose remarks on the state and management
of the asylum are printed below. A larger number of individuals passed through the asylum
in 1873 than in any previous year of its existence. Notwithstanding the increase of
accommodation which was made in 1871, there was during the year a dangerous want of room
for the lodgment of patients; and the facts which Dr. Payne places on record regarding
the prevalence and fatality of chest diseases, and more particularly of phthisis, and the
inferences which he draws from these, are consistent with knowledge founded on
experience. A discussion took place during the year respecting the practicability of still
further increasing the accommodation of the asylum by the addition of new buildings. The
superintendent and visitors held that the present number of the lunatics was quite as much as
an establishment, organized according to the present plan, could safely and effectually control.
In this opinion I entirely concur. There is a limit to the growth of asylums, which Dullunda
has fully reached; and if it is desired to add to asylum accommodation at the Presidency, it
will be necessary to provide another asylum with a similar and complete staff of officers
and servants—the latter in proportion to the number of lunatics.
Walls.
40. Dr. Payne's remarks on the subject of enclosing walls are consistent with reason
and with the doctrines as to asylum management of the present day.
Mechanical
restraint.
41. Mechanical restraint is still employed in this asylum, but to a considerably smaller
extent than in 1872. Thirty-nine persons were subjected to restraint, against 70,—14 because
they were " dangerous to themselves or others by exhaustion or violence," and 25 for surgical
disease. These patients were restrained on 130 occasions, the mean duration of restraint
being 200 hours, against 900. Fourteen of the patients were restrained by means of woollen
bags, and 25 by ligatures. Dr. Payne submitted in October a long report on this subject, in
forwarding which I laid my views regarding the practice of restraint as used by him before
Government at some length. I could not concede that the figures which were adduced in
support of the practice rendered any proof of its advantages. While hesitating to recommend
any interference with a practice adopted by an officer of Dr. Payne's experience and talent,
and advocated with such force on the ground of personal observation, I stated that, however
fully he had satisfied himself of the merits of his practice, he had failed to furnish the
evidence by which it would commend itself to others, namely the detailed evidence presented
by records of similar cases treated with and without the bag. I also showed by extracts from
English reports, that the men who were loudest in their condemnation of an absolute non-
restraint system, as a matter of fact employed restraint in very exceptional circumstances, and
in a very modified form. The extract which he now embodies in his report from an English
medical periodical is merely a protest against an absolutely uncompromising non-restraint
system, and is not to be read as advocating aught except the rare and occasional adoption
of the practice when it is found absolutely necessary. While, therefore, every latitude must