DACCA LUNATIC ASYLUM.
39
Paralysis.
One case of paralysis of the insane was under treatment during the year, but death
was caused by a casual attack of pneumonia.
Shaik Mahomed, aged 55, a bheesti by profession, had been an inmate of the asylum
over four years. Difficulty in articulating, a dribbling of saliva, incoherent talk about Rs. 12
due him, and a hurried unsteady walk, were the chief symptoms of the brain disease. From
the 1st November 1872, until his death on the 28th May, his temperature was recorded twice
daily. The morning entries always exhibited a temperature lower than in health, even
during the hot months, while the evening register was occasionally above normal range.
On the 24th May he was attacked with pneumonia, which ran a very acute course. On
the third day the highest point registered was 104°, on the fourth 104° 4'.
Pneumonia.
Pneumonia was less prevalent in 1873 than in 1872; but still the admissions and deaths
from this disease were excessive. In 1871 the admissions from inflammation of the lungs
made up 1.3 per cent. of the total admissions; in 1872, 6.3 per cent.; and in the past year,
2.8 per cent.
The mortality due to this cause has risen greatly. The deaths to seizures in 1871 were
44.4 per cent.; in 1872, 45 per cent.; and in 1873, as high as 47 per cent. In the Dacca jail
the deaths to seizures during the past year were only 21.7 per cent.
In the report for 1872, this frequency of inflammation of the lungs was referred to the
vitiated air developed in the overcrowded cells. On this point my opinion is unaltered. As
long as only 28 superficial feet per man is the average allowance, and when most crowded
only 26 feet are available, we cannot expect affections of the lungs to diminish in frequency.
It is, however, undoubtedly true that since the introduction of the clinical thermometer,
many cases, formerly entered as remittent fever, are now correctly classified. The commence-
ment of pneumonia in a debilitated lunatic is most insidious, and the faint respiratory
sounds heard through the stethoscope are apt to deceive the listener. With the thermometer,
however, and a careful estimate of the symptoms, a correct diagnosis is always certain.
The disease was not confined to any particular season. Three cases were admitted in
January, two in February, two in August, two in September, two in November, and one in
each of the following months—March, April, May, and July.
The average age of the patients, who were all males, was 35½ years.
Both lungs were affected in six cases; the left lung alone, in five; the right lung alone,
in three; and in four the side affected was not recorded. The inflammatory attack was
secondary to cholera in two cases; to dysentery in one; to diarrhœa in one; and to general
dropsy in one. In one instance the inflammation was due to tubercular deposit in the
lung.
In several the disease appeared subsequent to a sharp attack of ague. In nine cases,
the temperature ranged from 104° to 105° 3', an elevation never attained in mild cases. On
the first, third, and fourth days, the temperature was highest. In only one instance did death
occur during an accession of fever. In all the others the temperature fell rapidly below the
standard of health on the day of decease. The fatal cases were characterized by typhoid
symptoms—a semi-comatose state, and muttering delirium.
Types of insanity.
Table 12 shows the types of insanity admitted during the year.
Of the total admissions, 42.5 per cent. were classified under acute mania; 22.8 under
chronic mania; 23.6 under melancholia, and 9.4 under chronic dementia.
The largest number of cases were under chronic dementia; next, under chronic mania.
Three males are returned as not insane. In last year's report reference was made to
two of these. The third is a man from Mymensingh, who wounded his own children while
insane after a severe attack of fever. A Commission was appointed to consider what
should be done with him, but the members declined to recommend his release.
Assigned causes
of insanity.
Table 13 exhibits the assigned causes of insanity among the lunatics treated.
In 1872 no cause was mentioned in 20.6 per cent. of the cases; this year, in 18.4.
Among the males, madness was attributed to physical causes in exactly one-half of the cases;
while among the females, only in one case in fourteen.
Abuse of ganja.
The abuse of ganja still heads the list of physical causes. In 29.16 per cent. of the
total treated the insanity is referred to this head, although every means have been employed
to distinguish the habitual from the occasional smoker. Of the 102 males admitted and
re-admitted, 30, or 29.2 per cent., were represented to have become insane from ganja;
while of the females two out of 25 had become mad from the same cause. One male
criminal was admitted whose insanity was referred to ganja; but he had been regarded as
mad for five years, and for six months before committing the theft with which he was
charged he had been kept bound with ropes. Eighty-three per cent. of the males were
Hindus, and only 16 per cent. Mahomedans. Among the five Mahomedans, however, two
were Hindus by birth. The two females admitted from this cause were Mahomedan prosti-
tutes. Tea coolies are notorious ganja-smokers, and of the nine admitted, all had their
insanity referred to the abuse of this weed.
Natives generally ascribe insanity to " bayu," which seems to be vertigo; due to blood-
poisoning from putidal emanation, or to any chronic and debilitating disease.