( 4 )
YEAR.
1856 ... ... ...
1857
...
...
...
1858
...
...
...
1859
...
...
...
1860
...
...
...
1861
...
...
...
1862
...
...
...
1863
...
...
...
1864
...
...
...
1865
...
...
...
1866
...
...
...
1867
...
...
...
1868
...
...
...
1869
...
...
...
1870
...
...
...
1871
...
...
...
1872
...
...
...
1873
...
...
...
1874
...
...
...
1875
...
...
...
1876
...
...
...
1877
...
...
...
1878
...
...
...
1879
...
...
...
Death-rate.
34.75
31.94
......
......
......
......
27.00
16.60
22.00
27.00
33.00
23.00
17.91
16.40
12.62
12.82
12.42
10.84
13.38
16.01
11.37
7.04
7.15
......
Quantity
of
food.
Oz.
40
33½
31
30
28
Cost of food
per
patient.
A.
1
1
1
1
1
1
1
1
1
1
2
2
1
2
2
2
2
2
2
2
2
2
2
1
P.
4
4
4
4
4 4
4
7
7
7
1¼
1¼
10
2½
4¼
6
5
9
8
4
5
6½
5
9
*
* Patients fed by contract.
Dr. Payne says: ''An indolent, unhealthy sore is very rarely seen here." In 1871
Dr. Payne having gone to England on furlough, a series of observations were made by
Dr. Bird with a view to deciding the question of the existence of scurvy.
Careful
notes were taken of the condition of the gums of all patients and new admissions,
and it was found that the supposed scorbutic condition of the gums described by
Dr. Saunders was not due to scurvy, but to the habitual neglect of their teeth by lunatics.
The Surgeon-General, in his remarks on the report, says: " The observations on the condition
of the gums in lunatics, which gave rise to the impression that they were suffering from scurvy,
are important ;* * * * * * it is very doubtful whether the peculiar appearances noticed
betoken scurvy at all, and quite certain that scurvy does not develop within the institution."
This seems to show that the improved and more expensive diet was ordered under a mis-
apprehension as to its necessity.* The reduced mortality which attended its introduction was
followed by a considerable rise in 1874 and 1875 ; the increase, like the decrease, not being
attributable to it. In 1875 the ration of ghee was stopped, yet in 1876 the death-rate
was lower than in any previous year save one ; while in 1877 and 1878 it has been lower
than ever, and is now lower than in most English asylums, in spite of the fact that there
is a larger proportion of cases likely to die in the Indian asylums. Since the beginning of
this year the meat ration has also been abolished, two ounces of pulse being given in lieu of
it, and the present diet-scale is less than that pronounced " thoroughly inadequate " by
Dr. Saunders ; yet the patients are surprisingly
healthy. The statement in the margin shows
the death-rate, the quantity of food supplied in
ounces, and the cost of food per patient per diem
since 1856. One main cause of the increase in
the cost has been a general rise in the price of
provisions; but the general high level between
1869 and 1878 was due to the issue of meat and
ghee. The marked reduction in 1879 has been
brought about by the stopping of the meat ration
and the substitution of a cheaper but more nutri-
tious quality of rice. The provisions of all sorts
are still fully equal to " the best kind in use by
the corresponding classes of persons in the
neighbourhood." Every patient has as much as
he wants. Extras are freely ordered for the
sick, but the great majority of the patients get
the ordinary full diet, which is very similar to
what they are accustomed to at home. Dr. Payne
is convinced that it is in every way sufficient, and
the general appearance of the patients seems to
prove it to be so. The Committee can testify
from personal knowledge that the lunatics at
Dullunda are amply fed with excellent well-cooked food.
The Lieutenant-Governor entirely accepts the conclusions of the Committee
on this point.
8. The expenditure on bazar medicines is small, and the differences
unimportant, depending probably on the more or less free use of indigenous
drugs by different Superintendents. No statement of the value of English
medicines has been furnished to the Committee by the Examiner of Medical
Accounts.
To these items of expenditure the Surgeon-General will no doubt now
give careful attention.
9. The figures of contingent charges show great variations, and prove on
examination not to be comparable inter se. They are—
Dullunda ... ... ...
Dacca ... ... ...
Patna ... ... ...
Cuttack ... ... ...
Berhampore ... ... ...
Hazareebagh ... ... ...
1877.
Cost per patient.
Rs.
14
2
6
3
2
3
A.
5
15
1
8
4
4
P.
11
7
1
5
6
11
1878.
Cost per patient.
Rs.
20
3
8
3
1
2
A.
12
10
0
2
12
10
P.
7
1
11
1
9
3
The Dullunda asylum shows under this head expenditure on account of
paying patients. Great differences in the cost of lighting are found to exist,
* There can be little doubt that Dr. Saunders' impression as to the inadequacy of the ordinary diets had a considerable
influence in raising the cost of diet elsewhere. He was Chairman of the Committee which in 1870 raised the rates at the
Medical College Hospital from 8 annas 10 pies to 12 annas, in spite of the statement by the Principal that "every patient receives
in full all that can conduce to his recovery." It was on his recommendation also that the expenditure on diet in the North
Suburban Hospital was more than doubled, to the serious embarrassment of the resources of the hospital, until the old scale
was reverted to, to the benefit alike of the patients and the hospital funds. See Appendix I of the Report on the Calcutta
Hospitals.