( 11 )
TABLE No. III.
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
12.63
12.82
12.42
10.84
13.38
16.01
11.37
7.04
7.15
......
Quantity
of
food.
Os.
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
2¼
4¼
6
5
9
8
4
5
6½
5
9
0
* Patients fed by contract.
the gums, but a swollen suppurating state of the gums with recession from the
teeth, the latter having in many cases fallen out." Dr. Payne did not consider
this to be due to scurvy, and " did not consider the dietary defective,"
but on Dr. Saunders' recommendation, a daily ration of four ounces of meat
was substituted for the fish ration, the allowance of rice being slightly
diminished, and an ounce of ghee added. Of this diet Dr. Payne writes
that " it is more ample and more complete than in any other institution, and
contains everything that can be thought useful." He also remarks—" Several
of the lunatics are unable to consume the rations allowed them." These
changes added materially to the cost of the diet. The death-rate continued
to diminish, but the fall was attributed by Dr. Payne to other causes than the
altered diet scales, although he admitted that " the healthier men had gained
in flesh and general appearance." In 1869 Dr. Saunders writes : " It is a signi-
ficant fact that the simplest sores at Dullunda heal with difficulty." In 1870
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 misapprehension as to its necessity.* The
reduced mortality which attended its introduction was followed by a consider-
able rise in 1874 and 1875 ; the increase, like the decrease, not being attri-
butable 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 sur-
prisingly 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 re-
duction in 1879 has been brought about
by the stopping of the meat ration and
the substitution of a cheaper, but more
nutritious, 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.
* There can be little doubt that Dr. Saunders' impression as to the inadequacy of the ordinary diets had a con-
siderable 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 annus 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 1 of the report on the Calcutta Hospitals.