NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
REPORT BY SURGEON-MAJOR N1VEN, M.D.
I have the honour to submit the Annual Report of the Lunatic Asylum
for the year 1873-74, together with the detailed statements of expenditure
and the statistical tables.
Accommodation: su-
perficial and cubic space
per head.
2. Under the present system of arrangement and management in the
asylum, there is sleeping accommodation in the male
division for 200 native and 35 European patients.
In the female division, where there is no separation
of the races, there is accommodation for 50 patients
only. In the above estimate, allowance is made for the temporary accommo-
dation and safe custody of 30 European soldiers during the cold weather, or
what is called the trooping season. With the above numbers, the average
superficial area per head is 74 feet for natives and 75 feet for Europeans.
In the female division, the superficial area per head amounts to 70 feet only.
As the heights of all the rooms and galleries is 10 feet, the cubic space
can readily be found by multiplying by 10 : for native males the cubic feet
per head will be 740 and for females of all classes it will be only 700 cubic
feet. The out-door accommodation is very limited indeed : the whole of the
exercising yards and garden together measuring about 7,831 square yards,
which give about 30 square yards for each patient.
Sanitary condition.
3. The sanitary condition is not very good; heavy and offensive odours
pervade the wards and courts night and morning;
and when the weather is calm and sultry, this pecu-
liarity continues throughout the day, and haunts the numerous corners of
the buildings in spite of the most careful use of deodorizing and disinfecting
agents. The drainage, like that of the city of Bombay in general, sadly
wants extension and improvement. But when it is borne in mind that this
small space of ground is surrounded and intersected by high walls, and that
all the excreta and washings of upwards of 250 lunatics accumulate daily
and nightly within these walls, the wonder is that the institution is so free
from disease and death. It can, in my opinion, only be accounted for by
the prevalence of high winds which clear the atmosphere, and the periodic
rains which wash away all impurities once every year.
Water-supply.
Except during the monsoon, the supply of water from the pipes of the
Vehar Water Company is at all times deficient; and
in the months of April and May it ceases altogether,
and water has to be brought to the asylum from some considerable distance
by means of bullock carts. Of course, this is not a satisfactory state of
things, and does not add to the welfare of an institution of this kind, nor in
any way diminish the other sanitary defects.
4. On the 31st March 1873 the numbers in the asylum were males
188, females 44 : total 232.
1 L A
2
Admissions, discharges,
and deaths.
The admissions during the year have been males
170, females 24: total 194.
The discharges during the year have been males 141, females 15 : total
156. The discharges include one escape.
The deaths during the same period have been males 26, females 7: total 33.
The admissions have exceeded the discharges and deaths by 5.
Mean population.
The mean population of insanes under care and
treatment during the year has been males 197.3,
females 45.2 : total 242.5.
The largest number resident at any one time was 260 in February 1874,
and the smallest 232 in April 1873.
The numbers in the asylum to-day (31st March 1874) are males 191,
females 46 : total 237.
The total under care and treatment during the year has, therefore, been
males 358, females 68: total 426. These may be classed, in a social point
of view, as follows :—
Eur ope a ns .
Natives of the
country, of all
causes.
Commissioned Officers of H. M.'s Indian Army...
Soldiers and Soldiers' wives of H.M.'s British Army
Seamen of the merchant service, mechanics, &c. ...
Paupers under Section IV. of the Act ... ...
Soldiers of H. M.'s Bombay Army ... ...
Paying or private patients under Section VII.
of Act 36 of 1858
...
...
...
...
Paupers under Section IV. of the Act... ...
Criminal lunatics ... ... ... ...
Total...
Males.
1
74
3
8
12
22
212
26
358
Females.
...
3
...
3
...
8
53
1
68
Total.
1
77
3
11
12
30
265
27
426
Of the soldiers, 53 were from the Bengal Presidency, 8 from Madras, and
only 13 belonged to the Bombay Command.
Particulars of previous
history of patients.
5. It is much to be regretted that so little information is given regard-
ing the previous history of persons sent to the
asylum by the Commissioner of Police under Section
IV. of the Act. It is true the Act does not distinctly
lay down that Statement B. should be furnished for native lunatics as it does
in Section VII. for Europeans; but I think it is competent for the local Go-
vernment, under Section II., to enact special rules for the admission of patients.
The scanty information which, as a rule, is given in the medical certificate,
Form A, would not be considered sufficient for the confinement of the mean-
est individual in England. The same is the case with criminal lunatics;
neither the magistrate nor the medical officer concerned ever furnish any
particulars of the trial, or of the previous history of the supposed insane, who,
there is some reason to believe, in not a few cases, would not be sent to an
asylum if the Prussian Code of Medical Jurisprudence were applied to them.
3
Percentage of recove-
ries.
6. Leaving out of the calculation the Europeans who are sent to Eng-
land after a very short residence in the asylum,
for reasons not connected with the institution, the
numerical results of the year yield the following per-
centages :—
Recoveries: males 47.7, females 40 : total 46.6 on the admissions.
Calculated on the total treated, the percentage will be males 15.5,
females 13 : total 15.
With regard to recoveries or cures, it will be seen, by looking at Table
No. 8, that by far the largest number get well after from 3 to 6 months'
residence in the asylum ; and 90 per cent. of all the cures take place with-
in one year after admission. Those mentioned in the table as having been
from 6 to 15 years in the asylum were criminals.
Deaths.
7. The mortality for the year, excluding Europeans, is males 13.8,
females 15.8 : total 14.2 per cent. on the mean popu-
lation resident, which is above the average, but not
so high as it has been in some previous years. Two of the patients who died
had been over 20 years in the asylum, five had been over 10 years, and one only
15 days. See Obituary Table, No. 15 and No. 8.
Escapes.
8. Only one escape took place during the year, namely, a paying patient,
who was admitted for the second time under Section
VII. He escaped over the railing on the top of the
sea-wall, and went at once to his own house in Mazagon. His family
declined to send him back to the asylum.
Refusal of food.
9. During the past year there have been ten patients who have refused
food, and in three cases with such determined ob-
stinacy, that the stomach-pump had to be used. None
of the cases proved fatal, although two were reduced to a very low state of
vitality. One of the cases, a Parsee, admitted as a private patient under
Section VII., resisted with such determination, that when the beef-tea was
administered by means of the stomach-pump, as soon as the tube was with-
drawn, he ejected the whole of the contents of the stomach. Beef-tea was
also given by injection through the rectum ; but after being one month in
the asylum, and no improvement taking place, his friends were advised to
remove him; and after being 36 or 48 hours at home, I was informed that he
took his food voluntarily, and I believe has got well. The other bad case,
supposed to be a Hindu convert to Christianity, was discharged cured, after
a residence of eight months in the asylum.
A strong water-douche, by means of the hose of the small hand fire-
engine pump, was tried in two cases with success in rousing the dormant
senses.
Causes of insanity.
10. So little is known in general of the previous history of the patients
received into the Kolaba Asylum, that not much faith
can be placed in the correctness of the causes as-
signed for the disease. In Table No. 3, the supposed causes are shown for
4
the whole under care, but in most of the old cases no cause whatever is entered
in the register; so that, of those remaining on 31st March 1873, in 50 per
cent. of the cases the cause is unknown. I have prepared a table, No. 16,
which shows the supposed causes of all the new cases admitted in 1872-73
and 1873-74.
According to this table, the chief causes of insanity in the cases admit-
ted in 1873-74 were excess in ganja and malarious fever: 33 per cent. of
the known causes were from the former, and 20 per cent. from the letter.
In Table No. 16 A, the causes amongst Europeans are shown, and about the
same proportions are assigned to excess in liquor as to excess in ganja
amongst the natives. A blow on the head is the next most frequent cause ;
and after this follows exposure to the sun. In the case of the European
soldier, the cause given is that entered in the Detailed Medical History by
the regimental surgeons.
Treatment.
11. No particular kind of treatment is pursued in cases of insanity
arising from ganja. The acute stage has generally
passed away before the patient reaches the asylum,
and all that is required is to see that the man gets plenty of food and is
kept clean and quiet. Poverty of blood and malnutrition of the brain
appear to be the pathological conditions of such patients, and a good hearty
meal with a little stimulant is found to be the best sedative that can be given.
The general principles of treatment consist chiefly in the removal of all
causes of irritation, mental or bodily. On a patient being brought to the
asylum, he or she is placed in a single room for two or three days, well
washed, carefully fed, the state and condition of the excretions and secretions
examined, and the general character of the disease noted, with any particular,
vicious, or other propensities which may be observed.
When there is any obvious bodily disorder found to exist, appropriate
medicines are prescribed for its removal; but when there is no bodily dis-
order present, medicines are not much relied on. In the medical and moral
treatment of the patients, the want of means and opportunities for out-door
employment is much felt. It has several times been brought to my notice
how well all the noisy patients sleep when they are employed for three or four
hours in the afternoon, carrying sand or mud for garden or reclamation
purposes from the foreshore when there is ebb tide. My firm conviction
is that if the asylum had 20 or 30 acres of cultivable land attached to it
the cures would be doubled.
No mechanical restraint is adopted in the treatment of violent or un-
ruly patients. Such patients are placed in one of the dark, boarded cells, or
merely shut up for a few hours in an ordinary room, until the excitement
subsides.
Criminal lunatics.
I have no remarks to make on the criminal lunatics, excepting on one
who is noted for effecting his escape from jails and
once from the asylum. On this man's legs irons are kept
with the view of keeping the attention of the warders constantly upon him.
He is generally a quiet man, and orderly in his conduct, and occupies him-
self with a small garden in the yard.
9
the expenditure might appear to rise and fall when it really did not do so. As
the cost of the asylum when made from the Accountant General's books will
most likely differ from that furnished by my statements, the above remarks
will help to explain and elucidate the matter.
Medical
subordinates,
overseers, and warders.
18. The behaviour of the medical subordinates attached to the asylum
has been exemplary, and their conduct in the manage-
ment of the inmates all that could be desired. The
European overseers and native warders have gene-
rally performed their duties in a satisfactory manner. Mr. Peter MacDaniel,
who had been a good many years employed as an overseer, resigned, and
Mr. John Durham was engaged to fill his place. During the short time he
has been in the asylum he appears to be well suited for the duties of the
situation.
2 L A
10
REPORT BY DEPUTY SURGEON-GENERAL
JOHNSTONE, M.D.
I have the honour to submit the report of the Superintendent of the
Lunatic Asylum, Kolaba, for the year 1873-74. Since 1871-72 the cost of the
institution to Government has been considerably decreased. In that year the
accounts showed an expenditure of Rs. 1,10,742, including the cost of new
buildings, repairs, &c., while in the year 1872-73 the cost was, including the
new buildings, repairs, &c., Rs. 99,267. In the year under report the cost
was still further reduced, being Rs. 59,683, including cost of new buildings,
repairs, &c.
In 1871-72 original buildings cost Rs. 19,160; in 1872-73, Rs. 30,230, and
in 1873-74, Rs. 1,087, being part of balance of works done in the preceding
year.
In 1871-72 the diets cost Rs. 40,993, in 1872-73, Rs. 29,073, and in
1873-74, Rs. 20,613, according to the Superintendent's figures, showing a
saving on diets of Rs. 19,695 during this period, notwithstanding an increase
in the number of lunatics. The Superintendent has shown the cost of each
diet; and every attention will continue to be paid to such economy in this
and other respects as is compatible with the welfare of the persons entrust-
ed to the asylum for care and treatment.
2. In last year's report the Superintendent of the Asylum stated that "it
would appear to be settled thus, that the military authorities have a permanent
claim for 20 beds for European soldiers. It will be important to bear this
in mind, as .I have no doubt that the asylum will be quite full in two or three
years." This number has in the last year been increased to 30, on the
authority of the Superintendent.
The need for this accommodation causes, I think, a waste of the space
provided in the new wing, as that for these thirty must, to a great extent, be
unoccupied during several months of the year; unless, indeed, as appears now
not unlikely, European insane inhabitants increase, not from increase of in-
sanity, but from difficulty in sending them to their own countries; in which
case the soldier insanes, if numerous, will not find the necessary accommoda-
tion.
Under present circumstances, from about April to the early part of
November, a considerable part of the wing is, to all intents and purposes,
unoccupied.
3. The admission of European soldiers, en route to the west, interferes
with the regularity of the institution, and some confusion is created. A
European guard is necessary in the grounds. Would it not be better that
these men should be kept at Deolalee until the period of the departure of the
troopships, and be at once transferred to them ?
The objection to this is that there is no establishment at Deolalee where
any number of insanes could be kept and taken care of for a time; the
advantages would be the immediate increase of space in the asylum for its
legitimate purpose, which has been, perhaps, lost sight of in arranging for
requirements of the soldier insanes, who are simply temporary lodgers on
their way to England. One set last year, however, did pass directly from
Deolalee to the troopship.
12
poor discharged insanes, and in adding to their comforts in the asylum. By
small benefactions, &c., this fund has been kept up to the present time. It
would be, perhaps, better if the whole should be made over to the Accountant
General, who might be authorized to grant a certain sum, under the sanction
of the Deputy Surgeon-General, for the working fund only ; and that small
gratuities, sanctioned at each period of discharge, should be allowed to poor
insanes to enable them to pass to their villages with less risk.
10. Such charges might be sanctioned under the Budget grant, a
regular account of the work, &c., being kept and submitted.
Frequent visits to the asylum enable me to report that much attention
is paid to the care of the insane by the Superintendent and his establishment.
13
REPORT BY DEPUTY SURGEON-GENERAL JOHNSTONE , M.D.,
ON INSANES OUT OF ASYLUMS.
I have the honour to submit a table , No. 15, giving such information as
has been available, concerning the lunatics who have been brought to civil
surgeons, or to dispensaries in the Presidency Division, during the years
1872-73 and 1873-74, from district magistrates, police, and jails, or by
friends. From the recent census I have caused the numbers of insane and
idiots to be tabulated, and my return will show what a small percentage of
these has required to be removed to an asylum, or has appeared for any
treatment.
2. The greater number sent to civil surgeons are so for observation,
and some of these are, on the declaration of the medical officer, sent to the
lunatic asylum at Kolaba, to that of Ahmedabad from Surat, and to Dharwar
from Kanara. Recently, some criminal lunatics have been sent from the
Kanara Collectorate to Kolaba.
3. At the Jamsetjee Jejeebhoy Hospital insane patients have been
treated, the insanity appearing whilst under treatment for other diseases.
In 1872-73 there were 22 cases, out of which number 2 were cured, 10 sent
to the lunatic asylum at Kolaba, and 10 consigned to relatives. In 1873-74
there were 29 cases, of which 7 were improved or cured, 11 sent to the
asylum, and 11 consigned to relatives, &c.
4. In the European General Hospital, in 1872-73, 3 lunatics were treated,
1 was cured, and 2 sent to the asylum. In 1873-74 there was only 1
treated, the case was discharged cured.
5. In the Tanna Civil Hospital, in 1872-73,4 cases were either treated
or sent for observation ; 1 of these was sent to the asylum, and 3 to friends,
unimproved. In 1873-74 there were 8 cases, 1 of which was sent to the
asylum, the remainder were given over to their friends, unimproved.
6. In the Surat Civil Hospital, 14 cases were either sent to the civil
hospital for treatment or observation in 1872-73, chiefly for the latter ; most
of these were, it is believed, sent to the lunatic asylum at Ahmedabad, 1
died in hospital. In 1873-74, 7 cases were received into hospital, 2 sent
to the Ahmedabad Asylum, 5 were entrusted to the care of their friends or
relatives, and 1 died.
7. At the Broach Civil Hospital, 5 cases were brought to notice in
1872-73 ; some of these were transferred to the lunatic asylum at Ahmed-
abad. In 1873-74,12 cases were sent to hospital, 4 of which were transferred
to the same asylum.
8. At Ratnagiri 1 case occurred in 1872-73, which was transferred
to a lunatic asylum. In 1873-74 no cases were brought to notice.
At Vengurla, in 1872-73, 5 cases were sent to the medical officer, 2
of these were transferred to the lunatic asylum, 3 were entrusted to their
friends, 2 apparently cured, and 1 very much improved. In 1873-74
there was only one case which was transferred to relatives much improved.
14
9. At Dapuli only one case occurred in 1872-73, which was transferred
to the asylum at Kolaba. In 1873-74 no case was sent to the medical
officer.
10. Karwar Civil Hospital received 7 cases in 1872-73, one of
which, according to the register, was transferred to an asylum. In 1873-74
there were 9 lunatics, 4 of whom were transferred to the Dharwar Asylum,
1 died, and 4 were given to the care of their relatives, &c.
11. At Alibagh, in 1872-73, 3 cases were sent to the medical officer;
all were sent to the asylum. In 1873-74, 5 cases were sent to the medical
officer for observation, and of which 3 were sent to the asylum at Sawantwari.
None were sent for observation or treatment.
12. At Aden, in 1872-73, 2 cases were treated and subsequently
transferred to friends, &c. In 1873-74 there were 3 cases, of which 1 was
cured, 1 not improved, sent to friends, and 1 died.
13. The causes of the mental disease are chiefly stated to be "unknown."
In each year 1 is put down as hereditary, 4 and 6, respectively, to
ganja, or intoxicating drinks, 7 and 12, respectively, to diseases, acci-
dents, masturbation, &c., 52, and 44 to causes unknown. Endeavours will
be made to ascertain more closely the probable causes which lead to the
mental disease in those brought up for observation or treatment.
14. At dispensaries a total number in 1872-73 of 50, and in 1873-74
of 42, lunatics have attended ; in general their friends bring them, but
they soon cease to attend, and are then marked absented. At some
dispensaries, such as Surat Civil, Bassein, Kumpte, &c., more than usual
numbers appeared. In 1872-73, 12 were stated to be cured—4 at Kumpte,
1 at Bassein, 1 at Paruck, 2 at Nowsari (Victoria Dispensary), 1 at Kelvi-
Mahim, 2 at the Charitable Dispensary, Tanna, and 1 at Bulsar. In 1873-74,
2 were cured at Kumpte—all others in each year were under the care of
their friends, except, in 1872-73, 3 were sent to asylums—from Bassein
2, and from Kumpte 1. In 1873-74 none were sent to asylums from dis-
pensaries.
15. In jails, in 1872-73, in Tanna, 1 case of mania was admitted; he
improved and was not sent away. In 1873-74 a case was admitted and
cured. In Ratnagiri Jail 1 in 1873-74. In Karwar Jail, in 1872-73, 1
case of mania was treated and died ; in 1873-74, none. In the County Jail, in
1872-73, there were none; in 1873-74 there was 1 case admitted and sent to
the asylum. In the House of Correction, in 1872-73, 3 cases were admitted
and sent to the asylum; in 1873-74 none were admitted. From the work-
house, in 1873-74, 2 European insanes were sent to the asylum.
16. Police.—In the Karwar Police 1 case occurred in 1873-74, which
was treated in the dispensary at Kumpte; the case improved.