NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
10
months, the soil about the upper part of the asylum and in the airing courts
is often soaking during the monsoon season. The three main drains which
convey all the liquid matter and waste water of the establishment to the sea-
shore very frequently become choked, as all sewers opening on a flat tidal
surface are liable to be. They are covered in, and furnished at intervals with
trap-doors for the purpose of seeing that they are clean and free.
Conservancy.
30. The night-soil is regularly removed to some distance on the shore
by the regular staff of sweepers on the establishment,
and carbolic acid and McDougall's powder freely
used daily for deodorizing and disinfecting purposes.
Winds.
31. The prevailing winds are from the S. and S.W., and they thorough-
ly penetrate the upper floor of the asylum ; but when
the wind is light, the lower floor in the south wing is
often very close, and disagreeably hot and steamy.
Vaccination.
32. Vaccination was practised on 71 patients who bore neither marks
of small-pox nor previous vaccination; but as only 34
proved successful, it may be inferred that the larger
number of the 71 had really previously suffered from mild small-pox, or had
been vaccinated.
General Health.
33. The health of the inmates generally has been good. There was no
epidemic, nor have any severe diseases prevailed to
any extent. It is stated that scabies and ringworm
caused the greatest number of admissions on the sick list. Dr. Murphy says
that "in an asylum so crowded, and where there are no means of isolating the
affected cases at night, this must necessarily to a certain extent be expect-
ed."
Dysentery and Diarrhœa.
34. Dysentery and diarrhœa caused 5 and 6 deaths respectively. In
my previous report the figures were 10 and 8 in a
total of 33 deaths. This year the total deaths were
just the same as last year.
Treatment.
35. The treatment of insanes is and always must be of a mixed kind
and the method of it must vary with the circum
stances of each case. Notwithstanding this, however
there are some well-recognized principles which should guide every one in the
care and treatment of insanes. But unfortunately the physical conditions at
Colaba render the application of these principles all but, if not quite, impossi-
ble. Dr. Murphy says in regard to the treatment pursued by him:—"There
was no uniform method adopted ; it may, however, be divided into medical,
moral, and dietetic. The medical has been directed chiefly towards regulating
the bowels and altered secretions in some; while in others such sedatives as
potassii bromidum, belladonna, conium, Indian hemp, and morphia have been
largely employed, and with success, to quiet excitement and induce sleep.
The moral has been characterized chiefly by the entire absence of any coer-
cion or mechanical appliances for restraint. The criminal patient alluded to
in last report as wearing irons, had these removed early in the year. If a
patient happens to get excited and unmanageable, he is removed at once from
the other patients, and locked up till the excitement subsides. The subject
as to the sources of out-door employment is still under consideration. It is
11
difficult to know what to undertake so as to cover the outlay and give suit-
able employment to the lunatics, at the same time few, if any, of them are
handicraftsmen or tradesmen, nearly all belonging to the class of wandering
beggars or religious mendicants. It is obvious that some kind of agricultural
labour or gardening would suit best, but this is impracticable for want of soil
and water, a fact of which Government are already aware. The greatest
economy and supervision have been exercised in the regulation and distribu-
tion of the food. The diet is a very liberal one."
Out-door
Employment
of Inmates.
36. The difficulty of finding out-door employment for the greater
part of the patients is insurmountable. A few are
employed in the workshop, a few help in keeping the
garden clean and in the general conservancy of the
whole interior of the asylum ; but for agricultural labour there is no ground
and yet this kind of employment is the very best curative agency known to,
the profession.
Employment—Washing.
37. By the way of introducing one kind of employment—washing, I
would recommend the construction of the necessary
requirements for this purpose. What would possibly
answer the purpose best, would be washing and wringing machines, with a
mangle, all of which could be easily worked by any of the patients, and this
mode would, I think, be taken to more kindly by them than the one
usually adopted by the natives. The Superintendent reports that, were any
system adopted within the walls of the asylum, there would be less liability
to making away with the clothes, or substituting old for new ones ; and the
ground tax of Rs. 16-4-0 paid at present, would be saved.
Europeans.
Soldiers and their Wives.
38. At the close of the previous year there remained of males 6
civilians and 1 soldier, and of females 2 ; during the
year, 97 males and 6 females were admitted, and 1
was re-admitted, making a total of 113 Of the admissions, 76 were sent
from the other Presidencies, 91 were soldiers, and
5 wives of soldiers.
39. The following table gives the proportions from the various
Presidencies:—
Bengal
Madras
Bombay
Males ... ...
Females ... ...
Males ... ... ...
Females ... ...
Males
Females ... ...
Mania.
49
2
24
1
18
2
Melan-
cholia.
12
1
8
...
5
...
Demen-
tia.
20
...
7
...
9
2
Imbecility.
1
...
1
...
...
...
Total.
49
2
24
1
18
2
Causes.
40. It is still to be regretted the cause of the insanity is so often "un-
known" as is the case in the majority of these.
I observe that Dr. Murphy does not state that
he called for information on this point from the authorities by whose order
the lunatics were sent to the asylum. Dr. Murphy writes :—" In the
12
majority of these cases the cause of their insanity is entered as 'unknown'.
I make no doubt, however, excessive indulgence in spirits, coupled with
climate, are constant factors. It might be interesting to observe that
there are more dementia cases than usual, and that the total number of
military treated shows an increase of 19 as compared with the previous
year."
A loose statement of this kind, regarding the constant factor in
causation, is of no real value, more especially as the family history in re-
gard to heredity is wanting.
There, surely, ought not to be much, if any, difficulty in obtaining the
causes in the cases of soldiers and their wives.
Europeans only tempo-
rary Residents.
41. As stated in my report for last year, the
history of Europeans is mainly one of reception
and discharge during the trooping season.
Civilian Europeans.
42. The civilian Europeans numbered 16 under treatment, 2 of whom
were criminals, 1 of whom recovered and was sent to
England at the Government expense. There were
3 of the non-criminals sent home at a cost, to Government, of Rs. 1,100,
exclusive of outfit ; and an Italian was handed over to his Consul to be sent
to Italy; 3 recovered and were discharged ; and 1—improved—was made
over to his friends.
Deaths among Europeans.
43. Three deaths occurred—1 from phthisis, 1 dysentery, and the third
from long-standing diarrhœa associated with para-
lysis; this last patient had been in the asylum 18
years. The two former patients were in the asylum only 19 and 9 days
respectively, and, as far as I can judge, neither the soldier dying of consump-
tion, nor the soldier's wife, who lived only 9 days, should have been sent to
the asylum. The soldiers and soldiers' wives in the Colaba Asylum help to
swell the daily average population considerably, and yet it can hardly be said
that they are brought under the influence of the Medical Officer's treatment,
since they are merely housed and taken care of until they can be shipped to
England.
Natives.
44. At the close of the preceding year there remained 184 males and
44 females, and during the year there were 91 males
and 18 females admitted; and 8 males were re-
admitted. The total number under treatment was therefore 345, but the
actual number of persons was 337; 8 of them came twice under treatment.
The greatest number of natives in the asylum at any one time was 209
males and 54 females—total 263.
Daily Average, &c.
There were on a daily average 249.2 insane natives, of whom 200.3 were
males and 48.9 females. There were discharged 40
males and 6 females as cured, 19 males and 2 females
as improved, and 11 males and 3 females not improved. The improved and
not improved were given in charge of their relatives on the condition of
responsible care being taken of them. These cases are carefully selected
and known to be harmless. I think it is very probable that many of the harm-
less insanes in our asylums might be left in charge of their relations, and
13
Magistrates should be allowed some latitude in this matter. With the advice of
the Civil Surgeon and the evidence of the relatives and police, a Magistrate
would have little difficulty in many cases of coming to a conclusion on the
subject of the insane being a harmless or dangerous lunatic. As a matter
of fact there must be thousands of lunatics among our population, and yet it
is, comparatively, quite a rare thing to hear of violence done by them.
Deaths.
45. The deaths among natives amounted to 33, of whom 24 were
males and 9 females, the total being the same as
in the year preceding. The percentage of deaths to
admissions is greater among females than males.
Causes.
46. The causes of lunacy among natives are, probably, in kind much
the same as among all races : here ganja and opium
taking the place of alcoholic liquors.
Cures.
47. With regard to cures, Deputy Surgeon-General Johnstone re-
marks:—"The cures were 18.7 per cent. to average
daily number; they have never in the ten years
comprised in the statement been higher than 23, and have been as low as 8.
Cures to admissions have, however, been as high as 54, and in the year under
report they were 23.6."
Total treated.
48. The total number treated in the asylum
was 113 Europeans and 345 natives.
Over-crowding prevented.
49. To prevent over-crowding, a bungalow, just outside the asylum
wall, was, by the permission of Government, occupied
by harmless insanes. These were removed after
the trooping season into the asylum, agreeably to order, but the bungalow
is still allowed to be available in case of any increase in numbers at a future
time. It will always be required during the cold season, when the insane
soldiers are awaiting, in this asylum, passage home.
Refusal of Food.
50. There were 6 cases of refusal of food. One was of a very obstinate
and protracted nature in a young Parsi suffering
from acute mania; he had to be fed with the stomach-
pump regularly for about two months; he was in consequeuce very much
reduced. One day he was accidentally given some beer, which had the de-
sired effect, as he began to eat soon after of his own accord, and became stout
and strong, and shows signs of improvement. In 3 the stomach-pump
was only had recourse to for a few days, and in 2 others it was not re-
quired.
Escapes,
51. There was one escape from among the patients, who went to
the fort for articles of supply, and 4 unsuccessful
attempts.
Post-mortem Examinations.
52. Thirteen examinations were made without eliciting any particular
facts relating to the disease, except in one case, in
which an organized clot, about the size of an olive,
was found in the left ventricle ; but the Superintendent is unable to say
whether there were any symptoms during life to indicate the presence of this
morbid condition.
14
New Airing Court.
53. A new airing court has lately been completed, which will be of
some advantage in classifying the patients. I have
observed invariably at my visits to the asylum that
in the male yard some of the insanes appeared to be in a state of excitement,
which probably would have been mitigated, if not prevented, had there been
the means of separating the patients.
Workshop.
54. The income of the workshop amounted to Rs. 542-5-9, which,
added to the sum of Rs. 246-5-9, carried forward
from the previous year, gives a total of Rs. 788-11-6.
The sum of Rs. 358-4-10 was paid into the Treasury, the balance having been
expended on material, and in giving small sums to discharged patients to
help them on their way home. The chief employment is cane-work ; a few
helping the tailor, mason, and carpenter. In comparing the total amount
realized by the workshop this year with that of last, there is an increase of
Rs. 170.
Income.
55. The following details show the income
and sources of it:—
Realized from the sale of articles ... ...
Paid into Treasury by Commissioner of Police on
account of patients under Section 15 of Act
XXXVI. of 1858
...
...
...
...
Received from patients under Section 15 of Act
XXXVI. of 1858
...
...
...
...
Received from patients under Section 7 ... ...
Total ...Rs.
Rs.
358
72
8
3,033
4,052
a.
4
6
12
3
10
p.
10
0
0
5
3
Expenditure.
56. The expenditure is here shown as compared with the preceding
year, from it the income is deducted, and on the
balance the average net cost of each patient for the
year is shown to be Rs. 199-7-4, or Rs. 15-2-11 less than in the preceding
year :—
Establishment
...
...
...
...
Diet
...
... ... ... ...
Clothing ...
...
...
...
...
Bazaar medicines ...
...
...
...
Contingencies
...
... ... ...
Total ...
Deduct income ...
...
...
...
Average yearly cost ... ... ...
Net cost after deductions ...
...
...
1873-74.
Rs.
26,335
20,613
3,728
305
6,476
57,458
4,503
237
218
a.
2
14
2
3
6
13
9
6
13
p.
6
3
7
5
5
3
8
11
1
1874-75.
Rs.
25,844
21,808
2,903
370
6,361
57,288
4,052
214
199
a.
0
1
11
14
8
4
10
10
7
p.
10
3
4
9
6
8
3
3
4
18
Mechanical Restraint.
73. No mechanical restraint was used, and the
patients were easily managed.
DHARWAR ASYLUM.
Superintendence.
74. The lunatic asylum at Dharwar is under
the charge of the Civil Surgeon at that station,
Accommodation.
75. It is contiguous to the civil hospital, and is a very poor place indeed,
affording very miserable accommodation for about 18 insanes; as compared
with any of our other asylums it is by far the least suited for its purposes.
It has two wards or day-rooms and 18 cells, but when the present regimental
hospital is transferred for the use of the civil patients the building at pre-
sent occupied by these will afford increased accommodation for insanes.
The two day-rooms are for the separation of the
sexes. The male day-room has 7,950 cubic feet of
air and the female 5,300. There are small court-yards in which the patients
take air and as much exercise as such a limited space can allow of. In these
small courts there are two privies, one for females and the other for males, and
on either side the range of cells, each of which is 12 feet by 10 and 11 1/4
feet high : so each contains 1,350 cubic feet of air. The ventilation is said to
be good both in the cells and day-rooms. Two of the cells are padded
rooms, and used for refractory patients. Padded rooms in India are objection-
able, as they give cover to vermin, and as a matter of fact they are now
little used anywhere. The accommodation is not equal to the requirements of
the district, and during the year many applications for admission had to be
refused.
Unsuitability of
this
Asylum.
76. This asylum is about as unsuited for curative purposes as it well
can be ; and as regards classification all that can be
done is to separate one sex from the other. But
the mild and gentle monomaniac recovering to sanity
is compelled to associate with the foul and obscene howling maniac who
constantly shocks every sense of decency. Although the building is really
intended for only 18 patients yet 24 have been crowded into it at one time :
the excess were placed at night in the day-rooms,—a violation of one of
the principles of physicians who make this disease their special study ; but
in Dharwar, where the ventilation is good, perhaps it does very little harm.
Inmates.
77. The whole of the insanes were natives. At the end of the year, 24
remained and 8 were admitted during the year. Of
the admissions 1 only was a female. There were no
re-admissions. Two were discharged cured. I regret to observe that Dr. Bell
does not state whether the cures occurred among the recently admitted or
among the old residuum. Five recovered so far that they could be entrusted
to the care of their friends ; 2 criminals were transferred to Colaba. One
death occurred from softening of the brain. There remained, on the 31st
March last, 18 males and 4 females, or 2 less than at the end of the previous
year.
Classification of the Insanes.
78. The cases were classified as 16 mania—14 males and 2 females ;
and 16 dementia, of whom 13 were males and 3
females.
19
Causes.
79. The alleged causes of the insanity are stated to be ganja in 2
males, fever in 1 male, grief in 3 cases—1 male and
2 females, and in 26 the causes were unknown.
General Health.
80. The general health was very good.
Cost.
81. The total expenditure was Rs. 3,981-8-9, and the average cost of
each insane was Rs. 185-2-7 as compared with
Rs. 181-10-9 in the preceding year. But in my
previous report the calculation was based on the total treated, which showed
it to be Rs. 137-8-1.
Employment of Insanes.
82. On an average there were 7 males employed in digging and
watering plants and keeping the grounds tidy.
This employment is stated by Dr. Bell to be more
of an amusement than remunerative. The first object of all employment
in asylums is curative, and without interfering with that it should be, as
far as possible, remunerative. If the insanes keep the grounds tidy and
clean, and water plants, it saves having servants for this work, and thus it
is remunerative. Dr. Bell adds :—" None are employed in in-door work, and,
indeed, beyond those selected for garden work there is not a man or woman
of sufficiently high mental capacity who would have sense to grind grain
or put their hands to work of any description ; the majority of patients
in this asylum being paupers, mentally and physically the lowest of the
low."
Paying Patients.
83. Only one inmate of the asylum was in a position to pay for
his maintenance, but Dr. Bell does not record any
payment.
Garden.
84. The garden supplies abundant vegetables to the insanes. More
ground could be put under cultivation, but there is
said to be no certain market for the sale of the pro-
duce. This statement appears to me rather strange when, I believe, the town
of Dharwar has a large population, some of whom, it is to be presumed, would
consume vegetables. I trust the attempt being made to make the garden
pay, will be successful. Much, however, will depend on Dr. Bell's own zeal
in this matter.
AHMEDABAD ASYLUM.
Superintendence.
85. The asylum of Ahmedabad was under Surgeon-Major Johnson's
superintendence from the beginning of the official
year till 28th January last, on which date he was
relieved by Surgeon-Major Wiehe, who held charge till the end of the year.
These officers have each submitted a report on the asylum for the time
they held charge, and Dr. Wyllie has written an able review of the working
of the past year. My remarks are based on the information supplied by
these three documents.
Buildings, Capacity, &c.
86. In last report (page 26) it was mentioned that the asylum, as
constructed in 1862, was intended for 70 inmates,
but that it had been enlarged in 1869 and 1872 to
accommodate 108 : already more room is required, the inmates at the end
of the year exceeding by 5 the number which the asylum has space for,
21
Mean Population.
between these two percentages of 3.7 is the rate of increase in the insanes
for the year. Dr. Wyllie states that in English county and borough asylums
this rate is 2.8 and in Bengal in 1873 it was 3.1. But it is manifest that
this rate here is liable to extreme variations, as we have never yet met the
wants of this Presidency in regard to the necessary accommodation for our
insanes. The average number of daily inmates was
108.9, or 90.4 males and 18.5 females. This average
has more than doubled in the last ten years, and in the same period the
increase in the number of persons treated amounts to 67.5 per cent.
Cured, transferred, &c.
81. Ten were discharged as cured, 6 were transferred to friends, 1
escaped, 9 died, and at the end of the year under
report there remained 113, or 4 more than in the
preceding year. The cures and transfers to friends are somewhat less than
in the preceding year. Of the cured 1 had been over 8 years in the asylum,
1 over 2 years, and 2 for over 21 months. These 4 showed no signs of
improvement, Dr. Wyllie says, until after they had been more than a year
in the asylum: all the rest of the cured were less than a year under
treatment. Of the 6 transferred, only 3 showed signs of improvement.
Long Residence.
92. Dr. Wyllie says with reference to the effect of long residence, &c. :—
" Notwithstanding the number noted as amending,
prospects appear to me less encouraging than in the
past. Only 23 per cent. of the residents are under one year, while the
tendency is naturally towards further diminution. The significance of this
lies in the fact that some 69.3 per cent. of recoveries occur within the past
year. Thus the statistics of this asylum for the last decade show that in a total
of 180 cures, 123 were effected in the first year, 32 in the second, 12 in
the third, 8 in the fourth, 3 in the fifth, while in the second quin-
quennial period there were only two (both criminals convalescent within the
first period), and none later. Of 18 residents at present above ten years, all
must thus be regarded in the category of incurables; while of 25 in the
second quinquennial period hopes of recovery are no better than in ratio of
1.1 per cent. at most."
Castes.
93. The Hindus were 111, Mussalmans 26, and
Parsis 2.
State as regards Marriage.
94. Fifty-three were married, 16 widowers or widows, 51 unmarried,
and it is not known whether the other 19 were mar-
ried or single.
Previous Employment.
95. Fifty-four were beggars, 23 cultivators, 21
labourers, 12 servants, and the rest were traders and
artizans.
Paying Patients.
96. The cost of maintenance or contributions thereto was made in 16
cases, the rest were maintained at the cost of the
State, being paupers who were mostly friendless.
Causes.
97. In 56 cases the cause of the insanity was unknown. The use or
abuse of ganja is said to be the cause in 34 cases, in
15 epilepsy, in 10 debauchery, 4 cases are said to be
the result of ill-treatment, 3 to be from loss of money, 2 from grief, 2 from