NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
17
Sixteen of the whole number, or 28 per cent., were able to pay for their
maintenance, whilst 41 or 72 per cent., were paupers.
Poverty gave 15 cases : 7 were cured, 2 died.
Fever is a common cause of insanity. There were 29 cases, 8 of which,
or 27.6 per cent., were cured ; 4,or 14 per cent., improved ; and 4 died, or 14
per cent. Three were able to pay for maintenance ; 26 not able.
Puerperal.—Two cases ; 1 cured : both pauper patients.
The remaining physical causes do not require special mention. Ten are
said to have been from blows on the head, and the cases being those of sol-
diers who were all sent to Europe, no results of treatment can be given.
Of the moral causes there were 15 cases of " grief ", 4 of them were cured.
There was no death. Cases in which the loss of money has been the cause
seem the most incurable. Of 15 such cases, none were cured, but 2 were
improved. A previous attack renders the prospect of cure most unfavour-
able. Of 17 cases, 1 only was cured; half of the cases of "ill-treatment "
got well. Of the predisposing causes, " advanced age " and " congenital "
are incurable ; but " hereditary " is less hopeless, as of 15 cases, 2 were cured
and 1 improved.
Nothing need be said as to modes of treatment. Medicine, in the shape
of drugs, holds a useful but subordinate position. Good hygiene, careful
sanitation, suitable employment, and a humane and patient consideration
for those who are unable to think properly for themselves; these
arethe
main items in the cure or improvement, when happily brought about, and
secure for " incurable " cases all the alleviations which their condition per-
mits. Much, however, is still wanting to bring the above named salutary
influences up to the necessary degree of completeness.
Unknown Causes.—During the past year, of the total treated, in 45 per
cent. the cause was unknown. There was a slight difference in regard to sex,
the proportion of unknown causes to the whole number of men being 45 per
cent., of women 43.2 per cent. These numbers appear large, but on exa-
mining the figures of a large English asylum, I find that the unknown causes
bore the following proportion to the annual admissions of each sex :—Men
45.2 per cent.; women 66.2 per cent., and if the generally careful way in
which English statistics are prepared be taken into consideration, the above
figures would seem to show that the table gives a more hopeful account of
the amount of information possessed as to the causes of insanity in this
country than might, perhaps, have been anticipated. The unknown may be
presumed to be made up of all the known causes, which in their variety give
a fair representation of the influences generally believed to induce insanity.
During the past year there were 365 cases : the results of treatment
were that 29 were cured, or 7.9 per cent. ; 9 improved, or 2.6 per cent. ; 31 died,
or 8.5 per cent.; 35 were able to pay for maintenance, 330 were unable to do
so. It is very generally held that insanity is the companion of poverty,
and that the well-to -do are rarely subject to it. The figures in the table
give some support to this view.
3 l a
18
Table No. XIV.—Finance.
The principal difficulty in compiling this table has hitherto been found
to be in the figures pertaining to the Kolaba asylum.
They have now been arranged so as to show with
greater correctness the incidence of the various items of expenditure on
the three classes of inmates in the asylum : 1st, Europeans and Eurasians;
2nd, Parsis, Jews, &c.; 3rd, Hindoos and Mahomedans; each class having
a dietary scale differing in cost from the other. Up to this time the whole
of the expenses have been massed into one sum and divided by the daily
strength of all races. The result of this was that the diet cost, for example.
of the ordinary native insane, was made to appear much larger than it ac-
tually was, and so with other items.
The total expenditure during the past year shews a decrease of Rs. 7,852
compared with 1872-73, the average daily strength having been 14 in excess
of that year.
Examining the various headings, the following show an increase over
the previous year :—
Establishment ... ... ... ...
Bedding and clothing ... ... ...
Bazaar medicines ... ... ... ...
Rs.
1,309
1,813
293
Whilst in the two remaining items there is a decrease of Rs. 9,825 on
diets, and of Rs. 1,442 in contingencies.
As to the " receipts " there has been an increase during the past year
as compared with 1872-73, in each item as follows :—
Received from patients ... ... ...
Cash received for labour ... ... ...
Estimated value of do. ... ... ...
Rs.
1,400
636
109
Whilst of " miscellaneous receipts" a sum of Rs. 465 was given to the
Kolaba Asylum during the year by native princes and chiefs, to assist the
Working and Relief Fund.
At the Kolaba Asylum, the total cost, without deduction of each Euro-
pean and Eurasian patient, was Rs. 405-12-4; of Parsis, Jews, &c., Rs. 263-0-2;
of ordinary natives (Hindoos and Mahomedans) 213-6-1 ; in all cases, a
considerable reduction in the cost in the previous year.
At the Poona Asylum, each patient cost Rs. 187-3-4, the figures of
1872-73 being Rs. 169-9-2. This increase during the past year is due to the
fact that " bedding and clothing " fell into the charges of the year, there
being none on this account in the year preceding.
At Dharwar the cost was ... ... ...
„ Ahmedabad ... ... ...
„ Haidarabad ... ... ... ...
Rs.
137
106
95
a.
8
12
4
p.
1
0
4
These figures represent a considerable reduction in the cost of an insane
in the Guzerat and Sindh Asylums over the previous year ; whilst at Dharwar
the cost was about the same in both years under comparison.
The average annual cost of each patient was as follows, during the past
year, in relation to establishment:—
Europeans ... ... ... ...
Natives ... ... ... ...
Rs.
161
77
a.
12
3
p.
4
1
19
The variations in this item of cost as regards natives are considerable,
ranging from Rs. 105-9-2 at Kolaba to Rs. 37-1-7 at Ahmedabad. At Kolaba,
it will be remembered, there is a medical officer in sole charge ; at all the other
asylums the charge is additional to other duties.
As to the Mofussil asylums at Poona and Dharwar, there are compara-
tively few patients to bear the cost of " establishment," whilst at Ahmed-
abad and Haidarabad the charge is distributed over a large number, and so
becomes very moderate.
The average yearly cost of each patient in relation to diet was—
At Kolaba, Europeans ... ... ...
Parsis and Jews ... ...
Hindoos and Mahomedans ...
Rs.
200
114
64
a.
9
0
6
p.
1
2
2
all showing a large decrease over 1872-73.
At Poona ... ... ... ...
„ Dharwar ... ... ... ...
„ Ahmedabad ... ... ... ...
„ Haidarabad ... ... ... ...
Rs.
65
41
56
34
a.
11
14
5
5
p.
5
3
7
8
all showing a decrease, with the exception of Haidarabad, which is only
a trifle more than last year; but the cost of diet is cheaper at this asylum
than at any other in the presidency.
The average cost of each patient in relation to " bedding and clothing "
is as follows :—
At the Poona Asylum ... ... ... ...
„
Kolaba
„
...
...
...
„
Haidarabad Asylum ... ...
„
Ahmedabad „ ... ...
„
Dharwar „ ... ...
Rs.
37
15
8
7
3
a.
9
6
5
5
15
p.
9
6
10
2
11
These sums vary very much; the large sum credited to each insane at
Poona being, probably, attributable to the system of account. There were
no charges for bedding and clothing in the previous year, and possibly, even
for an antecedent period.
The expenditure on account of " bazaar medicines " does not require
remark.
The average cost per head for " contingencies " is—
At Kolaba ... ... ... ...
„
Poona
...
...
...
...
„ Dharwar ... ... ... ...
„ Haidarabad ... ... ... ...
„ Ahmedabad ... ... ... ...
Rs.
26
8
10
9
3
a.
12
12
3
12
10
p.
2
9
0
0
9
There are circumstances special to Kolaba which render a comparison with
other asylums unequal in the matter of contingencies. Such an item as
water, for example, is not to be found in the contingent bills of other asylums,
whilst at Kolaba its cost is over Rs. 3,000.
20
Table No. XV.— Insanes out of Asylums.
Remained ......
Admitted ......
Total ...
1872-73.
36
302
338
1873-74.
33
343
376
The number of "remained" is small in
proportion to the "admissions," contrary to
that which obtains in the case of lunatics in
asylums.
The admissions were 302 in 1872-73 and 343 in 1873-74; an increase of
41. It will be seen that the largest number of these were received for treat-
ment into civil hospitals, 216 during the past year, and 160 in various dispen-
saries.
106 were discharged cured, 80 absented, 71 were transferred to asylums,
73 to friends, 7 otherwise, that is, to some other place for cure and treatment,
9 died, and 30 remained on the 1st April 1874.
This class of insanes is a large one, but we have no means of knowing
how far it represents the number of insanes in the presidency, not actually in
asylums.
Probably, after the publication of the General Census, it may be possible
to arrive at the number of insanes to a given number of the population, and,
in this way, a general idea may be obtained of the amount of lunacy exist-
ing in the Bombay Presidency and Sindh ; but the materials not being avail-
able, the information cannot be given.
I now proceed to pass a few observations on the individual asylums.
KOLABA.
This is the only asylum in which there is accommodation for Europeans,
of these, soldiers form by far the largest portion ; and as they have already
been mentioned in this report, I need not recapitulate here.
The admissions have exceeded the discharges by 38. This increase
is accounted for both as regards Europeans and Natives. Dr. Niven is
of opinion that, were the Prussian Code made applicable to this country,
many of the inmates would not find admission into the asylum. But in the
present state of divided opinion regarding responsibility in mental disease,
any change in the system is not desirable.
With regard to recoveries or cures, the tables of this asylum cannot
be taken as a foundation for correct information, by reason of the number
of houseless wanderers picked up by the police in the streets of Bombay,
and for whom, probably, the police hospital would be the proper place of
reception.
As regards the seasons, the admissions do not follow any regular course,
but the deaths are greater in number during the rains. This may, I think,
be accounted for by the cold and damp predisposing to bowel affections
which prove fatal in the old and infirm. The Deputy Surgeon General
ascribes this to the exposure consequent on the want of sufficient protection
at all times afforded by the sheds, and also the want of a proper hospital for
the reception and treatment of bodily ailments for which there is only
a shed.
21
A hospital is very urgently needed.
The increase in bodily ailments, especially fevers, the Superintendent
attributes to the asylum being too much shut in.
Escapes.—Only 1 patient, a male, escaped.
Recoveries.—These amount to 46.6 per cent. of both sexes on the
number admitted.
Deaths.—There has been rather a large number, 33, or 14.2 This is not
accounted for.
Causes.—Of the assignable causes, 33 per cent. are said to be the excessive
use of ganja, and 20 per cent. malarious fever. It is rather remarkable that
excess in liquor, as a cause of insanity among Europeans, bears the same
proportion as ganja does among natives.
Restraint.—In one case has this been had recourse to, a criminal
lunatic on whom leg-irons have been placed, with the view, the Superintendent
states, of directing the constant attention of the warders to him. In my
opinion this is a mistake, as likely to irritate rather than soothe, and to
render the patient more than ever desirous of effecting his escape ; besides,
I do not consider the reason given by the Superintendent a sufficient one,
particularly as the man is stated to be generally quiet and orderly in his
conduct. To my mind, this case illustrates Dr. Niven's remark of " a poor
lunatic receiving too much treatment, and too little care."
The restraint was no doubt considered by the Superintendent necessary,
and I acknowledge it to be, under certain conditions, both salutary and
humane; I yet think, in this instance, the mode of applying it objection-
able.
The general accommodation is very limited indeed, and, under the present
system, every attempt to carry out a full and proper curative treatment
in its entirety must be set aside.
When Lord Napier of Magdala visited the asylum in December last,
he entered the following note in the visitor's book :—" The insane asylum is
much improved since I last saw it. The accommodation is very clean and
well ventilated, and the care of the patients appears all that could be desired
as far as the disadvantages of the situation will permit. It is, however, very
painful to see the violent insanes in the same airing ground with those who
are quiet and, perhaps, recovering. The restoration to health must often
be retarded, if not prevented, by the necessity of such unhappy association.
It is to be hoped that the long projected removal of the asylum to a
better situation may be carried out.''
Regarding the interior accommodation, Deputy Surgeon General John-
stone alludes to a very important matter—the future accommodation for
European soldiers, which has, in the last year, been increased to 30 beds ; and
points out that, should the number of European insanes increase, which he
considers must be the case on account of the difficulty of sending them to
their homes, the space necessary for the soldiers will not be available. At
the same time, it is to be regretted that so large a portion of the building
should be kept unoccupied during more than half the year.
23
The cost has been considerably diminished as the following table shows.
The cost of European superintendence is, and must be, arbitrary, so long as
Europeans and natives are mixed in one asylum.
Total cost, including buildings, repairs, &c. :—
1871-72.
Rs. 1,10,742
19,160
1872-73.
99,267
Cost of original buildings.
30,230
1873-74.
59,683
1,087
In the cost of diets there has been a gradual saving:—
1871-72.
Rs. 40,993
1872-73.
29,073
1873-74.
20,613.
Showing a lessening in the cost of Rs. 20,380, notwithstanding an increase in
the number of inmates.
The mode of estimating the cost of bedding and clothing by the quan-
tities expended during the year, is fair, but the clothing should be supple-
mented yearly, so as to assimilate the yearly cost as much as possible ; other-
wise, the cost in one year, when the stock of clothing required to be renewed,
would far exceed that of the ordinary average, of which we have an instance
in the asylum next to be noticed.
Dr. Johnstone reports that much care and attention is bestowed on the
inmates, and to this I can add my testimony.
I can assure His Excellency the Governor in Council that, every atten-
tion is given to economy in all matters, both on the part of the Superin-
tendent and of Deputy Surgeon General Johnstone, the latter, at all times,
exercising a most careful supervision over the whole asylum.
POONA.
This asylum may be considered as affording temporary accommodation
to the inmates, until such time as a larger building may be erected at Poona
or elsewhere.
The Superintendent reports the present one " utterly devoid of the
most evident requirements of a medical institution." But while the Deputy
Surgeon General reports that additional accommodation is still urgently
needed, he does not concur in the views of Dr. Lord, that any alteration and
improvement of the present asylum and grounds would do away with the
necessity for building another asylum. I think Dr. Maitland's reasons of
too great weight to be overlooked, and agree with him in opinion, regarding
outlay in adapting the present asylum to the wants of the district.
Considering, however, the great want of accommodation, especially for
male patients, it appears to be very desirable a part of the old civil hospital
should be converted to the use of the convalescents, so strongly recom-
mended by the Deputy Surgeon General, and approved by the visitors. A
bathing-place for the males is also required.
Excess in expenditure.—The excess in the expenditure is accounted for,
and need not occur again with proper management of clothing requirements.
Supply of Clothing.—Dr. Lord's suggestion regarding the supply of
clothing is good ; indeed, all clothing which can be supplied of a suitable
quantity from jails should be used, both in asylums and civil hospitals.
25
feeling sure it would, under his supervision, which I know would be cheer-
fully given, with the labour of the inmates, be erected at no great cost.
The work of grinding grain is evidently the kind of labour best suited
to the females, as also that best adapted to the many hopeless cases of criminal
lunatics.
As might be supposed, the abuse of intoxicating drugs, as ganja, is
the cause to which many cases of insanity may be traced, more especially
among the poorer classes. Dr. Wyllie is of opinion the abuse of opium
alone has not this effect.
The arrangement of the asylum is admirable, admitting as it does of
extension on the same plan and classification, so much to be desired, not
only as regards the malady, but also as it affects caste, as pointed out in
the Deputy Surgeon General's report.
The system of management is all that could be desired.
The Deputy Surgeon General suggests the purchase of a small piece of
ground, and the means by which this should be effected. I hope Govern-
ment will sanction this, as well as the additional accommodation so much
required, that it may, indeed, be considered an absolute necessity.
The cost of maintenance has been reduced, and an advantageous contract
made, will, it is hoped, enable the Superintendent to show a still further
reduction for the current year.
I would respectfully invite attention to the remarks regarding patients
the subjects of H. H. the Gaekwar, and the system by which they obtain ad-
mission into the asylum, no attempt being made to recover the cost of main-
tenance which should be arranged for prior to their reception.
I am sure His Excellency the Governor in Council will agree with me
in opinion that the institution at Ahmedabad, under the able management
of Dr. Wyllie, may be considered in every respect a model asylum.
I beg to recommend this Officer as most deserving the cordial thanks of
Government.
HAIDARABAD.
Although the site of the asylum is reported to present much that is
objectionable, the Superintendent states it is yearly improving, and that he
hopes to do away with most of its defects in time, and this by lunatic
labour. The limited accommodation brought to notice in the previous
report has been supplemented, and though the form of construction is objected
to by Dr. Miller, it appears calculated to answer the purpose for which it was
intended.
There has been an addition of two new wards, which the Superintendent
pronounces excellent, and a wall has been constructed which affords privacy
to the women's ward, the ground has been levelled, and a bathing-tank and
shed built. The building of the wall around the female quarters has been
followed by good results, the patients, who before were frightened and trouble-
some, having become subdued in demeanour and improved in behaviour.
4 l a
26
It is satisfactory to know this work has been done by the inmates, the
bricks being made on the premises, and the little money required being
raised by the sale of garden produce.
Admissions.—There has been an increase of only one of each sex, with
a decrease of two criminal lunatics, with ample accommodation for all, the
number being 44, by far the larger proportion being males,—the number
discharged only 8 less than the admissions.
Causes.—A large number of cases are due to habits of debauchery,
insanity, if not induced, having been greatly aggravated thereby.
The Superintendent, in mentioning the large proportion of Mussulmans
to Hindoos, 66 to 28 per cent., considers this due to the latter preferring to
keep their relatives with them. Dr. Miller ascribes it to the use of intoxi-
cating drugs. The Deputy Surgeon General is of opinion that bhang alone
does not produce mental derangement, but that, used habitually with datura
or opium, does certainly lead to mental disorder.
These substances are largely used in Sindh, and the results are demora-
lization, with crimes of various kinds.
General Health.—The general health of the inmates has been remark-
ably good, and this is attributed to the lesser overflow of the Indus. The
sickness was from ordinary diseases.
There has been no epidemic. Deaths 7, compared to 17 in the previous
year, and 5 of these due to other diseases.
Escape.—Only one prisoner escaped, a criminal who had recovered.
General Management.—In this, the broad rules of hygiene are adopted
rather than medical treatment, the latter being used as auxiliary only.
Removal, in many cases from the causes which have produced the malady,
with forbearance and kindness, added to employment and bathing, have been
found most conducive to recovery.
Diet.—Reported suitable and sufficient.
Conservancy.—The dry-earth system, which has been improved.
Employment.—The men are employed in out-door labour, and the females
in grinding grain. Of the criminal lunatics, 8 work well, the remainder are
not considered sufficiently trustworthy.
Restraint.—If such it can be called, is of a mild character, being only
confinement in a cell.
Increase in Lunacy.—This is rather ascribed to the central position of
the asylum in the province, and to the willingness of the people to bring
their friends, having seen for themselves how kindly and carefully the
patients are treated, and how much the prospect of cure is enhanced. This is
greatly to the credit of Dr. Holmstead.
27
Average Cost.—Rs. 95-4-4. This is rather less than last year.
Dr. Holmstead has allowed those suffering from bodily sickness hitherto
to remain with the other inmates, but Dr. Miller has very properly directed
that the hospital be used for these. He calls attention to the want of suffi-
cient protection from the sun, as afforded by the present verandah, and I
recommend that his suggestion for widening it should be carried out. The
sleeping blocks are objectionable, and should be removed.
Insanes out of Asylums.—There have been 65 persons treated out of
asylums in Sindh. Of these 20 were cured, 6 absented themselves, 28 were
transferred to asylums, and 11 were made over to their friends.
The Deputy Surgeon General points out the difficulty as to obtaining
accuracy in these returns, which has been before noticed.
I have the honour to be,
Sir,
Your most obedient Servant,
W. THOM,
Surgeon General, Indian Medical Department.
Dates of Receipt of the several Lunatic Asylum Reports.
Ahmedabad ..............................
Poona .......................................
Dharwar....................................
Surat.........................................
Bombay....................................
12th June 1874.
18th „ „
18th „ „
25th „ „
2nd July „