0
I would point out that there are certain circumstances which make percentages
delusive in the case of this Asylum, for we are constantly discharging the healthy, while
we admit and retain the sick, very often quite restored in mind. In thiB respect, the
Asylum partakes largely of the nature of a hospital, and in no way resembles a
healthy community.
Our inmates arc recruited largely from the most destitute classes, and reach the
Asylum, in a very large proportion of cases, in bad health, e.</., in no less than 16 cases
out of the above 28 deaths the patients were actually received in bad health.
3. The lives of the large majority of our lunatics are beyond doubt prolonged by
their being sent to the Asylum ; and to attribute any blame to the Asylum in consideration
of these cases alone would be unfair.
However, during the past year a very large number of deaths occurred from lung
disease—a number out of all proportions to what occurs among the general public,
allowing for the fact that lunatics (who throw off their clothes, go naked, refuse their
food, and are dirty in their habits) are more liable to lung disease than others. Still the
number is excessive, and I think these are the deaths for which some explanation should
be found with a view to preventive measures being taken.
Since the close of the year I had the good fortune to have the Asylum inspected by the
Sanitary Commissioner, Assam, with special reference to the mortality from lung com-
plaints. I think 1 am correct in saying he found no serious defects in our general sanitary
arrangements, but considered that the Asylum buildings were damp to an extent
sufficient to account for the prevalence and fatality from distinctive pulmonary diseases.
The lunatics are well fed (getting an abundance of fresh vegetables daily), the
latrine arrangements and water-supply are good, and the clothing, now that three
blankets are given at night, is fairly satisfactory.
I believe that excessive dampness is the main cause of our preventible sickness-
Earthen floors with open walls are necessarily damp in Assam ; and when such buildings
are used for lunatics who soil the floors, dryness is rendered more difficult. Dry earth
spread in a layer over the floors was tried, but it caked in a day or two and became
useless. Now we are going to try river sand at the Deputy Commissioner's suggestion.
The question of high mortality was considered by the Deputy Commissioner and
myself on the 30th November last. We came to the conclusion that cold and damp had a
good deal to say to it, and on this account we advised an extra blanket at night in the
cold weather. I don't think I can do better than quote the following passage from the
proceedings oi the Committee held on the 30th November last:
Tho Committee considered a letter from the Chief Commissioner, through the Deputy Surgeon
General, on the subject of the high mortality in the Asylum during the first three quarters of the
current year. Tho year has been an unhealthy year in the district, but the Committee also believe
that the mortality is to bo attributed to the fact that many lunatics received from tea-gardens are
received in a bad state of health. The inmates aro chiefly foreigners, often received in a destitute
condition. Twenty-two out of thirty-five lunatics received in 1893 were foreigners, and of the
balance of thirteen received from Lakhimpur, Sibsagar, or Mangaldai, many no doubt were garden
coolies. In the opinion of the Committee the Asylum cannot bo fairly compared with Bengal
asylums. In many cases the so-called lunatics are idiots, who have no friends and the locality of
whose homes it is impossible to ascertain. .
The buildings in some respects arc very suitable. They are inexpensive and easily
removed if contaminated by cholera discharges. The only suggestion I can make with
a view to improvement is that the plinths be made pucca by degrees, say, one each year,
as prison labour is available, The lunatics themselves could do a portion of the work,
and the cost would not be very great.
The onset of all destructive lung diseases is insidious, and I would again urge the
desirability of a resident hospital assistant who would be always present to see the
lunatics properly fed and treated, and to look after their welfare generally. I know this
suggestion has been more than once objected to on the score of cost. A good hospital
assistant might be put in subordinate medical charge (in place of the present jemadar, if
economy is necessary). I think that as a jail with 130 prisoners has a hospital assistant
in immediate charge, that a similar number of lunatics, nearly all physically as well as
mentally weak, should have one too.
Although the mortality for the year is high, there has been no cause acting in 1894
that was not acting in other years. It was a very wet and unhealthy year. We sent no
patients from the Asylum to the dispensary as mentally improved, but we reversed the
process, transferring some two patients from the dispensary (largely overcrowded at the
time) to the Asylum.
19. Cash account (see Statement No. IX) —For average cost per head of average
daily population refer to Abstract of Cash Account annexed,