( 10 )
by the police amongst strangers who know nothing of the previous history of the
man.
The principal physical factors of the insanity were ganja (now less frequent
than formerly), opium, spirits, general bad health, injuries to the head, and
epilepsy; and the chief moral causes were attributable to loss of property, grief,
domestic troubles, fright, and poverty.
I should explain that in last year's summary no cases due to epilepsy were
shown, when five cases due to it were under treatment; these were erroneously
placed under heading poverty. The mistake has been rectified by deducting five
cases of epilepsy from the seven placed to poverty and entered under heading
epilepsy.
It will be seen that the moral causes predominate over the physical; of the
former there is a total of 84, and of the latter 74. I am, however, of opinion that
in those cases of which full and reliable information could be obtained the physi-
cal cause was generally found ; that some changes in some part or parts of the
organism preceded the earliest manifestation of mental disturbance; that in these
cases some diseased condition of the body outside of the brain generally preceded
the cerebral symptoms and the consequent insanity; in a very large number of
cases, especially amongst Natives of India, the predisposing cause is placed to ill
health. The history of most of these showed varied morbid conditions as co-
operating causes, all tending to depress vital energy and to interfere with nutri-
tion.
In many the more remote causes continue as exciting or depressing factors
acting on the brain, and must be arrested or removed by suitable treatment as
an antecedent to mental restoration, the morbid state of the brain then often
subsiding. This is particularly the case when disease of the lungs, uterine dis-
eases, and disordered menstruation are the efficient causation. Here mania or
melancholia may arise from disturbance of the circulation within the cranium,
and from ill-nourished nervous centres and defective assimilation, and if these
people are feeble, some slight final cause, as a severe cold in the lungs, overwork,
anxiety, loss of sleep, domestic troubles, or money difficulties, causing undue
activity in the brain, brings on nervous exhaustion, the action of the heart is dis-
turbed, nutrition interfered with, and we have insanity as the final catastrophe.
I should add that the cause of insanity in a large number of cases is placed to
opium. The examining officer under whose care the patient comes first, if the
patient states that he is an opium-eater, enters in the case that the disease is
due to opium. Now, from frequent observations made after admission, it is found
that the patients scarcely ever ask for the drug, and when offered is often refused,
so that in the majority of cases the drug if taken at all must have been indulged
in in very small quantities, certainly not in sufficiently large doses to produce
any very disastrous results.
Statement No. VIII shows the hospital statistics during the year. There were
seven cases left from 1883 with a total of 101 admissions, making a grand total
of 108. Of these 73 were discharged cured, 23 died, and 12 remained at the
close of the year.
The diseases in order of frequency treated during the year were intermittent
fever, general debility (a very large number occurring amongst recent admissions),
diarrhœa, ulcers, dysentery, wounds, and rheumatism; of the latter disease, however,
only two cases came under treatment, and of lung disease none, which would
seem to show that the patients do not suffer from diseases induced by exposure
insufficiently clothed. Anæmia is one of the most common symptoms of failing
health, and loss of appetite, emaciation, and diarrhœa quickly follow.
During the rainy season the diarrhœa occasionally becomes dysentery, with
rapid ulceration of the large intestines not very amenable to treatment.
General debility was generally applied to the combination of asthenic dis-
eases of which the majority died. This term, though it accurately depicts the
general deterioration of the system and combination of diseased actions so general
in asylum hospitals, is indefinite, but I think it is preferable to taking the most
" prominent disease " on admission into hospital and enter it in the nominal register.