( 6 )
When I took charge of the Asylum from Brigade-Surgeon Griffith, who
has held charge of the Asylum since it was opened, and who may be said to have
brought it to its present efficiency, he told me when he handed over charge in May
that the deaths up to date were already the same as that of the previous year,
being 17, and that I would find many more who would not live much longer. I
inspected the convalescent gang and at once placed 25 on one side who evidently
would not last till the end of the year. Of these 20 have died and the rest will
not last out the month of January. Many have also been admitted in a
wretched state of health during the past six months, three of whom have died.
Of the 25 picked out 12 were already found far advanced in tubercular phthisis
and beyond all remedy, whilst many others showed signs of lung disease, but
have temporarily improved under codliver oil and maltine. I attach a table of
the mortality with the dates of admission into the Asylum hospital, deaths, type
of insanity, state of health on admission, and the post-mortem appearances, &c.
From Statement VIII it will be seen that the greatest number of
admissions into hospital during the year was from intermittent fever, namely,
44, next comes general debility 39, with 11 deaths; most of these from post-
mortem examinations were tubercular phthisis; then follow seven deaths from
tubercular phthisis admitted as such, and then six from diarrhœa, one being
cholera, the rest more or less consecutive diarrhœa ; then three from paralysis,
two from epilepsy, two from phthisis pulmonalis, three from dysentery, one
leprosy, two pneumonia, one calculus kidney, one beri-beri, and one from perfo-
ration from ulcers of stomach, From the statement of deaths, taking a glance at
the post-mortem results, it will be at once seen that the chief pathological
appearance was tubercular infiltration of the lungs, which was in most cases the
ultimate cause of death. Out of the deaths 19 had tubercular infiltration and
most of these had cavities in the lungs, this being in fact the immediate cause
of death in these cases, the other organs being merely atrophied.
As far as I have had experience of this fatality from tubercular deposits
in the lungs I do not believe it is due to any hereditary tendency such as
one might find at home, but is more due to the state of health, lunacy,
and defective innervation predisposing to, with climatic influence from a high
moist temperature throughout the greater portion of the year. Of course it
may be easily imagined that the disordered and diseased state of the nervous
system lowers the general health of the individual, thereby inducing mal-
nutrition and favouring the deposition of tubercles in the lungs especially and
organic changes in the other internal organs, such as atrophy and various other
organic degenerations, the result of anæmia, diminished heart force, and gradual
failure of the heart's power. It is peculiar that in three-fourths of the post¬
mortems there was evidence of a premonitory stage of absolute mal-nutrition;
frequently the spleen was about the size of a walnut, and the heart about the
size of a hen's egg, showing how deficient the recuperative powers can be.
The other admissions, I think, call for no remark as they are incidental
occurrences.
The chief differences in the admissions are only in excess in a few, namely,
general debility, intermittent fever, diarrhœa.
The total number treated was 157 against 123 of last year. The other
diseases are more or less incidental.
As I have already remarked the high mortality, as far as I can at
present judge, is more due to gradual organic changes occurring in lunatics
brought to the Asylum in a very bad state of health, and with the Burmese and
Indian waifs only brought at the last moment to the Asylum, when they are too
troublesome to look after, more than to any insanitary state of the Asylum.
17. Treatment.—Treatment has been directed chiefly to the improvement
of the general health of the lunatics. Most of the patients who are brought
to this Asylum are of three sorts, the gunja, opium and spirit maniacs; these
are amenable to treatment and most recoveries without doubt recover from
these forms, but how far permanent after their discharge is questionable; the
other classes are the poor, emaciated, and ill-fed; these by good diet, care,