REPORT ON THE RANGOON LUNATIC ASYLUM FOR THE YEAR 1893.
19
The results were arrived at from a consideration of the statistics of the Metropo-
litan District Asylums and the general London population.
The following table gives the causes of mortality in the Asylum during the
year of report:—
Phthisis ... ... ... ... ...
Dysentery ... ... ... ... ...
Diarrhoea ... ... ... ... ...
Pneumonia ... ... ... ... ...
Brain disease ... ... ... ... ...
General debility ... ... ... ... ...
Other causes ... ... ... ... ...
Total ...
10
7
6
3
5
6
6
43
In treating of this mortality and its causes it must be borne in mind that
insane persons are peculiarly susceptible to one of the most destructive and fatal
of human maladies, namely, phthisis or tuberculosis.
It has been shown elsewhere that this disease prevails with threefold fre-
quency among insanes as compared with the general population. It is a dis-
order which is inseparably associated with insanity. It is the " twin-sister and
common sequel of insanity," and let the hygienic conditions of asylum life be
what they may it will continue to gain access to asylum populations and carry
off from among them many victims.
That a comparatively large number of insanes have died from tuberculosis
during the year of report need not therefore cause surprise. It would appear
that there have been more deaths from this malady during the past year than in
any former year, but it is not easy to give any other reason for the circum-
stance than that in a disease of such indefinite duration as tuberculosis the mor-
tality rate must be subject to fluctuation.
I am unable to arrive at the precise causes which have led to the heavy mor-
tality from bowel diseases in the Asylum during the past year.
In order to prevent mortality from dysentery it is essential to become acquainted
with the existence of the disease when in its earliest stages. Dysentery, when
recognized and treated at once, is not a disease from which much mortality is ex¬
pected, but on the other hand, if the disorder is suffered to run its course un-
checked by treatment when in an early stage, it passes outside the category of
readily curable diseases and becomes a very intractable and frequently fatal
malady.
The difficulties connected with an early detection of dysentery in an asylum
are often extreme. The importance of the early recognition of this disease is
sometimes unknown or disregarded by persons possessing common sense, and
with lunatics who lack the sense to either recognize or reveal the difficulties are
far greater.
This view receives some support from the figures in the following table.:—
Year 1893.
Dysentery
Number of cases.
21
Number cured.
14
Number died.
7
Percentage of deaths
to number treated.
33
I do not think that such a high percentage mortality would have resulted if very
considerable difficulties had not been experienced in the matter of early detection.
Having offered an explanation of the high mortality rate from dysentery, it
remains to consider the causation of this disease.
Although the actual cause of dysentery, or whether the disease is in any de-
finite manner communicable, is unknown, there can be no question that exposure
to circumstances leading to deterioration of health favours its production.
The general health of the Asylum inmates during the past year has been
bad, but the reasons for this are not easy to discover.