REPORT ON THE RANGOON LUNATIC ASYLUM FOR THE YEAR 1893.
11
treated in the usual way; and apart from these cases there has not been during
the year of report any very active administration of drugs.
Easton's syrup, an invaluable tonic, consisting of phosphate of iron, quinine,
and strychnine, has been extensively used both to promote appetite and
counteract debility. Sedatives, of which bromide of potassium is the most
popular, have found their usual sphere of usefulness.
Since I assumed charge of the Asylum the sedatives most frequently em-
ployed have been a combination of bromide of potassium and cannabis sativa
for use during the day, and either sulphonal or hyoscyamine by hypodermic
injection at night. These are all very reliable medicines, both as sedatives and
hypnotics.
In the annual report of the Asylum for the year 1889 there are some
interesting remarks on the action of sulphonal. The writer, Surgeon-Colonel
Griffith (retired), therein states that according to his experience the dose of
sulphonal requires to be " increased frequently " and that " when discontinued a
more excited form of sleeplessness results." Inasmuch as these opinions are the
very opposite of the views held by all recognized authorities on therapeutics who
have investigated the action of sulphonal, they are certainly very curious. This
observer further states he has found sulphonal useful in the " furore of epilepsy,"
but as the expression " furore of epilepsy" is liable to be misunderstood the
addition thus made to the literature of sulphonal loses much of its value.
Forcible feeding.—Insane patients frequently refuse to take food, and some
would no doubt starve themselves to death if not forcibly fed. The right time
at which to commence forcible feeding is a disputed matter. A well-known
authority has asserted that no patient should be suffered to remain without food
for longer than four days, while another experienced Asylum Superintendent
thinks that the time for forcible feeding has arrived when three consecutive
meals have been refused. The latter is probably a safe rule to adopt in
ordinary cases.
There are numerous methods of forcibly feeding patients, of which the most
simple is to slowly pour liquid food into the nose or mouth, with a spoon or
feeding cup, or to let it flow through a tube inserted into the mouth or passed
into the nostril; and this is the best plan when the patient will consent to
swallow. Not seldom, however, the attempt to forcibly feed in this manner is
frustrated by the patient refusing to swallow and spitting out the food. It then
becomes necessary to resort to the use of a long tube passed through the nose
or mouth for a considerable distance down the gullet. Through this tube, to the
free end of which a small funnel is attached, liquid food will readily gravitate
into the stomach. It is unnecessary to make use of a pump unless the con-
sistency of the food to be supplied is such that it will not pass by gravitation
alone.
Prior to the year of report, Asylum patients, whenever forcibly fed, were
invariably fed with the stomach-pump. The advantage of the funnel over the
pump are its simplicity and the facility with which it can be used ; it has no
taps to be turned, or valves liable to get displaced, and does not require the use
of both hands. The feeding tube may be passed through the mouth or nose.
But to introduce it through the mouth necessitates the use of a mouth-gag,
exposes the tube to the teeth of the person fed, and often jeopardizes the fingers
of the feeder, so that it is preferable to pass it through the nose.
An ordinary India-rubber catheter, to which a short length of India-rubber
tubing is added, for the sake of convenience, and a small glass funnel comprise
the necessary apparatus.
In the accompanying photograph of a patient in the General Hospital
deprived of reason from an injury to his brain, the apparatus is shown in use.
The man had been fed in this manner five or six times daily for 33 days before
the photograph was taken. The second photograph shows the apparatus when
not in use.
Escapes.—Eight lunatics escaped from the Asylum during the past year, of
whom five were re-taken during the year ; the remaining three are still at liberty.
Particulars of the escapes will be found in the following table.