ANNUAL REPORT ON LUNATIC ASYLUMS.
5
Amongst moral causes the most frequent were grief, family quarrels, loss of
property, and fear. Amongst physical, the most common were narcotic drugs,
congenital mental deficiency, hereditary influence, epilepsy, and starvation.
7. PROFESSION OR OCCUPATION.—Full information bearing on the previous
occupation of lunatics is given in table IV. In 54 cases the previous occupation
was unknown. There were 38 privates (Europeans and sepoys) admitted and 13
coolies; the remaining admissions were more or less equally distributed amongst
those following the common means of livelihood.
8. TYPES OF INSANITY.—Table VI of appendix gives full details under this
head. The cases are returned according to the classification in the new nomen-
clature of diseases. Under the heading of " Insanity " only those cases are included
which do not manifestly come under one of the other heads. The most common
forms of insanity in the three asylums were mania, dementia, and melancholia. In
Madras there were 37 cases of idiocy, 26 of epileptic insanity, and 36 of toxic
insanity, under which head are included cases due to alcohol, gout, poisoning by
lead, &c.
9. The following table shows the number of cases of the three most common
types of insanity under treatment during the year, and the percentage of recoveries
and deaths under each head :—
Name of Disease.
Mania
...
...
...
...
Dementia ... ... ... ...
Melancholia ... ... ...
Number of
cases.
320
265
52
Percentage of
Recoveries.
10.31
3.39
5.77
Deaths.
3.12
8.67
3.85
These results are in harmony with the teaching of experience in the treatment
of insanity in England and elsewhere, which goes to prove that dementia is the most
intractable and fatal of all mental derangements; next after it melancholia gives
the smallest number of recoveries and highest mortality. In cases of mania the
number of recoveries is higher and the mortality less than in other forms. A large
number of cases of dementia represents merely the later stages of other mental
ailments, thus, the usual mode in which cases of mania, more especially chronic
mania, terminates is by a gradual cessation of symptoms of maniacal excitement
and the supervention of the characteristic signs and symptoms of dementia.
10. SICKNESS AND MORTALITY.—In the Madras Asylum there was a considerable
improvement as compared with the previous year in the health of the inmates: the
daily average sick in hospital was 15.34 against 18.97 in 1887, when it was higher
than it had been for several years. The number of deaths in this asylum fell from
40 in the previous year to 33, and the percentage of deaths to average strength from
8.87 to 7.03, so that on the whole the health of this institution was satisfactory. Of
the total number of deaths which occurred, 23 had been for some time in the asylum
and 10 were lately admitted. The largest number of deaths resulted from phthisis
pulmonalis (9), which, as previously explained, is a very common disease amongst
insanes, and from diseases of the bowels—dysentery (5), and diarrhœa (3). The
remaining deaths were due to epilepsy (3), general paralysis of the insane (2),
softening of brain (1), meningitis (1), general debility (2), asthma (1), heart disease
(2), pneumonia (1), and other diseases (3). The most common diseases from
which the lunatics were under treatment in hospital during the year were in order
of frequency as follows: dysentery (32), diarrhœa (27), chronic pneumonic phthisis
(17), simple continued fever (16), epilepsy (12), bronchitis (9), spasmodic asthma
(7), tubercular leprosy (5), the remaining admissions were for ailments of a trivial
nature. Comparatively speaking, the diseases from which lunatics suffer and
die are seldom intimately connected with easily recognised lesions of the nervous
system, but are due to the malnutrition and consequent gradual lowering in the
vitality of important organs, caused by impairment in the functional activity of
the nervous centres, whereby they become more liable to contract disease. Of the
33 deaths which occurred in this asylum only 5 or 15 per cent. were caused by
2