16
ANNUAL REPORT ON LUNATIC ASYLUMS.
Health on Admission.
Good. ... ... ... ... ... ... ... ...
Unknown ... ... ... ... ... ... ... ...
Fair ... ... ... ... ... ... ... ...
Indifferent ... ... ... ... ... ... ... ...
Very indifferent ...
...
... ... ... ... ... ...
Bad
...
...
...
...
...
...
... ...
Very bad ...
... ... ... ... ... ... ...
Total ...
8
2
17
16
2
10
11
66
The death-rate for the year 1877-78 shows a marked and unprecedented rise in
the mortality which at first sight might appear to give cause for alarm. My special
attention was early attracted to it and increased care bestowed on the patients, but
without any sensible decrease in the number of deaths. It thus became evident
that the cause must lie outside the influences of the asylum and be connected with
influences which caused such terrible mortatily throughout the land. Out of the
8 recorded as health on admission " good," one was a man put down " good," through
an oversight during my absence, who should have been recorded as " bad " as he
was a confirmed epileptic and had violent and frequent seizures of a severe charac-
ter which ultimately proved fatal. A second, who was reported on admission to
be subject to epileptic fits occasionally, was put down as " good." She was a
congenital idiot, and it is probable that she had always been subject to these fits,
which, on admission, were not so frequent or of so severe a kind as they became
ultimately, one of which proved fatal. She was an inmate for four years and one
month.
Three more whose health was " good " on admission, lived over six years and
died of atrophy and dysentery, and the remaining three succumbed to atrophy after
three and two years' residence. Of the 16 whose health on admission was " fair,"
no less than 10 died of atrophy, a state so closely connected with the diseased condi-
tion of the nervous system that it may almost be regarded as the physical sign of
the inward mental decay. Of the 66 deaths recorded this year, no less than 38 were
from atrophy and 3 more from the closely allied general debility; and of 10 others
attributed to diarrhœa, it was in many cases only the fatal termination of atrophy
and frequently supervenes on that condition. It is thus more than probable that
the general unhealthiness of the season and the unusual character of the seasonal
phenomena throughout the year was the proximate cause of the death of a
large number of patients in whom this wasting process, concurrent with mental
malady, was slowly sapping the vital powers. Many might have lingered on this
little strength fostered by generous diet and constant care, had not the trying
season proved too much for their ebbing strength and thus raised the death-rate to
so unusual a percentage. It is evident that where the powers of life are so low,
the smallest climatic disturbance must act unfavorably, and therefore these poor
inmates of the asylum, although safely guarded from the famine, which committed
such ravages in the surrounding country, were even more susceptible to the unhealthy
influences of the season. Of those whose health was recorded as "indifferent,"
" bad," or " very bad," a briefer explanation will suffice, their condition on admis-
sion not affording grounds to anticipate either a favorable termination or a long
residence.
Of 21 classed as " very bad " and " bad," 3 died within a month of admission of
acute dysentery, gangrene, and diarrhœa respectively; the latter only lived seven
days, during which time he was in a dying state, Three more died within two
months ; 12 died of atrophy, of whom one had been ten and the others six years'
inmates of the asylum, and although their health was bad on admission, they had
been kept alive for so long a period by care and nourishment.
Of the 18 " indifferent" in health on admission, one died from valvular disease
of the heart after two years' residence, and another of abscess of the lung after
nearly six years. Five sank within a year from atrophy and diarrhœa, and one from
phthisis.