ANNUAL REPORT ON LUNATIC ASYLUMS. 5
as lunatics, no matter how well-fed and housed, are affected by the prevailing
climatic conditions and subtle aerial influences which affect the surrounding popu-
lation generally.
(b) That the hospital accommodation was not as good as it might be. Since
this was written the hospital accommodation has been much improved.
(c) That diarrhœa and dysentery are in a measure due to lunatics eating
all sorts of rubbish, grass, pebbles, seeds, &c. Doubtless some few cases of bowel
affections may be due to this cause, but it does not account to any appreciable
extent for the increase in the sickness and mortality from these affections.
(d) Another cause assigned for the prevalence of diarrhoea is that many
lunatics refuse their food and are in a low State of health, so that the slightest
change in the weather sets up diarrhœa.
(e) Many lunatics refuse to wear any clothing whatsoever and are thus
liable to chill; they will not sleep on cots and many when sick in hospital will
insist on lying with their naked abdomens against the cold ground, in fact, it is
impossible to keep the inmates dry and warm at any time.
(f) That the reduction of attendants in 1889 has resulted in lessened super-
vision, and consequently the well-being of the patients has suffered. To remedy
this the Superintendent recommends that until the wall before referred to is built,
that the number of attendants and sweepers, entertained prior to G.O., No. 280,
of 14th February 1889, be entertained.
He further considers that the night watchmen and women should be extra to
the day staff. This question is already under reference to the Government.
The Superintendent considers that his medical subordinate staff is not suffi-
cient, and asks that the Services of an extra subordinate by day at least be granted
during unhealthy seasons. The department is so short handed at present, and there
are so many pressing calls from famine districts, that I cannot depute even a " doing
duty" hand.
It will be noticed that the causes under B, C, D and E have always existed
and do not account for the increased sickness and mortality.
It is to be noted that 35 of the deaths from dysentery and diarrhœa occurred
during the cold or rainy months and 10 during the hot or dry season; in the
former period the rainfall was 28.15" and during the latter 1.28", and as a protec-
tion against cold. Dr. Dobie recommends that a better class of cumbly be supplied
to native patients. These, he says, will not alone keep the patients warmer, but
will be a protection against the cold hard floors of Portland cement on which they
lie, and compared with which the bare floor of a native hut is warm and soft.
Unfortunately the dirty habits of some of the patients necessitate the use of this
cement flooring. A better class of cumbly will be provided.
In Madras 13 cases of cholera occurred with 8 deaths. The disease first
attacked one of the asylum toties; the other cases rapidly occurred in the section
of the asylum in which the toty worked. Most of those attacked are reported to
have been either patients in hospital suffering from diarrhœa or men in the con-
valescent gang.
Percentage of Deaths according to sex, to daily average strength during the five years ending 1891.
—
Madras
...
...
...
Calicut
...
...
...
Waltair
...
...
...
1887.
Males.
9.64
4.38
4.49
Females.
6.69
...
...
1888.
Males.
5.75
4.14
...
Females.
10.69
3.83
10.02
1889.
Males.
7.61
4.76
...
Females.
15.24
10.25
...
1890.
Males.
17.90
20.03
9.55
Females.
21.26
20.42
17.76
1891.
Males.
23.87
8.42
9.50
Females.
20.64
11.71
...
The relatively high death-rate among females at the Madras Lunatic Asylum
has been noted for the last three years. In 1889 the female death-rate was nearly
2