19
ANNUAL REPORT ON LUNATIC ASYLUMS.
Dr. Rayne's lectures on insanity at Middlesex Hospital and Medical Super-
intendent at Hanwell writes : "In the medicinal treatment of the insane I have
entirely abandoned the use of the so-called neurotic medicines, which have been
supposed to exercise a direct curative action on the brain. I am convinced that
nothing can be more injurious to the brain than the continued use of drugs, which
act directly on it and pervert its nutrition."
In examining cases of recent insanity it will always be found that the digestive
organs are disordered, and that the patients are anœmic and have lost flesh, and
any improvement in the mental condition is almost invariably preceded by a gain in
weight. Of the 51 patients discharged recovered during the year, the average gain
in weight has exceeded 14 lb. During the past year I have treated all recent cases
of mania uncomplicated with epilepsy without drugs of any sort. Special attention
is paid to the diet, and any case of refusal of food for more than 24 hours is treated
by feeding with the stomach tube. Warm baths at bed time with cold to the head
have been found very efficacious in inducing sleep. Two very severe cases of puer-
peral mania in Europeans were treated thus, and made a rapid recovery. Large
doses of chloral and bromide had been administered for some time previous to
admission, and the patients becoming unmanageable were sent to this asylum.
Bromide of potassium has been used largely in epilepsy, in doses of half a drachm
to a drachm three times a day, and, with the exception of one case in which the
dose was increased to two drachms three times a day without apparent effect, all
were temporarily benefited, but in none was there an entire cessation of fits,
though the treatment was carried out for months.
Criminals.—The criminals are included in the general report, but for more
ready reference I give particulars here. There remained on 31st March 1881
males 37 and females 6, or together 43. Twenty-two have been admitted, so
that criminals formed 20 per cent. of the total admissions. One of them was a
readmission ; two of them were Europeans—all were males.
Discharges. —Seventeen patients were discharged : 5 males and 1 female
recovered ; 2 harmless incurables made over to their relatives ; 5 transferred to the
civil list, their sentences having expired ; 2 Europeans, one civil and one military,
transferred to England ; 2 men charged with murder have been, under the Coroner's
warrant, handed over to the Police. The average daily strength was 43¼. The
greatest number under treatment on any one day was 50. The total treated was
65. The number remaining under treatment on the 31st of March this year is
males 37, females 5, or together 42, one less than last year.
Caste.
Europeans.
2
Hindus.
17
Mahomedans.
2
Budhist.
1
There have been six deaths—all males. Of the 6 deaths, 2 were from phthisis
pulmonalis, 1 from disease of heart, 1 from chronic dysentery, 1 from exhaustion
of mania, and 1 from compound fracture of skull.
The general health of the criminals has been good as compared with former
years. I have already alluded to the cases of dysentery and diarrhœa which occur-
red in the early part of the year and the supposed cause.
Table showing the Death-rate of Criminal and Civil Insanes during the last Four Years.
1880-81
...
...
...
1879-80
...
...
...
1878-79
...
...
...
1877-78
...
...
...
Criminal
Patients.
13.17
26.804
25.61
37.83
Civil
Patients.
7.84
9.59
18.88
22.5
Financial.—The financial statement is very satisfactory. With an average
daily strength of 14 more than last year, the expenses are nearly Rupees 15,000
less. There is a decrease under every heading, except servants' wages, which are
necessarily higher owing to increase of patients. The principal saving (Rs. 11,080)