ANNUAL REPORT ON LUNATIC ASYLUMS.
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13. Sickness in the Hospitals of the Asylums.—The details of ordinary sickness
will be found recorded in Table VIII of the Appendix. During the year 182 cases
were admitted to hospital the total treated being 197 ; of these 93 were discharged
cured and 80 died, the remainder being otherwise accounted for or borne on the
sick list at the close of the year.
14. The Madras Asylum.—The Annual Report of this asylum by Surgeon-
Major Nanney is appended. It is a document of considerable interest showing
as it does the satisfactory working of the institution during the year under report,
as well as the commendable interest taken by the Superintendent in his responsible
charge. An abstract of the more important features of the report will now be
given.
The year opened with 276 insanes in the asylum and closed with 223; 110
patients were admitted during the year ; there were 97 discharges and 66 deaths.
The diminution in the population of the asylum Dr. Nanney attributes to two
causes: firstly, " to the large numbers of poor creatures swept off by famine and
disease, amongst whom those bereft of reason would be likely to succumb early, "
and, secondly, to " the large mortality amongst chronic cases by which the resident
population is mainly increased." The admissions numbered 110, one being a
readmission and the following table shows the constitution of the aggregate:—
Military insanes ... ... ... ... ... ... ...
Criminal do. ... ... ... ... ... ... ...
Paupers maintained by Municipalities and Local Fund Boards.
Do.
by Government ... ... ... ...
Better class patients ... .. ... ... ... ...
Patients partly maintained by relatives... ... ... ...
Total ...
11
16
29
49
2
3
110
Of these admissions 84 were males and 26 females. Dr. Nanney makes some
apposite remarks on the imperfect histories which are transmitted with insanes to
the asylum, on the importance of hereditary taint and on the " degenerating
influences " of intemperance "as a prolific source of insanity to the victim himself
and to his posterity." He gives it as his opinion that insanity is more frequently
the result of depraved bodily conditions than of overstrained mind. The percent-
age of recoveries for the year is the highest on record, being 70.909 on the
admissions, a fact which shows that the curability of mania is inversely as the stay
in hospital, the chance of cure as is generally admitted being greatest when the
duration of the disease is under six months. The percentage of cures to admissions
in the Bengal Asylums for 1876 was 35.51 and the average of a group of the best
English Asylums for ten years, that is from 1865—1874 inclusive, gives 30.51 per
cent. The success of the Madras Asylum is probably exceptional being dependent
on the number of entrants suffering from acute mania. The Superintendent was
careful to record the general health state of the patients on admission, a point of
importance not only as bearing on the welfare of the patient but as bearing on
the health state of the institution itself. Twenty seven of the casualties occurred in
patients over 40 years of age. Dr. Nanney dwells on the importance of mental
as well as of bodily treatment, placing great stress on moral influences, gentle
discipline, firmness united with kindness, exercise and interesting occupation in
rostoring mental power and in making life more endurable. The system adopted
is the non-restraint system in which great attention is paid to diet, to regular
exercise in the open air, to suitable employment and to occasional amusement.
Referring to the " boarding-out system " suggested in my last report Dr.
Nanney thinks that there will be great difficulty in bringing the system into
operation in Madras in consequence of the want of suitable persons to whom
such responsibility could be entrusted, and he thinks that the existing arrangements
of the asylum with its spacious grounds, cottages and warders render the adoption
of the proposed system unnecessary until the asylum becomes overpopulated.
The point however has been missed in these remarks.
A lunatic asylum
like that at Madras is an expensive institution, established for the cure of
the insane not for the detention of harmless incurables. To crowd such an institu-
tion with harmless cases of idiocy, imbecility and chronic dementia is to add
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