NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
43
GOVERNMENT OF MADRAS.
JUDICIAL DEPARTMENT.
Read letter from the Surgeon-General, Indian Medical Department, dated 18th June 1878,
No. 339, forwarding Annual Report on Lunatic Asylums for 1877-78.
ORDER THEREON, 30th July 1878, No. 1,523.
Madras .. .. .. .. .. ..
Waltair .. .. .. .. .. ..
Calicut .. .. .. .. .. ..
Total ..
386
63
64
513
The Annual Reports for 1877-78 on the three Lunatic Asylums established at
Madras, Waltair, and Calicut show that the number of inmates under treatment at the
commencement of the year was 363; that there were 148 admissions and two re-admis-
sions during the year, and that the
aggregate number treated was 513,* of
which 389 were males and 124 females.
The number cured and discharged was 97,
transferred to friends 16, and otherwise
disposed of 5, making in all 118 discharged from the Asylums, besides 80 deaths. The
number that remained in the Asylums on the 1st April 1878 was 315; 241 men and 74
females. Compared with the preceding year 1876-77, the admissions were less by 18,
and the re-admissions by 4 ; while the cures were greater by 41, and the deaths by 8 ;
the latter being due to the general unsatisfactory state of health of the Presidency.
2. The number of criminal lunatics in the three Asylums was 92 at the commence-
ment of the year, there were 23 admissions during the year, and the total number
under treatment was 115 ; of this number 25 were discharged and 26 died, and there
remained at the close of the year 64, or 28 less than the number (92) at the end of
1876-77. The daily average number for the last three years strengthens the opinion
expressed by the Surgeon-General last year, that special arrangement for the accom-
modation of criminal lunatics will soon become necessary.
3. The classes to which the persons admitted during the year belonged, were—
Europeans and East Indians .. .. ..
Hindus
..
..
..
..
..
Mahomedans .. .. .. .. ..
Native Christians .. .. .. .. ..
Other Castes .. .. .. .. ..
Total ..
Males.
19
72
13
7
3
144
Females.
11
16
4
3
2
36
Total.
30
88
17
10
5
150
Classed as follows:—
No occupation or unknown .. .. .. .. .. ..
Coolies .. .. .. .. .. .. .. .. ..
Private .. .. .. .. .. .. .. .. ..
Cultivators .. .. .. .. .. .. .. .. ..
Beggars .. .. .. .. .. .. .. .. ..
Laborers .. .. .. .. .. .. .. .. ..
Clerks .. .. .. .. .. .. .. .. ..
Sepoys .. .. .. .. .. .. .. .. ..
Weavers
..
..
..
..
..
..
..
..
..
Various
..
..
..
..
..
..
..
..
..
66
11
9
7
5
4
3
3
3
39
13
45
Madras .. .. .. ..
Vizagapatam .. .. .. ..
Calicut .. .. .. ..
1876-77.
RS.
168
128
82
A.
4
12
5
P.
7
10
9
1877-78.
RS.
161
125
120
A.
15
5
4
P.
1
7
8
an increase in the pay of establishments, diets, contingencies, and European medicines.
The average cost of maintenance was,
compared with 1876-77, less in the
Madras and Vizagapatam Asylums, but
increased in the Calicut Asylum, the
condition of the inmates there at the
beginning of the year rendering an improved scale of diet necessary. The profits
realized from work done by the inmates of the Madras Asylum are set down at
Rupees 581-9-6, and by those of the Calicut Asylum at Rupees 145-3-9, besides
much useful work done in connection with gardens and the conservancy of the
grounds.
(True Extract.)
(Signed)
D. F. CARMICHAEL,
Chief Secretary.
ANNUAL REPORT
ON THE
LUNATIC
ASYLUMS
IN THE
MADRAS PRESIDENCY
DURING THE YEAR
1878-79.
MADRAS:
PRINTED BY E. KEYS, AT THE GOVERNMENT PRESS.
1879.
OFFICE OF SURGEON-GENERAL, I.M.D.,
FORT ST. GEORGE, 30th June 1879.
No. 325A.
From
H. R. OSWALD, ESQ., M.D.,
Acting Surgeon-General, I.M.D.,
To
C. G. MASTER, ESQ.,
Offg. Chief Secretary to Government,
Judicial Department,
Fort St. George.
SIR,
Madras.
Vizagapatam.
Calicut.
I HAVE the honor to submit, to His Grace the Governor in Council, the Annual
Report on the three Lunatic Asylums of this Presidency, as
marginally noted, for 1878-79.
2. During the year under review public health was still
somewhat disturbed by scarcity and dearness of food and unfavorable climatic
conditions, and there are distinct evidences of the influence of these unfavorable
agencies in the disease and mortality returns of the asylums.
3. Proportion of Lunatics to Population.—The number of insanes under treat-
ment in Madras Asylums in 1878-79 was 491, giving a ratio of 1.68 per 100,000 of the
population under registration. In Bengal Proper the corresponding rate in 1877
was 2.42. In Scotland, on the 1st January 1878, the number of lunatics, officially
known to the Commissioners, was 247 per 100,000 of population. The corresponding
figures for England are not known, but of pauper lunatics alone the ratio per 100,000
population in 1877 was 240. Nothing certain is known regarding the comparative
frequency of insanity in India and Europe, but the great disparity in the rates given
above indicates that only a tithe of the subjects of insanity in India is under official
cognizance. It will be observed that the proportion of lunatics to population in
asylums in Bengal is larger than in Madras, the ratio per 100,000 of population
being 2.42 in the former and 1.68 in the latter Presidency.
4. Accommodation in Asylums.—The number of beds available in each of the
three asylums was as follows :—
—
Madras
...
...
Vizagapatam ... ...
Calicut ... ...
Total ...
Males.
418
48
72
538
Females.
129
12
24
165
Total.
547
60
96
703
The maximum number of patients confined during any one night of the year
in each of the three institutions was as follows :—
—
Madras
...
...
Vizagapatam ... ...
Calicut
...
...
Males.
179
40
34
Females.
67
10
12
Total.
246
50
46
6
ANNUAL REPORT ON LUNATIC ASYLUMS.
scruples, which prevent their being sent to public hospitals. Further details as to
the caste and sex of admissions, and also regarding the places from which the
patients were sent to asylums will be found in Table III of Appendix.
11. Previous occupations of Insanes.—Table IV of Appendix shows the occupa-
tion of the several patients admitted in 1878-79. From this it appears that 56 of the
176 admitted had no calling so far as known, and that the occupations of 10 could
not be ascertained. Of the others, 4 belonged to the better class of society, while
the majority of the remainder pertained to the lower and uneducated classes.
12. Ages on admission.—The following abstract gives detailed information as
to the ages of the several patients on admission in 1878-79 :—
Age.
Under 20 years
...
...
20 to 40 „ ... ...
40 to 60 „ ... ...
Upwards of 60 years
...
...
Total Admissions ...
Sex.
Males
...
...
Females
...
...
Males
...
...
Females
...
...
Males ... ...
Females
...
...
Males
...
...
Females
...
...
...
Admitted.
12
9
89
37
21
7
1
...
176
Ratio per
Cent. to Total
Admissions.
11.93
71.59
15.90
.56
...
The numbers of cases occurring under the 20th and between the 40th and 60th
years of age are comparatively few, compared with those ensuing in the intermediate
stage, viz., between the 20th and 40th years of age, or in other words, the greatest
number of cases occur when the mental faculties are in most vigorous activity.
These results are in accord with the experience of former years. The following
figures contrast the Madras age results with those of English asylums, as given by
Drs. Bucknill and Tuke :—
Age.
Under 20 years of age ...
...
...
...
20 to 40
„
...
...
...
...
40 to 60 „ ... ... ... ...
Upwards of 60 years of age
... ... ...
England.
Percentage.
13.73
52.53
26.5
7.24
Madras.
Percentage.
11.93
71.59
15.90
.56
In a recent paper on insanity in England Dr. Mortimer Granville states, that
"the average proportional age on admission of 32,026 cases in 36 years was 39.3."
This also harmonises with our limited Madras experience.
—
Puerperal mania
...
...
Acute mania
...
...
Imbecility
...
...
...
Acute dementia
...
...
Melancholia
...
...
Chronic mania
...
...
Chronic dementia
...
...
Percentage
of Recoveries
to Total
Treated under
each head.
37.50
29.23
28.57
22.22
20.00
7.14
5.81
13. Types of insanity amongst those admitted.—Full details on this head will be
found in Table VI of Appendix. Of the 176 admissions 60 or 34.09 per cent. were
cases of acute mania, 48 or 27.27 per cent. of chronic mania, 23 or 13.06 per cent.
of melancholia, 9 or 5.11 per cent. of acute
dementia, 15 or 8.52 per cent. of chronic
dementia, 6 or 3.40 per cent. of idiocy, 1 or .56
per cent. of imbecility, and 5 or 2.84 per cent.
of puerperal mania. From the marginal state-
ment it appears, that the largest number of
recoveries took place under the head of puer-
peral mania, a form generally dependent on
removable physical causes and readily amenable
to prompt treatment. The percentages of
recoveries in 1878-79 from acute mania and
acute dementia were lower, while those of
8
ANNUAL REPORT ON LUNATIC ASYLUMS.
15. Causes of Mortality.—The chief proximate causes of death are given in the
following summary, and it will be seen that the majority of them are diseases likely
to follow privation experienced prior to admission. Allowing for this it must also
be borne in mind, that insanity is ordinarily associated with physical decline.
Fortunately the asylums were free from epidemic disease:—
Disease.
Debiltity ... ... ... ... ...
Atrophy of the brain ... ... ...
Diarrhœa ... ... ... ... ...
Dysentery
...
...
...
...
...
Phthisis pulmonalis ... ... ...
Ulceration of bowels ... ... ...
Apoplexy
...
...
...
...
...
Softening of the brain ... ... ...
Ascites ... ... ... ... ...
Atrophy of the bones ... ... ...
Males.
14
9
6
3
3
3
2
2
2
2
Females.
5
1
2
...
...
2
...
...
...
...
Total.
19
10
8
3
3
5
2
2
2
2
16. More important results in each Asylum.—The following table gives an
abstract of the more important results in each of the three asylums in 1878-79.
Taking the ratio of recoveries to admissions it was highest in Calicut, next highest in
Vizagapatam and lowest in Madras. As regards mortality the ratio of deaths to
average strength was lowest in Calicut, next lowest in Madras and highest in Viza-
gapatam. In contrasting these rates, however, the smaller population in the Calicut
and Vizagapatam asylums, as compared with that of Madras, must be taken into
account.
9
ANNUAL REPORT ON LUNATIC ASYLUMS.
Table showing the more important results in each of the three
Asylums.
Asylums.
Madras
...
...
...
Vizagapatam ... ...
Calicut
...
...
...
Total ...
Asylums.
Madras
...
...
Vizagapatam
...
Calicut ... ...
Total ...
Died.
Males.
39
11
8
58
Females.
8
3
...
11
Total.
47
14
8
69
Remained
31st March 1878.
Males.
170
39
32
241
Females.
53
8
13
74
Remaining
31st March
1879.
Males.
164
35
28
227
Females.
63
7
13
83
Total.
227
42
41
310
Total.
223
47
45
315
Admitted during
the Year.
Males.
95
16
12
123
Females.
41
5
7
53
Total.
136
21
19
176
Daily Average Strength.
Males.
168.25
36.12
30.6
234.97
Females.
62.50
8.19
11.84
82.53
Total.
230.75
44.31
42.44
317.50
Total Treated.
Males.
265
55
44
364
Females.
94
13
20
127
Total.
359
68
64
491
Daily Average Sick.
Males.
12
2.64
1.14
15.78
Females.
5.25
.58
.12
5.95
Total.
17.25
3.22
1.26
21.73
Discharged.
A.
Cured.
Males.
38
9
6
53
Females.
18
3
7
28
Total.
56
12
13
81
B.
Transferred to Friends.
Improved.
Males.
16
...
2
18
Females.
3
...
...
3
Total.
19
...
2
21
Not Improved.
Males.
2
...
...
2
Females.
2
...
...
2
Total.
4
...
...
4
C.
Otherwise.
Males.
6
...
...
6
Females.
...
...
...
...
Total.
6
...
...
6
D.
Total.
Males.
62
9
8
79
Females.
23
3
7
33
Total.
85
12
15
112
Percentage of
Cured to Daily Average
Strength.
Males.
22.58
24.91
19.60
22.55
Females.
28.8
36.63
59.12
33.92
Total.
24.26
27.08
30.63
25.51
Deaths to Daily Average
Strength.
Males.
23.17
30.45
26.44
24.68
Females.
12.8
36.63
...
13.32
Total.
20.36
31.59
18.85
21.73
Cured to Admissions.
Males.
40
56.25
50.15
43.08
Females.
43.90
60
100
52.83
Total.
41.17
57.14
68.42
46.02
Deaths to Admissions.
Males.
41.05
68.75
66.66
47.15
Females.
19.51
60
...
20.75
Total.
34.55
19.04
42.10
39.20
3
12
ANNUAL REPORT ON LUNATIC ASYLUMS.
Madras.
1878-79.
RS.
76,101
A.
2
P.
0
1877-78.
RS.
76,867
A.
11
P.
7
Vizagapatam.
1878-79.
RS.
7,458
A.
14
P.
4
1877-78.
RS.
7,929
A.
8
P.
6
Calicut.
1878-79.
RS.
7,231
A.
14
P.
4
1877-78.
RS.
7,956
A.
7
P.
3
Total.
1878-79.
RS.
90,791
A.
14
P.
8
1877-78.
RS.
92,753
A.
11
P.
4
Full details as to receipts will be found in Table IX of Appendix. There was
a decrease in the receipts in 1878-79, as contrasted with those of the previous year,
to the extent of Rupees 1,961-12-8. The annexed table gives the expenditure in
the three asylums during the last two years, and shows a decrease to the extent
of Rupees 1,897-5-8 in 1878-79 :—
Madras.
1878-79.
RS.
76,101
A.
2
P.
0
1877-78.
RS.
76,867
A.
11
P.
7
Vizagapatam.
1878-79.
RS.
7,491
A.
1
P.
5
1877-78.
RS.
7,897
A.
4
P.
7
Calicut.
1878-79.
RS.
7,231
A.
14
P.
14
1877-78.
RS.
7,956
A.
7
P.
3
Total.
1878-79.
RS.
90,824
A.
1
P.
9
1877-78.
RS.
92,721
A.
7
P.
5
The details of expenditure are given in Table IX of Appendix. Table X of
Appendix shows the sanctioned establishment of the three institutions and the pay
of the several incumbents. In Table XI a statement is given of the financial results
of the various industries carried on in the institutions. The profits realised in
Madras amounted to Rupees 501-10-0 and in Calicut to Rupees 141-15-3. These
figures do not notice much important work done in the shape of gardening,
conservancy of the grounds, &c. The following statement shows the average cost
of maintenance per patient in each of the three asylums for the last two years :—
Asylums.
Madras
...
...
...
...
...
Vizagapatam
...
...
...
...
Calicut ...
...
...
...
...
1877-78.
RS.
161
125
120
A.
15
5
4
P.
1
7
8
1878-79.
RS.
181
110
111
A.
2
2
0
P.
7
7
4
In Vizagapatam and Calicut there was in 1878-79 a material decrease in cost
of maintenance. On the other hand, in Madras there was a marked increase, due
chiefly to increased cost of diets and the rise in the Superintendent's salary.
I have the honor to be,
Sir,
Your most obedient Servant,
H. R. OSWALD, M.D.,
Acting Surgeon-General, I.M.D.
ANNUAL REPORT ON LUNATIC ASYLUMS.
13
ANNUAL MEDICAL REPORT
OF THE
LUNATIC ASYLUM, MADRAS,
FOR THE YEAR 1878-79.
Remained 1st April 1878
...
...
...
...
...
Admitted
...
...
...
...
...
...
...
Readmitted
...
...
...
...
...
...
...
Cured ... ... ... ... ... ... ... ...
Relieved ... ... ... ... ... ... ... ...
Discharged as no better ... ... ... ...
Disease changed ... ... ... ... ... ...
Absconded ... ... ... ... ... ... ...
Died ... ... ... ... ... ... ... ...
Remaining 31st March 1879
...
...
...
...
...
223
135
1
56
19
4
1
5
47
227
I HAVE the honor to submit the report on the Madras Lunatic Asylum for the
official year 1878-79.
2. No new buildings have been erected during the year.
A door has been placed in the female enclosure in lieu of the open
gateway; this was much needed, and has proved a source of comfort and security
to the inmates.
A similar improvement has been made at the cook-room, and wire gauze nailed
over the windows, which is of great assistance in the prevention of petty thefts.
The water used in cooking is now conveyed by a subterranean channel from
the nearest well, and is drawn by a tap within the cook-room. This was suggested
by me to save the constant passing in and out of patients and warders carrying water.
It was proposed to carry off the refuse water from the neighbourhood of the two
wells near the kitchen by means of a drain leading into the main channel. Only a
portion of the drain was built, when the work was stopped for want of funds; its
completion would add to the sanitary condition of the place. Two patients having
effected their escape by climbing upon the top of the latrine in the criminal
enclosure, this latrine and the corresponding one in the noisy enclosure have
been removed as they were too near the outer wall, and have been rebuilt at a
distance of 10 feet from the main wall. The strong cottages for the use of dangerous
European insanes, which were sanctioned two years ago, have not yet been
commenced; their want is much felt, and during the hot weather there is not
proper secure accommodation for the violent European soldiers who are sent in at
this season.
3. The general condition of the asylum and its inmates is satisfactory. The
number of admissions is the highest on record, with the exception of 1871-72, when
the transfer of lunatics from Trichinopoly and the Monegar Choultry gave it
a fictitious value. The death-rate is 19 less than last year, and the percent-
age of cures 24.26 on average population. No epidemic has visited the asylum,
although the season has been unhealthy, and the town and suburbs of Madras
have suffered from epidemics of various kinds. No accidents of a serious nature,
nor suicides, nor homicides have occurred.
4
16
ANNUAL REPORT ON LUNATIC ASYLUMS.
6 per cent., and in melancholia 9 cases out of 41, recovered. In acute dementia
2 cases out of 7 recovered, but in chronic dementia only 1 out of 43 was cured.
The admissions also were most numerous under acute mania and chronic mania,
melancholia numbering only about half either of the forms of mania. This affords
confirmation of the physical character of insanity. As, in common with other
diseases, cures are more numerous during the acute stage while the malady is in
progress, and less so after changes in the cerebral substance have resulted and a
chronic state supervened.
8. The number of deaths during the year under review has been 47, of whom
39 were males and 8 females, being a percentage of—
20.36
13.09
34.55
on average population,
total treated, and
to admissions.
This mortality, though high as compared with some former years, shows a
marked decrease as compared with last year, and as the weakening effects of the
famine are yet much felt amongst the population at large, and the season has
been far from healthy, we must regard this diminution as satisfactory. The list
of deaths may be analysed in various ways, as by period of residence, age, and
health on admission. Pursuing the former inquiry we find that 4 patients died
within a month ; their health on admission was " very bad," and they lived only
6, 26, 27, and 8 days respectively.—
5 died under
...
...
...
...
...
...
1 do. do. ... ... ... ... ... ...
1 do. do. ... ... ... ... ... ...
2 months,
6 do.
1 year,
being a total of 11 from amongst the new admissions. On the other hand, one
patient had lived 45 years in the asylum—
4 over
...
...
...
...
...
...
...
...
7 do ... ... ... ... ... ... ... ...
7 do ... ... ... ... ... ... ... ...
5 do ... ... ... ... ... ... ... ...
YEARS.
10
7
6
3
As regards age—
1 over ... ... ... ... ... ... ... ...
10 do ... ... ... ... ... ... ... ...
Over 27 ... ... ... ... ... ...
YEARS.
73
50 and
from 30 to 50
Health on admission—
Very bad
...
...
...
...
...
...
...
...
Bad ... ... ... ... ... ... ... ...
Indifferent, verging on bad
...
...
...
...
...
Indifferent
...
...
...
...
...
...
...
...
Fair, verging on indifferent
...
...
...
...
...
Fair
...
...
...
...
...
...
...
...
Pretty good ... ... ... ... ... ... ...
Good.
...
...
...
...
...
...
...
...
Unknown ... ... ... ... ... ... ... ...
16
4
1
2
1
9
1
11
2
Of the two unknown one lived 45 years in the asylum and the other over 7
and died at the ages of 73 and 57, respectively, of general debility and atrophy.
Of the 11 good on admission—
2 were resident above
...
...
...
...
...
...
2
do.
do.
...
...
...
...
...
...
2
do.
do.
...
...
...
...
...
...
3
do.
do. ... ... ... ... ... ...
1 was do.
do. ... ... ... ... ... ...
1 died within the year of cerebral hæmorrhage.
YEARS.
11
10
7
6
4 and
ANNUAL REPORT ON LUNATIC ASYLUMS.
23
The official visitors have regularly inspected the asylum monthly.
Vaccination has been satisfactorily carried on.
I certify that the orders respecting the custody of poisonous drugs issued by
the Principal Inspector-General, Indian Medical Department, dated 23rd January
1863, are carefully carried out.
(Signed)
L. C. NANNEY, Surgeon-Major,
MADRAS,
Superintendent, Lunatic Asylum.
1st April 1879.
24
ANNUAL REPORT ON LUNATIC ASYLUMS.
ANNUAL REPORT
OF THE
LUNATIC ASYLUM, WALTAIR,
FOR THE YEAR 1878-79.
Remained ... ... ... ... ... ... ... ...
Admitted
...
...
...
...
...
...
...
...
Total treated
...
...
...
...
...
...
...
...
Discharged
...
...
...
...
...
...
...
...
Transferred
...
...
...
...
...
...
...
...
Died ... ... ... ... ... ... ... ... ...
Remaining ... ... ... ... ... ... ... ...
47
21
68
12
...
14
42
I HAVE the honor to submit the following report on the Lunatic Asylum, Waltair,
for the official year 1878-79.
2. During the year 55 male and 13 female patients were under treatment; of
these 39 males and 8 females remained from the previous year.
3. Admissions.—There were 21 admissions during the year, 16 males and
5 females. Of the former 3 are criminal lunatics, and the crimes they have committed
are theft and administering stupefying drug 1, assault 1, and murder 1. Of
the 21 cases admitted it was found that insanity in 3 cases was the result of
epilepsy, in 1 hereditary, in 3 bhang or ganjah smoking, in 2 conjenital, in 1
suppression of menses, and in 11 cases no special cause could be assigned, as in
most of these latter cases little or nothing was known of their previous history; in
several cases they were found wandering about, and it is often difficult to find out
even their names or the part of the country they belong to. No doubt privation
has much to do with the loss of reason in many of these cases.
There was no overcrowding in any of the cottages during the year. The
criminal ward is capable of accommodating 12, and contained on an average 7.68
inmates, and the largest number shut up on any one night during the year was 9.
4. Discharges.—Twelve cases were discharged having perfectly recovered. The
percentage of cured to total admissions is 57.14, and to daily average strength 27.27.
Criminal male insane Kristamah, who is a murderer, has perfectly recovered, but is
still detained in the asylum. He has been pronounced recovered by the official
visitors. His discharge has not been sanctioned by Government.
5. Deaths.—The death-rate has been unusually high, being 31.81 to daily
average strength. This is to be accounted for in a great measure by the fact
that the incurable cases are accumulating in the asylum, that many of them are
feeble and subjects of organic disease and impaired constitution, the result of
destitution and starvation previous to admission coupled with their mental disease.
It will be shown that a large proportion of the fatal cases was admitted in bad or
indifferent health.
Of the 14 deaths that occurred during the year, 11 were males and 3 females.
The diseases from which the mortality occurred are as follows : — Of the males
2 from ascites, I from chronic Bright's disease, 1 from conjestive apoplexy, 1 from
chronic softening of the brain, 1 from perforation of the bowels, 1 from syncope,
1 from anæmia, and 3 from general debility; and of the females 1 from old age and
2 from general debility.