7
ANNUAL REPORT ON LUNATIC ASYLUMS.
recoveries from melancholia, chronic mania and chronic dementia were higher than
in 1877-78. Next to puerperal, acute mania shows the largest number of recoveries.
The greatest number of recoveries takes place in cases brought under treatment
within the first six months of the commencement of the attack. After a year the
proportion of recoveries rapidly diminishes. In the management of insanity, there-
fore, time is of great importance, the chance of recovery being greatly increased by
prompt treatment. A reference to the statement given above shows, that the greater
number of recoveries took place amongst acute cases, and that recoveries from
chronic mental disease were comparatively few.
14. Proximate causes of Insanity.—The causes of insanity are necessarily obscure,
and the difficulty of the inquiry is increased by the circumstance, that a physical or
moral cause which would not disturb the mental faculties of one person would in
another, with a hereditary predisposition to mania or a less robust mental organiza-
tion produce an attack of insanity. Race, creed and intellectual culture also
influence the susceptibility of individuals to mental disease, and modify the operation
of physical and moral causes on the mental faculties. Taking into consideration
the existing conditions of society in England and India the à priori inference
would be, that physical agencies would be in the preponderance as causes of insanity
in India, and a reference to the subjoined abstract shows that such is the case.
Contrasting the typical European with the Hindu there can be no doubt that
the former is the subject of a restless mental activity, keen sensibility and suscepti-
bility of emotion to which the latter is comparatively a stranger, which render
him more liable to mental shock from moral causes which would not affect the
Hindu. Accordingly, we find that of 30,087 cases in European asylums in which the
existing causes were ascertained, the physical were at the rate of 129 to 100 moral
causes. In the Madras Asylum in 1878-79 there were 183 cases, in which the
causes of the attacks were ascertained, and in these the physical were in the ratio of
289 per 100 moral. The following statement gives a summary of these causes:—
Physical Causes.
Narcotic drugs
...
...
Congenital
...
...
...
Epilepsy ... ... ...
Intemperance ... ... ...
Hereditary
...
...
...
Puerperal
...
...
...
Other diseases ... ... ...
Starvation
...
...
...
Fever
...
...
...
...
Sunstroke
...
...
...
Blow on the head
...
...
Disease of the brain ... ...
Nymphomania
...
...
...
Syphilitic
...
...
...
Fall ... ... ... ...
Suppression of menses ...
Total ...
30
22
19
15
13
10
10
4
3
3
2
1
1
1
1
1
136
Moral Causes.
Grief ... ... ... ...
Misfortune
...
...
...
Fear ... ... ... ...
Domestic trouble ... ...
Religion ... ... ...
Desertion of husband or wife ...
Anger ... ... ... ...
Love and jealousy
...
...
Total ...
14
7
7
6
5
4
2
2
47
A reference to the list of physical causes shows that the most fertile source of
insanity was the use of narcotic drugs, and if we add to these cases the 15 under
"intemperance," we have thus 45 out of 136 cases, or 33.08 per cent., due to the
abuse of bhang, opium or alcohol, or to preventible causes. This result agrees with
the experience of European asylums, as Drs. Bucknill and Tuke state that of 9,867
cases in which the origin was ascertained, upwards of 18 per cent, was due to this
cause. Other English authorities estimate intemperance at 24 per cent. or higher.
The causes next prominent on the Madras physical list are congenital conditions
and epilepsy. The chief moral cause was grief, and nearly all the other moral
agencies were also of a depressing character. Further details as to the causes of
insanity will be found in Table VII of Appendix.