2
27TH
MAY
1893, Nos. 1080, 1081, JUDICIAL
The most noticeable points about this statement are the continuous decline in the
daily average strength and the extraordinarily high death-rate of the last three years ;
the former is, no doubt, the result of the latter. As regards the Madras Asylum, the
death-rate in 1892 (17.34 per cent.) was considerably below that in 1891 and
slightly below the figure in 1890, and this decrease combined with the very large increase
in the daily average number of sick suggests more careful medical supervision of the
patients ; but the mortality was still regrettably high. Calicut and Waltair, on the
other hand, show a very large advance as compared with 1891 in the rate of mor-
tality. The most fatal diseases during the past five years are set out in the following
statement:—
Year.
1888 ..
1889 ..
1890 ..
1891 ..
1892 ..
Madras.
Cholera.
..
1
15
8
8
Dysentery.
5
6
9
11
13
Debility.
2
2
2
5
9
Pneumonia.
1
2
2
5
8
Phthisis.
9
8
5
8
17
Diarrhœa.
3
8
11
34
4
Epilepsy.
3
2
3
8
..
Influenza.
..
..
19
2
..
Waltair.
Dysentery.
..
1
2
2
2
Beri-beri.
..
..
..
..
2
Calicut.
Cholera.
..
..
12
..
9
Dysentery.
2
2
2
1
2
Atrophy.
2
3
1
1
3
Phthisis.
..
..
1
2
4
Diarrhœa.
..
..
2
2
1
The numbers concerned in the Waltair and Calicut Asylums are so small as
scarcely to admit of any general observations; the constant recurrence of deaths from
atrophy in the latter institution is, however, noticeable. Some explanation of this
should have been afforded.
As regards Madras, it is necessary in comparing one year with another to exclude
from consideration those diseases the occurrence of which can hardly be assigned to
the defective sanitary arrangements of the Asylum ; such are cholera, phthisis, epilepsy
and influenza. The remaining diseases which proved most fatal during the last five
years are dysentery, debility, pneumonia and diarrhœa. The deaths from these four
causes have stood at the following rates during the quinquennium :—1888, 2.3 per
cent.; 1889, 3.9 per cent.; 1890, 5.5 per cent.; 1891, 13.1 per cent.; 1892, 8.3 per
cent. It thus appears that the increase in the mortality during the last three years is
in part to be ascribed to preventible causes, but it is, no doubt, true that the recent
scarcity was the cause of a lowered vitality and consequent predisposition to disease
on the part of many of the newly-admitted patients, and it is impossible to judge from
the statistics how far the excessive mortality from dysentery, debility, pneumonia and
diarrhœa ought to be attributed to this fact. On the whole, and having in view the
fact that the last few years have seen a similarly marked rise in the death-rate among
convicts in jails, the Government is disposed to think that the heavy mortality is
mainly due to causes which have affected the Presidency generally. Various other
reasons have been suggested, such as the introduction of Red Hills water into the Asylum
and the consequent water-logging of the ground, the inferior quality of that water, the
bad drainage of the female enclosure, and the substitution of gingelly and cocoanut oil
for ghee in the diet-scale. All these reasons may have had some effect and the
Government has endeavoured to remedy them by limiting the number of water-taps
in the Asylum, by directing the construction of a filter in order to improve the quality of
the water, by extending the drainage system, and by ordering a reversion to the ghee
diet. But, as observed above, the Government doubts whether the rise in the death-rate
can be assigned in whole to any purely local cause. At the same time, the health of
the Madras Asylum is a matter which requires the unremitting attention of the
Superintendent.
5. The figures under the head "Unknown" in Statement IV and the increase in
the proportion of cases where the cause of insanity was traced are satisfactory; the
latter especially. The number of cases of insanity attributed to "Privation and
starvation" among the patients admitted during 1891 and 1892 is noticeable.
6. The increase in the expenditure under the head of "Establishment" has been
explained in the report. The outlay per head of daily average strength upon other
items is compared for a period of five years in the following statement:—