NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
3
Cash accounts.
8. The cost of maintenance under head of " Diet" is
considerably greater than in 1928, but
compares favourably with the expenditure
in 1927, when it is borne in mind that the average num-
ber of patients was 1,010 as compared with 889. The in-
crease over 1928, is due to the fact that the tenders for
the supply of provision were called for at a time when the rate
was exceptionally high owing to floods and famine. Also there has
been a greater number of patients to feed and clothe.
The cost under the head of diet in 1927, 1928 and 1929, were
approximately Rs. 99,000, Rs. 81,000 and Rs. 98,500, respectively.
Another cause for the great discrepancy between 1928 and 1929
is the fact that Rs. 2,000 due to the milk contractor was not drawn
in 1928 owing to the receipt of prohibitory orders from court. This
amount had to be drawn and paid to the court in 1929, so that
the cash for 1928 and 1929 should have been Rs. 83,000 and
Rs. 96,500 and this reduces the difference by Rs. 4,000.
As anticipated in the last annual report there has been a great
increase in the " Receipts from Paying Patients," the figures for
the last three years being respectively Rs. 13,000, Rs. 17,000
and Rs. 33,000.
The actual net cost of maintenance for the year 1929, including
expenditure on diet, establishment, clothing and bedding, &c.,
amounted to Rs. 2,59,733 as compared with Rs. 2,30,224 in 1928.
The increase is largely explained by the fact that practically no
blankets were accounted for during the calendar year 1928, where-
as two consignments each amounting to nearly Rs. 7,000 were paid
for in March and October 1929. If these payments were distri-
buted according to the two financial years the apparent increase
of Rs. 29,500 would be reduced by Rs. 14,000.
It is anticipated that Rs. 1,57,684 will be recovered from Dis-
trict Boards, Municipalities, Cantonments, Notified Areas, Small
Towns, the Punjab and Rajputana States and private paying
patients as compared with Rs. 1,18,068 in 1928. Thus the net
cost to Government is Rs. 1,02,049 as against Rs. 1,12,156 in 1928.
Manufactures.
9. The net value of the manufactures, &c., during 1929,
was Rs. 28,571-2-9, as compared with
Rs. 19,404-14-11 in 1928. The increase is attri-
buted to the greater amount of garden produce grown in 1929.
No vegetables had to be purchased from the market during the
year. The total profits for the year were Rs. 19,579-4-1 as com
ared with Rs. 13,125-9-2 in 1928.
4
Acknowledgments.
10. My acknowledgments are due to Major C. J. Lodge-
Patch, M.C., I.M.S., who discharged his
onerous duties with marked zeal and efficiency
and to other members of the staff.
The Franciscan Sisters have continued to perform their duties
with great zeal and energy.
LAHORE :
The 10th April 1980.
H. M. MACKENZIE, COLONEL, I.M.S.,
Inspector-General of Civil Hospitals,
Punjab.
Triennial Report of the Punjab Mental Hospital for the
years 1927,1928 and 1929.
THE triennium under review is of particular interest since it
reflects a new and very much more enlightened point of view in
regard to the treatment of the insane in the Punjab. In the last
triennial report, a note was recorded to the effect that the cost of
maintenance was too high and that considerable economies should
be effected in the future. But after due consideration of the re-
ports of two deputations carried out by the Medical Superin-
tendent in 1926 and 1927, the Government has come to the con-
clusion that the local institution is not altogether a credit to the
province, and that a considerable increase of expenditure will have
to be faced if the Hospital is to be modernised and run on up-to-
date lines (vide Annual Report, 1927).
2. With this object in view, and on the representation of
Major-General Megaw, the late Inspector-General of Civil Hospitals,
Punjab, certain additions were made to the inadequate subordinate
staff with effect from 1st April, 1929. Further, a Committee has
been appointed with the object of making recommendations for
reorganising and reconstructing the Hospital. Some reference
will be made in the succeeding paragraphs to certain of the matters
which have been considered by this highly qualified and competent
Committee.
3. As one more indication of the progressive attitude of the
Government, it is veryg ratifying to note that the Deputy Medical
Superintendent, Dr. R. S. Sharma, has been sent to the United
Kingdom to gain experience of the working and administration
of British Mental Hospitals. Up to the present, the Medical Super-
intendent has been the only individual with any knowledge and
experience of what is done in more civilised countries. And his
whole time is so much occupied with administrative work and
office routine that he has literally no time to devote to the clinical
treatment of a thousand patients. A second skilled and properly-
trained alienist has been a crying need for many years past.
4. A reference to the tables showing " Establishment " in
former years will indicate many inadequacies, e.g., one cook for a
hospital containing over a thousand patients, one gatekeeper, etc.
It has, of course, been utterly impossible to manage with such
shortages of miscellaneous staff, and the only solution of the diffi-
culty has been the employment of attendants on certain special
occupations. This reduced the supervision of an already insufficient
nursing staff, and the welfare of the patients suffered. A few more
posts still need to be created. But already, since the increase sanc-
tioned on 1st April, 1929, a great stride forwards has been made in
2
the proper care and management of mental patients in this hos-
pital. Up to the last year, it was nearly always necessary to keep
a few of the more turbulent or troublesome patients secluded for
a portion of the day. But now it is no longer necessary to keep
a single male patient in his room during the hours of daylight.
II. Accommodation, new buildings, etc.,—Till last year, the
figures which had been given in former annual reports as repre-
senting the total accommodation have been accepted without
comment ; but recently the Medical Superintendent had these
checked so as to ascertain the degree of overcrowding in this in-
stitution and found that the former estimates
were based
on a scale of 50 square feet of floor space per patient. This
is quite inadequate. The scale for ordinary convicts in the newer
provincial Jail barracks is 75 square feet and in Jail Hospitals
from 100 to 130 square feet per individual. The scale in a Mental
Hospital, where numbers of patients suffer from dirty and unhy-
gienic habits, should be considerably higher than that of a Jail
Hospital. The Committee has re-estimated the total accommoda-
tion of the Punjab Mental Hospital, at 75 square feet per patient,
as 1,008, and this allotment of floor space is considered the irre-
ducible minimum. As the average daily number of patients under
treatment in 1929 has increased to over a thousand, it is obvious
that an extension to the existing institution will very soon be
necessary. This should take the form of a properly equipped
and up-to-date Hospital Section for the male side, as the existing
Hospital Section is obsolete and very unsatisfactory in many re-
spects.
During the triennium under review, the recently erected
Female Hospital Block, to which reference has been made in the
last triennial report, has been occupied. This is a real hospital
as distinct from the older buildings. The cell and the cage have
been eliminated, and there is little in it to offend the eye and
oppress the nervous patient with a feeling of confinement or in-
carceration. It consists of pleasant Hospital wards with a few
single rooms. The ventilation and lighting are excellent. It
is lined throughout with dadoes of white minton tiles and all the
windows are glazed. Although pessimists observed that not a
pane of glass would remain a week after its occupation, an
experience of over 18 months has shown that scarcely a single
pane has been broken during that period. The building is provided
with an excellent dispensary, a solarium, a linen store and a water-
flushed system of conservancy has been installed. In place of
the hard, straight prison bars, so dear to the Jail architects who
have designed the rest of the institution, there are ornamental
iron gratings which provide perfect security without emphasising
or even suggesting the atmosphere of a penal institution.
8
The so-called New Criminal Section, completed in 1924, re-
mained empty for many years, but the increase of staff has made it
possible to occupy it during 1928. It is a forbidding looking
section, built on strictly orthodox Jail lines, and is greatly inferior
in every way to the New Female Hospital mentioned above.
The Committee is considering the question of dismantling
some of the older, more obsolete, and insanitary structures, and
replacing them with up-to-date and hygienic Hospital wards for
general and specialised forms of therapy. The existing Male Hos-
pital is so badlyl ighted and ventilated that it is impossible satisfac-
torily to treat the large number of cases of pneumonia and other
acute diseases which carry off so many mental patients each year.
The accommodation for attendants has always been very re-
stricted and it is urgently necessary that an extension should be
made to the staff quarters. A temporary chappared barrack was
built towards the end of 1929 and has been occupied by a number
of unmarried male attendants.
IV. Sanitation.—During the triennium, a water-carriage
system has been installed on the female side of the institution and
this has been working most satisfactorily, in spite of the fact that
the motor pumps which carry the sewage and sullage to the
gardens are not of the right type. When these are changed, the
sanitation of this part of the institution will be still further im-
proved. It is very important that a similar system should be
installed on the male side, as, even with the greatest supervision,
it is not possible to prevent the inmates from drinking the efflu-
ent in the open drains which continue to run throughout the
Male Mental Hospital
A point which must especially be stressed in connection with
the water-carriage system in the Female Mental Hospital is the
enormous decrease in the death-rate. During the first ten months
of 1929, only eleven female patients died, the average death-rate
over the last six years being 24 per annum. Most unfortunately,
however, a severe outbreak of influenza occurred in November
and December, which carried off a large number of patients. Some
died from the disease itself, but a greater number succumbed to
other more chronic illnesses to which this complication was added
in a comparatively mild form, which ought not ordinarily to have
proved fatal.
A considerable amount of correspondence has been carried
out on the subject of the Mian Mir Storm Water Drain. Each
annual report contains reference to the extremely insanitary
affairs in the heart of the Hospital. Every monthly report calls
attention to this disgrace on civilisation. From the earliest
triennial report of the Punjab Lunatic Asylum published in 1903
4
scathing remarks have been made on this subject, but it would
appear from most recent correspondence that nothing can be done
completely to abolish the nuisance. The discharge from a Dhobi
Ghat has been diverted into the water-carriage system on the
female side, and twenty new latrines are to be provided for the
attendants and their families who continue, to use this drain as a
convenience. But the Director of Public Health has pointed out
that the complete elimination of sewage will be attended by an
increase in the incidence of malaria. The mosquitoes which carry
malaria breed only in clean water, so the mere purification of the
channel will not be an unmixed blessing.
V. Suicides, escapes and fatal accidents.—During the pre-
vious triennium covering the years 1924-26, there were two suicides,
seven escapes and two deaths from violence. In the triennium
under review, there have been no suicides, four escapes and two
deaths from violence, of which one escape and one accidental
death occurred during 1929. The patient who escaped during the
current year had completely recovered and was awaiting discharge
at the next meeting of the Visitors' Committee the following week.
It is unfortunate that he should have anticipated this by taking
the matter into his own hands while working in the gardens.
A very large number of patients attempted to escape, but
they were apprehended before they had got away. Abdul
Manan, to whom reference was made in last year's report, made
another, and even more desperate, attempt. He persuaded an
untrustworthy night attendant to unlock the door of his room,
seized and thrust the latter into the cell and bolted the door on
him. He then burst open the store godown, seized a stretcher
and ramba (a small grass-cutting implement) and with the
help of the former escaladed a fifteen-foot wall. Unfortunately
for him, he lost his bearings in the dark and got over an inner,
instead of an outer, wall. But not deterred by this mishap, he
proceeded to dig his way through an outer wall with the four-
inch blade of the ramba, and had cut through three feet of
mud wall when he was seized. A few seconds later, he would have
effected one of the most daring escapes in the history of this
institution, for he had already got his head through the gap he
had made.
Even with the strictest supervision, it is impossible to prevent
fatal accidents. An impulsive patient playfully punches an-
other in the ribs and he drops dead from a ruptured spleen. This
is the commonest form of fatal accident which occurs in this insti-
tution, and there is such a high incidence of malaria that quite
a large proportion of patients and attendants have enlarged or
5
friable spleens. One death from violence during 1929 is of suffi-
cient interest to record. Rahim Gul, a devout Pathan, overheard
a harmless demented patient express the delusion that he was God-
He took him apart and argued " if you are God, you can strike me
down dead." Gokal Chand replied that he did not desire to do
anything so violent. Thereupon Rahim Gul remarked " if you
are God, it will be impossible for me to kill you." And suggested an
experiment to which the unfortunate Gokal Chand willingly
agreed. They went behind one of the barracks, and the latter
helped Rahim Gul to adjust the sleeve of his kurta around his
throat. Rahim Gul thereupon strangled him. He has no regret
whatever for his deed and discusses its execution with complete
sang-froid. The routine magisterial enquiry has been held.
VI. Occupations and employment.—The patients continue
to be employed in various occupations, as such employment is
particularly good for their bodily health and mental welfare.
Of these, gardening is the most profitable and beneficial. During
1929, a most successful experiment was made in growing rice.
The crop was used in the kitchens and was of excellent quality ;
the stubble provided straw and was a considerable saving to the
Hospital. The increase in the staff of attendants enabled a much
larger number of patients to be employed in the fields ; the out-turn
of vegetables was greater than in any former years ; so indirectly
the employment of more attendants paid for itself.
VII. Recreation and recent innovations.—A great degree of
freedom is allowed to the patients both within the walls of the
Hospital and outside. Owing to the overcrowding, more than
300 patients were allowed to sleep out of doors during the summer.
A large number is allowed to attend melas and to go to the
races and polo tournaments. More than anything, the patients ap-
preciate drives in the motor bus ; but in spite of frequent renewals
of spare parts, the bus is threatened with signs of a complete
break-down, and the question of its renewal will have to be con-
sidered within the next year or two.
Outdoor games have failed to attract or interest Indian
patients in former years, and all attempts to introduce football,
volley ball, etc., have failed hitherto. During the last few months,
however, tennis has been started ; and it is hoped that an enthusias-
tic medical and clerical staff will encourage some of the better
class patients to take up this form of exercise.
The wards have been decorated and brightened with railway
posters. Some of these, especially those illustrating places of
pilgrimage and holy shrines, attract the interest and veneration
of the patients. By the kind permission of the Inspector-General
of Prisons, the band of the Borstal Institution visits the Punjab
6
Mental Hospital every Sunday and plays a selection of music to
the patients, who greatly appreciate this.
Till recently, a great wastage of the working hours of the staff
occurred each month when attendants and menials had to be given
a day's leave in order to purchase their month's supply of provisions
from the city. Now, however, a small shop has been opened at
which all ordinary commodities and a few luxuries can be obtained.
The prices and the quality of the articles sold are under the super-
vision and control of the Hospital authorities.
Very few contributions have been received for the benevolent
fund, but this is probably due to the fact that nothing is done to
advertise the institution or to bring it to the notice of the general
public. Many thousands of insane are at large in this province,
starving, neglected or maltreated. All these are potential dissem-
inators of physical and mental ill-health for future generations,
and some provision should be made for them. A course of lectures
was arranged in the summer of 1929 for general practitioners,
members of the Indian Mental Hygiene Association and others
interested in the care, treatment and welfare of the insane, so that
some interest might be aroused in the saddest of all human afflic-
tions. But only about 25 members of the general public attended.
DAIED LAHORE :
The 17th March 1930.
C. J. LODGE-PATCH, MAJOR, I.M.S.,
Medical Superintendent, Punjab Mental
Hospital.
ii
STATEMENT
SHOWING THE ADMISSIONS, DISCHARGES, ETC.,
LAHORE, DURING THE YEAR 1929
1
YEARS.
1927 ..
1928 ..
1929 ..
2
REMAINED ON
1ST JANUARY.
Males.
665
731
791
Females.
182
193
200
Total.
847
924
991
3
ADMITTED.
Males.
295
289
297
Females.
72
73
75
Total.
367
362
372
4
READMIT-
---.
Males.
22
33
16
Females.
8
5
5
Total.
30
38
21
5
TOTAL
POPULATION.
Males.
982
1,053
1,104
Females.
262
271
280
Total.
1,244
1,324
1,384
The capacity of the Punjab Mental Hospital is at 75 superficial feet per patient, for-
Males
...
...
...
...
...
...
Females
...
...
...
...
...
Total
...
826
182
1,008
There were 3 cases under observation.
NOTE.—Observation cases are not included in the figures for 1929.
iii
No. I.
OF PATIENTS IN THE PUNJAB MENTAL HOSPITAL,
AND TWO PREVIOUS YEARS.
6
Discharged.
A.
CURED.
Males.
110
103
138
Females.
22
16
22
Total.
132
119
160
B.
TRANSFERRED TO FRIENDS.
Improved.
Males.
41
46
48
Females.
17
23
19
Not improved.
Total.
58
69
67
Males.
3
16
39
Females.
3
2
3
Total.
6
18
42
C.
OTHERWISE.
Males.
19
17
13
Females.
3
9
3
Total.
22
26
16
D.
TOTAL.
Males.
173
182
238
Females.
45
50
47
Total.
218
232
285
The maximum number of patients confined on any one night was—
Males ... ... ... ... ...
Females ... ... ... ... ...
TOTAL
...
824
213
1,037
iv
STATEMENT
SHOWING THE ADMISSIONS, DISCHARGES, ETC.,
LAHORE, DURING THE YEAR 1929.
1
YEARS.
1927 ..
1928
..
1929 ..
7
DIED.
Males.
78
80
70
Females.
24
21
35
Total.
102
101
105
8
REMAINING ON
31ST DECEMBER.
Males.
731
791
796
Females.
193
200
198
Total.
924
991
994
9
DAILY AVERAGE
STRENGTH.
Males.
704.81
753.60
802.16
Females.
185.07
196.24
208.63
Total.
889.88.
949.84
1,010.79
10
DAILY AVERAGE
SICK.
Males.
73.63
57.28
75.86
Females.
28.04
23.26
29.81
Total.
101.67
80.54
105.67
The capacity of the Punjab Mental Hospital is at 76 superficial feet per patient, for—
Males
Females
.. .. .. .. ..
.. .. .. .. ..
Total ..
826
182
1,008
There were 3 cases under observation.
NOTE.—Observation cases are not included in the figures for 1929.
v
NO. I—CONCLUDED.
OF PATIENTS IN THE PUNJAB MENTAL HOSPITAL,
AND TWO PREVIOUS YEARS-CONCLUDED.
11
Percentage to
DAILY AVERAGE STRENGTH.
A.
CURED.
Males.
15.61
13.66
17.02
Females.
11.78
8.19
10.57
Total
14.48
12.53
15.84
B.
DIED.
Males.
11.07
10.61
8.72
Females.
12.86
10.75
16.82
Total.
11.45
10.64
10.39
ADMISSIONS.
C.
CURED.
Males.
10.56
15.83
23.00
Females.
15.00
7.69
13.75
Total.
18.64
14.25
21.12
D.
DIED.
Males.
3.47
5.90
3.10
Females.
5.00
3.84
6.25
Total.
4.73
5.50
3.81
The maximum number of patients confined on any one night was—
Males ... ... ... ... ...
Females ... ... ... ... ...
TOTAL
...
824
213
1,037
vi
STATEMENT No. I-A.
SHOWING CASES ADMITTED FOR OBSERVATION IN THE PUNJAB MENTAL HOSPITAL, LAHORE, DURING THE YEAR 1929
AND TWO PREVIOUS YEARS.
YEARS.
1927 ..
1928 ..
1929 ..
REMAINED OF
1ST JANUARY.
Males.
3
..
4
Females.
..
..
..
Total.
3
..
4
ADMITTED.
Males.
101
102
107
Females.
32
44
48
Total.
133
146
155
READMITTED.
Males.
17
13
9
Females.
8
3
5
Total.
25
16
14
CERTIFIED
AND ADMIT-
TED INTO
ASYLUM.
Males.
41
65
57
Females.
15
25
25
Total.
56
90
82
CERTIFIED AND
RELEASED
UNDER SECTION 14
ACT IV OF 1912.
Males.
69
32
40
Females.
22
18
20
Total.
91
50
60
RELEASED AS
UNCERITIFIED.
Males.
9
9
11
Females.
..
1
2
Total.
9
10
13
DIED.
Males.
8
5
7
Females.
3
3
4
Total.
11
8
11
REMAINED
ON 31ST
DECEMBER.
Males.
..
4
1
Females.
..
..
2
Total.
..
4
3
REMARKS.
vii
STATEMENT No. II.
RETURN OF CRIMINAL PATIENTS IN THE PUNJAB MENTAL HOSPITAL, LAHORE, FOR THE YEAR 1929 AND TWO PREVIOUS YEARS.
1
YEARS.
1927 .. ..
1928 .. ..
1929 .. ..
2
REMAINING
ON 1ST
JANUARY.
Males.
149
158
178
Females.
5
6
8
Total.
154
164
186
3
ADMITTED.
Males.
51
53
50
Females.
2
2
...
Total.
53
55
50
4
READMITTED.
Males.
...
3
3
Females.
...
...
...
Total.
...
3
3
5
TOTAL.
Males.
200
214
231
Females.
7
8
8
Total.
207
222
239
6
DISCHARGED
TRANSFERRED,
ETC.
Males.
30
26
27
Females.
1
...
3
Total.
31
26
30
7
DIED.
Males.
12
10
10
Females.
...
...
3
Total.
12
10
13
8
REMAINING ON
31ST DECEM-
---.
Males.
158
178
194
Females.
6
8
2
Total.
164
186
196
9
DAILY AVERAGE STRENGTH.
Males.
152.02
160.74
190.46
Females.
4.93
6.58
6.50
Total.
156.95
167.32
196.96
viii
STATEMENT
RETURN SHOWING THE RELIGION, SEX AND RESIDENCE OF PATIENTS
LAHORE, DURING THE YEAR 1929
1
DISTRICT.
Abbottabad .. .. ..
Ajmer
..
..
..
Alwar State .. ..
Almora
..
..
..
Ambala .. .. ..
Amritsar
..
..
..
Attock
..
..
..
Afghanistan, North-West Frontier ..
Bajnaur
..
..
..
Bannu
..
..
..
Bharatpur State .. ..
Buland Shehar .. ..
Campbellpur .. ..
Calcutta .. .. ..
Dera Ismail Khan
..
..
Delhi
..
..
..
Enta
..
..
..
Ferozepore
..
..
Faridkot State
..
..
Gurdaspur
..
..
..
Gujranwala
..
..
..
Gujrat
..
..
..
Garhmal .. .. ..
Hoshiarpur .. ..
Hissar
..
..
..
Hazara
..
..
..
Jammu State
..
..
Jullundur
..
..
..
Jhelum
..
..
..
Jind States
..
..
..
Jhang
..
..
..
Kohat
..
..
..
Kangra
..
..
..
Carried over .. .. ..
2
HINDUS.
Males.
..
..
1
1
..
15
..
..
..
..
1
..
2
..
5
2
..
7
2
4
7
2
1
5
3
1
3
6
2
2
1
1
4
78
Females.
..
..
..
..
..
4
..
..
..
..
..
..
..
..
..
..
..
1
..
..
2
1
..
1
..
..
..
4
..
..
..
1
..
14
Total.
..
..
1
1
..
19
..
..
..
..
1
..
2
..
5
2
..
8
2
4
9
3
1
6
3
1
3
10
2
2
1
2
4
92
3
MUHAMMADANS.
Males.
2
2
..
..
1
8
1
4
1
2
1
1
2
1
2
..
1
3
..
5
3
5
..
4
1
9
2
3
4
..
..
4
1
73
Females.
..
..
..
..
..
3
..
..
..
..
..
..
..
..
..
..
..
..
..
1
1
1
..
..
..
1
..
..
..
..
..
..
..
7
Total.
2
2
..
..
1
11
1
4
1
2
1
1
2
1
2
..
1
3
..
6
4
6
..
4
1
10
2
3
4
..
..
4
1
80
NOTE.—Figures exhibited in the