NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
2
led to a decline in the number of fresh admissions could be re-
garded with some degree of satisfaction, but the improvement in
the accommodation effected during the past three years by the
construction of a new criminal section and of a hospital section
for women and in other ways makes it no longer necessary to dis-
courage fresh admissions. Every effort should therefore be made
to render it possible to reduce fees so as to make the treatment
of the mentally afflicted in this the only institution of its kind in
the province available on as wide a scale as is practicable.
2. The percentage of the daily average strength discharg-
ed as cured declined from 16.45 in 1924 to 14.11 in 1925 and
11.47 in 1926, but the report is silent as to the reasons for
this decrease. The death-rate, on the other hand; after rising
from 11.31 per cent of the daily average population in 1924 to
14.23 per cent in 1925 fell to 9.25 per cent in 1926. During 1925
no less than 123 deaths occurred of which over half were due to
dysentery and diarrhœa : this led to a thorough inspection of the
premises by the Public Health Department with the result
that great improvements were effected in the conservancy
arrangements which were found to be very defective, and in
1926 only four deaths were due to dysentery and diarrhœa. There
was, however, a great increase in other sickness in 1926 and
the daily average sick which had been a little over 50 in the
two previous years rose to nearly 72. For this malaria was
largely responsible, due to the insanitary condition of the Mian
Mir storm water channel which runs between the male and
female sections of the hospital, but pneumonia and tuberculosis
also claimed many victims. Tuberculosis indeed caused more
deaths than any other disease, but the majority of the cases were
recent admissions who had been infected before arrival in the
institution. Efforts to improve health conditions have been un-
abated and in addition to the extension of accommodation which
has been referred to above a new cattle-shed has been built and
the drainage of the female section is being completely over-
hauled and a water-carriage system is being installed. A new
hospital with accommodation for fifty women patients has been
built and a Lady Assistant Surgeon placed in charge.
3. Captain C. J. Lodge-Patch, M.C., I.M.S., was in charge
as Medical Superintendent during the whole period of three
years except for some months when he was on leave and Captain
T. H. Thomas, I.M.S., officiated for him. Captain Lodge-Patch
has done much to ameliorate the condition of his patients, and
Government desire to take this opportunity of acknowledging
the zeal and sympathy with which he has discharged his duties:
to him among other things is due the inception of a Benevolent
3
Fund for the provision of extra comforts and amenities for the
patients, and Government wish to acknowledge the generosity of
His Highness the Maharaja of Patiala, His Highness the Raja
of Faridkot and Sir Edward Maclagan among others who have
contributed to this fund. They also wish once again to place on
record their appreciation of the devotion of the Mother Superior
and the Franciscan Sisters who look after the female section of
the hospital. The thanks of Government are also due to the
visitors, official and non-official, for the important and somewhat
unpleasant public service which they perform.
ORDER.—Ordered that a copy of the report and of the review
be forwarded to the Government of India, Home Department, for
information, also that the review be published in the Punjab
Gazette.
Ordered also that a copy of the review be forwarded to the
Inspector-General of Civil Hospitals, Punjab, for information.
By order of the Punjab Government (Ministry of Local
Self-Government.)
FIROZ KHAN NOON,
J. G. BEAZLEY,
Minister for Local Self-
Secretary to Government, Punjab,
Government.
Transferred Departments.
409 CS—271—1-6-27—SGPP Lahore.
Note on the Report of the Punjab Mental Hospital,
Lahore, for the triennium 1924-1926.
THE report forwarded, herewith, relates to the triennial
period 1924—26. Captain C. J. Lodge-Patch, I.M.S., held
charge of the Punjab Mental Hospital from 1st January 1924
to 15th September 1925, and then again from 30th November
1926 to the end of the year. During his absence on leave,
from 16th September 1925 to 29th November 1926, Captain
T. H. Thomas, I.M.S., acted as Medical Superintendent.
Population.
There has been no marked variations in the total popu-
lation of the Mental Hospital, the figures for
the triennium under review being 1,193, 1,154
and 6,150. The daily average strength also shows a slight
falling off from 875.27 in 1924, 864.54 in 1925 and 854.12 in
1926.New admissions which were 272 in 1924, fell to 267
in 1925 and again rose to 282 in 1926, while re-admissions
which accounted for 5C in 1924, fell to 25 in 1925, and rose to
31 in 1926.
Accommodation.
2. It is gratifying to note that there is no longer any-
overcrowding in the Mental Hospital owing
mainly to the provision of increased accommo-
dation. During the triennium a new criminal section with
accommodation for 200 patients was constructed, and it is hoped
that there will be no overcrowding on the male side for some time
to come.
Female
Mental
Hospital.
3. A new hospital with accommodation for fifty patients
has been built and this will include a certain
number of rooms for better class Indian ladies
who may desire to have special arrangements made for them.
Sanitation.
4. Improvements in the water supply of the Female
Mental Hospital have been administratively
approved by Government and it is hoped that
the work will be completed during the current financial year.
Escapes, suicides
and deaths from
violence.
5. There were seven escapes during the triennium under
review as compared with ten in the pre-
ceding triennium, while there were only two
cases of suicide as against three in 1921—23.
Sickness.
6. From the figures given by the Medical Superintendent
it will be seen that there has been a very
considerable decrease in the incidence and
2
mortality due to intestinal infections. The decrease is attri-
butable to the improved method of conservancy which has
been adopted since the beginning of 1926. The number of
cases under treatment in hospital was 52.17 in 1924, 50.64 in
1925, and 71.81 in 1926, while the percentage of deaths to
daily average strength was 11.31, 14.23 and 9.25. The incidence
of malaria, which was greater in 1926 than in any year since
the institution was established, is responsible for the increased
number of admissions in hospital. This large increase appears
to be due to the state of the storm water channel which runs
between the male and female sections and continues past the
Central Jail. Owing to the insufficient grading, stagnating
water remains in its bed all the year round and is a menace
to health of the inmates of the hospital and staff.
Acknowledgments.
7. Captain C. J. Lodge-Patch, M.C., I.M.S., and Captain
1. H. Thomas, I.M.S., who held charge of the
responsible office of Medical Superintendent
during the triennium, discharged their onerous duties with
marked zeal and energy. Dr. G. W. Hardy, Deputy
Medical Superintendent and other members of the staff ably
assisted the Medical Superintendent in the efficient administra-
tion of the Mental Hospital. My acknowledgments are due to
all these officers and to the Rev. Mother Simon and the Fran-
ciscan Sisters, whose unselfish devotion is worthy of special
mention.
C. R. BAKHLE, COLONEL, I.M.S.,
LAHORE :
Inspector-General of Civil Hospitals,
Punjab.
The 14th April, 1927.
Triennial Report of the Punjab Mental Hospital for the
years 1924,1925 and 1926.
I. Population.— The three years under review show that
there has been a steady decrease in the number of patients treated.
The average population of the hospital for these years has been
875, 865 and 854. This decline in the numbers of patients treated
is only partially accounted for by the very large number of deaths
in 1925 (123 as compared with 99 in 1924 and 79 in 1926).
A more potent factor to account for the decrease in the number
of patients is the fact that, with effect from 1st January 1924,
the rate of maintenance charged to private individuals and public
bodies was raised from Rs. 16 to Rs. 20 per mensem. The fall
in the population has been coincident with the rise in the rate
charged, but this rise was necessary as previously the institution
had been run at a loss, and a considerable and unnecessary
burden had been borne by Provincial Funds.
II. Accommodation.—There is no longer any overcrowding
in the hospital for, besides the reduction in the number of patients
referred to in the previous paragraph, much has been done to
increase the accommodation for patients and for staff. A new
criminal section was completed in 1924 and this is capable of
holding 200 patients so that there is no likelihood of overcrowd-
ing on the male side for some time to come. The improvements
and additions to the Female Mental Hospital will be referred to in
a later paragraph.
Two new houses have been built for the sub-assistant sur-
geons and fifteen quarters are under construction for attendants.
This will go far to relieve the congestion that has been experi-
enced among the staff. Sanction has not yet been accorded for
sweepers' quarters.
Twelve years ago it was suggested that a lecture theatre should
be built for the medical students who attend weekly demonstra-
tions at the Mental Hospital. Funds for this purpose were allot-
ted in 1925-26, but the amount would have been quite inade-
quate to build a room capable of holding 70 or 80 students com-
fortably, so it has been utilized to form an extension to the Office
of the Medical Superintendent. There is now ample accommoda-
tion for the final year class at the clinical demonstrations in
Mental Diseases.
The standings for the cattle have always been most unsatis-
factory, but within the last twelve months a new cattle shed has
been built, and this is regarded as a great improvement on any
2
similar structure in the Province. It is hoped that in the course
of time the institution will be able to have its own herd of milch
cows.
III. The Female Mental Hospital. —It is gratifying to be
able to report that a large swamp on the north of the Female
Mental Hospital has been reclaimed and now forms a much needed
extension to the grounds of the female side of this institution.
A new hospital section has been built with accommodation for
fifty female patients. This will include a certain number of
rooms for better class Indian ladies who wish to have special
arrangements made for them. The existing accommodation for
tubercular patients is very unsatisfactory, and it will be neces-
sary to build a tubercular section as an annexe to the new female
hospital.
The drainage of the Female Mental Hospital is being com-
pletely overhauled at present, and a water carriage system is being
installed. This drainage system will be connected with the new
drainage scheme on the male side.
The general supervision of the Female Mental Hospital
continues to be carried out by the Rev. Mother Simon and the
Franciscan sisters. One extra assistant matron has been
sanctioned within the last three years, and this has
enabled the Rev. Mother to spend a year's leave in France.
This is the first time she has been out of India in the last
eighteen years. It is proposed to send one of the assistant
matrons home this summer, and she has been recommended to
visit certain of the modern mental hospitals in France, so that
she may gain practical experience of recent methods employed
in the care and treatment of the insane.
IV. Sanitation —Reference has been made in the annual
reports for 1924 and 1925 to various improvements in the water
supply and drainage of this institution. When the water
carriage system mentioned above is completed, it will be neces-
sary still further to increase the water supply of the hospital.
At present, there is insufficient water for the flushing of the new
drains and water closets which are being installed.
Numerous complaints have been submitted from month to
month with regard to the channel which carries storm water from
Mian Mir. This forms a deep " nala " which runs between the
male and female institutions and continues past the Central Jail
and the Borstal Institution. As a result of frequent repre-
sentations this channel was deepened some two years ago, and it
was supposed that it would have been properly graded. Since the
alleged improvements, however, it has become even more insani-
tary than before. Stagnating water remains in its bed all the
3
year round, and this water is continually polluted by sewage and
sullage. This storm water channel is a menace to the health and
well being of more than five thousand individuals, and the sanita-
tion of this area can never be regarded as satisfactory until this
source of danger is removed. The enormous increase in the
number of cases of malaria admitted to the hospital wards is
directly due to this source of infection. There is also a consider
able wastage of staff owing to sickness during the malaria season.
V. Escapes, suicides and deaths from violence.—There were
three escapes in 1926 as compared with two in each of the pre-
ceding years. This makes a total of seven as compared with ten
in the previous triennium.
During 1924, there were two suicides and one death result-
ing from violence inflicted by an impulsive patient. In 1925
there was no unfortunate incident under these heads; and in
1926 there were no suicides but one death which apparently re-
sulted from violence, although the immediate cause of death was
the rupture of an enlarged spleen.
VI. Recent innovations.—A number of innovations and
improvements have been effected within the last few years. In
the last triennial report reference was made to the greater degree
of liberty which the patients enjoy. This has since been increased,
and a number of patients are allowed out for walks either alone
or in charge of an attendant. None of the patients has abused
this privilege.
" Occupational Therapy" has been further developed.
Patients have always been employed in weaving cloth for their
summer and winter clothing, and in making munj mats, but in
addition to these occupations others have recently been intro-
duced, such as " Darri", and towel making on the male side; and
embroidery, raffia work, and rug making on the female side.
The last is very popular with the lady patients. The cost of raw
material is negligible, as the canvas on which the rugs are
worked is manufactured in the weaving sheds, and the wool is
obtained from condemned blankets. Unravelling fragments of
torn blankets is a useful method of sublimating the energy of
certain patients who can be persuaded to do no other form of
work, and who find pleasure in destroying blankets and clothing.
Loose leaf ledgers have replaced the old fashioned bound
case books wihch were so cumbersome and bulky. The
medical records of each patient can now much more easily be
written up, and they are infinitely more accessible than they
were before these loose leaf ledgers were introduced.
4
Government sanction was obtained for an initial and
recurring grant in order to purchase books of reference and
standard text-books on mental and nervous diseases. A small
and excellent medical library which will be added to each year
keeps the medical staff up to date in their knowledge of the
diseases they are called on to treat.
While on leave last year, the Medical Superintendent was
deputed to visit many of the mental hospitals in the United
Kingdom in order to obtain ideas for improving the local
institution. Numerous ideas have been obtained and are
embodied in a separate report. The most outstanding feature
in which the Punjab Mental Hospital lags behind similar
hospitals in Europe is in the severity of its architecture.
It has previously been remarked that the only way in which
this institution could be made to look more like a hospital and
less like a jail would be to pull it down and rebuild it. The
report of the deputation, however, contains certain suggestions
for converting, at a very small cost, the present hideous criminal
section into what could be a very comfortable and convenient
hospital section. Several other recommendations have also been
put forward in the hope that this institution may yet be brought
into line with modern mental hospitals.
VII. Benevolent Fund.—From time to time, private indivi-
duals have made generous donations to this hospital. These
include Rs. 500 from Sir Edward Maclagan, Rs. 1,000 from
His Highness the Maharaja of Faridkot, and Rs. 500 from His
Highness the Maharaja of Patiala. Such sums have been
utilized as the nucleus of a Benevolent Fund for making a
patient's stay in this hospital more pleasant by providing small
" extras " which could not reasonably be charged to the local
Government. One of the first purchases was a Ford Motor
Lorry fitted with a special body in which sixteen patients can
be taken out for drives four or five times a week. This bus can
also be used as an ambulance whenever necessary. At times,
it is hired out to members of the staff, especially the sisters, at
the rate of four annas a mile which allows a very small margin
of profit on the running expenses. It has travelled 8,500 miles
in the last two years and the drives are very greatly appreciated
by the patients.
Other articles purchased out of the Benevolent Fund
include a specially designed fly-proof vehicle on bicycle wheels
in which food is carried from the central kitchen to the Female
Mental Hospital. This replaced an iron wheeled, insanitary,
coffin-like box which had rattled its way backwards and forwards
ever since the opening of the Female Mental Hospital as a
separate institution.
5
For the entertainment of the patients, a small cinematograph
projector has been purchased, and a library consisting of a few
hundred books in English and in the vernacular has also been
started.
VIII. Sickness and Mortality.—Some interesting facts are
to be noted under these heads. In all the years preceding
1926, the greatest causes of sickness and mortality have
been dysentery and diarrhœa. The figures for 1924, 1925
and 1926 are 179, with 34 deaths, 313, with 63 deaths and 167,
with 11 deaths, respectively. Owing to the fact that the
monthly and annual sick return forms do not contain a separate
column for cases of intestinal parasites (worms), such diseases
were included under the head of diarrhœa until 1926, when
a separate column was introduced. The 167 cases, with 34
deaths, in 1926, can be divided into 117, with 7 deaths due to
worms and only 50, with 4 deaths, actually due to dysentry
and diarrhœa. It is regretted that the sickness and mor-
tality under these heads were not similarly differentiated prior
to 1926, as a more satisfactory comparsion could have been
made, but the figures quoted are sufficient to show that there
has been a very considerable decrease in the incidence and
mortality of intestinal infections.
This decrease can be attributed to the improved method of
conservancy which has been adopted since the beginning of 1926.
The number of deaths was so high in 1925, that the Director of
Public Health was consulted, and certain recommendations were
made for reducing the number of flies, as it was believed that
the great majority of the infections were carried by flies. The
former method of disposing of nightsoil has been abandoned
in favour of trenches six feet deep ; many mulberry and other
trees which specially attracted flies have been cut down; the
drains are sprinkled with lime; the wards and barracks are
sprayed with "flit"; and when the cattle are removed from
their present standings to the new cattle shed, it is expected that
there will be a still greater reduction in the number of flies and
in the number of cases of fly-borne diseases which are admitted
to the sick wards of the Punjab Mental Hospital.
Although the type of diseases mentioned in the previous
paragraphs has been greatly reduced, there has been a considerable
increase in certain other forms of diseases. As regards
pneumonia, the figures for the three years under review are 34,
with 20 deaths, 14, with 5 deaths, and no less than 65 cases,
with 20 deaths. As regards tuberculosis of various forms the
figures are 40, with 13 deaths, 39, with 16 deaths, and 62, with 24
deaths. The great majority of cases of tuberculosis are recent
6
admissions to the Punjab Mental Hospital who have evidently
been infected in their own homes. Last year has been exceptional
in that tuberculosis in one form or another has been the greatest
individual cause of death.
The incidence of malaria was much greater in 1926
than in any year since the institution was built. The
figures for 1924, 1925, and 1926, under this head, are,
respectively, 24 cases, with 2 deaths, 34 cases, with 4 deaths, and
135 cases, with 5 deaths. This enormous increase appears to be
directly due to the abominable state of the Mian Mir storm water
channel to which reference has been made in a previous page.
These cases of malaria have increased the numbers of daily
sick, which are 52.17, 50.64 and 71.81 in the three successive
years. The death rate, however, in spite of the large number of
daily sick, and the unusually high mortality from pneumonia and
tuberculosis, shows a satisfactory decrease. The percentages of
deaths to the daily average strength for 1924, 1925 and 1926
are 11.31, 14.23 and 9.25, respectively.
IX. Cash Accounts.—It is satisfactory to report that there
has been a steady decrease in the amounts drawn from the trea-
sury for the upkeep of the institution. If Book Charges for the
work carried out by the Public Works Department, etc , are not
included, such amounts are Rs. 2,28,945-11-11, Rs. *2,33,140-12-3
and Rs. 2,18,510-15-3 for the years 1924, 1925 and 1926, respec-
tively. There has been a decrease in the amounts expended under
the heads of diet, clothing and beddings miscellaneous con-
tingencies, repairs and maintenance, rates and taxes.
The amount remitted to the treasury on account of paying
patients and miscellaneous receipts during 1926 was Rs.
13,411-0-5 as compared with Rs. 13,484-13-0 in 1925, and
Rs. 11,840-13-7 in 1924. This must be regarded as satisfactory
in view of the fact that the total number of patients has fallen
off in the last two years, and it seems to indicate that a greater
number of better class patients are being admitted to the hospi-
tal now than in former years.
C. J. LODGE-PATCH, M.C., CAPTAIN, I.M.S.,
Medical Superintendent, Punjab Mental Hospital.
*Owing to a clerical error in the Annual Return for 1925, the sum of Rs. 5,547-5-0 on
account of the pay of mentals was not included in columns 3, 8,9,19 and 23 of Statement VIII
for that year. The necessary corrections have been made, and the actual amounts expended in
1925 are as shown in the present triennial report.
ii
STATEMENT
SHOWING THE ADMISSIONS, DISCHARGES, ETC.,
LAHORE, DURING THE YEAR 1926
1
YEARS.
1924 ...
1925 ...
1926 ...
2
REMAINED ON
1ST JANUARY.
Males.
686
679
658
Females.
185
183
179
Total.
871
862
837
3
ADMITTED.
Males.
210
209
235
Females.
62
58
47
Total.
272
267
282
4
READMIT-
---.
Males.
33
23
26
Females.
17
2
5
Total.
50
25
31
5
TOTAL
POPULATION.
Males.
929
911
919
Females.
264
243
231
Total.
1,193
1,154
1,150
The capacity of the Punjab Mental Hospital is at 50 superficial feet per patient, for—
Males ... ... ... ... ...
Females
...
...
...
...
...
TOTAL ...
672
190
862
There were 3 cases under observation,
NOTE— Observation cases are not included in the figures for 1926.
iii
No. I.
OF PATIENTS IN THE PUNJAB MENTAL HOSPITAL,
AND TWO PREVIOUS YEARS.
6
Discharged.
A.
CURED.
Males.
116
99
92
Females.
28
23
6
Total.
144
122
98
B.
TRANSFERRED TO FRIENDS.
Improved.
Males.
49
38
95
Females.
21
11
16
Total.
70
49
111
Not improved.
Males.
15
12
6
Females.
1
8
4
Total.
16
20
10
C.
OTHERWISE .
Males.
2
3
4
Females.
...
...
1
Total.
2
3
5
D.
TOTAL.
Males.
182
152
197
Females.
50
42
27
Total.
232
194
224
The maximum number of patients confined on any one night was—
Males
...
...
...
...
...
Females ... ... ... ... ...
TOTAL ...
693
191
884