1876
restricting admissions into public criminal lunatics ; (2) lunatics who are dangerous to themselves or others, and (3) those who may haye no friends or relations to look after in
January
asylums
to
(i)
them ; and enjoining the necessity of discharging patients who have so far improved that they may safely The effect be committed to the care of their friends.
orders, when strictly carried out, is obviously the number of admissions, (2) to (1) increase the proportion of acute cases among these, and (3) to stimulate discharges. The asylum population is thus not only reduced but altered in character. The chronic residual element, which increases yearly when no special restrictions are placed on admissions, and discharges depend mainly on recovery, is reduced, and the asylum population consists chiefly of acute and comparatively recent cases. Asylums thus acquire the character rather of hospitals for the treatment of insanity than of places of detention. The events of the year?admissions, discharges and deaths?also come to bear a different of these
to diminish
relation to the resident and
Higher
population.
recovery
such circumstances be
may under
death rates
Criminal lunatics are not, however, so by these orders as non-criminal. No bar is placed upon the admission of these, and difficulties exist with regard to their discharge. They thus tend to accumulate and constitute an increasing
expected.
much affected
share of
BENGAL LUNATIC ASYLUMS.
the
asylum
The Report upon Lunatic Asylums in Bengal for the year 1877, drawn up by Surgeon-General J. Irving, M. D., supplies an excellent illustration of the
fact that the statistics of such institutions must be the light of the laws and administrative ar-
read in
smaller
from
those of non-criminal
the annual events must tend to bear
and
lunatics, a
and
diminishing
relation to
from
dependent
the differences
on
climate,
race
and
social usages, there is a special cause of divergence which must be taken into prominent consideration. It is this. the
The
Government of India found that
of lunatics
number
in
asylums
was
rapidly
increasing ; that loud calls came from every province for increased asylum accommodation?enlargement of old and construction of tenance
growing
of
lunatics
burden
on
new
the
and relations could with tribute to the
support
that the State
was
; that the main-
imposing
public
a
revenues
difficulty
large
and
; that friends
be induced to
of their insane
kinsmen,
con-
and
thus saddled with
necessarily dependent safety, or even humanity. not
asylums
was
on
responsibilities considerations of public
Orders
were
therefore issued
strength.
In
resolution upon this report the LieutenantGovernor affirms his determination to carry out the orders of the Government of India strictly. He the
does not recognise it to be the rangements affecting the admission and disposal of lunatics. The statistics of 1877 differ in many re- support destitute lunatics any
spects very strikingly from those of previous years, and present strong contrasts with the statistics of similar institutions in other countries; but, apart
Their statistics
population.
different
also must be
deaf and dumb
duty
of the State to
more
than
destitute
blind, unless they comprocripples, mise the public safety, or, possessing no other means of support, are thrown upon public charity. He goes further, and does not see why a lunatic or idiot who
has committed
or
petty crime, should on that account expensive asylum for the rest of his life at the public cost. Magistrates and visitors are therefore enjoined to exercise greater discrimination and diligence in carrying out the provisions of Act XXXVI. of 1858, which strongly lays down the responsibility of guardians and relations for the care a
be maintained in
and
an
maintenance
reading
considerations in
It
of lunatics.
mind, for,
is
necessary in to bear these if read in the of
the statistics of Indian
Asylums
light
European laws and anomalous
customs, they present startling and features. The statistics of the year
embrace figures
supplied by
Dullunda, Dacca, Patna,
seven
asylums
for natives at
Cuttack, Moydapore,
Berham-
THE INDIAN MEDICAL GAZETTE.
342
Hazareebagh. The transactions of the European Asylum at Bhowanipore are very properly separately narrated and tabulated. The Moydapore Asylum was closed in October and the patients transferred to the adjoining asylum at Berhampore. pore
and
The average number of lunatics under treatment during the year was 1,117?888 males and 229 females. Of these 268 or 24 per cent were criminal lunatics? As
247 males and 21 females.
compared
with
the
population
year, there is a reduction of 107 in the of asylums, but an increase of 21 criminal
lunatics.
The
preceding
asylum population had risen from 603 in 1867 to 1,224 in 1876, and the number of criminal lunatics in confinement has increased from 106 in 1867 to 268 in 1877. Criminal lunatics thus constitute a larger proportion of residents, and the number of females among them, it will be observed, is relatively very much smaller. The admissions of the year amounted to 247 (201 males and 46 females). There were 38 re-admissions (35 males and 3 females),
giving
total of admissions and
a
re-admissions of
285 against 454 the average of the six preceding The admisyears; of these 75 were criminal lunatics. sions bore
strength of 25-4 per cent, those 24-7, and those of criminal 28. These results indicate clearly the operation and tendency of the new order. The discharges otherwise than by death amounted to 266 against 272 in the six a
ratio to
of non-criminal lunatics
preceding
years. The difference is comparatively small. were 147 against 191, discharged im-
The recoveries
proved 96 against 57 and discharged otherwise 23 against 24. The discharges bore a ratio of 23*8 per cent of strength against 26*7 ; the cures 13-1 against 18-7, and the discharged improved 8'6 against 5*9 The ratio of discharges among non-criminal lunatics was
25*3 and of criminal 19. The
meaning
of these
figures is that, the number of curable cases in the population being smaller (owing to the decrease of admissions) the ratio of cures was also smaller ; but, in consequence of the stringent orders to deplete asylums, the number of those discharged improved This would in some degree neuwas nearly doubled.
This demonstrates very clearly the fallacy of reckoning cures on admissions unless the former take place under similar circumstances, and the superiority
of the average number resident The returns of
non-criminals died Two
5'6.
chronic incurable cases in the tained. The relation of
and the
population cures
to
proportion
of
51'6
a high ratio of cures, while there was decrease of curable cases and of cures aband a decrease of the ratio of cures to popula-
dation, urged
not
so
marked
for
asylum
repeats the strong previous reports, for
in
criminal
?
cases
lunatics.
usual
as
recommena
separate
Lieutenant-
The
Governor admits the propriety of this measure which has been adopted in England, Scotland and Ireland.
Apart
legal
from considerations connected with the
peculiar
and social
position and conditions of detention and management of these lunatics, it would greatly conduce to statistical accuracy if these lunatics were confined in a separate asylum. We hope, therefore, that the
which has long been under eventually carried out.
measure
The
report contains
detail, which
we
large
discussion,
will be
amount of
interesting reproduce or comuse or rather abuse of gunja is credited a
have not space
to
ment upon. The with 101 out of 236 cases, in which the cause was ascertained or assigned, hereditary predisposition with
10, fever
with 14, and alcohol with 13. The return of causes of mortality is noteworthy. Phthisis accounts for 12 out of 73 cases, dysentery for 11, diarrhoea for 7, cholera for 8, dropsy, exhaustion of mania
and
pneumonia
for
5 each.
The most
remarkable feature in the returns of the year is the reduction of fatal cases of dysentery and diarrhoea. Bowel have
always figured high
in
the death
asylums. In the Dullunda asylum only represented by one fatal case of dysentery.
returns of Indian are
There
were
only
were
42
8
cases
of the disease treated.
admissions and 14 deaths.
attributes this most remarkable
In Dr.
improvement
to
the precautions which were taken to ensure that the lunatics consumed nothing but pure water. This meahas also resulted in
sure
actually
intestinal worms,
solutely, tion. Including the discharged improved, the ratio reaches the startling figure 85'2 (against 35 in England).
death-rate existed
recent and acute cases?the
was
missions leads to a
the rate of 6*8 and criminals
in 18 77. The Surgeon-General
Payne
of ad-
at
females; the difference is
1876 these
interesting. Excluding improved, against 42 *1. That is to say, the diminution
against 120 in the six previous population of 11*7 and 6-5 ;
The recovery rate among both males 13*1, and the death-rate of the former The rule for Indian asylums is 6*0 and latter 6*1. a lower recovery rate and higher death-rate among
and females
admissions is are
The
interesting.
73
population.
is thus main-
the ratios
basis of calculation.
also
most prone to die ; and (2) the relatively larger number of criminal lunatics who are less prone to die in the
they
this,
as a
are
of diminished
causes
(1) the reduction of
whose discharge rate is necessarily much smaller, to extent counteracts
was
ratios to
giving
years
complaints
great
mortality
number of deaths
tralize the diminution of curable cases by restriction of admissions; but the accumulation of criminal lunatics, a
2, 1878.
[December
cautions
a
decrease in the
prevalence
of
result that has followed similar preIt is also worthy of at Hazareebaugh. a
remark that there was not a single case of cholera in the Dullunda Asylum, though the disease prevailed to a
December 2,
REVIEWS.
1878.]
considerable extent both in the city and its suburbs. The gross average cost of each patient was Rs. 101-9-1.
Only Rs. 1,704-11-3 (1*5 per cent of the total expenditure) were realized on account of maintenance from the friends of patients. A profit of Rs. 12,237 -5-1 (excess of credits over debits) was made in maDeducing these items from the total cost, the net average cost comes to be Rs. 89-1-5 per patient per annum. Industries of various kind, suitnufactures.
capacities of the people and circumstances locality, are diligently pursued in asylums and with great advantage. Nothing conduces so much to the good and orderly management of asylums and the recovery of the insane as occupation, and this is fully Amusements and reand practically recognised. ed to the of the
creations
are
resorted
might probably
to in the
Dacca asylum.
be done in this direction to
More
lighten
the
lives of these poor souls and divert their attention from their morbid fancies. The transactions of the European Asylums at Bhowanipore are separately reported on. 25 patients remained under treatment at the close of the previous year (13 males and 12 females), 34 (24 males and 10 females) were admitted and 3(1 male and 2 females) were readmitted, giving a total of 62 (38 males and 24
females). Of those admitted 30 came from the civil and seafaring populations and 7 from the army, 26 were Europeans, 7 Armenians, 2 East Indians, 12 natives of European habits. 15 (12 males and 3 females) were discharged cured and 11 (6 males and 5 females) improved, 4 were despatched to Europe under the Merchant Shipping Act, 3 were made over to the military authorities and 2 despatched to Bombay for transfer to England, leaving 27 (13 males and 14 females,) under treatment at the close of the year. The This was dimitotal expenditure was Rs. 33,303. nished by Rs. 16,696 realized from paying patients. The average cost was Rs. 575 per patient per annum. No death took place in this asylum during the year
3^3
restricting admissions into public criminal lunatics ; (2) lunatics who are dangerous to themselves or others, and (3) those who may haye no friends or relations to look after in
January
asylums
to
(i)
them ; and enjoining the necessity of discharging patients who have so far improved that they may safely The effect be committed to the care of their friends.
orders, when strictly carried out, is obviously the number of admissions, (2) to (1) increase the proportion of acute cases among these, and (3) to stimulate discharges. The asylum population is thus not only reduced but altered in character. The chronic residual element, which increases yearly when no special restrictions are placed on admissions, and discharges depend mainly on recovery, is reduced, and the asylum population consists chiefly of acute and comparatively recent cases. Asylums thus acquire the character rather of hospitals for the treatment of insanity than of places of detention. The events of the year?admissions, discharges and deaths?also come to bear a different of these
to diminish
relation to the resident and
Higher
population.
recovery
such circumstances be
may under
death rates
Criminal lunatics are not, however, so by these orders as non-criminal. No bar is placed upon the admission of these, and difficulties exist with regard to their discharge. They thus tend to accumulate and constitute an increasing
expected.
much affected
share of
BENGAL LUNATIC ASYLUMS.
the
asylum
The Report upon Lunatic Asylums in Bengal for the year 1877, drawn up by Surgeon-General J. Irving, M. D., supplies an excellent illustration of the
fact that the statistics of such institutions must be the light of the laws and administrative ar-
read in
smaller
from
those of non-criminal
the annual events must tend to bear
and
lunatics, a
and
diminishing
relation to
from
dependent
the differences
on
climate,
race
and
social usages, there is a special cause of divergence which must be taken into prominent consideration. It is this. the
The
Government of India found that
of lunatics
number
in
asylums
was
rapidly
increasing ; that loud calls came from every province for increased asylum accommodation?enlargement of old and construction of tenance
growing
of
lunatics
burden
on
new
the
and relations could with tribute to the
support
that the State
was
; that the main-
imposing
public
a
revenues
difficulty
large
and
; that friends
be induced to
of their insane
kinsmen,
con-
and
thus saddled with
necessarily dependent safety, or even humanity. not
asylums
was
on
responsibilities considerations of public
Orders
were
therefore issued
strength.
In
resolution upon this report the LieutenantGovernor affirms his determination to carry out the orders of the Government of India strictly. He the
does not recognise it to be the rangements affecting the admission and disposal of lunatics. The statistics of 1877 differ in many re- support destitute lunatics any
spects very strikingly from those of previous years, and present strong contrasts with the statistics of similar institutions in other countries; but, apart
Their statistics
population.
different
also must be
deaf and dumb
duty
of the State to
more
than
destitute
blind, unless they comprocripples, mise the public safety, or, possessing no other means of support, are thrown upon public charity. He goes further, and does not see why a lunatic or idiot who
has committed
or
petty crime, should on that account expensive asylum for the rest of his life at the public cost. Magistrates and visitors are therefore enjoined to exercise greater discrimination and diligence in carrying out the provisions of Act XXXVI. of 1858, which strongly lays down the responsibility of guardians and relations for the care a
be maintained in
and
an
maintenance
reading
considerations in
It
of lunatics.
mind, for,
is
necessary in to bear these if read in the of
the statistics of Indian
Asylums
light
European laws and anomalous
customs, they present startling and features. The statistics of the year
embrace figures
supplied by
Dullunda, Dacca, Patna,
seven
asylums
for natives at
Cuttack, Moydapore,
Berham-
THE INDIAN MEDICAL GAZETTE.
342
Hazareebagh. The transactions of the European Asylum at Bhowanipore are very properly separately narrated and tabulated. The Moydapore Asylum was closed in October and the patients transferred to the adjoining asylum at Berhampore. pore
and
The average number of lunatics under treatment during the year was 1,117?888 males and 229 females. Of these 268 or 24 per cent were criminal lunatics? As
247 males and 21 females.
compared
with
the
population
year, there is a reduction of 107 in the of asylums, but an increase of 21 criminal
lunatics.
The
preceding
asylum population had risen from 603 in 1867 to 1,224 in 1876, and the number of criminal lunatics in confinement has increased from 106 in 1867 to 268 in 1877. Criminal lunatics thus constitute a larger proportion of residents, and the number of females among them, it will be observed, is relatively very much smaller. The admissions of the year amounted to 247 (201 males and 46 females). There were 38 re-admissions (35 males and 3 females),
giving
total of admissions and
a
re-admissions of
285 against 454 the average of the six preceding The admisyears; of these 75 were criminal lunatics. sions bore
strength of 25-4 per cent, those 24-7, and those of criminal 28. These results indicate clearly the operation and tendency of the new order. The discharges otherwise than by death amounted to 266 against 272 in the six a
ratio to
of non-criminal lunatics
preceding
years. The difference is comparatively small. were 147 against 191, discharged im-
The recoveries
proved 96 against 57 and discharged otherwise 23 against 24. The discharges bore a ratio of 23*8 per cent of strength against 26*7 ; the cures 13-1 against 18-7, and the discharged improved 8'6 against 5*9 The ratio of discharges among non-criminal lunatics was
25*3 and of criminal 19. The
meaning
of these
figures is that, the number of curable cases in the population being smaller (owing to the decrease of admissions) the ratio of cures was also smaller ; but, in consequence of the stringent orders to deplete asylums, the number of those discharged improved This would in some degree neuwas nearly doubled.
This demonstrates very clearly the fallacy of reckoning cures on admissions unless the former take place under similar circumstances, and the superiority
of the average number resident The returns of
non-criminals died Two
5'6.
chronic incurable cases in the tained. The relation of
and the
population cures
to
proportion
of
51'6
a high ratio of cures, while there was decrease of curable cases and of cures aband a decrease of the ratio of cures to popula-
dation, urged
not
so
marked
for
asylum
repeats the strong previous reports, for
in
criminal
?
cases
lunatics.
usual
as
recommena
separate
Lieutenant-
The
Governor admits the propriety of this measure which has been adopted in England, Scotland and Ireland.
Apart
legal
from considerations connected with the
peculiar
and social
position and conditions of detention and management of these lunatics, it would greatly conduce to statistical accuracy if these lunatics were confined in a separate asylum. We hope, therefore, that the
which has long been under eventually carried out.
measure
The
report contains
detail, which
we
large
discussion,
will be
amount of
interesting reproduce or comuse or rather abuse of gunja is credited a
have not space
to
ment upon. The with 101 out of 236 cases, in which the cause was ascertained or assigned, hereditary predisposition with
10, fever
with 14, and alcohol with 13. The return of causes of mortality is noteworthy. Phthisis accounts for 12 out of 73 cases, dysentery for 11, diarrhoea for 7, cholera for 8, dropsy, exhaustion of mania
and
pneumonia
for
5 each.
The most
remarkable feature in the returns of the year is the reduction of fatal cases of dysentery and diarrhoea. Bowel have
always figured high
in
the death
asylums. In the Dullunda asylum only represented by one fatal case of dysentery.
returns of Indian are
There
were
only
were
42
8
cases
of the disease treated.
admissions and 14 deaths.
attributes this most remarkable
In Dr.
improvement
to
the precautions which were taken to ensure that the lunatics consumed nothing but pure water. This meahas also resulted in
sure
actually
intestinal worms,
solutely, tion. Including the discharged improved, the ratio reaches the startling figure 85'2 (against 35 in England).
death-rate existed
recent and acute cases?the
was
missions leads to a
the rate of 6*8 and criminals
in 18 77. The Surgeon-General
Payne
of ad-
at
females; the difference is
1876 these
interesting. Excluding improved, against 42 *1. That is to say, the diminution
against 120 in the six previous population of 11*7 and 6-5 ;
The recovery rate among both males 13*1, and the death-rate of the former The rule for Indian asylums is 6*0 and latter 6*1. a lower recovery rate and higher death-rate among
and females
admissions is are
The
interesting.
73
population.
is thus main-
the ratios
basis of calculation.
also
most prone to die ; and (2) the relatively larger number of criminal lunatics who are less prone to die in the
they
this,
as a
are
of diminished
causes
(1) the reduction of
whose discharge rate is necessarily much smaller, to extent counteracts
was
ratios to
giving
years
complaints
great
mortality
number of deaths
tralize the diminution of curable cases by restriction of admissions; but the accumulation of criminal lunatics, a
2, 1878.
[December
cautions
a
decrease in the
prevalence
of
result that has followed similar preIt is also worthy of at Hazareebaugh. a
remark that there was not a single case of cholera in the Dullunda Asylum, though the disease prevailed to a
December 2,
REVIEWS.
1878.]
considerable extent both in the city and its suburbs. The gross average cost of each patient was Rs. 101-9-1.
Only Rs. 1,704-11-3 (1*5 per cent of the total expenditure) were realized on account of maintenance from the friends of patients. A profit of Rs. 12,237 -5-1 (excess of credits over debits) was made in maDeducing these items from the total cost, the net average cost comes to be Rs. 89-1-5 per patient per annum. Industries of various kind, suitnufactures.
capacities of the people and circumstances locality, are diligently pursued in asylums and with great advantage. Nothing conduces so much to the good and orderly management of asylums and the recovery of the insane as occupation, and this is fully Amusements and reand practically recognised. ed to the of the
creations
are
resorted
might probably
to in the
Dacca asylum.
be done in this direction to
More
lighten
the
lives of these poor souls and divert their attention from their morbid fancies. The transactions of the European Asylums at Bhowanipore are separately reported on. 25 patients remained under treatment at the close of the previous year (13 males and 12 females), 34 (24 males and 10 females) were admitted and 3(1 male and 2 females) were readmitted, giving a total of 62 (38 males and 24
females). Of those admitted 30 came from the civil and seafaring populations and 7 from the army, 26 were Europeans, 7 Armenians, 2 East Indians, 12 natives of European habits. 15 (12 males and 3 females) were discharged cured and 11 (6 males and 5 females) improved, 4 were despatched to Europe under the Merchant Shipping Act, 3 were made over to the military authorities and 2 despatched to Bombay for transfer to England, leaving 27 (13 males and 14 females,) under treatment at the close of the year. The This was dimitotal expenditure was Rs. 33,303. nished by Rs. 16,696 realized from paying patients. The average cost was Rs. 575 per patient per annum. No death took place in this asylum during the year
3^3
