Z\k
3nbian riDebical (5a3ette ffift? fears ago INSANITY IN INDIA
(From
the Indian Medical 1899, Vol. 34, p.
Gazette, 373)
October
The
following tables, compiled from the upon the Lunatic Asylums of Bengal, Madras and the Punjab, show the relative numbers of lunatics in the asylums at the end of the year 1898 :?
reports
Bengal Madras i Punjab 25
33
34
39 62G
43 453
335
167
43
82
..
3
..
126
1 124
4 24
33 58
2 14 1
13
j 1,083
714
558
Idiocy ]\[ ania?
(a) Epileptic (b) Other forms Melancholia? (a) Epileptic lb) Other forms
4
..
..
oo
i !
Dementia?
(a) Epileptic (b) Other forms Mental stupor General paralysis Delusional insanity Not yet diagnosed covered. ..
Total
..
or
treated
re-
..
5 1
7
From this table it will be seen that in all three the vast majority of lunatics suffer chronic mania. Idiocy is or from acute apparently least found in Bengal asylums and most in the Punjab. The proportion of insanity due to epilepsy is somewhat greater in Madras and Punjab than in Bengal. Forms of dementia appear much less common in the Punjab.
provinces
Oct., 1949]
FIFTY YEARS AGO
473
General paralysis lri Bengal during
admission. The Punjab report merely remarks that the large number of cases admitted into the Lahore Asylum, due to alcohol drinking, is remarkable.
^unjab, Madras
The general health of the Bengal lunatics was very good, in fact, the best on record for the last 13 years (except 1890), and compares favourably, says Colonel Hendley, with the death-rate, of county asylums in England. At Dullunda (Calcutta) Asylum, the number of sick was much less than in previous years, which Colonel Hendley attributes to improved sanitation, the issue of quinine1 prophylactics and to the institution of an infirm gang', which facilitates the easy recognition and care of those losing health, and affords a means of keeping the weakly and aged under closer observation. The patients are regularly weighed, as are prisoners in jails, and Dr. Macrae at Dacca says this tends to prevent actual disease arising, for any one losing weight is at once brought under observation. Major Whitwell, at Patna, was able to report an improvement in dysentery, which used to be so common in that ill-constructed asylum. The dry-earth system is thoroughly carried out, and the issue of warmpadded coats to old and feeble lunatics led to a diminution in the number of cases of pneumonia and phthisis. At Berhampur, even'the mildest cases of diarrhoea?a very trivial complaint?are at once admitted to hospital, which plan, if it raises the nominal sick rate, has the advantage of lowering the death-rate. Some difference of ' opinion exists as to the use of an infirm gang ', as maintained at Dacca and Dullunda Asylums. Colonel Hendley thinks the system a useful one and has recommended Government to order it to be kept up in all asylums. The Superintendent of Berhampur Asylum thinks such a gang unnecessary, as all deviations from the normal condition should be treated in hospital under the of the medical subordinate. But, as eye Colonel Hendley says, it is to prevent such deviations that the infirm gangs were introduced. It simply means that weakly-looking persons are more frequently weighed, receive some extra ration and are given tonics with the advantage of keeping off serious disease. There is no doubt that such a gang can be made very useful, provided that medical subordinates are not allowed to use (as they are too prone to do) the infirm gang as a sort of less troublesome substitute for hospital. This, however, is the abuse, not the use of the gang, and it is probably this point that Major Welsh had in mind. Numerous minor and important improvements in the sanitation of the Bengal asylums were carried out during the year. The important subject of amusements for the inmates continued to receive attention; books, papers, cards, musical instruments and pet animals were provided. Nautches and theatrical performances were provided inside the asylums, and in Calcutta selected patients were taken under proper escort to the
of the insane* was unknown the year and has only two cases in Madras and one in the Punjab. Melancholia was about equal in Bengal and but it was much less common in the
institutions.
The
following table gives as nearly as possible recorded causes of the insanities; unfortunately the Madras report goes less into detail in this matter than the other two reports :?
the
Alleged
causes
of insanity
among the
total treated
_
! Punjab
Cause
Cliaras Oanja
Madras
I
Bhang
26 5 11
Aicohoratins
1 10
I
Opium smoking
Other intoxicants
?Poverty Congenital
j^Pilepsy Over
\ .!
study
heredity
of
6
7
;
57
157
5 1 3 10 2 s
1 1
7 33 8 18
2 1 5 30
7 23 3 3 1
Childbirth
venery gxcessive ^.on-appearance
..
i
I
ever
Heat
1
menses
72
Masturbation
1 2
injury Grief
Bengal
"
|Uness(?)
6 1 1 3 1 12
'
Syphilis
Senility
Acute disease
xcess dose of quinine vJther causes
As regards Bengal, Colonel T. H. Hendley, c.i.e., writes : ' Of the 159 admissions three Were due to alcohol, and 21 were attributed to
ganja smoking '. In Dacca Asylum, LieutenantColonel Macrae, after careful inquiry, could only attribute two cases to ganja. In Patna, Major Whitwell only reported ganja as the cause jn clearly proved cases. Major Tull-Walsh
believes
aberration prothat the mental the abuse of hemp drugs is generally of short duration, and the patient The Madras report makes recovers. little comment upon the tabulated causes of
duced
by
ultimately
*The absence of general paralysis of the insane cases !r?m Indian asylums is very interesting. It is however accordance with experience. Savage writes (Albutt's System, Vol. VII, p. 693), general paralysis 'is rare among vegetable feeders, such as certain oriental races, though these may give way to excessive sexual indulgence. I understand that certain nomadic tribes, 1 hough saturated with syphilis, not being addicted to meat nor alcohol do not get general paralysis. The disease is associated with highly civilized states, and
most common among men who live in cities and do warn work'. Diabetes in some respects takes the
Place of general paralysis among educated cit3r-dwelling natives of India.?Editor. I.M.G. _
474
THE INDIAN MEDICAL GAZETTE
zoological gardens. The site chosen for the new Central Asylum at Chinsurah (Hooghly) was not considered satisfactory by Colonel Hendley, and another was selected. We cannot help thinking that Chinsurah is far from an ideal site for a central asylum. Hooghly is by no means a popular station, a matter of some importance, as the appointment of the Superintendent of the new asylum is intended to be made attractive and a good man might well hesitate before accepting an appointment, otherwise a good one, when it means residence for many years at a station like Hooghly. The new asylum will be ready none too soon, for the description given of the Patna Asylum by Colonel Hendley and the Superintendent may be summed up in the words of the former : Nothing short of demolition is required '. In the Punjab Asylum's report, Colonel A. Deane, i.m.s., notes a serious and steady rise in the population of the Lahore Asylum. There arc only two asylums in the Punjab?at Delhi '
(
and at Lahore. The percentage of deaths is considered satisfactory, viz, 9 per cent. Twelve per cent of the daily average strength arc reported cured. Pneumonia was more prevalent, possibly due to the intense cold of the winter. A new asylum at Lahore is in course of construction. Surgeon-General Sibthorpe, in the Madras report, notes a steady rise in the epileptic population of the asylums. Many sanitary
improvements were introduced, as portable pumps for washing out what arc called sewage cysterns '. The dry-earth system is in vogue. The Superintendent recommends the artificial heating of certain rooms, a proposal not often heard in India. Ragi was the staple grain in in the Madras Asylum. For destructive use maniacs, special garments of canvas and drill, not removable by the wearers, were introduced at the Madras Asylum and proved useful. Gardening, weaving, preparation of grain, matmaking, etc., were the chief occupations of the insanes. Amusements were provided, as in Bengal. The health of the inmates was good; tubercle of lungs caused six deaths out of twentysix. Surgeon-General Sibthorpe is not satisfied with the nursing arrangements. He suggests that members of the hospital staff should be '
male and female ward attendants trained in the general hospital for a year, and then transferred to the lunatic asylum for a course of special training in sick-nursing of the insane.
[Oct.,
1949
3nbian riDebical (5a3ette ffift? fears ago INSANITY IN INDIA
(From
the Indian Medical 1899, Vol. 34, p.
Gazette, 373)
October
The
following tables, compiled from the upon the Lunatic Asylums of Bengal, Madras and the Punjab, show the relative numbers of lunatics in the asylums at the end of the year 1898 :?
reports
Bengal Madras i Punjab 25
33
34
39 62G
43 453
335
167
43
82
..
3
..
126
1 124
4 24
33 58
2 14 1
13
j 1,083
714
558
Idiocy ]\[ ania?
(a) Epileptic (b) Other forms Melancholia? (a) Epileptic lb) Other forms
4
..
..
oo
i !
Dementia?
(a) Epileptic (b) Other forms Mental stupor General paralysis Delusional insanity Not yet diagnosed covered. ..
Total
..
or
treated
re-
..
5 1
7
From this table it will be seen that in all three the vast majority of lunatics suffer chronic mania. Idiocy is or from acute apparently least found in Bengal asylums and most in the Punjab. The proportion of insanity due to epilepsy is somewhat greater in Madras and Punjab than in Bengal. Forms of dementia appear much less common in the Punjab.
provinces
Oct., 1949]
FIFTY YEARS AGO
473
General paralysis lri Bengal during
admission. The Punjab report merely remarks that the large number of cases admitted into the Lahore Asylum, due to alcohol drinking, is remarkable.
^unjab, Madras
The general health of the Bengal lunatics was very good, in fact, the best on record for the last 13 years (except 1890), and compares favourably, says Colonel Hendley, with the death-rate, of county asylums in England. At Dullunda (Calcutta) Asylum, the number of sick was much less than in previous years, which Colonel Hendley attributes to improved sanitation, the issue of quinine1 prophylactics and to the institution of an infirm gang', which facilitates the easy recognition and care of those losing health, and affords a means of keeping the weakly and aged under closer observation. The patients are regularly weighed, as are prisoners in jails, and Dr. Macrae at Dacca says this tends to prevent actual disease arising, for any one losing weight is at once brought under observation. Major Whitwell, at Patna, was able to report an improvement in dysentery, which used to be so common in that ill-constructed asylum. The dry-earth system is thoroughly carried out, and the issue of warmpadded coats to old and feeble lunatics led to a diminution in the number of cases of pneumonia and phthisis. At Berhampur, even'the mildest cases of diarrhoea?a very trivial complaint?are at once admitted to hospital, which plan, if it raises the nominal sick rate, has the advantage of lowering the death-rate. Some difference of ' opinion exists as to the use of an infirm gang ', as maintained at Dacca and Dullunda Asylums. Colonel Hendley thinks the system a useful one and has recommended Government to order it to be kept up in all asylums. The Superintendent of Berhampur Asylum thinks such a gang unnecessary, as all deviations from the normal condition should be treated in hospital under the of the medical subordinate. But, as eye Colonel Hendley says, it is to prevent such deviations that the infirm gangs were introduced. It simply means that weakly-looking persons are more frequently weighed, receive some extra ration and are given tonics with the advantage of keeping off serious disease. There is no doubt that such a gang can be made very useful, provided that medical subordinates are not allowed to use (as they are too prone to do) the infirm gang as a sort of less troublesome substitute for hospital. This, however, is the abuse, not the use of the gang, and it is probably this point that Major Welsh had in mind. Numerous minor and important improvements in the sanitation of the Bengal asylums were carried out during the year. The important subject of amusements for the inmates continued to receive attention; books, papers, cards, musical instruments and pet animals were provided. Nautches and theatrical performances were provided inside the asylums, and in Calcutta selected patients were taken under proper escort to the
of the insane* was unknown the year and has only two cases in Madras and one in the Punjab. Melancholia was about equal in Bengal and but it was much less common in the
institutions.
The
following table gives as nearly as possible recorded causes of the insanities; unfortunately the Madras report goes less into detail in this matter than the other two reports :?
the
Alleged
causes
of insanity
among the
total treated
_
! Punjab
Cause
Cliaras Oanja
Madras
I
Bhang
26 5 11
Aicohoratins
1 10
I
Opium smoking
Other intoxicants
?Poverty Congenital
j^Pilepsy Over
\ .!
study
heredity
of
6
7
;
57
157
5 1 3 10 2 s
1 1
7 33 8 18
2 1 5 30
7 23 3 3 1
Childbirth
venery gxcessive ^.on-appearance
..
i
I
ever
Heat
1
menses
72
Masturbation
1 2
injury Grief
Bengal
"
|Uness(?)
6 1 1 3 1 12
'
Syphilis
Senility
Acute disease
xcess dose of quinine vJther causes
As regards Bengal, Colonel T. H. Hendley, c.i.e., writes : ' Of the 159 admissions three Were due to alcohol, and 21 were attributed to
ganja smoking '. In Dacca Asylum, LieutenantColonel Macrae, after careful inquiry, could only attribute two cases to ganja. In Patna, Major Whitwell only reported ganja as the cause jn clearly proved cases. Major Tull-Walsh
believes
aberration prothat the mental the abuse of hemp drugs is generally of short duration, and the patient The Madras report makes recovers. little comment upon the tabulated causes of
duced
by
ultimately
*The absence of general paralysis of the insane cases !r?m Indian asylums is very interesting. It is however accordance with experience. Savage writes (Albutt's System, Vol. VII, p. 693), general paralysis 'is rare among vegetable feeders, such as certain oriental races, though these may give way to excessive sexual indulgence. I understand that certain nomadic tribes, 1 hough saturated with syphilis, not being addicted to meat nor alcohol do not get general paralysis. The disease is associated with highly civilized states, and
most common among men who live in cities and do warn work'. Diabetes in some respects takes the
Place of general paralysis among educated cit3r-dwelling natives of India.?Editor. I.M.G. _
474
THE INDIAN MEDICAL GAZETTE
zoological gardens. The site chosen for the new Central Asylum at Chinsurah (Hooghly) was not considered satisfactory by Colonel Hendley, and another was selected. We cannot help thinking that Chinsurah is far from an ideal site for a central asylum. Hooghly is by no means a popular station, a matter of some importance, as the appointment of the Superintendent of the new asylum is intended to be made attractive and a good man might well hesitate before accepting an appointment, otherwise a good one, when it means residence for many years at a station like Hooghly. The new asylum will be ready none too soon, for the description given of the Patna Asylum by Colonel Hendley and the Superintendent may be summed up in the words of the former : Nothing short of demolition is required '. In the Punjab Asylum's report, Colonel A. Deane, i.m.s., notes a serious and steady rise in the population of the Lahore Asylum. There arc only two asylums in the Punjab?at Delhi '
(
and at Lahore. The percentage of deaths is considered satisfactory, viz, 9 per cent. Twelve per cent of the daily average strength arc reported cured. Pneumonia was more prevalent, possibly due to the intense cold of the winter. A new asylum at Lahore is in course of construction. Surgeon-General Sibthorpe, in the Madras report, notes a steady rise in the epileptic population of the asylums. Many sanitary
improvements were introduced, as portable pumps for washing out what arc called sewage cysterns '. The dry-earth system is in vogue. The Superintendent recommends the artificial heating of certain rooms, a proposal not often heard in India. Ragi was the staple grain in in the Madras Asylum. For destructive use maniacs, special garments of canvas and drill, not removable by the wearers, were introduced at the Madras Asylum and proved useful. Gardening, weaving, preparation of grain, matmaking, etc., were the chief occupations of the insanes. Amusements were provided, as in Bengal. The health of the inmates was good; tubercle of lungs caused six deaths out of twentysix. Surgeon-General Sibthorpe is not satisfied with the nursing arrangements. He suggests that members of the hospital staff should be '
male and female ward attendants trained in the general hospital for a year, and then transferred to the lunatic asylum for a course of special training in sick-nursing of the insane.
[Oct.,
1949
