DACCA LUNATIC ASYLUM.                                     41

Hereditary predis-
position.

Hereditary predisposition is said to have been the cause of insanity in 12 cases, 9 males
and 3 females, or 1 in 24. The insanity was—

Immediate cause.

The immediate cause in one case was loss of husband, in a second desertion of wife, and
in a third loss of family talook. In a fourth instance the madness was referred by the natives
to a bite inflicted by an insane elder brother.

Return of sick.

Prevalent diseases.

Table No. 14 is the annual return of sick patients treated in hospital during the year.
As already mentioned, the figures include all those borne in the " convalescent roll " together
with the really sick. The former are classified under " debility." The diseases in order of
frequency treated during the year were intermittent fever, dysentery, diarrhœa, and anæmia.
A sick lunatic as a rule has a combination of ailments. There is first of all the mental disease,
which predisposes to many disorders of innervation and nutrition, and there is the climate
causing fevers, chronic spleen, and liver disease.

Anæmia, diarrhœa,
dysentery, and
pneumoni .

Anæmia is one of the most common symptoms of failing health, and loss of appetite,
emaciation, and diarrhœa, quickly follow. During the rainy season the diarrhœa becomes
dysentery with rapid ulceration of the bowels. During the cold season pneumonia complicates
and aggravates the danger of all protracted illnesses.

"Cachexia."

Vague ness of the
term.

* Vide General Statement No. 8.

In former years " cachexia" was generally applied to the combination of asthenic
diseases of which the majority died. This term, though it accurately depicts the general
deterioration of system, and combination of diseased actions so general in asylum hospitals,
is indefinite. It has therefore become the practice to take the most prominent disease on
admission into hospital and enter it in the monthly register. In the course of the illness
other diseases may spring up, and the one under which the patient was admitted is probably
not the one of which he ultimately dies. This practice simplifies the returns, but unless
understood, it vitiates the comparison between one asylum and another. In register No. 4,
instead of filling up column 8, the condition of the organs after death, under the heading

" remarks," shows the actual disease of which the person
died. Table No. 11* only shows the fatal disease, while
the present table shows the disease for which he was admitted into hospital.

Dysentery.

Abscess of the
liver.

Dysentery is the most intractable disease treated in the asylum. Ulceration is
generally found at the lower end of the great bowel; the glandular structures are as a rule
atrophied, and the ulcers for the most part are without vitality and are mere sloughing sores.
In a few cases only is thickening of the walls of the bowel found. When this occurs, the
ulcers are healthier and more disposed to heal. Abscess of the liver is very rare as a conse-
quence of dysentery among lunatics. Now and then when the patient has died of dysentery
no ulceration at all is found, but merely a congested state of the mucous membrane.

Scurvy.

Scurvy is rarely found in the asylum, except among new admissions.

Prevalence of dy-
sentery.

Causation ?

Importance of
milk.

The number of patients admitted with dysentery was 66, and this, with five remaining at
the beginning of the year, makes up 71 treated, or 1 in 4 of the total number resident. I
have paid particular attention during the year to the diet, clothing, and drinking water
supplied to the inmates, in the hope of ascertaining whether the disease was owing to any
deficiency or scarcity of any of these. My observations have not as yet proved that the
prevalence of bowel complaints is due to any of these causes. The use of animal food by
persons who never taste it at their own homes may be injurious, but I cannot say that I have
traced any greater prevalence of bowel complaints among the Hindoo than among the
Mahomedan population. The type of dysentery prevalent is that which some writers refer
to malarious influence, and which is not benefited by ipecacuanha. It generally begins with
diarrhœa of the congestive or inflammatory form, attended by loss of appetite, thirst and
rapid emaciation. Food is unpalatable, and when it is forced upon the patient, it excites
vomiting or purging. The action of the medicines in such cases is uncertain. Good milk diet

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