APPENDIX.

                        CIRCULAR MEMORANDUM No. 105.

                                                                                                                                FORT WILLIAM :
                                                                                                                                OFFICE OF INSPR. GENL. OF HOSPITALS,
                                                                                                                                INDIAN MEDICAL DEPARTMENT;
                                                                                                                                The 26th December 1871.

THE Inspector General of Hospitals observes that some diversity exists in the forms of Statistical Returns
of Lunatic Asylums. As it is essential, for purposes of comparison and compilation, that these forms shall be
uniform, the following illustrations of those which should be invariably appended to the Annual Report have
been prepared. Forms of Registers are also laid down, on which it is believed that the facts required for the
preparation of the returns may be conveniently noted. While the forms of returns now prescribed should be
accurately adopted, it is not intended to prevent Superintendents from preparing and adopting other and
additional forms of returns which they may wish to exhibit for the purpose of proving or illustrating
particular points.

The data necessary for preparing all these Statements for 1871 may not be available ; but as many as
can be compiled from recorded facts should be given; and when any form is submitted blank, a note should
be made of the cause.

The Registers and Forms now required are as follows:—

                                                               A.—Forms of Registers.

                                                                           No. 1.

          General Register of Lunatics confined in the                                 Asylum during the year 18

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Number.

Glass—Criminal or Non-Crimi-
nal.

Name.

Age.

Occupation.

Religion, and Cast, if Hindoo.

Domestic condition, (married
or single, &c.)

Residence, Pergunnah, Village
and Zillah.

From whence received.

Mental disease, and its duration
prior to admission.

Cause.

Cerebro-spinal complication
(Epilepsy, Paralysis, &c.)

Bodily condition, and disease,
if any.

DATE OF

REMARKS.
Page in Diary or Case Book.

Admission.

DISCHARGED

Death.

Cured.

Transferred
to friends.

Otherwise*

Improved.

Not Im-
proved.

                                                                                                    * To be invariably noticed in the Remarks.

A separate register should be kept for males and females.

                                                                                     No. 2.

     Register of Criminal Lunatics confined in the                                            Asylum for the year 18

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Serial Number.

Number on General Register.

Crime—charged or established.

SENTENCE.

DATE OF

REMARKS.

Date.

Nature.

Period.

Remand to Jail on cure.

Transfer to Non-Criminal
Class.

Discharge from Asylum
when not remanded.

Discharge from Asylum to
stand trial.

Death.

Years.

Mouths.

Days.

A separate register should be kept for males and females.