LUNATIC ASYLUMS IN BENGAL.                           7

mortality are instructively exhibited, in comparison with the results of the decennium
1863—72, in the following statement. The classification employed is a special one:—

Comparison with
previous years.

                                             STATEMENT No. 7.

Peculiarities of
1874.

The chief peculiarities of 1874 were, therefore, an excess of dysentery and lung
diseases. I shall offer a few remarks on each of the classes above specified :—

Mortality from
bowel complaints.

(1) Bowel complaints have always constituted the main cause of death in asylums; but
on looking into the statistics of other institutions in India, I find that this circumstance is
by no means peculiar to hospitals for the insane. I have compiled the following statement
from data in my office. It exhibits the percentage which dysentery and diarrhœa constitute
of total deaths in the institutions specified. The figures are for the year 1873 :—

Comparison with
other institutions.

                                             STATEMENT No. 8.

Faulty
conservancy.

Treatment of
dysentery by
ipecacuanha.

Necessity of
improving the
hygiene of asylums.

From this table it appears that asylum mortality from bowel complaints exceeds that
of the native army and Calcutta hospitals, but is less than that of provincial hospitals and jail
hospitals in Bengal. The large share which these two diseases constitute of asylum death-causes
is therefore not a subject of surprise or wonder. These diseases (more especially dysentery) are
often attributed to faulty conservancy or some defect in general hygiene ; but I am inclined
to think that they are, in cases which occur in hospitals and asylums, mere modes of death
among a class of worn, wasted human beings in whom little life is left. It would be interest-
ing to learn from superintendents what proportion of these cases die soon after admis-
sion. It is also necessary to remember that in the use of large doses of ipecacuanha we
have acquired a new power over dysentery. It is consequently disheartening to find
that the proportion of fatal cases is increasing. I doubt very much, however, whether
ipecacuanha, marvellously potent in the acute dysentery of strong subjects, is of any avail in
the fatal fluxes of moribunds. I suspect, though I have no very demonstrative data to prove
it, that an excess of fatal bowel complaints will be found to depend rather on an unhealthy
year and a low hygienic state of the community, than on any defect in sanitation in the
institution where the deaths occur. Still, with so large a number of fatal cases of dysentery and
diarrhœa, it is imperatively necessary to place the hygiene of these on the best possible
footing, and, at the least, to remove known insanitary conditions, such as overcrowding. As
regard individual asylums, the deaths from bowel complaints were principally confined to
the three larger asylums, none showing a striking disproportion to population. Cuttack
had no deaths under either disease ; but the six deaths which took place at Berhampore
were all due to dysentery.

Mortality from
cachectic
conditions.

(2) Under the term cachectic conditions I have included all the terms indicative of
general constitutional fault or infirmity—debility, anæmia, &c.,—and I might have enlarged
it by including terms indicative of the change or degeneracy of structure which constitutional
defect is apt to cause. As regards this class of causes, 1874 shows well; but I suspect
that the cause of this consists in the recent employment of a more exact nomenclature
and greater care in investigating the material or organic causes of deaths. Diseases
of this class do not as a rule originate in asylums, but stretch far into the previous life of
individuals. They do not enter into the category of preventable causes of asylum
mortality, and they aid in constituting the large number of inevitable deaths which
must always be looked for among the insane.

Mortality from
brain diseases.

(3) Deaths from brain diseases generally arise from states of the nervous system on
which the brain disorder depends. They must always be more numerous among insane than