18                                  REPORT ON THE RANGOON LUNATIC ASYLUM FOR THE YEAR 1893.

         Of the 69 admissions the cause was ascertained in only 31 instances. The
most instructive feature in this relationship is that among the cases wherein the
cause was discovered " drink " was responsible for no less than 35.5 per cent. of
the admissions and that insanity having its origin in the abuse of opium was
conspicuous by its absence.

         Statement VIII, showing the return of sick in the hospital of the Lunatic
Asylum, Rangoon, for the year 1893.—The admissions to hospital during the past
year have been more numerous by far than during any previous year; and this
circumstance, taken in association with a heavy death-roll, affords strong testi-
mony to the high prevalence of disease.

         Considered by itself, however, the number of lunatics admitted into hospital
during the past year does not furnish a very safe guide to the state of the general
health, for in the period in question the Superintendentship of the Asylum changed
hands three times, and it is highly improbable that the various incumbents of the
office held precisely identical views on the nature or degree of illness for which
admission to hospital was necessary.

         Thus during the first six months of the year there were 75 admissions with
26 deaths, whereas during the last six the numbers were 104 admissions and 17
deaths.

         The following table shows the admissions to the hospital and deaths during
the past three years :—

         I should not be disposed to attach more than a relative value to the number
of admissions, even if the Superintendentship of the Asylum had remained in the
same hands throughout the period the figures embrace. Seeing that the Deputy-
ship of the Asylum underwent one change in 1892 and three changes in 1893,
the figures are, in my opinion, valueless.

         I do not think the hospital return of sick calls for any further remarks, unless
it be to state, in explanation of the fact that none but fatal cases of phthisis came
under treatment, that among the insane the symptoms of phthisis are often absent
and the disease thereby rendered impossible of detection.

         Mortality.—The mortality among the Asylum inmates during the year of
report has been exceptionally heavy. Although for some years past the death-
rate has been unusually high, the mean annual mortality has never been so largely
exceeded. The mortality for 1893 is the highest on record in the annals of
the institution. There were 43 deaths among a daily average population number-
ing 255 persons or 16.8 per cent. of strength.

         If the registration of deaths among the general population were perfect, it
would be interesting to contrast the mortality in the Asylum with the death-rate
which prevails outside.

         An accurate and useful comparison can, however, be made with the mortality
among the prisoners in the Rangoon Jail who live under conditions very similar
to the inmates of the Asylum.

         The percentage of deaths in the jail during the past year was 2.5. In the
Asylum, as I have stated, it was 16.8. For the decade 1883-92 the jail mortality
was 3.5 of mean daily strength, while the Asylum mortality was 10.

         In a paper read before the Royal Statistical Society in February 1890 by
Mr. Noel Humphreys it was stated that between the ages of 20 and 40 years
the mortality among insane persons was six times greater than among the gene-
ral population, and among insanes over 40 years of age nearly three times greater.