10                       ANNUAL REPORT ON LUNATIC ASYLUMS.

not included in the average daily sick rate, but their condition necessitated a
liberal diet on preventive principles.

A proper record of the convalescents, or, as they were formerly called " weakly
gang," waas not kept up in former years, but there is no doubt that the average
daily strength of this class for 1891, viz., 63, is far higher than in previous years.

This class of inmates, when suffering from any specific complaint and under
observation for 36 hours, were entered in the returns as hospital admissions, but
by far the largest number were those, merely in bad health, who were dieted and
had special attention paid to them generally. If all this class of persons were
admitted into hospital, the accommodation would have to be increased enormously :
this is not necessary as the asylum is practically a hospital.

With the object of showing fluctuations in diet from this cause, I have directed
a register to be kept up of all those not alone on the convalescent gang, but all
others who may receive from any cause an excess of the sanctioned scale. In
this matter of dieting sickly lunatics, particularly in unhealthy years, much latitude
must, I think, be allowed to the Superintendent. Dr. Dobie remarks when called
on for explanation on this point that " the giving of extras is a necessity in all
asylums where lunatics are treated as patients and not as criminals." He further
quotes his recent observations in English asylums; he says, " I found the pauper
inmates of the Hampshire County Asylum better fed than the majority of paying
patients at a large private institution."

As I quote Dr. Dobie in several places, I may here remark that he has made
this branch of medicine a special study and has more experience of lunatics and
lunatic asylums than any other officer of the department.

It was, however, observed by Government in reviewing last year's report that
in other provinces economy has been secured without any ill-effect on the health of
the patients and supported this statement by a comparison made of the death-rate
and cost per head of diet in the Madras asylums with those in other Presidencies,
but with due deference I do not think it possible to draw any conclusions from
such a comparison. I have found it impossible to draw any deductions from a
comparison of the diet scales of one Presidency and another ; the bases of the diet
and the price of grain are so dissimilar that it is very nearly as difficult to draw a
comparison between the cost of feeding an insane in the Punjab and Madras as
between the Punjab and England. The same remark holds true of the death-rate.
The circumstances of climate under which the insanes are placed are different; they
are differently affected by diseases and their temperaments practically differ.

Dr. Dobie in this connection reports from his personal experience that in the
late campaign at Suakim he found the Punjabees living on a diet which was so
insufficient for the Madras troops and followers that the latter had to be given a
meat ration in order to combat disease against which he had warned the authori-
ties three months before it broke out.

The above remarks fully explain the cause of the increase under dieting, and,
at the same time, throw some further light on the general subject of dieting
lunatics in this Presidency.

According to the diet sanctioned in G.O., No. 1307, of 30th July 1889, the
cost of a European diet, according to current market rates, amounts to 4 annas
3 pies, that of a native 2 annas 8 pies ; this is exclusive of all extras. The annual
cost of an insane during 1891, including Europeans and natives and extra diets, is
Rs. 72-9-9 or 3 annas 2 pies per diet; from this it will be seen that the cost of
dieting is not excessive.

The present scale cannot be considered at all too liberal, and I am of opinion
that no reduction can be made in it. It must be kept in view that the most import-
ant factor in the treatment of insanes is a wholesome and liberal diet to make up
for the great nervous and general waste of tissue that occurs in their cases, and this
apart from the generally bad condition they are in, on arrival, at the asylum.

In last year's review the cost of feeding an insane in Bengal was Rs. 35-13-0,
that is, 1 anna 7 pies per diet. I am sure Government will see that it would be im-
possible to feed insanes of this Presidency on this sum, and it is not to be forgotten
that the Madras rate includes Europeans.