STATISTICAL RETURNS OF THE LUNATIC ASYLUMS.                             33

seven for diarrhœa. In the Tezpur asylum, dysentery is said to have been pre-
valent in the same year, although it only accounted for four deaths. In Rangoon,
dysentery and diarrhœa are said to have been epidemic, and in the Singapore
lunatic asylum, dysentery accounted for 22 out of the 64 deaths, or over 34. per
cent. of the total mortality. In the Madras asylum, dysentery has been present in
every year, since the present site was occupied in 1871, with the solitary exception
of the year 1901, when no case was recorded. The greatest number of admissions
recorded in one year was 63 in 1891.

The questions which obviously arise are :—

I.  Is asylum dysentery in India, identical with the bacillary dysentery of the
English asylums, and if the diseases are not identical, in what does the difference
consist ?

II.  By what measures may we hope permanently to eradicate the disease
from the Indian and English asylums ?

III. What is the best treatment for the individual cases of the disease, in
India and in England, with which we are acquainted ?

In endeavouring to discover answers to the above questions, a brief analysis
of the dysentery cases which have occurred in the Madras asylum for the past
three and a half years may be of some use. But as the investigations have as
yet scarcely progressed beyond the initial stage in some of the most important
aspects of the disease, any conclusions embodied in these notes can only be
regarded as provisional, and liable to modification with further experience.

                                 THE MADRAS CASES.

The incidence rate of dysentery in an asylum may be calculated in two ways.
The number of attacks of dysentery in a year may be shown as a percentage on
the daily average number resident for that year. This is the method employed by
Dr. Sidney Coupland.

According to this method, as there were 197 attacks of dysentery in the
Madras asylum during the 44 months under review, the yearly rate of dysentery
incidence works out at approximately 9.5 per cent. of the daily average number
of patients resident—a high incidence rate assuredly, but actually lower than
that which obtained in several English asylums, amongst others, in Cardiff and
Hellingly asylums in 1911, although both these British asylums were built and
opened within the past twelve years.

Another method of estimating the prevalence of dysentery in an asylum for a
period of years, is to express the total number of patients attacked as a ratio of
the total number of patients who came under treatment during that time.

According to this method, as 146 patients were attacked in Madras, and as
1,205 patients came under treatment during the 44 months in question, the
proportion of the patients attacked to the patients treated during that period
works out at 12.11 per cent.

Of these 146 individuals, 29 eventually died of the disease—a mortality of
19.8 per cent.

Of the individuals affected, one had six distinct attacks, five were attacked
four times, five had three attacks, twenty-one had two attacks, and 115 were only
attacked once. The stay in hospital varied within wide limits according to
whether the disease was acute or chronic in type. The longest stay of any patient
in hospital was 128 days, and the shortest one day; the average time which elapsed
before the patient was discharged from hospital as cured being about 40 days, but
for a considerable part of this period, all symptoms of dysentery would have
disappeared—the patients receiving hospital diet for the purpose of rehabilitating
their strength and picking up their weight. The stools were examined micros-
copically in every case, and in the case of 86 patients, plate cultures were made, and
the plates were incubated and the growths investigated at the King Institute of
Preventive Medicine, Guindy, by Assistant Surgeon M. Kesava Poi, M.B., who also
prepared the autogenous and polyvalent vaccines used in the treatment of the
cases, and in the prophylactic inoculation of the patients, and is at present
engaged in the investigation of the agglutination reactions, the toxicity, etc., of