Medical report / Federated Malay States.

  • Federated Malay States. Medical Department.
Date:
[1914]
Catalogue details

Licence: Public Domain Mark

Credit: Medical report / Federated Malay States. Source: Wellcome Collection.

    6/34 (page 6)
    While on the subject of discharges I should like to allude to the assistance given to discharged patients by the “ After-care Association,” which is composed of leading men of each nationality, from which our patients are drawn. This association, under the Chairmanship of the Protector of Chinese, Ipoh, helps discharged patients, who have no friends, or no work to go back to, to find work on leaving the asylum. It has done very good work during 1914, and I hope in the future to be able to arrange for branches in the other States. We have found employment as grass cutters, etc., for six discharged patients, and at present four are employed here. The only difficulty in employing ex-patients is that it is not advisable to employ them in the wards, and outside the wards there are few appointments. Absconding.—The number of patients absconding is extremely high, I regret to say, but this can be, to a large extent, attributed to the fact that during the whole year building has been proceeding which necessitates openings in the fences, and the continual passing backwards and forwards of tukans and bullock-carts ; so that the opportunities for escape were numerous. In a few cases, however, the escapes were directly due to carelessness on the part of attendants, necessitating in some cases dismissal. There were no escapes from the farms. The two escapes amongst the criminals are a mystery, which, though enquired into both by myself and the police, have never been cleared up. It is to be hoped when the additions to the Institution have been completed that this high rate will cease, but until then I cannot hold out much hope of improvement in this direction. Deaths.—The total deaths numbered 85, two of these being criminals. The deaths amongst the males, excluding criminals, 72, and females 11. The death-rate was 9.22 per cent. The commonest causes were as follows: dysentery, phthisis, general paralysis of the insane. Dysentery (30 deaths) was extremely prevalent, in fact too prevalent, and, in spite of all efforts, is still present. It was principally, in fact almost wholly, on the male side. The difficulties were largely increased by the number of patients admitted suffering from this disease. I have now, after making necessary repairs, begun to send all cases of dysentery to the Infectious Disease Ward, thus completely isolating them. It is too early to say what effect this will have, as it was not until December that I was able to make these arrangements. Phthisis was the next most common cause, accounting for 15 deaths. This is wdiat one would naturally expect, as asylum patients are very prone to develop phthisis. General paralysis of the insane takes third place, appearing nine times. There can be no doubt now as to the presence of this disease in this country. Several cases were admitted in an extremely bad state, and four died within a week of admission. Fatal accidents.—There were two deaths from ruptured spleen, and I believe I can fairly describe them as accidents. In one case a patient was extremely excited, dancing, shouting, and gesticulating as he commonly did. He suddenly fell, and on the attendant reaching him, was collapsed. He died within a few minutes, and the post-mortem showed a large rent in a greatly enlarged spleen. The evidence in this case is quite clear, and convincing that there was no blow struck by any one. What probably happened is that the man slipped, and fell, and in his fall struck the edge of his bed. The other case was that of a patient who snatched some tobacco from another patient, and ran away. The owner of the tobacco followed the thief and struck him. Result: collapse—death—post-mortem, a very large spleen ruptured. In neither case could any blame attach to the attendants, as an excited patient may slip and fall at any time, and accident of an enlarged spleen could not be prevented. In the other case quarrels between patients arise with the utmost suddenness, and are comparatively common, and their prevention in many cases is absolutely impossible. So that one lias only to be thankful that ruptured spleens are not more common. Post-mortem.—Post-mortem examinations were made in the case of 70 deaths. Of the remaining 15, nine were Muhammadans, in the case of the other six the friends refused permission for post-mortem. Suicide.—I am happy to say there have been no suicide during the year, though there have been many attempts. This, I believe, points to the fact that the attendants are paying more attention to their duty. Though sleeping on night duty is still too common, in spite of the fact that this offence is invariably visited with punishment, and if frequently repeated leads to dismissal. Transfers.—There was only one transfer—i.e., a man to the Leper Asylum.