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and delusional insanity among the women as well as among the men, the effect of alcohol as a causative factor. Altogether the misuse and abuse of alcohol may be consi- dered the principal, and perhaps the leading, factor in the production of mental derange- ments, especially among the outlanders in this Colony. The type of disease produced varies from cases of delirium tremens too severe to be fit for treatment in the wards of a general hospital, to typical cases of alcoholic insanity. It will be noticed that England, Scotland and China contribute each a fifth of the cases, and Ireland and India abont a tenth. The reason for this excessive indulgence in alcohol which so often leads to such disastrous results in persons of unstable mental equilibrium is perhaps not very difficult to seek for it is an undisputed fact that the abuse of alcohol is common in this Colouy especially among the wage-earning classes and a certain section of sea-faring folk. I may mention incidentally that I have seen more cases of alcoholic insanity and more cases of excessive alcoholic indulgence during my short period of service in this Colony than I have seen in a longer period of service in another Colony. The reason then most generally assigned is that the climate here is enervating and that in consequence the system requires bracing up. This idea combined with the well-known camaraderie among a set of men earning a precarious livelihood, often out of work, always isolated and bereft of home ties, must lead to excessive alcoholic indulgence and this in its turn surely leads to mental derangement. It cannot be too strongly insisted upon that if the climate is bad the means adopted to counteract its effects are worse and but angment its injurious effects, if any. Total abstainers and mode- rate drinkers, that is, those that drink with discretion, come off best.
DEATHS.
These amounted to 7-of whom 6 were males and one female, giving a percentage on cases treated among the males just under 4 per cent, and among the women just over 2 per cent.
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The immediate cause of death was as follows. Two males succumbed to exhaustion supervening on chronic mania. The patient who suffered from melancholia attempted suicide before she was admitted into the Asylum by inflicting wounds on her neck with a pair of scissors. These wounds apparently superficial set up extensive and deep sented cellulitis which proved fatal. One male suffering from dementia died of acute pleuritis, and one suffering from idiocy contracted pulmonary tuberculosis prior to admission which carried him off. One patient suffering from acute alcoholism suddenly and without warning developed extravasation of urine. He made no previous complaint nor were we led to suspect that such a condition might supervene. He succumbed in spite of the most active treatment. One male patient under observation with reference to his mental condition was suffering from pericarditis which proved fatal.
OCCUPATION OF PATIENTS.
The occupation of those under treatment during the year is stated in Table III as far as ascertainable.
It is a great pity that the patients, both Europeans and Chinese, display a strong disinclination to work or to keep themselves occupied in some way that would distract their thoughts and take them out of themselves. Work and occupation as a means of treatment are well recognised in all English Asylums and have been found effective in ameliorating the mental condition of such as are able to undertake the one or the other. Our resources in this respect are limited, but we find European patients are particularly intractable. It is all we can do to induce the native patients to undertake a little gardening from time to time.
BUILDINGS.
New water-closets were put in both Asylums.
New hardwood flooring was put down in Receiving Room and Wardmaster's Quarters.
STAFF.
I took over charge on June 16th, 1905, vice Dr. LAING.
Wardmaster MCKAY was sent from Kennedy Town Hospital in June and was trans- ferred to the Harbour Department in December.
Several minor changes occurred among the junior staff.
W. V. M. Kocu, M.D.