Ranchi Institute of Neuro-Psychiatry and Allied Sciences: A pioneer in the field of psychiatry in India.

Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS; Ranchi Indian Mental Hospital; Ranchi Manasik Aryogyashala) traces its origin from a lunatic asylum for Indian soldiers established at Munghyr in Bihar in 1795 and thus is the first mental hospital in India established by the British purely for Indian patients as well as the second oldest functioning mental hospital in India. The hospital made great strides in improving patients care and using modern methods of assessment and treatment as well as education and research during the tenure of Dr J E Dhunjibhoy the first Indian medical superintendent. As a result the mortality rate was the lowest among the mental hospitals in Indian. There was a shift from custodial care to curative treatment. Since 1930s psychiatric training was given to undergraduate medical students of Patna Medical College and subsequently from Darbhanga and Cuttack. The Institute was affiliated to Universities of London and Edinburgh for Diploma in Psychological Medicine in 1936. The thesis work of the first Indian MD (Psychiatry) was done at this institute. Subsequently many psychiatrists completed their MD (Psychiatry) under the guidance of Dr L.P. Verma at this institute. A number of staff and alumini of the institute held the post of President and office bearers of Indian Psychiatric Society (IPS), starting with Dr J.E. Dhunjibhoy, the first president of the IPS. The Institute declined in the 1980s but after intervention of the Supreme Court it was transformed into an autonomous institute. Under the new dispensation the institution is regaining its vitality. Care and facilities for inpatients has greatly improved. Laboratory and imaging services have been updated. Modern facilities for eye and dental surgery are available. Attendance in outpatient department and especially in satellite clinics is increasing. Postgraduate training in psychiatry, clinical psychology, psychiatric social work and psychiatric nursing has started and research is once again a priority.

INTRODUCTION

The history of Psychiatry in British India is the history of establishment of mental hospitals and then increasing its bed strength from time to time as the exigencies of the time demanded. It is interesting to note that the capacity of a mental hospital was increased just to accommodate the existing population. However, the mental hospital patients kept on increasing. Therefore, by the time the plan was executed, the mental hospital remained as overcrowded as ever.[1] The first mental asylum of India was established in 1745 in Mumbai and the second in 1784 in Kolkata, but no trace of these remain. The third mental asylum established in 1794 at Chennai exists at the same location as Institute of Mental Health, Chennai. In 1795, the Commander in Chief of the Bengal Army requested the Governor-General of India for permission to establish a house at Munghyr, in which mad sepoys could be incarcerated. The Commander mentioned that even at that time, due to lack of facilities, three such soldiers had to be locked up in the guard room at the invalid depot in that garrison. This state of affairs was considered highly undesirable. The Governor-General agreed that this was a good idea and sanctioned a facility for the reception of about twenty patients, which could be expanded further, should there be the demand.[2] As a result, in 1795, a lunatic asylum was established at Munghyr in Bihar, located near the court premises south of the Ganges River. The asylum was shifted to Patna in November 1821 and was located on the outskirts of the town on the lower road (the site is now occupied by the Patna Collegiate School). The name of this institution was changed to Patna Mental Hospital. In 1925, after the patients were transferred to Ranchi IMH at Kanke, this hospital was closed down. Thus, Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS) is the first mental hospital in India established by the British purely for Indian patients as well as the second oldest functioning mental hospital in India.

Construction work for the Ranchi Indian Mental Hospital (IMH) began at Kanke, Ranchi, in 1918. The male wing began functioning on September 4, 1925 with the first batch of 110 patients shifted from Patna. The female wing started functioning on September 19, 1925, with the first batch of 53 patients shifted from Patna. This was followed by a series of patients who came in batches of 100 to 150 from Patna, Berhampore, and Dacca mental hospitals. There were a total of 1226 patients on December 31, 1925 [Table 1].

Table 1

Details of patients transferred to Ranchi Indian Mental Hospital in 1925

The last batch of patients arrived here from Dacca on January 8, 1926 and consisted of 83 patients, of whom 46 were male and 37 were female. The sanctioned accommodation for this hospital was 1286 patients only (1014 were meant for males and 272 for females) but the maximum number of patients resident in the hospital on any one night in 1926 was 1391 (1172 males and 219 females).[3]

Captain (later Col.) J.E. Dhunjibhoy I.M.S. was appointed the first Superintendent of IMH from April 1, 1925. He was entrusted with the job of equipping the hospital and was required to finish the job by the end of August 1925. Dr J.E. Dhunjibhoy was lecturer in Mental Diseases in Patna University. He was a prolific writer, travelled widely and had a large circle of influence.[4] He used to publish nicely detailed annual reports about the hospital and a Triennial report every three years about the condition of the hospital and its activities.[5]

CARE OF PATIENTS

At the time of the relocation of IMH to Kanke, the facilities for the treatment of mentally ill in India were limited and challenging. In fact, Mental Asylums had become synonymous with stigma, isolation, squalor, negligence, and brutality, which were associated with the mentally ill. Col. Berkeley Hill, Superintendent of Ranchi European Hospital, in 1920 persuaded the Government of India that the name of all mental asylums in India should be changed to mental hospitals.[6] Thereafter, the emphasis was on improving the conditions of existing mental health care and treatment facilities. Ranchi European and IMHs became leaders for these positive changes in patient care and treatment, and for the next decades, the Ranchi hospitals became a symbol of excellence in India,[6] having the lowest mortality rate among different mental hospitals in India during 1930–1932 [Table 2].[3]

Table 2

Percentage of deaths in different mental hospitals in India during 1930-1932

As seen earlier, the male section of IMH was overcrowded from the very first year of its existence.[3] Despite this, the IMH was a great advance over the other three mental hospitals (at Patna, Behrampore, and Dacca), which were now abolished, as patients were provided here with far more comforts than elsewhere. The wear and tear of clothes was naturally high. Unlike many other IMHs of that period, at Ranchi IMH all the patients were provided with iron beds, coir mattresses, bed sheets, blankets, and pillows. The patients appreciated the facilities of sleeping on beds so much that they refused to leave them in the morning and the staff had to pull them out of beds.

Every effort was made to improve the physical health of inmates. Good nutritious diet was provided to all patients. Cases refusing food were spoon fed by nurses and attendants. Recourse to artificial feeding was resorted to in cases exhibiting active refusal to food or patients in stupor. Weight charts were maintained, and good environmental sanitation ensured. The death rate in this hospital was among the lowest in IMHs [Table 2].[3]

Occupational therapy was the sheet anchor of treatment in those days. Patients were chiefly employed in gardening, weaving, cane and bamboo work, smithy, carpentry, tailoring, cobbling, mattress and pillow making, lace making, mending clothes, knitting, embroidery work, domestic, and office work, etc. The patient's work was fully utilized toward supplying the needs of the hospital. It has been recorded that Rorschach test was done in 1937. Gradually, more psychological tests were procured, and clinical psychologists were appointed.

There was a shift of approach from custodial care to curative treatment, but the inpatient facilities were being optimized. The medical library was present since beginning, but there was no library for the use of the patients initially. The hospital was equipped with a library for inpatients, with a fund of Rs. 2000. Bengali, Urdu, Oriya, Hindi, and English books written by well-known authors were bought and a library was started. Arrangements for recreation were further enhanced, and one of the wards was temporarily fitted up as a recreation room in the male section. On July 20, 1926, an informal conference for the improvement of hospital was held and proposals were discussed and approved. These included a recreation room, a theater, a music room, and a library. A separate ward was established for hydrotherapy treatment where 12 patients could receive this treatment. Hydrotherapy was the sheet anchor of treatment in most of the excited eases at that point of time. The conference resulted in addition of some buildings and staff and addition of 50 emergency beds in 1929. Thus, the total capacity for accommodation was finalized for 1380 patients.[1]

OPENING OF A PSYCHIATRIC CLINIC AT PATNA

Acting on the suggestion of Dr. Dunjibhoy given in 1936, a one-day clinic per week in Psychiatry was started in the Outpatient Department of Patna Medical College hospital in January, 1939, under the guidance of Dr. S.M. Ghoshal, M.R.C.P. (London).[7] In 1937, Dr Dhunjibhoy also suggested opening of a Psychiatric Ward in Patna Medical College Hospital.

IMPORTANT RESEARCH ACTIVITIES OF HISTORICAL IMPORTANCE (1930–1940)

Dr J.E. Dhunjibhoy was selected to attend as India's delegate the First International Congress on Mental hygiene held at Washington on May 5, 1930. He read a paper entitled Possible objectives of International Mental hygiene. He served as member of the International Governing body of the Society for 10 years [Figure 1].

Figure 1

Mrs Shirin Vacha Dhunjibhoy and Dr. Col. Jal Edulji Dhunjibhoy, I.M.S., Superintendent, Ranchi Indian Mental Hospital 1925-1941

Dr J.E. Dhunjibhoy was a founder member of the International League against Epilepsy in 1935. Dr H.I. Schou in 1936 requested Dr Dhunjibhoy to provide all-India statistics of epileptics treated in separate colonies and in Mental Hospitals for publication in Epilepsia.[8]

Historically, many studies using various treatment strategies (novel and exciting for those days) were conducted at the institute. Various biological agents (some herbal) were experimented and the results were reported.[9101112131415161718] Positive and encouraging results from treatment using hydrotherapy (prolonged bath), bromo-chloral compositus, sulfosin, evipan sodium as hypnotics; benzedrine for mild depression; and sodium dilantin for epilepsy were reported. Organo (glandular) therapy was also practiced. Encouraging results were found for the use of liver and thyroid therapy for anemia and melancholia, respectively. Most importantly, earliest trials on convulsive therapy using cardiazol were conducted in this institute; this form of treatment was successfully tried in as many as 42 patients after Dr. Dhunjibhoy was invited by Dr. Ladislaus Meduna of the Royal Hungarian State Mental Hospital to see this novel treatment of schizophrenia evolved by him in 1935. Partial results were noted with use of sodium luminal (oral or i/m), paraldehyde (i/m), and nitrogen gas inhalation in cases of acute excitement. Trials using snake venom for epilepsy; Rauvolfia serpentina and Basilicum citratum (subji leaf/biswa tulsi) for excitement disappointingly showed negative results.[910111213141516171819]

ASSESSMENT OF THE HOSPITAL

The best way to judge the condition of a hospital is by an outsider. In the case of the IMH, an unbiased assessment is available in the Bhore Committee report. Col. M Taylor, Medical Superintendent, Ranchi European Mental Hospital and Hon. Consultant Psychiatrist, Eastern Command, India, on his tour for the Bhore commission, reported daily average occupancy of 1297.82 patients during 1943–1944. He acknowledged the very high standard of patient care, better than the new Mental Hospital in Bengaluru, especially with regard to the availability of beds, bed linen, and mattress for every patient. Col, Taylor concluded that the management of the patients and the wards was superior to any other hospital he visited on his tour. This was in contrast to “majority of mental hospitals in India (19 mental hospitals with bed strength of 10181) which were quite out of date and are designed for detention in safe custody without regard for curative treatments [Appendix 1].”[20]

ACADEMIC ACTIVITIES

Since the 1930s, students of the Prince of Wales Medical College Patna used to be sent in two batches to this hospital for intensive training in mental disease and demonstration of cases. Postgraduate students of the Departments of Psychology and Philosophy from the Universities of Calcutta and Dacca used to visit this hospital for lectures in mental diseases and demonstration of patients. Undergraduate medical students from Dharbhanga and Cuttack Medical College also underwent intensive training in Psychiatry.

Recognition of the hospital for the postgraduate study by the Universities of London and Edinburgh

The Ranchi IMH was recognized by the universities of London and Edinburgh for practice in Mental Diseases for the purpose of the postgraduate diplomas in Psychological Medicine of London and Edinburgh in 1936.

Dr LP Verma was the first MD (Psychiatry) of India from Patna University in 1943 and his thesis “Observation on the incidence and etiology of Schizophrenia” was done at this institution. [Figure 2] Many eminent psychiatrists have done their postgraduate training in psychiatry from this hospital; the list includes – Dr. K. Bhaskaran (1960), Dr. B. K. Jha (1963), Dr. Sridhar Sharma, Dr. A. B. Khurana, Dr. James T. Anthony, Dr. Md. Nazir (1966), Dr. Brig. S. B. Chatterjee (1970), Dr. Brig. R.N. Bhattacharya (1972), Dr. G. C. Kar (1973) and Dr. S.R.I. Kazmie (1978).

Figure 2

Dr Laxman Prasad Varma, Superintendent, Ranchi Mansik Arogyashala 1957-1973

POSTINDEPENDENCE DEVELOPMENTS

After Independence, this hospital came under the administrative control of the State Government of Bihar. On August 30, 1958, the name of IMH was changed to Ranchi Mansik Arogyashala (RMA). RMA provided inpatient care to patients from the states of Bihar, West Bengal, Orissa, Manipur, Mizoram, and Tripura. The officially sanctioned bed strength was 1620. However, there was perpetual overcrowding with patients usually being more than 2000. In addition to PG training, the training of MBBS students and Psychologists continued along with research activities during the tenure of Dr. L.P Varma [Figure 3].[2122232425262728]

Figure 3

MBBS students of Patna Medical College on completion of Psychiatry attachment at Ranchi Indian Mental hospital with Senior Staff members (first row beginning 3rd from left) Dr. Pyres, Dr L.P. Varma, Dr SA Hasib and Dr. B.K. Ghosh (1956)

ASSOCIATION WITH INDIAN PSYCHIATRIC SOCIETY AND DRAFT OF MENTAL HEALTH ACT

Dr. J.E. Dhunjibhoy was the first president of Indian Psychiatric Society and presided over the first meeting of Indian Psychiatric Society held at Delhi on January 7, 1947.[4] Dr. LP Varma was the editor of Indian Journal of Neurology and Psychiatry from 1951 to 1958. Dr. S. A. Hasib was the General Secretary and Treasurer of Indian Psychiatric Society during 1955–1957. Among the psychiatrists who were trained at this institution, Dr. L.P Varma, Dr K. Bhaskaran, Dr. Sridhar Sharma, Dr Brig. S.B. Chatterjee, Dr. James T. Anthony, and Dr. G.C. Kar have held the prestigious post of the President of Indian Psychiatric Society.

In the Madurai conference held in 1971, Dr. B. K. Jha Psychiatrist of this hospital was nominated as the first convener of the Eastern Zonal branch of the society. The first conference of the Eastern Zone of the Indian Psychiatric Society was held at the Hospital for Mental Diseases, Ranchi on November 28, 1971. Dr. L.P. Varma was the Chairman and Dr. B.K. Jha was the Convenor Secretary of the Reception Committee. Many prominent psychiatrists from Eastern India attended this very first conference [Figures 4 and 5].

Figure 4

First Eastern Zonal Conference, Indian Psychiatric Society, Ranchi, 28th November, 1971. L TO R: Sitting on Ground–Mrs V. Kalla, Mrs. G.Stephan, Mrs. R. Mathews, Mrs.S. Verghese, Umesh Sham, Dr. S M Agrawal, P.K. Singh, A.N Varma, Dr. S.R.P. Shukla, Dr. K. C. Kaushal, Mrs. Alexander Mrs. S.George, Mrs.M. Idiulla, Sitting on Chairs: Dr. B. B. Singh, Dr. D. P. Sen Mazumdar, Dr. Mrs. S. Rae, M. Kumar, Dr. A. Mukherjee (Cal), Dr. N.N. Sinha, Dr. Dutta(cal), Major R.B. Davis, Dr. L.P. Verma (Chairman), Dr. K. Bhaskaran, Dr. U. Nandi(cal), Dr. B.K. Jha(convenor), Dr. A. K. Sikdar. Dr. S. Kumar, Dr. A. K. Singh, Dr. B. Prasad, Dr.S.N. Sarkar, Dr. R.R.P. Sinha, Standing 1st row: Miss. K. susamanma, Miss. T. Marriamma, Dr. M.Dayal, Dr. D’Souza, Miss Hodgeson, Dr.B. Dasgupta, D.K. Kenswar, Dr. D. Bhagat, Dr. S.N. Deb, Major Bhattacharjee, Dr. N. K. Bohra. Dr. S. N Sharma, Divan Chand, V.N. Rao, Dr. S. R. Das, Mr. Hassan, L. M. Hollkar, Miss Rita Prasad, Miss Rita Panday, MissQuisar Jahan, Miss Shuklasree Gupta, Mrs. S. Sengupta, Standing 2nd row: Mrs, R. Sarojani, Miss T. T. Alyammma, Dr. D.K. Ghosh, Dr. R. N. sahay, Dr. R.N. Sahay, Dr. N. Mohanty, R. N. lal, M. N.Holkar, M. R. Chandak, S. K. Das, Dr. I. B. Das, M. N. Jha, Dr. P. R. Purohit, Dr. B. N. Singh, B. Mustafa, Dr. D. K. Srivastva, Standing 3rd row: S.S. Mehta, Dr. M.V. Gevergees, S. N.Sahu, Dr. B.K.R. Nair, Dr. U.K. Nair, C.B.PShrivastva, Dr. K. T. Thomas, Dr.J. Sengupta, K.B. Pramanik, Madan Mohan, Ph.J.M.Sharma, S. I.Ahemad, V. R. kuccha,J prasad, L. A. Kumar, Dr.S.K.Biswas, Standing 4th row : DR. P. K. Sukumaran, P. G. Diwakar, S. K. Jana M.Prasad, T. U.Mazundar, P.P. Solanki, Bijai Kumar, S. P. Chaubey.

Figure 5

Sixth Eastern Zonal Conference of Indian Psychiatric Society held at Ranchi Mansik Arogyashala, 11and 12 Sep 1976.

S.A. Hasib of this hospital along with R.B. Davis, then Medical Superintendent of CIP, and J Roy, from Mental Hospital, Nagpur wrote the first draft of Mental Health Act in 1949 at Ranchi, which subsequently became the Mental Health Act of India (1987).[29]

DECLINE OF THE INSTITUTION

However, since the late seventies of the last century, there was overall decline of RMA in terms of the care of mental patients, teaching, and research. PG course in Psychiatry was discontinued, as one by one, faculty members left the institute [Figure 6]. A PIL was filed in Supreme Court by Mr. Rakesh Chandra Narayan on behalf of mental patients regarding the pathetic condition of inmates of RMA. Ranchi Mansik Arogyashala once upon a time enjoyed an international reputation and patients from outside India used to come for treatment there, but the complaints that the Supreme Court received about the institution were of a serious nature. During the pendency of the matter, the Supreme Court, therefore, gave interim directions for –

Figure 6

Farewell to Dr L.P. Varma, Superintendent, Ranchi Mansik Arogyashala on his retirement 9 March 1973

Increased daily allocation for diet to patients

Supply of pure drinking water to the hospital

Restoration of proper sanitary conditions in the bathrooms and toilets of the hospital

Supply of mattresses and blankets to the patients

Immediate removal of ceiling limit which was in vogue in respect of costs of medicines allowable for each patient and for providing them medicines as prescribed by the doctors irrespective of the costs

Appointing a qualified psychiatrist and a medical superintendent for the hospital.

The Supreme Court, in its order dated September 8, 1994, directed the government of Bihar to notify RMA as autonomous institute. The Hon’ble Supreme Court also framed the RMA rules and constituted Management Committee for administrative and financial management of RMA to avoid red-tapism. The Supreme Court vide its order dated November 11, 1997 entrusted the National Human Rights Commission to monitor and supervise the functioning of RMA. On January 10, 1998, the name of RMA was changed to RINPAS.

TRANSFORMATION OF RANCHI INSTITUTE OF NEURO-PSYCHIATRY AND ALLIED SCIENCES

The Honorable Supreme Court specified the following objectives for the institute:

To provide diagnostic and therapeutic facilities for mental patients

To develop infrastructure for providing social and occupational rehabilitation to mental patients

To provide professional and paraprofessional training in the fields of Psychiatry, Clinical Psychology, Psychiatric Social Work, and Psychiatric Nursing

To extend Mental Health Services at the community level by providing training to medical and paramedical personnel in the field

To conduct research in Behavioral Sciences.

Under the new dispensation of an autonomous institution under the state government, the institution has undergone a rapid transformation. Dr. P.S. Gopinath, on lien from the NIMHANS, was the first Director; followed by Dr. (Maj Gen) K.R Banerjee and Dr. (Brig) P.K. Chakraborty. The bed strength was reduced to 500 and every effort was made to discharge chronic patients. A vigorous and very successful drive was launched to increase outpatient-based services, resulting in increase of outpatient department (OPD) attendance from 20 to 30 patients/day to 200–400 patients/day. Annual OPD attendance in 2008–2009 was 57,154. In addition, monthly outreach camps are run at 4 locations which provided treatment to 29,939 patients in 2008-09. RINPAS's major activity is the care of mentally unwell persons by improving the quality assurance, rehabilitation, community outreach program, teaching, and research activities.[30313233343536] The institute's far-reaching catchment area thus attracts patients in large numbers. With increasing awareness among people about mental illness and the facilities provided in the institute, OPD numbers have increased to 100,262 patients in the year 2015–2016 (i.e., doubled in the last decade), as compared to 76,594 in the year 2010–2011. The institute not only provides OPD treatment but also has indoor facility (with an average bed strength of 622 patients during 2015–2016), with 2430 admissions and 2371 discharges. All OPD patients now receive one month supply of medications free of cost.

Since the year 2000, M Phil and PhD courses in Clinical Psychology and Psychiatric Social work are being conducted. MD and DPM courses started from 2007 and DPN from 2009. In addition, MBBS students from Rajendra Institute of Medical Sciences, Ranchi, and Patliputra Medical College and Hospital, Dhanbad, undergo psychiatry training at this institute. Doctors of Jharkhand State Medical Service, Students of MSc Nursing, BSc Nursing, PCBSc Nursing, GNM, and ANM course from various Nursing training institutions of Jharkhand, Bihar, West Bengal, Chhattisgarh, and Madhya Pradesh undergo Psychiatric orientation training. Students of Clinical Psychology from West Bengal, Bihar, and Uttar Pradesh come for short training course. Postgraduate students of Social work from Maharashtra and Karnataka come here for psychiatric training. RINPAS is recognized by National AIDS Control Organization as a center of excellence for training HIV/AIDS counselors from Jharkhand, Bihar, Orissa, and West Bengal. Multicenter ICMR project on the impact of counseling on HIV-positive cases was undertaken and completed during 2001–2003 [Figure 7].

Figure 7

New Academic and Research Centre, Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Kanke, Ranchi

The institute was running only one satellite clinic at Jonha 15 years back and since August 2003 it has opened up three more satellite clinics at Khunti, Seraikela Kharsawan, and Hazaribagh. The institute sends medical team comprising of psychiatrists, paramedical staff, and students to these outreach community centers at where they are given consultation and free medication for a month. A total of 11,016 male and 8447 female patients were attended in these centers in 2015. Once a fortnight, a psychiatrist visits Birsa Central Jail, Ranchi and Cheshire Home, Ranchi to treat inmates with psychiatric illness. RINPAS is also the nodal center for the functioning of the District Mental Health Programme at Dumka, Daltonganj, Gumla, and Jamshedpur.

CONCLUSION

RINPAS (Indian Mental Hospial, Ranchi Mansik Arogyashala) once upon a time enjoyed international reputation, and patients from outside India used to come for treatment here. Unfortunately, from the heights of glory, it plummeted to the pits of shame. After the intervention of Supreme Court, there has been all round progress to implement the objectives set by the apex court. This is a period of transformation for the Institute. Under the supervision of the National Human Rights Commission, and the support of Union Government, and the Government of Jharkhand, it is hoped that this pioneer institute may regain its former glory and rise to the level of a Center of Excellence in the field of Mental Health.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

In the scattered writings on the history of the lunatic asylums of colonial India, the history of the Indian Mental Hospital at Kanke in Ranchi holds a rather special place, as does its first Medical Superintendent, Jal Dhunjibhoy of the Indian Medical Service. Custom built in the early 20th century, and paid for the Governments of Bengal, Bihar and others; it showed a certain attention to design, rather than the disused barracks, which were the practice often. Explorations using a variety of sources have shown us many things about the life and times of both Dhunjibhoy and the two mental hospitals in Ranchi in the early 20th century. As the historian of psychiatry, Waltraud Ernst points out in her writings, what may surprise the modern day student of psychiatry is the _modern thinking of the colonial time. In fact, the acknowledgment of the reality of distress and the active engagement in attempt to assuage it, which was the hallmark of the philosophy of the time, may offer much to learn for the present day practitioner. So while the terminology of the rights discourse has changed, many of the concerns about providing good care and service reverberate through stories in Kanke in the 1930s. Equally fascinating is the story of how developments in independent India were not so kind to the hospitals in Ranchi, which from a place of preeminence in the mental health landscape, fairly soon fell into disrepair and disrepute, especially this Indian mental hospital. The article does offer a glimpse of these events. Factors such as the varying roles and responsibilities of the center and states (provinces); the paucity of funds at the periphery; the diminution in funds and role as eastern India was partitioned into several smaller states after Independence with an effect on health and welfare services; perhaps all played a role. The effort of the faculty to continue with their efforts to reform and extend the services is described.