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of worms in the intestinal canal. Post mortem examination revealed an anœmic state of
the brain with sub-arachnoid effusion in all. In a few cases atrophy of the brain, heart or
spleen were met with. Of the 15 deaths from cachexia 6 were complicated with tubercular
disease of the lungs or brain, 3 with malarious poisoning, 1 with worms, and 5 with anœmia
without any organic disease of the viscera. Three cases which are returned as meningitis
chronic might with justice be included under the same head.
Seven deaths occurred from diseases of the lungs, or 20 per cent. of the whole.
During the last .25 years the proportion was only 4.3 per cent. Pulmonary diseases
are very common in Dacca, especially in the cold months of the year, and the mortality among
the inmates of the asylum is from this cause always much greater during November and.
December than at any other time of the year. Since 1841 the deaths during these 2
months have been 29.3 per cent. The healthiest month is July, then June, then September.
This shows that the mortality depends much upon the season, and that the hot months in
which there are no great alternations of temperature are most favorable for the health of the
insanes.
Of the 35 deaths, 21 were found, at the post mortem examination, to have disease of
the lungs. In 11 there was tubercular deposit, in 6 pneumonia, in 2 pleurisy, and in 2 small
circumscribed abscesses were found.
Pneumonia, which is now the peculiar disease of Eastern Bengal, was very rare in this
asylum previous to 1853. During 12 years only 1 death occurred from it. From
1853 to the end of 1866 25 fatal cases are returned. This disease appears in an
asthenic form, and often as a complication of fever. It is difficult to explain this increase in
one disease, unless it can be attributed to the foul air the inmates breathe.
From zymotic diseases the mortality was very small. Cholera and small-pox were-
prevalent all round the asylum during several months of the year, but only 2 cases occurred,
1 recovering, 1 dying. Dysentery and diarrhœa, which have caused 40.7 per cent. of the
deaths in the last 25 years, have been becoming year by year less frequent. Between
1841 and 1858, the mortality from dysentery and diarrhœa averaged 18.05 per annum of
the total deaths ; from 1859 to 1866 only 4.76. This striking reduction is to be referred to
the improved sanitary state of the asylum and to the ipecacuanha treatment of those diseases.
Five cases of measles were treated during the year. They occurred at a season
when the disease was epidemic in the neighbouring bazars.
The case returned as acute congestion of the lungs was peculiar. It occurred in a
man aged 74 years, who had been over 18 years in the asylum. He was attacked with
remittent fever in March, and died very suddenly during a remission.
Five deaths, or one-seventh of the whole, were caused by apoplexy : 2 cases occurred in
lunatics who had been under 1 year in confinement, 1 after 4½ years residence, 1 after
8½, and 1 after 34 years. The last was the oldest inmate of the asylum. This was the
third attack he had suffered from.
The high rate of mortality among the inmates of this asylum during the two last years
is due to the frequency of cachexia among them. I can refer this to no other cause than the
bad air which the inmates breathe in the overcrowded wards. During the year the average
superficial space for each individual has been only 32 feet, less than one-third of the space
allowed in native military hospitals. The new ward, which has been building during the past
two years, was completed in November. This provides accommodation for 40 lunatics.