10
REPORT ON THE TEZPUJl LUNATIC ASVLUJt.
and it is not improbable that the improved death-rate depended, in part at least, to the
keeping of such cases constantly in hospital under observation.
23. The main causes of disease during the year will be found in the following
table. The actual figures are given, so that it is necessary in drawing comparisons to bear in
mind that the average population was considerably more in 1878 than in 1877, and
slightly more in 1877 than 1876:—
Average population ...
Fevers
Dysentery
Diarrhoea
Other bowel-complaints
Debility ...
Anaemia ...
Lung diseases
Lumbricus
187C. (0 months).
3-1*83
1ST
35-4(5
1878.
40-42
37
9 >21
7)
4
1
1
20
9
2 ^24
3j ■>
7
5
3
31
2 J-28
18 j
2
4
5
7
Fevers were more numerous than in 1877, but they were altogether of a much
milder and more tractable type, and occurred at times when mild forms of malarious fever
were far more common by comparison amongst the general population. Dysentery and
diarrhoea were less common than in the previous years, and very mild and easily treated,
and in only one instance proved fatal. Of other diseases of bowels there were 18 cases,
and these were either constipation or slight disorder of the digestion, shown by loss of
appetite and disordered conditions of the bowels not amounting to diarrhoea.
24. The number of cases of lumbricus treated as such was the outcome of the
extreme care devoted to their detection in the excreta noted before, and there is no means
of comparing the frequency of the occurrence of this with former years, for in 1876 and
1877 those cases that were treated occurred in patients admitted into hospital for other
diseases.
Whilst admitting the importance of the influence exerted by these parasites on the
constitution when otherwise unsound, I do not see my way to accepting that view which
considers them as the chief or only cause of that form of diarrhoea which has proved and
may prove so fatal in Lunatic Asylums and analogous institutions.
The occurrence of lumbricus is so common, and these worms are met so often in
bodies which have died from other diseases than those of the bowels, that I cannot help
considering their malignant influence as secondary. It is my habit to make post mortem
examinations of nearly all the bodies which die in the dispensary or jail, and, whatever the
causes of death may have been, in but comparatively few are lumbrici found absent. It
seems to me that, just as lumbricus has been assigned as the cause of cholera, because in
epidemics of that disease in districts where these parasites are common, lumbrici have
been passed by mouth and rectum in nearly every case, so we might talk of hepatitis,
nephritis, and pneumonia as dependent on the parasites, because they happen to be found
in the intestines of those who die of these diseases.
25. The mortality shows in most favourable contrast to that of the two former
years, for, whilst in 1876 and 1877 it amounted respectively to 34 and 36 per cent.,
in the year under review it reached only 4*94 per cent.
In my last report I called attention to the fact that of the total mortality 12 were
admissions of 1876, and only 1 of 1877, and a shniliar observation has to be made on
the mortality of this year, viz., that both were admissions of 1876. I also then stated that
the condition of the patients at the commencement of 1877 was generally unsatisfactory,
and that anaemia was prevalent.
One of the fatal cases, though in good health on admission in 1876, I found anaemic
in March, 1877. In April, he managed to escape, and, after being absent two months, was
brought back in such a state of emaciation and debility, that it was a wonder that he
retained life so long as he did. He died from consumption.
The second case, admitted in good health, had suffered considerably during her
residence in the Asylum from fever, congestion of liver, diarrhoea, lumbrici, &c. Her last
illness commenced with intermittent fever, but subsecpiently the diagnosis was changed into
hepatitis. Shu never developed any symptoms of dropsy, but sank gradually and died.
Post mortem examination showed a thick layer of fat over the body, the heart loaded
with fat, and of pale colour and flabby, the lungs healthy, a fatty liver, contracted kidneys,
and small ovarian cysts. Though she had passed a large number of lumbrici during the
whole period of residence from time to time, and finally, within a few days of death, the
stomach and intestines were found absolutely free from all signs of disease.
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