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10 cases having been treated, an increase which seemed to arise chiefly among
worn out and debilitated patients, and was attributed to the influx of a consider-
able number of feeble chronic cases at the latter part of last year.
With these exceptions the institution had presented no remarkable degree
of sickness, and when cholera was prevailing in the town its inmates appeared
likely to escape the infliction with the same remarkable immunity they have
enjoyed since the house was opened in 1871.
The first alarm as to the presence of cholera within the asylum was excited by
the sudden illness of one of the inmates on the 18th November. This man was
attacked with vomiting and diarrhœa, and, though his case was not distinctly
marked, the symptoms were considered suspicious ; he was kept in bed, isolated
from the other patients, and his case carefully watched. All the wards were
thoroughly cleansed, washed, and fumigated, and for five days it was hoped that
there would be no other cases.
This hope, however, was extinguished by a re-appearance of the disease in
a male patient in No. 1, a man who could have had no direct communication
with the inmate of No. 4, who was attacked on the 18th. The next days, the
23rd and 24th, four other men were admitted from entirely different cottages;
and on the 26th the breath of the pestilence had spread all over the asylum,
and each day added to the number of its victims and the intensity of its virulence.
Not a single ward escaped, and there seemed no difference in any as to the
nature of the poison or the rapidity of its operation.
It may be somewhat consolatory to observe that only one came from the
men constantly employed, and that, with scarcely an exception, the patients
carried off have been subjects of incurable mental derangement, and in a
majority of instances so demented as to be unable to describe their symptoms,
while many perversely refused alike food and medicine. A few of the fatal cases
appeared suddenly death-struck, without premonitory symptoms of any observable
kind, and sunk in from eight to 12 hours; in others the attack was more pro-
longed, and some survived two or three days.
I have already stated that the majority of the cases of cholera were not
preceded by what are termed premonitory symptoms, that is, the collapse came
on without, or before, or simultaneously with, vomiting and diarrhœa. Out of
31 who suffered from cholera, in 26 it was the primary attack; either the patient
was observed sinking into collapse before he began to vomit or was purged ; or
as soon as attention was drawn to him by the advent of sickness or diarrhœa,
the patient was found to be already in a state of collapse.
Some were not discovered till the door of their ward was opened in the
morning ; no sound of illness or distress had been heard by the night watchmen
or Hospital Assistant, who were specially requested to look out for cases; but at
6 A. M. they were found in livid collapse, having been recently sick and purged.
The instances thus commencing were four in number. All of them had gone
to bed in apparently good health; and as they were all in a state of more or
less advanced collapse when found, and the diarrhœa may be presumed to have
come on contemporaneously with collapse, they were recorded as without pre-
monitory symptoms.
The probability that the attack of diarrhœa and of collapse were simultaneous
is corroborated by the resemblance of others whose cases were under immediate
observation during later periods of the day. In them, unquestionably, and most
probably in the former, there had been no amount of liquid diarrhœa to drain off
the serum from the system before their illness was discovered.
Whether preceded or not by alvine disturbance, the attack of collapse was
rapid. It did not appear a gradual result of disordered bowels, but in many
instances a sudden and fatal accession of fresh illness. It came on at all hours,
but more frequently during the night or in the forenoon.
The total number treated was 31 with 12 deaths, or 38.71 per cent. on the
admission.