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He scarcely raised his feet, and had just enough sensation in his feet to know
that they touched the ground. He maintained the power of discrimination in
regard to hot substances; he could feel a hot spoon, though the usual delay in the
appreciation of the warmth after the touch (which such cases always more or
less exhibit) was characteristically marked.
After about three months' detention the sensation of the face became impaired
and the sensibility of the fauces too was so much diminished that food collected
in his mouth, and he was not aware that it was there; the sense of taste was also
vitiated, if not lost, the patient complaining that he could not distinguish one
diet from another ; saliva would flow over his lips and at the angles of his mouth;
he had cramps of the legs, ptosis of the right eye, and amblyopia. From this
period the disease showed very markedly its characteristic progressiveness, and the
patient took to his bed permanently. He, however, occasionally got up on the side
of the bed, but when he tried to walk his feet swung about without control when-
ever he tried to advance one or other of them, and when the feet touched the
ground he was not now conscious of the fact. On the 19th November he had
several abscesses in the left thigh and sloughing of both gluteal regions, he even-
tually got several epileptiform seizures followed by paralysis of the mouth, lips,
tongue, and pharynx, owing to which he was quite unable to take his food; he
then became insane, talked or made a sound incoherently for hours together.
On several occasions the bladder had to be emptied with the catheter, and to-
wards the close of his life his urine and fæces were constantly passed involuntarily
and unconsciously. On the 7th February symptoms of carbuncle at the back of
neck manifested themselves, going on through the usual course. He eventually
became comatose, and so died on the 19th March 1884. It was a matter of great
regret to me that I was not allowed to examine the brain and cord; the friends
of the patient objected to a post-mortem examination being made. The special
feature in the case was the absence of insanity until very late during the progress
of the malady.
The mortality as calculated on the daily average strength was 12.7, or 6.35
per cent. more than in 1883, and 3.5 higher than the average of the last ten years;
it is therefore (apparently only) the most unhealthy of the series excepting
1881. Fluctuations of this kind will necessarily occur in all establishments
for the insane, and in the experience of this asylum a year of excessive mortality
has usually been compensated by a succeeding year in which the deaths have
been few.
The majority of those who died had been for years in bad health, kept alive
by nourishing food and careful nursing, so that their deaths were expected; the
greater number of these having succumbed this year we may look for less mor-
tality in 1885.
Of the total of 23 deaths one was admitted in a moribund state and death
occurred three days afterwards. Steers was incurably ill with progressive paralysis
when admitted. A man named Nga Su had a complication of disorders when
received, and died 25 days after admission. Another, a Chinaman named Lun Khay,
was affected with paralysis, dropsy, and chronic lung affection when admitted, and
died a month after admission. Bangyo, a general favourite with all in the asylum
and one of the first admitted into it in June 1871, may be said to have died of old
age; he had been in bad health for years. Nga Myat Hman, who had unusually
severe epilepsy, died in one of the fits, and was not a patient in hospital at the time
of his death. Old Maung Tuk, entered in the register as 70, must have been con-
siderably over 80 years of age; and a man named Jagean showed greater age
than that recorded in the register, namely, 65, so that after analysis it will be
found that the mortality is very nearly about what it should be, namely, 8.2 per
cent. The mortality was due to the following diseases : paralysis one, diarrhœa
three, epilepsy one, general debility nine, dysentery two, erysipelas of scalp one,
carbuncle one, small-pox one, fever (intermittent) three, ulceration of œsophagus
one. Three cases of small-pox were admitted with one death; these cases were
all vaccinated, but it must be remembered that the virus does not get fair play
when used on the insane, the patients invariably rub it away, and if any inflam-
matory action sets in, the vesicle is not allowed to form, so that it is really im-
possible to say whether or not it is characteristic of the true virus and the patient
properly protected.