( 4 )
the general deterioration of the system and combination of diseased actions
so general in new admissions into the jails and hospitals of this province, is
indefinite. It has therefore become the practice to take the most prominent
disease on admission into hospital and enter it in the nominal register of sick.
In the course of the illness other diseases may spring up and the one under which
the patient was admitted is probably not the one of which he ultimately dies.
This practice simplifies there turns ; but, unless understood, it vitiates the com-
parison between one set of statistics and another.
Dysentery is the most intractable disease treated in the Asylum. Ulcer-
ation is generally found at the descending colon and sigmoid flexure; the glan-
dular structures are as a rule atrophied, and the ulcers seemed to be for the most
part without vitality and are mere sloughing sores. In a few cases only is
thickening of the walls found. Abscess of the liver is very rare as a consequence
of dysentery amongst insanes here ; occasionally nothing is found but a trans-
verse streak of vascularity.
Scurvy is rarely found in the Asylum, but it is frequently discovered in new
admissions.
The number of patients admitted with dysentery was 13 and more than half
of them died, or 53.85 per cent.
I have paid particular attention during the year to the diet, and especially
to the clothing supplied to the inmates, in the hopes of ascertaining whether the
disease was owing to any deficiency or scarcity of any of these. My observations
have not as yet proved that the prevalence of bowel-complaints is due to any of
these causes. Believing the fall in temperature at the beginning of the rains and
at the close of the year had something to do with the prevalence of this disease,
as a precautionary measure the whole of the Asylum inmates were clothed in
flannel, and it is certain that none of them suffered from the cold; notwithstand-
ing the mortality from this cause was just the same as it was during the year
1887. The type of dysentery prevalent is that which is not benefited by ipe-
cacuanha. Indeed I have reason to believe that this remedy causes such exhaus-
tion very difficult to get over. The disease generally begins with diarrhœa, the
discharges are watery, generally pale, often chalky and yeasty in appearance,
and if the patients can be got at without delay, the administration of bismuth
and chlorodyne checks it at once and seems to arrest its progress for a time.
But a great many are not found out in time and not until the disease has become
a congestive and inflammatory one attended by loss of appetite, great thirst,
and very rapid emaciation. Food is unpalatable and when it is forced on the
patients it excites nausea and vomiting. The action of medicine in such cases
is uncertain. Good milk diet is a necessity and of this there is abundance in
the asylum.
Fever.—Of intermittent fever there have been as many as 40 admissions,
but no deaths. It may be said that a considerable proportion of the admissions
from intermittent fever are of individuals who have arrived from malarious dis-
tricts, and who reaching Rangoon in the rains or the cold season have the disease
re-excited not by the malaria of Rangoon as an exciting cause, but by cold or
other atmospheric states acting on a tainted system.
Jaundice.—With reference to the admission into hospital of four cases of
jaundice it should be noticed that numbers of the inmates were observed to be
suffering from the disease, but as it was not attended by any constitutional dis-
turbance they were not admitted into hospital. This disease or symptom, which
is not frequently met with in Rangoon, was very prevalent at the end of April
and the beginning of May last. The symptoms do not seem to have differed
from ordinary cases of jaundice and it is difficult to explain the cause. The
ordinary period of the affection was about 10 or 11 days. Epidemics of jaundice
have occurred in Europe; there was one in Paris in the autumn of 1870.
Cholera.—Eleven cases of cholera were admitted into the hospital during
the year with eight deaths, or a percentage of 72.72. The epidemic so long as it
lasted (namely, from the 8th to the 30th July) was of a very virulent nature,
more cases having terminated fatally and that more rapidly than on former
occasions.