REPORT ON THE RANGOON LUNATIC ASYLUM FOR THE YEAR 1894.
15
asylum, on the day of his death, and he walked back to the asylum at the close
of the day's work. At meal time he was seen by the Hospital Assistant to be lying
on the ground. The Hospital Assistant finding the man had fever, sent him to
hospital. He died before midnight. On making a post-mortem examination
not a trace of splenic tissue could be found ; the situation usually occupied by
the spleen was seen to be filled up with blood clot, while in the peritoneal cavity
there was some uncoagulated blood.
There were no marks of injury on deceased's body, and no evidence of rough
handling was forthcoming.
78. Influenza.—The epidemic of influenza set in on the 13th March, on
which day two cases of the malady were admitted into hospital.
It is a common but none the less interesting experience to find that isolated
communities, such as the inmates of jails, often remain free from epidemics during
the periods of greatest prevalence, but nevertheless suffer at a later date. And
such was the case with the epidemic of influenza which attacked the inmates of
the asylum during the year of report. This disease was very prevalent in Ran-
goon in the years 1892, 1893, but had almost ceased in 1894.
Having gained admission to the asylum, the malady, true to its reputation,
quickly spread. The epidemic lasted for three weeks, and 49 lunatics, represent-
ing 20 per cent. of the population, became afflicted. Some of the patients suffer-
ed severely, but none of them died.
The chief features of the disease were general malaise, fever, frontal head-
ache, nasal and bronchial catarrh, painful cough, and considerable prostration.
The mean duration in hospital for treatment was 10 days.
Beriberi.
79. Beriberi.—History of epidemic.—The existence of beriberi among the
lunatics was brought to light on the 4th October.
On that date one of their number, Ohn Thi by name,
on being weighed, was found to have gained 17 lbs. in 30 days, a result which, on
investigation, was seen to be due to an anasarcous condition of the body. There
were at this time two patients in hospital suffering from œdema, one of whom,
admitted for swollen legs, had, in the short space of four days, become extreme-
ly dropsical.
The presence in the asylum, therefore, of three cases of dropsical effusion
affecting the entire body, one of which had increased with extreme rapidity, gave
rise to the suspicion that the anasarcous condition was due to an outbreak of
beriberi of an acute type among the asylum population. That the disease was
beriberi soon became evident, for on examining the main body of the lunatics,
the fact was established that several of them were suffering from various degrees
of œdema; furthermore, the discovery of the outbreak was soon followed by loss
of life, when a post-mortem examination revealed the infiltration with serous
fluid of all subcutaneous and connective tissues throughout the organism, a
pathological condition characteristic of the dropsical form of beriberi.
80. Before proceeding further with the history of the epidemic, it may be
as well to state that, as œdema of the lower limbs is sometimes the only, as it is
generally the first, definite symptom exhibited by persons suffering from beriberi,
every lunatic found with œdema of the lower limbs, however slight, for which no
other explanation was forthcoming, was considered beriberic.
81. By the 14th October, 10 days from the origin of the outbreak, the
number of lunatics in hospital for beriberi had risen from 3 to 30. On the follow-
ing day 18 of those suffering were transferred to Moulmein, two lunatic attend-
ants accompanying them.
On the 24th October a painstaking examination of every lunatic in the
asylum was made, with the result that, of a population of 233 then present, 84,
equal to 36 per cent., were found to have more or less œdema.
In addition to daily inspections, weekly examinations of the entire popula-
tion, conducted with the utmost diligence, were persevered with until it became
manifest, from the results obtained, that the disease had ceased to spread.