NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
108
Private Hospitals.
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Ward
B
B
C
!
Hospital.
Adamjee
Peerbhoy,
Churney Road, for
Borah Community.
Beni-Israel , C o n -
naught Road.
Bhattia, Mint Road, by
Govindji Thakersey
Mooljee.
Brahma Kshatri
Chinese
Cutchi Memon, Jac-
karia Musjid Street.
Dariasthan
Lohana,
DeSouza Street.
General Mahomedan,
Northbrook Gardens
Greaves, Cotton & Co.
Hallai Memon, Me-
monwada Street.
Haji Kasam Josoob,
Abdul Rehman Street.
Hindu Fever Hospital.
Imambara, for Moguls
by Aga Abdul Hus-
sein.
Islam Nagdevi, Surtee
Dawoodbhai Mussa-
bhai Hospital.
Jain Hospital, Pinjra-
pol.
Jain Parel Hospital...
Jullaha (Sooni Maho-
medan)
Hospital,
Ripon Road, Madan-
pura .
Kapol and Lad Joint
Hospital.
Khatri
Mahomedan
Hospital,Bapu Khote
Street, Null Bazar.
Kolsa Moholla Memon
Mahomedan Hospi-
tal.
District.
Girgaum ...
Tarwadi
Fort, North...
Bhuleshwar .
Mandvi
Do.
Kumbhar-
wada.
Worli
Umarkhadi ..
Market
Khetwadi ...
Umarkhadi .
Chakla
Byculla
Bhuleshwar,
Do.
..
Admission.
Total.
222
13
264
40
134
457
297
62
62
52
771
34
84
588
326
546
264
14
35
Plague.
207
11
?
?
77
?
?
?
55
?
695
?
?
510
336
284
172
?
26
Deaths.
Total.
129
5
191
32
45
338
164
33
32
29
540
13
46
396
232
271
131
7
21
Plague.
129
4
?
?
45
?
?
?
32
?
528
?
1
381
232
200
131
1
21
Mortality
per cent.
General
58·10
38·46
72·80
80·00
33·58
73·96
53·21
53·22
51·61
55·76
70·03
52·94
54·76
67·34
71·1
49·64
49·62
50·00
60·00
Plague.
62·01
40·00
?
?
58·44
?
?
1
58·18
1
75·'97
?
?
74 70
75·81
70·42
76·16
1
30·7
Report,
Page
109
Prívale Hospitals—continued.
No.
21
22
23
2t
25
26
27
28
29
30
31
32
33
34
35
36
Wari
Hospital.
Khatrya Hospital
Churney Road Gar
dens.
Maratha Hospital,
Connaught Road —
(a) " Under English
treatment."
(b) " Under Native
treatment."
Marwadi and Fatte-
puria Hospital.
Modh and Porwad
Hospital, Pinjrapole.
Mahomed Ebrahim
Khojah Hospital,
Dontad Street.
Nizampura Fever
Hospital, Bapu
Hajan
Street
Bhendy Bazaar.
Parsi Fever Hospital
Pathare Prabhu Hos-
pital, Churney Road
Gardens,
Port Trust Hospital...
Shikar pur i and Mul-
taní Hospital, Arab
Gully Lane.
Telegu Hospital,
Bazar Street.
Textile Mill Hospital.
Thakurdwar Lohana
Hospital.
3rd B Bhoiwada Hospital
Vaishnav Samprayada
Maharajah's Ser-
vants' Hospital.
Vassanji Trikamji
Hospital, Clive
Road.
District.
Dongri
Kamathipura
Bhuleshwar...
Dongri
Admission.
Total.
43
981
261
86
58
176
71
40
158
14
241
6
70
147
15
121
Plague.
40
738
235
?
58
159
?
40
157
?
216
5
19
?
?
117
Total.
32
645
176
65
44
85
36
25
119
10
174
5
14
114
10
89
Plague.
31
542
162
?
44
84
?
25
119
?
157
5
14
?
?
89
General
74·41
65·74
67·43
75·58
75·86
50·70
62·5
75·31
71·42
72·19
83·33
70·00
77·55
66·66
73·55
Plague.
77·50
73·44
68·93
?
75·86
52·33
?
62·5
78·80
?
72·86
30·00
70·68
?
...
76·06
Report.
page
110
CHAPTER VIII.
HOSPITALS.
Nurses.
In the middle of June 1897, with the rapid decline of the Plague,
all the temporary hospitals were closed owing to the monsoon. Parel,
Grant Road, and Arthur Road contained only a few acute cases, and it
was therefore decided to close Grant Road, to gradually clear Parel, and
to concentrate all Plague patients at Arthur Road.
This arrangement necessarily released most of the English
Nurses :—
Miss Jones.
„
Robinson.
„
Wheatley.
„
Coleman.
„
Steele.
„
Reynolds.
Miss Morey.
„
Katsch.
„
Oram.
„
Franklin.
„
Kendall.
„
Hale.
Several of these were desirous of joining the Indian Nursing Service
at once, viz. :—
Miss Robinson,
„
Morey.
„
Wheatley.
Miss Coleman.
„
Reynolds.
Others expressed their readiness to do so after completion of their
year's current engagement, viz. :—
Miss Steele,
3,
Kendall.
Miss Franklin.
„
Oram.
However, Miss Franklin and Miss Oram being still in Cutch Mandvi,
Miss Steele and Miss "Wheatley were the only two who could be
spared. The first two ladies shortly afterwards, on their return from
Cutch Mandvi, were directed to report to the Surgeon-General, and
subsequently proceeded to the Front. Miss Wheatley was prevented by
ill-health from joining them in August. In the beginning of July Miss
Morey was appointed Lady Inspector at Khana Junction. Miss Coleman
and Miss Reynolds were temporarily engaged at the Committee Office.
Thus only three Nurses—Miss Jones, Miss Hale and Miss Wheatley—
were on duty at Arthur Road ; but shortly afterwards, with the
outbreak of cholera, Miss Reynolds and Miss Coleman were detailed
111
for duty in the Cholera Ward at Arthur Road, whither Miss McDonald
Ritchie was also despatched a month later to take charge of that ward.
Meanwhile ( July 15th ) information was received from the
Secretary to Government to the effect that the Government of India and
the Local Government had been addressed as to the possibility of their
affording employment for the Nurses, who in the meantime were
directed to report themselves to the Surgeon-General as they became
available.
At this time Miss Robinson and Miss Kendall were on leave, Miss
Oram an invalid, Miss Morey at Khana Junction, and Miss Franklin and
Miss Katsch fit for duty.
With the increase of Plague in the Mofussil during the month
of September, and its recrudescence in Bombay after its rapid decline
in July, a further supply of Nurses and Doctors was called for from the
Imperial Government, and at the end of October the following ladies
reached Bombay, and were posted as follows :—
Miss Green
„ Mill
„ McDougal ...
„ Dowson
,, Harris
„ Hitchman ...
„ Truman
„ Moyd
„ Mowat
...
„ Crowdy
„ Tetley
„ Phillips
Mrs. Potts
... Arthur Road
Do.
Do.
Do.
Do.
Do.
Do.
Do.
... Sholapur.
... Parel
... Grant Road.
Arthur Road.
Do.
... Transferred to Maratha.
Do.
to Parel.
...
...
...
Transferred to Parel.
Do.
do.
Do.
do.
Transferred to Surat.
Transferred to Parel. (11-
12-97.)
The distribution of Indian-trained Nurses during the summer and
autumn was as follows :—
July—September
... Arthur Road...Mrs. Baker, Mrs. Gibson, Miss Fern,
Miss Christie, Nurse Thakoobai.
Grant Road ...Mrs. Nesbitt, Mrs. Shehan.
October & December ... Arthur Road ...Miss Crichton, Mrs.Storrie, Miss Simp-
son, Mrs. Young, Mrs. Rosario,
Mrs. McDonald, Mrs. Manning.
Grant Road...Miss Crichton, Mrs. Rimington, Misa
Fernandez, Mrs. Manning.
In January and February the services of all available Nurses
became requisite, and the following additional Nurses were on duty :—
Arthur Road ... Nurse Moore, Canon, Yates, F. Yates, Lynsdale, Hanson,
Grant Road
...
„
Beale, Winscom.
Parel ...
...
„ Overthrow.
Modikhana
...
„ Saye.
Maratha
... „
Lazarus.
112
On the 12th of February 25 more English Nurses arrived from
England, and were posted to the several hospitals :—
Arthur Road
Grant Road
Modikhana
Narielwadi
Police Hospital
... Nurse Foxlee, Scott, Gardiner, Pearse, Chick, Bleaney,
Greening, Cracknell.
„
Truman, Richardson, Evans.
„
Grieveson, Wood, Brown, Campbell, Hodges,
Buckley, Snowdon.
„ Murphy, Bradshaw, Riley, Hylands.
„
Smith, Harvey.
It was difficult to house so many ladies at once. Old Govern-
ment House, Parel, could accommodate no more. Accordingly a suite
of rooms was taken at the Adelphi Hotel and put in order and
furnished by the Committee, while tents and huts were erected at
Narielwadi and Modikhana for the staff at those hospitals.
With so many Nurses it was necessary to select one of them as
responsible head to organize and direct the others under the require-
ments of the Committee, and Miss Robinson was accordingly appointed
Lady Superintendent of Nurses, the duties of which post she carried out
with commendable zeal and capacity, In April she resigned the post of
Lady Superintendent to join the Indian Nursing Service, and Miss Green
was appointed in her place.
The Committee are glad to state that the whole baud of English
Sisters and Bombay Nurses have performed their duties with admirable
credit and patience under the severe strain thrown upon them by the
novel, harassing, and painful work that they were called upon to do.
They were suddenly placed in the midst of all the trying circumstances
of native Plague hospitals, with no knowledge of the language or
customs of their patients; and they had also to face the unknown
dangers of a dreaded and loathsome disease. Further, they experienced
the terrors of the fire at Modikhana Hospital and of the riots, and on
both occasions behaved with great courage and fortitude.
The Committee have greatly appreciated the services of the whole
Nursing Staff, and are confident that their devoted and tender care of
their patients has created a revolution in the attitude of a considerable
section of the people of Bombay towards hospital treatment.
The services of Miss Robinson, the Lady Superintendent of Nurses,
of Miss Green at the Maratha Hospital, of Miss Kendal at Grant Road,
of Miss Bridge at Narielwadi, and of Miss Winscom at Modikhana,
deserve special mention,
113
It is with the deepest regret that the death from Plague has to be
recorded of Miss MacDougal, on the 22nd February 1898. This lady
was a distinguished Nurse from St. Bartholomew Hospital, London,
and was a victim to the cause to which she truly gave her life.
Medical Offi-
cers.
As the Epidemic heightened, the Hospital Staff was increased both
in number and quality. During January the staff of Medical Officers
in charge of hospitals was increased. Of those who were especially
successful as heads of hospitals were Dr. Hutchinson at Grant
Road, Dr. Julius at Modikhana and Dr. Choksey at Arthur Road.
Private Hos-
pitals.
The system of Private Hospitals inaugurated last year by the
Committee has been adhered to and considerably extended during the
second Epidemic. In spite of much adverse criticism, it has been found
that Private Hospitals, open to all members of any particular caste or
sect, have as a whole been a distinct success. The many intricate
questions relating to caste habits, food, religious scruples and other
similar difficulties, have in this way been overcome and the various
apprehensions and fears of the people have been set at rest. The
result has been a moral and practical support to the measures adopted
by the Committee that has proved invaluable. To the munificent
founders of these hospitals and to the gentlemen who devoted so
much time to their management, the Committee are most grateful, and
cordially acknowledge their good services for the public benefit.
The choice of a building satisfactory in every sanitary detail,
together with convenience of position for the special caste for whom
it was intended, has often proved most difficult. Undoubtedly there
has been much left to be desired in this respect as regards certain
private hospitals : yet no effort has been spared to make them as
efficient as possible, and in no case can it be shewn that any
private hospital has proved a source of infection to its neighbourhood.
The Jain Hospital, the Kapol-Lad Bania Hospital, and the Modh
Porwad Hospital, all in the Bhuleshwar Ward, have done excel-
lent service. On the other hand, Dariastan Street, the site of the
Lohana Hospital, is too narrow and too crowded for safety, and the
management of its sanitary details has not been entirely satisfactory.
Among Musalman Hospitals the Khojah Hospital in Don-Tod
Street, though in a crowded locality, was too carefully managed to be
a so urce of anxiety. Among the hospitals whose open sites free them
from the risk of spreading infection are the Maratha, Beni-Israel, Parsi
and Jain Hospitals in the Connaught and neighbouring Parel Roads ;
114
also the Musalman General Hospital in the Northbrook Gardens and
the Jullaha Hospital in Ripon Road. The Maratha Hospital was opened"
about the end of January, and the Northbrook Garden Muslim Hospital
a little earlier. They were filled almost as soon as they were open,
and have continued well filled till after the close of April.
During the cursory examination of a large number of persons in
dimly lighted houses and chawls it was frequently impossible to say
at once if a case was Plague, In the best interests of the patient and
of the other inmates of the house, it was necessary to place such
persons under observation : and in all Government and in most private
hospitals separate accommodation was provided for these suspicious
fever cases.
The result of careful enquiry at the Hospitals shews that the
number of cases that were thus sent in, without sufficient reason,
amounted to only a fraction per cent. This is totally at variance with
the groundless statements circulated by certain persons of influence
and position, whose false accusations did incalculable harm. Yet in
spite of their adverse criticism, a large number of persons voluntarily
applied for admission to the Hospitals and few who were admitted
failed to shew their appreciation of all that was done for them.
Special Re-
ports.
The special reports which now follow are in almost every instance
only a very brief statistical record of the work done. This is in part
due to the fact that the Epidemic still (April) maintains a firm hold on
the city, and in part to the absence of any important advance in our
knowledge of the clinical, therapeutical, or pathological aspects of the
disease. During the height of the Epidemic the pressure of work in
the hospitals has been so heavy that any systematic research work has
/
been impossible.
In reference to the Government Hospitals, both Narielwadi and
Modikhana have been most unfortunate in having frequent changes
in their Medical Officers. This has greatly interfered with the produc-
tion of any detailed report. Arthur Road claims the largest number of
admissions, namely, 1,917 Plague cases in the past 9 months. Bat
during this epidemic the demands of routine work on Dr. Choksey,
himself in poor health from overwork, have been too incessant to
permit of his making a clinical report on the material to his hand,
such as he contributed with so much effect last year.
In this connection it is to be noted also with regret, that compara-
tively few of the Private Hospitals have kept any trustworthy record of
the cases treated in them.
115
PAREL HOSPITAL.
STATISTICAL AND CLINICAL RECORD OF WORK FROM THE
15TH NOVEMBER 1897 TO 31ST MARCH 1898,
BY SURG.-CAPT. W. E. JENNINGS, M. B., C. M., I. M. S.
1. Parel Plague Hospital was opened as a convalescent hospital
on the 15th of November 1897, extended as an acute hospital in the
following month, and remained as such on the 31st of March 1898.
2. During that period 992 patients were admitted, of whom 426
recovered, 488 died and 78 remained under treatment.
3. The following table gives details of those admitted, with re-
ference to caste, sex, and results :—
European... ... ...
Native Christian
Jews
...
Parais
Mahomedans...
...
Hindus
Total ...
Total.
329
4
41
40
778
992
Males.
90
3
25
28
547
G93
Females.
39
1
16
12
231
299
Died.
88
2
29
16
353
488
Recovered,
32
2
12
22
358
426
Remained
9
0
0
2
67
78
4. The following table gives particulars of those admitted, with re-
ference to age :—
Infanta.
1
2
to
5
years.
20
5
to
10
79
10
to
20
243
20
to
30
360
30
to
40
164
40
to
50
84
50
to
60
33
60
to
70
8
70
and upwards.
Nil.
5. The following table gives details referring to the position of
buboes :—
Situation of Bubo.
Right axilla ...
Left axilla ...
Right femoral
Left femoral
...
Right inguinal ...
Left inguinal ...
Right cervical ...
Left cervical
...
Eight parotid ...
Left parotid ...
Multiple... ...
No Buboes ...
Total.
68
64
31
25
192
150
27
14
12
8
57
344
Total
...
... 992
Grand Total
...
992
Percentage
69
6·5
3·1
25
19·4
15·1
2·7
1·4
1·2
0·8
5·7
34·7
......
Males.
44
47
23
19
137
107
21
12
5
3
42
233
693
Females.
24
17
8
6
55
43
6
2
7
5
15
111
299
Died.
39
35
15
32
114
99
11
10
5
4
35
109
488
Recovered.
,
24
21
12
9
63
34
11
3
6
4
19
220
426
Remained.
5
8
4
4
15
17
5
1
1
0
3
15
78
116
6. The following table gives details relative to the distribution of
buboes, relative to sex, in adults and children :—
Distribution of Bubo.
Left axilla
Right femoral
Left femoral
...
Right inguinal
Left inguinal
...
Right cervical
Left cervical
Right parotid
Left parotid
Multiple
No Buboes
Total
Grand Total
Men.
39
45
22
18
128
102
20
11
5
3
39
221
653
Women.
21
14
8
6
38
38
4
2
G
4
11
101
266
9
Boys.
5
2
1
1
5
5
1
1
0
0
3
12
40
92
Girls.
3
3
0
0
5
5
2
0
1
1
4
10
33
7. On November 15th, 1897, the Resident Medical Officer was
Dr. Pais and the staff was as follows :—
Sister 1, Nurses 2, Assistants 3, Clerk 1, Ward-boys 8, Ayahs 2,
Cook's 3, Sweepers 5, Dhobi 1.
8. On 8th January 1898, Dr. Pais was relieved by Dr. Castellote
and in consequence of an increased influx of patients the subordinate
staff was somewhat strengthened. On 19th February 1898, Dr.
Castellote having been placed in charge of the District Health Camps,
Dr. Clemow relieved him, and the Female Wards were placed in charge
of Dr. (Miss) Alice Corthorn on the 5th March 1898. The sub-
ordinate staff then stood as follow :—
Sisters 4, Nurses 4, Assistants 5, Compounder 1, Clerk 1, Ward-
boys 22, Ayahs 11, Cooks 4, Sweepers 18, Dhobis 2.
9. During the period under report, fifty cases of A cute Plague were
treated by Dr. Felix Jassenski by the injection of an antitoxic serum
prepared in the Imperial Institute of experimental Medicine in St.
Petersburg, and I am obliged to him for the following particulars which
he has permitted me to incorporate in this report.
The serum was obtained from the blood of horses rendered immune
by the repeated injection of cultures of Plague bacilli in which the
bacilli had been killed by heat. Cases were not specially selected for
this treatment, but in order to obtain two entirely comparable groups of
inoculated and control cases, Dr. Clemow and Dr. Jassenski daily divided
117
the newly admitted cases into two groups—one containing doubtful and
moribund cases, and the other cases of undoubted Plague (not obviously,
moribund). The inoculated and the control cases were taken solely
from the second group, every alternate one being inoculated, and the
remainder forming the control cases. At first the quantity of serum in-
jected-was 20 c.c. daily in one dose, later on 10 c.c. were injected in-
the evenings as a second dose, and still later the morning dose was in-
creased to 30 c.c. These doses not having any effect, they were further
increased to 40 c.c. in the morning and 20 c.c. at night (more than
half of the cases were treated with the latter doses). In seventeen of the
cases the blood was examined for bacilli and in thirteen of these the
bacilli were found in a drop of blood obtained from the buboes during
life, and in one base 11/2 hours after death. In twenty-six cases out of
thirty-four albumen was found in the urine;
The following tabular statement gives comparative results of the
inoculated and control cases :—
Results.
Discharged cured
Deaths ...
Under treatment
Convalescent
Totals ...
Inoculated.
2
39
1
8
50
Control.
0
40
1
9
.50
Dr. Jassenski sums up the results of his experiments as follows :—
" In general terms the effects of the injections of the Russian serum
have been negative. In some cases the temperature fell and the
patient felt better after the injections, but it is doubtful whether the
phenomena should be ascribed to the injections. No harmful results
were noted in any case, whether on the heart, the kidneys, or any other
organ. Finally, from the above results, but one conclusion is possible,
that the serum prepared in St. Petersburg and employed by me in the
above cases, is an absolutely indifferent substance, with no influence,
either for good or evil, on the course of Acute Plague."
10. Various other methods of treatment were adopted, based upon
special indications in each case, but no method was observed to have
any advantage over others, and success depended mainly on early attend-
ance to cases, absolute rest until about a week after the, subsidence of
all acute symptoms, supporting the powers by stimulants, and relieving
insomnia by narcotics.
118
11. Appended to this report are notes of twelve cases of special
interest, six selected by Dr. Clemow, and six by Dr. Alice Corthorn.
12. It is with great regret that I have to mention the death of
Hospital Assistant Waman Narayan, who fell a victim to the Plague,
contracted in a post-mortem examination. He was an able and willing
worker and in him the Department has lost a most promising member. I
have also to record with regret the death from Plague of one hospital
sweeper and one ayah, both good workers.
13. The above is a report of the entire work of the Hospital during
the period under consideration. Of the 992 cases on which the statis-
tics are based, 247 were convalescent patients transferred from other
hospitals. Of this number 2 subsequently died. Observation and cases
other than Plague numbered 158 with 51 deaths. The actual return of
Acute Plague cases admitted and treated is therefore as follows :—
Cases admitted
„ discharged
„ died ...
...
...
...
...
...
587
152 Plague mortality 74·10.
435
Report of six cases treated in the old Government House Plague
Hospital, Parel.
(By Frank G. Clemow, M.D., Edin., D.P.H., Camb.)
CASE I.—BUBONIC PLAGUE.—ACUTE KERATO-IRITIS ; LATE DEVELOPMENT OF
SECONDAEY BUBO ; EXHAUSTION AND DEATH ON THE 15TH DAY,
Gunpat Khundoo, Hindu male, aged 21 ; admitted to hospital
March 6th, 1898, with a history of three days' illness.
State on admission.—The patient is semi-conscious and restless, at
times delirious and violent. The conjunctivæ deeply injected, and there
are signs of commencing conjunctivitis. The tongue shows the charac-
teristic greyish-white coating covering the dorsum and leaving the tip and
edges pink and clean. The pulse is rapid and weak. The bowels have not
been opened for four days. There is no cough. There is severe frontal
headache. In the right groin is a very tender bubo, the size of a walnut.
The urine is acid and contains a considerable quantity of albumen. The
temperature is 102·4° ; pulse 120 ; respirations 28 ; the spleen is not
enlarged.
119
Treatment :—Rest, milk diet, poultices to the bubo. Four ounees of
rum in the 24 hours and the following :—
Quin. Sulphat, grs, V.
Acid Hydrobromic dil., rn. X.
Sp. Aetheris Nitrosi, m. XXX.
Potass. Nitrat, grs. V.
Liqr. Strych., m. III.
Aquam, ad. oz. I.
every four hours,
Later, he was ordered hypodermic injections every four hours, each
injection containing Liq. Strychnia, m. IV, and Sp. Eth: Sulph., m. XV ;
Inject. Morph., Hypod. m. III, was added to the injections when the
delirium was troublesome.
Course of the disease :—March 8th signs of commencing Kerato-iritis
in both eyes. Ordered Atropia drops to be repeated until the pupils are
fully dilated ; frequent bathing of the eyes with Boracic lotion, and a
pressure bandage. At 3 p.m. the patient received hypodermically 20
c. c. of an antitoxic serum prepared in the Imperial Institute of Expe-
rimental Medicine in St. Petersburg. The injection was made by
Dr. Jassenski, the Principal Member of the Plague Commission recently
sent to India by the Russian Government. This was the first case so
inoculated.
Between March 8th and 12th (inclusive) a daily injection of 20 c. c.
of serum was given. The temperature remained high until the 13th,
when it fell to 99·6°. From that date onwards it remained normal with
one slight rise to 99° on the 17th, and the injections were consequently
discontinued. The general condition showed some improvement for a few
days. The tongue cleaned completely and the pulse became slower and
stronger. Delirium, however, recurred at intervals and sleeplessness was
troublesome. On March 11th, there was nauseaæ and hiccough which
was controlled with difficulty. From the 14th to the 16th there was
troublesome vomiting which was scarcely affected by the ordinary reme-
dies. The Kerato-iritis continued to increase ; the corne became quite
opaque and a large ulcer formed in the centre of the left cornea. The
Kerato-iritis also increased. The bubo gradually became larger, till it
measured 5x3 inches ; suppuration did not occur. On March 16th a
diffuse, hard, tender swelling appeared in the right neck, and this slowly
increased in size during the remaining 48 hours of life, but showed no
signs of suppurating. On March 18th, hæmorrhage occurred from the
gums, which had become soft and spongy as in scurvy, and the patient
died of exhaustion at 10-5 p.m, that night,