APPENDIX TO ANNUAL REPORT ON LUNATIC ASYLUMS.
23
APPENDIX I.
REPORT ON THE OUTBREAK OF CHOLERA IN 1894-95.
BY SURGEON-MAJOR D. ELCUM, SUPERINTENDENT OF THE LUNATIC ASYLUM.
THE outbreak commenced on the 29th December 1894, though one doubtful case occurred on
the 24th. A Mr. Downey, one of the European attendants, who had been feeling slightly indis-
posed from the 22nd, had several evacuations on the 23rd and by the 24th was so ill that he
was transferred to the General Hospital. This case was, however, not looked upon as one of
cholera, but rather as an attack of diarrhœa resulting from eating a particular kind of vegetable
on the evening of the 22nd. On the 27th one case from Block 7, Section IV, 'Komki Chitti-
vadu,' was admitted to hospital with diarrhœa at 3 A.M., there being no distinct indication at
that time that the disease was cholera. A woman 'Kulliamal' was admitted to the female
hospital a few hours later, suffering from a similar attack of diarrhœa. On the 28th no fresh
cases occurred, but the cases admitted on the 27th were still under treatment and regarded as
suspicious. On the 29th six fresh cases were admitted showing symptoms of cholera, and these
together with the two previous cases admitted for diarrhœa were kept under treatment. On the
30th another case of cholera was admitted, and the case of 'Kulliamal' resolved itself into one
of cholera, having up to this date been treated as one of diarrhœa. On the 31st all the cases,
including one admitted on this date, were pronounced as typical of cholera, though the motions
were not of the typical rice-watery consistence, but consisted of undigested rice, raggi and
vegetables suspended in fluid at first and gradually assumed a rice-watery character as time
went on. Vomiting was almost entirely absent in some cases and in others consisted of undigested
food. Total suppression of urine only occurred in a few cases, but the secretion of the kidney was
diminished in all.
2. I did not pronounce the cases to be cholera until the morning of the 31st December, up
to that date I considered them as doubtful; the gradual character of the onset, the absence of
pronounced symptoms and the continuance of those symptoms, as a whole, made me rather lean
towards the opinion that the disease was caused by catarrhal inflammation of the intestines due to
undigested food and cold combined. The cases continued to increase in January 1895 as will
be seen by the nominal roll (appendix A). From January 1895 up to the termination of the
epidemic on 9th February, 20 more cases occurred, details of which will be seen in the nominal
roll (appendix C). This brings the grand total up to 64 attacks with 44 deaths, being equi-
valent to a percentage of 68.75 deaths.
3. All the cholera cases among the men were removed to the infectious sheds and into tents
obtained from the Ordnance and pitched in an open space to the south-east of the criminal
enclosure. The women were treated in the isolation block in the female enclosure. I am puzzled
in accounting for these cases, as they were more isolated from the outside world than the other
portions of the asylum, the female attendants alone having any access to their enclosure, while
the food, water and surroundings are so entirely in common that I should have anticipated a
much larger number of cases once the disease started; the total number of cases being only five,
and all these proving fatal.
4. Remarks on Causation—(a) Drinking water is unlikely to be the cause, as all the inmates
drink the same (the Red Hills water laid on in pipes); had this been the cause I fancy far
more cases would have occurred. Water from a well in the criminal enclosure, where the earlier
cases came from (except the women), might have been drunk surreptitiously, not otherwise ; the
patients being insanes, this is quite possible.
(b) Food consisted largely of raggi, rice and vegetables. The same reasoning will apply
to this as to the water, but in the early post-mortem examinations made before the cases were
pronounced as cholera, I found acute inflammation of the small intestine and in some cases
ulceration, with a good deal of undigested food—raggi and vegetables—and a good deal of mucus.
The raggi used since 12th July last was very old ; it was procured at the Penitentiary and the
issue of it as a food was discontinued on 31st December 1894 by order of the Surgeon-General
as not being of good enough quality.
(c) Air.—This might be a cause, some cleansing of the floors and the washings (sullage)
having been applied to the jail garden. This sullage is freely used in the asylum garden outside,
and from both the gardens vegetables are freely supplied to patients. Of late the sullage has
almost entirely been applied to the outer garden only.
(d) Infection from without.—This might equally well be; we have free communication
with the outside world by the warders and other servants, whose houses are adjoining the asy-
lum. Some prisoners and other patients have recently come in from different districts, though
Nobody appears to have actually brought cholera in with him.
(e) Overcrowding has not existed.
(f) Clothing.—The usual cotton, clothing and native blankets are used in the asylum.