26
APPENDIX TO ANNUAL REPORT ON LUNATIC ASYLUMS.
(5) That the cholera exoreta should not be buried in the compound even after disin-
fection;
(6) That buckets used for emptying out drain water should be of a different pattern from
those used for the ward, and that care should be taken that buckets used for wards are not
employed in any manner, in connection with the washing of eating and drinking vessels;
(7) That special vessels should be used for giving water to patients at night, and that
each ward should have its own flushing pail and if this is too expensive, that each pail be washed
with perchloride of mercury lotion before passing from ward to ward, and that the drains should
be cleansed daily with perchloride of mercury lotion;
(8) That, as far as possible, all clothing and blankets in use should be soaked in per-
chloride of mercury lotion and then exposed to the direct rays of the sun ;
(9) That blankets used by cholera patients should be subjected to two hours' boiling in
perchloride of mercury lotion ;
(10) That patients should be numbered off to their wards and transfers be discountenanced
as far as possible, and that each transfer when made be registered with a view to maintaining
the history of each patient;
(11) That segregation of the excreta of patients recovered from cholera should be observed
for at least ten days after such apparent recovery ; and
(12) That pay or batta be sanctioned that will ensure the regular attendance of toties
during the epidemic.
7. His suggestions (1), (2), (3), (4) and (5), had already been carried out under my
instructions. I ordered that (8), (9) and (11) should at once be carried out and that (6), (7) and
(10) be acted upon if possible, and that I would pass or recommend special batta to any men who
were reported to have done good work.
8. In reply, the Superintendent proposed that the cistern be used for the daily bath alone
and that the well water be used for gardening and bathing only, under the supervision of a
European attendant. This was approved.
The disinfection of the well with chlorinated lime and sulphite of sodium was thought to
be too late. It is a great pity that this was not carried out in time.
The continuation of the ordinary garden cultivation and the use of the vegetables were also
allowed, as the epidemic had subsided.
9. All clothing, except 81 blankets used during the epidemic, was destroyed. I have sanc-
tioned the proposal of the Superintendent to keep these blankets separate in the isolation blocks
ready for future use in epidemics.
10. This outbreak of cholera is the most severe that has occurred in the asylum for many
years. There were altogether 64 cases and 44 deaths or a mortality of 68.75 per cent. I concur
with the Acting Sanitary Commissioner that it is a great pity that the earlier cases were not
diagnosed as cholera and prompt steps taken for their isolation and the disinfection and destruc-
tion of their evacuations The facts that Mr. Downey, the European attendant, passed several
of his evacuations on the 22nd in the general latrine of the criminal enclosure, that the first
native attacked was from Block 7 in the criminal enclosure, and that the third case occurred in
the female enclosure and was a woman who had been in contact with the men from the criminal
enclosure seems to me to show a connection between these cases. If these facts are taken in
connection with the fact that Professor Hankin discovered a microbe indistinguishable from that
of cholera in the slime of the water sent to him from the criminal enclosure about thirty days
after the first case. I consider the sequence is as clear as one can expect to get it in most
epidemics.
11. Professor Hankin's investigations are most important as illustrating the advantages of
such bacteriological investigations being carried out early in such doubtful cases. Surgeon-
Major Elcum had some reason for doubting these early cases being cholera at all and appears to
have had no suspicion about Mr, Downey who was sent to the General Hospital where he was
admitted for and treated as suffering from ptomaine-poisoning of a doubtful character. The
subsequent history of the epidemic seems to me to clearly prove that Mr. Downey doubtless was
suffering from actual cholera which a bacteriological examination would have at once put out of
doubt.
12. The history of this epidemic has strongly shown the absolute necessity of carrying out
an efficient system of drainage. The filthy habits of a large number of these insanes render
the necessity of good drainage which will prevent the soakage of human evacuations into the
soil even more necessary in a Lunatic asylum than in any other building.
13. It has also brought prominently to notice the fact of our great dependence on the
services of the toties and the absolute necessity of our being able to deal with them. As it is not
possible to punish them, I have laid certain propositions before Government with the view of
encouraging good work by a system of rewards. Notwithstanding the fact that during the past
ten years (see appendix B to the report) cholera has appeared in five different years, no general
rules regarding quarantine and the isolation of such cases have been drawn up. Such rules are
now under preparation and will be inserted in the new edition of the Asylum Code.