7
in the previous year. The causes were epilepsy, dysentery and exhaustion.
The fatal case of epilepsy was that of a male, aged 35, who, on admission to the
asylum on 9th June 1898 for delusional insanity with epilepsy, was in a feeble
state of health, and had suffered from sunstroke prior to the present attack
which was stated to be of six weeks' duration. At 4 A.M. on the 24th January
1899, the patient, who had appeared well on the previous day, was heard moan-
ing, and the Hospital Assistant was sent for. Up to 7 P.M. of the same day he
had ten fits at irregular intervals ; and although under the use of bromides and
cannabis indica the violence of the fits was lessened, they ended in coma from
serous effusion, and death occurred on 31st January. The patient who died of
exhaustion was admitted into the asylum for acute mania on 13th December
1898 in a fair state of health. She had what is described as a chronic occipi-
tal hæmatocele, and was restless, noisy, violent, indecent and dirty in her habits.
The tumour on her occiput gradually increased to the size of an orange without
any febrile symptoms, and on the morning of the 5th March 1899, owing to
her incessant raving, she was addmitted into the asylum hospital, where she
was quite unmanageable and refused to take her food. On the 8th March she
was very exhausted and the hæmatocele had burst, discharging blood and pus,
and the case terminated fatally from exhaustion on the 11th March 1899. The
Superintendent gives no opinion on the nature of the tumour on the head,
nor does he state whether there existed any history or signs of syphilis.
The case of dysentery came into the asylum for dementia on 12th April 1890.
He was morose and given to stealing, and used to steal fruits and vege-
tables from the asylum garden and eat the latter uncooked. On the 29th
March 1899 he suffered from vomiting and pain in the abdomen, and was placed
on the sick list. He passed round worms per rectum and in his vomit on
various occasions, and their appearance was followed by acute dysentery which
ended fatally on the 2nd April 1899.
At Poona there were 11 deaths against 10 in 1898. The ratio of deaths
per mille of the total population was 76.9 as compared with 70.4 in the previous
year. The mortality was due to debility 3, pneumonia 4, plague 2, and dysentery
and albuminuria 1 each. The patient with albuminuria was admitted into the
asylum on 16th June 1892 for acute mania, and, though not of a robust constitu-
tion, had not been in hospital until admitted on 10th January 1898. He then
remained permanently on the sick list up to his death. On transfer to the
hospital he was in a weak and debilitated condition, with face and legs swollen,
the urine diminished in quantity and containing albumen. He steadily got
worse and died on 6th February 1899. The post-mortem examination showed the
membranes and substance of the brain to be pale in appearance. The ventricles
of the brain contained some serous fluid. No abnormal growth was seen. The
brain weighed 44½ ozs ; the right lung was solidified in its upper third, its lower
two-thirds and the whole of the left lung was markedly congested, both the
lungs weighing 44 ozs. The heart was pale ; its valves were normal ; the kidneys
were pale in appearance and weighed 8 ozs. ; the liver and spleen were pale, and
the former had undergone marked fatty degeneration. One death from pneumonia
was that of an epileptic patient, who entered the asylum on 22nd January 1896 as
a criminal lunatic and was transferred to the non-criminal class on the 31st idem.
On admission he was suffering from severe epileptic fits, and on 16th October
1896 it was considered advisable to permanently transfer him to the sick list, on
which he remained until his death. On 11th February 1899 he had high fever
with dulness over the upper lobe of right lung, and in the left lung crepitant
râles, and the case terminated fatally on 13th idem. At the post-mortem exami-
nation it was found that the body was fairly nourished ; membranes of the brain
somewhat congested ; the brain congested and weighed 41 ozs. ; its ventricles
contained some serous fluid but no abnormal growth. The right lung was con-
solidated by red hepatization at its upper two-thirds and weighed 29 ozs ; the
left lung congested and weighed 13 ozs. The heart was normal, and the liver,
spleen and other abdominal organs presented nothing remarkable. Another fatal
case of pneumonia was, on admission into the asylum for melancholia on 19th
April 1899, reported to be in a debilitated state owing to repeated attacks
of bronchitis, &c., which had undermined his constitution. Though not actually
placed on the sick list until 10th January 1899, he had now and then been