7
and exhaustion, the temperature suddenly falling below normal on the day of
her death. There were neither glandular inflammation or enlargement nor
pneumonic symptoms to indicate suspicion of plague. Of the two fatal cases of
diarrhœa, one was a man of about 70 years of age, who arrived at the asylum
on 2nd August 1890 with mania. During the last three years he was subject to
chronic rheumatism, which greatly impaired his constitution. He was admitted
into the asylum hospital for diarrhœa on 18th November, and from that date
he refused to take food or medicine. His diarrhœa gradually became more
severe, and for a week or so before his death he passed his motions involuntarily.
General anasarea gradually supervened, and he eventually succumbed from
exhaustion on 7th December 1898. The other case of diarrhœa ending fatally
came into the asylum for dementia on 3rd April 1880 in bad health.
He was
subject to frequent epileptic fits which recurred at intervals of about ten days
up to the time of his death ; and was also liable to attacks of fever and bronchitis
which reduced him to a feeble condition. On 23rd June 1898 he was placed on
the sick list for diarrhœa, which lasted for about 15 days, leaving him quite
prostrate and feeble. Bronchitis supervened, and from this and frequent
epileptic fits he sank and died from exhaustion on 21st July 1898.
At Ahmedabad there were two deaths, or the same as in the previous year.
The mortality was at the rate of 16.5 per mille of the total population as
compared with 16.7 in 1897. The first case was an insane, aged 45 years, who
was an inmate of the asylum for over 13 years, and was subject to chronic
diarrhœa. The other was a man, aged 27 years, twelve years resident in the
asylum, who died on 31st December 1898 during an epileptic attack to which
he was subject.
The Sir Cawasji Jehangir Lunatic Asylum at Hyderabad shows a decrease
of one death on those of the previous year, viz. 7 against 8. The ratio of deaths
per mille of the total population was 50.4 as compared with 54.4 in 1897. The
mortality was due to anæmia, dysentery, debility, diarrhœa, heat apoplexy,
cirrhosis of liver, and rupture of the spleen. As regards the fatal case of rupture
of the spleen, the cause was not known : there were no marks of external violence.
The patient was a criminal lunatic transferred from the Hyderabad Central
Prison on 7th August 1897. He was suffering from melancholia and in a weak
and emaciated condition. On the 26th August 1898 he became very ill; and
being admitted into the asylum hospital, his abdomen was found so tender
that he could not bear pressure. The following day abdominal section was
performed and the spleen was found ruptured in two places on the anterior
superior aspect from which hæmorrhage had taken place. The splenic vessels
were ligatured, and the spleen was removed. It was enlarged and hypertro-
phied, weighed 24 ozs., and was 7 inches long and 3 inches wide. The splenic
substance in the immediate neighbourhood of the rupture was friable. The
patient died on the morning of 29th idem, i.e. on the 3rd day after the opera-
tion.
Post-mortem examination showed that the liver was contracted and
cirrhotic, and the under-surface of the left lobe congested. All the other
organs were normal. The case which died of heat apoplexy was that of a
female admitted into the asylum on 18th October 1896 for mania associated
with insomnia, and liable to frequent and violent outbursts of passion. On the
afternoon of 14th June 1898 she was attacked with sunstroke and never rallied,
dying the same night at 10 P.M. The brain was congested and weighed 46 OZS.;
lungs congested, liver enlarged, weight 3 lbs. 15 OZS.; spleen enlarged and con-
gested; the heart weighed 7 ozs., and there was fluid in the pericardium. All
the other fatal cases were in an emaciated condition on their admission into the
asylum.
The suggestions made by the Director General, Indian Medical Service,
in his note on the Reports of Lunatic Asylums under Local Governments and
Administrations for the year 1894, regarding the issue of prophylactics in the
unhealthy seasons when malarial fevers of intermittent type were mostly rife,
were carried out in all the asylums. Quinine and cinchona alkaloids were freely
used during these seasons, and quinine and ferruginous preparations were usually
given to those who were debilitated and anæmic, with advantage.
At Colába, Poona and Hyderabad, no cases of injuries of a "major" kind
were treated. The Superintendents of the Ratnágiri, Dhárwár and Ahmedabad