9
damp weather, for on the evening of 6th April 1899 he had a temperature of
103.2 o . He refused to eat his food or take medicine, but rolled about his cell
in a violent manner and threw off his clothing. Next morning, consolidation
of the bases of both lungs with crepitation was detected, and on the 9th idem
he died. The second case was that of a weak, anæmic man with œdematous
extremities who was admitted into the asylum on 5th May 1898. He was sub-
ject to frequent fits of excitement, dirty in his habits, and constantly exposed
himself. He gradually lost flesh, and on 14th March 1899 was transferred to
the sick list. The heart's action was very weak ; there was no enlargement of
spleen or liver. The urine was pale and scanty ; specific gravity 1010 ; no
albumen ; mucous membranes pale and anæmic ; bowels irregular ; stools loose
and at times passed involuntarily. He refused nourishment and medicine, and
constantly threw off his clothing. General anasarca supervened, and he died on
l7th April 1899. The fatal case of bronchitis was that of a middle-aged man
who came into the asylum on 12th January 1897. He had been very violent
for some months, but latterly he grew quiet and morose, and frequently refused
to take his food. On 10th April 1899 he was admitted into the asylum hospital
for fever and chills, his pulse being feeble and tongue dry, &c. The next day
signs of acute bronchitis developed with congestion of bases of both lungs ; cough
was attended with frothy expectoration, and, in spite of every care and attention,
he gradually grew weaker and died on the morning of 19th idem from exhaus-
tion. The patient who died from cholera was, on admission to the asylum on
4th July 1889, reported to be in a very poor state of health. On 2nd May 1899,
at about 4 P.M., he was suddenly attacked with violent purging followed in half
an hour by collapse with whispering voice, imperceptible pulse and involuntary
rice-water evacuations. There were neither vomiting nor cramps, but the urine
is said to have been suppressed. He had no reaction, and succumbed within four
hours. The fifth death (debility) was that of a woman aged 81, who had been
confined in the asylum since July 1875. During the last six months she was
subject to frequent attacks of intermittent fever, and suffered from anasarca
and a gangrenous ulcer on one of the legs. For over a month she took little or
no food, was excessively emaciated, almost pulseless, and lay in a torpid condi-
tion from which she could hardly ever be aroused. She died on 14th May 1899.
The sixth fatal case had been in the asylum for five years. Her general health
was fair ; but she was most excitable, restless and loquacious. She was attacked
on the 4th June 1899 with violent vomiting ; but there were neither purging,
nor suppression of urine or cramps. The vomit consisted of bilious fluid containing
several round worms. Sudden and extreme collapse ensued, with cold extremi-
ties, whispering voice and imperceptible pulse, and she succumbed at 6-15 P.M.
of the 6th June. The post-mortem examination revealed fatty degeneration
of heart ; its semi-lunar valves were encrusted and incompetent, and a large
antemortem clot was found in the right ventricle. The stomach and intes-
tines were normal, but the jejunum was blocked by a coil of round worms
which may have given rise to the severe vomiting. The brain is reported to
have been normal. The seventh death was that of an elderly man who came
into the asylum for acute mania on 21 st June 1899. He was very restless,
violent, destructive, and dirty in habits, and latterly declined to take any
nourishment. He was greatly emaciated ; the conjunctivæ were tinged yellow,
the liver was contracted, and the spleen enlarged. He was admitted into the
asylum hospital on 20th July, as, in adition to his refusal of food, he had wander-
ing delirium, which eventually terminated in coma and death on the 24th July.
The post-mortem examination revealed contraction and fibrosis of the liver, which
was of yellow colour ; the spleen was enlarged, and there were petechiæ in the
mucous membrane of the intestines, the lower portion of which was distended
with dark coffee-coloured pultaceous matter. The other organs were normal.
The Ahmedabad Lunatic Asylum returned 5 deaths against 2 in 1898, and
the ratio of deaths per mille of the total population was 39.1 as compared with
16.5 in the previous year. Dysentery accounted for two deaths, and anæmia,
pneumonia and phthisis for one each. Of the two deaths from dysentery, one was
in an old man of 55 years who was an inmate of the asylum for over six years ;
his habits were very filthy, and latterly he suffered from dysentery which did
not yield to treatment. He gradually wasted, and died after having been under
B 2419—3