216 REPORTS FROM THE SECTIONS. 
responsible for upwards of another fifth. 
Pneumonia is a less common cause of death in the institutions 
for the insane in New South Wales than in those of the Mother 
Country, but it is very insidious and not unfrequently makes some 
headway before the patient is noticed to be ailing. It attacks as 
a rule the more demented cases, who make no complaint of pain, 
and who often have no cough, so that the symptom first noticed 1s 
loss of appetite. The thermometer is most useful in demented 
patients for the purpose of detecting the presence of serious disease, 
and where the temperature is high the chest should at once be 
exam 
in an asylum e insanity accompanying and sometimes causee — 
by phthisis has occasionally been classified as a distinct form of 
the affection. is as a rule characterized by delusions of sus 
irritable and often violent in consequence. 
e mental condition it might be imagined would aggravate and 
accelerate the physical disease, but such is not the case. Phthisis 
as-seen in asylum practice is as a rule a decidedly chronic affection. 
In e cases you will notice that death was due to suicide. In 
one the patient had been an inmate for seven years and had never 
displayed the slightest suicidal tendency. The case is interesting 
on this account, as showing that in insanity with defective reason 
ing power and weakened mental balance suicide may occur 1m any 
case where least expected. This patient often asked to . 
an attendant, and I was never able to assign any reason for his — 
act beyond a pang of disappointment because I appointed a new 
attendant, and neglected his imaginary claims. My experience has 
taught me to believe that a very large number of the insane, eve® 
among the more imbecile class, may at any moment and from 
trivial causes attempt their own lives. th 
In the second case a patient undid a complex bandage W7 
ich his arm was fastened to his side, and spite of a fractured 
