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A UNIQUE CASE.
20 amining a specimen of a gravid uterus about one month after impregnation. The specimen is now in the museum of St. George’s Hospital, and was described by Dr. R. J. Lee
that the district intervening between this town and the Ottoman frontier will have escaped. Dr. Dickson, the physician to the British Embassy at in THE LANCET for 1873, vol. ii., page 549. Sections of the Constantinople, in a letter to The Times of the 21st inst., has decidua serotina and maternal placenta of this specimen endeavoured, but unsuccessfully, to set Messrs. Gray, Dawes, showed, under the microscope, a few uterine glands, but so and Co. right as to the existence of plague in Mesopotamia. few as to remove all doubt that the villi were connected But that firm, ignoring Surgeon-Major Colvill’s opinions with them. The specimen showed also the early develop- formed on personal observation of the disease, does not hesitate ment of the maternal sinus system in the existence of large also to question Dr. Dickson’s conclusions. So little is the in the Levant that it blood-containing spaces, with thin epitheliated walls-in firm acquainted with sanitaryis matters the British representative on is unaware that Dr. Dickson fact, little else but greatly dilated capillaries. the Ottoman Sanitary Administration, and of necessity has coming under his observation all the official information communicated to the Ottoman Government on the subject. THE PLAGUE. Messrs. Gray, Dawes, and Co. refer to the Government for information on the subject, but when the two Government WITH the commencement of the hot season in Mesopotamia official medical reporters, Dr. Dickson and Surgeon-Major Colvill, disagree with them, they do not hesitate to reiterate plague manifestly declined, and now that that season has their own foregone conclusion, and put aside as of no moment fully set in it is reported that the disease is rapidl3 the opinions of the responsible medical reporters of the ceasing. A like course was followed by the disease in tht Government. As the statement of the Government on the two previous years of prevalence, and in those preced. plague, in the House of Commons on the 26th inst., would be ing outbreaks of plague in Mesopotamia of which we havt founded upon the reports of Mr. Colvill and Dr. Dickson, we It appears to be the rule of plague in presume that this will prove equally unconvincing to Messrs. a definite knowledge. the lower valleys of the Tigris and Euphrates, to become Gray, Dawes, and Co. Whatever may be the vexations of it is difficult to understand how the British active in the winter, attain its most considerable develop. quarantine, Government can help British merchants in obtaining an ment in spring, and decline and die out, or become dormant, amelioration of them if this is a sample of the temper in in the summer. This seasonal variation of prevalence cor- which they deal with so difficult a question. responds with that which was formerly observed in Egypt, but differs considerably from that which held good in more The winter," says Volney (quoted by southerly countries. A UNIQUE CASE. Gavin Milroy), 11 stops the plague at Constantinople because To the Editor of THE LANCET. the cold is great, and the summer lights it up because the SiR,-I beg to send you brief notes of a case which heat is then humid; while in Egypt the winter favours it to me rather singular, and would be glad to hear appeared because the climate is then warm and moist, and the summer if any of your readers have met with its parallel in practice. stops it because it is hot and dry." The heat is only injurious An old man, about sixty years of age, had been affiicted when associated with humidity. Mr. Bourke, the Under- for upwards of two years with a singular spasmodic affecSecretary of State for Foreign Affairs, in answer to a question tion. It consisted essentially of a hiccough, the spasm being put by Mr. Twells in the House of Commons on the 26th inst., inspiratory and distinctly diaphragmatic, differing, however, gave the following statement of the deaths from plague in from ordinary hiccough in two particulars. The contractions were always double, and they were less sudden and jerky, Bagdad to the end of the second (?) week of June :-February the vibration of the vocal cords producing a deliberate note. These and March, 259; April, 1707; May, 1550; June, 143. he was not free from paroxysms for five minutes Ordinarily figures are merely approximative. The later Ottoman official together. When conscious of being observed, however, or returns from Mesopotamia have either been very irregular while talking, he would be attacked with a series of double and imperfect, or else they have not been made public during hiccoughs almost every minute. Lately his rest had been the confusion arising out of the deposition and subsequent very much disturbed from this cause. The physical and mental anguish which this man suffered, suicide of the Sultan Abdul Aziz. All, however, show a to his own account, is worthy of note. The conaccording great falling off in the prevalence of the disease. Thus, in stant spasms, besides being by themselves a source of perHillah, where, during the week ending the 28th April, petual annoyance and fatigue, necessarily became the 245 cases of plague and 148 deaths from the disease were solitary theme of his thoughts and fancies, utterly banishing recorded; the numbers recorded in the week ending the repose of mind. When he went out of doors, too, it was 19th of May were 68 cases and 111 deaths; and in the week only to be made the subject of curiosity, sympathy, and perhaps ridicule. There was, indeed, something intensely ending the 26th of May 46 cases and 36 deaths. In ludicrous in the serio-comic cacklings-they resembled Bagdad the deaths from plague, which had numbered 399 cacklings more than any sound I know,-heightened by the during the week ending the 29th April, had fallen to 162 grotesque appearance of the subject himself. during the week ending the 27th May; and the latest reports As to the cause, I could gather nothing more than that it state that there have been in the present month three or came upon him gradually after having suffered from a severe four days without new cases of the disease. In Kerbella, cold. There was no pain whatever, and in other respects Nedjef, Imam Musa, and elsewhere, plague has either con- the subject was apparently healthy enough. He consulted siderably diminished, or has died out, or has become upwards of half a dozen doctors and a druggist, who predormant. scribed abundantly and with great assurance, but without With the news of the rapid decline of plague in Meso- the least relief. I treated him with large doses of bromide of potassium potamia comes also the news of its appearance in Persia. Some little time ago it was rumoured that plague had again and assafaetida, and he began immediately to improve. In appeared in Persian Kurdistan, and about the same time it less than three weeks he was quite cured, to his great was said to have broken out at Kerkuk in Turkish Kurdistan. delight. It is now six months since he was free of it, and A recent Russian telegram announces the appearance of the there has been no recurrpncp. It may have been reflex or disease in one of the southern districts of Persian Kurdistan, sympathetic irritation, traceable to the stomach, duodenum, and so much weight does the Russian Government attach to liver, pancreas, or spleen; but then it lasted steadily for this report that it has adopted precautionary measures twenty-four months and rapidly yielded to simple antispasagainst possible dissemination of the disease to Southern modics. Could it have been a tumour pressing upon the Russia by way of the Black Sea navigation. There would, eighth pair of nerves ?-if so, would there be complete imhowever, appear to be little doubt that plague has passed the munity from symptoms for six months together, after it had Turco-Persian frontier at a more southerly point, and entered lasted steadily fur two years ?P Khuzistan. Shuster, on the river Karun, is said to have Truly yours, been attacked, and, this being true, it is hardly to be hoped J. A. AUSTIN, M.B. "
that the district intervening between this town and the Ottoman frontier will have escaped. Dr. Dickson, the physician to the British Embassy at in THE LANCET for 1873, vol. ii., page 549. Sections of the Constantinople, in a letter to The Times of the 21st inst., has decidua serotina and maternal placenta of this specimen endeavoured, but unsuccessfully, to set Messrs. Gray, Dawes, showed, under the microscope, a few uterine glands, but so and Co. right as to the existence of plague in Mesopotamia. few as to remove all doubt that the villi were connected But that firm, ignoring Surgeon-Major Colvill’s opinions with them. The specimen showed also the early develop- formed on personal observation of the disease, does not hesitate ment of the maternal sinus system in the existence of large also to question Dr. Dickson’s conclusions. So little is the in the Levant that it blood-containing spaces, with thin epitheliated walls-in firm acquainted with sanitaryis matters the British representative on is unaware that Dr. Dickson fact, little else but greatly dilated capillaries. the Ottoman Sanitary Administration, and of necessity has coming under his observation all the official information communicated to the Ottoman Government on the subject. THE PLAGUE. Messrs. Gray, Dawes, and Co. refer to the Government for information on the subject, but when the two Government WITH the commencement of the hot season in Mesopotamia official medical reporters, Dr. Dickson and Surgeon-Major Colvill, disagree with them, they do not hesitate to reiterate plague manifestly declined, and now that that season has their own foregone conclusion, and put aside as of no moment fully set in it is reported that the disease is rapidl3 the opinions of the responsible medical reporters of the ceasing. A like course was followed by the disease in tht Government. As the statement of the Government on the two previous years of prevalence, and in those preced. plague, in the House of Commons on the 26th inst., would be ing outbreaks of plague in Mesopotamia of which we havt founded upon the reports of Mr. Colvill and Dr. Dickson, we It appears to be the rule of plague in presume that this will prove equally unconvincing to Messrs. a definite knowledge. the lower valleys of the Tigris and Euphrates, to become Gray, Dawes, and Co. Whatever may be the vexations of it is difficult to understand how the British active in the winter, attain its most considerable develop. quarantine, Government can help British merchants in obtaining an ment in spring, and decline and die out, or become dormant, amelioration of them if this is a sample of the temper in in the summer. This seasonal variation of prevalence cor- which they deal with so difficult a question. responds with that which was formerly observed in Egypt, but differs considerably from that which held good in more The winter," says Volney (quoted by southerly countries. A UNIQUE CASE. Gavin Milroy), 11 stops the plague at Constantinople because To the Editor of THE LANCET. the cold is great, and the summer lights it up because the SiR,-I beg to send you brief notes of a case which heat is then humid; while in Egypt the winter favours it to me rather singular, and would be glad to hear appeared because the climate is then warm and moist, and the summer if any of your readers have met with its parallel in practice. stops it because it is hot and dry." The heat is only injurious An old man, about sixty years of age, had been affiicted when associated with humidity. Mr. Bourke, the Under- for upwards of two years with a singular spasmodic affecSecretary of State for Foreign Affairs, in answer to a question tion. It consisted essentially of a hiccough, the spasm being put by Mr. Twells in the House of Commons on the 26th inst., inspiratory and distinctly diaphragmatic, differing, however, gave the following statement of the deaths from plague in from ordinary hiccough in two particulars. The contractions were always double, and they were less sudden and jerky, Bagdad to the end of the second (?) week of June :-February the vibration of the vocal cords producing a deliberate note. These and March, 259; April, 1707; May, 1550; June, 143. he was not free from paroxysms for five minutes Ordinarily figures are merely approximative. The later Ottoman official together. When conscious of being observed, however, or returns from Mesopotamia have either been very irregular while talking, he would be attacked with a series of double and imperfect, or else they have not been made public during hiccoughs almost every minute. Lately his rest had been the confusion arising out of the deposition and subsequent very much disturbed from this cause. The physical and mental anguish which this man suffered, suicide of the Sultan Abdul Aziz. All, however, show a to his own account, is worthy of note. The conaccording great falling off in the prevalence of the disease. Thus, in stant spasms, besides being by themselves a source of perHillah, where, during the week ending the 28th April, petual annoyance and fatigue, necessarily became the 245 cases of plague and 148 deaths from the disease were solitary theme of his thoughts and fancies, utterly banishing recorded; the numbers recorded in the week ending the repose of mind. When he went out of doors, too, it was 19th of May were 68 cases and 111 deaths; and in the week only to be made the subject of curiosity, sympathy, and perhaps ridicule. There was, indeed, something intensely ending the 26th of May 46 cases and 36 deaths. In ludicrous in the serio-comic cacklings-they resembled Bagdad the deaths from plague, which had numbered 399 cacklings more than any sound I know,-heightened by the during the week ending the 29th April, had fallen to 162 grotesque appearance of the subject himself. during the week ending the 27th May; and the latest reports As to the cause, I could gather nothing more than that it state that there have been in the present month three or came upon him gradually after having suffered from a severe four days without new cases of the disease. In Kerbella, cold. There was no pain whatever, and in other respects Nedjef, Imam Musa, and elsewhere, plague has either con- the subject was apparently healthy enough. He consulted siderably diminished, or has died out, or has become upwards of half a dozen doctors and a druggist, who predormant. scribed abundantly and with great assurance, but without With the news of the rapid decline of plague in Meso- the least relief. I treated him with large doses of bromide of potassium potamia comes also the news of its appearance in Persia. Some little time ago it was rumoured that plague had again and assafaetida, and he began immediately to improve. In appeared in Persian Kurdistan, and about the same time it less than three weeks he was quite cured, to his great was said to have broken out at Kerkuk in Turkish Kurdistan. delight. It is now six months since he was free of it, and A recent Russian telegram announces the appearance of the there has been no recurrpncp. It may have been reflex or disease in one of the southern districts of Persian Kurdistan, sympathetic irritation, traceable to the stomach, duodenum, and so much weight does the Russian Government attach to liver, pancreas, or spleen; but then it lasted steadily for this report that it has adopted precautionary measures twenty-four months and rapidly yielded to simple antispasagainst possible dissemination of the disease to Southern modics. Could it have been a tumour pressing upon the Russia by way of the Black Sea navigation. There would, eighth pair of nerves ?-if so, would there be complete imhowever, appear to be little doubt that plague has passed the munity from symptoms for six months together, after it had Turco-Persian frontier at a more southerly point, and entered lasted steadily fur two years ?P Khuzistan. Shuster, on the river Karun, is said to have Truly yours, been attacked, and, this being true, it is hardly to be hoped J. A. AUSTIN, M.B. "