THE HEALTH OF THE AMIR OF AFGHANISTAN.

930 known than in his final testament. His character, his opinions, beliefs, regard for other men, purposes, hopes, disappointments, hobbies, all find expression here. Happy ’I is the man, especially if he be wealthy, who knows how to shape the future of the goods he must relinquish. We are disposed to treat the rich man’s obligations somewhat liberally. First of claims, naturally comes that of the family. With some men it is last as well as first ; with , others, admittedly unnatural in their neglect, it finds no place. First it stands, nevertheless, in the law and custom of all time. But there remains in many instances an additional and substantial tribute which is not and need not be thus absorbed. In the assignment of this residue a man’s true character will usually make itself apparent : it is as if his ideal of life were minted in his gift. To one man his fellow’s barren mind requiring cultivation will especially appeal ; to another it is such a mind in its mystical attitude of soul or spirit, helpless of means to connect it with the inspiring centre of all good ; with a third, the physical or social aspects of life will present themselves as most urgently in need of material amelioration. Each project is in its way a worthy one, and our times, no less than those which have preceded them, can point to examples which at every turn in life’s road stand out as the signs of brotherhood and generosity. May this continue, and the recent munificent grants to certain Manchester Hospitals from the"David Lewis Fund "; the bequest of .E12,000 to the Lincoln County Hospital by the late Miss Ana Well, and the charitable will of the late Mr. Edward Hollingworth Penfold show that our institutions for the benefit of the sick poor are suffering from no present neglect.

252

deaths ;

for

September, 1893, 314,

and for

September,

213 deaths ; for the first two weeks of October, 1893, I, 1894, and and for 120 for those of

DIPHTHERIA IN LONDON. JUDGED of by the returns of mortality, the records for last week show a decline in the epidemicity of diphtheria in the metropolis. The deaths registered from the disease, which had been 67 and 66 in the two preceding weeks, fell last week to 54, a decline of some 18 per cent. They, however, exceeded the corrected decennial average for the week by 19, and were widely distributed over London, 9 belonging to Camberwell, 4 each to St. Pancras and Limbeth, and 3 each to Hackney, Islington, and Mile-end Old Town districts. The admitted cases numbered 106, and showed an increase over the two previous returns, which were 90 and 98 respectively. On Saturday last the number of

diphtheria patients remaining under treatment was 521, a rise of 26, 25, and 19 on the three preceding weeks. Thus, attacks have shown disposition to increase, though the fatal form has diminished. Taking the fortnight ended Oct. llth, we find from the returns of the Metropolitan Asylums Board that the notified cases of the disease in London numbered 479 as compared with 499 in the previous two weeks, but that the cases under treatment in the hospitals of the Board rose from 411 to 448, the accommodation for the treatment of the disease probably accounting for this increase. It was only on the second day of jthis present month that the beds available were equal to the demand made on them for many days previously ; and two wards, containing forty-eight beds, are to be given up for the treatment of the disease by the Fountain Hospital in consequence of the pressure on the accommodation in other institutions. Of diphtheria in its non-fatal form there is without doubt morejust now than in like periods of the past two years in London, the figures being for the fortnight ended the llth inst. and the corresponding fortnights in 1893 and 1892 thus : Cases admitted in 1894, 448 ; in 1893, 276 ; and in 1892, 305. But with deaths it is far otherwise as compared with last year, the data being for Jaly, 1893, 244, and for July, 1894, 176

deaths ;for August, 1892, 302,

and for

August, 1894,

deaths;

October, 1894,

160,

the whole period of fifteen weeks in 1893, 1020, and in 1894 761 deaths, the latter being upwards of 25 per cent. below the records of 1893. It would thus appear that we have this year to deal with a disease of a milder form.

THE HEALTH

OF THE AMIR

OF AFGHANISTAN.

IT is a somewhat remarkable coincidence that two rulersthe Czar of Russia and the Amir of Afghanistan-on whom the maintenance of peace so greatly depends should be suffering at the same time from a similar malady. The exact nature of the Amir’s illness and his present condition are not officially known, but there is every reason to believe that His Highness is suffering from some complication of an acute kind arising out of chronic renal disease, and that he is seriously ill. He has repeatedly suffered from and from attacks of fever, probably of gout, occasionally malarious origin ; and if it be true, as alleged, that internal haemorrhage is one of the symptoms of his present illness it is quite possible that this may be attributable to some visceral congestion the result of chill and previous climatic disease. Malarial fevers are of common occurrence in the Peshawar Valley and the Khyber at this season. It must be remembered that in the winter of 1890 His Highness was in a very serious state from gout and renal and other complications. The report on his case in our columns from the pen of his English medical attendant stated that there was "gout in every joint." The right shoulder, elbow, wrist, and knee were particularly affected, while the serious complications o!f pleurisy and cystitis, with albuminuria., were present. Such a condition three and a half years ago must inevitably lead us to regard a recurrence of any of the symptoms, whether complicated or not by malaria, with much apprehension. The gravest issue may well be anticipated. Officers of the medical staff who took part in the late Afghan campaigns, and possess a know. ledge of that country and an acquaintance with its different hill tribes and factions, will readily appreciate the gravity and political significance of this news. The personal influence of the Amir-who is known to be a firm but just ruler and a man of decision and ability-with the various tribes in Afghanistan is very considerable, and the cessation of his rule might easily lead to serious political complications.

THE

EPIDEMIC AT THE

RICHMOND LUNATIC

ASYLUM, DUBLIN. THE epidemic that has broken out among the patients of the Richmond District Asylum, Dublin, appears, from information we have received, to be identical in its clinical features with beri-beri. There have been altogether about 150 cases, of which seventeen were fatal. Eighty-five cases are still under treatment. We are informed that, speaking generally, the cases have presented themselves under the snbacute form (Scheube) or mixed type of Da Sylva Lima. The earlier cases appeared to begin with cedema of the legs. In many cases this passed off, and after a brief period wasting and tenderness of the calf muscles appeared, and the patient passed into the dry atrophic or paralytic stage. In some cases, however, the oedema became general and extreme. Death has usually resulted from cedema of the lungs, sometimes from heart failure (occasionally rather sudden), never from laryngeal trouble. Ascites is rare, pleural effusion common, hydro-pericardium occasional. The characteristic heart symptoms are usually well marked. Peripheral neuritic conditions are well marked in the lower extremities; in only one case have they been well marked in the upper. Not infrequently cases which have passed through an initial I

wet"

period of well-marked oedema and have become wasted

I