EICHWALD.

Professor Eichwald now proposed that before suppressing the sanitary cordon the Commission should inspect the population of Vetlanka, in order to determine whether cases of plague still existed amongst them, and to take note of the character of the sequelae left by the outbreak.

This proposal was at once acceded to by the Commission, and Dr. Cabiadis was requested to attend at the inspection, seeing that he had already been present at two outbreaks of the plague in Mesopotamia. The inspection took place four days after this meeting had occurred, and as Dr. Cabiadis was not sent for to take part in it, he complained of the neglect to M. Alexandre Ossipovicz Pregenof, the correspondent of the Golos, and begged him to mention the fact to the Governor. The result was, that soon afterwards Professor Eichwald invited him to attend it; the room, however, in which it was to take place was extremely small, and, as Professor Biesiadecky wanted to be present during the whole of the inspection, and the other Commissioners had full confidence in him, Dr. Cabiadis voluntarily withdrew from it, and turned his attention to making inquiries amongst the local population.

Professor Eichwald was evidently vexed that the Commissioners had not signed Pelikan's report, for on the evening of March 3 (15) he said at Count Orloff Denisoff's, and in the presence of Hirsch, Biesiadecky, Cabiadis, and Zuber (the French delegate), that it was not in accordance with scientific research to elicit the details of an outbreak from the sayings of Cossacks rather than gathering them through one's own observations and experience, and that the Commission would have done better had it assisted at the inspection of the people instead of listening to the stories of Cossacks. As Hirsch also expressed himself in similar language to that of Eichwald, Biesiadecky asked him upon what grounds had he based his own opinion when he arrived at Vetlanka and telegraphed to his Government that the outbreak was one of plague, if not on the sayings of Cossacks.

On Sunday, February 25, while Cabiadis was following up his inquiries amongst the inhabitants, he was suddenly sum moned to Count Orloff Denisoff's residence, and from thence proceeded with the Count, Eichwald, some other Russian doctors, and the correspondent of the Golos, to a large open court, in the midst of which were strewn nineteen fez (Turkish red caps), 304 handkerchiefs of various sizes and colours, three knapsacks, a Turkish brass inkstand, and a valise belonging to a Turkish military saddle. On their way to this place they were met by an immense crowd of people, and as soon as they got there, Professor Eichwald, addressing himself to Cabiadis, spoke the following words :"Dr. Cabiadis, we have invited you to come here so as to show you these articles brought by the Cossacks from Kars, and which had belonged to the Turkish soldiers that had come from Bagdad. We trust, therefore, that you will no longer deny that the outbreak of Vetlanka owes its origin to these pestiferous articles."

Dr. Cabiadis replied:-"These fez have never belonged to the Turkish army; for neither the caps nor their tassels are in accordance with the Turkish Army regulations. They are the head-dress of civilians, and must have been obtained at shops, for they are of different sizes, to fit persons of different ages, from that of a child to that of an adult; and, besides, fifteen of them are quite new, and have never been worn at all."

Count Orloff Denisoff then declared that he had fought against the Turks and had seen them wearing similar caps. But Professor Petresco remarked that he too had served in the last campaign, and, according to his experience, the only article which could have belonged to the Turkish army was the saddle valise. As for the fez, he had seen similar caps worn only by the volunteers. Dr. Cabiadis then explained that, on the day previous to the arrival of the cavalry regiment at Salahié, a sheïk and his son, with a hundred

followers, came there from a tribe inhabiting a district five days distant from Bagdad. The plague had never visited this tribe; still, the sheïk and his followers were made to perform a quarantine of fifteen days. These people were volunteers, and did not wear the fez (red cap), but the kuffieh (a square handkerchief tried round the head with a cord), nor has Dr. Cabiadis ever seen Arab volunteers wear any fez at all. Besides (he added), even supposing that these articles had come from Bagdad by way of Kars, how could they have been the fomites or carriers of plague, when, setting aside the quarantine performed at Salahié, it is well

known

1. That no plague existed at Kars either amongst the population or amongst the Turkish or Russian army.

2. That the Cossacks who came from Kars had spent two months on their way from that place to Astrakhan; had always been in excellent health; had passed through and stopped in many towns and stations, and had communicated with thousands of persons, without ever having given rise to any manifestations of plague. After their arrival, moreover, at Astrakhan, they had dispersed amongst twenty-two villages, thirteen of which were in the province of Astrakhan, and nine in that of Saratoff, and yet neither they themselves nor the population of the numerous villages amongst which they had settled had shown the slightest sign of the plague

3. That the result of their inquiries had shown that the first case of plague was noted upon Mavra Pissareff, who, they say, went to Astrakhan to see her son, a Cossack, whom she supposed had returned from Kars. She did not see him, however, because he had not yet come back. Mavra, on that occasion, slept for five successive nights in a boat which had come from Nicolskoi (a village on the right bank of the Volga) with ten other passengers. On the third day she fell ill, and sent for her relative, Ivan Huritonoff, who, after a delay of two days, came to her, and finding her dangerously ill, carried her to the church to receive the communion, and then put her into the steamer which conveyed her back to Vetlanka on that very same day. As soon as she arrived there, she took to her bed, and died after three days (viz., on the 17th). From this starting point the malady spread from person to person and from family to family throughout Vetlanka, and from thence to the other villages. (To be continued.)

HYSTERIA IN THE MALE SEX.

By ROBERT SAUNDBY, M.D. Edin., Member of the Royal College of Physicians, and Assistant-Physician to the General Hospital, Birmingham.

MM. BOURNEVILLE AND D'OILLER have published, in Le Progrés Médical for November 20 and 27, 1880, an account of a case of hystero-epilepsy in a boy of thirteen, as a contribution to the study of hysteria in the male sex. This boy had hemianasthesia of the right side, affecting the special senses, and partial colour-blindness. There were numerous hysterogenic zones or areas, pressure upon any of which was followed by a fit. These fits were epileptiform, being preceded by an aura, and having their stages of tonic spasm, clonic spasm, and delirium. The boy's mind was never affected. Metallic bracelets and magnets caused transference of the hemianæsthesia, but could not effect a cure. Attempts to hypnotise him failed. He was cured by the douche.

As the study of hysteria has taken a new departure since so much light has been thrown upon it by the labours of Charcot and his colleagues at the Salpêtrière, and as wellmarked cases of male hysteria are not common in our literature, the following case, which presents many curious features, may not inopportunely follow the publication of that just described :

J. W., (a) aged thirty, married, a house painter, applied as an out-patient, on May 25, 1880, complaining of pain in the chest and between the shoulders. His tongue was furred, bowels confined; nothing abnormal in thoracic or abdominal organs; a strong blue line on gums; no albumen in urine. The case was diagnosed as plumbism, and treated with a mixture containing magnesium sulphate, iodide of potassium, and tincture of opium, and he was ordered to take a warm bath twice a week.

(a) The early part of this case was published in the Birmingham Medical Review for July, 18:0.

Personal History.-The following facts were learnt later on in the case :-He does not recollect any illness until he was fourteen, when he had a "sunstroke" while he was employed painting a window at St. Peter's Church, Walsall. He was standing on a ladder about eight feet from the ground, when he fell, and was taken up insensible. He remained unconscious for three or four hours, and afterwards suffered from giddiness and lightness of the head. Three months after this he had his first attack of what he himself called "hysterics," and has continued to have similar attacks at long intervals-six months, and once eighteen months intervening-till the present time. Seven or eight years ago "his right arm shook for a fortnight." He never had any fits as a child.

Family History.-Father died at forty-seven, of apoplexy. Mother still living, and in good health. There are two brothers and two sisters all in good health. No one suffers from fits or hysteria. No insanity in family.

Progress of Case.-June 1.-No better.

5th.-Patient came to show his left hand, which was firmly clenched, and looked cyanosed. He stated that on Wednesday evening (three days ago), as he was taking his supper, both hands were spasmodically flexed so that he could not let go his knife and fork. This went off in about half an hour, but on Thursday morning, about eleven o'clock, the left hand "went altogether." At present the fingers of the left hand are firmly flexed on the palm, the thumb lying over the fingers. The fingers are slightly cyanosed, and the hand feels a little colder than the other. There is slight numbness on the palmar aspect, but no definite anæsthesia. No anæsthesia in the right arm. The movements of pronation and supination are free, but the wrist can be flexed and extended very imperfectly. It gives pain to attempt to force the hand open. After the application of gold (a sovereign and a half-sovereign) for twenty minutes, loss of sensibility in the opposite forearm and hand, without any remission of the previous symptoms. The gold was then applied to the right arm for twenty minutes, after which sensation completely disappeared in the left hand and lower part of forearm, but returned completely in the corresponding parts on the right side. Silver had no effect. Both poles of constant current, and unipolar excitation on an insulated stool, were quite ineffective.

8th.-Gold (two half-sovereigns) applied to left arm at 9.25 a.m. after twenty minutes no change. Gold re-applied 9.50 after twenty minutes no change. Re-applied to right arm at 10.25 without any result. 11 a.m.: A piece of copper wire to which a piece of zinc was soldered was dipped in acetic acid and applied to the left arm. Arm faradised for twenty minutes: the muscles reacted, but were unable to overcome the spasm of the flexors.

9th. After fifteen minutes' faradism the thumb and index could be passively extended.

10th. The second finger could be extended by force after faradising. He began to-day to wear a zinc and copper bangle with a pledget of wet calico put between it and the skin. 11th. The remaining fingers were extended by force, but this could not be effected by stimulating the extensors by the battery.

12th. The fingers are semi-flexed, and can be partially extended by the battery.

13th. Slight improvement.

14th.-The extensors respond to battery almost normally, and the patient can voluntarily partially extend his fingers. 15th.-Partial voluntary flexion and extension. Anæsthesia of left hand and wrist unchanged. No affection of sensation in right hand and wrist. Two sovereigns were applied to the front of each forearm successively for twenty minutes, without producing the least change. Faradic current given for ten minutes, when muscles responded almost normally.

17th.-Can extend hand now pretty well. Not faradised yesterday owing to battery being out of order. No alteration of sensibility since last note. Faradism given for ten minutes, with same result as on June 15. Bangle discontinued.

18th.-Voluntary extension was not quite so free as yesterday at first, but became better afterwards. Muscles responded normally to faradic current. Anesthesia unchanged. 19th.-Same result as yesterday.

21st.-Extends his finger very well; muscles respond well; sensation unchanged. Yesterday, while patient was asleep, his wife noticed that his right lower extremity

twitched, and this morning he complains of pain down the course of the great sciatic nerve.

22nd.-Sensation has returned to the left arm down to the flexure of the wrist, and over about half an inch of the outer part of the thenar eminence. Complains of pain in the course of the right sciatic nerve, and says that yesterday afternoon when he was asleep the leg jerked about. On giving the continuous current great pain was caused by applying the pole to the following situations, viz.:-1. Popliteal space (middle). 2. Just below the patella. 3. Outer side of upper epiphysis of fibula. 4. Close to the internal condyle. 5. Junction of middle and lower third of calf. Ordered constant current, twenty cells, for twenty minutes to right leg. This was given, with no result at that time.

23rd. Same treatment was given, but with no result as regards the lower extremity. The pain is quite as bad as yesterday. Forearm movements still improving; anesthesia gradually diminishing.

24th. The area of sensation is passing slowly downwards, and now extends for about one inch and a half on the back of the hand, and over the whole of the thenar eminenceand the radial side of the palm. Both batteries given, with same result as yesterday.

26th.-Faradism for ten minutes; continuous current for fifteen minutes. Arm slowly improving. Pains in his legs are not so severe, although patient says the legs twitch about in his sleep quite as much.

29th.-Sensation has returned pretty well all over the left hand. He can open it now quite freely. The blue line has not quite disappeared from his gums.

One evening about this time he was brought into the hospital in what was diagnosed and treated as a hysterical fit, but I was not present.

July 13.-Returned with left hand as firmly contracted as ever. Battery has been omitted for a few days. He has not been at his work.

17th.-Came up complaining of slight conjunctivitis in right eye. This was treated by a zinc sulphate collyrium,. and gave no further trouble.

29th.-Complains of a choking sensation, as "if a ball was coming up in his throat." His hand remains contracted now in spite of the battery.

From this time he remained in the same state. The battery was discontinued, and he came up now and then for medicine.

October 12.-To have battery to extensors of left band and wrist three times a week.

19th. He was brought into the hospital in a cataleptic condition, having had a fit in the street. The left hand could be moulded easily, and was placed upon a splint and bandaged to it in the position of extension. He was allowed to come round spontaneously, and went home.

26th. The splint was removed, and the hand showed no tendency to resume its contracted position. He was cautioned to keep it in use, and not to allow it to become flexed.

December 8.-He has been seen frequently since, the last time yesterday, and the hand has kept quite well.

The diagnosis of hysteria was not made till after some time had elapsed. The existence of symptoms of leadpoisoning, in which Debove has recorded the occurrence of hemianæsthesia, amblyopia, achromatopsia, amyosthenia, loss of smell, taste, and hearing (Le Progrès Médical, Nos. 6 and 9, 1879), made me for some time inclined to attribute the nervous phenomena to this cause. Had I known the patient's previous history I should have escaped this mistake.

HEMIGLOSSITIS.-Dr. Cameron, of the United States Navy, observes that the rarity of this affection, and our ignorance of its true cause, renders it desirable to place every case on record. A private of marines, aged twentyseven, was admitted to the hospital with sore throat and erysipelas, and five days after was attacked with hemiglossitis on the right side. The tongue was enormously enlarged, preventing swallowing and impeding respiration to such an extent as to require tracheotomy. Incisions of the tongue, rectal alimentation, and stimuli all proved of no avail, the patient dying on the seventh day. In the cases hitherto on record the glossitis occupied the left side.-New York Med. Record, November 27.

BULLET WOUND OF THE LUNG PHLEBITIS RECOVERY.

(Under the care of Mr. BELLAMY.) [FOR the following notes we are indebted to Mr. HAYWARD WHITEHEAD, F.R.C.S. Eng., Surgical Registrar.]

Hermann H., aged twenty-three, a German tutor, who, being unable to find employment, had enlisted in the army, was admitted on July 28, 1880. On that night he had attempted suicide by shooting himself with a revolver. The bullet entered the left side of the chest a quarter of an inch below the nipple, and one inch and a quarter to the inner side. He was immediately brought to the hospital, and on admission presented the following appearance: -He was in a state of extreme collapse; pulse almost imperceptible, breathing sighing, and intensely blanched; he was almost unconscious. The wound, which appeared very small, was bleeding profusely, especially on any movement or on a deep inspiration, the hæmorrhage being arterial in character. There was slight emphysema around the wound, the edges of which were blackened and contused.

The patient was immediately conveyed to bed, his head and thorax raised, and an ice-bag applied to the wounded -side.

July 29.-Has recovered slightly from the shock; the pulse is still extremely feeble, and the respirations sighing; the hæmorrhage has ceased; he has no cough; the injured side of chest does not expand on respiration.

30th.-Passed a very good night; very prostrate and depressed; no more hemorrhage from wound; his face extremely pallid; pulse very feeble and irregular.

August 1.-Ice-bag left off to-day. Has a slight cough now; the expectoration is bloody in character, but little in quantity; complains of very severe pain in the chest Temperature this evening 99°.

3rd. Bloody expectoration still continues. On examination it was found that the lower part of pleura was filled with fluid, and complete dulness extended up to past below the angle of the scapula. Vocal fremitus and respiratory murmur quite lost up to this line. The heart was pushed to the right side, the apex beating in the epigastrium. Pain very severe in left side. Ordered six ounces of brandy.

5th. The temperature has been gradually ascending the last two days, and this evening stands at 100.1°. The expectoration is rusty; pulse fast, but small; has a rather flushed appearance this evening.

6th.- Continues in much the same state, but dyspnoea more urgent; the wound is inflamed, and poultices have been ordered for the area of inflammation round the wound Temperature—morning 100·4°, evening 101·4o.

8th.-Temperature still keeps up at 101°. Expectoration rather greater, but not so rusty; dyspnoea not so great. Complains of great pain. Dulness on percussion the same.

10th.-Is much better to-day. Very slight expectoration, and less pain; feels easier. Temperature-morning 98.3°, evening 100.3'.

13th.-Dulness on percussion growing smaller, and more expansion on injured side. Wound nearly healed, discharges slightly. Complains to-day of some tenderness in the left leg; on examination the veins were found (in the track of the saphena) hard and tender. Temperature-morning 98.4", -evening 101°.

15th. The left leg is being poulticed; it is very tender to touch. There are no rigors, but patient complains of a slight feeling of chilliness.

20th.-On the 17th the temperature in the evening was 102-4°. There was a great deal of pain in the left thigh about Scarpa's triangle, and the foot was swollen. There is now less swelling of the foot and less pain. Temperature in the evening 101 2°. The thoracic dulness is less and the breathing is easier.

26th. The temperature now is about normal. Patient bas had an attack of colic and diarrhoea, but is better now, and the swelling in the leg has much decreased. The lung

is clearing up, and the wound has nearly healed, but there is still a shallow ulceration at the seat of injury.

From this date patient continued to improve, but suffered from pain in the left side of the chest and palpitation of the heart on exertion. He continued anæmic, but was well enough to go to a convalescent home in the middle of September. The bullet was never detected; it was a small saloon bullet about half-inch by quarter-inch in dimensions. Patient was seen again in December, when he was in good health and free from pain or palpitation. He said that before the injury he had always been a healthy man, and had never had any weakness in the veins; the phlebitis had come on for the first time after the wound, and since then he had noticed that over the abdomen and in the legs there were frequently small lumps or swellings in the course of the superficial vessels.

NERVOUS STRAIN ON RAILWAY POINTSMEN. ON December 22 last, Alexander Ewing, a signalman, employed at the Pennilee signal cabin, on the Glasgow and Paisley Joint Railway, was tried in the Old Court, Glasgow, before Lord Young, on a charge of culpable homicide, or culpable violation or neglect of duty, in having been the cause of a collision on September 8 last, whereby five persons were killed and twenty-three persons injured. None of the facts of the case were disputed, and indeed Ewing, in his own statement, as much as admitted that he had He caused the collision by wrongly pulling the levers. pulled two levers instead of one, thereby placing a goods train on a wrong line, and then signalled it to go forward, so as to meet an express train which was due from Glasgow. How he had come to make such mistakes he could not tell, only "he was so put about." The only question was, whether there was culpable negligence, and, after hearing the case for the prosecution, Lord Young settled this in favour of the prisoner. There was no evidence, he said, that the prisoner was not at his post and attending to his duty to the best of his ability, and attending to nothing else. The mistake made by him was a grave misfortune, but there was no

high, and the effect of this heavy downfall was to fill rapidly all the drains and sewers at a time when the outfall of the main sewer was closed by the tide. Any sewer-gas would at such a time be driven backwards towards the dwellings, and in those houses where there was no ventilation of the soil-pipes, or where the sink-pipes were in direct communication with the drain, the foul air would be carried into the houses. Wherever a defective drain existed there would be an opening for the sewer-gas to escape; and wherever the defect was inside the house the air of the dwelling would become polluted. The same pipes that carry liquid and solid refuse from a house will, if improperly constructed, carry back the sewer-gas into a house."

There was a heavy rain-storm on August 26, and the foul air was driven backwards, but there was no outburst all over Worthing: it was limited to one or two houses in the same neighbourhood. Now, had the sewer-gas alone been the cause of the outbreak, we should have expected to find it wherever there were means for its escape, in every badly drained or badly ventilated house in Worthing, which certain side hints would seem to indicate is not absolutely perfect in sanitary arrangements. Dr. Kelly was evidently not satisfied with the view that typhoid could be generated by sewer-gas alone, for he adds, as a rider, that in Glo'sterplace, one of the spots where the fever prevailed, the houses "were small, and in many cases dirty and damp." To prove that the typhoid depended on sewer-gas alone, everything else should have been excluded.

But we are met by still greater difficulties. The fall of rain occurred on August 26. The first case recognised as typhoid occurred on the 28th. That means practically an incubation of twenty-four hours-something less than that commonly assigned to typhoid. The last case occurred on October 16 -something like eight weeks after the heavy rainfall and the eruption of sewer-gas. These two cases could hardly be due to the same cause acting similarly in the two instances.

Thus it stand, then, with regard to the sewer-gas theory. We know that in certain cases escapes of sewer-gas may give rise to typhoid, in others that it does not. In this clearly and carefully observed instance as investigated by Dr. Kelly we find him driven to seek for something more than the universal diffusion of sewer-gas, and we find recorded, over and above, the long interval between the first and last attacks. The first of these is by no means certainly connected with the rainfall and the high tide; the last still less so. Thus again we are driven to seek something else than sewer. gas as the cause of this outbreak. To our minds it is not hard to seek, and the clue is given in the next outbreak recorded by Dr. Kelly. The sewer-gas can at best be but a carrier of a specific poison-a poison which may also be carried by water,-but sewer-gas by itself alone, though it may predispose to disease of an evil form, cannot, we hold, be credited with the power of generating the poison of a distinct and specific malady. Once begun, and however begun, this poison may undoubtedly lurk in sewers and drains, and may by means of any current of air be carried thence; but we cannot believe that it originates there de novo,—at least, such an idea is against all common notions of logic. It is not in large towns and among a moving populace that the true clue to these outbreaks is to be sought. We are only surprised that Dr. Kelly has succeeded so well in his researches.

The last case reported of this sewer-gas epidemic occurred on October 16, but on October 14 a case of enteric fever occurred in "a well-built house," and this seemed to be the first of another group of cases not apparently connected with the former. Very soon it was found that this might be traced to the fact that all houses where cases occurred

were supplied with milk from one dairy. This dairy had in its back yard a well. This well had been used for many years, but had recently been cleaned out. “For the washing out of milk-cans the well-water was used." The cans appeared to have been "scalded" with water derived from a different Unfortunately it is not made quite clear which process came first, or, if the washing came first, what the temperature of the water used for the scalding process might have been. But that is of importance, inasmuch as if the scalding came last it would give us some idea of the temperature affecting the typhoid poison.

source.

At this point we find Dr. Kelly assuming a position we can hardly understand. We know what his thesis is-that typhoid comes of sewer-gas or sewage-impregnated water. He says, 66 So long as the well-water remained pure, no harm would ensue; but if by any mischance this wellwater could become polluted with any discharge from a patient suffering from enteric fever, then the washing of milk-cans with such a water might entail serious results, for the milk would become polluted, and the individual would be poisoned by drinking the fluid." Thus he here limits the fatal contamination to "discharge from a patient suffering from enteric fever." This is a totally different position from that assumed at first, and thus strictly limits the field of inquiry.

But if we know that typhoid fever can be produced by means of "discharges from patients suffering from enteric fever," why assume that another cause exists or is possible? If foul air and bad water may be used with impunity year after year, and suddenly, after known impregnation with enteric discharge, become fatal so far as the production of the disease is concerned, why, again we say, should the appearance of the malady where there is foul air or foul water be relegated to these factors, excluding the third, known in other cases to be the only potent one?

Briefly put, we have the question thus: Does typhoid fever ever appear from foul air or from foul water by themselves or is something more-in the shape of typhoid poison of an; organic kind, which grows and multiplies in a favourable soil such as that afforded by sewage-absolutely necessary?

It would greatly help us in this inquiry if we could make up our minds as to whether typhoid is directly infectious. Those who know much of the disease will have no great hesitation in affirming that it may be. True, in hospitals, where cleanliness is strictly insisted upon, such cases do not often occur; and it is always difficult to trace clearly the separation of the first attack from the second-that, namely, where a nurse has been infected by means of the discharges from a patient, and those which may follow by infection of her sister nurses in the ordinary way; but it may be done, and has been done; and again we hold that if one case alone is proved, that will suffice for many.

It has been assumed that the poison may be generated by intestinal excreta accumulated and exposed to heat and moisture, but we have never heard of a self-generated typhoid where the excreta were retained and under the most favourable conditions for that change which would produce the poison. To our thinking it is as clear as noonday, that whilst the spread of typhoid is closely and intimately associated with human excreta, there is no certain proof that it is ever begotten afresh from human excreta.

In all cases it may be well, in one sense, to insist on the importance of attending to faulty drainage, but to make this the principal matter is assuredly locking the stable door after the steed has been stolen. Cleanliness should begin at the beginning, and every discharge of a typhoid kind should, as soon as discharged, be effectually destroyed by disinfection or otherwise. Every time that a patient is touched, the hands should be washed in a disinfectant.