429
Remarks.—Modern writers hardly mention relapses in plague and I should think they were very uncommon. LIEBERMEISTER however states "Genuine relapses may also take place." [Ziemssen Cyclopedia of the Practice of Medicine, 1874].
SUICIDAL CUT THROAT. TETANUS. ACUTE MANIA. DEATH.
A Chinaman was admitted on August 12th with a history of having first murdered his wife and then cut his own throat.
Patient had a jagged wound opening into the trachea and had evidently lost a good deal of blood. He went through an attack of septic pneumonia but in fourteen days' time was doing well.
On September 5th as there was trouble in breathing a tube was inserted and kept in for ten days.
On September 16th he suddenly developed tetanus the fils being ushered in with trismus. Resus sardornicus was well marked and opesthotonos occurred
several times.
He had gr. morphia hypodermically and 4 drams of ammon: bromid: every 3 hours. Whilst under chloroform he was fed by a tube and three doses of 30 miuims of carbolic acid given.
In 48 hours he had apparently recovered being conscious, without fits all the previous 12 hours and taking his food by mouth.
On the 19th be became maniacal, being very restless with occasional slight fits, laughing and trying to talk and get out of bed. He had bromide but continued in the same restless demented condition and died on the 30th September-six weeks after the injury.
Pust-mortem.—Nothing was discovered to account for the condition.
Remarks.-The incubation period of the tetanus was somewhat long-nearly five weeks. The fits were bad and very frequent so one may claim that the energetic treatment cured the disease. The bacillus was not found either in the wound or on the knife. The mania which eventually killed the patient was probably the original cause of the whole trouble of murder and suicide.
I am much indebted to Dr. HUNTER, Government Bacteriologist, for seeing the case several times and for kindly making the post-morten examination.
CASE OF PHTHISIS. DEATH FROM TUBERCULAR MENINGITIS.
A Chinese lukong aged 32 was admitted to hospital on 24th September, with cough and fever. There were well marked signs of phthisis of the left apex and the sputum was full of tubercle bacilli. The fever was of the remittent type vary. ing between 103° and 101° (without any malaria) but the patient looked and felt fairly well.
On 30th September he suddenly became delirious and very irritative resisting any attempt at examination. The following day it was necessary to feed him by nasal tube but he was much quieter though quite unconscious. He gradually
sunk and died on the 3rd October.
Post-mortem.Well marked signs of phthisis of left apex. Meninges slightly congested and slight increase in the amount of cerebral fluid. On carefully examination a few small nodules were found at the base of the brain mears from which teemed with tubercle bacilli.
Remarks. This is a very uncommon ending to a case of phthisis especially in an adult. The sudden onset and rapid termination are also rare. The signs after death were very slight and might easily have been overlooked but for the usual smear preparation as the tubercular nodules or rather spots were very few and very indistinct and only on the base. I cannot find any mention of a similar ending to a case of acute phthisis.