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kind is rare unless the patient has been previouslyaffected in the same way. Attacks of an hystericalnature soon after recovering consciousness are not atall infrequent among emotional persons. In these there

may be great excitement. Delirium lasting for somedays has been known to follow anaethesia. There mayalso be speech defects, and loss of speech certainlyfunctional in character has occurred after a shortinhalation of nitrous oxide, without, however, persistinglong. It is noticeable that Surgeon Lieutenant-Com-mander A. B. Clark’s patient was, apparently, the kindof subject in whom congestion of the vessels of the headis particularly apt to occur during narcosis, and that hewas inhaling anaesthetics for a long space of time, overtwo hours. It appears that, whether there was a

structural lesion or not to account for the motor

aphasia, there was certainly present also an emotionalcondition of the mind not very infrequent afteranaesthesia in neurotic people. The mental, or as

Dr. Dudley Buxton calls them, ".quasi-mental,"phenomena which occur during and after narcosisprovide an interesting and a little-trodden field for

investigation. It is probable that wide study wouldreveal a number of curious mental after-effects, of !,,longer or shorter duration, in persons who have been ’,through anaesthesia-effects which, up to the present,have been little noticed and are quite unexplained.

THE MEDICAL DIRECTORY.

THE Medical Directory for 1921 makes its appearancebetimes. It is specially welcome in view of the generalpost which has marked the settling down to morenormal conditions of medical practice. The slow rateof demobilisation of temporary military and navalmedical officers and their difficulty in securing suitableconsulting-rooms when released from military dutyhave made the last two issues of the Directory indis-pensable for reference. The 1921 volume is nearly thesame size as its predecessor. The numerical summaryof the medical profession, which is a little hard to findin the present issue, shows 44,926 names, an increase of666 over 1920. Two more pages are devoted to the services,five more to dental surgeons, and eight more to practi-tioners residing abroad. An alteration in paragraphinghas crowded out the asterisks which used to indicatethat the infirmation given had not been confirmed bythe return of the annual circular. We trust that thiswill not lead to any less diligence on the part of pub-lisher or of those who supply the information in keepingthe record scrupulously up to date. It is true thatthe Directory has no legal value as evidence, but it isnevertheless freely used by public bodies for supple-menting the exiguous record of the Medical Register.We regret the dropping of a useful summary of theprincipal laws affecting the medical profession, andhope to see it again next year in revised form, alongwith the list of spas and health resorts abroad. I

Such little up-to-datenesses are welcome as the per- ’,sonnel of the Medical Research Council and of themedical department of the Board of Education. The

distinguished medical staff at the London County Councilstill remains anonymous. The Directory is, however,as nearly perfect as most human things.

THE progress of plague, yellow fever, and cholerathroughout the world, for the first three years of the

. duration of the war, is the subject of a Report madethis week by Dr. R. Bruce Low to the Ministry ofHealth. It will be read with interest in connexionwith epidemic threats to the world.

LOCAL AUTHORITIES AND THE IRISH L.G.B.-During the past few weeks the Local Government Board inIreland has obtained conditional orders of mandamus againstsome 20 or 30 local authorities, including the Corporation ofDublin, directing them to produce their books for audit. Onthe other hand, a few local authorities, notably the CountyCouncil of Galway, which had adopted resolutions decliningto recognise the Local Government Board, have rescindedthese resolutions and expressed their willingness to abide by

. the usual regulations. There are hopes that some workingmethod may be devised so that the usual grants will beforthcoming.

CHOLERA IN TURKEY AND ADJOININGCOUNTRIES SINCE 1914.

BY F. G. CLEMOW, C.M.G., M.D.,BRITISH DELEGATE, INTER-ALLIED SANITARY COMMISSIONS,

CONSTANTINOPLE.

IN a former letter (THE LANCET, Nov. 20th) I gave abrief account, based upon unpublished Turkish records,of the prevalence of plague in various parts of theformer Turkish Empire since 1914. In the present Ishall endeavour to do the same for cholera, adding,however, some information from other (mostly official)sources upon the disease in some adjoining countries.The figures must be accepted with the same limitationsas those for plague. Like the latter, the Turkishfigures are said to include both military and civilreturns.The severe epidemic of cholera in and near Con-

stantinople during the Turco-Balkan War (1912-13) willbe recalled. A revival of the infection occurred inAugust, 1913, and from then to the end of the year191 cases, 13 suspected cases, and 82 deaths wereregistered in the capital. In 1914 the returns were asfollows :-

Between July, 1914, and May, 1916, there is no mentionof cholera in Constantinople. But between May 19th,1916, and Feb. 14th, 1917, 291 cases with 139 deathswere recorded in the capital, followed by 10 cases andand 6 deaths in March, 16 cases and 12 deaths in April,2 cases and 1 death in May, and 1 case in June.Another apparently cholera-free interval of over twoyears followed ; then on August 25th-26th, 1918, 2 caseswere seen, between Sept. 6th and 13th 5 fatal cases,and on Dec. 1st 1 case. In March, 1919, a case of

laboratory infection occurred; and in May, July, andAugust a few cases, some confirmed, some onlysuspected, were again recorded. The capital has sincebeen free from the disease.Some pre-war figures of cholera in other parts of

Turkey may also be quoted as forming links betweenthe past and present records. In January, 1914, thefollowing returns were made:-

I A more serious outbreak occurred at Adrianople, asshown by the following figures :- .

Some later cases were seen at Trebizond and theDardanelles, and a few cases were recorded in Kirk-kilisse, Eregli (near Koniah), and Yanina.There appear to be no records of cholera in any part

of Turkey in the year 1915. Passing mention may bemade of a return of 3 cases of the disease in Kazvin inNovember, 1915, and of 10 cases with 7 deaths inKermanshah in July, 1916 ; but these are Persian towns,and are only incidentally mentioned in the Turkishreports. In the spring of 1916 cholera reappeared inmany parts of Turkey, and an epidemic of considerableseverity followed, as shown by the following figures.From this table it will be seen that the epidemic was .

exceedingly widely spread, and that the highest figureswere returned from Smyrna, Damascus, and Aleppo,and from the neighbourhood of those towns.

’

After February, 1917, the records are less complete.Some portions of territory had already passed out ofTurkish possession ; others fluctuated between Turkishand Russian occupation ; from yet others returns wereirregularly received; and complete records exist onlyin the case of certain towns. From these it has been