was given and hot douches used without benefit.

The hot

water arrested the flow for two hours when it returned as freely as before. Examination showed a uterus normal in size and position, no hyperesthesia, no granulations, no disease of adnexa. After dilating the cervix I swabbed out the uterine cavity with tincture of iodine, ordered a cold douche twice a day and gave liquor sedans. The flow became less iminediately after using the iodine and in three days ceased entirely.

Cancer in women over 35 is the most frequent cause of metrorrhagia. On account of the importance of recognizing this disease early, it is the doctor's duty to insist upon a local examination as a means of diagnosis.

To cure menorrhagia or metrorrhagia, local treatment must be given in the most of these cases. Internal medication is rarely of benefit unless the general system is at fault. In a few instances I have found ergot combined with the fluid extract of hydrastis of value in controlling bleeding.

Avoid the use of tampons, they are generally more than useless. After having prepared the patient, dilate the cervix uteri with a steel dilator and with a sharp curette remove granulations or retained placental pieces. The attending hemorrhage can be quickly controlled by injections of hot or ice cold water. I never use the gauze packing as I get better drainage without it and it is a very painful process. By cleanliness and antiseptics the danger in the use of the curette is reduced to the min

imum.

Menopause.-A perfectly healthy woman, not having any local disease should cease menstruating without any general or local disturbance at about 45 or 48 years of age. It is generally believed by the profession and the laity that it is natural for women to suffer from hemorrhage and reflex nervous symptoms during the "change of life," and nothing is thought of it unless the woman's life is endangered from loss of blood or insanity is iminnent.

Premature menopause, that is coming before 40, may result from prolonged amenorrhoea after some debilitating disease resulting in atrophy of the generative organs. Removal of the tubes and ovaries does not always bring about the menopause. If menstruation is too profuse or two frequent, a careful ex

amination should be made. Fungous granulations and polypi are especially apt to occur at this time. Some women menstruate after they are 50; but if the flow is too profuse with nervous symptoms, hot flushes etc., if the cervix is dilated granulations or polypi will frequently be found, the removal of which will cause the menopause to come about normally. Dilatation of the cervix occasionally, will relieve the nervous symptoms.

DIURETIC ACTION OF SALICYLIC ACID AND CAF

FEINE.

SIEGERT (Münch. Med. Woch.) concludes a study of this subject. In a case of chronic peritonitis salicylate of sodium in both small and large doses lessened diuresis, the specific gravity of the urine being increased. With pure caffeine there was constantly observed a markedly increased diuresis, but with caffeine natro-salicylate the opposite effect was seen, the caffeine diuresis being suppressed by the salicylate. Caffeine produced its most marked effect after a course of small doses of salicylates. The use of caffeine alone made tapping of the ascites unnecessary owing to the absorption of all the oedema, which, on the other hand, was increased by the use of salicylates. The author shows by experiments on animals how the salicylates can abolish the diuresis produced by caffeine. Thus it is undesirable to use the combination of caffeine and salicylates where a diuretic effect is aimed at. In one case where tapping had been done some ninety times the use of caffeine made any further tapping unnecessary. The author has used caffeine with digitalis, and has found the diuretic effect very marked. It is desirable to use the insoluble caffeine in preference to the soluble combinations. The author would recommend the use of caffeine with or without digitalis in all cases of venous engorgement with intact kidneys in order to remove the oedema by diuresis. Br. Med. Jour.

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Editorial.

THE BUBONIC PLAGUE.

Very interesting studies of the bacillus of the bubonic plague are being made by Passed Assistant Surgeon H. D. GEDDINGS, and reported through the pages of Public Health Reports. DR. GEDDINGS is pursuing his studies in the Pasteur Institute, under the direction of DR. ROUX. In his earlier reports he described the bacillus, drawing attention to its peculiar characteristics as to shape, size, manner of growth, staining properties, etc. Attention was called to the misleading statements in KITASATO'S first published description. KITASATO likened the bacillus to that of chicken cholera, a small fine bacillus with rounded ends, staining well with the ordinary basic aniline dyes. In reality the organism is a cocco-bacillus, almost as broad as long, about two micromillimetres in greatest diameter, staining readily, it is true, with the ordinary aniline dyes, but also very readily overstaining. It is completely decolorized by the method of GRAM. It grows readily upon ordinary culture media; in

bouillon it forms flakes which rapidly sink to the bottom of the test-tube, leaving the liquid above clear, which appearance is very characteristic. The virulence of the bacillus is extreme and is increased by being passed successively through different animals. It is reduced by successive cultures on ordinary media, but can be restored by passing again through animals. While its usual mode of entrance is through some abrasion, a break of continuity does not appear to be necessary, for healthy rats were infected by eating the spleen or other organs of an animal dead of the plague. This point, however, is still under active discussion. As a rule a small red spot marks the point of infection, which in Hongkong, where the natives go barefooted, is usually on the foot, while with the Hindoos, who wear a covering upon the feet, it is usually on the hands or face, the infection being carried by insects and vermin. This red spot becomes successively a vesicle and a pustule and in the ganglionic form of the disease, a general redness or a series of vesicl.s marks the passage of the infection along a lymphatic

tract.

The disease is divided into three types (a) the bubonic, or ganglionic, (b) the septicemic, and (c) the pneumonic. The bubonic is the most common type, the septicæmic furnishes the largest proportion of the small number of recoveries, while the pneumonic is the most fatal. The most reliable reports place the mortality of the present epidemic in India at 90 to 95 per cent. of those attacked. This does not include those subjected to the serum treatment and is probably too low rather than too high as the aversion of the Hindoo to hospital treatment causes the concealment of many cases. The results of serum treatment have not been as brilliant as was hoped for from the success attending the experiments made on a small scale by GERSIN in the epidemic at Hongkong. In the present epidemic serum was used from two sources, one prepared by GERSIN at the Pasteur Institute at Saigon, the other prepared at the Pasteur Institute at Paris. With the former the mortality was 33 per cent., while with the latter it reached 50 per cent. The mortality in all cases treated by serum before systemic intoxication -that is to say on the first or second day of the disease— was 12 per cent. The lack of success is attributed to the

An

inability to get serum of sufficient antitoxic strength. accident in Dr. GERSIN's laboratory cut off the supply from that source and he was furnished with serum prepared at the Pasteur Institute in Paris. The supply from this source was quickly exhausted, and in the belief that a weak serum would be better than none, a serum was issued which, though having a high immunizing power, had a comparatively low antitoxic or curative power. The difference is one of degree not of kind. If a horse is injected intra-peritoneally with a culture of the plague bacillus, killed by exposure to heat, the animal in time acquires a certain immunity to these injections, and his serum is found. to have certain preventive properties, viz, it will protect an animal into which it is injected against a culture of the plague bacillus; in other words it is preventive or prophylactic. This result has been arrived at by the action of the toxines contained in the killed culture, but it is to be borne in mind that the toxine is not in a soluble eondition, but it is largely held enveloped in the bodies of the dead microbes. On the contrary, if the horse is injected with a live culture of plague, or a soluble toxine, and intravenously instead of intra-peritoneally, an immunity will be established, and the serum of the animal will be found to have not only an immunizing power as before, but in addition an antitoxic or curative power, that is to say, it will protect an animal against the toxines of plague, or the animal having been inoculated with plague, it will exert its curative or antitoxic influence. But the process of treating horses with the live culture is one requiring great caution and care and necessarily requires much time.

This statement accounts for the reports antagonistic to the serum treatment, and leaves room for hope that the persistent efforts of DR. GERSIN and RR. ROUX and their assistants will be crowned with success, and that the world will be given, against its will, probably, a remedy for this horrible and fatal malady. One instance was cited by DR. GEDDINGS clearly showing the immunizing power of the serum:

The Bombay manager of the local branch of the Credit Lyonnaise resided with his wife, children, and a numerous retinue of native servants in a dwelling in an infected portion of the city. His little daughter was stricken with the pest in a virulent