Observations conducted upon 27 pa tients and bodies. These revealed the presence of a bacillus corresponding to Yersin's, and therefore not to Kitasato's. It was pathogenic for mice, rats, rab bits, guinea-pigs, and cats, while dogs, fowls, and pigeons were refractory. The bacillus had but little power of resist ance to antiseptics. It was killed at once by 1-in-20 carbolic acid; in 1 in 200 it survived five minutes, but after fifteen it could no longer on nu tritive media. In 1-in-1000 sublimate solution it perished at once, in 1 in 10,000 not for five minutes. Saturated lime water for five minutes stops its growth permanently, while sunlight kills it in less than four hours. Ogata (C-entralb. f. Bakt., xxi, 20, 21, '97).
The author found that the chief dis tinctions are afforded by the lymphatic glands, and they will depend upon whether the glands were primarily or secondarily affected. Primary involve ment may be of two kinds: of the first order being the point of original recep tion of the virus; of the second order representing the extension to a second, contiguous group of glands. Buboes of the second order are less marked than those of the first. Secondary buboes may be found in any or all glands, within the body, and at a distance from the primary lesions, infection having fol lowed through the blood-circulation. Primary buboes of the first and second order are described minutely, as well as tonsillar infections. The spleen in plague is enlarged moderately and the consistence is somewhat diminished. The color is deeper than normal, but it is not the type of the acute splenic tumor of the septicmmias. The author emphasizes that, although the spleens in the autop sies made all contained bacilli, often in very large numbers, the cases them selves were examples of the bubonic, and not of the septicannic, variety per se of the disease. The morbid anatomy of the experimental disease in the guinea-pig is also given minutely. Two main types of the plague—bubonic and pneumonic— may be considered as established by ob servation. Simon Flexner (Univ. of Penna. Med. Bull.. Aug., 1901).
Treatment.—The medicinal treatment of plague, judging from the great mor tality of that disease—SO to 90 per cent. —does not seem to merit much confi dence. "A plan of treatment which suc ceeds in one case totally fails in another" said Gatacre in his report on the bubonic plague in Bombay of 1S97. He found that calomel was largely used: an index of its general worth. Cantlie (Brit. Med. Jour., p. 249, '97) states that this agent should be given in from 5- to 10-grain doses, and be followed by a saline in some five hours' time. This experienced au
thor recommends that from the very onset, or certainly after twenty-four or forty-eight hours, it will be found neces sary to stimulate the patient by food, alcohol, or medicine. Food should be given in small quantities, frequently re peated, and of a kind which is easily di gested. Essence of beef, in fluid or jelly form, is recommended. Ox-tail soup, mutton-broth, beef-tea, and chicken-tea are also useful. Milk with ice, sipped slowly, and ice-cream are particularly grateful. Thirst is a marked symptom, and ice to suck, if not kept up too long, water or lemon and water (not lemonade) to drink, iced beer and stout, brandy, or whisky diluted with three or four times its quantity of water (not aerated waters) may all be used. When the pulse shows signs of failing or collapse or faintness supervenes, alcohol is beneficial, and brandy is preferable to whisky. Cantlie found that active delirium is best con trolled by cold to the head: Leiter's coils, ice-bag, or wet cloth. Hyoscine in/ grain dose hypodermically is the most efficient and safe of the hypnotics. Mor phine, in 7,- to dose subcu taneously in combination with atropine, is most useful when painful adenitis com plicates the cerebral intoxication. Diar rhcca may be treated by salol in 10-grain doses, or by a suppository of morphine, '/, grain; and cocaine, grain. Vona itiug may be controlled by a mustard plaster to the epigastrium, ice to suck, and an effervescent draught of a few drops of hydrocyanic acid and solution of morphine. For pyrexia Cantlie con tends that chemical antipyretics should not be used. Frequent sponging with tepid wated, ice to the head and nape of the neck, iced drinks, and a short appli cation of the wet pack, with the admin istration of brandy by the mouth or rec tum. Smelling-salts and strong am monia to the nostrils often arouse a pa tient in collapse and permanently revive those apparently moribund. Hypodermic injections of ether must be used fre quently and freely. Internally, ammo nium carbonate in a tincture or decoction of cinchona is most useful, while digitalis and strophanthus are unsatisfactory. Camphor, either hypodermically in ster ilized oil or as a 2-grain pill, is a direct stimulant and a stomachic carminative. Musk may be given in 5-grain doses every six hours. Strychnine sulphate in grain dose hypodermically in 10 minims of distilled water is valuable. Inhala tions of oxygen are also recommended. Abscesses should be opened when they point.