and vomited twice during operation. During operation pulse went up to 120, but returned to normal after, and no nausea or fever.

CASE 2.-Mr. G. B., City and County Hospital, aged 56 years. Varicose veins and ulcers. Injection 16 minims of 2 per cent solution cocain as in case first. Anesthesia was profound in 10 minutes, and extended into arm pits. Excision of saphenous vein and Schedes operation and grafting ulcers. Operation lasted 55 minutes, and anesthesia profound. No nausea during or after operation. Pulse 120, returned to normal.

CASE 3.-Mr. F. K., City and County Hospital, aged 33 years. Inguinal hernia. Sprayed parts with ethyl chloride before introducing needle. Injection 15 minims cocain. Anesthesis completed in 8 minutes. Operation lasted 55 minutes, and patient amused himself by watching operation until he became slightly nauseated. Pulse remained about 100 after operation, temperature 102°, but dropped to normal next day. No complications.

CASE 4.-Mr. B. W., City and County Hospital, aged 45 years. Necrosed tibia and lipoma. Ethyl chloride and the usual injection of 15 minims 2 per cent solution cocain. Anæsthesia complete in six minutes. The stump was opened, necrosed tibia and lipoma removed, no pain or nausea, and patient held the stump up for a photograph. Pulse varied from 80 to 110.

CASE 5.-Mr. MoN., City and County Hospital, aged 40 years. Fistula in anus and piles. Injection 15 minims 2 per cent solution cocain. Anaesthesia complete in 8 minutes. Sphincter dilated, hemorrhoids removed by cautery and fistula curetted and closed, no vomiting. Pulse varied from 96 to 115.

CASE 6. Mr. C. S., City and County Hospital, aged 50 years. Abscess of left leg. Injection of 13 minims 2 per cent cocain solution, curetted and stitched. He said he could feel but no actual pain. No vomiting during or after operation. Pulse varied from 120 to 126.

CASE 7.-Mr. J. O. C., City and County Hospital, aged 52. Ulcer left leg. Injection 14 minims, 2 per cent solution of cocain. Anaesthesia in 10 minutes. Ulcer covered by skin flap. Operation lasted 25 minutes; pulse rate not above 74, no vomiting or complications.

CASE 8.-Mr. D. B., City and County Hospital; aged 60

years. Right inguinal hernia, hydrocele and hemorrhoids. Injection 15 minims 2 per cent solution cocain. Anaesthesia complete in 15 minutes. Radical cure for hernia, hydrocele and hemorrhoids. Big clamp cautery. above 90.

Vomited, pulse not

CASE 9.-Mr. R. G., City and County Hospital, aged 44 years. Ulcer on arm. 15 minims 2 per cent solution cocain. Injection, anesthesia not complete. Grafts removed from lower limb and placed in position. No nausea, pulse 85. Cocain had been exposed to too high temperature.

CASE 10-Mrs. V., aged 30. Pregnant, primipara. Labor had been in progress for two hours. Cervix dilated so finger could pass. Membranes had ruptured. Injected 15 minims 2 per

cent solution cocain as directed after parts had been sprayed with ethyl chloride. Pains stopped for a few minutes, but started after passing finger into cervix, and continued not regular but each time she had a pain the parts seemed to relax and the child was born in little less than one hour and a half. The patient was free of pain after the injection, and said she felt no pain when the head passed, but could feel me take the child away. The pulse went to 116 during the labor, but dropped to 85 one hour after. The uterus contracted and remained so after the labor. No complications.

Before making the lumbar puncture I always use a spray of ethyl chloride which prevents the pain of the needle passing through the skin and keeps the patient quiet. I use a needle made by Mr. Wm. Hatteroth of this city. The syringe consists of a barrel of glass graduated, and the piston of glass which makes them easy to be sterilized. The needle is a little larger in the lumen than the one recommended by Tuffier and made of steel. It is not so apt to close with blood or tissue and fits by a joint to the syringe, which is important, as it keeps the needle quiet while the syringe is connected. We cannot yet tell what objection may arise, as there have been only a few hundred cases reported, but as yet there has not been a serious accident. It appears to me to be the safest, quickest, cheapest, and best anaesthetic, but it will take thousands of cases to demonstrate its safety.

RELATIONS OF RATS AND FLEAS TO MAN AND THE PLAGUE.

By P. C. REMONDINO, M. D., San Diego, Cal.

Up to not a very distant period, plague epidemics were ascribed to divine displeasure, the belief having for its existence ample biblical authority. Malign angels clad in the shroud of death carrying an urn and hovering over an afflicted city, sowing broadcast the essence of the infection, fitly illustrated the then popular idea of the origin and march of the dreaded disease, whilst it also served to convey the idea of the existence of a pestilential miasma that pervaded the atmosphere. Water was long looked upon as a purificator and as a destroyer of the contagion, and it was not an uncommon practice in Europe to place a tub or barrel of water at house entrances during plague epidemics into which everything was dipped before being taken

into the house. Vinegar was then employed very much as carbolic acid or other disinfectants are now, cloths or sponges moistened with solutions of these, being popularly believed to exercise a purifying influence on the surrounding air.

In the early part of the eighteenth century an attempt was first made to study into the details of the disease in a systematic manner, the school of Montpellier sending a commission of investigation to Marseilles, then ravaged by the plague, but the extreme virulence of that epidemic and the poverty of scientific methods or knowledge of the time, prevented the commission from reaching any accord or tangible results. In the latter part of the same century, the prevalence of the plague among the French army then operating on the shores of Asia and Africa on the Mediterranean sea, gave to the profession an opportunity to increase its knowledge. The painting founded on the historical details, representing Bonaparte visiting the plague hospital and touching the infected, tells us, as Desgenettes more fully explains, that the belief no longer existed among the more intelligent that the disease was transmitted by contact or proximity with the infected body, as, according to that observer, the dead body of the infected was not under ordinary circumstances capable of communicating the disease. Unlike cholera or putrid or typhoid fever, it was observed that the disease could not be imparted through the alimentary canal. Dogs-always in abundance and famishingly hungry in Mohammedan countries-with impunity greedily devoured the poultices coming from the sores of the diseased, and even ate of the sloughs from the bubonic enlargement, without infection. This observation was also made by Professor Deidier of the Montpellier Commission as long ago as in 1720, who went still further, by injecting some bile from a plague stricken patient into the femoral vein of a dog that had been safely fed on the sloughs from the bubos. The dog soon developed the characteristic plague symptoms and died in four days, thus demonstrating the fact that while breathing the supposed infected air, simple contact or exposure, and even the ingestion of the bubonic matter, were not sufficient to induce an attack, something, however, readily followed when the infecting matter was inoculated or introduced directly into the circulation.

The advent of bacteriological science to the aid of medicine has since greatly simplified matters in many particulars, and it

has enabled us to complete much of our knowledge concerning the history of epidemics which would otherwise have remained incompleted, just as the experimental physiologist has as a secondary step aided medicine in inducing serum immunizations. Some of the ancients had observed effects which, through their inability to understand, they considered were coincidences. Mr. Hankin tells us that one of the ancient Hindoo books contains this advice, "On the moment that rats fall down the roof above and jump about and die, the people will at once leave their houses with their friends and relations and go to the plain," advice that has been regularly followed for generations by the inhabitants of Gurhwas and of Yunnan, who remain on the plain for a stated period of time before returning to their homes.

Wherever the plague possesses an endemic center, the rats suffer greatly and generally primarily from the same disease. This is notably the case in Formosa where the disease goes under the name of "rat pest," and in many other parts of southern China. From an address delivered by Dr. Frank Tidswell before the New South Wales branch of the British Medical Association upon the state of the present pandemic of plague, we learn much of its relation to the rat, and of the manner through which it is transmitted from the rat to man. From that address we quote the following interesting items:

1st. Primary cases of the epidemic generally appear in persons working about wharves or in grain stores, in stables or in the hold of ships-localities usually infested by rats-and the disease as well as the deaths are as usually observed to appear first in rats and secondarily in man.

2nd. Simond, who has studied and experimented extensively upon the subject, with a view to defining the relations of rats to the spread of the plague, unhesitatingly places the rat fleas as the sure carriers of the infection by inoculation. According to this observer, perfectly healthy rats harbor but few fleas, but as they sicken and neglect their usual toilet, the fleas upon them increase in numbers until dying rats at times literally swarm with them, and this at a time when their bodies are more or less well saturated with the plague bacillus. Upon the death of the rat and its gradual cooling in death, the fleas leave its body for another host, thus gradually infecting a greater number of rats. To fully establish the capability of the flea to inoculate other