purify the air; as soon as thunder and hail are announced all will be protected by this shower, and should light fires of vineyard clippings, laurel and other green woods; great quantities of absinth and chamomile should be burned in public places, and in densely populated quarters. No one should go out in the country until the earth is perfectly dry, and three days after; each one, during such times, should take but little nourishment and avoid the early morning air, also the evening and night airs; one should not eat poultry, nor aquatic fowls, nor young pork, nor old beef, nor, above all, fats. One should only use the flesh of such animals as are of hot and dry nature, those that neither heat nor irritate. seaside or on isles over which pernicious winds blow." This wonderful medical report gives one a good idea of the Faculty of Medicine in Paris in the fourteenth century. Gentile de Foligno, professor at Perugia, was the first to treat of this plague ex professo, according to the doctrines of Galen and the Arabian physicians. He attributed the malady to a corruption of the blood in the heart, extending from thence to all portions of the body. He advised fumigations with odoriferous woods, an analeptic regimé to resist the contagion; and for the sick, bleeding, evacuants, oxycratic lotions, afterwards a quantity of cardiac potions that he praised as being marvelous in their action; he speaks but little of the influence of the stars, but believes in infection from the air. The treatment of Guy de Chauliac It consisted in bleeding, purging and provoking the gland to suppuration, incising buboes and cauterizing these, as well as the carbuncles, with a redhot iron. This plan of treatment saved thousands of lives. Galeazzo de Ste. Sophia, a learned physician of Padua, where he lived in 1330, also treats of the plague with great clearness. "We recommend sauces with plenty of pepper, cannella and spices, especially for persons who have the habit of eating little and of choice meats. To sleep in the daytime is an injurious is not, for the remainder, so very bad. thing; sleep should never be prolonged beyond sunrise or a little later. One should drink but little at breakfast; soup should be taken at 11 o'clock, and at this time one may drink a little more than at breakfast; one may take clear wine, mixed with a sixth part of water; dry and fresh fruits may also be taken with wine, and are not then injurious, but without wine such sweets are dangerous. Carrots, beets and other vegetables, fresh or salted, may be prejudicial; aromatic vegetables, such as sage and rosemary, are, to the contrary, salubrious; cold foods, watery or moist, are, in general, injurious. It is dangerous to go out at night up to 3 o'clock in the morning, owing to marsh airs. No fish should be eaten. Too much exercise is injurious. One should be warmly clothed, to avoid taking cold and not be wet by dew or rain, nor cook anything by such liquids; take a little theriacum at each meal; olive oil in food is fatal; fat men should go out in the sun; too great abstinence, nervousness, wrath and drunkenness are very dangerous; dysentery is to be feared; baths are injurious; the bowels should be kept open with clysters; connection with women is fatal. These rules are especially applicable to those living at the The first laws for the protection of the public health against a return of the plague date back to 1374, and were formulated by Bernabo Visconti, Duke of Milan. This city was preserved for some time against the plague of 1348 by closing its doors and barricading those houses where persons had been attacked by the disease. Jean Visconti followed the same measures as his predecessor. The quarantine that was afterwards established for the lazareths was limited to forty days, with the idea that contagious diseases took that time for incubation before becoming manifest. [THE END.] THE addition of a little tincture of guaiac renders pus cells more easily visible by coloring them blue. E. S. MCKEE, M.D., Secretary. The President, DR. RUFUS B. HALL, reported the following cases: Double Uterus with Congenital Closure of one Cervix; Uterus Distended with Menstrual Fluid. This case is out of the usual, and has many interesting features connected with it, both to the specialist and general practitioner. The subject of the report, Miss H., is a strong, vigorous girl, aged thirteen, well developed for one of her years. She was seen in consultation with her physician, Dr. C. C. Agin, of this city, October 25, 1896. The following history was elicited: About two months prior to this visit Dr. Agin saw her and prescribed for rectal tenesmus. He did not make any physical examination at that time. She did not get entire relief, and the neighbors advised the family to consult a physician in the city who advertises. This they did, he having her in charge until a few days before my visit. Her condition then became so alarming they again asked Dr. Agin to see her. She had been confined to bed for about three weeks with pain in her abdomen; this had gradually grown worse. She first menstruated seven months ago without much pain; the flow lasted three or four days and recurred regularly every four weeks after that time, the last period being from October 15 to October 20. The flow was always free. She says she has never felt perfectly well in her abdomen since the second time she menstruated, and for three or four months has felt uncomfortable, with a full feeling in her pelvis. For the three weeks past she had had rectal tenesmus, and it was well marked at the time of my visit. She had a constant desire to go to stool. About two months before my visit, while learning to ride a bicycle, she sat down heavily on the saddle, and, as she says, hurt herself. She located the seat of the injury over the right tuberosity of the ischium. She grew worse rapidly from this on, and believed it to be the whole cause of her illness. child, anything like a satisfactory phyThe patient being a very unruly sical examination of the abdomen or pelvis by rectal examination could not be made. As the hymen was intact, I made no attempt at vaginal examination. the bowel I could make out, in spite of On attempting to pass the finger into her cries and struggles, a tumor of some kind filling the entire pelvis and extending above the pubic arch, even pushing the perineum forward. The child was in great agony, with rapid pulse and great tenderness over the abdomen. There could be no doubt about the presence of active peritonitis, and it was evident to all that she must have immediate relief. It was agreed to send her at once to the Presbyterian Hospital. She entered there at noon, October 25, and was prepared for operation. At 11 o'clock on the morning of the 26th she was given an anesthetic. Assisting, Drs. Colter and Rousch. Present, Drs. Agin and Hamma, of this city, and Drs. Finley and McClellan, of Xenia, O. Rectal examination revealed the tumor as before described, filling the entire pelvis and extending into the abdomen more to the patient's right. It could not be pushed up, and the finger introduced into the bowel passed behind the tumor and somewhat to the patient's left. Nothing definite could be determined by this examination. I passed my finger into the vagina. It was very narrow and fitted closely around the index finger, but the cervix could not be felt; it was beyond the reach of the finger. The vaginal canal was pushed far to the left side of the pelvis. I could pass a probe two and one-half inches beyond the end of the finger, demonstrating that the vagina was elongated. Above this and to the patient's left side, apparently firmly attached to the tumor, could be made out a small hard lump. This was believed to be the uterus. By a little manipulation the sound was carried into this lump, confirming our belief. What the tumor was, was very uncertain. No manipulation could move it from the pelvis; neither could any manipulation bring the uterus nearer to the examining finger. The question of dermoid tumor of the ovary, rapidly growing sarcoma, and a number of other conditions were all mentally discussed while making the examination. Yet I was wholly at sea as to the true condition, and at once determined to make an exploratory incision and be governed by what that revealed. The abdomen was opened in the median line, with a three and one-half inch incision. The omentum was adherent over the top of the tumor to the patient's right, and a portion two and one-half by three and one-half inches was discolored almost black. It was ligated and removed. The tumor occupied the entire pelvis, extending two and one-half or three inches into the abdomen. The small lump previously described to the left of the tumor proved to be a normal sized uterus. The ovary and tube on that side were perfectly normal. The tumor itself appeared to spring from the right side of the uterus, and had all the appearance of a pregnant uterus of about four months' gestation that had become blocked in the pelvis. By palpation there seemed to be a semi-fluctuation like that of a pregnant uterus. Passing the hand well to the right side, I found the other ovary and tube perfectly normal. The Fallopian tube was about two inches long, acutely inflamed and but slightly enlarged. It entered the tumor, which proved to be the uterus, at a point corresponding to its right cornu, five and one-half or six inches from the point where the left Fallopian tube entered the left side of the opposite uterus. The broad ligament was drawn taut on both sides but not thickened. For the first time the true condition dawned upon me. I had to deal with a double uterus, with the right side distended with menstrual fluid, with the cervices pushed up out of the pelvis so that the distended uterus really lay crosswise of the pelvic cavity. I immediately packed the abdomen with sponges, temporarily closing it, and put the patient in the lithotomy position. I made renewed efforts to reach the cervix. This I could not do any better than before. With a male steel sound, short curved, which I passed into the vagina, I made an effort to make an opening into the distended uterus. After a little time, by using considerable force, I succeeded in doing 80. At once a gush of dark, thick menstrual fluid escaped. By pulling down with the hooked end of the sound I dilated the opening and a pint or more of the fluid was discharged. I could then reach the cervix with my finger. I removed the sound and passed my finger through the opening, which proved to be the right cervix. This was dilated and the cavity carefully washed out. There were altogether about two and one-half pints of fluid discharged. When the uterus was thoroughly emptied the cervix could be brought down to the perineum. Two uteri, one recently emptied, the other of normal size, were easily demonstrated by passing a sound into the left uterus and the finger into the right through separate cervices. A strip of gauze was carried into the uterus just emptied and the vagina lightly packed with gauze for twelve hours. It was then removed and irrigation of the vaginal canal carried out every eight hours for the first week. After placing the gauze dressing in the vagina the hands were carefully cleansed preparatory to closing the abdominal incision. The sponges, which were left to close the incision temporarily, were removed. The tumor in the pelvis had practically disappeared. Inspection now revealed a perfect double uterus united laterally to within one-half inch of the fundus. The left was of normal size, the right appearing nearly double the size of its fellow. There were but two ovaries and tubes, one at the left of the left uterus, the other at the right of the right uterus, as previously described. The abdominal incision was was closed without drainage. The patient made an uninterrupted recovery. This case is an exceedingly interest ing one in many particulars, not only | the vagina. This had a slit extending from the rare condition of a double somewhat to the patient's right, leaving uterus with a single vagina, but the two large tags that were exceedingly many obstacles to a correct diagnosis. sensitive to the touch-so much so that The history of injury from mounting a the patient could hardly endure vaginal bicycle led me to suspect either a hema- examination. She cried out lustily from tocele or ischio-rectal abscess. It only pain when I attempted to make a required a moment's time after she was vaginal examination. I believe the vaunder the influence of the anesthetic to ginismus was due to this irritable condemonstrate the absence of either. My dition of the hymen. Further examinaexplanation as to why she always tion revealed the uterus retroflexed; the suffered after the injury from mounting fundus in Douglas' cul-de-sac, with an the bicycle is this: She had a pelvic ovary at either side of the fundus. The tumor gradually coming on from her cervix was narrow, elongated and rested first menstrual period, seven months against the pubic arch. before. This is plainly indicated by her clinical history. The tumor probably filled the pelvis fairly well, and in well, and in mounting the bicycle she received a trauma which may have been the cause of the lateral displacement of the uterus. This was the direct cause of her peritonitis. The case illustrates in a forcible manner the advantages of exploration in these doubtful cases. Vaginal Fixation of the Round Liga ment for Backward Displacement of the Uterus. I advised removal of the hymen and fixation of the uterus after the manner recommended by Dr. Hiram N. Vineberg, of New York, in an article presented to the Canadian Medical Society at Montreal in August last. The patient entered the Presbyterian Hospital, where the operation was made October 14, 1896. Drs. Colter and Rousch assisted, and Dr. Edwin Ricketts was present by invitation. The patient being anesthetized, the vagina was dilated by force after the manner of dilatation of the rectal sphincter. I then proceeded to the operation upon the uterus. I had never seen the operation Mrs. H., referred by Dr. W. W. Hall, of Springfield, O. A strong, vigorous-looking woman, aged twenty-made, so tried to follow the description eight; married five years, no children, no miscarriages. She gave a history of having suffered very severely from vaginismus from soon after her marriage. She menstruated regularly, the flow lasting from two to three days; always suffered some pain the first day. This has grown worse for the last two or three years. She complained of constant bearing down pain when on her feet, with backache and pain in the top of the head. She suffered some inconvenience from pelvic pain before her marriage, but it has grown steadily worse since that date. For two and a half years she has been incapacitated from doing any work that required her to be on her feet. She had an irritable bladder, requiring her to empty it every three or four hours during the day and usually once or twice during the night. Examination revealed a very thick, well-developed hymen, which originally blocked three-fourths of the entrance to given by Dr. Vineberg in his article as published in the Medico-Surgical Bulletin of October 3. He advises "longitudinal incision in the anterior vaginal wall and free dissection of the flaps on either side." It occurred to me before the operation that a transverse incision in front of the cervix, in connection with the longitudinal incision, would. give ample room and make the operation comparatively easy. I decided, however, to follow out the directions given and make the operation with the longitudinal incision only. Free dissection of the flaps gave very limited working room. After the dissection was well along, feeling I was about to enter the peritoneal cavity with the finger, I was chargined to find I had opened into the bladder instead. It is an accident which has never before befallen me in all my vaginal work. This I am certain was due to the lack of working room with the longitudinal incision Over the two ends of one suture was passed a perforated shot, then coiled wire one-half inch in length, then another perforated shot, the suture brought home as tight as desired, the last shot compressed. Each one of the silkworm sutures were treated in the same manner. I have found this very convenient in vaginal work, facilitating the removal of the remaining loop of thread. The uterus was now in an anteverted position, the cervix pointing backwards. A little gap remaining, it was closed with cat-gut suture. The hymen was cut away and the margin of mucosa united with fine cat-gut. A self-retaining catheter was placed for forty-eight hours, when it was removed and the patient catheterized every three or four hours for four days. After that she was permitted to relieve herself. She never had the least particle of leaking, but made an uninterrupted recovery. Her pulse was 86, the highest at any time; her temperature the evening of the operation was 99°, and never up that high again during her convalescence. only. I at once made a transverse in- | ing manner. When I came to remove the silkworm sutures on the twenty sixth day I had considerable difficulty, owing to the fact that the first shot placed on the two lateral sutures had become imbedded under the mucous membrane. It necessitated the administration of an anesthetic to dissect them out. This could be obviated by using larger shot and attaching them to the coil of wire. The patient's present condition is satisfactory in every way. The vaginismus is entirely relieved the uterus is fixed in an anteverted position. The pain in the pelvis and back have entirely disappeared. Of course, it is too soon to say that all these results will be permanent, but it is not unreasonable to believe that she will be materially relieved of her distressing symptoms. I do not want to make any extended comments upon the operation or the technique, but I am convinced it is one of the best methods yet advocated for backward displacement of the uterus. Theoretically, to my mind the shortening of the round ligaments by anterior vaginal section, as described by Drs. |