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in three days and the ascites more slowly. A man, aged58 years, had hepatic cirrhosis with ascites for eight years.He was repeatedly tapped during the first few months, andthen epiplopexy was performed. For eight years he wascomparatively comfortable but had persistent ascites. Three

injections of 5 to 10 c c. of ascitic fluid were given andfollowed by diarrhoea but not by diuresis. The abdomen

diminished in circumference from 91’2 to 84’2 centimetres.A man, aged 47 years, had cirrhosis of the liver with ascitesand ae1ema of the legs. He had been tapped twice. The

abdomen measured 95’5 centimetres and the urine amountedto 4 pints in the 24 hours. 4 c.c. of fluid were withdrawnand 2 were injected. After the second day the quantity ofurine passed daily rose to 8 pints. On the twelfth day largequantities of blood were vomited, the ascites had practi-cally disappeared, and the abdomen measured 81 centi-metres. A man. aged 38 years, had cirrhosis of the liverwhich was supposed to be due to syphilis. Autosero-

therapy was practised thrice without any effect on

the ascites. In. a case of tuberculous pleurisy withconsolidation at both apices the treatment also failed.These cases confirm the view that the good effect of

autoserotherapy is due to the diuresis. But why the injec-tion of the patient’s own serous exudate should producediuresis has not been explained. The most extensive series

of cases of autoserotherapy has been published by Marcou.’He states that he has employed the method in 82 cases duringfour years with uniform success. He used it in all cases of

pleurisy with effusion and hydrothorax, no matter what thecause, the only condition being that the fluid was non-

purulent. He watched the patients for two to four yearsafter the injection, and did not observe any cases of

generalised tuberculosis-a contingency anticipated by some.However, such very favourable results have not been

obtained by other observers. The method has also been usedwith success in hydrocele by Bertholon.2 In a middle-agedman, who had a large hydrocele for three years, he

punctured the sac with a hypodermic syringe and withdrew2 c c. of fluid which he injected into the thigh. The patientrefused to lie up, but on the following day the sac hadsoftened and two days later had considerably diminished.The operation was repeated and in three days the scrotumwas normal, and after more than a month there was norecurrence. The method has also been adopted in erysipelasby V. Jez, who treated ten cases by injecting 5 to 10 c.c. offluid obtained from blisters on the patients. This wasfollowed by a rise of temperature and rapid improvement.

WE understand that at the Royal College of Physicians ofLondon there are still a few seats not yet allotted to viewthe Royal Progress on Friday, June 23rd, and that these seatswill be allotted to Licentiates of the College in the order oftheir application. The price of each seat is the same as toFellows and Members-viz., 12 guineas, to include refresh-ments-and applications should be sent to the College,Pall Mall East.

1 La Presse Médicale, Sept. 4th, 1909.2 Journal de Médecine et de Chirurgie Pratiques, June 25th, 1910.

THE Queen’s Hospital for Children, Hackney-road, has hitherto had a committee composed exclusively ofmen. At the annual meeting on May 24th a new departurewas taken by the appointment of two women on the com-mittee of 20 governors elected for the ensuing year. Noother Children’s Hospital in London has yet placed womenon its committee. The hospital has 134 beds in London andwill shortly have 30 beds at a seaside branch at Bexhill,which is to be opened on July 13th by H.R.H. PrincessLouise Duchess of Argyll.

PLAGUE IN RUSSIA AND THE NEAR EAST.

(FROM THE BRITISH DELEGATE TO THE CON-STANTINOPLE BOARD OF HEALTH.)

Plague in Odessa.A SINGLE case of plague was seen in Odessa on Feb. 19th

(March 4th). It will be recalled that a somewhat severeoutbreak of the disease occurred here last year. In acommunication recently made to the Constantinople Board ofHealth by the Russian delegate a summary is given of thisoutbreak and of all others occurring on Russian soil duringthe year 1910. This document, however, adds but little tothe information already received, a summary of which hasbeen recorded in my periodical letters to THE LANCET. InOdessa between May 22nd and Nov. 13th 140 cases of plaguewith 42 deaths were registered, and another case occurred onDec. 26th. The infection is believed to have been importedto Odessa from Alexandria. Two cases were seen in thevillage of Roxolany in the Odessa district on Oct. 22nd and25th respectively. At Batum a fatal case was recorded onNov. 28th, and at Baku a suspected case was seen on

Nov. 30th. (All the above dates are according to the OldStyle.)

Plague in tlte Kirghiz Steppes.No fresh light is thrown on these outbreaks by the Russian

communication above referred to, save that it is now statedthat the epidemic of pneumunic plague in the Prejevalskdistrict of the Semiretchinsk province in July and Augustlast (mentioned in my letter appearing in THE LANCET ofJan. 7th last, p. 59) was accompanied by an epizooticamong the marmots, or tarabagans, in the surroundingcountry.Plague still prevailed in the early part of the present year

in certain portions of the Kirghiz steppes. In and near theurotohistck6 of Sartubé, in the 1st Maritime district, 31 casesof the disease, with 29 deaths, occurred between Jan. 4thand 20th. In another settlement, that of Djaltir, also in theAstrakhan government, 7 persons in one hut (zei7ilianka) fellill with plague, between Feb. 3rd and 7th, and 3 died.This and the adjoining huts, as well as the bodies of thedead, were burnt, and no further cases seem to have occurred,though the surrounding settlements (composed of 344 huts,sheltering a population of 2068 persons) were kept for sometime under careful observation.

Plague tn Jeddah.The seasonal revival of plague in Jeddah began, as already

recorded, on Jan. 14th (after a single isolated case on

Dec. 16th). Between that date and April 8th 33 cases with30 deaths were registered. Between April 10th and 18ththere were 4 more cases and 2 deaths; and none haveoccurred since. The totals, 37 cases and 32 deaths, aremuch below those of the last three or four years. A singlecase of the disease, in its pneumonic form, occurred on aBamb1tk arriving from Jeddah at Suakim on April 3rd; andanother, of the bubonic form, on a steamer arriving fromJeddah at Camaran on March 21st.

Plague at Musoat.On April 4th the British Resident at Bushire reported by

telegram that plague had broken out at Muscat, that thatport had been declared infected, and that 9 cases with 5deaths had occurred there. A little later it was learnt thatthese cases had developed not in the town of Muscat itselfbut in the adjoining village of Sidah, but that, in conse-

quence of the frequency of communications between thetown and village, it had been judged wiser to declare theformer infected. The figures since received for the outbreakat "Muscat" " (without indication of their actual place ofoccurrence) have been as follows :-

Week ending April 8th.., ... 10 deaths." " " l5th...... 13 cases, 12 "

" " 22nd...... - 8 "

" " 19 29th...... 10 9 "

" May 6th...... 18 " 16 "

" " 13th...... 5 5 "

Plague at B1tshire.It will be recalled that an epidemic of plague, causing

some 62 cases and 46 deaths, occurred at Bushire in the

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spring and early summer of last year. (Some details were Ifurnished in my letter published in THE LANCET ofOct. 29th, 1910, p. 1310). Recently there has been arevival of the disease in this port, giving rise to the followingcases and deaths :-

Week ending April 22nd ...... 2 cases." " ,,29th...... 5 6 deaths." " May 6th ...... 5 5 "

" " ,, 13th ...... 12 7 "

Plague at Bahrein.A fatal case of plague was reported from Bahrein, as

occurring in the week ending April 29th. A later telegramstates that down to May 5th as many as 30 deaths from thedisease had been recorded in this group of islands. Nodetails have as yet been received, tending to show the con-nexion, if any, between these outbreaks of plague at Muscat,Bushire, and Bahrein.

Plague at Basra.A few isolated cases of plague were seen at Basra in the

spring of last year, and again in August. Now once morethe infection has shown its presence in this town ; one caseoccurred on May 6th, the patient being a grocer’s assistant,who, it is said, had found some dead rats in the shop. Hedied on the 10th. On the llth his father also died fromthe same disease. No further cases have since been reportedfrom Basra.Constantinople, May 18th.

ROYAL COLLEGE OF SURGEONS OFENGLAND.

Eleetion to the Coitizeil.

A MEETING of the Fellows of the Royal College of Surgeonsof England will be held at the College in Lincoln’s InnFields, on Thursday, July 6th next, at 3 P.M., for the elec-tion of two Fellows into the Council of the College in thevacancies occasioned by the retirement in rotation of Mr.Clinton T. Dent, surgeon to St. George’s Hospital, and Mr.G. H. Makins, C.B., surgeon to St. Thomas’s Hospital. BothMr. Dent and Mr. Makins are to be candidates for re-election.Mr. Butlin was also to have retired by rotation, but, holdingthe office of President, retains his seat on the Council foranother year.

Visit of the German Emperor’s Physioian.During the recent visit of the German Emperor to this

cuuntry Surgeon-General Dr. von Ilberg, His Majesty’sprivate physician, paid a visit to the Royal College of

Surgeons, accompanied by Sir James Reid, the King’sphysician. They were received by the President, Mr.Butlin, and were conducted over the library and theHunterian Museum by the College officials.

Closing of the College tor Whitsuntide.The Royal College of Surgeons of England will close for

the Whitsuntide holidays from the evening of to-day (Friday,June 2nd) to the following Tuesday morning. The Museumwill, however, be open on Whit-Monday.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 77 of the largest English towns 8389 births and 4111deaths were registered during the week ending May 27th.Based on the results of the recent Census, so far as they areat present available, the estimated population of these 77towns in the middle of this year is 16,257,983, and less bynearly a million than the estimate based on the rate ofincrease between 1891 and 1901. The annual rate ofmortality in these towns, calculated on the revised esti-mates, which had been equal to 14 2 and 13 2 per 1000in the two preceding weeks, rose slightly to 13’3 in theweek under notice. During the first eight weeks of the

current quarter the annual rate in these towns averaged14 9 per 1000 ; and in London during the same periodthe mean rate was equal to 14’5. The annual reporteddeath-rates last week in the 77 towns ranged from4-2 in King’s Norton, 4-3 3 in Hastings, and 4 6in Hornsey and in Bournemouth, to 19 3 in Sunder-land, 19-5 in Halifax, and 23 9 in Tynemouth. The4111 deaths from all causes in the 77 towns last weekexceeded by 34 the number returned in the previous week,and included 366 which were referred to the principalepidemic diseases, against 422 and 341 in the two precedingweeks. Of these 366 deaths, 153 resulted from measles, 87from whooping-cough, 53 from infantile diarrhoea, 42 fromdiphtheria, 20 from scarlet fever, and 11 from enteric fever,but not one from small-pox. The mean annual death-ratefrom these epidemic diseases in the 77 towns last week wasequal to 1-2 2 per 1000, against 1-4 4 and 1’1 in the two pre-vious weeks. The fatal cases of measles in the 77 towns,which had steadily declined in the 11 preceding weeks from474 to 136, rose again last week to 153 ; the highest annualdeath-rates from this disease recorded in these towns lastweek were 1’7 7 in Sunderland, 1-9 9 in Stockton-on-Tees, and20 in Manchester. The deaths from whooping-cough,which had ranged from 134 to 96 in the five preced-ing weeks, further declined last week to 87 ; they caused anannual rate of 1’6 6 in Blackburn, 2-4 in Burnley, and 5’0 0 in

Warrington. The 53 deaths of children under two years of

age attributed to diarrhoea only exceeded by 1 the numberin the previous week. The deaths referred to diphtheria,which had been 45 and 30 in the two previous weeks, roseagain to 42 last week; they included 15 in London andits suburban districts, 5 in Manchester, and 2 each inStoke-on-Trent, Birmingham, and Rhondda. The 20 fatalcases of scarlet fever exceeded the number in the previousweek by 5 ; 6 occurred in London, 4 in Liverpool, and 2 inLeeds. The deaths referred to enteric fever were fewer by1 than the number in each of the two previous weeks, butincluded 2 in Bolton, 2 in Bradford, and 2 in Rotherham.The number of scarlet fever patients under treatment in theMetropolitan Asylums and the London Fever Hospital, whichhad increased from 982 to 1082 in the six preceding weeks, hadfurther risen to 1097 at the end of last week ; 158 new cases ofthis disease were admitted to these hospitals during last week,against 167 and 157 in the two previous weeks. These hos-pitals alsq contained 823 cases of diphtheria, 600 of measles,301 of whooping-cough, 30 of enteric fever, and 7 of

small-pox on Saturday last. The 1061 deaths from allcauses in London last week exceeded by 35 the low numberin the previous week, and included 153 which were

referred to diseases of the respiratory system, against 232and 173 in the two preceding weeks; 5 deaths were

directly referred to influenza. The deaths attributed todifferent forms of violence in the 77 towns, which had beeD170 and 184 in the two previous weeks, were 177last week, and 353 inquest cases were registered. Thecauses of 31, or 0-8 per cent., of the deaths registered inthe 77 towns last week were not certified either by aregistered medical practitioner or by a coroner. All thecauses of death were duly certified in London and itssuburban districts, Manchester, Leeds, Sheffield, Bristol,Bradford, Hull, and in 48 other smaller towns ; the 31uncertified causes of death in the 77 towns last weekincluded 5 in Birmingham, 4 in Liverpool, and 3 each inBootle, Sunderland, and Gateshead.

HEALTH OF SCOTCH TOWNS.

In eight of the principal Scotch towns, having an

estimated population of 1,710.291 persons (based on therecent Census enumeration) 869 births and 581 deathswere registered during the week ending May 27th.The annual rate of mortality in these towns, whichhad declined in the four preceding weeks from 19 to 15-8per 1000, rose again to 17-7 in the week under notice.During the first eight weeks of the current quarter theannual rate in these towns averaged 18 0 per 1000 of therevised estimate of their population. The annual death-ratelast week ranged in the eight towns from 10 and 14-2in Paisley and Leith to 19 in Dundee and 21-8 8in Perth. The 581 deaths from all causes in theeight towns last week showed an increase of 68 on

the low number in the previous week, and included 67