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purposes of diagnosis. With further observation of such preparations, coupled with the results obtained in all types of the disease, often in the absence of an examination of the patient, and the negative reaction obtained when GRAM's method was employed as a precautionary test, I feel convinced that this method of Ross applied to the haematology of plague opens up to us an entirely new field of research into the pathology of plague and will alter our views as regards the types of the disease, if such distinct varieties of plaque are existent.

Recently Dr BELL published a short note on this method in the British Medical Journal (March 1904, p. 544). He says : I have examined numbers of cases, mostly on the first or second day of illness, and in every case, the result has been positive." Further he comments thus: "a case can be diagnosed almost as easily as a case of malaria.”

In my opinion these expressions are too absolute. The method is not absolute. One may easily fall in error unless great care is exercised in the preparation of these thick blood films. Again unless a fair number of these bacilli are found present, the diagnosis should be withheld until a more favourable blood film is obtained.

The method of finding plague bacilli in the peripheral blood during the phase of the disease is of the greatest interest, and the results obtained are more or less in direct opposition to the views expressed by most scientists in regard to this question.

This is so entirely new that I would not support such a result, in the face of so great an amount of contrary evidence, had I not convinced myself of its actual presence. The method has been successfully prosecuted at the Government Civil Hospital, and I believe the Medical Officer in charge of Kennedy Town Hospital has reported favourably upon it. From this result, it would appear that the views held in regard to the bacteriology of plague must alter in a manner similar to those held a few years ago in regard to typhoid fever. The B. typhosus was, up until a few years ago, supposed to have an extremely limited distribution in the body. The organism had scarcely ever been found apart from lymphoid tissues. Typhoid was regarded as a disease of the abdominal cavity. With extended research, all this has become changed. Typhoid fever is now recognised as a septicemia, with the presence of the B. typhosus in the blood, and the majority of the symptoms and physical signs of the disease, are regarded as being due to the actual presence of the specific organism itself, rather than to the absorption of poisons produced by the bacillus at some distance.

Plague, viewed in this light, would appear as a septicemia-a disease caused by the B. pestis, which is present in the blood stream and can multiply there. This septicemia may remain as such, or in other cases may be accompanied by the formation of one or more so called bubonic swellings in connection with certain groups of lymphatic glawls, or again, may be accompanied by secondary pneumonic processes in the lung.

Such a view of the disease would account for the majority of plague cases. It must not be forgotten that there probably exists another type of the disease, distinct from that commonly found, namely, the primary pneumonic pest, which is caused by direct inhalation of virulent B. pestis. From all researches, it appears that this inhalation disease is something different, and the distinguishing features of this form, and the significance of its presence are discussed under a separate heading.

For purposes of comparison, it will be of use to sketch briefly the present day opinions in regard to the pathology and bacteriology of the disease.

Plague, with all its so called types or varieties is caused by the specific or- ganism, known by the name of the B. pestis, and, were it not for the constant presence of this characteristic micro-organism in all the different manifestations of the disense, there would, as in past ages, be a tendency to regard the principal types of plague as distinct diseases.

The general consensus of opinion is that the bubonic type of plague is the standard variety of the disease. The causal agents are found in the bubo, but not in the blood. Throughout the disease the bacilli are pent up in the bubo. The