IN a review of the more recent investigations into the pathology of tetanus, Mr. Wm. Anderson states (THE LANCET, Feb. 4th, 1888): " It is certain that although 1 tetanus may be induced by the inoculation of a specific micro-organism or of a specific ptomaine, its occurrence as the result of direct transmission from one subject to another has yet to be demonstrated by clinical experience." As a note on the above statement, I wish to record the following cases. Chai S-, farmer, aged thirty-one,

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... as admitted to the Foochow Native Hospital on Sept. 28th, 1887, suffering from a crushed toe. The accident had occurred three or four days before admission, and our native assistant, finding the toe gangrenous, amputated it. Symptoms of tetanus appeared on the following morning. The patient was removed to a little private room, carefully fed, and put on full doses of chloral and bromide of potassium. Severe opisthotonos developed, and death from exhaustion occurred on Oct. 1st. Sin T-, preacher, aged thirty-one, was admitted to the hospital on Oct. 8th, suffering from internal bleeding piles. The bowel was cleared out with castor oil, and on Oct. 10th the piles were ligatured. After operation the patient was placed in the little room in which the man Chai Shad died ten days previously. Opium was given, and the bowels kept at rest till the piles dropped off. Recovery was rapid and uninterrupted. Nine days after the operation, considering himself perfectly well, the patient returned to his home, some three miles distant. On the following morning, Oct. 20th, he reappeared at the hospital, complaining of stiffness in the jaw and muscles of the back. Placed in a different ward, he was at once put on full doses of chloral and bromide of potassium. The rectum was washed out with warm carbolised water. The anal wound looked perfectly clean. Opisthotonos soon developed, but under the chloral the spasms were limited to two or three an hour. The urine was drawn off every six hours under chloroform. Nourishment was taken well, and good hopes were entertained of recovery. On the fifth day of his illness, however, influenced by some foolish friends, lie took a gloomy view of his own case, gave up hope, refused nourishment, and died of exhaustion on Oct. 26th. Remarks.-The coincidence of the two cases was striking, and strongly suggestive of contagion. Tetanus is not common in Southern China. In eight years of hospital practice I had previously met with but one case. Our present hospital was built a year ago, is thoroughlyventilated, and occupies a healthy site. The room which the two laatients occupied is 10 ft. bv 8 ft., and has a wooden floor raised 2 ft. above the level of the ground. Though it appeared clean, the room had neither been swept nor washed since the first patient had died therein. Is it possible that our second patient was inoculated through the anal wound by dust containing specific micro-organisms generated by our first patient, and tetanus produced? The necessity for the thorough cleansing of a ward in which a case of tetanus has occurred is clearly indicated. examine a case of malformation of the rectum of a female child aged six months, and found, as stated by the parents, that the fasces passed through the vagina, and had done so from birth. There was no orifice externally. The child had been operated upon superficially several times previously by other physicians, but unsuccessfully. When the bowels were about to move the child suffered great pain, and strained to such a degree that she became nearly black in the face and was convulsed. The bowels did not move unless medicine had been given. I examined the child, using a small silver catheter, and, having passed it into the vagina, found an opening leading into the gut, through which the faeces were disci] arged. The parents having given their consent, an operation was decided upon as the only means of affording relief. The next day, the child being placed in the lithotomy position, the catheter was passed through the opening from the vagina into the gut, and, the catheter being held by Dr. Black, I cut down with a straight bistoury more than an inch deep upon the catheter, afterwards making as free an incision in extent through the gut as was deemed necessary ; then passed the catheter through the opening made in the bowel, and through the incision made in the perineum, and so brought the catheter out externally. The child was teething, and although the bowels had previously been much constipated, diarrhoea now set in, which had to be relieved by medicine, and this continued throughout the case. Having passed the catheter, we next took a piece of tape saturated with olive oil, and (Irew it through the incision and through the opening into the vagina by means of the catheter. I gave directions to the mother to draw some of the tape through the incision when the bowels were about to be moved. The result was that, from the first, part of the fseces followed the tape, whilst the remainder still continued to pass through the vagina; but by perseverance in this way the discharge through the vagina became less daily, and more passed by the opening made. A good external orifice having been established, the tape was withdrawn. The result was perfectly satisfactory : the operations of the bowels took place naturally, all pain ceased, and the opening from the gut into the vagina closed, the child suffering thereafter no inconvenience whatever, but being in all respects the same as if no malformation had ever existed. A complete recovery was effected within six weeks from the date of operation. Junction City, Kansas. __ A FEW days ago a child, aged four, was brought to me in a state of complete insensibility, foaming at the mouth, and suffering from tetanic spasms and spasmodic breathing. The history of the case, as told me by the father, was to the effect that the child had swallowed some liniment, the bottle containing which ivas handed to me. I was unable to say at the moment what the contents of the bottle might have been, but finding the child's pupils fully dilated, I came to the conclusion that at least one of the ingredients was belladonna, The child, being insensible, could not swallow, so I injected into its right arm a quarter of a grain of sulphate of morphia, and into the left one-tenth of a grain of pilucarpine ; these were in tablets sold for the purpose. In about ten minutes the foaming at the mouth ceased, and shortly afterwards the tetanic spasms ; the breathing also became quiet and normal in character. The pupils soon began to contract, and to all appearances the child seemed in a quiet natural sleep, which lasted from 7 P.M. till 3 A. when it sat up and vomited. A small quantity of brandy-and-water was administered, and the child sent home out of danger. Next day it seemed quite well. I noticed that no sweating ensued from the injections, owing, I believe, to the belladonna taken. I heard afterwards that it was a belladonna and soap liniment which had been prescribed for the child's mother. , aged twenty-one years, farm labourer, in March, 1885, got cold and suffered from congestion and bronchitis for three or four weeks. He got better and went out. In July he had a relapse and suffered from pneumonia of the left side, of a subacute type, which in the third stage became chronic, and he had expectoration of pus all the following winter, during which he was confined to bed. He