London was the first who contended that Rötheln was a specific contagious exanthem, distinct from either measles or scarlatina, but he did not propose a name for this distinct disease—it was left to the American Dermatological Association to suggest a name, one that represents this allied but distinct form of Rubeola, by the diminutive of this: Rubella.

One of the main points laid down as distinctive of the group of contagious exanthemata, from Cullen's time downward, is that each of these diseases occurs in the same individual but once in a lifetime-that is, that one attack of any of these eruptive fevers confers in the individual who suffers it immunity from a second; and the rule has been found to hold good, not indeed as absolutely true, but with exceptions so few and rare as not to seriously invalidate the general law. But measles is not a protective against scarlet fever or chicken-pox or small-pox, nor is chicken-pox protective against small-pox; neither is measles protective against Rötheln, nor Rötheln against measles. Both of these may attack one person within a very short period; indeed the one may break out before the patient has fully recovered from the other.

In most cases Rötheln requires little care and attention, yet it is not always a trivial disease. A slight fullness of the head, heaviness, pain, or giddiness, with a little aching of back or limbs, or tenderness of throat, is in a few hours followed by a rash, beginning on the face in rose-red spots, extending next day to the body and limbs. The cervical lymphatic glands perceptibly enlarge, the fauces or uvula are red, tonsils are full and smooth, eyes are suffused, but there is little or no coryza; eyelids are somewhat swollen and irritable, face is flushed, cheeks red and full, even before the appearance of the spots; the spots are bright red, raised, rounded, with clear skin between them, but they soon coalesce, are not grouped as in measles, but are more prominent than in scarlet fever. While extending to the limbs it begins to fade from the face and subsides with the fever on the third day. A continuous rise in the temperature commences with the appearance of the rash, and this may reach 102° or 103° and be evenly maintained as the eruption proceeds. Slight coryza may come on after the rash has faded; the eyelids become sticky, the nostrils stuffy, the throat sore, or some cough begins. Exposure or want of care

ally with pulmonary complications.

at this time may determine serious disturbance of health, generThe urine is often high-colored in the early part of the illness. Rarely does desquamation follow. The disease is propagated by contagion. It has a long period of incubation; authorities give it from 11 to 12 days, Thomas says from 2 to 3 weeks. Its period of invasion is from 2 to 3 days, but in mild cases it may not be more than 24 hours. In all cases of Rötheln look to the throat and examine the chest. Two months may elapse before health is quite restored, and not very infrequently permanent deterioration of health dates from this disease.

Again and again this eruptive disease has assumed a dangerous and even malignant type. London was visited by an epidemic of such a severe type in 1879. It was marked by extreme hoarseness, incessant croup-like cough, marked implication of the larynx and bronchi, the rash was confluent on the face and backs of the wrists and hands, accompanied with much swelling, and did not reach its maximum until the third day. The temperature went up to 103° as the rash came out, and continued to rise to 104° or 104.5°; the pulse ranged from 130 to 160, was feeble and irregular; the tongue was much coated and became dry; there was night delirium, and as the eruption came out drowsiness beyond all precedent, lasting for some days after the rash reached its height; vomiting was another notable feature during this epidemic-it occurred mostly during the eruptive stage, and most commonly about the second day. Another symptom observed in all severe cases was ear ache; it came on with the greatest uniformity, about 48 hours after the eruption began to decline, lasted with much severity for several hours, and then disappeared; no discharge from the external meatus was noticed, but persistent deafness resulted in one case. Cases are on record in which the laryngeal obstruction was so great that tracheotomy had to be performed. While some authorities positively declare that in no case of Rötheln albuminuria has occurred, Duckworth and Cheadle both observed during the London epidemic transient albuminuria in a number of cases.

A SANITARY PROBLEM.

Dr. Henry Gibbons, in the last number of the Pacific Medical and Surgical Journal, which is, by the way, one of our best exchanges, has concluded an article having the above title. The view is taken that there is an apparent contradiction in the conditions surrounding diseases which arise in filthy localities, and the disturbance of health from unhealthy ódors; it is not a defense of filth or dirty modes of life, but an attempt to show that the specific causes of infectious disease possess no odor. The paper concludes with these propositions:

1. The specific poison of infectious and contagious diseases has no odor.

2. It may be associated with offensive odors or it may not. In by far the larger proportion of instances it is not.

3. Offensive odors cause no permanent disease. They may excite nausea or transient disturbances of digestion, or lower the standard of health by long exposure.

4. Certain emanations offensive to the smell, notably if sulphur be the basis, tend to destroy organic germs. (This is undoubtedly true.)

5. Water which has been polluted by excrementitious or other organic matter is mostly drank with impunity, the gastric juice digesting or destroying the organic germs. The production of disease by such water is the exception and not the rule.

6. Polluted water becomes purified by agitation in streams, by filtration in the earth, and by a spontaneous fermentation.

While there is a great deal of valuable truth in a large part of this article, we are not able to agree with all these conclusions. Water cannot be had for drinking purposes which is too pure for the human family. We don't want sewage filtered into our water supply to take the chances of its oxidation or purification by being agitated, and we have no doubt that many forms of disease arise from its use. All stomachs are not strong enough to kill the myriads of animalculæ, infusoria, and other water inhabiting bugs with which a large percentage of our sources of water supply is contaminated.

And it is a fact, though not relevant to this subject, that a

very large proportion of liquor and beer drinking habits are formed in large cities, especially in hot weather, from the difficulty of getting a good drink of pure, wholesome water.

With reference to stenches and malodorous emanations, the writer is certainly correct when he says that it does not necessarily follow, because odors are offensive, that they are dangerous to health. Simply because it "smells bad" is no evidence whatever that it is injurious. We send children to the purifying rooms of gas works to relieve the paroxysms of whooping cough, and with good effect; and a variety of odors, notably those having a sulphur basis, though not agreeable, are not therefore the vehicles of contagion.

As we are writing there comes wafted upon the cool night air an indescribably sickening stench which will find its way into the house even if the windows are closed. We are at Fifteenth street; right across the East River are a number of large petroleum refineries, and the smoke of their tormenting odorate ascends day and night. When the wind is in the right quarter, we get the full benefit of its sickening qualities. Many persons are unable to bear it—yet, except for the nausea occasioned, it is not injurious; it is a powerful antiseptic, and, like the vicinity of gas works, is a healthy locality. But it was very difficult for the proprietors to persuade a committee of the Legislature that they were not responsible for all the zymotic disease occurring uptown in New York, and the chances are yet that they may have

to move.

Butchers are always healthy-exceptionally so; the vicinity of slaughter houses is always avoided with fear, yet there is no evidence that any of these badly smelling vapors contain the germs of disease. A great number of trades and occupations may be cited which have been and are classed as unhealthy, but in which the workmen live as long and enjoy as good, or better health, than those of more favored professions.

Shakespeare compels the grave-digger in "Hamlet" to bear testimony to the value of a tanner's occupation to preserve his body after death, attributing this result to the absorption of the materials used in his trade during his life. Tanners are long

lived, yet they work among the worst smelling stenches of any trade.

We need a good deal more light on this whole matter, and it repays investigation. Dr. Gibbons' paper should be carefully read.

EDITORIAL NOTES AND SELECTIONS.

PULMONARY CONSUMPTION.

Is-consumption contagious? This question has, from its importance, given rise to so much discussion of late, and so much laborious and painstaking work has been done by eminent men toward solving it, that we will give a short resumé of what the advocates of the theory of the contagiousness of consumption claim:

I.-There is one man (Koch of Berlin) who does know that the bacillus tuberculosis is a fixed fact in science, and who is able to convince anyone that it, and it alone, is the cause of the disease.

II. In a clinical lecture by Prof. J. Burney Yeo, published in the British Medical Journal, he lays down the following propositions regarding the contagiousness of this disease:

1. Tubercle is an effective malady, originating in a specific virus, and propagated by the conveyance of that virus from body to body, and originating in no other way.

2. The specific virus of tubercle consists of a particular microorganism, found only in tubercle; this organism can be seen in the cells of tubercle, can be obtained in a separate form and cultivated in successive generations without losing its original properties.

3. Certain forms of disease, termed "scrofulous," are essentially tuberculous, and their characteristic anatomical morbid products contain the infective organism peculiar to tubercle.

4. The disease known as pulmonary consumption is, in the main, a tuberculous disease, and is dependent on the presence and propagation in the body of the infective organism characteristic of tubercle.

5. Pulmonary consumption is a contagious disease.