when shaved, or upon his body. I had ordered his outside relatives to keep away, and I urged he have no funeral and simply took the mother and sister to the grave, his own brother digging the grave, and a prayer made over it by myself was all this poor unfortunate had in the way of a funeral. I vaccinated the other members of the family, fearing possibly it might be small-pox, but as it had not shown itself so as to be recognized I could not say definitely, and therefore cautioned people to keep away. I must confess that with the mother's story I had fixed the diagnosis of measles with "purpura hæmorraghiæ." He died on the 1st of February, and on the 11th I was called to see his brother's wife, in whom the disease appeared as small-pox. I called counsel from Detroit who corroborated this, and we quarantined at once. The panic then began among our citizens, and the priest and myself had hard work in putting into the coffin one victim from whom every one fled. None of the citizens would dare to assist. I ordered a sign up at once. A board of health was afterwards formed and Dr. Snow appointed the health officer, and a notification was issued for every one to be vaccinated. Dr. Snow's report of the 24th of February shows how few came. In the meantime I had to fight it in the Hall family. I vaccinated all, the nurse included, and Mr. Wm. Hall, the brother of the deceased; also his sister. They all escaped. The Episcopalian minister, who baptised Mrs. Hall's babe just before its death, I vaccinated and took to my own home until all danger of his having the varioloid was over. He remained with me three weeks. A young person who sat up with the corpse of young Hall went home and must have had a light varioloid. I did not see him; he was under health officer Snow and he infected several in his neighborhood. A family in his neighborhood sent one morning for me and said that a Mrs. C., who had expected to be confined, was complaining with headache, etc., and wished I would send something for it. She was constantly vomiting. I told them that looked suspicious and said I would be up, sent remedy by the boy and called soon after upon the patient. On my arrival I found I had a case of variola hæmorraghicæ in a patient eight months advanced in pregnancy. I reported to the family she would be dead in less than 24 hours, the throat and glottis involved so terribly. Immediately I left my report with the board of health. My report was: "Small-pox at Bernard Magoonah's, a fatal case; put up sign at once." I called with the priest to put the dead woman in her coffin; I vaccinated all the inmates, one a soldier without arms I was compelled to vaccinate on his leg. I

found Miss M., the sister of the deceased, with varioloidal crusts on her face. I immediately vaccinated the brother, the mother and a little boy, and as the priest led out the sister to be vaccinated I perceived instead of typhoid fever she was just getting over varioloid.

I vaccinated my families in the neighborhood, and the plague was stayed in this portion of the town only to reappear elsewhere. The next case happened in my own practice, and I think conveys such proof of the human hair retaining the smallpox virus that I cite the circumstances minutely, as I think it will upset some of our usually received opinions as to the drive in the air taking away all danger of contaminating the next patient.

The history of this case was as follows: A Mr. Jno. Ford sent for me, stating he was suffering from trouble of the lungs. I changed all my clothing, washed my body, etc., but did not wash out my hair, thinking the drive through a heavy snow storm that the air and moisture would remove all danger of infection clinging to it. I drove six miles to his residence in wind and storm in my sleigh, exposed all the way to the snow, and occasionally lifting my hat to let the air blow through. On reaching his residence I found him suffering from pneumonia, and in ausculating his chest, I brought my head very near to his face. My patient made a very good recovery from his pneumonia, and one Sunday morning I was surprised by his brother appearing at my office with word that "John was getting sick again." The brother said he had such a fear of small-pox, and knowing that Dr. Snow and myself were both involved in it, for it was a pestilence then in Dearborn, telegraphed for Dr. Batwell, of Ypsilanti, who had while residing in Detroit been their family physician, to come down and see him. Dr. B. did not see anything to excite his suspicions of small-pox, although Mrs. Ford, the mother of the patient, asked the doctor if he did not think Dr. Duffield might have carried some small-pox into the family. Dr. B. laughed and said he thought it impossible. In fact, Dr. B. did not himself think there was any danger.

My visit was made two days after Dr. B.'s, and I found I had a case of "variola discreta." The anxious mother asked me what was the matter with her boy, and showed me the medicines Dr. Batwell had prescribed and called my attention to the rash appearing on his face. On my inquiry whether there had been any tramps around there, she said no, there had been no person there except relatives since he was sick. I asked if any one had been in the city and returned. There was no

loophole here, for she again said "no." My reply then was, "Mrs. Ford, your son has the small-pox, and I presume I am the party who has carried it to him." The morale of that family can better be imagined than described. I tried to assure them that we could cut it short so that it would not spread, and vaccinated every one in the family and sent after every one who had been exposed, and vaccinated them. Fortunately all arms took and not another case appeared. Of course I could not charge anything for that case. The patient recovered with but little scarring. Now what I wish to impress upon the minds of all is, the only way that young man could have taken the small-pox was from me, and the only vehicles of the virus were my beard and hair.

Our township was divided into three districts, health officer taking one, the priest another, and I another. I furnished the priest his virus. The virus I used was from Griffin, of Fond du Lac, and it acted perfectly. I want nothing better.

SCARLATINA.

BY J. HENRY CARSTENS, M. D., LECTURER CLINICAL MEDICINE, DETROIT MEDICAL COLLEGE, ETC.

Having had many continuous cases without a single death, has prompted me to prepare this paper.

"It is indisputable that the cause of scarlatina is a peculiar substance which is transferable from the patient to the unaffected individual." [Louis Thomas in Ziemssens.

This poisonous substance circulates in the blood, and is probably eliminated by the skin, lungs, and kidneys. The blood of persons affected with scarlatina has been examined, the serum found "filled with an infinite number of small rapidly oscillating bodies, which under a magnifying power of five hundred diameters, appeared as dark points between the groups of blood corpuscles. In addition there were also rod-like formations, which at many places were recognized as being composed of three or four or more of these first minute bodies disposed in rows." [Riess.] Some of this blood injected under the skin of rabbits caused the death of the animals in twenty-four hours, and the same small, dark bodies in its blood.

The contagious principle can be conveyed by clothing, letters, furniture, hair, milk, animals, especially cats and dogs. The greatest care should be exercised to prevent the spread of the disease by the attendants and the physician. By thorough ventilation of the sick room and dilution of the contagion the chances for infection are greatly diminished. The tenacity of scarlatina contagion is extraardinary. It has been found that clothing worn by patients will convey the poison to others three. to six months afterwards. Cases are even on record where the contagion has retained its integrity for one and one-half years.

The vitality of the contagion is not affected by cold, but by heat it is destroyed. Substances containing the contagion of scarlatina exposed to a temperature of 212° Fahr. can be used thereafter with perfect safety.

The period of incubation is shorter than has been formerly supposed. It is generally two to four days occasionally, though

rarely twelve to fourteen days. The period at which a scarlatina patient can communicate the disease has not been definitely determined, although unquestionable at any period, still the first two days the danger is less than during the period from the third to the twelfth day. After this the danger of infection is gradually diminished to the sixth week. Even at this late period it has been proven that the disease can be communicated by one person to another.

ANATOMICAL CHANGES.

The cutaneous vessels are found surcharged with blood, rete mucosum thickened and containing cells with large nuclei; the ducts of the sweat glands occluded, frequently the basement membrane thickened and without epithelium; an excessive formation of new epidermis takes place which desquamates, sometimes even repeatedly. When the throat is involved we find inflammation of the mucous membrane of the soft palate, uvula and the tonsils; sometimes such a state of inflammation of the latter that abscesses result. In very severe cases œdema occurs, which may involve the glottis. Other changes are also observed, such as are found in bronchial catarrh, diseases of the lymphatic or mesenteric glands, pancreas, kidneys, etc.; but this paper is not intended to treat of the pathology of this disease.

VARIETIES.

We usually call scarlatina simple, anginose, or malignant, according to the severity of the attack, although it is all due to the same poison. The popular notion that scarlet fever and scarlet rash and scarlatina are all different diseases should be disabused by the regular medical profession. In my experience I have found that simple scarlatina can cause the most malignant form in another person, and vice versa. I have also found that a small child can give the disease to an older person, even to an adult, the popular notion to the contrary notwithstanding. In some cases also no rash appears, scarlatina sine eruptione; in others it is confined to certain parts of the body; but these are all only modifications of one and the same disease.

DIFFERENTIAL DIAGNOSIS.

This is generally easy, except in those cases where no eruption appears. The disease might be taken for erythema, which spreads in an irregular manner; rubeola, which is of short duration; sudamina and miliary eruption without affection of the glands; erysipelas, with oedema of the parts affected. In