or heart failure appear, tincture of digitalis or carbonate of ammonium with some alcoholic stimulant are indicated. The latter especially may be given freely when the case is malignant.]

As regards staying in bed, measles varies so much that no rule can be laid down. It is generally well to keep a child in bed for a couple of days after the temperature becomes normal, and to its room for a week further. It should be kept indoors for three weeks or a month. The room occupied by a child with measles is to be kept well ventilated. In most cases the window may be allowed to be a little open at the top; all draughts are to be avoided, and in obtaining fresh air the temperature of the room must not be allowed to fall.

Broncho-pneumonia, if it exist, must be treated as in other cases. If the child be feeble, a few drops of sal volatile or a grain of carbonate of ammonium may be given, and some liquid extract of liquorice; or expectorants, such as squill, ipecacuanha, and compound tincture of camphor may be necessary. Counter-irritation may be applied by mustard-leaf for a few minutes over the diseased part, followed by a warm fomentation or warm linseed-meal poultice at first, and then a cotton-wool jacket. The diarrhoea that sometimes accompanies measles is probably due to some catarrhal state of the gastro-intestinal mucous membrane, and the first thing to be attended to therefore is the quantity of food that is being taken. The milk may be too much, and thin broth or cream and whey, or egg albumen, may suit better for a few hours. In severe diarrhoea cold compresses are very useful. Several folds of linen are to be wrung out of cold water, put over the abdomen and covered with flannel, and changed every two or three hours. For medicines, thirty drops of brandy with some syrup and cinnamon water is a simple and an effectual remedy repeated

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appetite should be guided, if possible, back to normal by the same means, or by the judicious administration of stimulants, and above all by change of air—a dry, bracing air— whether it be sea or inland, and plenty of it, is one of the best restoratives. If there be any tendency to enlargement of the glands, no doubt sea air is the better; otherwise I am inclined to think that a farm-house life, with its freedom from restraint, its good milk and bread, its rough-and-tumble exercise on a farm-pony, is the best restorative in existence.

CHAPTER XI.

SCARLATINA.

Of all the diseases of childhood there is none which presents greater varieties of aspect than scarlatina-none which so often brings, with very short notice, unexpected deaths into a healthy household, or which more often selects for its victims the robust and healthy. Thus writes the late Dr. Hillier; and it would be difficult to put more shortly and more graphically the terrors of this scourge. Some years ago, when taking charge of a practice in the country, I was called to a village some miles away to see a child who was very ill. I found a well-nourished girl of about five years old. She was pulseless, livid, and comatose, with an almost petechial scarlatinal eruption covering the skin. I was told that she had been quite well till the preceding afternoon. She had suddenly vomited while at the Sunday-school, and came home ill. I saw her about eight P.M. the next day, and she died within three or four hours; so that the duration of the disease from its outbreak to the death of the child was under thirty-six hours.

Scarlatina is in great measure a disease of childhood, sixty-three per cent. of the deaths, according to Dr. Murchison, being under five years of age; ninety per cent. under ten; and ninety-five under fifteen years. The disease is not prone to attack children in the first year of life, and this is more markedly the case even than with measles; but it may occur at any age, and cases are on record where infants have been born with the eruption upon them, and in which desquamation has occurred in due course. Meigs and Pepper

have seen it perfectly well-marked in an infant twenty-one days old. It is a disease which occurs in epidemics, though no large town is ever quite free, and it varies much in severity. Epidemics differ from each other in this respect, and case from case. To be infected from a mild form is no guarantee of an equally mild attack, etc. It is a disease which spreads by infection, though it is often difficult to fix the source of contagion.

Incubation. This is somewhat variable. It may be only a few hours-in many cases it is stated not to exceed fortyeight hours, and it rarely exceeds seven days. Consequently any one who has been exposed to the poison of scarlet fever, and who does not sicken within a week of quarantine, may be pronounced safe. The disease is generally latent at this stage, and the child retains its ordinary health.

Prodromal Stage is short; so much so that it is common to find a child quite well, or apparently so, till it suddenly turns pale and vomits; and from that time onwards it is seriously ill, its extremities perhaps cold, fever high, and its whole aspect one of dulness and exhaustion. The disease may set in with convulsions or bad headache, but this is not common. More often there is some soreness of throat for a day or two before the child regularly sickens.

Eruptive Stage.-Within a very few hours of the initial symptoms, during which the child will be more or less heavy and prostrate, and in high fever-perhaps vomiting frequently, perhaps with bad headache, perhaps convulsedthe eruption appears. It is seldom delayed beyond twentyfour hours. The rash consists of a general rosy blush upon which are set darker red points, the surface being smooth unless, as often happens, it is accompanied by miliaria. Some authors state that the dark red points in the eruption are sometimes distinctly raised. In case the roseola is not