a girl 18 months old, very feverish. Temperature 103°. On the forehead was an exanthem resembling eczema; on the chin were a few small vesicles; on the left arm was a well-developed vaccine pustule. Dr. Hayes informed me that he had vaccinated the child January 24. I ascertained that the child had been very sick when she was about 9 months old, and had an eruption similar to the one developed January 31. Dr. E. S. Berry was called to see the child March 15, 1881, and found her with high fever, and an eruption which he diagnosed eczema, and all the conditions were such that no one expected that the patient would recover. After three weeks she became better, but remained feeble to the time when the second eruption took place. When I saw the patient there were no umbilicated pustules, nor any conditions by which I could diagnose variola vera or varioloid.

Dr. Hayes states in his notes as follows:

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"On Wednesday, Jan. 24, 1882, I vaccinated the family of Ralph Frost, living on the second floor of the house with Mr. Wm. T. Tibbetts, who was at this time convalescing. The Frost family had a few days before been quarantined by the local board of health.

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Saturday, Jan. 28, I visited the family, which, by the way, consisted of Mr. and Mrs. Frost, and little daughter about one year and six months old, and found the vaccination taking in all. On the child's arm there was a well-formed vesicle, which in a few days developed into a pustule.

"Sunday A. M., Jan. 29, I was called to see the child, which had been taken vomiting during the night. Her temperature was 103.5° F.; pulse about 150. By the child's gestures I thought she was suffering from intense pain in head and back, tongue coated, and a great deal of thirst. There were all the indications of a high fever. * * *

"P. M. Temp. 104°; pulse about 150. The child had been very restless during the day, and had suffered much from pain in head and back.

"Monday, Jan. 30, A. M. Child passed a comfortable night, but was awake many times. Temp. 104° F.; pulse very frequent. The cathartic which was administered the day before had not operated. Eruption beginning to show itself about the nose and

upper lip; tongue coated.

All symptoms indicated an illness of considerable gravity. From the history of a probable exposure, and from the symptoms, I felt justified in making a diagnosis of either small-pox or varioloid. Accordingly I reported the case to the local board of health. They put out the red flag.

Eruption on head,
About the upper

"Tuesday A. M., Jan. 31. Temp. 103°. neck, back, and limbs, papular in character. lip and nose it was vesicular. Over the face the eruption was very thick. Photophobia was a troublesome symptom, and the child kept its eyes closed all the time after Tuesday. Dr. Horsch saw the case in consultation. He thought the eruption not fully enough developed to warrant a positive diagnosis. The vaccination was taking quite well.

"P. M. Symptoms the same, with considerable constipation, which had been a marked symptom all the time.

Wednesday and Thursday. Temp. 99° to 100° F. Photo phobia excessive; face and eyelids much swollen. Thursday, Dr. Fenner saw the case and confirmed my diagnosis. From the appearance of the vaccine pustule on the child's arm, he thought it a case of modified small-pox. The child was given stimulants in the shape of wine and quinine from Wednesday till she died. She nursed quite well all the time, and drank milk and lemonade. There was a great deal of itching. The child got its hands loose by night and tore its face badly with its finger nails.

Temp. 100° F.

Temp. 98.5° to 99° F
The child refused to

"Sunday A. M., Feb. 5. nurse or take milk. Continued the stimulants in shape of brandy and wine.

"Monday, Feb. 6, a. M.

The child opened its eyes, drank milk, and seemed better. Temp. 101.5° F. P. M., Dr. Fenner saw the patient a second time. The eruption was confluent over face and back, but the child seemed so much better we were in doubt about the prognosis.

"Tuesday A. M., Feb. 7. The child died at 8:30 o'clock.

To Dr. C. H. HORSCH.

J. G. HAYES'

REPORT OF DR. C. M. LATHROP.

Grace Hull, aged five, was vaccinated Jan. 5th, with very mild, though perfectly normal, local results.

On the seventh day of the vaccination, and before the appearance of an aureola, she was suddenly seized with a rigor which was the juncture of a fever, with evening exacerbations to temperature of 103° to 104°, the whole subsiding coincidently with the appearance, some time on the fourth day of the fever, of one papula upon the side of the nose, having a typical resemblance to those of variola, and two or three others upon right wrist of ambiguous appearance. These, without further development, soon began to disappear as by resolution, and on the following day were entirely gone.

Vomiting, headache, and backache were severe during the first day or two, also an exanthem like measles upon the lower half of the patient throughout the fever.

This case was in the neighborhood of several declared cases of variola, and of two other cases whose early fatal termination, while preventing positively definite diagnoses, had not freed them from suspicions of having been the same disease. Further, a strong probability of indirect exposure was believed to exist, while there was full susceptibility.

Under these circumstances, I deemed a tentative seclusion to be important, and this was fully secured for a sufficient period by the voluntary parole of the family.

M. C. LATHROP, м. D.

REPORT OF DR. CHAMBERLAIN.

Report of cases occurring in Dover, January, 1882:-
:-

I was called, Dec. 31, 1881, to see W. I. Tibbetts. He reported himself as having been somewhat indisposed for several days past, and as having had a slight chill.

I found tongue furred, pulse quickened, temperature 101°, some cough, pain in left side, and quite a severe headache, the last symptom not being very significant in his case, as he had been out of health for several years, and a great part of the time under a physician's care, the most prominent symptom having

been cephalagia, from which he had suffered so severely that he had almost constantly taken bromides in some form.

I found him manifesting considerable anxiety in regard to what his disease might prove to be, as he said he had assisted in laying out a Thompson, who had died some twelve days before, and he feared he might have contracted some disease from him. I allayed, as much as possible, his fears by telling him that if Thompson's disease was what I understood it to have been, no trouble could come from that source.

Jan. 1st, I was out of town, and patient was seen by my partner, Dr. Smith, who diagnosed it as a case of pneumonia, and, finding a temperature of 104.2°, prescribed a 15-grain dose of quinia to reduce it.

Jan. 2d, I saw patient again, found pulse 84, and a temperature of 102°, a reduction evidently due to the quinia. There were pain and dulness on left side, some cough, and expectoration of a dark, tenacious matter, also considerable bronchial irritation and irritation of conjunctivæ, with eyes sensitive to light, and on the forehead an eruption beginning to show itself, having the appearance of measles.

Jan. 3. Pulse 96, respiration 32, temperature 104°. Pain in head continued. There was evidence of broncho-pneumonia, and he was raising rusty sputa; also had an eruption extending all over him, having every appearance of measles.

Jan. 4. Pulse 85, respiration 24, temperature 102°. The eruption was not quite as bright as the day before, and he was coughing considerably.

Jan. 5. Pulse 78, temperature 99.8°. He complained of a feeling of exhaustion, which was relieved by the use of stimulants. Jan. 6. Pulse 96, sitting up, and temperature normal. From this date pulse and temperature remained normal. The measlelike eruption on the face had become of a duller hue, but the face was somewhat swollen, not more so, however, than I have often seen it in measles, and there were a few places, especially on his limbs and back, where some vesicles formed; but none of them presented the appearance of varioloid, or pursued the course of varioloid vesicles.

There were also several petechial spots on his limbs, and numerous points on him where there were no vesicles, where the

characteristic measle eruption was most prominent, that a little capillary hemorrhage had taken place under the epidermis, leaving a spot about the size of a pin-head.

As regards the character of the eruption and its deviation from the usual course of measles, which I had diagnosed it to be: I took into account the condition of the patient previous to this attack; and as authors mention similar abnormal courses which exanthematous diseases often take, and being at that time almost certain that he had not in any way been exposed to variola, I could not from the course the disease pursued see any reason for calling this variola or varioloid.

In the usual time, after the severity of the attack had passed, some desquamation took place, similar to what is seen after measles.

Jan. 18, I was called in the evening to see T. L. Tibbetts, a brother of W. I. Tibbetts. He said he had been suffering for several days from headache, and that day had been nauseated. I found him restless, pulse 100, temperature 101°.

Jan. 19. Pulse 90, temperature 1000; had vomited some during the night, and his head still felt badly. P. M., pulse 90, temperature 100°.

Jan. 20, 8 A. M. Patient was sitting up, said he felt better, and had slept six hours during the night; pulse 90, temperature under the tongue 101.8°, the highest point it was at any time during his illness. At 10:30, was sent for to see patient; at same time Dr. Berry was called in consultation.

We found him pretty much covered with an eruption resembling measles, with some quite large petechial spots on his legs, and on his body there were many places where capillary hemorrhage had taken place into the eruption. None of the eruption was raised more than ordinary measles, and on passing the hand over the forehead and other parts of the body there was none of the evidence of variola usually found in the commencing stages of eruption. On the arms, especially, there was as perfect an eruption of measles as I have ever seen, the conjunctivæ were inflamed, and the eyes sensitive to light. We diagnosed the case as one of hemorrhagic measles.

On the evening of the same day the eruption had completely