able, for, attached to some garment, they may live even a year. A second attack is of great rarity, for in nearly every supposed instance of it the child really had some unrecognized rash on one of the occasions. The disease may be so mild that it is overlooked, or so severe that the child dies in a few hours. The lightest case is capable of giving the most severe form to other children. In a case of average severity the first symptoms are vomiting, fever, rapid pulse, and sore throat. The rash appears within twenty-four hours, and often first about the neck, but rapidly spreads over the whole body except the face. It consists of minute red points, not at all elevated, and so closely crowded that the skin appears a uniform bright red. As a rule, the eruption is widespread when the child is first examined. The color increases in intensity for two or three days, begins to fade in three or four days after the onset, and lasts in all about a week. At about the end of the first or second week the skin begins to peel in large or small shreds, and this characteristic desquamation continues several weeks. During the height of the disease fever persists, the throat is sore, swollen, bright red, and often seriously inflamed, and the tonsils may be covered with white patches resembling diphtheritic membrane. The tongue loses its coating and becomes bright red with the minute natural prominences unusually large ("strawberry tongue"). The rapidity of the pulse is greater than the elevation of the temperature would lead one to expect. The fever disappears in seven to nine days, and the acute stage is over. In bad cases with severe throat-symptoms fever may last much longer than this, while in the mildest cases the rash may disappear in twenty-four hours and there may have been but the slightest fever. The disease is always alarming, because the cases which begin mildly may eventually become severe,

or be followed by inflammation of the ears, pneumonia, abscesses of the glands in the neck, or Bright's disease. The last-mentioned disease may come on even after the child has been convalescent from the fever for two or three weeks. It must be guarded against with especial

care.

In the way of treatment, the slightest possible chance of taking cold must be avoided. The child should be confined to bed, and the windows must not be opened in the slightest, or any bathing or sponging employed, until the doctor in charge is asked what he wishes done in the matter. Very often he will have the child oiled all over as an additional safeguard against cold and to keep the desquamating and very infectious skin from getting about the room. Further preventive measures against spreading consist in isolating the child the moment the mother suspects that it may have scarlet fever, in carrying out careful disinfection during the attack, and in deferring the removal of quarantine until she is quite sure that the danger is over. The caution about bathing is given not because it expresses the writer's views on its danger, but because some physicians are greatly opposed to all bathing in this disease. It does not apply to the first hot bath, useful at the beginning of nearly any acute disease in children.

Measles; Rubeola; Morbilli.-Probably the most frequent and most contagious of the eruptive fevers; occurring generally in the cold season, and rarely in babies less than one year, or, especially, six months, old. It appears to be contagious even during the period of incubation. It is caught generally from the breath, for, although the contagion can cling to objects about the

ient and be carried by a third person, this occurrence

is certainly very rare. The germ has little vitality as compared with that of scarlet fever. Second attacks of measles, although more frequent than is the case with scarlet fever, are still very unusual. In nearly all the reported instances so often heard of the children had measles upon one occasion and German measles or some skin affection upon the other. Measles is usually regarded as a disease of little consequence; but this is an error. In children not previously in good health it may prove fatal, generally by inducing pneumonia, tuberculosis, or some other complication. The attack begins with all the symptoms of a very bad cold, such as feverishness, sneezing, running of the nose and eyes, heavy, stupid expression of the face, hoarseness, and cough. The child is so often stupid and sleepy that the expression "sleeping for the measles" has become a common one. Frequently the onset is much milder, and the child is out of doors, very slightly sick. The rash begins upon the fourth day of the disease, in the form of purplish-red, slightly elevated, flattened papules about the size of a split pea. These appear first upon the face, but spread over the entire body in about twenty-four hours. Many of them remain distinct, while others unite by their edges and form irregular blotches and lines many of which are crescent-shaped. This grouping is very characteristic of the disease. Plate IV. is from a photograph of a child with measles, and shows very well both the nature of the eruption and the heavy, somewhat swollen face and thickened lips. All the symptoms mentioned persist or grow worse, and there may also be diarrhoea. By the sixth or seventh day of the disease the fever has ceased, and by the seventh or eighth day the rash has disappeared. There is often a faint mottling and a fine desquamation of branny scales lasting a week after the rash has discr