was not previously seen by me, but was found absent on the 4th day; coma supervened, terminating in convulsions, and death on the 4th day from commencement of eruptive stage; in the 5th, 6th, and 7th cases the eruption remained vivid for five days; in the 8th case appearing scantily for 24 hours, suddenly receding, appearing again three days after, and permanently disappearing in 24 hours; in the 9th case the eruption was persistent for three days, reappearing every third day, and on the ninth day after its first appearance it became again vivid, and finally disappeared in 24 hours thereafter. An imperfectly established but normally persistent eruption was present in eleven cases.

With one exception the period of the eruption in these 170 cases was unattended with any special complication requiring treatment; the exceptional case being one of croup, where that disease had manifested itself in the premonitory stage. In three cases the eruption supervened while the patients were convalescent from pertussis, a number too small to corroborate the opinion of Copland, West, and others, as to the connection between these two diseases.

In one case a second appearance of the disease was observed-the first attack having occurred two years before, and having been attended by catarrhal symptoms.1

In no instance was the rubeola sine catarrho or sine exanthemate observed.

And now having discussed the general features of the disease in its premonitory and eruptive stages, we proceed to consider the general features of the disease in its decline and disappearance as exhibited in the sequela, and the complications arising therefrom.

1st. Of the Nervous System.-A remarkable immensity from sequelae of this class was observed. In one case only, was there complete coma and convulsions; in other two cases, slight coma followed the sudden recession of the rash; these cases, however, are not so much specimens of sequelæ as of accidents arising suddenly, and referable not to a local lesion, but to a general one, namely, blood poisoning.

2d. Of the Respiratory System.-In fifty-four cases symptoms of acute bronchitis supervened, and in three cases proved fatal, the disease arising during the recession of the rash, and in all the cases observed the eruption being vivid, and the accompanying fever of the inflammatory character. In one case croup supervened and proved fatal, complicated with bronchitis and extreme collapse of lung. In two cases lobar pneumonia supervened-these cases recovered.

3d. Of the Digestive System.-In eight cases symptoms of dysentery supervened upon the subsidence of the eruption, and in one case proved fatal; latterly complicated with cancrum oris. In all the

1 Upwards of 20 cases of rubeola have been twice attended by the medical men of Leith; in all, catarrhal symptoms were present. The seizures occurred at various periods of this epidemic, with four exceptions; two with an interval of two years, two with an interval of one year.

eruption was vivid, and the accompanying fever of the inflammatory form. In five cases apthæ of the mouth supervened. In two cases only was enlargement of the submaxillary glands observed.

4th. Of Organs of Sense. No Sequela connected with the Ears was observed. In two cases only did an ophthalmia occur requiring treatment; these were instances of the more severe form of catarrhal conjunctivitis, attended with some degree of palpebral swelling, and muco-purulent discharge, but leaving no corneal ulcer. In no instance was the cornea primarily affected; in two cases to be noticed under the complications of typhoid fever, it was implicated secondarily. 5th. Sequele of a General Nature and probably connected with Blood Poisoning.-Under this head at least 2 of the cases of sequela of the nervous system might be put, probably all of the cases, but as this might be objected to, we have put them under the aforesaid head.

Excluding these accidental cases, we find that the sequelæ under this designation were consequent upon an imperfectly established, ill-coloured, and sometimes quickly receding eruption, and consisted of a typhoid form of fever, which supervened in nine cases, and in eight proved fatal. In two cases the fatal termination was ushered in by diptherite, in four by pneumonia, in one by tuberculosis and sloughing of both corneæ, in one by collapse of the lung; the case which recovered was not attended by any special complication. The arrangement of several apparently distinct diseases, under the head of complications, may be considered to be rather arbitrary, but as they seemed to be the direct effects of the sequelæ, it was thought advisable so to arrange them. The following table presents at a glance these various sequelæ, and the complications arising therefrom:

Having thus briefly sketched the leading features of this epidemic, we now proceed to describe the various forms which the disease assumed, and the tendency to sequela which characterised each variety. Dismissing from our consideration those cases which proved suddenly fatal from toxæmia, we may consider the disease to have exhibited itself in three forms, which were generally well defined.

1. The type of the disease, accompanied by a well-marked copious eruption, which appeared on the 5th day, with alleviation of the symptoms which preceded its appearance, a pulse but little accelerated, slight catarrhal symptoms; a critical discharge of urine on the 3d day, containing urates of soda; albumen in quantity suffi

cient to be appreciable, frequently by chemical tests, if not by chemical tests, almost always disclosing the presence of blood corpuscles by the microscope in the cases examined, and a speedy return to health thereafter.

2. An inflammatory form, characterised by a vivid, copious eruption on the 5th day, the accession of which was attended by aggravation of the previous febrile symptoms, along with considerable hoarseness and dyspnoea, and on the 3d day, coincident with the fading of the rash, the signs of acute bronchitis or dysentery arising; these diseases being cut short if seen early, but if fully formed before treatment was adopted, proving frequently fatal.

3. A typhoid or asthenic form, with scanty, livid, and sometimes quickly receding eruption; in severe cases proving fatal on 3d or 4th day of eruption; in milder cases a typhoid form of fever occurring, attended with great prostration, dyspnoea, scanty or suppressed secretion of urine, with progressive emaciation, terminating generally in death, from the 8th to the 18th day; in all but one the chest being unaffected primarily, but in many the fatal termination being ushered in by inflammatory affection of the lungs.

We now proceed to inquire into the mortality of this epidemic, and the various cognate causes which may be supposed to have had an influence upon it, as well as the morbid anatomy in those cases in which a post-mortem examination was permitted.

In connection with this point we proceed to consider,

1st. The Influence of Season, Temperature, etc., upon the Mortality of this Epidemic.

Under this head we purpose not merely to inquire into the mortality of this epidemic as influenced by these combined causes, but also the relative proportion of sequelæ at different periods, and their mortality at such times. In the following rather complex table we have arranged the mortality in different months, as well as the total number of sequela from which that mortality was derived.

We find from the above table that the highest mortality occurred in March, and arose principally from respiratory sequelae and typhoid fever, while in the same month the greatest number of cases occurred. In connection with this subject, a table illustrative of the temperature and prevailing winds in these months was prepared, but the evidence was of so negative a character as not to warrant its insertion; the only point worthy of consideration with reference to the high mortality in March, was the frequent occurrence of wet days. To give the true value to the varying mortality in different months, we must also bear in mind that this epidemic lasted for 7 months, and that probably epidemics, like individual diseases, have a development, a maturity, and a decline. We find, then, that the month of March may be held to represent the maturity of the epidemic, and the period of its greatest virulence. In fine, it may be considered that season influenced mortality, but that this influence was strengthened by the maturity of the epidemic at the period of greatest mortality. We next proceed to consider,

2d. The Influence of Age upon the Mortality.-I have arranged the results furnished under this head in the following table :

From this table it would appear that the epidemic was most fatal to children between 1 and 2 years of age, a time corresponding to that of dentition; the mortality steadily declines from this period, ceasing between the age of 4 and 5, and not commencing again until at 13, when we have another fatal case. These cases show the fact alluded to by Copland, etc., that measles is most fatal during the period of dentition. The numbers about the age of puberty are not sufficiently great to corroborate the opinion as to the danger of measles at this period, although there is presumptive evidence in its favour, seeing that from the age of 5, up to a period approaching puberty, no fatal cases occurred. In accordance with the established views of infantile pathology, we would, a priori, have been inclined to expect the fatal cases which occurred during the period of dentition to have arisen from sequelæ, involving the respiratory or diges

Per Centage.

ve systems, seeing that sympathetic disorders of these systems are mmon at such a period; still further, we would have expected e respiratory system to have been solely affected, as in winter and ring (the times in which these cases occurred) sympathetic disder of the respiratory system is common; while in summer and atumn sympathetic disorders of the digestive system preponderate. 'he results obtained do not, however, corroborate our expectations, r we find that, of the 5 cases fatal between the age of 1 and 2 ears, one arose from sudden recession of an ill-coloured, scanty ruption, two from typhoid fever, one from bronchitis, and one from roup. While of 7 cases between 2 and 3 years, when the symathetic irritation of dentition is nearly or entirely gone, we find hat 2 cases prove fatal from bronchitis, 4 from typhoid fever, and 1 rom sudden recession of an ill-coloured eruption. The fatal cases between 3 and 4 being one of typhoid fever and one of dysentery; between 4 and 5 one of typhoid fever; that between 13 and 14 being a case of speedy death from recession of rash.

As it might be objected that a mere recital of the ages at which the fatal cases occurred, can afford no valid information as to the frequency of the sequela at different ages, we have in the following table arranged the sequelae according to the ages at which they occurred.

This table, then, shows us that, during the period of active dentition, namely, between 1 and 2 years, the number of cases of respiratory and digestive sequelæ is considerably less than between the age of 2 and 3 years, a time when, in the great majority of instances, process of dentition is completed. From the facts exhibited by

the

NEW SERIES.-NO. IV. APRIL 1855.

2Q

Typhoid Fever.