Dr. John B. Roberts, in a discussion before the Philadelphia County Medical Society, February 10, 1892, says: "If I am called in surgical consultation to a child with difficult respiration due to some inflammatory disease of the throat, it makes little difference to me whether some pathologists call it croup and some diphtheria; I call them all diphtheria, and advise the attending physician to report the case as such to the board of health."

Dr. W. H. Dickerson, chairman of committee, Royal Medical Society, London, on diphtheria and membranous croup, reported, after thorough investigation, that they could distinguish no difference chemically, microscopically, or in etiology, that would justify them in classifying as two diseases. 1

We find in the last number of the Medical Mirror, published at St. Louis by I. N. Love, M. D., an interesting preface by Dr. Love to an article from the Medical News upon the "Identity of Diphtheria and Croup." He says:

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Many years ago, after a careful study of the arguments presented upon both sides of this question, I became convinced in favor of the thought that diphtheria and croup were identical, and as each year has passed, additional evidence has accumulated within my experience justifying this conclusion."

An abstract from the Medical News, as given by the Medical Mirror, says: "One of the most conclusive clinical arguments of their identity is afforded by the fact that in some of the large continental hospitals cases of croup and diphtheria are placed side by side in the same ward, and the cases of croup do not become infected; while it is not rare for diphtheria to develop in a family in which an apparent case of croup has been present."

For a confirmation of this latter statement, see pages 178 and 179 of May Bulletin.

The Medical News gives, as reported by Fraenkel, the

1 Memphis Medical Monthly.

results of "autopsies in four cases, all clinically typical instances of croup, in two of which tracheotomy was performed. Examination of the membranes present in each case disclosed the presence of the bacillus of diphtheria described by Klebs and Loeffler, the identity of which was absolutely assured by the presence of morphologic appearance, by its behavior in culture, and by its pathogenicity to animals. It is true that the number of cases reported is small, but the evidence adduced is positive and conclusive, and not to be controverted by any negative evidence." 1

Dr. Hermann M. Biggs has recently reported to the New York city board of health the result of bacteriological examinations made by him during the past four months in thirty-six cases of so called membranous croup. The mortality from this disease had increased to an alarming extent.

In all the cases examined, Dr. Biggs says the diseased membrane was confined almost entirely to the larynx. In thirty cases the Loeffler bacillus of diphtheria was abundantly present. Those, therefore, were really cases of laryngeal diphtheria. In six cases no Loeffler bacilli were found. These, therefore, he characterizes as cases of catarrhal pseudo-diphtheritic inflammation of the larynx, analogous to similar pseudo-membranous inflammations (non-diphtheritic) in the larynx. In five of the laryngeal cases, in which the Loeffler bacillus was found, cases of pharyngeal diphtheria both preceded and followed within. a week in the immediate vicinity of the locality of the patient. In three other instances the cases of croup were preceded by cases of true diphtheria, and in seven instances were followed by cases of true diphtheria. In the remaining fifteen cases of membranous croup, pharyngeal diphtheria neither preceded nor followed in the immediate vicinity. None of the six cases of croup, in which no

1 Monthly Bulletin.

Loeffler bacilli were found, was followed or preceded by cases of diphtheria. During the last four months nearly eighty-four per cent. of the cases of so called membranous croup, referred to the health department for bacteriological examination, have proved to be diphtheria.

In 1884 there were forty-nine deaths returned from "croup;" in 1885, seventy-four; in 1886, sixty-four; in 1887, eighty-four; in 1888, ninety-four; in 1889, eightyeight; in 1890, sixty-four; in 1891, fifty-six.

Without doubt a great majority of these cases, if not all of them, were true diphtheria.

MEASLES.

The registration returns for the past seven years show that the average death-rate from measles in New Hampshire is greater than from scarlet-fever. This results from two causes: First, that the death rate from the latter disease has been greatly reduced within a few years by the restrictive work of local boards of health. Second, that no efforts have been made to prevent the spread of measles. Believing that the mortality from measles may be considerably reduced, the board has included this disease in the list of those which the physician must report to the local board of health, while the latter must placard the infected house or apartment as follows:

MEASLES.

Any person having the Measles, however mild the case may be, and all persons in a family where Measles exist except those who have had the disease, are forbidden to attend school or any public or private gathering, or to mingle with persons who have not had the disease.

Persons who have not had the Measles are prohibited from entering these premises.

All persons are strictly forbidden to remove this card without orders from the Board of Health.

Any violation of these regulations will be punished to the fullest extent of the law.

BOARD OF HEALTH.

If every case of measles were reported, the premises at once placarded, and the above regulations strictly observed, there is no question but that the prevalence of the disease would be greatly reduced, with an equal reduction in its death-rate. That this disease can be entirely controlled

by our local boards of health is not to be expected, inasmuch as it is communicable in its prodromal stage-before a diagnosis can be positively made-but this peculiar characteristic of the disease is no reason why health officers should be any the less vigilant in attempting to restrict it, with the certainity before them that the spread of the disease may, by their efforts, be greatly restricted.

Measles is essentially a disease of early childhood. The longer children are protected from it the less the liability of contracting it. In New Hampshire over seventy-two per cent. of the deaths from this disease are among children under five years of age-thirty per cent. occurring in children under one year old. The mortality statistics of other states show substantially the same percentages.

Thomas says: "The age of the patients is, under all conditions, of the greatest influence upon the mortality of measles. Disregarding the fact that healthy and very young children (up to about the age of six months) probably from their feebler predisposition, are attacked very mildly, if at all, the rule may be laid down that measles is essentially dangerous only for young or very young children; that its danger decreases rapidly with the accession of years, and in the late years of childhood is already at a minimum; in old people who have, however, but little predisposition and are rarely attacked, the disease is again dangerous. Exceptions to this are not often reported."

William Squire (Quain's Medical Dictionary): "The catarrhal stage, infectious throughout, is often mistaken for a common cold, and no timely separation is attempted. The cough is an important means of conveying the infection at this time. Infection begins before the rash appears, and the contagion may be given off by the third day, most probably during the greater part of the incubation period. The contagious principle, developed only in the bodies of the sick, is found during the height of the disease in the tissues, the secretions, the blood, and the