Clark died at his home in People's Township.Clinton reports a case of small-pox.—The annual meeting of the Iowa and Illinois Central District Medical Association was held in Davenport July 11.; Dr. J. H. De Armond was president.-Clinton has a new hospital. It has been fitted up entirely by the ladies of Clinton -Dr. A. C Peters has been appointed a professor of the University at Iowa City. Dr. L. C. Moore of Blue Grass will remove to Muscatine.-Dr. J. F. Kennedy of Des Moines, secretary of the State Board of Health, has returned from Nevada -Small-pox is reported at Nevada Dr. Guthrie of Dubuque has been elected to the chair of physiology and microscopic anatomy in the medical department at the State University-Improvements at Mercy Hospital, Davenport, are going on rapidly.-Dr. Mercer of Lenox City was accidentally shot at Kasper, Wyo., July 4.-A family with small-pox were quarantined at Estherville by the State Board of Health -Dr. I. W. Martin of Des Moines is dead.-Dr. Grieg of El Paso, Texas, will remove to Davenport.-Drs. Samuel Bailey and R. W. Selley of Des Moines have been appointed local medical examiners at Mount Ayr; and Dr. J. V. Nelson at Winterset.-Dr. F. M. Brady of Forest City died at Osceola June 12 -Dr. Ambrose C. Smith of Galena has accepted the presidency of Parsons' College, Fairfield —Dr. A. C. Olney of Fairfield died at Chillicothe, June 23.-X McPhilips and A. B. Stewart, graduates at Manitoba Medical College, will begin the practice of medicine in Sioux City.— Drs. Chamberlain and Stitzell of Nevada, and Dr. Richmond of Ames, have been appointed a board of pension examiners by the new administration The following changes were made in pension boards throughout Iowa: Dr. D. S. Moore, appointed at Northwood; Dr. A. D Bendy, at Osage; Drs. S. G. Blythe and E. Wilber, at Charleston City, and Drs D. H. Bowen, R. C. Ambler, and J Shepherd, at Waukon.

KANSAS-Dr. Ed. Blair, of Atchison, has declined the position of assistant in the Soldiers' Home Hospital at Leavenworth. Dr. Blair returns soon to New York to take a post-graduate course in medicine. Dr. Charles A. Skene died at Westmoreland June 8-Dr. D. F. Rodgers, of Wamego, will remove to Topeka.-Dr. J. C. Ryan, of Washington county, has permanently relocated at Palmer. -Dr. May, Jr., has removed to Kansas City Small-pox is reported at Piqua.-Dr. Harry Betts, of El Dorado, died of small-pox at Topeka.-Dr. P. Russell Phillips sailed for Europe July 1I. Dr. Phillips will study at Vienna -Dr. J P. Stewart, of Clay Center, intentionally shot and killed a libertine a few weeks ago. Dr. Stewart is admired for his courage.-Topeka has a "medicine" college with a capital of $100,000.

KENTUCKY -Dr. Joseph Lloyd Martin, of Balti. more, is dead.-Dr. Daniel R. Gardiner, of Newark, died June 30 at White Sulphur Springs, W. Va.Drs. Ormsby Gray, of Kentucky, and L Russell, of

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Tennessee, Democratic medical examiners, have been discharged from service-Dr. S. C. Fewell, of South Carolina, has succeeded Dr. A. V. Griswold at the City Hospital in Louisville.-Dr. Robert J. Thompson, of Woodford county, is dead-Dr. A. Whitney Whiley, of Louisville, is missing.

MAINE. New barracks are being erected at Augusta for the care of patients at the Insane hospital. The new board of pension examining surgeons, of Portland, which has just been appointed, is constituted as follows: Dr. Charles O. Hunt, Portland; Dr. A. O. Shaw, Portland; Dr. William Osgood, North Yarmouth.

MASSACHUSETTS.-Dr. E. T. Cook, of Trinity, has removed to Houston.-Dr. A. W. Thompson, of Springfield, is dead.-Dr. Northing W. Miner, of Springfield, has sailed for Liverpool.

MICHIGAN.-Dr. C. V. High, of Morley, and Miss Florence S. Ames were recently married.-Dr. G. D Green, of Saginaw, will remove to Mason.-Dr. A. R. Smart, of Hudson, has been made Dean of the Northwestern Ohio Medical College.-Dr. C. M. Kimball, of Adrian, and family have removed to Cooledge, Kan.-Dr. J. T. Salter, of Detroit, is dead.-Dr. C. S. Clark, of Kalamazoo, died at Grand Rapids, June 23.-Dr. Judson Bradley, of Detroit, is dead.-Dr. H. H. Haynes, a graduate of Detroit College of Medicine, has begun practice in Detroit-Dr. Flemming Carrow has been appointed to succeed Prof. Frothingham at Ann Arbor.

MINNESOTA.-E. M. Nesmith, of Minneapolis, died July 16.-Dr. Henry Lincoln Bryant, of St. Paul, and Miss Georgiana Kate Crary, daughter of Dr. G. H. Crary, are married.-Dr. Asa F. Goodrich and Miss Marion L. Banker were recently married at St. Paul.-Dr. Phalen, of Duluth, has gone on a visit to the South.-Dr. John Kurtz, of Moorhead, and Miss Helen Peyton Swiser, of Willow Bank farm, were married June 27.-Dr. George Crawford, of Glasgow, Scotland, and daughter are visiting at Duluth.-Dr. J. F. Hurlbut, of Duluth, and Miss Jessie E. Webster were recently married.— Dr Louis L. Gregory, of Chicago, and Miss Sarah R. Throckmorton, of St. Paul, were married June 25.

MISSOURI. Mrs. Marguerite G., wife of Samuel C. Graham, died in Centreview July 3-" Dr.” F. R. Boyd, the St. Joseph quack specialist, has been arrested for practicing medicine without license."Dr." Albert Benson, of the Benson Medicine Company, was arrested in Kansas City for distributing obscene literature.-Dr. D. P. Bigger, formerly of Kansas City, is dead.-Dr. A. C. Bernays, of St. Louis, is confined to his home by blood poisoning -The new Ensworth Medical College at St. Joseph will soon be open to the public.-Dr. A. G. Galloway, of St. Louis, committed suicide at Sylacauga, Ala.-Dr. W. P. Flint, of Marysville, Cal., died at St. Joseph July 1.

NEBRASKA. Dr. H. B. Lowry of Lincoln, has been appointed examining surgeon in the pension

commission department.-Two persons recently died from trichinosis in Omaha.-Dr. J. V. Dawson has returned from Carthage, Ill., to his home in Lincoln. -Dr. J. A. Hosseman has been appointed county physician for Louisville and vicinity.-Dr. George L. Skinkle of Sterling, killed himself. He took morphine. Dr. Thomas Kelly of Omaha, has been appointed professor of chemistry in the College of Physicians and Surgeons at Chicago.-Colonel Dallas Bache of Fort Riley, Kansas, has been made medical director of the department of the Platte Drs. Daily, Wilson and Hershey have been appointed a new board of pension examiners for Nebraska City. They are all republicans.

NEW YORK. Dr C. E. Greenman, '89 Albany Medical college, has "set up shop" in South Troy. -Dr. Darwin Codwin has been made treasurer and Dr. J. N. Arnold censor of the Wayne County Medical Society.-2,000 persons in Newburg, the Buffalo "Express" says, have the "Harrison grip." We need enlightenment -A dormitory is being built to the Fairview Home at Albany.-Dr. Joseph Waters of New York City, committed suicide recently.

The doctor took cocaine, but its slow effect so exasperated him that he made quick work of it and shot himself through the head -The State is severely punishing fraudulent milk dealers.-Dr. N. C. Scudder of Rome, N. Y., is rusticating at Sylvan Beach.-Dr. R. H. Satterlee, senior resident at the City Hospital in Rochester, has resigned.-Dr. H. S. Quinn has been appointen surgical director at St Elizabeth's Hospital, Utica -Dr. H H. Beecher of Norwich, died July 14.-Doctors F. H. Bartlett and J. C. Clark have established a public hospital. Poor people will be cared for free of charge. A large staff of ladies has been appointed to act as visiting committee.-Dr. Woolsey, ex-president of Yale, died July 1.-Dr. W. L. Bartholomew of Lowville, will remove to Canestota.

OHIO.-Dr. L. L. Helt of Columbus, has succeeded Dr. T. C. Martin as member of the Board of Penitentiary Managers.-Mrs. Dr. Margaret R. McIntyre of Toronto, is dead.-Dr. H. N. Kimnear of the Harbor, has been appointed member of the Board of Commissioners to China.-Dr. C. E. Harris and family of Springfield, have removed to Clifton, their former home.-Dr. Samuel S. Wilson and Miss May Harper were recently married at Orient Hill -Dr. Don De Witt of Columbus, has removed to Dayton.-The Home for the Jewish Aged and Infirm at Cincinnati, will be ready for patients September 1 —Dr. John Martin Crawford of Cincinnati, has been appointed to the consul generalship at St. Petersburg. Dr. Crawford sailed for his foreign post July 13.

PENNSYLVANIA.-Dr. L. T. Smith, of Pleasant Mills, was robbed and beaten by three masked men. Dr. Smith is in a critical condition.-Dr. Bushrod W. James, of Philadelphia, has been made a professor in the Female Medical College at New York. -Typhoid fever is prevalent in Allegheny.-Dr.

M. F. Loman will go to Jamaica -The Southside Hospital at Pittsburg has been legally organized Dr. Joseph Thomas, of Quakertown, has been appointed Trustee of the Johnstown Hospital for the Insane-Dr. John K. Reinoebel, of Philadelphia, has been made a member of the County examining board.-Dr. Elwood Wilson died July 14, at Mardon.- Dr. J. A. Oldshue has gone to New York.Mrs. Dr. Pike, of Titusville, is dead.-Dr. P. Clark of Jamestown, is at Philadelphia.

RHODE ISLAND.-Dr. Charles J. Thurston, of East Greenwich, is dead.

TENNESSEE.-Dr. C.S Bailey and wife, of Clarksville, visited Lookout Mountain on their bridal trip. -An act of the law of the last legislature requires all physicians in the State to present for inspection their diplomas to the County clerk.-Dr. R. F. Evans, of Shelbyville, is ill.-Dr. W. T. Foute and Miss Jodie Prater were married at Chattanooga June 23 Dr. Le Roy Brown, of Nashville, has removed to New York.- Dr. Robt. A. Hardin, of East Nashville, is ill.-Dr. J. S. Hare will begin the practice of medicine at Vandalia.-Dr P. J. McCormick, of Yazoo City, Miss., has removed to Chattanooga.

TEXAS.-Dr John M. Colley and Miss Mary A. Hunter were married at Palestine, Texas, July 10. -Dr. Jose H. Reuss, of Cuero, has been graduated with honors in the College of Physicians and Surgeons, New York City.-Dr. Fouts, of Dallas, was shot and killed June 21. Dr. H. Watkins and H. B. Rosenberry have been held on suspicion.— Mineral wells have been discovered at Springfield Dr. Williamson, of Chappel Hill, thinks of removing to Dallas.-Dr. G. M. Patrick, of Anderson, is dead. Dr. Carroll, of Tennessee colony, is ill.

VIRGINIA-Dr. Theoderick P. Mayo, of Richmond, died June 22.-Dr. Henderson, a recent graduate of the Medical College of Virginia, has been appointed physician to the almshouse at Richmond-Dr. J. P. Munroe, of Raleigh, has been made principal of the Davidson Medical College — Dr. Barringer, former principal, has gone to the University of Virginia.

WISCONSIN. Dr Carlson, of the Protestant Orphan Asylum at Milwaukee, has been succeeded by Dr. A. S. Johns.-Dr. Clarence Lacy, of Aberdeen, Dakota, and Miss Bertha Silverthorn, of Frostville, were married July 10-Dr. and Mrs. H C. Cutler were given a lawn party at their new home in Eau Claire. Dr. Louis R. Head, superintendent of the Lake Geneva Private Hospital, is to be married to Miss Reed, of Rhode Island.--Dr. C. E. Armstrong, of Fond du Lac and Miss Emma Pennewell, were recently married.—Dr. Fanning, of San Antonio, Texas, has gone to Dakota to get specimens in his special line. He will return after his trip to Waukesha.-Dr. R. Neitzel, of Fort Howard, has gone to Oshkosh.-Dr. P. S. Pitway, of Enfield, died June 26.

VOLUME VI. NUMBER 3.

Varioloid is simply variola modified by some circumstances, the main modifying influence being vaccination. Before vaccination, cases were occasionally met with of such mild character as to fall within what is now called varioloid.

Case I. In the winter of 1887,I met such a case in a young negro. He was seen by Dr. Brodie, and Dr. Klein, who concurred in my diagnosis. The case was of such a mild character that it would have escaped detection, but the young man felt somewhat ill and applied to Dr. George who brought him to the Health Officer. There were no marks of vaccination. He denied having been vaccinated. He had not over six or seven papules on his whole body, He had a temperature of 105° before the rash broke out. Severe headache, backache, and rigors. The next day the rash was fully out, the temperature fell, and from that day forward no more fever.

This could certainly be nothing more nor less than an extremely mild variola, or, varioloid. But here arises the question, whether it be right to call this "varioloid?" as varioloid is a term applied to the disease modified by vaccination. Varioloid has its stages of invasion and maturation which differ somewhat from variola. The invasion stage of varioloid varies greatly in violence, but its severity is no measure of the disease. The invasion rash, erythema, is of frequent occurrence in varioloid. The regular eruption, does not generally appear on those parts which have been occupied by the "invasion rashes." My experience has been that the more extensive the invasion erythema, the less the number of pocks to appear. Erythematous eruptions point to varioloid, while petechial foreshadow variola. The better the invasion rash in varioloid, the milder the disease.

While the invasion stage of varioloid may be shorter, it is more generally longer than that of variola, more often four than three days.

The fever is generally high. There may be headache, and backache, but as soon as eruption appears rapid defervescence takes place, the temperature reaching normal or even below it, and all suffering ceases.

The fever does not appear again, except in a few cases when it occurs during suppuration. The appearance of the eruption of varioloid, is

IDetroit Acad. of Med. Trans. Condensed.

CHICAGO:

G. P. ENGELHARD & CO.

without regular order, in one patient on the body, the face showing almost no papule or a stray one which may abort; in another patient the face may be covered, and in another the rash may cover the whole body spreading regularly like smallpox. Again it may appear at the same time on all parts of the body. The eruption itself is not even the same. The pock has the same structure as that of variola, and even in varioloid extends sometimes deeply into the true skin leaving a true cicatrix; but more frequently it does not fully develop, or passes through the several stages of development imperfectly. The eruption of varioloid where it goes through all stages, begins as a small papule and in twelve to eighteen hours assumes a vesicular character, sometimes with and sometimes without umbilication. On the third or fourth day the clear fluid of the vesicle begins to cloud from pus beginning to form and it is surrounded by an areola without any swelling of the skin. The pustules dry by the fifth to the seventh day usually without bursting, and the scab soon falls off leaving behind it a slightly colored spot which gradually disappears. The number of pustules varies, and of course the more numerous the pustules the severer the disease.

Authors in speaking of the dangers of confounding variola with other diseases, lay stress upon the danger of confounding it with measles, but medical men of to-day have not any conjunctival, nasal, laryngeal, bronchial, and difficulty in making this distinction; Ist, the catarrhal symptoms being usually present in measles; 2d,the different temperatures record, the invasion stage of variola varying from 104-105° F., while rubeola rarely registers above 103° F. In typical variola as soon as exanthem appears defervescence is marked, while in rubeola the temperature keeps steadily up and sometimes may even rise. Again, the difference in the rashes are apparent the papules of variola even in the confluent form are in the beginning discrete, remarkably so, and exhibit no tendency to grouping; while macula papules of rubeola are developed on the face and trunk at the same time. While variola appears first on the face and subsequently on the trunk-the older and larger

on the site of earliest appearance, the crescentic appearance of papules is distinct in rubeola with little or no halo, while the varioloid papule rests upon a circlet of hyperæmic integument. The differences are so marked that there should be no trouble in diagnosis.

But the serious point in diagnosis in these cases comes when the doctor is called upon to decide between what is called a severe case (?) of varicella and varioloid, in a grown person or even child. Varicella is an acute disorder of childhood, in the course of which appears a cutaneous exanthem of vesicular type accompanied at times by systemic symptoms of moderate severity, terminating in the course of from three days to a fortnight, after the formation of relatively few crusts upon the skin with occasionally persistent cicatrices sometimes called chicken-pox, wind blattern, schaf pocken. But it is otherwise when we come to varicella. Hyde claims that there is in both forms of disease but a single virus, that of variola; but this, modified by evolution among generations of vaccinated children, has by a process of natural cultivation or attenuation, produced a malady of tender years whose attacks do not protect from variola and occur irrespective of vaccination. I deny the existence of any relation between the pathological conditions recognized by them as occurring in two distinctly different affections.

Varicella is essentially a disease of children, although mothers have taken it from their children. It is a contagious disorder which at times in hospitals and asylums may occur in epidemic form. The period of incubation is not fully established. At times an entire fortnight elapses between the dates of exposure and the evolution of the disease, but both longer and shorter intervals have been recorded.

The prodromal stage of disease, in the vast majority of cases cannot be recognized. Dr. Hyde speaks of having watched twenty children gathered into the Home of the Friendless, no one of whom was recognized as sick and ailing before the eruption appeared. Occasionally the disease is preceded by mild or febrile symptoms.

even severe

The exanthem, the first symptom generally of the disorder, occurs as reddish puncta from which rosy colored maculations rapidly develop and these become tensely distended, transparent or slightly yellowish vesicles, of average size of split pea, though they are occasionally smaller or may enlarge to the dimensions of a bean or small nut. The eruption appears first upon the upper segment of the body, implicating the chest in front and behind, the neck, the scalp,

particularly the extremities and quite sparingly the face also, which sometimes, however, entirely escapes. In cases where the eruption is profuse it may be completely generalized, involving largely the trunk and extremities, and the lesions on the back being as closely set together as in discrete variola. In the majority of cases, however, the exanthem is less profuse, not more than 15 to 20 vesicles springing to the surface. These vesicles are superficial in situation, the firm papule so characteristic of variola being altogether wanting. From the beginning they are transparent, their contents showing plainly through their translucent roof wall, composed of the stratum corneum of the epidermis. They are both acuminate and globular and occasionally rest upon a slightly hyperæmic integument. Umbilication occurs rapidly at the apices and at the same time their contents become lactescent and gradually sero-purulent. Occasionally vesicles are transformed into genuine pustules, of the size of a coffee bean, while intermingling with these may be found illy developed and abortive vesicles. By the end of a period lasting from twelve hours to the second day, involution has usually begun, and the lesions, most generally ruptured, are dessicating, becoming transformed into yellowish brown, circular circumscribed crusts resting upon the apparently unaltered integument. Crusts are often firmly attached, not falling off before five or eight days. Throughout the disease systemic symptoms may be altogether wanting or may occur in a mild, but in rare cases, a severe type. In some cases the temperature is increased by one or two degrees upon the appearance of the exanthem, and a moderate fever may persist for forty-eight hours, possibly a little longer. Defervescence is always rapid and perfect.

There has been much confusion as regards this disease. For instance:

physician called me to see a case which he thought was "suspicious." The case had advanced to the stage of pustulation. The family said he had been seen by two physicians who diagnosed the case chicken pox. I noticed certain features about the eruption, and on investigation of the others, who had had the disease, the youngest child, who had been vaccinated the most recently, was found to have the chicken pox so mildly that it appeared only over the abdomen. Two other practitioners were called in,one a very respectable one,thought it was varicella but did not like some other features of the case and, therefore, held it subjudice. Dr. Klein,the president of the Board of Health carefully examined the case and said determinedly that this was a case of varioloid. I found the patient had been working in a printing office in the city of Detroit. As I could get no facts from him or his irate mother, who could not see anything beneficent in a health officer, I repaired to his employer who told me that for several days he was unfit for work, had sat close by the steam radiator, complained of being cold, etc., had headache, pain in back, latterly had rigors with pain in back and head, and had a red rash coming out on his forehead when he went home. The physician (city physician) who was called took his temperature and found it 105°; when I saw him later the temperature was only one degree above normal. After getting this history and again seeing the case with President Klein, we quarantined him, which was done. In the meantime the irate mother belabored me in the "Free Press," and while I was enduring the attack not caring to rise and explain, for my explanation would involve some physicians having made a mistaken diagnosis, I took the proper course to protect the city and let the papers scream. I, however, took some of the matter from the pustules and inoculated a young calf upon the udder. The result was a typical umbilicated vesicle which pustulated and formed the usual scab and on dropping off, left the scar such as is left after vaccination, indented. While the test was being made some parties from the house, prior to my quarantine, had been visiting a saloon near by, and just after the requisite number of days, one came down with varioloid, so distinct and positive that he was taken to the city hospital.

Here was a distinct case where practitioners of ability had diagnosed varicella at the onset. This case had boils, abscesses, and a very slow convalescence.

Modified smallpox constantly resembles chicken pox; Ist. In the mildness of its symptoms, premonitory and concomitant. 2d. The scarcity of eruption and its character of coming out in successive crops. 3d. The duration of the disease, viz., its shortness. The initiatory fever of varicella is very slight, whereas the temperature even in varioloid is high. Twenty-four hours only elapse in varicella after commencement of illness before the eruption begins to appear. There is not the hardness to the eruption that is present in smallpox and

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no areola. The eruption in varicella has its seat just under the cuticle, between the external and deeper layers. It is vesicular as if raised by boiling water. Those vesicles which form around the little pustules in true small-pox, especially in the case of very young children and which possess clear or light yellowish contents, and are thickly crowded together so that they form when drying, yellow gummy crusts like those of eczema, or "mellitagra flavescens" can hardly be regarded by any one as proof of the varicellous nature of the eruption of variola, the characteristic constitution of which is proved by countless other pustules in the same case. If we are guided solely by the character of the skin very serious difficulty will be encountered, but coupled with temperature and other symptoms, there need not be any difficulty in reaching a correct diagnosis.

It cannot be denied that many variola efflorescences and especially simple eruptions not developing into true pustules (varioloid), have sometimes a close resemblance to varicella.

The measurement of temperature is of the highest importance for differential diagnosis. But this must of course be taken during the whole course of the disease or especially before the eruption is fairly established. Moreover, in varioloids with which this paper has to do, the increase of temperature ends with the outbreak of the eruption. But the feverish period of the mildest varioloid lasts always several days. The advocates of the identity of varicella with variola have never yet been able to furnish thermometric proof in the discussion.

Dr. Cleland said there was no clearly differential symptom until the development of the papule. In varicella the papule will disappear on pressure, while in varioloid it will feel like a shot under the skin. It is very possible to make a mistake in the erythematous stage, but the prodromal symptoms, especially the backache, will aid in the diagnosis. I remember this as a most important symptom in my experience during the war and the epidemic here ten or twelve years ago. Patience will usually determine, although it is sometimes impossible to decide.

Dr. Russell said he depended on the high fever, the intense pain shooting through the back, and on the groaning. It has been said that if a patient who is supposed to have varicella groans, variola should be suspected. Variola could be communicated by a case in which no eruption existed. He did not believe syphilis could be communicated by human virus.

Dr. Gilbert believed varicella to be a modified variola which merited quarantining.