similar to, if more severe than, those caused when the sores, wounds, or abrasions of farm labourers are infected by mildewed cereals. There is no difference in principle between the parasitism of the fungi on these practically raw surfaces, though that on the placental site may of course be more active than that on other surfaces. When scarlet fever, or rötheln, or any of the congeners of measles, are present in the house of a lying-in woman there may be a corresponding extension of the several specific forms of vegetation to the womb either ab extra or by way of the blood.

Formerly the puerperal woman was literally "in the straw," and in these days housewives, as a rule, remove their best bed furniture and prepare for lying-in on their oldest paillasses. The conditions surrounding childbirth, therefore, offer unusual facilities for the germination and growth of whatever fungi may grow on straw loaded with more or less organic matter; and hence numbers of puerperæ, it may be assumed, ensure their own infection.

Discussion has been going on for years on the questions whether the puerperal poison may not sometimes be an autogenetic product, and whether, if it is a heterogenetic agent, it enters the body solely by way of the utero-vaginal tract, or may enter, at times, through other gates. Pathogenic vegetation in the bed of the parturient before parturition has not, however, been taken into account in the discussion; and this assumption has to be exhausted out before sound conclusions can be got at by gynecologists. With these few hints the subject must be left.

6. HAY FEVER.

One form of hay fever is clearly an ally of measles, from the straw mildew point of view: for, first, the symptoms in aggravated cases of the former are hardly distinguishable from the milder kinds of the latter; and, secondly, the source of the infection of both affections is the bed. This is well shown in an interesting paper1 by Drs. Ringer and Murrell.

Passing by the numerous other excitants of paroxysmal sneezing referred to by Drs. Ringer and Murrell, they say:-"The widow of a clergyman has suffered for many years from this complaint. She sneezes a good deal, but the running from the nose and eyes is very profuse, and out of all proportion to the sneezing. The attacks occur all the year round, but are most severe in the summer. They often occur the first thing in the morning, as soon as she begins to move in bed. They are excited at any time by grasses, roses, privet, and in a less degree by other flowers. Driving in the face of a strong wind will always bring on an attack. Any dust, especially the dust of a bedroom, brings on a violent paroxysm. It may, of course, be

...

1 Remarks on Paroxysmal Sneezing by Sydney Ringer, M.D., F.R.S., &c., and William Murrell, M.D., F.R.C.P. &c., British Medical Journal, June, 1888.

argued that all dust is liable to contain pollen, but in this particular instance bedroom dust was found to be more likely to provoke “an attack than dust from any other source.” Of another lady who suffered from the affection they observe:- "Dust, as we have seen, is a common exciting cause, its influence being attributed by Blackley to the very general distribution of pollen. House dust will bring

on an attack, bedroom dust and the dust from shaking a bed being most potent. The dust of the street, curiously enough, does not affect her. Her mother has been a sneezer all her life."

Again, after referring to the intimate relations between intermittent sneezing and asthma, Drs. Ringer and Murrell observe of a case: -"Bed-dust always induced severe attacks, first of sneezing, then of asthma. As bed-dust is insoluble, the part affected must have been either the mucous membrane or the terminations of the nerves, first of the mucous membrane of the nose, next of the lungs, whilst the change in the type of the disease from intermittent sneezing to well-marked peptic asthma favours the theory that the seat of the affection was in the nervous centres."

A curious case is given of a lady aged sixty, who sneezed of a morning but was not affected by dust, pollen, or any known excitant. She would get relief by going away, but the sneezing would come on in new places in about a fortnight. Drs. Ringer and Murrell also refer to the influence of locality, as shown by a total cessation of the symptoms.

Whatever may be the explanation of the mode by which some of the excitants of paroxysmal sneezing cause their effects, little doubt can be entertained as to the main source and general nature of bedroom-dust, and especially of the dust raised in shaking the bed. Nor can there be much room for doubt that the morning attacks of sneezing shortly after waking are caused by particles issuing from the bed when moved. The precise nature of the infection in individuals in this class of cases is, however, open to question. We may eliminate pollen and many other agents, and we may reduce the number of possible excitants to particles given off from the bedding; but even then they are far too numerous to deal with here. over, it is palpable that the specific infection may vary in different cases; and, possibly, more than one agent contained in the bedroom may be an efficient infection at different periods in the same case: and as bed-dust is infinitely variable as to composition in different localities, and in the same localities at different times and seasons, it follows that the specific infection in a given case of paroxysmal sneezing developed in a bedroom is to be determined only by special investigation. So that, practically, bed-dust will remain an unknown quantity in regard to the infectious element in particular instances of infection.

More

It would be waste of time, therefore, to go far into this speculative field. It is sufficient to suggest that the spores of the "straw fungi” are indicated as the most infectious components of "bed-dust:" and

I submit that the spores of some one or more of these are more frequently concerned as the excitants in bedroom sneezing than any other particles suspended in the air of the room. I conceive, indeed, that "bed-dust" is the starting-point of a largely preponderating majority of the cases of every description of hay fever. Looking at the phenomena of its occurrence and making allowance for peculiarities or idiosyncrasies, it appears to me that the tendency to sneeze on the slightest provocation-the emotional sneezing, for instance, brought on by an artificial rose or by a vivid picture of a hay-fieldtogether with the proneness to paroxysms from pollen, oil particles, and such agents as have no injurious effects on people generally, have been acquired in the bedroom. That state of the mucous membrane of the nose which most modern authorities treat locally, either in order to give immediate relief or with a view to effect a permanent cure, may have taken its rise from measles, or it may have begun by the inhalation of bed-dust, and may have been aggravated by frequent inhalations of bed-dust. Or, in other words, the mucous membrane and the subjacent parts (including the nerve terminations), may have undergone hypertrophic and other changes consequent either upon inordinate functional work, or upon purely mechanical irritation from the dust, or upon successful or abortive parasitism of the vegetal forms represented in the dust, or more or less upon all these causes combined, until at last the nerve terminations have become so hyper-sensitive that paroxysmal sneezing is brought on by particles other than those which were the first excitants-particles that, in the normal state of the nose, would have been inert.

From the social position of the mass of sufferers from hay fever, it may be inferred that filth, in the ordinary sense, has little or nothing to do with the affection; and from all indications the infective principle, whatever it may be, contained in bedrooms, is taken into the air in the shape of dust. This points to infection by the dried spores of the "straw fungi," and furnishes one instance, out of many, of the evils that may come of sleeping on straw, moist or dry. It need hardly be observed that the hair mattress is not to be excluded from consideration in this matter. From what has been advanced in regard to the common moulds, their occurrence at certain seasons on the hair in old mattresses in private houses, unteased, unexposed, and undusted as it often is for many years together, and therefore enriched with human emanations, may readily be understood. The enormous fund of spores from these fungi retained in such mattresses, together with, probably, the still larger fund of the spores of the common moulds stored up in old paillasses, will no doubt be ever ready and powerful adjuvants to the spores of the "straw fungi" proper in setting up mischief, not alone in one part, but in any or in all parts of the respiratory tract, or in the lungs themselves.

All that can be added now is that when the classes specially subject to this troublesome affection called hay fever shall have learnt,

through the faculty, how to provide themselves with wholesome bedding, or how to sleep so as not to inhale "bedroom-dust" in excessive or efficient quantities, they may reasonably expect amelioration of their distressing symptoms, if not a gradual disappearance of them; whilst future generations may find a great falling off in the numbers of paroxysmal sneezers.

7. ASTHMA.

If hay fever is a congener of measles, asthma must be ; for hay fever and asthma are so closely allied that their attacks may be brought on by the same class of excitants, and sometimes even by identical excitants at different times in the one person. On this point Drs. Ringer and Murrell, in the paper before referred to, observe of one case:- "Bed-dust always induced severe attacks, first of sneezing, then of asthma." Again they say :-"Our cases show that paroxysmal sneezing is related on the one hand to bronchitic and peptic asthma, and on the other to hay fever. They are allied to the bronchitic form of asthma in being excited by dust, cold and driest irritants, and to bronchitic asthma through those cases which commence with paroxysmal sneezing, and are subsequently complicated with bronchial asthma. To the peptic forms of asthma this paroxysmal sneezing is related through those cases in which the attack is excited by food. We have other cases which illustrate the intimate relation which exists between bronchitic asthma, peptic asthma, paroxysmal sneezing, and hay fever, these varieties of the same complaint occurring in different members of the same family, either concurrently or in successive generations. It is generally recognised that when attacks of sneezing and asthma both affect a patient, they do not, as a rule, occur at the same time; one form replacing the other; in fact local applications which arrest the sneezing sometimes induce an attack of dyspnoea. It often happens that as the asthmatic paroxysms become more frequent and more prolonged, the attacks of sneezing temporarily cease. Not uncommonly as the patient grows older, or as the bronchial attacks decrease in frequency and severity, they are replaced by sneezing or peptic asthma." Consanguinity in the excitants of the two affections may therefore be taken to be established.

Drs. Ringer and Murrell give many instances in which these several forms of the one disease have occurred in different members and in successive generations of a family, and they are clearly of opinion that the tendency to what they consider these neurotic affections is hereditary. Without staying to discuss heredity in this matter, it may be suggested that the questions of a physical external cause for the diseases, and of the submission of a family to the same local surroundings, have to be disposed of before the influence of heredity can be admitted.

Although attacks of asthma may be induced occasionally in the day-time, the malady is pronouncedly a night complaint. No matter whether its form is peptic or bronchitic, the one great, though not sole, excitant is the malaria of the bedroom. The influence of particular rooms on the asthmatic has long been recognised, but the full explanation of the phenomenon of the early morning paroxysm, when the sufferer flies to the window for gasps of open air, has yet to be given. The intimate connection between asthma and hay fever, however, brings us a step nearer to the understanding of the etiology of this disease. The assumption as to the primary cause of hay fever almost necessitates the further assumption that though the excitants of both affections are generically related, the differentiation in their effects on the organism is due to specific differences in the vegetation suspended in the air of the bedroom. No doubt the attacks of asthma may be brought on in certain cases indiscriminately by any kind of "bed-dust," but from well-known data it may be inferred that the common moulds are chiefly concerned in causing asthma, and that the part played by the "straw fungi" proper is a subordinate one; and, further, that the affection is due more to the fresh and less to the dry spores of the moulds than is the case with hay fever.

But whatever may be the origin of the malady, or the nature of the local lesions, or of the functional derangements of the smaller bronchi and air-cells, I conceive that the interpretation of the common early morning attack is that the air of the bedroom of the affected person is, from some cause, surcharged with the spores of moulds, and that after sleeping in it for some hours the sufferer has inhaled a sufficient number of the spores to enable them to become efficient excitants. It is not until the full dose has been taken that the effect is induced; and the full dose will vary in individual cases. In some instances asthmatics are affected at once on entering malaria, but in the general run of cases it takes some few hours' exposure to the air of the malarious bedroom to bring on the attack.

Every one knows the peculiarities of asthmatics in regard to their sleeping arrangements; how some of them will manage to pass the night in tolerable comfort sitting up in a chair in a bedroom in which they dare not go to bed; and how others take to couches in day-rooms, or lie in verandahs or passages, or anywhere rather than bedrooms. All these and other curious and long-inexplicable phenomena are to be understood perfectly by the light of a bedroom malaria, the main source of the poisonous element in which is the bed-although there may be abundance of soil elsewhere in many bedrooms to sustain fungi which will add to the value of the malaria. Such bedrooms, I submit, will be found to be deprived of the requisite chemical light to preclude this injurious vegetation. By excluding the sun from them between the hours of 10 A.M. and 2 P.M., and by retaining paillasses and mattresses for years without