other infective diseases, notably of measles, it would appear highly probable that they did bring them about, in effect, in many places, and that adults as well as children were infected with the influenza plus the measles or some other infection.

If all these assumptions have a solid foundation, we have the interpretation of the greatly differentiated influenza of the British Isles. They will further enable us to appreciate the relative values of the surface pollution of localities in the production of malariæ and to perceive how the damp bedroom, during past visitations of this scourge of influenza, has furnished the means of concentrating the exotic infection, and of adding to it the spores of such homebred fungi as happened to be cultured and to be in season in the

room.

12. ACUTE RHEUMATISM.

That this disease is caused by a specific malaria or miasm, often engendered in the damp bedroom through an incursion into it of the spores of fungi growing_naturally in the flora of the region, I have suggested elsewhere. It may be added here that the bed may play but a secondary part in the reception and establishment of the vegetation in the room; yet, as dampness of the bed is a matter of certainty in the damp bedroom, and as the damp bed will offer soil, if not always the most favourable conditions, for the vegetation, its importance as a means of adding to the infective value of the malaria created by the vegetation is not to be underrated. This is especially the case after infection of the occupant of the bed. However small the contribution from the bed to the sum of the infection which brings about the attack, the "wringing wet" state of the bed shortly after acute rheumatism sets in furnishes just such conditions as (presumably) favour an extension of this vegetation. By becoming an accessory after the fact in this way the sodden bed may increase the air-contamination of the room, and may keep up the nightly supply to the patient of the spores of the rheumatism-plant long after the vegetation would have died out on the soils it first overran.

One inference from the phenomena of acute rheumatism is, that the notable changes in regard to increased or diminished severity of the symptoms correspond with an increased or a diminished intake of the infective vegetation. This inference not only helps us to the interpretation of the variations in the course of the disease, but accords with the view that a bedroom malaria is either the primary cause of the affection, or the secondary means of prolonging it, or both, No doubt there is the conflicting inference that the originally introduced vegetation may, from some law in parasitism, take on increased activity and swarm at certain periods in the animal host, so that there is no occasion to assume fresh introductions of the vegetation from without. But for an infinity of reasons that

1 The Prevention of Consumption, p. 54.

cannot now be adduced, I conceive that acute rheumatism is one of the infective diseases in which the patient continues to receive further instalments of the infective vegetation after the inception of the disease. Some of these diseases, after having been caused by their respective efficient doses of infection, obviously run their course without re-infection. Others, again, are, it appears to me, as obviously subject to more or less re-infection for a shorter or longer period-dependent on the nature of the vegetation, the conditions for its growth, and the facilities for its access to the airpassages of the infected.

Taking the assumption of re-infection in acute rheumatism as granted, it may readily be seen that the deluged bed will not only furnish water and soil for the rheumatism-plant, whatever it is, but -if there be any foundation for the general belief that the perspiration of persons with infective disease contains the infection-it may also have received an abundance of the spores, or of the pro-spores, of the fungus. (As there is no theoretical difficulty, however, about getting these spores into the bed from other sources, we have not to depend on this source.) From this point of view, therefore, the bed may be regarded as a most potent auxiliary in re-infection.

One reason for assuming that the species which induces acute rheumatism generally takes entire possession of the bed after, if not before, the infection of the occupant, is that if it got no footing in the paillasse or mattress, there would be so much the more room for the various other fungi that affect these damp soils; and we should hear of complications of the rheumatic affection with several diseases. But almost the only disease we find overlapping or grafting itself on rheumatism is pneumonia. Measles, scarlet fever, and the allied disorders, and even papular, bullous, herpetic, and other eruptions that so often occur during tedious diseases involving confinement to bed, are scarcely ever seen in connection with acute rheumatism The exceptional position in this respect of this protracted fever has, no doubt, more than one explanation; but the only one that, to my mind, meets the case completely is that the rheumatism fungus monopolises the soil in the bed and leaves no room for other fungi. Some observers have traced a connection between erysipelas and acute rheumatism, and have recorded that the articular manifestations often appear as the erysipelas disappears. And as erysipelas is pre-eminently a bedroom-bred disease, the conclusion I draw from the one disease treading on the heels of the other, is that the one vegetation usurps the soil and drives the other vegetation from the field.

Before the days of salicylic acid, the well-known remedy for acute rheumatism was "six weeks." No one then thought it possible to cut short this formidable disease by treatment; and now no one dreams of preventing its occurrence. But two of the corollaries from all the conclusions here drawn in regard to the causation of acute rheumatism are, first, that its attacks might formerly have been curtailed, probably by weeks, without the administration of parasiti

cides; and, secondly, that it was then and is now perfectly feasible to prevent nine-tenths of the disease.

To have ensured the former results all that was necessary was to have precluded the re-infection of the patient, and thus to have allowed the self-limitation of the disease to come into play; or, in other words, to have restricted the term of the disease to the period required for the completion of the parasitical life of the vegetation then in the host. And this was to have been done by simply putting the patient on a dry bed in a dry room, and by keeping both room and bed dry-matters well within the resources of the hygienist. The method of preventing the disease is sufficiently obvious; but as certain classes of people cannot, under the conditions obtaining in high civilisation, be provided with dry, well-sunned, and wholesome bedrooms, and must continue to lie in damp, dark, and noisome places, there is no help for them. They must wait until the etiologist shall have a fuller knowledge, and until civilised man shall at length apprehend that for centuries he has surrounded himself in his habitations with miasms which are more or less deadly to those who breathe them night after night. When a higher culture shall teach this, and shall show, further, how these infectious malariæ are to be precluded, not only the rich but the poor may have some measure of relief from numerous diseases that are now supposed to be inevitable, or to come in the natural order of things, but are, I suggest, the direct consequences of sleeping in an atmosphere contaminated with the spores of noxious fungi grown, or forced artificially, in man's dwelling. And not until this stage of enlightenment shall be reached may we look for effectual systematic efforts for the prevention of the diseases specially referred to here, as well as of other diseases that are, demonstrably, caused by the infectious air of the bedroom-notably consumption and all descriptions of (non-traumatic) tuberculosis.

It would be superfluous to do more than skim over the remaining associates of measles.

13. MUMPS.

Some of the phenomena of the incidence of this obscurely originating complaint would seem to localise its source in the bed; but others point to the addiction of its highly specific vegetation to fœcal matter. Dr. Chevers, for example, said : "At Howrah there was an endemic of mumps among the children inhabiting a row of houses fronting a partially tidal earthen ditch, into which the excreta of the large jail were voided;" and the complications of the disease with diphtheria, referred to by Dr. Chevers, disconnects its occurrence in these instances from the bed; so that, while the bed is indicated by other phenomena as one of the sources of the infection, it is not the only, and perhaps not the main source.

1 Medical Times, November 15, 1884.

14. SMALL-POX AND CHICKEN-POX.

The relations of these diseases and of their congener (or analogue) in the cow point to the implication of one of a class of fungi capable of saprophytic life on straw, as well as of facultative parasitism in the animal body. Possibly more than one species may be concerned in the causation of these diseases; or it may be that the difference between the infections of small-pox and chicken-pox may be one of degree and not of kind, and may depend on a difference of stage in the course of the development of the species. The subject is too large, however, to be entered on here. All that I shall observe is, that some of the occurrences of chicken-pox which are apparently, if not really, occurrences de novo, suggest the germination and fruition of the spores of the species in the straw bed.

15. CEREBRO-SPINAL FEVER.

The manifestations and skin complications in this affection denote infection by a fungus which, from its comparative rarity, is clearly not specially connected with straw: but its outbreaks in towns as well as in country places, indicate the bed as one of the most likely sources of the spores directly concerned in the infection of man both in town and country. For as the fungus occurs naturally somewhere in the flora of a region, it is obvious that a certain number of spores are necessary to constitute an efficient dose, or few persons in the region would long be safe from wandering spores. A place of growth for the species not far removed from man must, therefore, be assumed for infection to occur: and the most favourable places are those provided by excreta-disposal systems and by beds. Perhaps both may furnish the soil and the conditions, though from certain phenomena I incline to the view that the spores of the fungus germinate more frequently, in the first instance at all events, in the paillasse. If one might hazard a conjecture as to the class of the vegetation, it might seem from its effects upon the nerve-centres to have possibly some affinity with the species concerned in the causation of tetanus, or of rabies; but when regard is had to the eruption, the vegetation would seem to be more nearly allied to that which induces the peculiar malady got from handling the larger reed.

16. RELAPSING FEVER.

This fever bears all the impress of a bed-bred disease. Passing over the deeply interesting and important botanical questions connected with the Spirillum, it can only be said here that if the relapses are the results of the introductions of fresh infective material into the body-and the evidence on the whole shows that this is most probably the case—it is patent that even if the original infection

taken in by a patient be taken in elsewhere than in the bedroom, the subsequent relays of infection must, almost of necessity, be supposed to be supplied to him from some place within the bedroom itself. In short, I conceive that the specific vegetation which causes this disease, though perhaps foreign to straw, is nevertheless cultivated in the filthy bed, whether of straw or other material; and the soundness of the conception may easily be tested-by preventing relapses. This may be done by simply placing patients at once on clean under-beds. If this were done, and the beds were kept dry, the patients would have no relapse-provided this sign has here been rightly understood.

17. DENGUE.

If the views propounded touching the causation of measles are right, the etiologist will see from the history of dengue that it originates in somewhat like manner to measles from some fungus transferred from the natural flora to the bedroom: but it would be idle to attempt to identify the species or to evolve its habitats. It suffices that fungi are so rife in the tropics and sub-tropics that at certain seasons some of them overrun everything in the shape of soil. It may readily be supposed, therefore, that the species which causes dengue may find both soil and conditions for growth in damp tatties and mats, or even on boots and shoes left in the bedroom, and may thus create a local malaria.

18. PELLAGRA.

Few etiologists of these days can examine the accounts of this disease in Italy, or elsewhere, but must conclude that its characteristics are eminently those induced by parasitical vegetation. And this is substantially the verdict of the scientific men who were deputed to inquire into this perennial plague of Italy. The only question of practical importance to refer to here, is the question whether the specific vegetation (assumed to be) implicated in the causation of pellagra is introduced into the organism by way of the ingesta, or by the air, or by both ways. The reports sent in to the Italian Government refer the disease mainly to the mouldy maize flour or meal eaten by the poorer labourers in certain districts; though, so far as I can make out, neither has the species of the fungus poisoning the maize been identified, nor has the precise mode in which the infection takes place been demonstrated. Although in the dark in regard to the bedding of these peasants, it occurs to me that they probably stuff their bed-ticks with maize straw, or lie on the straw itself. If so, the inference is to be reached that these wretched folk are condemned to nightly exposure to a malaria loaded, not only with the spores of the common moulds that grow on such material, but with the spores of the particular fungus, whatever it