disease with the so-called "spotted fever" of a former day.* It appeared again, to a limited extent, in April, 1857, in the town of Becket, in Berkshire County. Dr. Jackson stated that he had occasionally met with sporadic (isolated) cases of the disease in later years, or since the epidemic of 1806-16.† Since about the time of the outbreak of the disease among our soldiers during the war, it has made its appearance at various points in this State. Five cases came under the observation of the writer, in the Boston City Hospital, in 1865-6. Some of these cases originated in the hospital. Dr. Page saw a considerable number of cases, near the close of the war, at Gallop's Island, a military post in Boston Harbor. The report of the committee from the Massachusetts Medical Society, in 1866, covers all the cases which could be collected in the State from 1857 to 1865 inclusive,-280 in all. These were distributed over the different years as follows: From the above it appears that instances of the disease have occurred in this State in each year from 1857 to 1865, inclusive, with the exception of 1860. Doubtless a considerable number of cases might have been chronicled in 1866, but the report did not include the record of that year, other than the mention of seven cases in Brookline, in January. * Records of the Boston Society for Medical Improvement, 1849. + Extract of a letter from the late Dr. James Jackson to Dr. L. Parks, in 1866. See report of the Committee of the Massachusetts Medical Society for that year. I am not able to find any reliable account of the number of cases of this affection which have occurred from 1866 to 1871, inclusive. Neither the state or city registration reports render much assistance in this investigation. In the former, the nosological term, cerebro-spinal meningitis, does not appear. We have the right to infer, however, from an actual knowledge of the existence of the disease, to a greater or less extent, in these years, that it may be embraced within' the term "cephalitis," under which all the inflammatory affections of the brain and its coverings seem to have been classed. Among the causes of death for the years below stated, the number attributed to "cephalitis" stands as follows: We would call attention to the fact that in the years 1864 and 1865 the disease was known to be epidemic in many portions of the State; and the greater number of deaths attributed to "cephalitis" in these epidemic years tends to confirm our opinion that the disease existed, and was reported under the above title. In 1872 it appears for the first time in the state nosological records under its true name, 157 deaths being returned as occurring from cerebro-spinal meningitis, 16 from spotted fever, and two from black fever, all which were supposed to be cases of the affection now under consideration. In his annual report for 1872, the city registrar states that the whole number of deaths in Boston from this cause in that year was 60, of which number 34 were males and 26 were females. He further says that in 1867, when this disease was first distinctively reported to him, under its present name, there were seven deaths; in 1868, eight; in 1869, seven; in 1870, five; and in 1871, three.* During the early months of the present year it became evident that the disease had again assumed an epidemic form, and was prevailing to an unusual extent, in the eastern portions of the State especially. In the month of May a notice was inserted in the Boston Medical and Surgical Journal, calling the attention of physicians to this fact, and asking their aid and co-operation in collecting statistics. Subsequently a circular was issued by the Secretary of the State Board of Health, and distributed to his regular correspondents throughout the State. This circular contained the following questions: 1. How many cases of this disease have come within your knowledge or observation within the present year? (If no cases have been observed, please give a negative reply.) 2. State the sex, nationality, age, and occupation of the patients. 3. Character of the attack, whether sudden or otherwise. The distribution of deaths attributed to this disease in 1872 will appear from the following table. 4. Stage of the disease when the patient was first seen. 5. The earlier and later symptoms. 6. The duration of the disease. 7. The treatment. 8. The result. 9. The post-mortem developments, when obtained. 10. Name of the attending physician. 11. Has the disease prevailed among animals,-horses, cows, hens, etc.? If so, please state the symptoms and pathological appearances when possible. 12. General remarks upon the case, with especial reference to its supposed origia or cause. In this connection a detailed account of the locality, hygienic conditions and circumstances of the patient,—his home and home surroundings, living-rooms, cellar, sinks and privies, nature of the soil, drainage, character of the water used for drinking and culinary purposes, etc., etc., is especially desired. And for the greater convenience of record, when a considerable number of cases had been observed, a tabular form, with headings indicating the desired points of information, was added. Replies have been received from 199 physicians, representing 77 towns and cities, who have furnished the statistics, more or less complete, of 517 cases of the disease. In this enumeration we have retained only those instances which we believe to be genuine and authentic. The following will serve as examples of these tabular returns received from various parts of the State : |