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INO. 2, 1901. in the ward. (I conclude that it has been under such circumstances that what have been termed "second attacks," or relapses, have been diagnosed.) Now these are facts, call the disease what we will. I contend that it is a distinct and definite disease, which I have provisionally named the "fourth disease." But it is with some diffidence that I still urge this. For one speaker at the Cheltenham meeting regarded my recorded cases as rubella; and another was persuaded that they were scarlet fever. Well! thiey cannot be both. And when we come to practical politics the above-mentioned confusion is not what we, as physicians, can desire for those who place themselves in our trust.-I am, etc, Rugby, Oct. 218t. CLEMENT DUKES.

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