the local affection. In the advanced stage of the disease, however, they should be employed with caution. They are liable to excite severe general irritation; there is a danger, also, of their causing gangrene of the part upon which they are applied.

In 1849, Dr. Schneemann, physician at the Court of the King of Hanover, recommended, as an effectual means of preventing the injurious effects of the exanthem on the functions of the skin, the inunction of the entire surface, with the exception of the face and scalp. When inunction is resorted to scarcely any desquamation takes place, we are told; and the skin being preserved in a state of comparative integrity, a beneficial influence is exerted over the several organs implicated in the disease, particularly the throat, so that their normal condition is, in every case, speedily restored.

Dr. Schneemann directs the inunction to be performed every morning and evening, with a portion of bacon or lard, in such a manner that the skin may become throughout, but not too quickly, saturated with fat. This simple plan of treating scarlatina has attracted considerable attention. Of those who have given it a more or less extensive trial, some speak of it favorably, while others believe it to be productive of little or no benefit. Dr. Lindsly, who resorted to it during a very severe epidemic of the disease, believes that it "will probably be found the most important improvement that has been made for many years in the management of scarlet fever." Dr. Ebert employed inunction during an epidemic of scarlatina in Berlin; the result, according to his account, was tolerably encouraging. Of twenty-eight severe cases six terminated fatally; of these six, five had not been subjected to inunction; the remaining one was an infant who died suddenly after one inunction. According to Dr. Ebert, the inunction appeared to hasten rather than to prevent the appearance of the exanthem. In those cases which were assiduously anointed, no desquamation occurred, neither were any of the sequelæ, as anasarca, abscesses, &c., observed. The anointing was also thought to prevent infection. Dr. Walz (Schmid''s Jahrbuch.) has employed inunction in seventy-four cases, all of which recovered. In sixty-nine cases there was no desquamation; in four there was secondary dropsy, which was readily cured in one case by diaphoretics, and in three by sulphur. Dr. Paul F. Eve, of Augusta, Geo., has resorted to inunction in scarlatina, and reports favorably of its effects, as does also Dr. Cain, of Charleston, S. C.

In the reports on epidemics, made to the American Medical Association, as well as to the Pennsylvania State Medical Society, at their session of 1852, the inunction of the surface with pure, fresh lard in cases of scarlatina, is spoken of in very favorable terms. A sufficient amount of evidence, in regard to the general results of the practice, has not yet been accumulated to enable us to form any very decided opinion as to its effects. From the decided benefit we have invariably derived, in cases of erysipelas, from covering the inflamed surface with a thick coating of fresh lard, we should infer that the same practice would be beneficial, also, in scarlatina.

Throughout the attack, the patient should be confined to a large, well-ventilated apartment, the utmost attention being paid to insure

the strictest cleanliness of the chamber, and of the bed-clothing, and garments worn by the patient. The diet should be adapted to the degree and stage of the disease, but should be invariably spare, light, and easy of digestion-being composed entirely of farinaceous articles, boiled in water. The drink should be given cool, and slightly mucilaginous; the addition of a small portion of lemon juice will render them more palatable, and at the same time, as many suppose, be somewhat remedial. In the anginose form of the disease, the dilute mineral acids have been considered advantageous. The free use of diluted sulphuric acid, is said by Steiglits and Wolff, to produce an excellent effect; by Montsey, and a few other practitioners, the hydrochloric acid, largely diluted with water, is recommended both as a drink and as a medicine.

We have found, in many cases of scarlatina attended with disease of the throat, much advantage from the use of hydrochloric acid internally. Our common prescription is a drachm of the acid to five ounces of water, well sweetened with sugar: of this we direct a teaspoonful to be given every two or three hours. Dr. J. P. Heister, and Dr. Beaver, of Berks County, Pa., also, both speak favorably of the effects of diluted hydrochloric acid, when freely administered. (Trans. State Med. Soc., vol. ii.)

Dr. I. B. Brown, of London (Treat. of Scarlatina by Acidum aceticum dilutum, 1846), has recommended the diluted acetic acid of the London Pharmacopoeia as an excellent remedy in scarlatina, and Dr. Schneck, of Lebanon, Pennsylvania, also bears testimony to its efficacy. The latter diluted 3j. of the officinal acid with 3iv. of water, and gave a tablespoonful every few hours, sweetening it at the time of its administration.

In the fourth volume of the Medical Gazette of London, there is a communication from Messrs. Tayton and Williams, in praise of chlorine as a remedy in scarlatina. The chlorine is procured by dissolving two drachms of the chlorate of potass in two ounces of hydrochloric acid, diluted with two ounces of distilled water. The solution is to be immediately put into a stoppered bottle, and kept in a dark place. Two drachms of the solution being mixed with a pint of distilled water, one or two tablespoonfuls of this mixture, according to the age of the patient, may be given frequently.

Dr. McNab, of Edinburgh, speaks highly of the effects of the sesquicarbonate of ammonia in the treatment of all the forms of scarlet fever. He uses it both as a gargle and internally. As a gargle two drachms were dissolved in six ounces of water; the gargle being repeated at intervals of four hours. Internally, five to ten grains, according to the age and strength of the patient, were given three times a day. (Edinb. Med. Jour., Oct. 1861.)

The plain soda water of the shops affords, in many cases, a very grateful and refreshing drink.

Dr. N. C. North, after a trial of the hyposulphite of soda, believes it to be a remedy of much power, when given after the development of scarlatina, to control its symptoms as a prophylactic means, when the

disease is prevailing in the neighborhood. (New York Med. Journ., March, 1866.)

In the simple inflammatory and anginose forms of scarlatina the veratrum viride is regarded by many American physicians as almost a specific. Under its use, it is said, the skin becomes moist, the nervous restlessness subdued, the pulse reduced in momentum, and the affection of the throat and fauces decidedly improved, without any danger of the occurrence of permanent prostration; the danger of the occurrence of the usual sequelae of the disease is also lessened. (C. Butler, Trans. Vermont Med. Soc., 1865.)

The bowels of the patient should be kept regularly open, by any mild laxative. The daily use of the tepid or warm bath will always be found advantageous.

After the disappearance of the eruption, it will be necessary to allow a more nutritious diet; but at the same time, we should be cautious to proscribe all indigestible and stimulating articles of food, and to prevent too much of even the lightest and most appropriate from being taken. Daily exercise in the open air, in mild, dry weather, will be proper, as soon as the patient is sufficiently strong to attempt it. In some cases, it will be necessary to aid in the restoration of the patient's strength, by the administration of some gentle tonic; the cold infusion of cinchona, the sulphate of quinia or an infusion of wild cherry tree bark, may, in such cases, be employed with advantage. The more stimulating tonics and wine should be avoided.

The patient for some considerable time subsequent to his recovery should be carefully guarded against exposure to cold or damp. Dur ing convalescence from attacks of even the mildest and most simple character, a slight amount of exposure is liable to be followed by dropsical effusion, and other disagreeable consequences.

To promote the growth of the hair, which very generally falls out after an attack of scarlatina of any severity, the head, during conva lescence, should be shaved two or three times, and frequently washed with warm water, followed by smart friction with a brush or coarse towel-care being taken, in cold and changeable weather, to preserve the head moderately warm by a light cap.

The congestive form of scarlatina constitutes what has been denominated the malignant scarlatina by many writers. The suddenness of the attack, in the more violent cases, the extreme faintness, and the pale, sunken countenance of the patient; the dark livid or dusky ap pearance of the eruption; the absence of any decided reaction; the dark gangrenous appearance of the throat; the rapid occurrence of a general depression of the vital powers, with the dissolved state of the blood, the petechiæ, vibices, &c., have all concurred to deceive in regard to the real character of the disease, and lead to a belief that it is one bearing an unequivocal stamp of putridity, and requiring for its cure the most active stimulants, antiseptics, and tonics. Sounder notions of general pathology have led, however, to more correct views in regard to the nature of this form of scarlatina, and its appropriate

treatment.

The congestive form of scarlatina, has, with great propriety, been

divided by Armstrong into the regular and irregular; the first being unattended with any marked reaction, while in the latter, a partial and irregular reaction is manifested. The more violent cases of the first variety run their course with extreme rapidity, and are always attended with the utmost danger. Often has the patient been known, when the disease prevails epidemically, to sink, almost immediately, upon exposure to its infection, into a state of complete insensibility, terminating shortly in death. The irregular form of congestive scarlatina, though confessedly a very formidable malady, is, however, by no means so dangerous as the regular form, nor so rapid in its progress as it forms a kind of intermediate link between the inflammatory and purely congestive forms, it will be first considered.

It attacks pretty much in the same manner as the inflammatory; with a sense of chilliness, headache, sickness and lassitude, &c. These symptoms, after a period much longer than in the inflammatory form, are succeeded by a partial reaction-the heat being principally confined to the trunk and upper portions of the extremities, while the wrists, hands, ankles, and feet are often cool, or at least remain of the natural temperature. Throughout the day, the patient complains at one time of a sense of heat, and at another of chilliness; the latter being often complained of when the surface of the body feels hot to the touch. During the period of imperfect excitement, the eruption, upon the skin becomes more florid, but again fades as the reaction subsides. The fauces become more or less red and swollen, and in a few days, grayish specks appear upon their mucous membrane, and assume a dark gangrenous appearance often as early as the end of the first week, but more commonly, not until the second week.

The efflorescence upon the skin is less diffuse, and of a duller hue, than in the inflammatory form; it is also more liable to disappear, leaving the face of a sickly pallid color; the lips and edges of the tongue, also, are less intensely red. Early in the attack, the patient often evinces an appearance of dejection or alarm, which is strongly expressed in his countenance; occasionally, he sinks early into a state of dulness or stupor-of confusion or indifference the eyes having a dul, vacant look, with dilatation of the pupils. In some instances, the mind remains for a time perfectly clear; but there is invariably a sense of uneasiness in the head, and often of oppression and anxiety at the præcordia. Delirium is not common in the early stage, but very generally ensues at a later period, and is usually a conspicuous symptom in the advanced stage of the disease. The bowels are irregular, and the discharges always unnatural in color and odor, indicating either a deficient or morbid secretion of bile. At the commencement of the attack, the pulse is slow and oppressed, but with the effort at reaction, it becomes quick and variable, though it rarely acquires much firmness or fulness.

This form of scarlatina, when uninterrupted in its progress, often runs on to the end of the second week, and sometimes for a much longer period. When it terminates favorably, the recovery is very slow. Unless properly treated in its early stage, symptoms indicative of some serious affection of one or more of the internal organs

most generally ensue, which if not promptly arrested, augment in violence, when coma, low muttering delirium, extreme difficulty of respiration, or violent vomiting and purging occur, and speedily terminate in death. Towards the close of the disease, indications of a dissolved. state of the blood often ensue; such as dark-colored petechia, oozing of dark-colored blood from the mouth, nostrils, bowels, &c.

In this form of scarlatina, there is, throughout, an imperfect effort at reaction; the stage of excitement, however, being never fully developed.

In the purely congestive variety of scarlatina, there is, as it were, but one continued stage of oppression, which gradually augments, until life is extinguished. The patient is, for the most part, attacked suddenly with paleness of the face, faintness and nausea; he complains chiefly of a sense of heaviness, pain and dizziness of the head; great oppression, and considerable uneasiness at the præcordia.. Occasionally he sinks at once into a state of depression, with the utmost confusion and torpor of the intellect, and makes but little complaint. In other cases, continues about, for one or two days, in a languid, listless condition, and then takes to his bed as though worn out by great fatigue. When the disease is fully formed, the respiration becomes quick and anxious, or slow and laborious. The paleness of the countenance is often mixed with a degree of lividness: the eyes are dull, though occasionally they have a glassy appearance, and acquire a vacant or drunken expression in the course of the disease. Delirium soon ensues; or there is an indifference to surrounding objects, succeeded by a state of stupor, in which the patient expires. From the commencement of the attack, the pulse is ordinarily low, impeded, and irregular, and generally continues unchanged to the close of the disease. The tongue is commonly, at first, paler than natural, whitish in the centre, and thickly covered with a ropy mucus; towards the close of the disease it often assumes a rough and darkish aspect. The breath is usually more or less offensive. The bowels are commonly distended with flatus; they are costive or irregular, in the first stage, but are frequently affected with diarrhoea in the last; the discharges being either of a darker or of a lighter color than natural. There is often great irritability of stomach; occasionally, however, it retains whatever is taken into it. As the disease advances, deglutition becomes more and more difficult.

The efflorescence, from its first appearance, is of a purplish, coppery, or livid hue, which becomes deeper as the disease proceeds. Occa sionally, it quickly recedes, without again returning. In some very rapid and fatal cases, the throat is but little affected; when, however, the disease continues beyond the fourth day, and the vital powers begin rapidly to sink, the fauces are generally covered with dark colored specks. The heat of the surface is usually rather below, than above the natural standard; even when the central portions of the body are warm, or perhaps hot, the extremities are, for the most part, cold.

This form of the disease frequently runs its fatal course in two, three,