nitrate of urea, in doses of a third of a grain, combined with a little. powdered sugar; this has generally produced the desired effect.

Scarlatina, particularly the anginose variety, is often succeeded by a deep-seated pain in one or both ears, with deafness, followed, in a short time, by a discharge of either pus or a fetid serous fluid. This in general arises from the inflammation of the throat extending along the Eustachian tube to the internal ear. When violent, long continued, or neglected, the inflammation sometimes terminates in an entire destruction of the organ of hearing. So soon as any indications of the occurrence of otitis are observed, leeches should be applied behind the external ear, followed by repeated blisters, while the bowels are kept in a regular condition, by small doses of calomel, prepared chalk, extract of hyoscyamus, and ipecacuanha, at bedtime, and mild aperients during the day.

When a discharge from the ear occurs the meatus should be fre quently syringed with tepid barley water, or other bland mucilaginous fluid. When the discharge is dark-colored and offensive, the best fluid to syringe with is a weak solution of the chloride of soda, or a decoction of black oak bark. The patient should be confined to a light, nourishing diet, and have regular exercise daily, in the open air, whenever the weather is mild and clear. Repeated blisters behind the affected ear we have found, in many cases, to arrest the discharge, and occasionally, under their use, the function of the ear has become fully restored.

The severe and fatal character of scarlatina, particularly when it occurs as an extensive epidemic, has caused various plans of prevention to be tried. The one which has attracted most attention is that suggested upwards of thirty years ago, by the celebrated founder of homoeopathy. It was long known that belladonna, when given in small and repeated doses, would cause a heat and dryness in the throat, and an efflorescence upon the skin, having a very close resemblance to that of scarlatina. Hahnemann hence maintained, in accordance with one of the fundamental principles of his theory, that when adminis tered so as to give rise to these symptoms, it would prove a certain preventive against the occurrence of scarlatina. In proof that such is actually the case, a considerable amount of testimony has been presented from various sources.

In a paper published by Bayle, in 1830, it is stated that of 2027 individuals to whom the belladonna was administered, 1948 were preserved from scarlet fever, and 79 were attacked. Dusterberg reports, that in all who were placed under the influence of the belladonna for the space of two weeks, it acted as a prophylactic. To ascertain the real value of the article, he purposely omitted to administer it to one child in each family, and this one alone, according to his report, was attacked by the disease. Occasionally a child who had been taking the remedy during only three or four days, was attacked; even in such

cases the fever was always mild, and often the only manifestation of the presence of scarlatina was the occurrence of desquamation. Zeuch, physician to the Military Hospital for Children, in Tyrol, after 84 of the children were attacked with scarlet fever, was induced to try the prophylactic powers of belladonna on the remaining 61 children. With a single exception, all of the latter were preserved from the fever, although it prevailed all around them. Schenk, Berndt, Köhler, Meglin, De Lens, Massius, Bayle, Godelle of Soissons, and many other respectable practitioners, speak in equally high terms of the preservative properties of the belladonna. Dr. Stievenart, of Valenciennes, however, has published the results of a very extensive trial of the belladonna, as a prophylactic during the prevalence of epidemic scarlatina which results, if they are correctly stated, and all sources of error have been carefully guarded against in the performance of the experiments upon which they are based, go very far to prove that belladonna does actually possess the property of shielding the constitution from an attack of scarlet fever. An epidemic of the disease raged, during the winter of 1840-41, in several villages in the neighborhood of Valenciennes, when Dr. Stievenart was induced to try the prophylactic properties of belladonna. The fatality of the epidemic was such that 30 had already died out of 96 attacked; consequently any means of prevention was a subject of vast importance. In a small village, out of 250 individuals, 200 took the belladonna, and were all preserved from the attack of scarlet fever. Of the fifty others, 14 were seized with the fever, and four of them died. Dr. Stievenart administered the belladonna to the children at the public school of the village of Curgies, who were allowed to continue at their lessons, and have free communication with the children of the village. All to whom the belladonna was administered escaped the scarlet fever, while a few who refused to take it were attacked. He gave the drug either in solution or in powder. Two grains of the recent alcoholic extract of belladonna were dissolved in an ounce of any aromatic infusion; of this two drops were given to a child of one year old, daily, for nine or ten days; an additional drop being added for every additional year of age. The largest daily dose was, however, limited to twelve drops. Of the powdered root half a grain, mixed with a small quantity of sugar, was divided into ten doses. One of these was given, morning and evening, to children of from one to two years old; two to those from three to five; three to those from six to nine; four to those from ten to fifteen, and five to adults. These small doses never produced the toxicological effects of belladonna; in fact, they scarcely exhibited any marked action. In five or six cases, it is true, a rash similar to that of measles was observed; and, in a few others, headache, with dilatation of the pupils, dryness of the fauces, and a slight soreness of the throat, but not resembling that of scarlatina anginosa. Dr. Stievenart, generally, continued the use of belladonna for from nine to ten days; in some cases, it was given for fifteen days. He recommends its use to be resumed if the epidemic, after abating, should return. In an epidemic of scarlatina which occurred in South Carolina, Dr. Irwin made a very extensive trial of the prophylactic properties of

belladonna. Of two hundred and fifty children who were placed under the influence of the drug, less than half a dozen had the disease, and that very mildly. In the families, the members of which were not placed under the influence of the belladonna, the disease occurred with scarcely an exception. Dr. M'Kee, in the extension of the same epidemic, made use of the belladonna, and derived from it the same protective influence. Dr. Rufus Hammond, of Indiana, also bears testimony in favor of the prophylactic powers of belladonna, based upon ample opportunities for observation.

The above is, unquestionably, strong evidence, from sources deserving of great consideration, that the influence, whatever that may be, which belladonna exerts upon the organism, when given in small doses, for a certain length of time, is sufficient to protect it from the morbific action of the poison of scarlatina. Viewed en masse the evidence would seem, indeed, to be irresistible. When, however, we subject it to a careful analysis, and weigh cautiously the observations upon which it is based, it will not be found of that conclusive character which at first sight it would appear to be. Everything connected with scarlatina-the manner in which it spreads, the character it assumes as to mildness or severity in different epidemics, or in different cases during the same epidemic; the susceptibility to an attack of the several individuals exposed to its infection is always subject to such. striking variations and unexpected anomalies, that unless it could be shown that those who had been placed fully under the influence of the belladonna, or the majority of them, would, at all times, and in every visitation of the disease, escape an attack, we cannot with any certainty affirm, that any one who during the prevalence of scarlatina in their vicinity remains unaffected by it, or if attacked, has the disease in its mildest form, owes to any extent his immunity or the mildness of the attack in his case to the influence of the supposed prophylactic. Besides, we have the most positive and direct evidence that the belladonna, even when carefully and faithfully administered as a prophy lactic, will not, in all epidemics, positively and generally prevent an attack of scarlatina. The experiment has been made by placing a certain number of children under the influence of belladonna, while to an equal number no bellanonna is given, all being equally exposed to the infection of scarlatina; when it was found that no striking difference was manifested in the numbers of the two classes who were attacked.

According to Dr. Andrew Wood, of Edinburgh, recent observations, especially those made by Mr. B. Bell, in Watson's Hospital, and by himself in Heriot's Hospital, would seem to prove that belladonna neither prevented scarlatina nor mitigated its symptoms. Dr. G. W. Balfour is thoroughly convinced from his observations, that it is utterly inadequate to prevent the disease; he even believes its use to be abso lutely improper, because, when given in even the ordinary small doses, it is sure to give rise to disordered digestion, foul tongue, etc., circumstances not the best adapted to ward off any disease. (Monthly Journ. of Med. Science, 1853.)

We have, in repeated instances, tested the prophylactic power of

belladonna, but although redness and dryness of the throat, and a diffuse scarlet efflorescence were produced in the majority of the cases, we never found it to exert the slightest influence in mitigating the character, or preventing the occurrence of scarlatina. The experi ments were made during the prevalence of the disease, and in numerous instances the subjects of them were attacked. In one case, the efflorescence was kept up, by the use of the belladonna, for forty-eight hours; in a week afterwards, this individual took the disease in its most violent form, and died on the fourth day.

It has been asserted, that scarlatina, like many other analogous diseases, may be inoculated so as to determine a local inflammation without reaction of the economy, but generally preservative from a second attack of the disease. Miguel employed the matter procured by pricking several papule with lancets, which was inserted in incisions made in the arm of the child intended to be infected. In three cases, he states that he was enabled in this manner to produce a local disease, which followed the march of the scarlatinous inflammation.

Although not invariably successful, yet it will be prudent, in all cases to endeavor to prevent the spread of the disease by the seclusion of the sick, by free ventilation, by frequent changes of linen, and by the strictest cleanliness.

3.-Roseola.--Rubeola.-Rubeola Notha.-Scarlet Rash. Roseola consists in a rose-colored or scarlet efflorescence, without wheals or papulæ, not contagious, and in many cases accompanied by a sensation of tingling or itching. The efflorescence may be confined to the face, neck, and upper extremities, or it may occasionally extend over the greater part of the body. In some cases, the redness is diffused over a large surface; in others, it assumes the form of rings and spots, while in others, again, irregular lines of a darker color have their interstices filled up by a lighter shade of red. We have often found the efflorescence to be much more decided around the large joints, than upon other parts of the surface.

The disease is frequently ushered in by a slight degree of febrile excitement, which abates as the efflorescence makes its appearance, and disappears with it. The pharynx often presents a similar efflorescence to that upon the skin, and the patient feels a sense of dryness and roughness in swallowing. The efflorescence upon the surface gradually declines after the second day, and in general, disappears by the fifth. It seldom continues longer than a week, and is not followed by desquamation of the cuticle. It occasionally reappears and declines again and again, without any perceptible cause, or in consequence of any undue excitement, or upon the use of heating food or drinks. The efflorescence often occurs, in succession, on different parts of the body. If generally diffused, in the form of small patches, with intervals of sound skin between them, it is sometimes with difficulty distinguished from measles, the difficulty being increased in many cases by the presence of catarrhal symptoms.

The sudden recession of the efflorescence is frequently attended by

some derangement of the stomach, headache, and more or less of languor and lassitude, which symptoms immediately cease, upon the reappearance of the eruption. In a number of instances, we have found the eruption attended by very decided catarrhal symptoms, and to be preceded and followed by pains of the limbs, and sometimes by slight redness and tumefaction of the joints.

Roseola is peculiar to no age or sex; it is, however, much more frequent during infancy and childhood than subsequently. In infants, the peculiar irritability of the skin, and of the constitution, predisposes to its occurrence from the most trifling causes. It is most commonly observed during the period of dentition, or in connection with the ordinary intestinal and febrile affections of infancy; but it may originate from any slight irritation of the stomach or of the alimentary canal generally. It is more common during the summer and autumnal seasons, than at any other period of the year.

Roseola has been divided, by Willan and others, into several varieties, founded upon the age or season at which it most generally prevails, and upon some slight difference in the appearance of the eruption. This division is more apt, however, to perplex and mislead, than to serve any useful purpose.

The affection is one of little or no importance; requiring, in many cases, no treatment, and in none any further interference than to relieve the bowels of any cause of irritation which may exist, by some gentle laxative, to moderate the tingling or itching sensation of the surface by the use of the tepid or warm bath, and to place the patient upon a mild, unirritating diet. When the disease becomes chronic, or returns several seasons in succession, and continues for many months, attention to the condition of the alimentary canal will be demanded, with sea bathing, and the use of mineral acids.

We have deemed it necessary to notice the disease, in this place, from the fact of its having been repeatedly mistaken for a mild attack of measles or scarlatina, and in this manner has given rise to some of the reported cases of a second attack of the latter diseases. So closely do some of the forms of roseola resemble measles, that it has been questioned by Sydenham, Rayer, and others, whether it is not, in fact, a modification or variety of that disease, without catarrh. Orlov, Seiler, Heim, and Stromeyer, have thought it necessary to devote distinct treatises, to determine the diagnosis between it, scarlatina, and measles. No difficulty can be experienced by an attentive observer, in readily distinguishing roseola from the other febrile exanthemata, by the difference in the appearance of the eruption-the patches of which are more regularly circular in shape, and more circumscribed than those of either measles or scarlatina, while they are larger than those of the former and smaller than those of the latter-the general symptoms, also, are very distinct from those of either measles or scarlatina. The slight evanescent febrile excitement of roseola, can scarcely be confounded, even by the most careless observer, with the severe catarrhal fever of the first, or with the intense febrile reaction of the second.

Rubeola, according to the German medical writers, is a hybrid