Hamilton Bell, of Edinburgh, recommends the tincture of the mu riate of iron in infantile erysipelas-two drops to be given in a teaspoonful of sweetened water, every two hours. We have employed the tincture of the ammoniated tartrate of iron, in small doses every hour, so that from twenty to thirty drops, or even more, may be taken every three hours, and the effect of the remedy has appeared to us decidedly beneficial.

Should diarrhoea ensue after suppuration has taken place, it should be immediately checked by the cretaceous mixture, with the addition of tincture of kino and laudanum; if this should not succeed, the acetate of lead, ipecacuanha and opium may be substituted.

R.-Acetat. plumbi, gr. xij.
Ipecacuanhæ, gr. iv.

Opii, gr. j.-M. f. ch. No. xiv.

One to be given for a dose three times a day.

When the discharges from the bowels are of a vitiated character, or attended with griping or colicky pains, a few drops of turpentine, three times a day, will be found a very valuable remedy. The turpentine may be combined with the tincture of kino and laudanum.

R.-Aq. cinnamom. Ziij.
Tinct. kino, zij.

Spir. terebinth. 3j.

Magnesiæ calc. gr. viij.-M.

A teaspoonful may be given at a time, three times a day, or oftener.

Various local applications have been recommended by different practitioners, as highly beneficial in the treatment of infantile erysipelas, while by many these are denounced as invariably injurious. Washing the parts frequently with tepid water, or some mucilaginous fluid, will, in many cases, be productive of very great relief, and we think that we have seen an abatement of the disease take place under the practice. In the intervals, the parts may be dusted with powdered starch, or covered with carded cotton.

When the disease is attended with considerable distension of the skin, a lotion composed of the acetate of lead and subcarbonate of ammonia (half a drachm of each dissolved in eight ounces of water) has been highly recommended. Other washes have been proposed as occasionally beneficial, of the effects of which we have no experience— as the camphorated tincture of opium, applied by covering the diseased parts with rags wet with it; a solution of corrosive sublimate, three grains to an ounce of water, applied in the same manner; a solution of nitrate of silver, three grains to the ounce of water, similarly applied. Pencilling the sound skin, for about an inch around the margin of the diseased parts, once or twice, with a very strong solution of the nitrate of silver, has been said to effectually arrest the progress of the disease. Folds of linen saturated with the chloride of lime, in solution, half a drachm to the pint of water, is said to be one of the best local applications in cases which early show a tendency to gangrene. A solution of the sulphate of iron, half an ounce to eight ounces of water, has also been employed with advantage by Velpeau. This is said to have subdued the erysipelatous inflammation in two days.

We have used a wash of acetate of lead, ten grains to the ounce of water, in many cases, with the very best effects, but our favorite application, in the ordinary cases of the disease occurring in children, is fresh lard, with the addition of acetate of lead, in the proportion of ten grains to the ounce. To those cases which exhibit, from the first, a decided tendency to gangrene, this application is not adapted. The local remedies just recited are to be employed in the early stage, previous to the rupture of the vesications, and to the occurrence of suppuration or gangrene.

Among the local remedies from, which much good may be anticipated in erysipelas, as it occurs in children, is a blister, sufficiently large to extend over the diseased surface, and for a short distance beyond it. After vesication has been produced, the serum should be evacuated, and the vesicated surface dressed with fresh lard. When the erysipelas occurs upon the extremities, a blister applied around. the limb beyond the affected surface, will frequently arrest the pro gress of the disease in that direction. In the cases in which we have resorted to blistering, we have usually applied strips of leather, spread with blistering ointment, along the edges of the inflamed part, partly on the latter, and partly upon the sound skin, at the end of three hours removing them, and immediately covering the parts with a soft emollient poultice, with the addition of lard. The most important result which we have derived from the use of blisters, is the prevention of the spread of the disease.

The mercurial ointment has been strongly recommended in the treatment of infantile erysipelas, as well as in that of adults, by Dewees and Metmeyhr. It is applied by covering the diseased surface with a piece of soft linen, spread with the ointment. We have never employed it, preferring to keep the inflamed skin constantly covered with a coating of perfectly fresh lard. In many cases, attended with an intolerable sensation of burning, we have seen some good result from the use, as a lotion, of a watery solution of opium.

In those instances in which there is considerable restlessness, and the patient is prevented from sleeping at night, a few grains of Dover's powder, or a dose of the camphorated tincture of opium, adapted to the age of the patient, should be given at bedtime.

When erysipelas terminates in gangrene, washes of a solution of the chloride of lime or soda, of water in which a few drops of creasote are diffused, or of a strong decoction of galls or black oak bark, should be immediately employed; the sphacelated surface may also be covered with either the charcoal or yeast poultice. Pencilling the edges of the gangrenous ulceration which often ensues, with the creasote wash, or the balsam of Tolu, will occasionally arrest its progress. We have seen, we think, good effects result, in some instances, from washing the gangrenous surface with a very strong solution of the sulphate of copper.

In all cases in which the cellular membrane is involved, free incision should be early made, as well to unload the vessels, and relieve the swelling and distension, as to give exit to the purulent fluid and dead portions of cellular structure. The pus, if allowed to remain, by

making its way beneath the skin, and between the muscles and tendons, has a tendency to increase the extent of the disease, and to cause the death of the patient, by the irritation and exhaustion to which it gives rise. After the incisions, the parts should be covered with a soft emollient poultice. The patient, or the affected limb, should be kept at rest, and the inflamed part, if possible, somewhat elevated, so that the flow of the blood from it may be facilitated by gravity.

Should indications of pulmonary or cerebral disease occur in cases of erysipelas, these will demand their appropriate remedies.

When convalescence has been established, and a degree of weakness and languor remains, some light mineral tonic, with the mineral acids, should be administered, and the child should be allowed a nutritious, but mild and easily digested diet. He should be immersed daily in the warm or tepid bath, and enjoy a dry, fresh, wholesome atmosphere.

9.-Phlegmonous Tumors.

These tumors occur on various parts of the surface of the body, either as indications of some internal disease, or constitutional derange ment. They are often critical when they appear towards the decline of acute febrile diseases. They have received a great variety of appellations, but may all be included under the general denomination, phlegmon.

There are two leading species. The one involving the cutis, and the cellular tissue beneath, often to a great extent; while the other is confined to, and only involves, in the suppurative process, the substance of the cutis.

The first appears in the form of a painful, dark-red, circumscribed tumor, of a somewhat conical form, excessively painful to the touch, and often attended with more or less febrile excitement. At the apex of the cone, a little white speck or slough is generally observed, which, when picked off, is not followed by the discharge of matter, but leaves an excavation of a corresponding size and shape. It is very probable, Plumbe remarks, that the matter is formed, in this species of phleg mon, within a very few days after the occurrence of the disease, deeply imbedded in the cutis, and is prevented from making its way to the surface, in consequence of the thickening of the superincumbent structure from adhesive inflammation.

The second species is in the form of a dark-red, lenticular swelling, very painful to the touch, and slow in maturating. When pressure is applied to the sides of one of these small tumors, soon after suppuration has commenced, a transparent serum exudes. Pus first appears in a minute yellow elevation on the centre of the tumor, the surrounding parts of the latter being hard, solid, and painful. The abscess seldom gives discharge to much matter, and in most cases, where the inflammation is not very obvious at the surface, a small portion of the cutis is destroyed and comes away in the form of a slough. After the excavation, formed by the separation of the latter, is filled up, and the inflammation has subsided, a thickened and hardened condition of

the part, which is of a bluish color, remains, and is only slowly removed. These phlegmons appear in the greatest number upon some portion of the trunk, particularly the abdomen, while the first species occurs most commonly on the arms, thighs, and nates. (Fosbrooke, Plumbe.) We have very frequently seen the latter in children of a gross habit of body, upon the back part of the neck, and between the shoulders.

They are always of a chronic character. Very generally a new crop makes its appearance as fast as the first subsides, so long as the diseased condition of the system, by which the local affection is produced shall continue.

Children of full, gross habits, and who are fed upon coarse and rich food, are the most frequent subjects of phlegmonous tumors. They are more common during the spring and summer than at the other seasons of the year. When extensive, they often give rise to a greater or less degree of febrile excitement.

The proper treatment consists in placing the patient upon a plain vegetable diet; the evacuation of the bowels by a dose of calomel, followed by a saline cathartic, and free exposure to a fresh, pure atmosphere. When the phlegmonous tumor is very extensive, hard, and painful, particularly when accompanied by febrile symptoms, the application of a few leeches to its centre will be proper.

The early suppuration of the tumor should be encouraged by the application of large emollient poultices; the best are those composed of the crumb of stale bread, or linseed meal, boiled in milk, with the addition of lard. When suppuration has taken place, and the matter does not readily find its way to the surface, the abscess may be opened with a lancet, and the application of the poultices continued. In general, in a few days, the excavation will be filled up with healthy granulations, and completely cicatrized. If, after the abscess bursts, or is opened, it exhibits no disposition to heal, it should be dressed with the common resinous ointment.

In the second species of phlegmon, the use of the sulphuric acid internally, continued for a length of time, has been said to prove peculiarly efficacious. It should be used largely diluted with water, and in as large doses as is compatible with the age of the patient. Under its use, we are assured by Fosbrooke, that the pain of the tumors is deadened, and the latter gradually absorbed, without suppuration. An alterative course of treatment, continued for many weeks, with the use of the compound decoction of sarsaparilla, will, in general, be required.

Children, who are subject to boils, should be restricted to a light, unirritating diet, composed chiefly of farinaceous substances; they should use daily exercise in the open air, and be daily immersed in the warm or tepid bath.

Children are often affected with a phlegmonous inflammation of the glands of the neck and groin, unconnected with indications of scrofulous disease, and occurring under the same circumstances as the cuticular phlegmon.

Its treatment differs in nothing from that recommended for the more

extensive forms of phlegmon; low diet, saline purgatives, and the application of leeches, and of cooling applications when a considerable degree of inflammation is present. When the tendency to suppuration is evident, emollient poultices are to be resorted to, and frequently repeated. When the inflammation and swelling of the glands are of an indolent character, remaining for a considerable time without either increase or diminution, we have generally found the application of a blister to cause a rapid suppuration to ensue. The abscess which forms should be early opened by a free incision, and the application of the poultices continued, until the cavity is filled up by granulations, and a disposition to cicatrization is apparent.

There is a form of phlegmonous abscess of common occurrence in children which we have not seen noticed by any writer. It is consequent upon a deep-seated inflammation beneath the fascia, upon the anterior part of the thigh, or upon the lower part of the back; sometimes immediately above the hip. It may, perhaps, appear in other parts, but the above are the only ones in which we have seen it. The disease is generally met with in children of a lymphatic tempera

ment.

The first symptoms are usually deep-seated, dull pains at the part where the inflammation occurs, which are often increased at night, and always upon the application of pressure. If the inflammation takes place in the thigh, or upon the hip, the child walks lame. In many cases, when in the latter situation, the symptoms bear a strong resemblance to those of morbus coxarius, for which the disease may be readily mistaken by an inexperienced physician. There is at first no redness or increased heat of the part, and but little or no swelling; by degrees, however, a swelling is perceived, which gradually increases in extent, and finally, upon a cautious examination, a fluctuation of matter may be detected. The skin over the tumor is smooth and shining, and very tense, and a deep-seated, throbbing pain, increased by paroxysms, is complained of: it is often so severe as to deprive the child of his rest.

In children over four years of age, we have seen, after suppuration has occurred, a well-marked hectic fever, with two exacerbations in the course of the twenty-four hours, profuse perspirations at night, and occasionally colliquative diarrhoea. We have never observed any disposition in these abscesses to approach the surface; this has usually been prevented by the matter forming beneath the aponeurosis or fascia enveloping the muscles. Occasionally, the matter in the thigh has travelled downwards, and given rise to a swelling in the neighborhood of the knee. In one case in which the abscess formed in the lower part of the back, the matter found its way to the groin, where it formed a fluctuating tumor of considerable size. When the contents of these abscesses is discharged by an incision, it is of a healthy appearance, though occasionally containing flocculi, and large fragments of dead cellular matter.

The treatment we have pursued in these cases is, in the early stage, the application of leeches over the seat of inflammation, followed by blisters a dose of calomel, succeeded by saline catharties, and if the