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After waiting from a half to three quarters of an hour, to observe the effect of what had already been done, I administered an ordinary sized teaspoonful of chloroform by the mouth, every two hours, until four doses were given. This had the desired effectnot a symptom of the convulsions recurring after administering the first dose.

Three hours after the last dose was given, Mrs. G. was delivered of a dead foetus. I then left for home, leaving a vial of chloroform, with directions to give a half teaspoonful every four hours, until four more doses were taken. Also, for her bowels to be moved by castor oil at night; after the action of which, 15 grs. Dover's powders to be given at one dose.

Friday morning. Again visited Mrs. G. Found her doing well; free from fever, bowels having been moved, and she was feeling very much refreshed by a good night's sleep.

This constitutes the whole of the treatment for this case, with the exception of five grains Iron by Hydrogen, which was given morning and evening, for ten days after; since which time Mrs. Grubbs has enjoyed excellent health.

[However happily chloroform, in the above doses, may have acted in the isolated case of Dr. B., we feel constrained to state, in connection with it, that our own experience has been rather against large doses, internally administered. On one occasion, we, by accident, gave a patient (a strong negro man) about 1 teaspoonfuls of chloroform, for chloric æther; the effect was truly alarming-it required hours of the most energetic exertions, with emetics, cold douche and revulsives, to keep him alive; at the end of which time, he slowly recovered. Anthony, our own office servant, while suffering from cramp colic, during our absence, took one tablespoonful of chloric æther, which happening to be the concentrated preparation used in surgical cases, the effect was more alarming than in the above case, even to the apparent suspension of life. For nearly ten minutes of the time, he was without perceptible pulse and respiration was extremely embarrassed. Since these cases, we have a species of horror for large doses of chloroform, internally administered. It must be recollected, however, that the doses recommended by Doctor Brown were but one teaspoonful, while in our accidental cases, the quantity given was nearly double that amount.]-Edts.

On the Treatment of Scarlatina by the Diluted Acetic Acid. By B. F. SCHNECK, M. D., of Lebanon, Pa.

During the past twelve or fourteen months a severe epidemic of scarlatina has prevailed in my neighborhood. Of 190 cases of the discase treated by me in accordance with the method recommended by our best authorities, I lost 1 in 8 to 9.

Dissatisfied with this result, I was induced to try the diluted acetic acid as recommended by Dr. I. B. Brown, whose work* I had the good fortune to meet with at the commencement of the present year. Of 60 cases treated subsequently by this plan, I did not lose one. The disease at this time had not undergone any abatement from its former violence; for among the sixty recoveries there were cases of such malignancy, as would inevitably have perished under the best directed previous efforts. It is true that two of the sixty afterwards died of thoracic and cerebral dropsy; and one, after a nearly two weeks' convalescence, from purpura hæmorrhagica, with epistaxis, hæmaturia, &c.; but these cases cannot be regarded as affecting the integrity of the plan in question. I am thus enabled to bear a flattering testimony to the success of Dr. B.'s method.

Many medical men, after unsatisfactory trials of all the ordinary modes of treatment, now declare that the less there is done for scarlatina the better. All such will be apt to think lightly of Dr. Brown's method; if, indeed, they do not condemn what they may choose to call his nimia cura medici. Let such rest assured, however, that this is a disease which, like weeds, flourishes most when least attended to; and further, that the character of medical advi ser must be merged, for the time, in that of nurse also, to a certain extent, if his ministrations are to be successful. He should see his patients several times in a day-the oftener the better; and following the example of our author, he should even be found holling nightly vigils by the bedside, if the urgency of the case required it. The daily dressings of the fauces with caustic should, if possible, be made by himself; he should direct the frequency of the repetition of stimulants; and even the minutest details should ever be under his immediate cognizance. Thus fully occupied, although he may be able to take charge of fewer patients, he will save more lives; and only thus will he be able to realize the truth of the otherwise almost incredible statement of a friend of the author's engaged in extensive practice, who writes, "that the number of fatal cases occurring to him under this treatment did not exceed four." This gratifying result, it is the writer's firm conviction, will be the reward of all who will adopt and faithfully carry out the plan.

* On the Treatment of Scarlatina by the Acidum Aceticum Dilutum of the Pharmacopoeia. By I. B. Brown, M. D., London, 1846.

The following is a synopsis of Dr. Brown's views:

1. Scarlatina is always and essentially a disease of debility, or tending to debility, and not of an inflammatory nature. Its poison acts primarily and most fatally upon the blood, producing a dissolved, semi-vitalized and putrescible condition of that fluid; so that it possesses more serum and less fibrin than in its normal state. "Consequently the serum percolates, or is effused into the cellular tissue and cavities, through the coats of the vessels. Salines favour this dissolved state of the blood; but acetic acid prevents the separation of the serum from the fibrin.

2. Acetic acid is an excellent antiseptic; "it gives tone to the blood in scarlatina, and prevents the separation of the serum from the fibrin." It also "acts as an astringent upon the lymphatic system and serous membranes, and so effectually prevents dropsy." 3. It is a grateful refrigerant.

4. No medicine has a inore decided influence in promoting digestion than this acid. We are further directed, while adminis tering it, to "allow patients almost anything they fancy; it will seldom hurt them in severe and even dangerous disease."

These four points lie at the foundation of Dr. Brown's very simple and very successful treatment. The specialities of his method will not be given, as applicable to the several forms of the disease.

Whatever may be the type, he prepares the system for the acid, by giving

1. An aperient of 3 to 5 grs. of calomel, to be followed in two hours by castor oil. All saline aperients are condemned; "salines favour a dissolved state of the blood." If from great gastric irritability, the oil is rejected, he recommends an aperient mixture (rhubarb and magnesia,) which contains no saline substance.

2. Apply a piece of flannel round the throat from ear to ear, saturated with soap lin. f 3j; camphor lin., laudanum, aa 3ij.-M.

3. After the operation of the oil, give-for a patient nine years old-distilled vinegar, diluted,* f3j; syrup f3iv; distilled water f3iv.-M. Two tablespoonfuls every four hours. This mixture is to be continued throughout the entire duration of the case, whatever the form of the disease; and for one or two weeks afterwards, or until desquamation is well over. "It acts as an astringent upon the lymphatic system and serous membranes, and so effectually prevents dropsy."

4. Whenever, in scarlatina simplex, there is slight delirium in the beginning, with a thick, viscid phlegm on the tonsils, apply daily-nitr. silver grs. x; distilled water f3j.-M. You thus prevent s. anginosa. If the throat require it, a linseed poultice may be placed over the flannel, and kept there constantly.

* R.-Distilled vinegar, offic., one part; water seven parts.—M. 30


5. On the third or fourth day, in simple cases, allow muttonbroth.

6. As soon as desquamation comes on, order a warm bath or two, and keep the patient strictly in bed during the whole process.

S. Anginosa. Here the treatment is the same, except that the caustic must be used more frequently, and the proportion of acid in the solution must be increased. A good rule is to increase the strength according to the violence of the attack, in bad cases giving it as strong as the patient can take it. Poultices to throat. Should symptoms of adynamia come on, give arrow-root, with a spoonful of brandy in it; add comp. sp. ether to acid solution; wash face, hands, legs, and chest with tepid vinegar () and water (3). lf restless at night, give tinet. hyoscyam., or () to (4) gr. morphia, according to age. The decoction of bark may also be added to the acid mixture. Whenever, in s. anginosa, symptoms of adynamia come on, dress the throat frequently with caustic, and increase the quantity of acid from day to day; you thus prevent s. maligna.

For adults, in cases partaking of the nature of s. maligna, the following formula is given: B.-Distilled vinegar f3iv; syr. red poppies f3iv; distilled water f3 1v.-M. One-fourth part to be taken every four hours.

In s. maligna the same course of treatment is to be pursued; calomel, oil, caustic, acid mixture (strong,) liniment or sinapism to throat, followed by poultices; brandy or port wine every four to six hours, with arrowroot, beef tea, or mutton-broth; morphia at bedtime, or whenever restless, and sponging with tepid vinegar and water. All the bed furniture, carpets, &c., to be removed from the room, and chloride of lime to be sprinkled about the floor. During desquamation, the patient is not to sit up at all. Give at this time one or more warm baths. Use wine and brandy in s. maligna, even in the febrile stage; when combined with the acid, which so powerfully assists digestion, no harm will ever accrue from their use.

This is a brief statement of Dr. Brown's views and practice in this terrible malady. To the work itself we must refer for a number of valuable cases, illustrating most happily the treatment which he advocates, and interspersed with many highly practical remarks. I cannot help transcribing at length, as a fitting close to this portion of the subject, the following observatious, which I have copied from his work:

"Very much depends on careful watching in this disease; there is always in one or the other of the stages, a critical moment. For instance, in the eruptive stage, even in s. simplex, delirium will come on, and the throat will become more clogged with viscid secretion in a few hours; and if attention be not promptly given, and this phlegm, which impedes free respiration, be not removed, the delirium and laborious breathing will in

crease, and the disease will soon run into the second or anginose form. In this case, the throat must be promptly cleansed, and some gentle nourishment be given. Again, in s. anginosa, it will not seldom happen that the tonsils and fauces will suddenly become worse, or great sickness or sudden prostration will come on; now, unless the throat be instantly attended to, delirium, laborious breathing, difficult deglutition, and restlessness will make serious ravages upon the patient, and all remedies will quickly become unavailing; or where sudden prostration should arise, then we must promptly and unsparingly administer stimulants and cordials till the pulse exhibits more steadiness and power."

The practical importance of these directions cannot be over es timated. As assisting the cleansing of the fauces from viscid secretions, I have, for several years past, been in the habit of injecting the diluted chlorinated soda into the nares, with the happiest effects. Extensive ulceration, not only of the posterior nares, but of the entire nasal tract, with an abundant secretion of a peculiar tenacious mucus, are an attendant on every bad case; and these passages cannot be long obstructed without great distress and imminent danger. The daily or bi-daily injection of Labarraque's solution, therefore, while it effectually clears away the obstruction (as any other liquid would as well,) exerts besides an alterative and healing influence upon the ulcerated surface itself; and it destroys, while it removes, the morbid products which, if swallowed, as they are otherwise sure to be, disturb so seriously the intestinal canal; and last, but not least, it corrects the fetor which is so disagreeable a concomitant of such cases. So signal is the relief derived from this proce dure, that, unpleasant though the sensation must be, I have seen the little patients, instead of shrinking from the operation, instinctively court the repetition of it, and if old enough, ask for it. It is a measure which, in the class of cases referred to, cannot be dispensed with, without loss. But as it may happen that a considerable quantity of the injection may be swallowed, and the blood be thereby impaired, it will be proper always to precede or follow the injection with a strong dose of acetic acid, so as to neutralize the saline ingredient.

The preparation of the acetic acid solution may be varied somewhat from the formulas given above, and so simplified, without in the least affecting the result. Instead of first diluting the concentra ted acid to the strength of vinegar, and then using the dilution for the preparation of the solution, I have been accustomed merely to add from f3j to f3iv of the officinal acid to f3iv water and ordering a tablespoonful every few hours, sweetening at the time of administering it. We must, however, never forget to increase the strength in proportion to the threatening nature of the symptoms. In the use of stimulants, also, a little license has been taken with our anthor's directions. Having ventured upon the guarded employment of brandy, beef-essence, &c., as a precautionary step,

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