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it passed off that way. The effect of the watery stools thus procured was to exhaust the patient. The affection of the throat seemed rather to increase, and a poultice of light-bread and milk was prepared and applied as hot as could well be borne. From this some relief was obtained, and as she was kept in a state of nausea by a preparation of squill, and vin. antimon. combined with paregoric, some improvement was observable. The bowels had been acted upon by gentle cathartics, and I thought she was about to recover, when upon calling on the evening of the fourth day, I found her worse than

The poultices had been steadily continued, yet still the pain and swelling of the fauces, and the difficulty of deglutition were worse, and my apprehensions for her safety were much excited. A large blistering plaster was applied to the throat, and a strong decoction of cayenne pepper prepared, of which she was prevailed upon to drink freely, and under this plan of treatment, with due attention to the bowels, her health was restored. While in this, and some other cases, I am of opinion that vesication was productive of good, I am by no means prepared to say, that the practice should be gene. rally adopted; on the contrary I look upon the cataplasms as safer, and as free from the objections so justly entertained against blisters. In my practice the epispastic has usually been employed after poultices and sinapisms had failed to secure the desired ends; and while I admit a doubt as to the general utility of vesication in this fever, I would unhesitatingly employ blisters, and risk gangrene, and the whole host of evils to which they are supposed to be accessary, before I would lose my patient without making the experiment.

Gargles I believe may be omitted. The cayenne pepper so prepared as to be comfortably swallowed, is a valuable adjuvant in the treatment of scarlatina, of which I have made

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much use, and which I can safely recommend. That the dryness of the skin should be obviated is very desirable, and this I have generally been able to effect by the use of the cayenne, and a preparation of vin. antimon., spt.nit. dulc., and paregoric, giving the pepper tea without limit, and, of the other, a teaspoonfull every hour, unless it acted too freely upon the stomach, in which case the time was prolonged.

Thus I have communicated the treatment pursued by me in the scarlet fever of Calloway county, and I may state, as the result, that out of some fifty cases thrown directly upon my hands, I lost but two, where the course of cure was begun by myself. Many received directions whose cases I never saw and were relieved; while others, laboring under the impression from having observed the great fatality of the disease elsewhere, that but little could be done by medical treatment, made no application for aid, until help was beyond reach, and thus cases were lost, two and three in a family, which by timely and judicious aid might have been saved.

The subjects of the fatal cases to which I have alluded were stout, robust children, one of them my own, whose sufferings were most intense, and upon whom no effort of mine made any impression. The brain became most deeply involved, and a heavy coma supervened, out of which I was unable to arouse her. The death of the other, from the peculiar formation of the child, I predicted while it was yet in health, should it become the subject of the disease. Every practitioner must have observed, that children of robust forms, short necks, and large heads, are the least likely to recover from scarlet fever. The congestive form of scarlatina is not of very common

of the entire number of my cases, I am

*wo were of that character. In one

occurren

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of these, the eruption never did fully appear. The child was sick some time before I saw it, was finally thrown upon the hands of another practitioner and lost, he with myself having failed in any manner to aid it. My experience in this form of the disease having been so limited I shall not pretend to speak of the best mode of treatment, but would simply remark, that while in inflammatory scarlatina I have dispensed with calomel, I should regard it as the most valuable remedy in cases of a congestive type.

In two instances I have met with a feature in this disease, that I have not seen described, which it may not be amiss to mention here. These patients were both convalescent, and one of them was able to leave the bed. They were taken with violent spasms of the forearm and hands; the contractions were very strong, and the suffering most excruciating and obstinate, not readily yielding to the means exhibited for its alleviation.

June, 1840.

Art. III.—A case of Fracture of the Cranium, with wound of

the Dura Mater and loss of Brain. By A. H. BUCHANAN, M.D., of Columbia, Tennessee.

On the 27th of August 1824, a boy aged 8 years, was found in a horse lot apparently lifeless, with a deep wound in the left temple, extending from the anterior part of the ear to the external corner of the eye. It was supposed, that he had been kicked on the head by one of the horses in the lot. I saw him about six hours after the accident, and upon examination found the temporal muscle greatly lacerated and bruised,

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and entirely cut through, down to the subjacent bone; and discovered in the wound several small portions of brain. The left eye was much injected with blood, and the eye-lids were swollen and livid, and the pupils widely dilated. The pulse was full and slow, and the patient slightly comatose. Upon dilating the wound with the scalpel, I found the anterior inferior angle of the parietal bone, and the adjoining portions of the temporal and frontal bones, to the size of half a dollar, fractured and depressed. The dura mater was, pierced by a spicula of bone, and several portions of brain, about the size of a pea, were perceived lying on its surface. The cheek bone where it unites with the zygomatic process of the temporal bone, was also fractured and depressed. The portions of cranium which were depressed being entirely loose, were removed by a pair of forceps; which left exposed the wounded dura mater, the middle artery of which now bled freely, but soon ceased without any application. The cheek bone being properly adjusted, the lips of the wound were brought together by three stitches, and by adhesive strips; a compress was placed upon the wound and retained by a bandage drawn firmly about the head.

The boy complained but very little during the operationbeing during the greater part of the time in a state of stupor.

. After he was put to bed he remained in a comatose condition for two days, with full, slow pulse, about 60 in the minute, and pupils dilated; but during this time, if roused up he recognised his acquaintances, and was sensible to all external impressions. He was bled freely, on the second day, and purged with Epsom salts ; during the following night he complained at times, of some pain in the wound. Suspecting that the pressure from the compress and bandage might be too great, it was diminished a little, and in the morning on rais

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ing a corner of the adhesive strips at the lower end of the wound, a free discharge of pus took place. The pulse being full and slow he was again bled, and also purged with salts. The accumulation of pus in the wound occasionally produced some pain, but when he complained it was always evacuated, which relieved him. From this time, by keeping the bowels open with salts or oil, and restricting him to the lightest of diet, he gradually recovered, and in four weeks was walking about the house. No untoward symptom occurred afterwards.

The boy, I suppose, lost about half an ounce of brain, which as far as I could discover did not seem to affect his intellectual faculties, and his father is of opinion, that his mind is not injured. His mother, however, is quite sure, that his memory is not so good as before the accident. The case I consider worthy of reporting, because it gives additional evidence to the cases already on record, that a wound of the dura mater, with loss of brain, is not necessarily fatal, nor always followed by fungus cerebri. It is highly probable that the firm support maintained by the compress and bandage, in this case, during the cure, and even for several weeks after the external wound had healed, was the most efficient remedy in preventing the fungous growth so apt to occur under such circumstances.

July, 1840.

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