filled with sphacelated cellular tissue was open-it was poul

ticed.

May 1st. The integuments two inches below incision became spontaneously lived and gangrenous, and those of the left side of the mamma soon got black, loose, particularly below the nipple. Poultices now increased the local agony, and were evidently injurious; sponging the whole sphacelating surface, from the neck to the nipple, with tepid water, could also be scarcely endured; cold water dressings alone gave most ease.

May 4th. At 1, P. M., the tough gangrenous integuments loosened by the subcutaneous sphacelation of the cellular, fibrous and aponeurotic tissues, and extending from above the left clavicle to within two inches below the nipple of the left mamma, and from the acromion process of the left shoulder, embracing the space below the left axilla, across the mesial line of the upper part of the thorax, to about two inches beyond the costal cartilages of the sternum to the right axilla—all the space about ten inches long and eight broad-being painless and dead, were detached with scissors; the sponging of the putrid sore at the angle of the lower jaw with tepid water, and carrying away from behind the integuments a large quantity of thick, greyishbrown, flocculent and decomposed fibrous tissue downwards, gave evidence of there having been established a subintegumentary communication between the uppermost putrid sore at the angle of the jaw and the lowermost one below the nipple.

May 6th. At 8, P. M., my friend, Dr. Russell, was just on the road with me to see my patient, when we met a skilful and friendly surgeon, who was anxious to see what the case was like, he went with us about two miles distant. The case was desperate the edges of the mortified mamma bled much when examined; linseed poultices, recommended by the surgeon, were intolerable to her during the night; they were replaced by water dressings, and Arsenicum was continued.

May 7th. Mrs. P. was removed to a large drawing room, and I saw Mr. Syme regarding her, but having received no satisfactory answer as to the surgical part of the case, I saw next morning Professor Miller; at 10, A. M., he was on the spot, and was struck with horror at the extent of the breach of texture, almost irreparable, and recommended a solution of Chloride of soda for

external use, to modify the stinking exhalations from the mass of putrefaction. Pulse 120, weak; voice tremulous.

May 8th. The black, hardened portion of the gangrene, the size of a hen's egg, and formed at the outer side of the nipple of the mamma, detached itself into the basin during the dressing, was still painful; pulse 108, soft, intermittent; her jaws more open, and she liked cream. Cont. Ars.

May 9th. Perspired last night; begged to have Chloroform * during the dressing of the sore; was also raised out of a half recumbent posture, and a large quantity of yellow, thick inoffensive pus was discharged from behind the integuments of the right pectoral region, they having been undermined with the decayed fibrous tissue to the extent of four or more inches round the edges of the separation of the sloughed integuments. Water for dressing and cleaning the sore and the undermined portions round it was substituted henceforth by warm sweet milk, and the sponge by a glass syringe. Great relief followed this. Pulse 104; she fell asleep, and took chicken soup afterwards.

May 12th. Not a vestige of gangrene remained in the mamma after the dressing; the milk injected below the integuments raised them uniformly towards the right shoulder, as far nearly as the acromion of that joint; it was injected twice a-day, and it always carried down a large quantity of yellow flocculent pus; the dressings were loose, and granulations healthy.

May 17th. Perspired last night; pulse 84, soft and full; dressings loose; the pus thick, yellow; the whole surface of the sore is ragged, and studded as if with warty excrescences-all covered over with a thick whitish fibre-like lymph; dressings changed twice a-day; the edge of the sore below the axilla irritable, painful, and studded with greyish-ash coloured spots, like aphtha; to prevent them turning black they were syringed with Arsenical solution; was much easier; took animal soup.

May 18th. Less pain in dressing; pulse 76; Ars. to be continued. I was summoned at 7, P. M. Mrs. P. was threatened with miscarriage; pained in the left infra-umbilical region of her abdomen, and synchronously with pain in her back; there

*Vomiting followed the administration of the Chloroform, and the result was the rupture of some denuded vessels and consequent severe hæmorrhage.

was strange pulsation to the left of the umbilicus, synchronous with the maternal heart's action, and increased with the agitations and strange movements of the fœtus; pulse 120; breathing hurried; breath fetid; was thirsty.

Aconite 3, and warm water enema.

May 19th. Vomited a quantity of greenish bitter liquid at 5, A. M.; slept well since; perspired; pulse 96; tongue white, clammy.

Mercurius solubilis and farinaceous food.

May 20th.

Better; pulse 80, weak; looks exhausted; Ars. Went on afterwards improving; was frequently on the sofa, and the sore began to contract in size from the bottom of the mamma till the 15th of June, when the originally affected portion of the neck became erysipelatous again in the afternoon, and the next morning the erysipelas extended over the whole thorax, anteriorly, and from the right infra-clavicular region was creeping over the right mamma; it was dusted over with flour; she had also diarrhoea last night, of greenish liquid stools; the pulse 130; dry, hot skin, and very thirsty; the jaws which could be open yesterday to half an inch, were more shut and stiff this morning.

Aconite and Belladonna, and whey for drink.

June 16th. Pulse 116; the scarlet rash extending over the left cheek, and the left ear.

June 17th.

Continue Acon. and Bellad.

Was slightly delirious last night, but perspired profusely in the morning, and slept well since; pulse 100,

June 18th. The red rash is fading on the chest, disappearing from the right mamma; the discharge of yellowish brown and offensive purulent matter from beneath the integuments of the left cervical region was enormous. Arsenicum.

June 19th. The erysipelas extended over the scalp of the occiput, which was sore to touch; was muttering a little last night; the purulent discharge is copious and less offensive; pulse 100.

June 20th. The skin of the chest and round the sore is VOL. X, NO. XXXIX.-JANUARY, 1852.

natural; the cheeks and the eyelids of both eyes and of the left ear still swelled, but paler.

Acon. and Bellad.

June 21st. Perspired last night; pulse 96; the purulent discharge was thick and abundant. Merc. sol. 6.

June 23rd. Soreness of the scalp alone; is able to be on the sofa again; pulse 80; and hungry. Arsen. 6.

June 26th. Reappearance of erysipelas round the left mamma; pulse 112; thirsty.

Acon. and Bellad.

June 27th. Was delivered at 5, A. M. of a living female infant; small, and with wrinkled loose skin and sallow complexion; at 6, P. M. was doing well; slept and perspired; pulse 80.

June 28th. Was anxious to nurse, though she had but one breast; the child was applied to it: went on nursing herself with the right breast for a week; the child was not thriving; a wet-nurse was procured for the child, and the mother began to recover her strength rapidly; the sore, from the depth of almost bare ribs, began to rise; the filling up process was rapid and exuberant; but the extent of the breach, which was filling up with an exceedingly slender and jelly-like muscular substance, devoid of its energy and fibres, and the process of adhesion that was slowly going on between the sound but loose portions of the integuments round and between their subjacent textures, were preventing the healing of the sore being accomplished by cicatrization-moreover, it was not desirable for the patient to have her neck crooked, and her head remain drawn to the left shoulder, a position not so much acquired by habit during her illness, as rather a result of the contraction of the left cervical and submaxillary regions during the process of destruction of the sterno-cleido-mastoideus and surrounding textures, and of subsequent reparation. In the middle of August she went for three months to the country. The contraction of the whole sore went on steadily without the least disposition to cicatrize; the edges of the lower and longer portion of it had nearly approached and nearly united together, when scarlet-fever visited Mrs. P.'s children on the 24th September, during the existence of which in her house the sore over her breast got larger, its edges became

Prophylactic Power of Belladonna in Scarlet fever. 147

more widely separated from each other, as if from relaxation of the whole system, and Mrs. P. had another and the last attack of erysipelas in her face, neck, and round the sore; and in the middle of October the discharge from the neck was brownish and offensive. Arsenicum to be continued three times a-day. From the beginning of November, and after she returned home, her general health got rapidly restored, and the sore nearly gone; it disappeared by gradual approximation of the edges towards each other, and absorption of the folds between them, so as to leave no puckering-in of the skin; there is only an irregular florid mark left, about an inch and a half on the integuments below the left clavicle, and a longitudinal furrow from it, traversing the breast towards the nipple. Neither distortion of the features, not of the neck, are now visible.

A CASE SHEWING THE PROPHYLACTIC POWER OF BELLADONNA IN SCARLET FEVER.

BY J. RUTHERFURD RUSSELL, M.D.

G. B., a fair haired somewhat flabby boy, two years and a half of age, was brought to me on the 22nd of September last. His mother said he had been delicate from his birth; for long his bowels had been alternately confined and relaxed; no worms had ever been seen; he had prolapsus ani always after stool. He was ordered four globules of the 15th dilution of Sulphura dose morning and evening for a week.

Sept. 29th. The report was, better. Urine thick; bowels loose; some small white worms have come away.

A dose of the 6th dilution of Merc. sol. night and morning, for a week, was ordered.

Oct. 13th. Better every way; stronger; sleeps well now; a few more worms have come away.

Repeat medicine.

Nov. 4th. Quite well every way.

On the 16th of the month he began to take Belladonna, about half a drop of the mother tincture in a day, in two doses. He took it for nine days when he stopped, from flushing of the face having come on.