Compiled by R. LUDLAM, M. D., Secretary.

XXIV. Hemorrhage as a sequel to Scarlatina.-In lieu of the regular Essay, DR. LUDLAM read notes of the following case:-

Willie S.-, aet four years, was to all appearance convalescent from an attack of Scarlatina Maligna; the worst remaining features of his case being a general debility, typhoid in character, with a tumor on the left side of the neck involving both the tonsil and the sub-maxillary glands of that side and their more immediate neighborhood. This tumor was very large, of rather slow growth, and did not form until subsequent to the suppuration and discharge of pus from the tonsils into the throat, internally. For reasons which will readily occur to the Members, I did not lance the abscess, but kept it soft and warm with emmollients. On the tenth day from the date of the eruption, this latter having had its usual course and disappeared without any untoward symptoms, it discharged spontaneously, a large quantity of pus and then of serum, escaping from the orifice. This orifice, from occupying a fold of skin along the surface, became a very large one, running in the direction of the pomum Adami. The serum secreted was very acrid in nature, and the slough, which had commenced forming before the bursting of the abscess, gave to the edges of the sore a red or livid hue. The erysipelatous complication of which Dr. Gregory speaks, was not present in this case.

Three nights after the spontaneous discharge recorded, I was hurriedly called to this patient, and who, the messenger said, was bleeding to death, and would not in all probability, live until my arrival. I found him bathed in blood from head to foot. The coagulae, from bright arterial blood, were numerous, but not of firm consistence. The hemorrhage had ceased before I came, in consequence of coagula about the orifice. The father had wakened from a sound sleep, the first he had enjoyed for a fortnight, and found the child's clothes covered with blood, the little fellow quite unconscious, the blood spouting with every pulsation from the wound in the neck, breathing stertorously, and exhibiting no particular signs of pain or uneasiness. Being an intelligent German, and happy in expediency, he had seized hold of a piece of schwamm- the inner coating of an old wine-cask, bound it over the wound and thus arrested the hemorrhage.

Excessive prostration followed, and the desquamation then going on, was accompanied by extreme debility, from which the patient never rallied. Six hours after the first hemorrhage he had a second, but less frightful and copious one. Then followed vomiting of a dark matter, looking greatly like venous blood; frequent stools of a similar character; the urine contained the same in solution; while from the ears and the nose there oozed almost constantly a dark-colored and fetid discharge, composed principally of the same elements.

At this stage a marked peculiarity exhibited itself:-the whole surface of the body successively, looked as though the eruptive stage had again set in; and, to the eye of one unacquainted with the fact that this had already been experienced, appearances would certainly have indicated the date of the legitimate, primitive eruption. In about ten hours more, however, there was a pretty general extravasation of blood beneath the cuticle, and every symptom of Purpura Hemorrhagica was presented, which state continued so long as the little patient lived. Death occurred about forth-eight hours subsequent to the first outbreak of the hemorrhage. His mind was clear to the last, and he drank enormous quantities of water almost greedily, and with much the same result as patients sometimes do when ill with the Asiatic Cholera.

The remedies administered against the exigencies of the case, were Arsenicum, Nitric Acid, and Carbonate of Ammonia, each of which were employed in either the second trituration or attenuation; while the hamamelis virg. was applied locally to the more immediate seat of hemorrhage. Beside these, he was allowed to drink large quantities of water acidulated with the juice of sour oranges; and ordered a nourishing diet of mutton soup, etc. But Medical treatment was necessarily of very slight avail, and I am led to record the case simply on account of its being an infrequent one; and also as showing the terrible effects of this particular poison in breaking down and dissolving the crasis of the blood.

XXV. Neuralgia.-Case reported by DR. D. A. COLTON.

Feb. 3d, 1858. I was called some sixty miles into the country to see Mrs. K., a woman aged 45, the mother of ten children, of nervo-bilious temperament, good form and active life. Inherited a good constitution and, with the exception of occasional slight rheumatic attacks, she had enjoyed good health until six years since, when she was troubled with faintness at the stomach which was succeeded by paroxysms of severe pain. At first these paroxysms lasted but a few minutes, and occurred once in three or four weeks, during some four of the colder months of the year, but latterly they had increased in frequency, occurring sometimes every twenty-four hours, and lasting from one to three hours. Pain, commencing at the stomach would soon extend round the right side to the back, and finally over the whole chest and a portion of the abdomen. The pain was of a pressing character, so severe as to nearly stop the breath, and caused so much tenderness over the region of the stomach as to forbid the touch. Neither could she lie down, but had to walk the house, or stand leaning against something. The paroxysms had generally been relieved by vomiting, and she had been in the habit of taking Ipecacuanha to hasten its recurrence. The ejected matters were the watery contents of the stomach, with an occasional mixture of bile. Had never suffered from eating anything except buckwheat cakes. Usually had a good appetite, but latterly, having dieted on Graham bread, toast, etc., to the exclusion of meats, a disgust for food was felt. Never had headache-between paroxysms, pulse normal.

Prescribed a mixed diet, such as to suit the appetite, also Arsenicum 2., alternately with Belladonna 3. at intervals of four hours. Nux vomica 3. one night only.

Feb. 7. Received report by mail that patient had a severe paroxysm the 4th, but none on the 5th; perspired freely the night of the 5th. The color of urine when first voided, like brandy; after standing for two hours, red like blood. Skin slightly yellow.

Feb. 8th. Mailed her Ars. 2., and Puls. 3.; the former to be taken the middle of the A. M., and middle of P. M.; the latter morning and night.

On the 10th, learning the paroxysms had been severe the last two days, the skin, white of the eyes and urine quite yellow, I mailed Bell. 3., and Ars. 2., to be taken alternately at intervals of three hours during the day, and Nux vomica. at night.

For the week ending the 17th there had been no occurrence of a paroxysm. Continued Ars. three times a day, and Sulph. 6 at bed-time.

March 1st Patient had but one paroxysm since previous writing; wanted strength, experienced no inconvenience from food, except it were taken when tired from over-exertion. Prescription, Verat-alb. 3. three times a day; Nux vomica 3. at night.

5th. Received note stating recurrence of old form of paroxysms. Returned to Ars. 2., and Bell. 3., with marked benefit.

Patient continued comfortable, attending to her household affairs until the fall, when the paroxysms returned, but with subdued intensity. For these Ars. 2., Bell. 3., and Arnica 3. were administered with gratifying results. Three or four other remedies than those named were administered from time to time, but from none did there appear to be so prompt and lasting benefit as from the last three remedies. The case was clearly Neuralgic supervening upon a rheumatic diathesis, and to be treated with reference to its periodicity.

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