measure to the medicine, although this was selected in accordance only with the concomitant symptoms of the malady, viz., with the constipation and the itching of the skin.

Purpura hæmorrhagica.

J. O—, engineer's assistant, æt. 30, admitted September 28th, 1869, suffering with hæmorrhagic troubles. Has generally enjoyed good health, but seven years ago was laid up with acute rheumatism, from which he recovered without any ill consequences remaining perceptible to himself. Is on admission rather thin, and is very weak with an anxious, worn expression of countenance. Appetite generally very moderate, has been not so good of late. Has eaten a good deal of fish, especially fresh fish; does not ever eat much fresh vegetables, and has of late taken less than usual. Seven months ago had a severe attack of epistaxis, and at the same time coughed up a considerable quantity of darkcoloured clotted blood, followed in fourteen days by some red spots on the hands and wrists of the size of flea-bites; these gradually extended to the arms, and thence to the trunk, while he became very much out of health and very weak. Cannot give any account of the treatment which was then employed. He recovered, however, but has ever since been troubled with occasional attacks of epistaxis. Seven weeks ago had a severe attack of diarrhoea which lasted two days, and during which he passed a large quantity of (florid ?) blood with the stools. Has remained very weak ever since, and the present eruption began to make its appearance almost immediately after. There are

a great number of purpuric spots over the legs and arms and a few on the trunk; they vary from the size of a mere point to that of a split pea, and a few which are even larger appear to have arisen from the coalescence of some of the latter. He has also here and there some ecchymoses which seem to have occurred from very trivial causes. He complains of aching in the limbs and of being very easily fatigued. Sleep not good, being much broken, and not refreshing.

The gums show no signs of hæmorrhage at present. Tongue clean; appetite moderately good; complains of constant thirst; bowels regular, urine rather pale coloured. There is slight tenderness noticed on pressure over the lumbar regions. The hepatic dulness normal, splenic ditto. Respiratory sounds good; heart sounds normal. Complains of dyspnoea on ascending stairs or with a very moderate amount of exertion. Spirits are very much depressed.

On admission he was put under the influence of Arsenicum 3, a drop to be taken three times a day. He was put upon the first diet with two ounces of lemon juice and a pint of beer per diem.

On October 5th he complained of a good deal of heat and soreness about the principal seats of the purpuric spots, which latter, however, had been lessening slightly, and one of the legs looked much less intense in colour as a whole, but upon examining closely I found there was somewhat of a blush (erythematous) over the part where the eruption was thickest, and the patient was complaining of some headache, and had not slept so well the last night or two. Belladonna 3, two drops three times a day.

The

7th. The erythematous condition has subsided. purpura is lessening. Complains of feeling very weak; takes and enjoys his food, but is troubled with flatulence shortly after, with much abdominal rumbling. Under these circumstances he was put upon China 3*, two drops three times a day.

From this time the case continued steadily to improve; there was no return of the erythematous condition, while the purpura gradually subsided, and he was dismissed on the 22nd October cured.

Erythema nodosum.

The next case, that of M. A. G-, a housemaid, æt. 25, is characteristic, though considerably different from either of the others. She is a fair, thin-skinned, rather delicatelooking girl. Has been getting out of health for some months, feeling easily fatigued, languid, and mentally

up the

depressed. Has lately, for some weeks, though she seems very uncertain as to its duration, noticed an eruption which affects her principally on the extremities, but has lately affected the trunk also. It occurs at first in the shape of patches of about the size of a split pea or bean. They are slightly elevated, red in colour, and raised a little above the surrounding surface, and itch and burn like the sting or bite of an insect; do not disappear but become purplish in colour and are very slow in subsiding, the irritation ceasing long before the spot disappears; fresh ones making their appearance here and there to keep up the supply. She is unable to give any account of the reasons of her present illness. Has lived well, and appears to have kept balance between animal and vegetable food well. little out-door exercise. The countenance is pale, sallow, with dark marks under the eyes, and an anxious expression. The temperature is good. Pulse 74. Complains of general aching pains, which trouble her most when at rest, and especially at night. Has occasional headache affecting her in the morning, generally passing off after breakfast. The catamenia have not occurred for several months. Has palpitation of the heart, which she feels under any exertion. On auscultation the heart sounds are found to be natural, and the cardiac dulness within its natural limits. No cough, but is liable to colds, which generally eventuate in cough.

Has very

Was admitted on December 2nd, 1870, and had Arsenicum 3rd, drop three times a day. She was ordered first diet, to which was added in a day or two four ounces of port wine a day.

Under this treatment a certain amount of improvement occurred, though it was so slight that on December 14th I thought it well to try another dilution of Arsenicum, and ordered the 12th to be given three times a day. Under this the patient remained much the same, but on the 21st she was suffering much with headache, the head having a sense of fulness with heat, aggravated by movement. The catamenia occurring with pelvic pains and scanty discharge, &c., the house surgeon ordered Belladonna 1 to be taken

as frequently as required. On the 23rd the head was greatly relieved and the catamenial discharge had ceased, this having been its first appearance for several months. The eruption was much the same. She is complaining much of severe rheumatic pains which wander from limb to limb, and are most troublesome at night when warm in bed. These pains have been somewhat relieved by the limbs being bandaged tightly. The appetite continues very bad. The bowels are constipated. The urine normal. Tongue clean.

Rhus toxicodendron 6, a drop three times a day, was then ordered, and from that time a decided and speedy improvement set in. The eruption then apparent gradually faded away, while there was little or no fresh appearance of spots occurring. At the same time the general health rapidly improved. The appetite began to improve and the pains to subside, while the headache generally disappeared.

On January 1st I find reported" vertiginous on going out to-day." Some headache afterwards. "Appetite

good." The eruption improving.

3rd." Still improving." "Vertigo ceased." "No headache." Strength improving."

7th. She has been improving, but when going out yesterday seems to have taken cold. Nasal, fluent catarrh with some sneezing, and soreness of the margins of the nostrils. Mercurius 3 was given every four hours.

On the 8th, at her own request, she was dismissed "greatly relieved," to continue as an out-patient, the eruption having nearly disappeared, and being manifestly in rapid progress towards cure.

E. P, a servant, æt. 35, was admitted June 17th, 1871, giving the following history. Has generally had good health, but for the last two months, and more especially the last month, she has been feeling weak and poorly, while her appetite has been failing her. No special dyspeptic symptoms.

The first symptoms noticed were some unsteadiness in walking, staggering gait, vertigo, trembling of the legs, &c.

She gradually got worse until the 15th, when she found she could no longer stand on her feet on account of the pain and stiffness there and in all the joints of the legs. Upon examining the limbs she found the shins covered with an eruption of light red spots very sparsely scattered, aching and somewhat sore to touch. These were followed by others, and at present they are pretty thickly spread over the whole of the lower extremities where they appear to be still coming out. The spots vary somewhat in colour according to the length of time they have been out, fading under pressure, and the older ones being the darker. They are all slightly raised above the surrounding surface, and are sore to touch, especially those on the tibia. The bowels were sluggish, acting every or every other day; evacuations light coloured and scybalous. The urine natural, rather copious. She complains of frequent headache, frontal vertigo, and confusion of sight, especially in the open air, and on suddenly rising up to the standing position. Sleep has been disturbed and broken of late and full of unpleasant dreams, with difficulty in getting to sleep again. wrist 96, rather full but soft.

Pulse at

Aconite 1 was prescribed, a drop every three hours. First diet and beer, one pint a day, was ordered.

19th. Much the same, does not think many fresh spots have made their appearance since she came in. In other respects is very much the same.

BellaDiet the

She complains that beer does not agree with her. donna 1, a drop every three hours, was ordered. same except that she was to have claret živ in place of the beer.

21st.-Better decidedly. The pain in the joints much less; the spots not so red nor so tender. Head better, and slept better last night.

24th. Continuing to improve. Feels sure no more spots have appeared, and the limbs are altogether easier as well as the head. Appetite better than it has been for a long time.

28th. She was still further improved, and on July 3rd she was discharged quite cured.