may be nearly but not quite vesicles. I think it practically useless to speak of varicella prurigo, or, indeed, of persisting or relapsing varicella.

The modified small-pox eruption is usually preceded for three days by severe symptoms-fever, pain in the small of the back and vomiting. The onset of varicella is far less severe, and the eruption appears as small, not shotty papules that usually vesiculate within six hours. Successive crops of vesicles appear for several days together. The disease lasts about ten days. The patients must not mix with other children. Two weeks should elapse before the practitioner can say that others have not taken the complaint. No medicines are required ordinarily. The fever hardly needs notice, though the temperature must always be taken; at the end of the disease the temperature of the body has a tendency to be lower than natural.

After the complaint has disappeared a change of air to the seaside may be recommended, especially if the patient come of a scrofulous stock. A few minims of the fluid extract and zii. of infusion of cinchona with some glycerine t.d.s. is the best tonic.

Ointments may be used to prevent itching and remove scabs vaseline, zinc ointment, &c.

A few grains of citrate of potash, or small doses of liquor ammoniæ acetatis, or bitartrate imperial (bitartrate of potash zii. to Oi. water sweetened with sugar and cinnamon water) may be given as a diaphoretic and diuretic, and the last may perhaps open the bowels. A little jalapine, gr. ii. in a pillule or a dose of fluid magnesia sweetened with syrup of orange, may be given as an aperient.

EPIDEMIC CEREBRO-SPINAL MENINGITIS.

This is a rare disease in this country; but young males are prone to be affected. It is a meningitis of sudden onset.

Its chief symptoms are retraction of the head, severe headache, vomiting, slow pulse, but liable to sudden variations, tetanic spasms of the whole body, local spasms of the face and neck, either of a discontinuous (clonic) or continuous (tonic) character, and local paralyses. In some epidemics purpuric blotches appear in the skin of the trunk and limbs. Experimental irritation of the pons Varolii has caused general purpura. Herpes about the lips and face is a frequent eruption. The temperature is usually low.

It can hardly be mistaken for any other affection. Tubercular and simple meningitis are causes of retraction of the head, but seldom begin as abruptly as the simple epidemic cerebro-spinal meningitis. Otitis sometimes has a likeness to cerebro-spinal meningitis, and retraction of the head may be marked with it; but otorrhoea is usually attended with complete relief; the crying of otitis is very continuous (see p. 461).

Of the treatment of epidemic cerebro-spinal meningitis I know nothing personally. Faulty hygiene should be remedied. Hypodermic injections of morphia, grain for a boy ten years old, repeated if necessary; large doses of bromide of potassium, gr. x. three times a day; chloral hydrate, gr. ii. every four hours, carefully watched for signs of coldness of surface and depression of heart; leeches behind the ears; spinal ice bag; hot fomentations to back of neck -have been recommended. Any persistent paralysis, should recovery ensue, may be treated by moderate doses of iodide of potassium with a view to promoting absorption of the products of exudation. The instructions given at P. 459 may also prove valuable.