TWO CASES OF SCARLATINA MALIGNA (HÆMORRHAGIC) CURED BY CROTALUS. Reported by JOHN W. HAYWARD, M.D. CASE 1.-Miss H-, æt. 9, was apparently quite well on the 5th of October, 1870, but in the evening she complained of sorethroat, with headache and dizziness. On examination the fauces and tonsils, especially the left one, were found dark red and swollen-cedematous. ordered every two hours. Bel. was The only exposure to infection that could be traced was that the cook was laid up with diphtheria; and the only traceable cause for that was that scarlatina was in the house of her family, and she had been there on Sunday, September 25th. During the night the patient was very restless and feverish, and retched a good deal, getting up some dirtylooking slimy mucus. At eight o'clock next morning she was found to be extremely weak and very tremulous; her pulse was 160; the skin was dry and burning hot, and there was some brownish miliary rash on the chest; the tongue was furred, the mouth dry; great thirst, but drinking only a little at a time, apparently because swallowing was painful; the fauces and tonsils were mottled with rather bright redness, and considerably swollen, as if with serous effusion into their structures, and there was a dark, dirty, sloughy appearance on the left one. Bel. and Rhus were now ordered every hour alternately, and a wet compress applied outside over the tonsils. In consultation, at 11.30 a.m., Dr. Drysdale diagnosed scarlatina maligna, and suggested Acon. instead of Rhus, to be alternated with the Bel.; these were given alternately every hour until evening. During the day she steadily grew worse; the pulse increased in frequency and feebleThere were extreme prostration and torpor, so that she lay apparently unconscious, except when roused by the retching of the brown, slimy mucus. The tonsils enlarged ness. rapidly, making considerable fulness at the angles of the jaw, and causing the head to be thrown up and backwards. Swallowing was very painful and difficult. In the evening of October 6th, that is, twenty-four hours after the beginning of the illness, as she was rapidly growing worse, Rhus and Merc. biniod. were substituted for the Acon. and Bel., and alternated every hour. During the night she continued to grow worse in every way; was extremely restless and uneasy, moaning constantly and attempting to turn about, but was apparently too prostrate to do so, and dirty mucus trickled from her mouth. In the morning of October 7th all the symptoms were worse; the throat was nearly closed, and she breathed with difficulty, with an occasional interruption as though from the swollen condition of the fauces; the fauces and tonsils appeared softened, jelly-like, and as if gangrenous, and the head was thrown upwards and backwards as far as possible. There was retching when anything was given by the mouth, even a teaspoonful of cold water would provoke it, and the matter brought up consisted of mucus reddened with the blood apparently oozing from the mucous membrane or resulting from the gangrenous state of the fauces, with some blood in streaks as if forced out by the retching. After retching she always fell back on to the pillow moaning, in a very weak and low voice, as though dying; she also sank down in the bed in a state of stupid lethargy like a dying typhus patient. The breathing was sighing, jerky, and intermittent, and there was loose, tickling, almost incessant cough, as though from trickling of the mucus into the larynx; the pulse could scarcely be felt; the rash was only faintly visible, and was brown and rough. Appreciating now the hæmorrhagic character of the attack Crotalus was (in the morning of October 7th) given internally, in the 4th attenuation, a drop in a teaspoonful of water dropped slowly into the mouth every half hour. Canth. p was also poured on the compress which was applied over the tonsils, in order to raise the cuticle, with the object of applying Crotalus to the denuded cutis. In the afternoon she appeared to be dying. The Canth. & having raised the cuticle round the throat this was removed, and the wet compress was sprinkled over with Crotalus, 3rd trituration; this was renewed after an hour, and then every three hours. There was no retching after the first application of the Crotalus to the denuded cutis; not even when beef-juice was administered, but the respiration and pulse remained much the same. In the evening as I sat by her bedside (for she was my daughter), expecting every moment to be her last, I noticed she gradually became less distressed; and during the night she dosed at intervals. Towards morning she really slept, and the breathing gradually became less laboured and less hurried and irregular; and on being roused for a dose of medicine she opened her eyes, and seeing me, she exclaimed: "Oh! Pa," as though surprised at my presence. By 8 a.m., October 8th, the pulse had fallen to 120, and could be distinctly felt; the respiration was becoming easy; the head was less thrown up; and the struggle appeared to be turning in her favour. The rash was now freely out on the body and legs, it was, however, of a purple colour. At his visit about 11.30 a.m., Dr. Drysdale was surprised at the alteration, and he gave a favourable prognosis. The same medicine was continued, now every two hours, and a simple water compress was kept to the throat. During the day of October 8th the rash gradually brightened in colour, and all the distressing symptoms receded rapidly, so that by evening she was able to drink with but little difficulty or pain; the respiration was almost normal, and the pulse was 100, and had gained some force and fulness. She slept well during the night, and the next day, that is, October 9th, her appetite began to return, and she looked wonderfully better; the change was really marvellous. From this date her recovery went on rapidly and steadily, the cuticle exfoliated rapidly, so that by the aid of vinegar baths and lard inunctions the skin was about natural on October 14th. She was attacked on the 5th, and nearly dead on the 7th under the treatment with Bel. Rhus, and Merc. bin. ; Crotalus was administered in the morning of the 7th, it rallied her almost immediately, and she recovered so rapidly that a confident prognosis was given on the morning of the 8th. CASE 2.-J. D. H-, æt. 13, brother of the above, began to complain on the fifth day after his sister, that is, October 10th. His attack began in the morning, and was marked by much the same symptoms as in his sister's case. He had Rhus every hour and a wet compress outside over the tonsils. There was at once great weakness, much dizziness, trembling, and staggering to falling before evening, and there were headache and nausea. The fauces and tonsils were dark red, and during the day they became tumid, and swallowing became painful and difficult. Pulse 130, small and soft. He had a restless, feverish night, with increase of all the symptoms, especially those of the throat; the prostration was extreme, and on blowing the nose it bled freely. The next morning, October 11th, that is, the morning of the second day of the illness, there was some brown miliary rash on the chest, and all the other symptoms were worse. Crotalus was now exhibited internally every hour, and Canth. 4 was poured on the wet compress round the throat. There was much hæmorrhage from the nose during the day, and reddish mucus hawked up from the fauces. In the evening he appeared much the same. The cuticle raised by the Canth. p was removed, and Crotalus 3rd trit. sprinkled on the compress as in the former case, and Crotalus 4 was continued internally. The epistaxis returned twice during the night. The next morning, October 12th, the rash was out well and the throat symptoms were diminished. He improved during the day, and had some sleep during the night. Next morning it was evident he was to recover. He made a like rapid progress with his sister, and was soon in fair health again. In this case, as in the former, Crotalus arrested the blood-poisoning almost immediately, and turned the scales in favour of the patient within a few hours. I am satisfied that the application of Crotalus to the denuded cutis had a considerable share in bringing about the recovery, and in such cases I am persuaded that it would be advisable, as suggested by Dr. Drysdale, to introduce the Crotalus subcutaneously in the second or first attenuation (vide Hahnemann Materia Medica, Article "Crotalus: Mode of Administration." 250 REVIEWS. Nitro-glycerine as a Remedy for Angina Pectoris. By WILLIAM MURRELL, M.D. London: Lewis, 1882. In this little monograph Dr. Murrell gives an account of the introduction of Nitro-glycerine into medicine which is singularly incorrect. He attributes its first notice and employment to Mr. Field, of Brighton, twenty-five years ago, whereas all who are familiar with homoeopathic literature are aware that the first to introduce it into medical practice was Dr. Hering, of Philadelphia, whose experiments were published in this journal thirty-four years ago, viz. in 1849, and that in 1853 some further observations were given also in this journal by Dr. Dudgeon. Since that time it has been extensively used in homoeopathic practice. So that it was not until nine years after it had become one of our common remedies that it was noticed by the old school. Dr. Murrell, who betrays on many occasions a considerable familiarity with the writings and remedies of our school, must have known perfectly well that the credit of its introduction into medical practice is due to us and not to Mr. Field, and it says little for his candour and sense of fairness that when giving a history of its medical use he omits all mention of the real source whence those of his own school derived their knowledge of it. In this, however, he acts only as is usual with the writers of his school. It was not until four or five years ago that Dr. Murrell determined to investigate the powers of Nitro-glycerine for himself. He prepared a one per-cent. alcoholic solution of it, and he found it to produce on himself the remarkable symptoms so well known to all who have tested its effects |