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nerves; the temperature rises, unrestrained by its regulating forces; the cerebrum runs riot in congestion with meaningless and unbalanced activity and babbling talk, or coma 'takes its place; involuntary evacuations occur, and flapping of the nostrils (untouched by lycopodium); finally exhausted nature ceases to struggle, as in cases of fatal' thermal fever.' Collapse (atelectsais) of the lung, is, I think, at least an occasional incident of these cases.

"Can any thing be done for such patients? Doubtful! Still we must try, and firstly, consider moschus. In old school practice it is held to be of high rank in febrile paralytic states, both algid and pyrexial With us it has been too little regarded. Dr. H. C. Wood has recently urged it upon the renewed attention of his own colleagues.',

Camphra and cuprum are in place when indicated.

The soreness of mouth and tongue are met by arum triphyllum. When there is ulceration of mouth, tongue, and nostrils, with acrid secretion, and after abuse of mercury, he recommends nitric acid.

For the various sequaelæ of ears and kidneys, he offers for consideration, for the ears: merc., nitric acid, phos., rhus, and puls. For the kidneys apis., ars., merc., helonius.

In a report read before the Beech Fork Med. Society at Lebanon, Ky. (Med. Herald, Louisville, Ky., Dec. 1886), Dr. R. D. Knott gives an account of an epidemic of scarlatina which occurred in his vicinity during the spring and summer of 1885.

The number of victims was from seventy-five to one hundred. No deaths resulted either from the primary fever or from the sequelæ. It was contagious in a marked degree, as few, if any, children escaped an attack after being exposed to the infection.

Many cases were so mild as to call for no medical treatment throughout the duration of the attack, hygienic restrictions and confinement to the room being all that was necessary.

The disease selected children of all ages and young adults for its victims.

Dr. K. dwells more particularly upon the treatment employed than upon the manifestations peculiar to this special epidemic.

The angina, which was nearly always present, he treated with hot water applied externally to the neck by means of flannel, and used as a gargle by older children. To this was sometimes added carbolic acid or listerine. When there was ulceration or sloughing of the tonsils, a powder composed of equal parts of pulv. sulphur, oxide zinc, and borate of soda was used with powder-blower or poured to the throat. In deep ulcerations, accompanied by great pain, he found the subnit. bismuth, applied in the same manner, afforded great relief.

For joint pains, simulating rheumatism, the salicylate of soda was given from the beginning until the period of desquamation.

Sulphate of quinine, in doses of seven or eight grains, was given to children of nine or ten years of age to reduce the temperature, but he found more satisfactory results from cold water baths and sponging with cold water. The results were not permanent, however, and the bath had to be repeated in from one to six hours.

The sequela, general anasarca, and renal complications were successfully combated with warm baths and digitalis.

Much has been said and written about the application of cold water by means of the pack, douche and bath, in the treatment of exanthematous diseases.

It would be gratifying to learn by what means the parents' objections to this mode of procedure are overcome, as well as how to quiet the resistance which is likely to be offered by the little patients themselves. 23 Smith St., BROOKLYN.

A

ROTHELN.

BY B. F. UNDERWOOD, M. D.

CCORDING to the text books, Rotheln, or as it is more commonly called, French or German measles, is a disease of comparatively small importance. "Rotheln is a contagious eruptive disease of benign nature, occurring epidemically, and bearing a close resemblance to mild forms of measles and scarlatina."-Meigs and Pepper. Dr. J. Lewis Smith also speaks of it as a mild disease, and says, "The prognosis in uncomplicated cases is always very favorable, and there is no liability to sequelæ more than in mild catarrhal inflammations of a non specific character." ("Diseases of Children.") In Strumpell's Text Book, the disease receives scant courtesy and is dismissed with but little more than a half a page of description, although he says, "The constitutional disturbance is generally so slight that the child can hardly be kept in bed. Important complications hardly ever occur. The prognosis is therefore perfectly favorable, and the employment of any special treatment is needless." In Arndt's "System of Medicine," Winterburn says of Rotheln, "that it is not a fatal disorder," and again, "As there are no fatal cases of rotheln." Quotations bearing testimony to the slight importance of the disease might be multiplied indefinitely, but from a recent experience with this disorder I am convinced that it is, either not always correctly diagnosed, or it is sometimes a much more serious disease than the above quotations would

indicate, assuming at times, even a malignant form. In a case recently seen, the attack was ushered in with chill, fever and sore throat, which was rapidly followed by the development of membranous patches upon the throat, hoarse cough and voice. When I first saw the cases these symptoms were present with the addition of fever, a pulse of 160. The throat symptoms yielded somewhat to treatment, but on the second day of my attendance, and the fourth day of the disease a rash appeared, resembling measles, which ran a regular course, the other symptoms gradually subsiding, although the pulse remained at 160 for nearly a week. With the disappearance of the rash the eyes became affected, inflamed and very sensitive to light, which symptom yielded very slowly to treatment and lasted for about ten days. In a second case, mother of the above patient, the disease was ushered in with neuralgia of the face which was followed by fever, a pulse of 140, and the appearance of an eruption on the face. This came out so thickly that the face was completely covered, not the smallest spot of the cutaneous surface being free, while the face was so swollen as to almost lose the semblance of a human face. With this there was a dry, hard cough which was so frequent and so hard, as to prevent any sleep or rest. The voice was almost lost in a kind of a squeal. The eyes were inflamed and swollen and were not able to bear any light for about a week. The rash extended gradually downward, covering the body and limbs as thickly as it had the face. For two days this patient was in a very dangerous condition and did not fully recover from the attack for a month. With the disappearance of the rash, a diarrhoea came on, of a light, watery, very offensive, frequent stool, with nearly constant abdominal pain. This diarrhoea was present in all cases, but in the last mentioned case it was increased to an actual inflammation of the bowels.

The diagnosis in the earliest of. these cases lay between rotheln and measles. In favor of the former was the character of the rash, the severity of the symptoms, the cough and bronchial symptoms. As against it, the fact that those affected had previously had the measles, that in one case the rash was more of the character of an evenly diffused redness, the absence of the usual catarrhal symptoms of the initial stage of measles, that the inflammation of the eyes followed the disappearance of the rash, and finally that in other cases where the symptoms were unmistakably those of rotheln, the disease was attended with the same complications. Winterburn mentions as a distinguishing sign from small-pox the absence of the peculiar, sickly odor of that disease, but in several of these cases a marked disagreeable odor was present. He also gives as diagnostic symptoms of rotheln, ". . The uniformly mild course of the disease,

the absence of the cough and marked coryza, the roundish spots of the eruption, which do not tend to run together into crescentic patches, the state of the bodily temperature before, during, and after the eruption, and the freedom from bronchial and laryngeal symptoms," all of which distinguishing marks were conspicuous by their absence. A severe and obstinate complication, or rather sequelæ, in these cases was the diarrhoea. The objection may be made that the diagnosis in these cases was not correct and that the disease was not rotheln, but the fact remains, that in cases where the diagnosis could be readily made the same complications and sequelae were present.

In the International Journal of Medical Science for January, Dr. Atkinson communicates the results of a special study of this disease. He defines rotheln, or as he thinks it should be called, rubella, as a specific, exanthematic, contagious disorder characterized by a period of incubation, lasting usually from two to three weeks; a prodromal period varying from a scarcely appreciable interval to one day, less commonly two, and very rarely several days; and an eruptive period in which there is an exanthem closely resembling that of measles; there is very rarely any desquamation after the rash."

There is, as may be seen from these extracts, a wide divergence of opinion on many points concerning this disease; thus Atkinson says there is very rarely any desquamation, while Meigs speaks of desquamation as frequent, and Winterburn refers to it as if it were constant. The latter also describes the rash as "never fully developed all over the body at the same time. No matter on what part of the surface it begins its invasion, it proceeds so sedately in its march from part to part, that the earlier macules have lived their life and departed, leaving nothing but a staining of the skin to show where they have been, before the later ones appear. As each macule remains visible only from three to twelve hours, if the first spots are upon the face, these will be quite gone thirty or forty hours before the development of the rash upon the thighs." This is not mentioned by any other author and is directly contrary to my own experience.

The point I desire to make is, that from a comparison of these authors it is evident that the disease is not yet thoroughly understood, and that it may be a much more serious disorder than is generally believed. In serious cases it is quite possible for rotheln to be diagnosed as scarlatina or measles, in one recent case the resemblance to scarlet fever being very strong. This being the case, a careful clinical study of the disease by those having the opportunity will amply repay the time expended.

ABSTRACTS.

APHORISMS On The Diseases Of Children.-In General.1. Diseases of children resemble those of the adult in location and name, but differ greatly in form, development, reaction and termination.

2. Age expresses the quantity and quality of vital force, as the figures on a dial indicate morn, high noon and declining day.

3. Before attaining an independent existence, the new born child must finish at the breast an existence, the first half of which has been passed in the womb of its mother.

4. New born children have but little power to resist external influences, consequently a quarter of them die before the end of the first year.

5. New born children may have at birth latent diseases, which do not develop for several days, weeks, or even years. These are hereditary diseases.

6. New born children, and infants at the breast, are in a condition certainly favorable to the development of certain diseases, especially ophthalmia, croup, eclampsia, diarrhoea, eruptive fevers, etc.

7. Disease is simply transformed impressions that is the manifestation in the body of external influences, acting upon the body.

8. During the first infancy, organic lesions are less frequently inflammatory than in the second infancy; suppuration of the tissues is less common, but more malignant.

9. Subacute and chronic forms of disease are less common in the infant than in the adult.

10. During the first infancy there is no absolute relation of the organic lesions and the intensity of the symptoms.

11. High fever, accompanied with restlessness, cries and convulsions, may disappear within twenty-four hours, leaving no traces or after effects.

12. The diseases of infancy usually present externally a series of symptoms sufficiently characteristic for their diagnosis.

13. During infancy, a yellowish tinge of the skin, sclerotic and base of the tongue, always indicates disease of the liver.

14. Sudden and rapid blanching of the face and lips, with deeply sunken eyes, is always a sign of grave and intestinal disorder.

15. Cyanosis, unaccompanied with fever, is symptomatic of heart disease, or the persistence of the foramen ovale.

16. Cyanosis, accompanied by fever and loss of sensation, is a sign of asphyxia, due to croup or bronchitis.

17. Sudden, momentary, and intermittent flushes of the face, accompanied with fever, is a sign of acute cerebral disease.

18. Alteration of the features by paralysis, successively of the eyelids, the nose, and muscles of the face, with or without strabismus, indicates an affection of the brain, sometimes only of the facial nerve.

19. Distortion of the features by great disproportion of the face and cranium is indicative of chronic hydrocephalus.

20. An infant with fever whose nostrils dilate and contract visibly at each respiration, is affected with acute pneumonia.

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