though nothing can be more judicious than Sydenham's prohibition of the heating and stimulating plan of treatment then in vogue, yet there are certain anomalous variola, in which the eruption is too slight and indolent; and then we must assist its development, as we may also when we wish to substitute an eruption on the extremities for one on the face.

As to the means of accomplishing the above ends, the authors do not approve of the administration of bleeding or emetico-cathartics in children, or of allowing them to rise from their beds while the fever is upon them, for the purpose of diminishing the amount of eruption, as recommended by Sydenham-this not being an object of the same consequence in the child as in the adult. In three instances, they tried the plan recommended by Eichorn, viz., vaccinating by 40 or 50 small incisions during the precur sory stage, or at the earliest period of the appearance of the eruption. In two of these the eruption became irregular and the children died. In the third, both eruptions proceeded simultaneously, and far more rapidly than usual. The cauterization of the individual pustules by a pencil of the nitrate of silver, is an infallible means of causing their abortion when. practised on the first or second day, although it frequently succeeds on the third, fourth, or even fifth day. "The inflammation as well as the pustule is cut short, at least this effect has never failed to follow our cauterizing the pustules at the edges of the eyelids. It seems incredible to behold how rapidiy the oedema of these parts then disappears." It is, however, difficult to apply the caustic individually in the confluent discase, and in any case produces great pain, so that the authors agree with M. Rayer that its employment must be confined to those parts where it is important to prevent cicatrices, and on which the eruption is discrete. There is another plan whose employment is easier and nowise painful, viz., the direct application of the emplastrum vigo cum mercuric to the pustules. It should be applied the first or second day, or not later than the third. To be of avail a well-applied mask must be kept in complete contact with the face until the eruption has terminated upon other parts of the body. To meet the difficulty of maintaining the due application of the plaster in children, the apothecary of the Hospital has invented the following pommade as a substitute: R. Mercur. oint. 24 parts, Yellow wax 10 parts, Black pitch 6 parts. M. The application sometimes induces an eruption of hydrargyria; but is effectual in arresting the eruption and preventing

scars.

We may observe that M. Goblin has published a paper in the "Revue Medicale," June 1845, in which he states, that a recent epidemic at Stains has given him the opportunity of observing the great benefit derived from the application of mercurial ointment, as recommended by him in 1834. Treating the premonitory stage in a manner so as not to check the deve lopment of the eruption, when this has appeared, he applies mercurial ointment, using it stronger and more frequently in proportion as the eruption has a tendency to become confluent. This arrests the progress of the pustule, and removes surrounding inflammation-the ointment being continued for several days. No salivation or other general symptom occurs, but a rapid disappearance of the eruption on the face takes place, leaving No. 109

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no disfiguring marks. Two practitioners who witnessed this treatment certify to its success.*

The Chapter on Scarlatina does not contain anything calling for particular notice; but we may extract some interesting observations from that devoted to

Rubeola.

Complications of Measles.-This is a very well-written section. Of all the complications that of Broncho-pneumonia is the most frequent. Thus in 167 cases of rubeola, MM. R. and B. observed 24 cases of bronchitis, several severe ones, 7 of pneumonia without bronchitis, and 58 of lobular broncho-pneumonia-several of the last, however, being slight. The bronchitis presents no special characters when occurring in measles, and dilatation of the bronchi has never been seen, unless the child had lived at least ten days after the occurrence of the inflammation. The pneumonia is almost always lobular, occupying both lungs to a greater or less extent -so that kernels of inflamed lung are found either isolated or united in every lobe-the posterior and inferior portions of the organ being those especially affected. Compared with pneumonia occurring under other circumstances, the formation of abscesses is very common in that of measles; nearly one-half the autopsies exhibiting these, and sometimes in large numbers. Broncho-pneumonia may arise at three periods of the disease,1, during the precursory stage and the earliest days of the eruption; 2, during the decrease of the eruption; and 3, during convalescence. It occurs more frequently during the first of these than during the other two put together. When the pneumonia occurs thus early, it deranges the progress of the eruption, so that it is in the anomalous form of rubeola that it is generally found. The pneumonia which comes on during convalescence may be independent of the rubeola, and separated from it by an interval of good health, and is then often lobar: but in other cases it has a direct connection with the febrile disease, or follows other complications, and is then lobular. Sometimes the pneumonia becomes very chronic, giving rise to the supposition of the existence of tubercle, until the autopsy exhibits but abscess of the lungs. Broncho-pneumonia is one of the most frequent causes of a fatal issue of the disease; for, while in simple rubeola a return to health is the general rule, hardly one out of four or five survives this complication, which is, however, often combined with others of a fatal character. Its occurrence in secondary and anormal rubeola is much more dangerous than in the primary disease. Its production seems often due to a sudden chilling of the surface, accompanied perhaps with a retrocession of the eruption. Pneumonia is most common in the younger children, while bronchitis, which is seldom dangerous, is found in the older

ones.

* Dr. Corrigan, in a recently-published lecture, speaks most highly, as a means of preventing future disfigurement, of the application of a compound, formed of lead plaster, melted with sufficient almond oil to allow of its being, when warmed, spread over the face by a pencil. It is allowed to dry, and the mask is retained until the scabs, detached by the new skin, gradually break it up and bring it

away.

Among the other complications a frequent one is Pharyngo-laryngitis. In the 167 cases there were observed 24 of pharyngitis, 19 of laryngitis, and 16 of pharyngo-laryngitis. The authors believe this great predominance of these pharyngeal affections to be due to the simultaneous prevalence of scarlatina epidemics, as they regard laryngitis as a more special complication of measles than pharyngitis. There are the same lesions observed as these diseases produce in other cases, those of laryngitis being more serious, although merely the spasmodic form of this is also 'sometimes observed. This complication generally shows itself about the third or fourth day of the eruption, and does not generally add much to the mortality of the disease.

Lesions of the Gastro-intestinal mucous membrane are next in frequency to the pulmonic inflammations. Purging and swelling of the abdomen, however, must only cause the presumption of the existence of inflamma. tory action; for the autopsy has sometimes found, in cases where they have been present, the canal healthy. Nevertheless, the condition of the measles bears some relation to the extent of the diarrhoea. The course of the eruption is however seldom modified, although the febrile action is sometimes increased. This inflammatory affection is generally found in the anomalous forms of rubeola, and is accompanied by some other complication. It may show itself at the very commencement of the eruption, or some time after it has ceased, being generally more severe in the latter case than in the former. It is rarely the sole cause of a bad prognostic, but adds infinitely to the danger of a broncho-pneumonia. Injudicious food, or too active employment of purgatives, especially in young children, who are most liable to it, may induce this complication.

Another not infrequent complication is Gangrene, the mouth being the part usually affected, and after it, the lungs. It occurs from the thirteenth to the thirtieth day, and is rather an effect of the other complications than a direct consequence of the eruptive fever. Of eleven cases only one recovered.

Measles may likewise become complicated with other eruptions; and thus the authors have seen scarlatina seven times, variolous eruption twelve times, and erysipelas three times in conjunction with it. Such complications render the rubeola anormal, and its diagnosis becomes very difficult, the symptoms of the co-existing diseases becoming mixed. "A very remarkable thing in these cases is, that the intensity of the complication is the inverse of that of the eruptions. Thus when the scarlatina predomi nates the bronchitis is most severe; but if the rubeola predominates the angina is most intense. This result, apparently so singular, is explained if we reflect that, in a great many cases, there exists a kind of balance between the phlegmasia of the skin and of the mucous membranes, so that if the one becomes diminished the other is increased; and thus the scarlatina, causing the disappearance of the rubeola, augments the gravity of the bronchitis."

The authors thus conclude their remarks on the complications:

"Until now we have only endeavoured to appreciate the separate influence of each complication, and it remains to consider them when united. It is rare in fact for a case of rubeola to become complicated with but one affection; for in general several co-exist or succeed each other, so that death results only from an uninter

rupted series of diseases. Broncho-pneumonia, pharyngo-laryngitis, and enterocolitis, are at once the most frequent complications of measles, and those which are most commonly found together. Broncho-pneumonia is as it were the centre around which the others are arranged. It is accompanied in fact almost as frequently by one as by the other, but the other two diseases are not often found together without a concomitant pneumonia.

"We have already stated the influence these complications have upon the progress of the rubeola, and that this becomes anomalous,-1. If a severe complication productive of febrile excitement is developed during the precursory stage or period of increase of rubeola. 2. If the rubeola appears during the course of another disease, or during the convalescence of a severe disease. *

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We have seen that complications occurring during the precursory stage prolong its duration and retard the appearance of the eruption; but when this shews itself, it will be irregular from its commencement, or will only become so one, two, or three days later, according to the epoch of the occurrence and increase of the pulmonary disease. Then, even, it will continue too pale, and will not take the coppery tint, or it will suddenly disappear between the second and third, or third and fourth day. The pulmonary inflammations, the most powerful of all in influencing the form of the eruption, are so, however, only when developed at its early stage, and before it has arrived at that stage in which it only disappears incompletely under pressure of the finger. It is seldom that the enterocolitis determines any variety in the course of the eruption.

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* Measles is considerably modified when it is developed during the course of another eruption, and that whether it comes on at the commencement of such disease, or after it is well established. In these cases its progress is more rapid, the period of decline becoming abridged, or altogether imperceptible, whether from its non-existence or its concealment by the other eruption. Lastly, the rubeola becomes anomalous when it appears during a severe disease which has deteriorated the constitution, after which some time is required before the child can recover its habitual health, as in the convalescence of severe variola, scarlatina, or pneumonia. It is the same if the rubeola arises during the course of a slow disease which debilitates the child, as chronic enteritis, or tuberculization. In all these cases it participates in the blanching of the patient: pale, shrunken, and small in quantity, the eruption rapidly disappears. Sometimes it slightly re-appears in a few days, and constantly hastens the fatal termination."

Influence of Measles upon Diseases in the course of which it appears.— It generally hastens the progress of these or provokes a relapse, when the affection is among those which habitually complicate it. But if it is not so, the measles may arrest it, render it regular, or even cure it. Thus it almost inevitably aggravates a pneumonia or tubercular disease; but under its influence a chorea, or anasarca after scarlatina, has been cured. In reference to its influence on Tubercles we have some useful remarks.

"This question is important, because its answer is contrary to the assertions we have made respecting the relations of tuberculization with the other eruptive fevers. Thus, we have seen that typhoid fever, variola, and scarlatina repel tuberculization, and we have sought our proof in the following facts-1. These affections do not engender tubercles. 2. They rarely attak tuberculous individuals, especially those in whom the cachexia has manifested itself. 3. They seem to exercise a favorable influence upon the tubercle by causing it to pass into the cretaceous state. We believe rubeola obeys quite a contrary law, and have shewn that it is the origin of tuberculization in a considerable number of cases. Te may add that it is not uncommon to see it developed in phthisical children.

We believe then that rubeola assists the development of new tubercles, accelerates the progress of those which are already deposited, and exerts no influence in causing them to pass into the cretaceous state."

M. Bouchut, speaking of younger infants, states the case as strongly.

"How many times have we seen, after this disease, pulmonary tubercles form in subjects who did not appear predisposed to them! How many times have we seen under this influence the tubercular affection, latent in the child, acquire a new force, and manifest itself with an unexpected rapidity! It is the fact that rubeola exercises a veritable power in the development of pulmonary tubercle, and much accelerates the progress of this affection in children who are its subjects."

Prognosis.-This is favourable when the disease is primary and the cursory symptoms do not continue longer than from two to four days. When the eruption commencing in the face gradually extends itself over the entire body; and the concomitant inflammation of the mucous membranes is not intense. When the febrile re-action is moderate. When the eruption increases during one or two days and then gradually declines, the fever, cough, &c., also diminishing and disappearing. When the child in losing its rubeolic aspect does not become excessively pale. When it asks for food, wishes to rise or play, or notices objects, &c. When the sleep is sound and natural. It is unfavourable when the precursory symptoms continue more than four days, and are accompanied with severe symptoms, as oppression, epistaxis, &c. When the eruption follows an anormal course, even when none of these anomalies have existed and the child has gone on well until the decline of the eruption, we must still fear complications and their consequences when the face continues red and flushed, or, on the other hand extremely pale; when the cough, dyspnoea, purging, &c., continue; if the nights are sleepless, and the child is dull, listless, and without appetite.

M. Bouchut quotes the following passage from that experienced observer M. Trousseau :

"It is a very prevalent prejudice among physicians, and especially in families, that rubeola and scarlatina are least dangerous when the eruption is most confluent. It is highly important to proclaim this a great and fatal error, for the influence of such a form of eruption is as hurtful as it is in small-pox. In this respect all our little patients (he is speaking of those in the epidemic presently alluded to) followed the general rule. All those in whom the eruption was discrete got well without difficulty. Three of those in whom it was confluent suffered from severe pneumonia ; and what I observed in this little epidemic, affecting only one of my wards, I also observed in my private practice. It is especially however in scarlatina that this is evident; for while those cases in which the eruption shows itself chiefly in the throat and but little in the skin, are of slight gravity, those in which it manifests a bright colour and great tumefaction of the integuments, are as destructive as the most confluent small-pox."

Incubation of Rubeola.-The period of this has been very differently stated, by different authors. Of 38 patients who remained in the wards, the duration of the residence of whom prior to the appearance of measles was noted, in four instances the eruption appeared in from 4 to 5 days, in eight from 9 to 13 days, in twenty from 15 to 25 days, and in six from 28 to 58 days.