the gangrene was concerned, and this healed in a few days, as only the outer skin and one nail was affected.

The feet grew rapidly worse. The line of demarcation encircled the ankles like a shoetop. Wherever the blisters broke the skin underneath appeared pale or light-green in color.

We had our hands full. The heart was feeble and rapid. The prostration was marked. Upon whatever portion of the body pressure was exercised, blood returned very slowly. When he laid on his side the under arm very quickly became ecchymosed and swelled, with a pearly-white appearance. He dreaded every movement, making it hard for us to turn him in bed.

The danger of bedsores was so great that he had to be turned. Strange to say the next appearance was not a bed sore. A patch of skin, beginning at the middle line of the sacrum extending to the left, started to gangrene. Then the bed sores began.

The skin over the crest of the left illium and above it turned dark. With it was a slight spot on the left shoulder. Then another on the inner aspect of the right knee followed suit. Then it stopped. He had the right side left and we eased him as much as possible in shifting him about on that side and padding it. Both hands and arms would swell when the body pressed upon the shoulder. The under side would remain pitted by the pressure. The smell of the gangrenous tissue was far from pleasant. Some of the Chinese assistants would wind their queues about their noses when attending him.

The feet grew worse and showed only one solution, that of amputation. The right foot just above the line of demarcation developed a fistula and poured forth pus, very evidently from the foot, as pressure in that direction would increase the amount. The other foot never discharged, although at a later period it showed evidences of pus.

The patch of gangrene over the sacrum was ultimately the cause of his death. It was four inches long by three wide, and over one inch deep. The slough was separated and a great ragged ulcer, still pouring forth pus, appeared to view.

The stomach pains lessened and the pains largely disappeared, except when the patient was shifted in position. He evidently was improving. It was likewise evident that he would lose both feet.

One Sunday evening, after he had been in the hospital about 20 days, the assistant came in hastily and announced his death. Our attention had not been especially drawn to him that day, as he seemed about the same. Hence his death was a surprise. Post mortems are not allowed in China and so we did not make an immediate examina

tion, thinking pyemia or septicemia to have been the cause of his death.

When, however, we came to prepare the body for burial the next morning, we found the dressings over the sacral ulcer soaked with blood. The ulcer had broken through the walls of an artery.

Raynaud's disease seems to be both uncommon and obscure as to origin. One author (Hyde) says: "There is a growing suspicion that many cases are of syphilitic origin." It sometimes succeeds tuberculosis, diphtheria, diabetes, and like diseases. The cause has also been traced to the eating of food made from wheat affected with ergot. The physiological action of the drug is very similar to the disease. Cases of poisoning from this drug have been reported in which all four extremities have been lost through the virulence of the drug. In the case cited the cause could be traced neither to a syphilitic or an ergot origin.

It seems to be due to a disturbance of the vaso-motor system. Local asphysia attends the gangrene. There is venous stasis and degeneration of the arteries may ensue. Where the line of demarcation readily forms, the prognosis is more favorable, but the degree of prostration and the extent of the lesions must be taken into consideration. The case cited was an extreme one.

Arsenic is the leading internal remedy. Tonics, electricity, fric-. tion with alcoholic preparations and heat applied to the affected parts are useful as adjuvants.

CASES: MUCOUS ENTERITIS AND HERPES ZOSTER.

By Josephine M. Danforth, M. D., Cleveland, Ohio.

The case of mucous enteritis which I have to report is interesting to me because of the length of time it was under my observation; its complication during that time with typhoid; the fact that at several times the child seemed about cured when the mucous condition would again develop, until at last it became so aggravated that we feared it was of a tubercular nature; and finally, at the eleventh hour, restoration to health by means of the meat and hot water, or Salisbury Treatment.

It was in April, 1901, that the child, a boy of 5 years, with fair complexion, light hair and blue eyes was brought to me, because of indigestion and mucus in the stools. The condition was of two months' standing, but the little fellow had always been delicate, and had in infancy a history of extreme constipation.

Prominent symptoms, besides the mucus in the stools, were coated

tongue in the morning, easy sweating of hands and feet, which were also clammy and cold, a great deal of flatus, especially at night, when a small portion of mucus would be passed involuntarily with it. Child nervous and excitable.

I directed my treatment especially towards the diet. Sweets, pastry, potato, fats and oils, cabbage, beans, corn, etc., were to be avoided. Milk, steak, baked potato, oysters, white meat of chicken, mutton broth and toast were to be allowed.

I also advised irrigation of the bowel every other day with a quart of warm water containing two teaspoonfuls of boracic acid, a sea-salt sponge every other day, and prescribed China 3x.

We had an immediate response to the treatment and in two weeks the enemas were discontinued to be used only if mucus reappeared and Calcara Carb. 30x was prescribed.

Except for colds, which always aggravated the mucous condition, everything progressed favorably for four months, then the stools became greenish and slimy with mucus, very offensive and much gas. We returned to the enemas and also used a drachm of sterile carbolized olive oil in the rectum every night. Calc. Carb 30x, which had been discontinued for two or three intercurrent remedies, was again prescribed in conjunction with Merc. Cor. 6x. Again improvement set in and everything went along nicely until the last of December, when a cold brought on an attack of diarrhoea, which aggravated the old trouble.

The 29th of December I was called to find patient in bed with a temperature at 7 P. M. of 102°; pulse 110.

He had been feverish and fretful for a week. There was no pain, no sore throat, no rash, and the bowel condition was better than the week previous. Tongue coated light yellow, offensive breath and severe sweating, which was worse on the last motion and at night, were the most prominent symptoms.

Placed child at once upon a liquid diet and prescribed Gel. 3x. The following day the temperature at 1:30 P. M. was 103°. Examinations of urine and blood for typhoid were negative.

In a few days a symmetrical course of fever developed with the peculiarity that it ran highest between 12:00 noon and 3:30 P. M. On the 6th day a faint diazo reaction was obtained. The fever continued two weeks, reaching 104° on two successive days during the middle of the day, then declining. During this time the stool remained constipated, very light and offensive, but the condition of mucus was not at all bad. There was a slight attack of diarrhoea at the end of the first week and profuse nose bleed on the 9th day. Om

the 13th day the temperature became normal in the morning, 99° at noon. The next day an attack of earache set in and on the 15th day the temperature went up and ran another two weeks' course with the same peculiarity as before, but running a degree lower. At the end of two weeks the temperature became normal again in the morning, but persisted in rising at noon to 99° or 100°. Deciding this was due to prostration and anemia we began pushing the diet and finally he was up and about again. The constipation necessitating the use of enemas, continued until the last of May, when the bowels began moving of themselves. The child gained in weight and strength and seemed to be on a fair road to recovery again. In June the temperature began to creep up and a listlessness and peevishness developed. The stools showed considerable indigestion and contained varying amounts of mucus and the fact that our little patient was steadily losing became apparent.

The middle of July counsel was held with the former family physician, who was visiting, from out of town. On his recommendation a milk diet was prescribed, a small amount, diluted one half with water, to be given often. In less than twenty-four hours vomiting of curds, followed by immense quantities of water came on and persisted for almost another twenty-four hours. Ipecac, followed by China, -controlled the vomiting. The milk treatment was at once abandoned, and after a slow convalescence the child was about again. This attack of indigestion was characterized by large quantities of mucus of the thick, ropy kind, from the colon. In August an examination of the stool for tubercle bacilli was negative.

The 1st of September was ushered in with another acute attack of fever. There was a decided increase in the amount of mucus and the temperature rose to 103°. The prostration was alarming. The flesh became extremely sensitive to touch. Perspiration was profuse and constant. The stools greenish, undigested and fermented, slimy with mucus, with distress and tenderness in the left iliac region.

At this time the Salisbury treatment was adopted. The Enterprise meat chopper was used for chopping the meat and the center cut of the round steak, 3 oz., three times a day, slightly broiled, for three days, then 5 oz. for a short time. The amount was gradually increased until by the end of the month that little chap was eating a pound and a half of beef-steak a day. Auxiliaries to the treatment were a cup of hot water sipped slowly an hour before breakfast, and two hours after each meal.

In a few days he was allowed a piece of bread about 211⁄2 inches square, dried first in the oven, then toasted, three times a day. The

white of an egg cooked two to three minutes in hot water, was soon allowed, and his diet gradually increased to the following list: raw celery every day, shredded wheat biscuit, cerofruito and farinose, lemon or orange juice in water.

For two weeks his hunger was dreadful and weakness extreme. Then he began to be satisfied and improvement set in, which has been continuous. A year later he was going to school, and seemed as hearty and well a little fellow as one would wish to see.

Sponge baths were given twice a week, followed with an alcohol. rub. The rise in temperature persisted for two months and mucus for six months, after which time the stools became normal.

HERPES ZOSTER.

The case of Herpes Zoster was one in which the trifacial nerve of the right side was affected. The eruption followed the margin of the hair, the center of the forehead, bridge of the nose to center of upperlip, with several points on the right cheek under the eye.

The ophthalmic branch was irritated so that we had a severe purulent conjunctivitis. A week previous to the attack, the patient. 69 years of age, had severely strained her eyes. This apparently brought on a severe headache, the pain extending from the eye to the top of the head.

In the outer corner of the lower lid of the right eye there was: located a peculiar excoriation and the subsequent swelling seemed to start from this point, giving it the appearance, for a few days, of an infection. As nearly as we could determine, on the eighth day afterthe first symptoms the characteristic eruption appeared, a grouping of vesicles on an inflamed base. These rapidly coalesced and became purulent; then hemorhagic, so that at the end of the second week deep black scabs had formed.

The inflammation during this week took on the erysipelatous form until the eye was closed and the nose twice its original size.

The submaxillary gland on the same side began to swell and was: hard and painful.

The pain and inflammation increased for a week regardless of treatment. Bell., Apis, and Rhus Tox were prescribed in the order mentioned, the pain, however, was so severe that it became necessary to give a little morphine on three successive days at the height of the disease.

Nothing could be borne in the way of a local application but hot. water, which gave considerable relief.

Pure ichthyol painted around the margin of the swelling and