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is placed over the patient, the bed-clothes are thrown over the cradle, and made to meet tightly round the patient's throat, so that he may breathe the outer air freely. A current of warm air is then driven by a long funnel-tube, made of tin, beneath the upper bedclothes into the bed. Another very simple and convenient plan is to put a couple of heated bricks into a common warming pan, and to place the pan thus heated in the bed, at a little distance from the patient, keeping it in gentle motion to prevent any scorching of the clothes. By this means there is no risk of breathing carbonic acid, the head of the patient need not be specially excluded, and the cradle for raising the bedclothes may be dispensed with. For hospitals, a simply constructed hot air couchbath is almost a necessary convenience.

Whatever means of this kind be employed, the object is the same—the production of a free diaphoresis; and this end achieved, the majority of the cases of scarlet fever would, in the presence of a pure air for respiratory purposes, recover naturally: but we must never forget that there is another element in the disorder, which may prove the fatal element, I mean the deposition of fibrine in the right cavities of the heart.

To meet this tendency to deposition, to prevent its occurrence, two remedies seem to me to be most reliable. The one is ammonia, as first recommended by Dr. Peart, and more recently by Dr. Witt; the other is acetic acid, as recommended by Mr. Isaac Baker Brown. I have often put these remedies into

use, in practice, and I am bound to say that they are both most effectual. It would be difficult to decide which is the best.

The action of these remedies at first sight may seem contradictory, but it is not so. Both acetic acid and ammonia have one property in common, that of holding the fibrine of the blood in solution. Both medicines also tend to eliminate carbonic acid; for ammonia, when freely administered, escapes from the skin, the breath, and perhaps the urine, in the form of carbonate; and acetic acid is decomposed entirely, escaping from the urine as carbonic acid in combination with a base. Further, by keeping the blood fluid, they favour elimination from every excreting surface. I have used with equally good effects a combination of these two remedies with an excess of ammonia, as in doses of two fluid-drachms of the liquor ammoniæ acetatis, with from three to five drops of liquor ammoniæ, in a liberal quantity of distilled water.

It is of importance in these exhibitions to administer the agent in small and frequently repeated doses, so that the blood may always contain the remedy; for, if the doses be given with intervals of three or four hours apart, the decomposition and elimination of the substance is over so quickly, that the system is left free of the effects during the greater part of the period between each dose. In a word, the secret of administration consists in putting aside the idea of a medicinal dose altogether, and in offering the remedy as a pleasant drink, rather than as a nauseous draught.

If the ammonia treatment be selected, there are two points particularly to be observed. The doses must be followed up until the agent is very distinctly presented in the breath. This presence may be determined by the holding of a glass rod, moistened with hydrochloric acid for the patient to exhale on; when, if much ammonia be expired, the white characteristic fumes will be developed. This test, however, is not very satisfactory. It is better to place a drop of pure hydrochloric acid on a microscope slide, and allow the patient to exhale some twenty or thirty times over the acid surface. Then, the glass slide being gently dried before the fire, or near a spiritlamp, there will be left a crystalline deposit, which on microscopical examination will present the characters depicted in plate 11, figure 1.

To effect this examination of the breath, Mr. Toogood, of Mount Street, has constructed, under my direction, a very simple pocket-tube, delineated in figure 2 of plate II.

The tube is in fact a strong test-tube, with a neck holding a stopper perforated in two places. One of the openings is armed with a mouth-piece, and the whole is covered in with a well fitted glass cap. When the tube is prepared for use, a microscope slide is moistened at one or two points with a minim of pure hydrochloric acid, and is inserted in the tube; the stopper and glass cap are then adjusted, and the whole may be carried in the pocket safely. When it is to be applied, the glass cap is removed, and the patient is made to expire gently

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