Preparations of iron have been largely used, both externally and internally, in the treatment of this malady. A strong ointment or lotion of the sulphate (about 1 in 4) was recommended by Velpeau after many comparative trials with other remedies; it does not, however, always prevent the extension of the inflammation [Bulletin, 1855). Mr. Hulke recommends a lotion containing 10 gr. in the ounce [British Medical Journal, ii., 1871). The application of equal parts of liq. ferri and spiritus vini rect. would seem still more valuable (Oswald White, British Medical Journal, i., 1876); and Mr. Foster, of Leeds, obtained so much success by painting the ordinary tincture of perchloride over erysipelatous surfaces, that this plan became known as the "Leeds method;" it was applied also to inflamed lymphatics, breasts, etc., and seems to have been especially useful in erysipelas after vaccination (Lodge, Medical Times, i., 1875). Mr. Hamilton Bell was the first to publish cases of remarkable benefit from the internal administration of the same remedy, or rather of the old "tincture of muriate of iron;" he gave 20 to 30 drops every three hours, so that sometimes 2 oz. were taken in eight days (Edinburgh Monthly Journal, 1852). In severe cases of "idiopathic" erysipelas, the spread of inflammation was arrested, the pulse lowered, and the fever relieved, and equally good results were reported by Balfour, Begbie, and other eminent men; and although Lehmann writes more re-cently in praise of the treatment (Lancet, i., 1880), we cannot concede to ferrum the "specific" virtue in erysipelas that has been claimed for it, nor is it the best remedy for every case. Todd curtly denied its efficacy (Medical Times, i., 1860); also H. Bennet and Estlander found it useless in traumatic cases (Medical Times, ii., 1871).

Dr. Marshall (Dover), after relating two acute cases well cured by 20-min. doses (and purging), states that he has found the remedy of less use in the traumatic form (British Medical Journal, i., 1872). The limited experience of Parkes need not weigh with us, because his cases received only 10-min. doses or less, and were therefore not tests of the method in question; but Aran, commenting on ten satisfactory cases recorded by Mathez (These, Paris, 1857), points out that iron is not the best remedy for young, robust subjects with high fever.

It is fair to add that Mr. C. Bell still maintains its very great value in all forms of erysipelas, and attributes the failures of other practitioners to the use of too small doses, or of less excellent preparations; he states that under his own care patients have recovered so soon as the old "tincture of muriate" was substituted for the modern "perchloride." The former, made with sesquioxide and hydrochloric acid, contains more free chlorine and some protochloride of iron, but the present tincture of the B.P. is a more definite preparation; any difference in curative power can be ascertained only by clinical experience, and Mr. C. Bell's observations deserve attention (Edinburgh Medical Journal, August, 1876). Some observers have sought an indication for iron in the locality affected, finding it least useful for erysipelas of the head or trunk; but Pirrie has obtained the best results in such cases. I think that in choosing a remedy for erysipelas we should look rather to the general constitution of the patient, the nature of the tissues affected, and the character of the inflammation; thus, I find iron to be really the best remedy in anaemic, weak patients, or in lymphatic constitutions when there is rapid extension or flitting of the inflammation, when the affected surface is dark-red or bluish, when the pyrexia is slight, and when, owing to debility, the attack tends to linger.

In the erysipelas consequent on surgical operations it is also useful if the subject has been reduced by long-continued suppuration or other causes of exhaustion. I believe it has also some prophylactic power.