irritating, and we have seen substituted, with advantage, the poultice of linseed meal; or the unguentum elemi, much diluted, may be substituted. In obstinate sores that do not slough, a very weak nitrate of mercury ointment may be used. All applications of a more stimulant nature are hurtful. It has been a common practice to resume the use of mercury when the bad symptoms are nearly removed; but the author observes, that his experience leads him to depart from this practice; and we had within these two years a well marked case of its bad effects. It is more prudent to allow the sore to heal, and to be regulated by the subsequent appearances, how far the mercury may be at all required. The author says that he has met with cases where the disease never returned. The author now proceeds to point out the application of the general principles he has so ably discussed, as applicable to the treatmentof bubo in its aggravated form, and the ulceration of the fauces. But here it is unnecessary for us to follow him. We would rather reserve the details for the perusal of our readers in the origi'nal work. He concludes by some remarks on the best mode of exhibiting mercury, so as to insure its effects in curing the disease. It is a common practice to throw in the mercury very rapidly at first, with the view of charging the system, and preventing the further progress of the disease; but this mode is apt to excite too much, and to develope diseases to which the habit is subject. The author, therefore, advises a smaller quantity, as a scruple of the ointment, to be used daily for a week, and increased by degrees according to its effects. He also disapproves of the practice of giving pills at the same time with the ointment, on account of the increased dose, and because it exhausts our resources too soon. The propriety of confinement, during the use of mercury, is generally acknowledged; but practitioners are often necessitated to comply with the wishes of the patient, and his desire to conceal the disease. The author concludes these commentaries with some useful practical remarks on the treatment of strictures, fistula in perineo, and the introduction of the catheter in retention of urine. We have bestowed much attention on the numerous important practical points treated of in this small volume, and we think it a work that will reward its careful perusal. It is evidently written by a surgeon who has had many opportunities of witnessing the effects of the different modifications of cure, which he shews to be essential for the successful treatment of this direful malady. PART III. MEDICAL INTELLIGENCE. REPORT of DISEASES treated at the PUBLIC DISPENSARY, near Carey-Street, London, from February 29th to May 31st A chilly and ungenial spring, which has retarded the progress of vegetation much beyond the usual period, has also prolonged the duration of catarrhal and rheumatic complaints, and rendered them obstinate and difficult of cure; so that those who happened to be attacked in the early part of the season, were often unable to conquer their disorders till towards the close of it. Other diseases do not seem to have been very rife; so that the character of the epidemic constitution has been principally catarrhal. The eruptive contagions never cease to shew themselves in this extensive metropolis, and even small-pox still continues to add some victims to swell the weekly bills of mortality; but we have had occasion to see but a few scattered cases of these exanthemata during the last three months. Typhus, or common contagious fever, has nearly disappeared from our district; for the cases, inserted in the list under the head of Febris, do not approach in any of their symptoms to that character; and it is long since we have witnessed any thing like the spreading of simple fever from one individual to another, in any of the courts and close habitations, which we are called upon to visit. The cases in the list are generally slight attacks of fever, of a gastric origin, with a white and somewhat loaded tongue, little or no affection of the sensorium, but with some manifest disturbance of the stomach or bowels, which yield speedily upon regulating the functions of these organs, with the use of the antiphlogistic regimen. The term Cachexia syphiloidea has been appropriated by Mr Pearson to a class of symptoms, with which he is undoubtedly better acquainted than any other practitioner, but which have not yet, perhaps, been sufficiently investigated to be finally subjected to generalization. It expresses the leading characteristics of this polymorphous disease with brevity, and is less equivocal than pseudo-syphilis, and some other appellations that have been proposed, as it implies merely a malus habitus, resembling, in its external signs, the morbid state which the poison of syphilis induces. The symptoms of syphilis were soon detailed with great minuteness and accuracy, and mercury early ascertained to be its specific remedy; but it seems to have first occurred to the sagacity of John Hunter, that such symptoms were not invariably the result of the syphilitic virus, nor invariably required the specific treatment. Observation has subse quently confirmed that opinion, and greatly extended it; insomuch that the soundest observers begin to admit, that there are, in fact, no symptoms which unequivocally characterize a disease of syphilitic origin, or unequivocally indicate the necessity of administering mercury; and that it is only by combining an examination of the appearances, with a history of their origin and progress, and of the treatment to which they have already been subjected, that a satisfactory conclusion can be deduced. Neither the nodes of the periosteum, the ulcerations of the fauces, nor any of the modifications of cutaneous eruption, upon which so much stress has been laid, can be relied upon as unequivocal indications of a syphilitic or non-syphilitic disease. An ingenious attempt has indeed lately been made with great confidence, in the sister island, to settle the characteristic eruptions connected with particular modifications of the cachexia, resulting from specific primary ulcerations, as well syphilitic as non-syphilitic; but, anxious as every zealous practitioner must be for solid instruction upon this subject, and ready as every friend of independent inquiry to admire the acuteness of the suggestion, it is but too manifest that this attempt is premature. If the point, indeed, could be thus expeditiously settled, it would have been determined long ago. The practical inference, from this state of uncertainty in the diagnosis, however, is, that we should be extremely cautious in pronouncing diseases to be syphilitic, without a careful examination of their history and treatment, and of subjecting a cachectic patient to the severity of a mercurial course, when he may be restored to health by more safe and certain means. London, May 31. T. B. REPORT of DISEASES treated at the New Town Dispensary, Edinburgh, from February 29, to May 31, 1816. |