in the practice of the healing art, especially in the country, where cupping is not commonly successfully performed, renders every thing connected with its history interesting. We must refer to the volume before us for what regards the medical, natural, and anatomical history of the leech, where the reader will find much information, and some novelty. As more immediately connected with the practice of medicine, the following observations on the application of the leech deserve to be generally known:

"But, for my own part, I always trust to their application by the hand. Bring a leech toward the part whereon you intend to fix it, and as soon as it begins to extend the head, to seek an attachment, endeavour that it may affix itself to the place required. Some little dexterity is requisite to make the leech attach itself at the first point of contact, for it often happens that it will pass over a great extent of surface, without evincing the least disposition to bite. In this case, puncturing the part with a lancet offers the only chance of success. When the patient is fearful of the lancet, and one leech only shall have bitten, where several are required, it may be of use to remove it, which is readily done, by inserting the nail of the finger between its mouth and the skin. The blood then flowing from the orifice, will induce the remainder to bite with the greatest avidity. As soon as the leeches are gorged, they drop off; this usually happens within ten or fifteen minutes. Sometimes they remain affixed a considerable time, and become indolent; but they are quickly roused from this state by sprinkling them with a few drops of cold

water.

"The leech, when filled, contains from half an ounce to an ounce of blood; and what is worthy of notice, this fluid is preserved in its stomach, in an uncoagulated state, for two or three months, and without producing any offensive smell. The only change it suffers is that of becoming deeper in colour, and a little thicker in consistency. Under some peculiar circumstances the blood, however, will coagulate, and it is then productive of disease. What peculiar action takes place in the stomach of the leech, to preserve for so long a time the blood in a state of fluidity, we cannot well determine. It may, how ever, be urged as probable, that a fluid is secreted, capable of resisting the developement or play of those affinities which are essential to the putrefactive process.

"When a lecch quits the part to which it was affixed, and the blood continues to flow longer than is required, the application of a slight compress will usually restrain it; but should this at any time prove ineffectual, we must have recourse to a compress steeped in some styptic, as brandy or spirits of wine.

"When from their scarcity but few leeches can be procured, advantage may be taken, according to an ancient custom, of snipping off their tail; the blood will then flow, drop by drop, from the artificial opening, as fast as the leech sucks it. But it is of no use to

resort to this operation unless the leech is in the act of suction; for should the pressure from the column of descending blood be removed, this artificial opening would be immediately closed by the strong action of the circular muscles. With the same view, an incision may be made close to the tail of the leech with a lancet.

"I have frequently performed this experiment, and, what is remarkable, have found them to suffer, apparently, so little from the operation, that they still drew the blood with as much freedom as before. In one instance, in a leech just fallen off and fully gorged, I employed this method of ridding it of its contents; and, severe as many might deem this treatment, the leech was no sooner returned to its former situation, than it began sucking with the same avidity as when first applied. Although the leech appears at the moment to suffer from this practice but trifling inconvenience, yet it afterwards becomes very languid; I would therefore only propose its adoption, at a time when, as before noticed, their scarcity might render such a measure expedient.

"To make a leech disgorge, the most common practice is, that of strewing the muriate of soda, or common salt, over its body. In a few seconds the blood is rejected, the leech assumes a coiled form, and loses its activity and vigour; and we seldom find it again fit for use until the expiration of four or five days. As the salt frequently blisters the body, we are advised to apply it only to the mouth; but I must remark, that if the lips are blistered, the same obstacle is presented against its re-application.

"To remedy this convenience, we are recommended to draw the Jeech between the thumb and finger of the left hand, keeping up a regular and uniform pressure, until the whole of the blood is remov This practice is certainly preferable to the former; for the leech continues active, and will again immediately affix itself. But the great disadvantage is, our being scarcely able to carry it into ef fect without injury to the internal structure.

ed.

"In preference to any of these methods, and one from which the leech appears to suffer the least inconvenience, is that of pouring a small quantity of vinegar upon the head. Following this mode of treatment, i have succeeded in making a leech bite four times successively, coming off each time completely gorged with blood.

"It will be scarcely necessary to observe, that leeches recently applied should be kept by themselves, and should be allowed to retain, for their nourishment and support, about one-third the quantity of the blood they extract,"

V.

Commentaries on the Treatment of the Venereal Disease, particularly in its exasperated state; including a second edition of a former Publication on that subject, considerably augmented and improved. On the use of Mercury, so as to insure its successful effect. With an Appendix, on Strictures of the Urethra, and on Morbid Retention of Urine. By EDWARD GEOGHEGAN, Member of the Royal College of Surgeons in Ireland, &c. &c. London, 1814. 8vo. pp. 219.

THE

HE difficulties which occur in the treatment of syphilis are so great, that it requires the employment of the best talents and experience to elucidate them. Various disputes have existed, whether the treatment of the disease ought to belong to the province of the physician or surgeon, and a great many arguments have been adduced in support of these two opinions. It is generally a constitutional disease, but the local symptoms are often very troublesome; and the separation of the healing art into medicine and surgery, has in no instance so materially impeded the improvement of both. It is also to be regretted, that writers on syphilis have not been sufficiently accurate in their descriptions, and have entered into theoretical discussions, instead of detailing the circumstances that constantly occur in medical and surgical cases, the careful attention to which can alone afford us correct rules for the treatment; and many considerations have been overlooked, which, if mi nutely attended to, would materially influence the practice.

The intention of the author of the present work is not to describe every form which the venereal disease exhibits, but to confine himself to some aggravated symptoms, in the treatment of which he has had considerable experience. These are, phymosis in its inflammatory stage, phagedenic chancre, venereal bubo, affections of the fauces, and on the use of mercury, so as to insure its success.

We have had an opportunity of witnessing the crowds of miserable wretches who daily apply for relief at the Lock Hospital in Dublin, labouring under all of the most aggravated forms of the disease; and the author mentions, that for many years his attention had been particularly turned to the treatment of these states, but that it was more particularly excited by the violence of the symptoms which occurred in the summer, au

tumn, and winter of 1799, and he found that other practitioners had made the same remark.

When a disease, which commonly presents mild symptoms, is unusually exasperated, we are naturally led to inquire, to what we are to attribute this change. If it were to the increased acrimony of the poison, mercury would be the antidote; but there is nothing more common, than to ascribe the venereal appearances which resist the effects of mercury, or are increased by it, to some peculiarity of constitution, and bark, wine, After opium, sarsaparilla, are thrown in indiscriminately. pointing out the indecision and fallacy of Mr Hunter's advice on this point, the author observes,—

"With respect to the question, whether increased acrimony of the poison has any share in producing these aggravated symptoms? Here it is necessary to take a view of the effects usually attendant on its application in the first instance-when applied to a non-secreting surface, ulceration is the usual consequence; and, although this state is accompanied by some degree of inflammation, yet it is rather circumscribed, and the ulcerative process goes on more rapidly than the inFemales flammatory, and, indeed, the latter is often totally absent. having the slightest appearances, without any inflammatory symptoms, ignorant, indeed, of being infected, constantly communicate the discase, and the persons whom they have infected show the disease.in various degrees and forms; in one man it will exhibit the most trivial, in another the most violent symptoms, although both bave been infected by the same woman, and at nearly the same time. Taken into the stomach, it produces no effect, and even proves harmless to many persons who expose themselves to it; it also remains in the habit for years, without manifesting itself, or exciting the least disturb. In the small-pox, we every day see the same infection produce the discase in one subject in the mildest, in another in the most malignant form. These facts establish the principle most unequivocally, that mild or violent symptoms, whether accompanied by inflammation, or ulceration, or in whatever form they appear, are not characteristic of the degree of acrimony in the infectious matter; hence we have no reason for attributing the aggravated state to the infectious matter alone; we are led, then, to look for an explanation of the phenomenon from some other cause. It is a common phrase, when things run untowardly, to say, this is owing to peculiarity of constitution; but in what this peculiarity consists we are uninform ed, and, of course, are without any guide as to the treatment. Whilst I agree that the true source of the mischief is in the state of the constitution, I cannot but express my astonishment at the nar. row view that is generally taken of this very material point. One would think, from the plans of cure laid down, and usually followed, that this condition of body meant something fixed and definite, not that fluctuating state which is liable to vary with every breeze.”

ance.

The principle contended for is generally admitted, and we proceed to its application to the subject before us. The diseases of the penis are frequently aggravated independently of the poison, which merely predisposes the part to be acted on by remote causes. Therefore we find that these symptoms frequently supervene, when the true venereal chancre has healed, and the system is fully charged with mercury, or when the body is reduced to a state peculiarly liable to be acted on by adventitious diseases. We have recently met with cases of true chancre, which healed under the use of mercury; while ulcerations that have appeared during the course of the cure, having put on the malignant appearance, particularly at the moment when the true venereal chancre was healed. In such cases, we are disposed to coincide with the author, in considering the continuance of the mercury as not only unnecessary, but even hurtful; and it is in such cases that the use of the sarsaparilla, as mentioned by the author, is particularly beneficial; and the practice of many medical men, of resuming the mercury when the sores are nearly healed, is evidently attended with very injurious effects.

With the author's remarks on the treatment of phymosis, we perfectly agree, Many old practitioners, in such cases, seem to think the exhibition of mercury in larger quantities the sole point of practice to be attended to; but, as the author remarks, the inflammation is greater than that usually produced by the venereal virus; it often appears where the other symptoms are mild, and the mercury exerting its full effects; it is frequent in the ill-aired wards of hospitals, and when diseases arise depending on the state of the atmosphere; in short, it is an accessary disease, and requires to be removed, before the cure of the original complaint is attempted.

"From this view, namely, that this symptom is not occasioned by the virus, and that mercury is not only unnecessary, but prejudicial, I would reject its use in toto, and treat the complaint as common inflammation, demanding prompt and vigorous measures for its cure. The great functions of the penis require that it shall be often distended, and for this purpose, an extraordinary quantity of blood is determined more frequently to it, than to any other part, and its return is in a great measure impeded. This structure and its natural sensibility dispose it to be rather suddenly inflated when irritated, and I think points out a leading feature in the treatinent; to lessen the determination of blood to the part, and to allay local irritation; the former will be best effected by blood-letting, and the other evacuations; the latter, by such applications as are refrigerant and sedative. If the symptoms run high, I take off a pound of blood at the onset, when there is no contra-indication, and I never find it necessary to repeat it; if the symptoms are moderate, i omit bleedVOL. XII. No. 47.

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