ing, and direct brisk purging in the day, and at night two grains of antimonial powder, and one grain of opium in a pill, which latter I repeat after six hours, if the distress continues. The tongue is gene, rally furred, skin hot, and pulse frequent; a state that forbids every medicine of the astringent kind, and, I think, opium also, unless its use is preceded by evacuations, and it is combined with antimonials or ipecacuanha in the proportion before mentioned."

In the local treatment, in these cases, we have often seen very severe symptoms rather aggravated by the application of leeches; and the author observes, that the bites of these animals are very liable to slough where there is a tendency to mortification, All stimulant injections are hurtful; and warm fomentations of milk and water, or a weak solution of acetite of lead, applied warm, prove the best applications for allaying the morbid sensibility of the parts; or the ointment of the acetite of lead, spread on linen, may be wrapt round the parts.

Of phagedenic chancre. In the treatment of this description of sore, we find considerable difference of opinion among authors: many advise the continuance of the mercury, and almost all of them stimulant applications to the sore. On this treatment, the author observes,

"The theory and practice for which I have contended, in treating of phymosis, apply here, namely, that phagedenic chancre is not a truly venereal ulcer, but a supervening disease, and that the habit liable to it is apt to suffer materially from the use of mercury; an high degree of morbid sensibility is manifest in every such subject, which condition is invariably increased by mercury; and I have observed, that a sloughy state, whatever might have been its original cause, is increased by this medicine. From this view of the disease, and of the remedy, as more particularly noticed in another part of this work, I am decidedly of opinion, that mercury is injurious in phagedenic chancre, and should be excluded entirely from practice, as au internal and external remedy. I know that several practitioners discontinue it for a time, and resume it on a change of appearances; in the opinion that it is dangerous long to withhold the venereal antidote; to which practice I object for the following reasons; once that a morbid condition of body has taken place, under the influence of mercury, that state, in such constitutions as we now speak of, will be continued a length of time, partly because it becomes habitual, from being slowly induced, and partly because the recuperative energy is so feeble in them, as to require a long restorative process, which mercury will readily interrupt, and in which it will soon shew its deleterious effects; hence the confused appearance of the sore, and the difficulty of its being so unequivocally characterised, as to fix the rule of practice; all is uncertainty, whether the venereal or the mercurial action prevails; experience has confirmed me in the opinion, that it is always the latter, or an accessary disease, that forbids the use of mercury.

To establish this point is of the first importance, but it can never be effected, whilst the practice is pursued of discontinuing mercury for a few weeks, and resuming it after that time. It is also the practice of some surgeons to give acrid preparations of mercury, often in conjunction with frictions."

"Having decided that the restoration of the health is the chief indica tion, the means of effecting this is particularly to be attended to. When phagedena, or a burrowing sore, is an early symptom, it is almost invariably accompanied by quick pulse, dry skin, furred tongue, and great pain; hence the necessity of purging until the tongue becomes clean, and the anodyne and sudorific medicines as directed in treating of phymosis. If the distress is excessive, bleeding in proportion to the strength will be advisable at this early period; and in the more advanced stage, warm baths, and the soothing plan. In obstinate cases, a dry and warm atmosphere, particularly in the country, will be of material service. The only medicine I can recommend from experience is sarsaparilla given alone; when it is combined with guaiacum, and the other ingredients that form the decoctum lignorum, the habit is too much excited, an effect that is unfriendly to an irritable condition. I also object to mercury in any form accompanying sarsaparilla, on the same principle, and also for the reasons advanced before, namely, that this description of ulcer is not perpetuated by the venereal poison, and that it has not a ver.ereal origin, in some cases. The effects of mercury appear to me to be of a different nature from those that are produced by sarsaparilla; the former evinces all the properties of an irritant, the other of a demulcent; hence the mercury will countervail the sarsaparilla, provided that the case forbids irritating medicines; that medicines of opposite properties will produce effects, when combined, which, separately, they would be unequal to, I am aware, and am satisfied, that this very combination I now forbid, is advisable in some par ticular cases of the venereal disease; but having witnessed the worst consequences from the use of mercury in every form, and finding that the records of practice abound with similar cases, I feel warranted in insisting, that its administration as an antisyphilitic is improper in the treatment of the particular sore, and state of body, I speak of, whatever might have been the original cause.”

It has been often remarked, that the scrofulous diathesis is frequently roused by the venereal virus, and the long continued use of mercury, and it is in such cases that the sarsaparilla is most beneficial. The best mode of using it is in the form of decoction; and, at the same time, attention should be paid to the diet. The food should be of easy assimilation, and not stimulating; milk and vegetables form the best articles; and, in all irritable habits, animal food, wine and cordials, and the tonic plan, should be used with caution.

With regard to the local remedies, the author recommends the fermenting poultice of a large size: but it is sometimes too

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 burtful.

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 treatment of bubo init- 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 original 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 pro longed 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 mor tality; 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 characteris tics of this polymorphous disease with brevitý, 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 pol son of syphilis induces. The symptoms of syphilis, were soon