following their application.

The application of mercury in a fluid form to indurated ulcerating sores, appears to act more beneficially than when mercury is employed in the form of ointment. It is applied more equally and easily, and only needs occasional renewing. The black and yellow washes are both thus employed: whilst, however, the latter is generally applied to ulcerations of the integuments in secondary syphilitic affections, the former is generally applied to primary ulcerations of the genital organs and parts round. For these reasons the application of mercury to the primary sore, in the ulcerated stage, is best performed by employing that substance in solution, as in that form it comes into accurate contact with the diseased surface. When, however, the ulceration has healed, the employment of mercurial lotions is not attended with such decided benefit, on account of the entire condition of the skin over the indurated part. To indurations on the mucous membranes or integuments of the genital organs, after all important inflammation has subsided, the strong mercurial ointment may be applied with the greatest advantage. If a portion of the ointment be occasionally rubbed on the hard part, and a piece of leather covered with it be constantly applied, a decided diminution is sometimes observed to occur in the size of the part." P. 214.

*

*

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Because a case is of old-standing and obstinate character we are not to have recourse to violent courses of mercury; the medicine must be then mildly administered for a very long period. Some of the best examples Mr. Ormerod has seen of its successful application have been in certain cases under Mr. Lawrence's care, in which small doses of hydrarg. cum cretá were continued perseveringly. When the quick and decided influence of mercury is required, or its effects on the bowels feared, frictions form the best means of employing it; but, in the majority of cases, the convenience of the blue-pill will secure it the preference. In the phagedænic form of ulcer the mercurial action should be rapidly induced by calomel and opium, as recommended by Mr. Lawrence. Some of these cases in the wards of that gentleman have improved as rapidly after the induction of mercurial action as cases of syphilitic iritis. After the phagedænic action is checked the cure may be completed by a milder preparation; and in these cases, in bad and unhealthy subjects, where the sore after a while becomes stationary, the hydriodate of potash with sarsaparilla and a good diet may be advantageously substituted, the patient being removed also into a purer ward. Certain phagedænic sores, attended with and maintained by a high degree of surrounding inflammation, require to be treated with local depletion and purgatives; while in other feeble, haggard patients, presenting instances of nervous rather than vascular disturbance, wine and opium are indicated. So successful has mercury been found in treating the various primary sores at St. Bartholomew's that iodine has been but little used, and apparently with no great advantage. It seems, however, to aid, when added to sarsaparilla, in recruiting the exhausted frames of certain patients in whom the disease has long lingered and become combined with secondary symptoms.

Among the great number of secondary venereal affections seen at St. Bartholomew's, those of the skin predominate. The papular and scaly eruptions, with an irregular mottling of the skin, are the most common; next the tubercular and pustular; and lastly, the phagedænic pustular disease termed rupia. Vesicular eruption is seldom if ever seen. The papular eruption in its earlier stages requires antiphlogistic proceedings,

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after which, mild mercurials, to the extent of just touching the gums, form the most efficacious treatment. The warm-bath and in some cases good diet and tonics are valuable adjuvants. Iodine is certainly less efficacious, and in obstinate cases very much less. In no form of disease is medicine so markedly useful as mercury in scaly syphilitic eruption. So useful is it that iodine has rarely been tried. This, however, possesses considerable efficacy when the affection is but slight. Syphilitic tubercular eruption, when the patient's health is good, will also yield to a mild mercurial course; but in the mildest form, and when the patient's general condition is unsatisfactory, iodine is preferable. Mercury too, is adapted for the pustular form, when the patient is not feeble, and there is no disposition of the pustules to degenerate into ulcers; but it requires careful watching. The secondary ulcers of the skin, which are met with chiefly in the most wretched class of patients, who have employed neither care or cleanliness, and whose general health is more or less ruined, have been attributed by many to the employment of mercury. This, Mr. Ormerod considers an erroneous view, believing that a cautiously conducted course of mercury has no tendency to produce them, admitting, however, at the same time, that mercury given rashly or at random, and the patient exposed the while to every injurious physical influence, may induce their formation. They usually present themselves under three different forms. They may be seen (1) as numerous small round ulcers scattered over various parts of the body, being usually accompanied by other secondary symptoms. The patient's health is not generally sufficiently bad to prevent the cautious administration of mercury, which, with the local use of the yellow wash, will usually effect a cure. 2. Large, semicircular, phagedænic, shallow ulcers form the symptom for which iodine may be most advantageously given. 3. Round, excavated ulcers, occurring in small numbers, or singly, attended with great pain, and sometimes extending very deeply. Opium, nutritious diet, and iodine are here indicated, the blackwash often forming a suitable local application. In the different ulcers mentioned, various measures one after another are tried in vain in some cases, and in such, the corrosive sublimate gr. ter, continued for a long period, sometimes succeeds where everything else has failed.

We must pass Mr. Ormerod's account of these medicines in the other secondary symptoms more rapidly under review. Ulceration of the throat is upon the whole better treated by mild mercurials than by any other measure. In the excavated ulcer this is especially the case, if cinnabar fumigation be simultaneously used. Iodine neither cures so rapidly or so completely as mercury. In a class of cases which combine the appearances of excavated ulcer of the fauces and sloughy ulceration of the pharynx, the local use of cinnabar, and the internal employment of iodine form a very successful mode of treatment. Persons labouring under sloughy or foul ulcers generally require good diet and wine or porter, and, in such, iodine is of the greatest service. Since iodine has been employed in these cases, fumigations have been much discontinued. Where, however, the object is to clean the sore very rapidly, other means having failed, and the patient is strong, fumigation will often be still found a valuable means; although its administration requires care in consequence of the ease with which a profuse and injurious salivation may be induced by the

application of the cinnabar to a large sore. In ulceration of the larynx, iodine, conjoined or not with mercurial fumigation, is a most valuable medicine. The patches of ulceration seen on the tongue are relieved by the mercury which is indicated for the fissures of the lips and scaly disease of the skin which usually accompany them. In a form of ulceration of the edge of the tongue and corresponding portion of the cheek, exactly resembling that induced by salivation, iodine effects a rapid cure. Excavated ulcer of the upper surface of this organ is occasionally seen, and a slight mercurial course is the appropriate remedy. The fissures occurring at the edge of the tongue often heal readily to recur again and again. They must be treated by iodine or mercury, according to the accompanying symptoms, and if these do not exist, by a mild course of mercury. Hernia Humoralis is usually of simple treatment. After the acute stage has been checked by antiphlogistics in a day or two, the hydrarg. cum creta 2 gr. ter, continued steadily, has been found of great benefit at St. Bartholomew's. The syphilitic testis generally yields very readily to mercury; but in some cases it may require careful persistence in its general and local use. Messrs. Lawrence and Stanley have found the application of the strong mercurial ointment or liniment to the scrotum, a very beneficial measure.

In respect to affections of the bones and periosteum, in no form of disease is iodine of greater use than in the dull aching pains of the long bones. It mostly relieves immediately or speedily, but if it does not do so shortly much benefit does not usually accrue from its prolonged employment. Since the introduction of this medicine, affections of the bones and periosteum have so frequently been cured, that incisions are now seldom called for. Cases, however, occasionally do occur in which these are advisable, others in which mercury is more useful than iodine, and others again in which neither medicine gives any relief. In nodes, unaccompanied by acute inflammation, iodine is a most excellent remedy. When the node is soft, mercurial ointment on a piece of soft leather, firmly applied over it, materially diminishes the swelling, and does not cause irritation or ulceration even if the skin be very thin. Sometimes this is so thin as to seem on the point of bursting; but we must cautiously avoid opening it in consequence of the troublesome ulcer which may result. Fluid and recent nodes admit of complete cure, while old bony ones are rarely if ever removed, although the pains accompanying them may be relieved. Iodine has been found very useful in gonorrhaal rheumatism, given after the constitutional irritation has subsided, or at once if this is not considerable. The cure, however, is not complete, the patient being long tormented by occasional pains, and it seems gradually only to wear itself out.

Cases of syphilitic ulceration of the eyelids, described by Mr. Lawrence in his treatise, are not so effectually treated by iodine as by a mild but effectual course of mercury. Sometimes the papular eruption of the skin extends to the conjunctiva, producing a very troublesome affection. The application of a few leeches to the lower lid much relieve the accompanying irritation. Iodine and mercury exert no influence apart from their action on the eruption of the skin. Although these cases usually do well, they are occasionally tedious and difficult of cure, the eyes being long left in a very painful and irritable condition. Benefit is sometimes derived from

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rubbing tartar-emetic ointment into the nape of the neck. Upon the vast utility of mercury in Iritis, we need not detain our readers, merely stating that in the chronic form of the disease Mr. Lawrence has found small, long-continued, doses of hydr. cum cretá, frequently of the greatest utility. The same may be said of iodine in those cases in which mercury has disagreed or proved inoperative. Puriform discharge from the meatus auditorius is an occasional secondary symptom, yielding to mild mercurials.

Mr. Ormerod's last chapter contains a general summary of the results of his observations upon these two valuable medicines. In treating of mercury he properly lays great stress upon the power which its judicious administration exerts in the prevention of secondary symptoms. From his remarks upon the different circumstances which do and do not forbid its use we may extract the following:

"The state of constitution usually denominated strumous is by no means a positive contra-indication to the cautious employment of mercury; if such were the case the frequency of this condition of constitution among the lower orders would often prevent mercurial treatment. In patients whose constitution is weak, and presents the common general signs of scrofula, the employment of mercury is sometimes attended with very great benefit, the patients gaining a degree of flesh and strength under its use which they had not previously enjoyed." P. 281.

The following is the author's general view of the utility of mercury in primary disease, his observations on secondary affections we have already quoted.

"The primary indurated, and the rapidly spreading phagedænic ulcers, the indurated cicatrices of old sores, and the glandular swellings accompanied with induration, but with very little surrounding inflammation, are benefitted so much more by mercury than by any other means, that its use is, if not necessary, at least most advisable. The same remedy, though less beneficial in the chronic form of bubo and ulcer, which lasts for months, and sometimes for years, is attended at times with success, and affords more chance of relief than any other means. The cautious employment of mercury in the treatment of a great mass of superficial sores and simple glandular swellings, whether suppurating or not, is attended with no danger, and leads to a good general result by curing a certan number of cases which simple means hardly touch. In acute inflammation of the glands, in acutely inflamed, irritable ulcers, and sloughing phagedæna, the employment of mercury is unattended with benefit, may do harm, and by taking the place of appropriate treatment is to be avoided." P. 233.

In respect of Iodine we have the following remarks:

"There does not appear to be at present any very clear proof of the efficacy of iodine in primary disease. This medicine, it is true, has been only partially tried; but the want of any repetition of these trials is a strong argument against the good result derived from its slight use. The greatest advantage derived from iodine in primary disease is seen in the treatment of patients, who from large quantities of mercury, or long standing primary disease, to which secondary symptoms may even be added, are reduced in health. To such, the employment of iodine is certainly beneficial, and aids in restoring them to moderate health. The foul condition of some superficial sores is at times relieved by the employment of iodine, but the local application of the tincture to parts in which considerable swelling and inflammation exist, is sometimes attended with serious injury.

"This small benefit derived from the use of iodine in primary disease is, however, quite compensated for by the advantage gained from its employment in

secondary affections. The painful affections and swellings of the bones and periosteum, gonorrhoeal rheumatism unaccompanied by much fever, single, foul, phagedænic sores, and large phagedænic sores scattered over the body, are relieved by iodine in a more rapid and a more certain manner than by any other means. Úlcers of the skin, from previous venereal eruptions of any kind, occurring in patients of reduced health, but more especially those following the tubercular and pustular forms, and the conical crusts of rupia, are healed by the internal administration of iodine. The same means have also been found useful after the employment of mercury in the treatment of iritis, as well as in the removal of the protrusion of lymph, which in some cases of iritis perforates the sclerotic at the margin of the cornea. In the papular and scaly eruptions sufficient benefit has followed the employment of iodine to recommend its use, where mercury is objected to, but not enough to render its adoption advisable in preference to that remedy.

"Such are the principal individual symptoms which are relieved by iodine; but the bare enumeration of them conveys but a faint idea of the value of this remedy. These symptoms are some of the most serious and obstinate that occur in syphilitic disease, and which are relieved but little by mercury. These, in fact, are the affections for the cure of which the most varied measures have been introduced at various periods, all of which have enjoyed more or less reputation. The employment of iodine, however, has been attended with greater and more uniform success than any other remedy, except mercury, which has ever been introduced for the treatment of venereal diseases. Those affections which yield least to mercury, and that condition of health which succeeds to long-standing disease and to the employment of very large quantities of mercury, yield to iodine in the most marked and decided manner.' P. 290-2.

وو

This is strong testimony, but we believe not stronger than deserved. The opinions of MM. Gibert and Payan upon the subject will be found in the Foreign Periscope of the present Number.

Hydriodate of Potash is the preparation of iodine employed at St. Bartholomew's, and it is prescribed in doses of 4 or 5 grains ter.

In concluding our notice of Mr. Ormerod's " Clinical Collections," we may again repeat our opinion that the work does him great credit. It supplies a good and long-wanted account of the practice prevailing in the surgical wards of one of our largest hospitals, and may be advantageously perused by both student and practitioner. Without sympathizing with that hypercriticism which insists upon elegance of medical literary composition, we must still regret that the verbal repetitions and neglect of relative pronouns somewhat mar the pleasure of reading a work otherwise so excellent. This is no doubt due to hasty composition, and may be rectified in another edition.

RECUEIL DE MEMOIRES DE MEDECINE, DE CHIRURGIE, ET DE PHARMACIE MILITAIRES. Vol. LX. 8vo. pp. 390. Paris, 1846.

THERE are two or three papers in the new volume of these Memoirs of Military Medicine an account of which we think will prove acceptable to to our readers. The first of these is