the colour so intense as to approach lividity. The ulceration is exceeding or depascent, instead of herpetic, extending equally and rapidly both in depth and circumference. Formerly I have seen two-thirds of the glans penis disappear in less than a week in acute cases; but these are now rare. Central sloughs are formed, but it is not by sloughing that it extends; the edges are sharp and abrupt, not shelving. The syphilitic ulcer has none of that shifting character which belongs to lupous, carcinomatous, and cachectic sores, viz. cleansing and cicatrizing in one part and spreading in another. Its extension is in a direction from the surface. It is only when exasperated by local irritants or stimulating regimen, and that in a debilitated habit, that the syphilitic ulcer turns sloughy; its character is purely ulcerative, not gangrenous phagedæna."

Mercury is the specific, but two states of constitution absolutely prohibit its immediate use ;-1st. excessive inflammation; 2d. excessive weakness. In the first the usual antiphlo gistic measures are required, and in the second the extract. sars. dissolved in the decoction, or if a higher tonic be required, the same with bark, and a free allowance of nutrient food, wine, or porter.

"If ulceration is making rapid strides the better plan is to introduce the remedy by the skin in frictions, night and morning; and if the system resists its entrance, to aid the process by the pill. In cases of great debility, I begin with the oxymuriate or the mercury and chalk, as a test of the capability of the system to bear it. The anodyne, if need be, and the tonic of course should be continued. In most cases mercury and bark or sarsaparilla are exhibited with excellent effect at the same time. In ulcers of the throat, fumigations are of the greatest efficacy. I often depend upon them alone in weakly persons, while other medicines are directed to the support of the system. They effect an improvement more rapid in these cases than the constitutional action alone. I should say generally, that to render the action of mercury

powerful over the disease, and to preserve the system from its injurious operation, the support of the patient's strength becomes the principal object of the surgeon's attention. Indeed, the successful treatment of the disease turns chiefly upon his knowledge and consistent pursuance of this indication."

The treatment of venereal ulcers requires the same attention to prevailing character as other sores; excessive irritability is best allayed by a saturated watery solution of extract of opium. In sloughy ulcers of the throat the linimentum æruginis is most effectual. We need not advert to the secondary symptoms, but may conclude this part of the subject, by stating in our author's words, that the profuse and wasting action of mercury is never called for.

COMPOUND OF SYPHILIS AND MERCURY,

Such a combination, especially when aggravated by the presence of scrofula original or engendered, gives rise to cachexia of the most formidable kind. Cold and dram drinking are the ordinary exciting causes, the abuse of mercury and the dregs of syphilis the predisposing. Excepting the eczema, a species of ecthyma, and the impetigo rodens, Mr. Travers has no acquaintance with eruptions proper to mercury as a single agent. That mercury has been frequently used to an injurious extent, he admits without hesitation, but still he objects to the terms 'mercurial eruption,' mercurial sore-throat,' ‘mercurial pains,' as equivocal in meaning, and therefore improperly used.

"From this source are doubtless derived the caricature portraits of the venereal disease abounding in the records of medicine and the reports of empirics; and I may add the cases, not now so numerous as formerly, of direful and sometimes fatal deformity in the foul wards of our hospitals. The emaciation, pallor, fetor; the deep, eroding, foul ulcers; the worm-eaten bones, as of the whole cranium; the rupia in the form of conoidal limpet-shell crusts covering the body; the continuous slough of the whole posterior fauces, extending beyond sight; the entire loss of the parts of generation; of the soft and

hard palate, and the falling in of the nose; the agonizing night pains, the severe hectic fever and excessive and offensive sweats, &c. sufficiently characterize these cases. Their termination is ordinarily in phthisis or hæmop tysis, or some special visceral disorganization. No remedy, next to the adjustment of a diet as generous as the patient can take, is equal to the extract of sarsaparilla in these cases. The infusion of the root in lime-water is a form admirably adapted to a weakened stomach, and with this fresh milk may be advantageously combined in equal proportions; but the extract dissolved either in its decoction, in milk, or in lime-water, to the amount of half an ounce per diem, or more, is the restorative upon which I rely in these cases. Its power is most extraordinary, more so than that of any other drug with which I am acquainted. To regard it as inert, as a mere diluent or an offen sive nutrient, is either a proof of a very limited experience or a very prejudiced observation. It is in the strictest sense a tonic, with this invaluable attribute, that it is applicable to a state of the system so sunken and yet so irritable, as renders other substances of the tonic class unavailable or injurious."

We have taken the liberty of mark ing in italics the passage respecting sarsaparilla, because we most cordially concur with Mr. Travers in the senti. ment which it contains. To consider sarsaparilla as an inutile lignum, a thing no better than saw-dust, appears to us to be the acme of prejudice, the wild fanatic scepticism of a book-learned theoric. But our space is nearly consumed, and yet we are unwilling to close this short review without enriching our pages with a graphic description of a frightful form of venereal atfection; it is the Swan-alley sore.'

“I shall avail myself of this opportunity to notice a peculiar and very formidable distemper, arising from the unlimited intercourse of young and delicate girls of scrofulous temperament, chiefly with foreign sailors, many of them lascars or men of colour, frequenting the brothels in the vicinity of the East and West India and London

Docks. The district of St. Catherine's (until recently converted into docks) was the most notorious for the propagation of this pestilence, and a place in that quarter called 'Swan Alley,' has given the sore that appellation in St. Thomas's Hospital. The subjects of the disease are almost exclusively females. I remember only one instance of a boy similarly affected, in whom the disease went unchecked to a fatal termination. The girls are slender, with very thin fair skins, and often light hair, and generally from 15 to 25 years of age. They have been a few months before decoyed by the Jews who keep these houses, and are systematically on the look out in the great neighbouring thoroughfares. The girls newly arrived in London, while in search of lodgings until they procure places, become victims to these miscreants.

"They receive the visits of as many men as there are hours in the day, and are supported on scanty food and abun dance of gin. Their visitors do not al ways restrict themselves to natural connection. When they become constitutionally ill, their keepers send them to the hospitals. The Magdalen ward of St. Thomas's is seldom without one or more of them. They have been only two or three days in the house, when the character of the sore displays itself; for by reason of the previous illness they are rarely detained in their occupation long enough for the ulcer to have assumed its genuine features. It is a circumscribed irregular ulcer with an inflamed blunt edge, usually situated at the lower angle of one labium, or in the cleft of the nates. When the sore inflames, its edge acquires a dark crimson colour to some distance around; the surface is covered with a deep, tenacious, ash-coloured slough, and it extends so rapidly, as to be increased visibly from day to day. It is generally attended with excessive unremitting pain, a very rapid and contracted pulse, great paleness of the surface, total failure of the appetite, and great depression of strength and spirits. It is, in fact, acute gangrenous inflammation. Where they recover, no secondary symptom of lues appears; nor is the disease

in any degree contagious. The treatment now adopted seldom fails to arrest it, unless admitted in a very advanced stage, as after the sloughing process has been some time established when the devastation is truly terrific. In addition to the slough of the pudendum, I have seen the entire lower opening of the pelvis deprived of its soft parts. The girl dies typhoid with a dry black tongue, and is first delirious, then comatose.

"When the pain is severe and the disc of inflammation strongly marked, blood-letting is beneficial to both. I usually apply lint soddened in a saturated solution of the extr. opii, over this a poultice of linseed meal, and cover the whole with a fomentation flannel. This seldom fails to relieve, if not to remove the pain. The exposure of the sores and the change of dressings much augment it; the continued application of warmth and moisture as much abate it. After clearing the bowels with castor oil, I gave a draught of camphor julep with a drachm of ether, and ten minims of the tinct. opii every four hours; and half a grain of opium additionally, if the pain is very urgent. If the slough is fast and the ulcer extends, the surface is washed freely with the strong nitric acid, and it is remarkable that very shortly afterwards the girl expresses great relief. The London treacle poultice I likewise find an excellent application, covered by the fomentation flannel. The object to be looked to for directing the application, is the colour of the surrounding skin; when this pales, the dilute nitric acid lotion, ten drops to an ounce of water, is the best application. Fresh eggs and milk, and as the stomach acquires tone, a mutton chop, and from ten to twelve ounces of port wine daily, are an appropriate support. The occasional repetition of the oil or the common enema should not be neglected under the habitual employment of opium.

"The strong acid must be repeated each third or fourth day, till the whole surface granulates. When the girl sleeps and takes nourishment, notwithstanding an immoderately quick pulse, she does well; and the sore, when once

clean, heals rapidly under the dilute acid lotion and simple cerate. The bark is useful at this period, but very secondary to the opium, wine, and nutriment. The former should be gradually reduced. A lotion of the chloride of lime and caustic soda, three drachms of the first and one drachm of the last to half a pint of water, acts with magical celerity in clearing the sloughs in many cases; but I have not found it so applicable or efficacious during the stage of acute inflammation, as when it is subdued. I once saw mercury rubbed in to rapid salivation, with manifest acceleration of the destroying process, and the vital powers were further greatly sunk by it. I have seen the inflammation begin after the taking of half a dozen blue pills, one every night and morning, which had been prescribed upon the girl's admission for a sore, which was then small and indolent, in ignorance of its character and tendency."

Mr. Travers believes that this sore is neither the result of the irritation of the matter of gonorrhea, nor merely a local disease. Bad constitutions, incessant local stimulus, want of clean linen, and the substitution of burning spirits for proper nutriment, induce as soon as ulceration appears this gangrenous phagedæna. The last point mooted by our able author is the origin of the venereal. Now we should just as soon dream of sailing to Cat Island, and invoking the manes of the Aborigines who first saw with wonder the Spanish caravals emerging from the bosom of the Western Ocean, as of ripping up this long-disputed question. It is very well for gentlemen with some leisure and much learning, but for us-morbleu ! it would be perdition. We cannot conclude without expressing the gratification we have derived from perusing this little Essay of Mr. Travers', of which we have now extracted the marrow for our readers. We beg Mr. T. to accept our best acknowledgments.

XI.

agitation of the other muscles, and was slightly furred in the centre. He com

NITIS.

THE following case is related by Dr. La Roche in our valuable trans-Atlantic contemporary, the North American Medical and Surgical Journal, for January of the present year.

Mr. E. G. æt. 60, of muscular frame and nervous temperament had long been subject to dyspeptic and hypochondriacal symptoms, and attacks resembling hysteria. His habits of life were, Dr. La Roche believed, regular, but six or seven years ago he was seized with an unusually severe paroxysm of nervous irritation, accompanied with slight delirium. A year ago when in Holland he had a still more violent attack, which would seem to have been considered as allied to delirium tremens, for it was treated successfully by opium. From this time till early in October Mr. G. enjoyed tolerable health, but he was then observed by his friends to become morose, avoid company, evince an occasional loss of memory, and complain of rheumatic pains in his lower extremities.

"At last, on the 19th of October, the explosion took place. I was called to see him at twelve o'clock of that day, and found him as follows: The muscles of his extremities were all in motion; he was unable, on this account, to remain on his feet or to walk. He could hold nothing in his hands, and it was with the utmost difficulty I could steady one of his arms sufficiently to feel his pulse. While holding my finger on the artery I could perceive a vibratory and continual motion in the muscles. His mind was perfectly sound, though his speech was rather more abrupt than usual. He had not slept the night before, and attributed all this agitation and a little heaviness over the eyes to this circumstance. His eyes were not affected by light: the head and indeed every part of the body was free from pain; but on sitting in bed he experienced some giddiness. The tongue was of a natural colour on the sides and tip, partaking a little of the trembling and

pulse about eighty, and rather hard and full; skin covered in parts with perspiration, but of natural temperature. He conversed gaily about his agitation, and related to me all I have stated above concerning his former at⚫tacks."

The patient objected to depletion and some opening medicine with abstinence were ordered, followed by mustard pediluvia, and night pills of camphor and acetate of morphia. On the next day he was so much better as to be found by the physician reading the newspaper, but the agitation of the muscles still remained. The sedatives were repeated, but towards evening he felt his hallucinations coming on, and accordingly next day they were fully established. Troubled images of dogs, cats, and men floated almost constantly before his eyes, the pulse became active and tense, and the tongue foul. Like persons affected with the mania à potu there was an odd mixture in the case of positive aberra tion and a knowledge of the unreal nature of his fantastic imagery. Depletion was refused, and infusion of senna with valerian was employed as a purge, with the application of cold to the head. The medicine operated well, and the patient appeared to be better, yet an oddness of manner remained, and thirty grains of assafoetida with two of acetate of morphia were prescribed, one half to be taken at bedtime and the other half in an hour if sleep was not procured. He retired to his room, but at 3, a.m. next morning jumped out of his window on the third floor, having previously locked his door for that purpose. Another physician prescribed a dose of laudanum after this occurrence, he fell into a quiet sleep, but this was even longer than the dreamer Nourjahad's, for he never woke again!

"On opening the cranium a large quantity of fluid escaped. The arachnoid on both parietal, as well as on the upper regions, was found thickened, and in some places slightly opaque. Other parts of this membrane, as also the pia

mater throughout, were highly vascular, and between them there was discovered a considerable serous effusion. The substance of the brain was much softer and more vascular than usual. The ventricles centained a large quantity of fluid, and were, especially the left, morbidly enlarged; so much so indeed, that Dr. HORNER and the rest of us were inclined to believe the subject must have suffered at one time from a chronic hydrocephalus. The cerebellum was also very vascular, but presented no unusual appearance. At the lower edge of the falx the dura mater was found ossified in a circumscribed spot.

"Back-On making an incision over the spine, from the neck to the sacrum, a considerable effusion of blood was seen at the lower part of the spine and beginning of the sacrum, not perceptible by any discolouration or swelling externally on the skin. No fracture of the spine could be discovered, and the spinal cord was found healthy through

out.

"Abdomen. On raising the intestines, a very extensive effusion of blood was visible under the peritoneum. This cut, the blood was seen partially coagulated over the region of the iliac veins, extending somewhat upward; but more particularly down into the cavity of the pelvis. No rupture of a large vessel was perceptible, so that we were led to infer that the blood proceeded from the rupture of several small veins.

"The stomach was somewhat distended, and contained a quantity of fluid, which, from its appearance and smell, could be easily recognized to be the wine and water and laudanum that had been administered an hour before death. The inner surface of this viscus was of a light ash colour, and the mucous coat so softened in its whole extent, that it was with the greatest ease scraped off with the handle of a scalpel. A portion of the mesentery was ruptured, and an effusion of blood was found between its laminæ. The liver was white and small.

"Thorax.-A large ecchymosis was found in the substance of the dia

phragm. The right lung was healthy in its whole extent. In the anterior portion of the left, a cicatrix of the size of half a dollar was discovered; around it a few aborted tubercles were situated. On neither side was there any adhesion of the pleura."

Dr. La Roche in his remarks on the preceding case, rather coarsely expresses his astonishment that it should "never have entered the heads of this patient's physicians for a minute," that the symptoms depended on an inflammation of the meninges. "Yet dissection," says the Doctor, "revealed to us the existence of a chronic inflammation of the arachnoid, which in all probability was the result of the acute forms of the disease supervening at every repetition of the complaint." Now we are by no means so certain of the truth of these statements as Dr. La Roche, for neither are the evidences of chronic inflammation of the arachnoid indisputable, nor the occasional attacks of acute inflammation of the same undeniable. An increased quantity of serons fluid, and that to a considerable amount, between the arachnoid and pia mater may exist without any inflam mation of either, and for the confirm ation of this statement we appeal to all who are in the habit of opening many bodies. We affirm that in two cases out of four, an effusion of serum to some extent between the membranes in question will be found after death. Neither is the enlargement of the cavities of the ventricles, a positive sign of arachnitis, on the contrary such enlargement is most frequent in dropsical patients, and independent in many instances of any thing a-kin to inflammatory action. We demur then, for these anatomical reasons, to the opinion that arachnitis necessarily existed, and our doubts are increased by the history and progress of the case. We grant that there was an excitement kindled up from time to time within the head, but we question

*The violent death of the patient would prevent our pinning any faith on the partial vascularities observed in the cranium.