symptoms of this poison, were too few to form any conclusion with respect to this particular.

"Fourth, and lastly. That the phagedenic and sloughing ulcers are generally attended by constitutional symptoms of peculiar obsti macy and malignancy; viz. pustular spots and tubercles, which formed vlcers that spread in general with a phagedenic edge, and heal from the centre, Extensive ulceration of the fauces, particularly of the back of the pharynx; obstinate pains of the knees and other joints; while nodes are frequently present, and the bones of the nose are oc, casionally affected."

After passing in review the opinions of Mr. ROSE, Mr. Gu THRIE, Dr. THOMSON, and Mr. HENNEN, respecting the cure of the syphilitic species of disease without mercury, the author relates the results of his own experience. We may now pass over this part of the work, since it engaged our attention on a former occasion, (see vol. xli. p. 60 et seq.) to the chapter on Iritis.

In his former essay on Venereal Diseases, Mr. Carmichael expressed himself disposed to consider venereal iritis as a consequence of the poison of syphilis, or that which occasions the chancre (of JoHN HUNTER) and the scaly eruption, because he had always seen it yield quickly to mercury, and he had not then seen this affection accompanied with any eruption. Since that period he has met with many cases of this combination of symptoms, and, with one exception, the eruption was always papular: of this, several cases are adduced. These observations are particularly interesting; they serve to elucidate an obscurity in the history of iritis, which so much embarrassed Mr. TRAVERS in his researches into the nature and cure of this affection. We cannot follow the author through all his judicious and highly valuable reflections on this subject; but, by way of summary, it may be stated, that it appears, from Mr. Carmichael's observations, that iritis is a symptom of the disease attended with the papular eruption, which disease will run its course in spite of the use of mercury, although some of its symptoms may be removed by that remedy; that it will occur with the papular eruption, when no mercury has been used; that it will happen without the presence of any eruption; and that, in either case, the use of mercury, although not essentially necessary for its cure, will be beneficial in conjunction with antiphlogistic measures, by assisting in removing the inflammatory action, and by preventing its disorganizing effects.

The subject of the next chapter, the phagedenic ulcer, is the most serious, and hitherto the least understood, of the forms of venereal disease. We may, in the first instance, refer the reader to the thirty-fourth volume of this Journal, for Mr. Carmichael's description of the character of this ulcer.

The origin of this from a peculiar species of morbific poison, has been disputed by some pathologists. They consider its phagedenic character to depend on the state of the constitution of the patient; and state, they have observed many cases of venereal ulcer, of the ordinary character on their first appearance, which have subsequently assumed all the characters of the ulcer designated by Mr. Carmichael as the primary phagedenic ulcer, and which have also been followed by the eruption he considers peculiar to that species of primary affection. This objection has been expressly made by Mr. GUTHRIE. This is an important objection, because, what forms the most powerful evidence of the propriety of Mr. Carmichael's distinctions, is the constant and regular connexion of the primary and secondary symptoms which he has described. In reply to this, the author states, that in every instance where he has had an opportunity of tracing the constitutional symptoms to the primary ulcer, this ulcer has always exhibited the phagedenic character; and it should be observed, that Mr. Guthrie acknowledges that the ulcers he refers to became afterwards phagedenic.

There is much difficulty attendant on the investigation of this question, which, as Mr. Carmichael readily acknowledges, requires further observations to enable us to come to a decision. These ulcers, he remarks, are not often seen in their first stage, generally not till some days, or even weeks, have elapsed, in consequence of the little uneasiness they then occasion; and to this must be added the fact, that various accidental causes will make any species of ulcer become phagedenic. The constitutional symptoms that Mr. Carmichael has seen ensue from ulcers of the latter kind, have however been of a mild character, and readily admit of cure; whilst those that have occurred after the primary phagedenic ulcer are always of a formidable character, and long and difficult of cure.

We, on a former occasion, mentioned that Mr. Carmichael had some doubts respecting the power of mercury to prevent constitutional affection from the syphilitic primary ulcer; he is still less disposed to place confidence in the efficacy of that medicine to prevent the constitutional symptoms of the phagedenic disease. He does not absolutely protest against its use; but, if it be employed, it should not be resorted to until the primary ulcer is perfectly healed. It is decidedly injurious in all cases in the primary affection. This latter point is generally agreed on by experienced surgeons; and wine, bark, and opium, are the remedies on which they have usually placed their reliance, until its phagedenic character has disappeared, and the ulcer, if not quite, at least very nearly, healed. Mr. Carmichael places most reliance on the efficacy of copious blood-letting in the treatment of this disease. He has frequently seen cases

where the ulcers spread rapidly under the use of the remedies we have mentioned, but ceased their ravages on the occurrence of a spontaneous or artificial hæmorrhage. With this he has usually conjoined antimonials, purgatives, cicuta, and opium. Warm fomentations and bread-poultices, frequently with the addition of opium, are recommended, as local applications. In every instance, low diet and the recumbent position should be strictly enjoined.

We now enter on the consideration of the secondary symp toms, which the author considers to be peculiar to the species of primary ulcer just described.

The eruption is frequently ushered in by a high degree of fever, and it "quickly passes into ulcers covered with thick crusts, that heal from the centre, whilst they are extending at the circumference with a phagedenic border." To this descrip tion we shall add some particular observations that our own. experience has afforded, which we think may be useful to the young practitioner, in assisting him to form the diagnosis of this affection. Whether it is the result of the influence of a distinct poison, or of syphilitic virus modified by particularity of constitution, may admit of doubt; but it is certain that there is an affection, offering constantly the morbid characters here, detailed, which is always formidable in its progress, and for which mercury is not an efficacious remedy. Reasoning by analogy on these data, would lead us to consider it as a distinct disease.

The eruptions, a few days after their first appearance, we have usually found to be about the size of a pepper-corn, not quite so prominent as the pustules of small-pox, forming about half a sphere; they are not surrounded by much diffused redness in the first instance, but this appears generally at a later period; the interstices are then very red, or of a purplish colour. The arms, neck, face, and shoulders, are the parts chiefly, and almost simultaneously, affected. The ulcers are very painful, and sometimes spread to a diameter of one or two inches often covered with fungus; and, when clean, have a scooped appearance. We have a suspicion that this disease may be communicated by these secondary ulcers, from having witnessed an ulcer on the prolabium of a female, obviously produced from contact with the matter of the secondary ulcers just described, which assumed all the characters of the primary phagedenic ulcer, and caused a considerable destruction of parts, before it was induced to heal by the exhibition of wine, bark, and, opium. It should be observed, that there was a slight breach of surface on the lip before the contact of the morbid matter. We could not ascertain whether or not this patient had secondary symptoms, having lost sight of her soon after the healing of the ulcer.

The affection of the throat, Mr. Carmichael observes, that attends the phagedenic disease, is of the most formidable character: it attacks more particularly the back part of the pharynx, sometimes passes upwards to the nares, and occasionally extends to the epiglottis and the larynx. The ulcer is mostly covered with a thick, white, tenacious, matter, and is attended. with considerable difficulty in deglutition. The ulceration often extends to the adjacent bones. It is this disease which causes the destruction of the bones and cartilages of the nose. Mr. JOHN PEARSON used to state, in his lectures on the venereal disease, that he had seen only two or three cases where the nose had been destroyed by syphilis, when suffered to proceed uninterrupted by art; but a great many by the influence of mercury. Mr. Carmichael has shown us how this circumstance should be regarded; that it is not from the influence of mercury alone that this destructive ulceration has ensued, but from mercury having been employed in the treatment of the phagedenic disease, and generally to a very great extent, in the hope of thus deriving benefit from it, after the ordinary measures had been used in vain: finding, then, the disease exasperated by the use of the medicine, the surgeon was led to consider it as the consequence of its agency.

Inflammation of the parts constituting the joints, especially of the synovial membranes, is another frequent affection in this disease.

Nodes were only traced to the phagedenic primary ulcer in such cases as were treated with mercury. Both Mr. Guthrie and Mr. Rose have stated the remarkable infrequency of this symptom in numerous cases which were treated without that medicine. The question, there fore, whether they occur in this form of disease where mercury has not been exhibited, remains to be resolved by future experience.

"The train of symptoms I have been endeavouring to describe, is so often found to be injured rather than benefitted by the exhibition of mercury, that we may well ascribe to this circumstance the coinage of the favourite terms mercurial, (in the unrestricted sense in which it is employed,) syphiloidal, sequelæ, &c. &c. and I have no doubt but that this form of venereal disease at length led to the present in

vestigation, to ascertain how far complaints can be combated

without the exhibition of mercury; an investigation, which, in spite of the common-place declamation and untractable dogmatism of professional bigots, will, I am persuaded, lead to an improved line of practice, and confer the most important benefits upon society."

Mr. Carmichael repeats, that he has not a doubt but that the embarrassing obstinacy of this disease arises from the premature and indiscreet interposal of mercury, which interrupts and encumbers its natural progress, and transfers it to the deep-seated parts, as the periosteum, fasciæ, and bones.

The synopsis of the pathology and treatment of venereal dis eases according to the doctrines of Mr. Carmichael, (which is transcribed in another part of this Journal,) will furnish a general account of his precepts for the treatment of the constitutional symptoms of the phagedenic malady. We shall here only observe, that mercury is of but occasional and partial utility; is more frequently deleterious than beneficial; although it sometimes alleviates some of the symptoms, it will not check the progress of the disease; and new symptoms commonly appear, when the system has been long under the influence of that medicine.

This disease in many respects resembles yaws; and the author refers to the work of Dr. ADAMS on Morbid Poisons, for some interesting facts and valuable observations illustrative of this resemblance.

We cannot follow the author through all his reflections on the mode of treating the different forms of this disease; they can only be contemplated with all the benefit they are calculated to produce, in connexion with the cases which accompany them, which serve as illustrations. We must also remark, that the value of the doctrine contained in this work is much increased by a view of it which now forcibly presents itself. The author has methodically illustrated his principal points of theory by ap propriate cases, which render his descriptions perspicuous, and at the same time show the bases on which they are raised,

The diseases of a less-distinctly marked character, though resembling in some respects the phagedenic malady, is next considered. On this subject we do not find many observations of important novelty, after the history Mr. ABERNETHY has given of those affections.

This work concludes with some critical remarks on the opinions of Mr. CHARLES BELL respecting the nature and treatment of venereal diseases.

From the account we have given of this treatise, it must, we think, be evident that it is calculated to be productive of much benefit to medical science. Although the pathological distinctions the author has formed of the diseases that form the subject of it should not prove to be precisely correct, a question which remains to be decided by further experience, his accurate and perspicuous histories of those affections will not be the less valuable, either in a nosographical or therapeutical point of view: all other objects are of far inferior importance. The true principles of medical logic which have guided the author's researches, and the methodic manner in which he has displayed the results of his labours, may serve as a model to those who may continue the investigation of the history of the same maladies.