Mr. G. B. aged 23, came to me in the month of June, 1813, with a very foul ulcer beneath the tongue; and said that he some time before had one on the upper part of it, which he said was healed; but on examination, there was a deep, irregular fissure, with raised, jagged, hardened edges, communicating with the ulcer under the tongue; which on examining with a probe, I found not only communicated with the fissure on the upper surface, but the instrument passed through the substance of the tongue, into a deep-seated ulcer at the root of it, and thence into the throat. The general appearance of the disease was most alarming, bearing a very strong character of carcinoma. A variety of means had been resorted to, without procuring the least alleviation of his sufferings, or producing any alteration in the state of the ulcer; he experienced great pain and difficulty in deglutition, and complained that the pain had of late extended behind the ears, to the back of the head and neck: mercury had been administered, but with evident bad effect; and the disease not only resisted every effort made to arrest its progress, but its baneful influence appeared to be extending itself to all the adjacent parts. The general health of the patient had sunk considerably; his pulse was small and tremulous; and he complained of excessive fatigue from the slightest exertion; his hand felt cold and clammy, and there existed a total want of energy in his whole system.

Under these circumstances I thought it a case in which arsenic might be administered with advantage; and I gave him ten minims of the solution every eight hours, gradually increasing the dose until he had experienced some sensible effect from it; and seventeen minims was the largest dose his stomach would at any time bear-the ulcer was injected twice a day, with a lotion containing a small portion of the solution in it, and I desired him to live on a light vegetable and farinaceous diet, with milk, and to abstain from wine, spirits, and fermented liquors; his bowels were regulated by means of small doses of magnes. sulphas.

The ulcer in about ten days put on a more favourable aspect, and at the end of a month it appeared perfectly healed.

Mr. B.'s health being now greatly amended, he indulged himself in taking very strong exercise; nor did he any longer restrict himself in his mode of living; and at the termination of some weeks the ulcer again made its appearance, and again yielded in about three weeks to the same mode of treatment. Not deterred by what had before occurred to him, he again became intemperate in his use of exercise, and careless in his manner of living; and at the latter end of the month of September, the disease returned with all its train of horrid symptoms, very greatly aggravated: at this time business calling me to town, I requested him to take the opportunity of consulting you; but before we commenced our journey I emptied his bowels well with magnes. sulphas, and once again desired him to have recourse to the solut. arsenici; and although he had taken it but four days, when I had the pleasure of seeing you, which was on the 1st of October, 1813, the ulcers had evidently assumed a much better appearance; and you desired him to continue the solution, taking at the same time, a drachm of pulv. sarsaparillæ twice a day: you likewise enjoined a most strict attention to that kind of diet which I ordered in the first instance; and impressed on his mind, the absolute necessity of persisting in it, for a very considerable time after the ulcers should again heal. He took the solution in doses of seventeen minims every eight hours for three weeks; the ulcers again healed, and he continued taking the solution for ten days after they were well. He complained at this time of great languor and debility; his pulse was small, feeble, and very quick; I prescribed for him two ounces of the mist. ferri comp. to be taken twice a day, which he continued taking for a considerable time with the most decided good effect; and I am happy to report, that this most alarming disease had at last yielded to the treatment he had now steadily pursued, and he has continued to enjoy an uninterrupted state of good health unto the present time.

I delayed troubling you with this statement, that I might have an opportunity of ascertaining the permanency of the cure; as more than three years have elapsed since the ulcers

had healed, I think I may safely calculate on the disease being perfectly subdued.

With every sentiment of esteem and respect, allow me, dear Sir, to subscribe myself,

Your most obliged and faithful,

TO HENRY CLINE, Esq.

CHARLES LANE.

On a new Mode of exhibiting Mercury; with Remarks upon Amputation at the Shoulder Joint. By JOHN GOOCH, Esq. Surgeon, R. N.

[From the Annals of Medicine and Surgery, for March 1817.]

EVERY surgeon is aware of the accidental manner in which Mr. Crowther salivated his patient, by dressing a blistered surface with an ointment, containing the corrosive sublimate; still no attempts have been made to try the effect of impregnating the system in this way, probably from the severe pain and inflammation produced by it in Mr. Crowther's patient; for, I must confess, this often deterred me, when in actual service, from making trial of the practice, in preference to that disgusting but efficacious mode, of inducing salivation by inunction. Accident has, however, discovered to me a mode of impregnating the system by the sublimate, with but a very trifling degree of pain to the patient. A few days since I was consulted by a most intimate friend, on the subject of a little boy, eight years of age, who had caught the itch, from sleeping with the servant; and as it was particularly wished to avoid the use of sulphur, I directed the whole surface of the body to be sponged nightly with a strong solution of corrosive sublimate dissolved in common gin: this, after the third application, caused considerable irritation on the surface, and raised some small vesications on the abdomen, where the eruption had been more full; these were suffered to break, and in twelve hours, without any application, they were quite sunk and dry without pain or irritation, and the boy's system was strongly impregnated by the medicine, the breath being highly fetid,

and the fauces somewhat swelled and sore. Although Mr. Pearson does not speak favourably of the sublimate in the cure of primary syphilis, yet he acknowledges it to be peculiarly "efficacious in relieving venereal pains, in healing ulcers of the throat, and in promoting the desquamation of eruptions;" and if so, what a great advantage it must be, to be enabled to apply this virulent medicine with better effect to the surface, than to the delicate coats of the stomach, where, from its nauseous qualities, few are able to retain it, except after a full meal. This practice, of sponging the surface with a solution of the sublimate, appears to me to be particularly applicable to cases of venereal eruptions, and worthy of trial in all cases, as a cleanly and far preferable application to the black and greasy unguent; and I would recommend to my naval brethren, whose practice is more absolute, to make full trial of it, and report the result. The principal object in the use of the ointment is to impregnate the system without impairing it, by not affecting the bowels, as the internal prescriptions will do in spite of all the opium we can use. After the system has become affected by the use of the solution, the mercurial action may, I imagine, be sufficiently supported by the use of the pil. hydrarg. should the irritation on the surface be so great as to forbid its further application. Should such a mode of producing mercurial action in the system be found to answer, how gladly would it be embraced by persons in all ranks of life, as simple and cleanly; and we should not find those insuperable objections we now meet with, when recommending the use of the unguent in preference to the pill.

17th Jan. 1817.

JOHN GOOCH,
Surgeon, R. N.

P. S. I do not mean to deny that the mode of fumigating the system, as recommended by Abernethy and Silonette, is not far preferable to this, where it is convenient to apply it; but this happens in few cases, except those under hospital treatment, where the surgeon no sooner forms his determination than he has the power to put it into execution.

Now that I am trespassing upon your columns, I shall take the liberty of offering a few observations on that "dreadful VOL. VIII.

D

No. 29.

operation," as it is called, of amputating the arm at the shoul. der joint, and which has lately been touched upon by Mr. Charles Bell, in his collection of surgical cases. That gentleman appears to doubt the possibility of entirely commanding the flow of blood by the compression of the subclavian artery, and recommends, after dividing the capsule to introduce the thumb of the left hand into the joint, "betwixt the glenoid cavity and the head of the humerus," and bending the fingers of the same hand into the axilla, to compress the artery between them and the thumb, whilst performing the semicircular incision which separates the arm from the body, and of course divides the artery. This has a very specious appearance; but might not many practitioners, operating in this manner, leave too much integument to form a handsome stump; as, in my opinion, the beauty of an amputation at the shoulder depends on the flap formed by the deltoid being rather small, and the integuments beneath not left too long, so as to require some little adhesive power to bring the edges of the wound together. As to the power of commanding the blood by pressure above the clavicle, there can, I think, be but one opinion, viz. that it is at all times possible, by the thumb of an assistant, or an instrument adapted to the parts; and perhaps the best that can be used is a boot-hook, lightly padded. With regard to calling the operation bloody, or dreadful, it is in my humble opinion ridiculous, as I conceive it may at all times be performed with greater facility, and with as little pain to the patient, as a common amputation: I do not wish it to be understood by this, that I am an advocate for the performance of this or any other operation, unless absolutely necessary, but to do away the idea of frightening the young surgeon, by making him believe the "mole-hill to be a mountain."

History of a case of Lithotomy, with a few remarks on the best mode of making the Incision in the Lateral Operation. By SAMUEL COOPER, Esq. surgeon to the forces.

[From the Medico-Chirurgical Transactions, Volume VIII. Part. I.] Of all the great operations in surgery, lithotomy is perhaps that, in which great aukwardness, mortifying failures, and