THE LANCET,]

ON POISONING BY TINCTURA FERRI PERCHLORIDI.

Those, students or otherwise, really interested in the subject, who wish to recall their knowledge of the anatomy and general functions of this complex organ, will find the best résumé of the subject in Mr. Wharton Jones's and Dr. Todd's essays in the "Cyclopædia of Anatomy." Although this treatise was published thirty years ago, its general accuracy, as far as knowledge of aural science then extended, cannot be impugned; and perhaps the best testimony to its excellence as an anatomical guide is the re-appearance of most of the engravings and diagrams as illustrations to Professor Owen's last volume on Comparative Anatomy and Physiology" (article Hearing) just issued from the press.

[JAN. 2, 1869. g

now related the bottle was full, and she had not taken any food for about seven hours. At 4 P.M. on the day named, Mrs. R, after a quarrel with her husband, in a fit of passion, swallowed the whole contents of the bottle, with a view to commit suicide. She continued well for about a quarter of an hour, when violent convulsions affecting the whole body came on. I arrived a short time afterwards, and found her lying on a sofa: face somewhat flushed, eyes injected, pulse small and accelerated; unable to speak, and apparently unconscious. A little mustard-and-water had been given her without effect. Another spasm soon came on, during which the body was much contorted; the muscles of the extremities contracted violently, and the teeth were clenched and ground together. She required to be restrained upon the couch, and her hold upon those near her could not be unloosed until the spasm suddenly ceased. She then appeared free from pain, but was only partially conscious, and continued unable to speak. After some little difficulty in opening the mouth, I gave her a sulphate-of-zinc emetic, with plenty of warm water. As this did not act, and the spasms recurred, in the next interval I repeated it, this time tickling the fauces with a feather. Copious_vomiting ensued, of a clear, reddish-yellow fluid, evidently containing a considerable amount of tincture of iron, with a little mucus. I may here remark that the duration of the attacks was about two minutes, that of the intervals three. After the vomiting, immediate relief was experienced; no more spasms came on, and she rapidly recovered the use of her faculties and limbs. Half an hour after the sickness she had an attack of diarrhoea, with black stools, which soon ceased. At 9.30 P.M. the patient felt quite well, with the exception of some soreness and stiffness of the limbs.

The chemist who supplied the "steel drops" told me it was the Tinc. Ferri Perchloridi, B.P. The symptoms of irritant poisoning in the above case were doubtless caused by the free hydrochloric acid, which is always present, more or less, in tincture of iron.

In reflecting upon the physiology of the tympanum as a whole, and upon the perfection with which all its component parts are arranged for the purposes of receiving, intensifying, and transmitting the aerial vibrations which impinge upon its external membrane, I am surprised to find that no physiological writer seems ever to have entertained the notion that the cavitas tympani contains air that has been respired. There is most conclusive evidence to show that in tranquil respiration the tympanum is usually closed against the ingress, through the Eustachian tube, of air respired or unrespired, of gases from the stomach, or even sounds generated in the fauces or mouth; yet, under certain normally-performed muscular actions, the air is permitted to enter and to escape from the interior of the tympanum in such proportions as may be requisite for maintaining the same tension on the inner as on the outer side of the membrana tympani. Without such arrangements for renewal and equalisation of air, the requisite vibratility of the tympanic membrane could not be maintained the air would become exhausted or absorbed, the membrane and ossicles would fall inwards, causing pressure upon the vestibular fenestra and labyrinth fluid: a condition attended with great diminution of hearing-in fact, all the symptoms usually depending upon an abnormal obstruction of the Eustachian tube would result. Besides the strong presumption that the tympanum, with its mastoid cells, would contain air already heated to an appropriate temperature, and fitted to circulate in and against delicate fragile structures in close proximity to the interior of the cranium, the idea receives confirmation by a personal experiment, which doubtless almost everyone has at one time or another unwittingly performed. This test is best applied out of doors on a cold day, for reasons which will appear obvious. Try to remove an irritant or adhesive mucous secretion from the upper and back part of the palate and fauces by repeated suction of air through the nose, with the mouth closed; you will put into action the levator palati muscle, by which the arch of the palate will become raised to some extent, and the inner wall of the Eustachian tube drawn apart from the outer; and if at the same time an attempt be made to yawn, with the mouth closed or only partially opened (para- inter se comparare.-MORGAGNI De Sed. et Caus. Morb., lib. iv. Proœmium. doxical as this act may seem), the tensor palati will be also put on the stretch, and the Eustachian tube still more widely opened by its outer wall being drawn apart at every fresh suction of air through the nostrils (the glottis being raised in this inspiratory movement), and cold, very appreciably cold, air will be drawn into the tympanum.

At this point, I cannot refrain from observing that by this experiment, as well as in further explanation of acoustic phenomena, Mr. Toynbee's strongly reiterated opinion, now generally accepted, that the Eustachian tube is only opened during an act of deglutition, is proved incorrect. (To be continued.)

Holland-place, Edgehill, Dec. 14th, 1868.

3 Mirror

OF THE PRACTICE OF

MEDICINE AND SURGERY

IN THE

HOSPITALS OF LONDON.

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, tum aliorum, tum proprias collectas habere, et

UNIVERSITY COLLEGE HOSPITAL.

TYPHOID FEVER; PERFORATION OF INTESTINE; LOCAL
PERITONITIS; ABSCESS DISCHARGING THROUGH
ABDOMINAL WALL; RECOVERY.

(Under the care of Sir WILLIAM JENNER.)
PERFORATION of the bowel, in typhoid fever, is computed
to occur in about 13 per cent. of cases of the disease ter-
minating fatally. A patient, who is now in this hospital,
and whom we saw a few days since, has sustained this ac-
cident under circumstances which were unusually favour-
able to him, and of very peculiar character. It is known
that occasionally a local peritonitis in connexion with the
base of an ulcer may cause adhesion of the bowel to a
neighbouring coil of intestine, and so a circumscribed ab-
scess may form, discharging itself into the bowel. But in
the case to which a brief reference is here made, the in-
flamed intestine has apparently attached itself to the peri-
toneal lining of the abdominal wall, and the abscess result-
ing from perforation, circumscribed by this adhesion, has
We are indebted
opened externally through the parietes.
to Dr. Squarey, the resident medical officer, for some
particulars of the case.

operation was very severe; but it was relieved, and sleep obtained, by subcutaneous injections of one-third of a grain of morphia, repeated as often as his sufferings rendered it necessary.

The patient, Henry P, aged thirteen, is a pawnbroker's boy, who was admitted on Nov. 27th, 1868, greatly emaciated, with a small opening just below his navel, discharging greenish-yellow fetid pus. The history showed that this was immediately connected with the intestine, for On the fourteenth day after the operation, we saw the food passed through it after his admission. It seemed that sloughs produced by the chloride of zinc lifted away with a several weeks previously he had gone through an attack pair of forceps from the orbit. As they were removed, they of typhoid fever, and was supposed to have recovered. He left the bones which they had covered perfectly bare and was allowed to get up, go about the house, and eat different blanched. No doubt in this as in the first case there will kinds of food; and, for some reason or other, a powerful dose be considerable exfoliation of bone. If any suspiciousof a drastic purgative was given to him. Some days after- looking granulations should spring up, they will be touched wards a swelling appeared in the abdomen, which was freely with the solid chloride of zinc, or with potassa poulticed, and soon broke "with a report," as was stated, cum calce. "like a pop-gun." This had been discharging two or three weeks when he was sent to the hospital. A drainage-tube was inserted, and proper measures were adopted for sustaining him. When we saw him, the tube, through which the discharge had been gradually diminishing, had been withdrawn, as no longer necessary, and the site of the opening showed a healthy granulation. There was still some tenderness upon pressing the abdomen, the muscles of which were kept in a somewhat rigid state; but to all intents the boy had recovered from this serious complication. Unhappily, however, his lungs show evident symptoms of advanced tubercular disease, dating, it is probable, from a period antecedent to the attack of typhoid.

GREAT NORTHERN HOSPITAL. THERAPEUTICS IN CERTAIN CASES OF UTERINE DISORDER.

(Under the care of Dr. MURRAY.)

We believe Sir James Simpson was the first who drew attention to the use of an intra-uterine galvanic or zinc and copper pessary in the treatment of amenorrhoea, the result of an imperfect development of the uterus. Lately we have noticed these pessaries being used by Dr. Murray for the The case seems deserving of being placed on record, not cure or relief of an almost opposite condition of mattersonly on account of its extremely rare character, but as a namely, subinvolution of the uterus. In this class of cases useful warning of the evil which may result from too early the uterus may be retroverted or inclined to one side; it is movement, injudicious feeding, and, worst of all, that reck-heavy, much larger than natural, and flabby to the touch; less torturing of a tender bowel, the administration of a "smart purge" after recovery from typhoid fever.

MIDDLESEX HOSPITAL.

TWO CASES OF ORBITAL TUMOUR, TREATED BY FIRST
EXTIRPATING THE DISEASE, AND THEN APPLY-

ING THE CHLORIDE-OF-ZINC PASTE.
(Under the care of Mr. GEORGE LAWSON.)
THE results of operations for the removal of orbital
tumours, and especially of those which are of the malignant
class, are generally so unfavourable, that it is pleasing to
be able to record instances in which the disease has been
eradicated, and the patient has continued for a long time
free from any recurrence. In a visit to this hospital a few
days since, we had the opportunity of seeing two patients
who had been operated on by Mr. Lawson for orbital
tumours, both of which were apparently of a cancerous
nature. The first patient was a female in the cancer wards,
who was admitted into the hospital as far back as January
30th, 1866. She was then suffering from a scirrhous
tumour of the left orbit, and from a small growth of a
similar nature on the cheek of the same side of the face.

From both localities the disease was excised, and, all hæmorrhage having been arrested by the application of the actual cautery, the chloride-of-zinc paste, spread on small pieces of lint, was laid evenly over the whole of both surfaces. In due time the sloughs separated, and the wound on the cheek

soon cicatrised; but in the orbit the whole of the bony walls perished from the action of the caustics, and were detached in one piece. The skin now contracted closely round the gap, and the patient soon became convalescent. As it was impossible to say that the disease would not recur, the woman was allowed to remain in the hospital, where she has continued up to the present time, and without any recurrence of the tumours. As it is now nearly three years since the operation, the committee have rightly considered that the patient is no longer a fit subject for the cancer charity, and she has therefore received orders to leave the hospital in a short time.

The second patient was only admitted into the hospital on December 1st. The account which he gave of himself was that the right eye was removed last June, on account of an intra-ocular growth, but that very shortly afterwards a tumour began to grow from within the orbit. On his admission, the lids were tightly stretched over a firm, nodulated tumour, which occupied the orbit, and bulged considerably beyond it. Mr. Lawson treated this case in a manner similar to the last one. The pain following the

the os uteri open, or readily admitting the point of the forefinger; the anterior, posterior, or both lips much thickened or elongated; and at times there is an unpleasant and constant discharge from the interior of the uterus, besides an excess at the periods. These conditions may exist either separately or combined, giving rise to various painful feelings in and about the pelvis. In a case with many of the above-mentioned conditions, where Hodge's pessary had failed to remedy the retroversion and support the uterus, Dr. Murray has met with very gratifying results from the introduction of a straight intra-uterine galvanic pessary. The difficulty of introduction being got over, the uterus was kept in its right direction, and the constant tonic action of the copper and zinc reduced the large flabby uterus, in the course of a fortnight, nearly to its normal and healthy condition.

In the non-specific forms of abrasion, ulceration, or granular inflammation of the os and cervix uteri, the local application lately used by Dr. Murray has been the new preparation of glycerine with tannic acid in the British Pharmacopoeia. This preparation, if thoroughly and freely during the week, has seldom failed to bring about a healthy used by means of a large camel-hair pencil twice or thrice condition of the parts. Where there is vaginal leucorrhoea, Dr. Murray passes a roll of cotton wool or lint, some four through the speculum (Ferguson's), which, when withinches long, well covered with the glycerine and tannin, drawn, leaves the plug in contact with the vaginal walls, and after an interval of a few minutes this is removed.

This treatment has been also used in cases of irritable

THE LANCET,]

CLINICAL RECORDS OF THE PARIS HOSPITALS.

[JAN. 2, 1869. 11

its possible complications, its duration, and the comparative value of different modes of treatment. This teaching should be mostly conducted at the patient's bedside. The lecturer said he would barely refer to a third plan, which consisted in giving pathological, and not clinical, lectures. Thus, in connexion with any single case, an exhaustive lecture was delivered on the subject of the respective disease. He would choose an intermediate course, partaking of the first two methods. Like Trousseau and Dupuytren, he would lecture on difficult and rare cases; but generally he would follow Chomel and Boyer's wise and prudent practice.

LA CHARITÉ.

fore, he would advise the students not to follow Trousseau's precept, who used to say "a little less science and a little more art." He could not understand this definition of art and science; and he thought it was the result of a mere confusion. Trousseau's savants were a narrow-minded, stationary set; his artists, a lively race, with a stock of ideas either good or bad. Artists, however, could not do without science. There was need to observe nature assiduously, and to study all her movements attentively and closely. Alluding to the different doctrines which are upheld in medicine, the lecturer said that in clinical medicine these questions were of small interest. All clinical teachers, whether vitalists or organicists, acted in a like manner at the patient's bedside. Whatever the general opinions, whatever the school to which one belonged, clinical observation commanded the practitioner at the bedside. The accessory sciences themselves, which were at present so arrogant-and of course no one thought of denying their value, were the mere tri-peutical indications, each of these departments had been butaries of clinical medicine. When their answers were in accordance with clinical results, it was well and good; but when the converse was the case, then those answers must be considered as wrong and of no value. It was just the same with regard to physiology; and here, notwithstanding the services which this science had rendered to medicine, he would put his hearers on their guard against the tendency which was manifested nowadays to refer everything in medicine to physiological experiment. Clinical experience was the supreme criterion of physiological research; it alone was capable of furnishing to physiology evidence which could not be dispensed with. Everything was brought under the control of physiology. This was carrying things too far. With regard to himself, his pace would be slower, and, like St. Thomas, he would wait until it was said to him: "Vide pedes, vide manus." Even facts were not so very positive; and the ipse dixit, though pronounced in Dutch or German, was not always acceptable. Physiological facts, even when positive, did not always agree with clinical experience. As an example of this, the lecturer mentioned alcohol, of which he made great use in the treatment of inflammatory diseases. He had formerly believed that it acted by removing the paralysis of the vaso-motor nerves, and by thus causing decongestion of the organs; but he had given up this view. Some said it acted on the pneumogastric; others on the cerebro-spinal centres. But where was the truth? The same criticism applied to the alleged action of coffee, digitalis, bromide of potassium, &c. Of course he did not mean to attack the experimental method; on the contrary, he believed it involved the progress of medicine. But he condemned the inconsiderate haste and enthusiasm which were manifested. Things did not flow on so smoothly as certain people thought. For his own part he would not fail to note every progress as it presented itself; but he could not resign himself to present facts as accomplished, whatever the authority which covered them, unless they were indisputably demonstrated.

HÔPITAL DES CLINIQUES.

PROF. RICHET said he did not intend to follow the same method of teaching which he had adopted during the preceding year at La Pitié. There were several methods of clinical teaching. The one which Trousseau followed was brilliant and animated, and for some time it predominated over all the others. Rare cases were chosen, and irregular pathological forms analysed. This mode of teaching was characterised by the originality of the form and the sagacity of the views. But there was the inconvenience of giving too great importance to exceptional cases, and of neglecting the forms of disease which are observed in everyday practice. This method the lecturer had followed at La Pitié, but he would now renounce it. Such a manner of teaching accustomed the mind to seek after exceptional cases, and prepared the way for many errors of diagnosis. There was another method-the opposite one, which consisted in choosing simple cases as the subjects of lectures, and which had been promoted by Rostan, Chomel, Boyer, and Desault. Nélaton occasionally employed it, and Velpeau had definitely adopted it towards the end of his life. Its advantages were indisputable. The patients were studied from the moment of admission into the wards to the time of convalescence; similar cases were compared, and inferences drawn with regard to the natural course of the disease,

PROF. SEE referred to the various causes which had conduced to the sterility of clinical medicine. Grounded on observation, on morbid anatomy, and on the study of therabadly investigated. The description of cases had become a long, sterile, and fastidious enumeration of symptoms, and the signification and relative value of the respective phenomena had not been studied. For instance, it had been remarked that in nine out of ten cases of typhoid fever there existed meteorism, and therefore meteorism had been taken as a characteristic sign of typhoid. Yet this symptom was present in other diseases, whilst it was sometimes absent in cases of well-marked dothinenteric fever; and it merely indicated a paralysed condition of the intestines, or a fatty or waxy degeneration of the abdominal muscles. These phenomena should be explained physiologically, and in doing this the observer should be free from all preconceived ideas, and not follow any predetermined direction. The intervention of physiology in the study of morbid appearances was not less necessary. Bayle and Laennec had not foreseen the full value of their discovery. They thought it was merely a means of distinguishing morbid tissues-of classifing lesions. Morbid anatomy had also served to determine the form, the volume, and the situation of morbid products, and thus elucidate the diagnosis. But it had not been expected that it would be utilised in regard to the treatment. In this respect the microscope had not yet furnished any improvement, and had even been injurious to the advance of clinical medicine. In attempting to take the cellule as a means of diagnosis destined to overthrow clinical observation, the science of histology had materially impeded the progress of clinical medicine. Nowadays it had been recognised that elementary normal forms underwent changes in regard to time or situation; but, after all, they were mere deviations from the normal type. They were not, therefore, noxious foreign beings, which invaded and destroyed the body; but their formation was under the dependence of physiological laws, which presided over the development of symptoms. Disease was therefore nothing else than a mere deviation from the normal type, both in regard to its anatomical elements and to its functional disorders. The sick man had neither new organs nor new functions. Only there were new conditions created by the causes of the disease. Physiology presided over the whole scene. The disorder being functional, it was physiological actions and means which must be employed to check them; and our idea of disease became much less alarming since we were brought to believe that the lesion was often not more fatal than the symptoms. This view led to a more definite determination of disease. If the histological lesion ceased to be a parasite, a sort of outlaw in the order of biology, its phases might be often followed, and its mechanism detected by the experimental method. Thus morbid anatomy would be vivified, and cease to be a caput mortuum. But it was particularly with respect to therapeutics that clinical medicine had been backward since the beginning of the century. Medical men were now empiricists or statisticians, and they pretended to be free from the influence of former doctrines; but unfortunately this was a mistake. The various doctrines which had successively reigned in medicine had left deep and pernicious traces. After having divided these doctrines into three grand classes-the solidist, the humoral, and the vitalist,—and after having shown in what way they acted injuriously upon medical practice, and how they had led to great uncertainty and confusion, M. Sée proceeded to say that the modern tendencies of rational empiricism and specialism were not worth much more. each specific disease a specific remedy was offered; and

To

to amputate during collapse; and he urged that the good results which followed in this case must be regarded as exceptional. He had once amputated when there was extreme prostration of the nervous system, associated with complaint of urgent pain, but such a case he regarded as quite distinct from instances of ordinary so-called collapse.

Mr. CROUCH, in reply, said he had followed the rule distinctly laid down by Abernethy for the treatment of cases similar to the one reported.

Dr. PAVY related a case of Diabetes in a female patient, aged sixty-eight, in which the treatment consisted mainly in the exhibition of opium in gradually increased doses, without restriction of diet. The first effect of the drug was limited to a diminution of the quantity of urine, without change in its specific gravity or in the relative quantity of sugar contained in it. But eventually, as the dose was increased, the daily excretion of sugar diminished, until the urine became entirely natural. Throughout the whole period of treatment, the dose of opium, the quantity of urine, and the quantity of sugar excreted in twenty-four hours were recorded daily, so that the effect of the remedy could be accurately judged of. By way of further illustration, Dr. Pavy mentioned two other cases, one treated by opium, the other by morphia, in which the beneficial results obtained were equally striking.

A discussion followed, in the course of which Dr. WEBER referred to the occasional recurrence of diabetes in patients apparently cured, whether by diet, regimen, or otherwise; and suggested that the case should be further reported on after an interval of six months; while the PRESIDENT drew attention to the age of the patient, with reference to the question whether diabetes is not more tractable, and at the same time more liable to recur, in elderly persons than in the young.

Dr. PAVY, in his reply, admitted that in advanced life diabetes might be regarded as a comparatively trivial dis

order.

Dr. BEIGEL read a paper, founded on 152 cases of Epilepsy, from which he inferred, that although unconsciousness and convulsion are so frequent as phenomena of the epileptic paroxysm that most writers regard them as characteristic, there are many cases undoubtedly of epileptic nature in which these symptoms are absent. He considered that the only invariable pathognomonic signs of epilepsy were those which arose from disturbances of the circulation, and set forth various facts and observations which had led him to localise these disturbances in the vaso-motor nerves. As regards the treatment of epilepsy, Dr. Beigel believed that the most important remedy for continuous administration was the bromide of potassium. He further strongly recommended the subcutaneous injection of morphia, guarded by atropine in the manner suggested by Dr. John Harley, immediately before an apprehended attack, as a means of warding it off, or at least of modifying its violence.

Dr. GREEN related a case, which he described as one of Irritative Hypertrophy of the Heart. The patient, a girl of fifteen, was admitted into hospital in the fourth or fifth attack of acute rheumatism. Soon after pericarditis supervened, and she eventually died, with great hypertrophy, adherent pericardium, and "finely granular" degeneration of the muscular fibres of the whole heart. In explanation of this and other cases in which hypertrophy occurs in young rheumatic persons, independently of any mechanical cause, the author maintained the theory that the overgrowth is intimately connected with chronic myo-carditis.

THE HARVEIAN SOCIETY.

THE anniversary conversazione of this Society will be held on Thursday, January 7th, when the President's address will be delivered.

The following is the new list of officers for 1869 proposed for election by the Council:

President: Dr. E. Headlam Greenhow. Vice-presidents: Dr. F. Cock, Dr. E. S. Haviland, Mr. J. Z. Laurence, Mr. H. G. Times. Treasurer: Dr. H. W. Fuller. Honorary Secretaries: Mr. J. B. Curgenven, Dr. W. Hickman. Council: Dr. H. F. Bate, Dr. Tilbury Fox, Dr. Greenhalgh, Mr. Berkeley Hill, Dr. Holmes Jephson, Mr. R. S. Jeffs, Mr. Newton Lee, Mr. Duncan Menzies, Mr. Edmund Met

[JAN. 2, 1869. 13

calf, Dr. Gueneau de Mussy, Mr. J. Rushforth, Dr. R. S. Sisson.

The past year has been a prosperous one with the Society.

Reviews and Notices of Books.

The Pathology and Treatment of Syphilis, Chancroid Ulcers,
and their Complications. By JoHN K. BARTON, M.D. Dub.,
F.R.C.S.I., Surgeon to the Adelaide Hospital, Lecturer
on Surgery at the Ledwich School of Medicine, &c. &c.
pp. 316. Dublin: Fannin and Co. 1868.

Syphilis and Local Contagious Disorders. By BERKELEY HILL,
M.B. Lond., F.R.C.S., Assistant-Surgeon to University
College Hospital, Teacher of the Use of Surgical Appa-
ratus in University College, Surgeon to Out-patients at
the Lock Hospital. pp. 505. London: James Walton.
1868.
(FIRST NOTICE.)

Ir is now many years since we, perplexed and wearied by the divergences of opinion and doctrine expressed by different writers on the subjects treated of in these volumes, determined to bring them to the test of our own observation and experience. We had an ample field for doing so, and were untrammeled by an affection for any preconceived theory. Some of the results arrived at were: (1) That there was such a disease as syphilis, and that, in the character and evolution of its phenomena, it was perfectly separate and distinct from any other; that it bore no further relation to the venereal ulcer, whose clinical history, as Diday says, terminates with the cicatrisation of the sore, than the fact that both were the results of impure sexual intercourse, and both were attended by a lesion more or less ulcerative in character. (2) That induration was very generally, but not invariably, the concomitant of that lesion which was the precursor of general symptoms. (3) That the two diseases sometimes rapidly followed one another, or even coexisted. (4) That they could be, as a rule, more easily distinguished from one another than can many cases of typhus from those of typhoid fever, or measles from scarlatina. And (5) that there were a certain number of cases, of a non-conformable type, which served as the battle ground of opposing theorists. These cases led us to perceive that a diagnosis could not always be made at once, or upon a single manifestation; but that, as in every other malady, the disease must be studied as a whole, and the period of observation must not be limited to one day or two, but extended sometimes over the whole period embraced from the appearance of the ulcerative lesion to the date of its cicatrisation. One fact which came out very forcibly was this: that the lesion which appeared from ten days to a month after exposure to contagion was almost sure not to prove a local disease; while another which appeared two, three, or four days after such exposure was so, provided it did not, in its subsequent progress, alter its character and acquire induration at its seat or along the neighbouring chain of glands. The inquiry embraced a great many more points: but upon these we need not dwell. Let it suffice, that whilst still prosecuting it, and after we had made up our own mind as to the bearing of a great many facts, we again consulted the works of the latest syphilographers, and Bumstead's book "On Venereal Diseases" among them. This was not what might be termed an original book; it was in great part a compilation. It was too voluminous, and did not contain all that was then known or has been since recognised. Still, Bumstead's work was the first in the English language which afforded a comprehensive and systematic view of the subject as a whole; and it has been the forerunner of others, resembling it very much in their treatment of the same subjects. It is only fair that this should