the summer, is the most favorable time for them on the elevated health resorts, that they feel themselves better, are more free from cough and cold, and make greater progress during winter than during summer. I must lay particular stress on this statement, because, in general, medical men, as well as the public, are inclined to admit the suitability of high alpine slopes and valleys during summer, but are afraid of the cold winter, which in reality seems to be the better season for most consumptive invalids.

As this communication has become longer than I had intended, I venture to sum up the principal points :

1. That the elevated regions deserve greater attention in the management of consumptive tendencies and affections, than they have hitherto received.

2. That they deserve this attention not only as summer, but also, and even more so, as winter health resorts.

3. That they offer great advantages in many cases of early consumption, or of tendency to consumption; in the disposition to catarrhal pneumonia, and the results of this disease, particularly the so-called tubercular deposits (cheesy deposits), and tubercular infiltrations (pneumonic infiltrations).

4. That in such cases fresh catarrhal, and other acute intercurrent affections appear to be less frequent in highthan in low-level health resorts.

5. That in elevated regions, the tendency to absorption and fibrous transformation or cicatrisation of pneumonic deposits is promoted, while the tendency to the rapid breaking down of tissue, and the formation of cavities is counteracted.

6. That the tendency to hæmoptysis is diminished, and not, as is usually believed, increased.

I cannot conclude this paper without acknowledging that

I do not wish to mix theory with facts, but it would be easy to base theories on the prominent characters of the winter climate, as the dryness of the soil in winter, the ground being covered with hard snow and ice; the diminished humidity of the air; the low temperature of the air; the comparative freeness of the air from foreign admixture, especially of organic nature; the greater number of clear days.

I am, with regard to the questions discussed in it, under great obligation to the late Dr. Archibald Smith, of Lima and Edinburgh, who not only has filled up the gaps in the histories of several of the cases related, but has also furnished me with the particulars of several other cases, and has given me the most valuable hints on mountain climates. His instructive publications on the climate and diseases of Peru are scattered through various journals, and are not much known; but a careful study of them will convince the reader that Dr. Archibald Smith deserves a foremost place amongst medical climatologists in the widest sense of the term, and thus amongst the benefactors of mankind.1

I have not attempted many bibliographical notices in this communication, but I ought to mention that it was only after I had delivered the paper to the Society that several important contributions on the subject have come to my notice. 1. Dr. Drysdale "On Alpine Heights and change of climate in Consumption," from the Transactions of the St. Andrew's Medical Graduates Association.' London, 1869. 2. The second edition of Dr. Brehmer's work, 'Die chronische Lungenschwindsucht und Tuberculose der Lunge, ihre Ursache und ihre Heilung.' Berlin, 1869. 3. Dr. Spengler's' Die Landschaft Davos, als Kurort gegen Lungenschwindsucht.' Basel, 1869.

CASES

OF

IRITIS OCCURRING IN SYPHILIS

TREATED WITHOUT MERCURY;

WITH REMARKS ON THIS FORM OF IRITIS.

BY

GEORGE G. GASCOYEN, F.R.C.S.,

SURGEON TO THE LOCK HOSPITAL; ASSISTANT-SURGEON TO ST. MARY'S

HOSPITAL.

Received March 27th.-Read May 25th, 1869.

THE treatment of simple iritis without mercury has, since its advocacy by Saunders in 1810,1 been occasionally tested by other surgeons, but the practice has not met with a favorable reception, and, therefore, has not been largely adopted, although it yielded very good results.

The conviction so long entertained, that a mercurial course was essential for the cure of all deep-seated inflammations of the eye, has, of late years, been greatly modified for the non-specific varieties; but mercury is still taught to be the only remedy, in those forms of disease which are caused by syphilis, that will prevent total disorganisation of the eye, or, at least, its very serious impairment.

1 Treatise on some Practical Points relating to Diseases of the Eye.' By J. R. Farre. 1811.

*

So strongly, indeed, has this impression prevailed, that most of those surgeons who have attempted to treat other syphilitic disorders without mercury, have, on the occurrence of iritis, at once resorted to the use of this drug, as indispensable for the eye affection.1

A sufficient number of cases has, however, been recorded to show that the iritis which supervenes during syphilis, may pass to a successful issue without the employment of mercury; but, so far as I am aware, the simple method of treatment has never been systematically carried out in such cases with a view of testing its efficacy.3

That this form of iritis, when left to itself, does not necessarily pass on to destruction of the eye, is sufficiently proved by the number of persons met with in practice, who, without any treatment whatever, have recovered from an attack. In many of these cases, however, irregularity of the pupil remains, although vision may be good.

The fact also has long been recognised, that iritis will

1 Guthrie, Lond. Med. Gaz.,' 1829, vol. iv, p. 509; 'Med.-Chir. Trans.,' vol. viii, p. 545, 1820.

Hennen, Principles of Military Surgery,' 3rd edition, 1829, p. 555.

Rose, Med.-Chir. Trans.,' vol. viii, p. 347, 1820.

Syme, Principles of Surgery,' 3rd edition, 1842, p. 457.

Egan, 'On Syphilitic Diseases,' 1853, p. 167.

2 Thomson, J., "On the Treatment of Syphilis without Mercury," Edin. Med. and Surg. Journ.,' vol. xiv, p. 84, 1818.

،

Hill, S., "On the Simple Treatment of Syphilis," Edin. Med. and Surg. Journ.,' vol. xviii, p. 567, 1822.

Carmichael, Observations on the efficacy of Turpentine in the Venereal and other deep-seated Inflammations of the Eye, &c.,' 1829.

Desmarres, Traité théorique et pratique des Maladies des Yeux,' vol. ii,

1855.

Boeck, 'Recherches sur la Syphilis,' 1862.

Williams, H. W., ' A Practical Guide to the Study of Diseases of the Eye.' New York, 1862.

Bidenkap, 'Aperçu des différentes Méthodes de traitement employées à l'Hôpital de l'Université de Christiania contre la Syphilis,' 1863.

6

Teale, T. Pridgin, jun., “On the relative value of Atropine and Mercury in the Treatment of Acute Iritis," Ophthalmic Hospital Reports,' vol. v, part ii, p. 156, April, 1866.

3 Mr. Teale resorted to the employment of mercury in those cases where atropine failed to dilate the pupil within twenty-four or forty-eight hours (loc. cit., p. 158).

sometimes occur in syphilitic subjects who are undergoing treatment by mercury, or even when they are fully under its influence; but in these patients, it does not appear that the disease is less severe, or passes to a more favorable or rapid termination, than in others who have not been taking this medicine, and I am strongly of opinion that, in such cases, recovery is retarded by a persistence in the use of the drug.

Examples, moreover, are not infrequent where mercury, though fully administered, fails to control the progress of the affection, but which begins to improve when this drug is discontinued and other remedies are employed.1

Since mercury, then, seems often to be inoperative to prevent, or moderate, or arrest, an attack of syphilitic iritis, it is difficult to believe that the medicine can exert such a powerful influence over the disease as has been ascribed to it; but it was not until I had seen Dr. Boeck successfully treat, with atropine drops and opium only, severe iritis in two patients who were undergoing the process of syphilisation in the Lock Hospital, that I ventured to try the simple method of treatment, and I have since employed it in the eighteen cases which are now brought before the Society.

As iritis commonly supervenes whilst other syphilitic symptoms are present, many patients are already under treatment-often mercurial—when the affection manifests itself. The number of cases, therefore, which are met with uncomplicated by a previous specific treatment is not large, and I have only seven such to record. (Class I.)

In those patients who were attacked with iritis whilst taking mercury for other syphilitic disorders, yet did not show its action upon the gums, the drug was at once discontinued and replaced by simple remedies; but, as it might be urged that the successful issue in these cases was to some extent due to the influence of mercury, they have been included in a separate list; of such, eleven examples are recorded. (Class II.)

1 Colles,Practical Observations on the Venereal Disease, and on the Use of Mercury,' p. 165, 1837.

2Med.-Chir. Trans.,' vol. 1, pp. 290 and 300, 1867. Cases 5 and 15.