The patient's health is rarely bad, is sometimes excellent, but is commonly indifferent. The previous history of the case varies. In the majority of instances, as I apprehend, it will be found that he has taken a good deal of mercury, and a mercurial affection I believe it, in most cases, to be. In others, we shall find a precursory sore, or condylomata, and nothing which can justify the suspicion of excess of mercury.

The affection, whatever its cause may have been, is too apt to be protracted. The patient gets better, seems well, and is attacked again and again. This, I would say, is peculiarly the case, where a mercurial cause is assignable, and I make a point of warning him of the probable tediousness of his disorder.

The treatment must be materially regulated by the history. If there has already been much mercury taken, I would most earnestly advise that no more should be given.

Sarsaparilla and the iodide of potassium appear to be, on the whole, the most efficient remedies, but change is as necessary for this as for the cachectic affection, and the object to be kept steadily in view, whatever measures are employed, is to sustain the general health. The ammonio-citrate or the iodide of iron I have found very serviceable here.

As a local application, none is comparable to the lunar caustic. The opaque spots upon the tongue may be touched with it twice or three times in the week. If the palate is affected it may be treated in the same manner, or painted with a strong solution of the same salt. The gargle of the bichloride of mercury, one grain to six ounces of water, or that of the sulphate of zinc, have their merits, and, in fact, many slightly stimulating applications are of use.

As an instance of the bad consequences of much mercury in this affection, I may advert to the following case.

It is some seven or eight years since I first saw the gentleman, the subject of it. He had then "psoriasis" of the tongue, and an exanthematous efflorescence pretty generally on the body. He was about 22 years of age, stout, robust, and with every evidence of a good constitution. He stated that about two years previously, while reading in the long vacation, (he was studying at Oxford,) he contracted what he supposed was a venereal sore. The gentleman whom he consulted assured him it was not, and for two months, while he continued under his care, he took no mercury whatever. At the end of that time he went to Oxford. The sore was then healed, but the cicatrix was extremely hard. The surgeon whom he consulted prescribed twenty-five grains of blue-pill daily, which he continued to take for seven weeks. The hardness of the cicatrix disappeared, his mouth was not made sore, and he appeared to be cured. But soon the throat grew sore, and a rash broke out upon the skin. For this he had advice in town, and again took mercury along with sarsaparilla. Prior to my seeing him he had had several such courses by the recommendation of various medical men. The rash would disappear for a time, and without apparent cause

return.

I endeavoured to dissuade him from resorting to further mercurial treatment, and prescribed sarsaparilla, the mineral acids, and so forth. But my patient was difficult to be controlled, and indulged in excesses, more particularly in drinking, against which cautions were vain. He disregarded, also, my injunctions with respect to mercury, and, with the sanction of others, underwent one or two courses more. Yet, after two or three years spent thus, he seemed, at last, to be well, and no further eruption occurred on the skin, nor did aught seem amiss with the tongue or throat. So he continued for two or three years, when, without any warning, one lachrymal bone grew carious. Ulcerations of the Schneiderian membrane followed, and the bony septum of the nose in its anterior part was destroyed. Then came caries and exfoliation of the palatine plate of the palate-bone, and the disease is still going on in the nose, without any prospect of speedy or permanent recovery.

It would be difficult, I conceive, to exonerate mercury from the blame of what happened in this case, though the patient's own excesses in other ways, contributed to aggravate the mischief.

V. SMALL SCIRRHOUS-LIKE TUMOR OF THE FRÆNUM LINGUÆ IN

A CHILD.

Frederick Pigott, aged 13 months, was brought to me by his mother, on account of a tumor beneath his tongue, interfering with articulation and with eating.

The tumor occupied the frænum, was attached to, or rather blended with, the gum below, and reached to the tongue, with which it was not blended, above. It was bigger than a horse-bean, of irregular shape, ulcerated upon the superficies with everted edges, hard to the feel, and in appearance not very unlike scirrhus. But the child was healthy, and there was no contamination of the lymphatic glands.

The mother had noticed it two months previously, just before he cut his central incisors. It began as a white speck, which had gradually increased up to its described dimensions.

In the course of a few days, I removed the tumor with the ligature, this being preferable to the knife on account of the ranine vessels. The only difficulty was occasioned by the young patient's refractoriness, but, by drawing out the tumor with a hook, the needle armed with a double ligature was passed, and the diseased part included in it. The slough separated; for security's sake, nitric acid was applied to the wound; this healed; and the child appears to be cured.

A case of RANULA presented itself. The patient was a girl, aged 13, the tumor was as large as a bantam's egg, of bluish colour, and evidently fluctuating. There was little impediment to speech or deglutition. The disease had existed for three months.

I passed a seton cross-ways through the ranula, and a quantity of glairy fluid escaped, the swelling subsiding much in consequence. I regret that I cannot report the result, the patient, soon afterwards, ceasing to attend.

VI. PUNCTURE SUCCEEDED BY BLISTERS FOR COLLECTION OF FLUID IN SUBCUTANEOUS BURSE.

In several cases of enlargement of the supra-patellar and supra-olecranal bursæ, from fluid connected within them, I have lately adopted the plan of first puncturing the sac with a grooved needle, and allowing the fluid to escape, and then applying blisters. The fluid forms again in the bursa, but is speedily absorbed, and it appears that time is gained by the proceeding. The two cases which follow are taken at hazard as samples.

Case 1.-Catherine New, aged 23, housemaid, applied July 12, 1843. Right bursa patella as large as a duck's egg-sac thin-skin red and much distended-little inflammation. Pulse small and weak, health rather delicate. Complaint has existed for fourteen months.

Puncture with grooved needle-much fluid let out. Emplast. lyttæ genu. 15th. No inflammation. Sac nearly filled. Blister just healed.

22nd. Effusion nearly gone.

Rep. emp. lyttæ.

Rep. emp. lyttæ.

After this there was no return of effusion, and some slight thickening of the

sac seemed to occur. A bandage and strapping were applied, and on the 5th of August, she was discharged cured.

Case 2.-Ann Neales, aged 22, servant, applied August 16, 1843. Effusion into right bursa patellæ, of two months standing. Bursa of the size of a small egg. No inflammation.

Punctured. Emplast. lyttæ.

The effusion returned in a less degree, the blister continued open, and it was not before the 1st of September that a second was applied. The effusion was then gone, and this was only for precaution's sake.

On the 9th the knee was bandaged, and she was discharged cured.

Of the permanence of the cure in these cases, I have no experience. In some, I dare say, it will, and in some will not, succeed. For the patients are usually compelled to resume their laborious kneeling, which as it induced, may naturally be expected to restore the complaint. But this seems to me an improvement on the plan of mere blistering, the one generally resorted to.

In subcutaneous bursæ, it cannot be hazardous, indeed I usually move the needle about, for the purpose of exciting inflammation. This, as in the case of hydrocele, may lead to adhesion of the walls of the sac, or tend to arrest the secretion of fluid in it.

VII. DIFFUSE INFLAMMATION OF THE DEEP CELLULAR MEMBRANE OF THE PELVIS.

The affection to which I would direct attention is not, I believe, very generally understood, at least in connexion with such cases as I shall allude to. The present notice is not intended to supply the deficiency, but rather to give a hint to surgeons, and to precede some more extended observations of my own.

The point to which I would advert at present, is the risk of inflammation of the cellular membrane of the pelvis from operations for hæmorrhoids or fistula, or even independently of any operation whatsoever. The general character and history of the affection may be briefly sketched as follows:

Two or three days after the pile has been tied, or the sinus has been laid open, a rigor, more or less distinct, ushers in pyrexia, with its usual features, heat of skin, frequent pulse, thirst, perspirations, and impaired secretions. But the symptoms are of rather a low character, and there is an expression of anxiety, exceeding their apparent gravity. Along with the feverishness, there is pain complained of in the lower part of the abdomen, and more particularly, I would say, in the groin. This has seemed to me an early symptom, and it is always a suspicious one. All this while, there may be little to attract attention about the rectum or the wound, the latter, if any thing, exhibiting a tendency to dryness.

With the progress of the disorder, the rigors may or may not return, there may or may not be sickness, but there is a frequency of pulse which never fails,* and an anxiety of countenance which is never wanting. Some pain, too, persists in the belly. It is not limited to one spot-perhaps it may be greatest in the groin, but it may even reach to the diaphragm. Not, however, that the patient will complain very much of it—he may rather be disposed to make light of it.

Possibly, the inguinal glands may enlarge they may even have done so at the first-the belly grows tympanitic-there is a disposition to sweats—perhaps

* In my experience, a pulse remaining frequent after injuries or operations, is always a dangerous, though not, of necessity, a fatal symptom.

rigors alternate with them. So the case may go on for some days, a week, or even more. Then may come hurried respiration, slight cough, obscure pain in the thorax, low delirium, death. The patient is cut off by secondary pleuropneumonia or deposits.

Or the termination may be more sudden. With the tympanitis the depression increases, the tongue embrowns, there is delirium, and the patient dies unexpectedly.

The subject of such symptoms is commonly cachectic, one broken down by mercury or by spirit-drinking, or by some depressing agency. But, in other instances we have not cachexia, but a highly nervous temperament to deal witha hysterical female, rather spent in years, or a man whose mind has been severely taxed.

When we come to examine the body after death, we find (this is not necessary) some traces of recent peritoneal inflammation. It is not "adhesive inflammation" that we see-not lymph and agglutination of the coils of bowel; but diffused vascularity, and turbid serum, with dirty pus dissolved in it, or flocculi of lymph, and when such appearances are found, they are principally about the pelvis.

I said they were not necessary, nor are they. There may not exist the faintest trace of peritoneal inflammation. Be it there or not, it does not constitute the gist of the disease. That is in the sub-peritoneal cellular tissue. In that we find pus or concrete lymph, diffused perhaps to a great extent. We commence discovering it in the vicinity of the tied pile or divided sinus-thence it spreads along the rectum to the pelvis, behind the mesentery to the belly, up to the kidneys, to the diaphragm. It does not, of necessity, go so far, that hinges on the case, but it is always found, and it palpably has its source about the rectum. It is, in short, diffuse inflammation and suppuration in the cellular membrane of the pelvis, spreading by continuity to the sub-peritoneal cellular tissue, and affecting by contiguity the serous membrane. That secondary inflammations of the pleura or the lung, or deposits any where, should under such circumstances occur, is no more than might naturally be expected.

On the treatment of this affection I have little to say. Whenever the symptoms that bode it, have appeared, we must dread the worst result. Not that I believe this always follows; indeed I have little doubt that it does not. But it is very apt to follow, and the surgeon ought to be prepared for it. Incisions, our main hope in diffuse cellular inflammation elsewhere, are here out of the question. The mischief is beyond the knife. Moderate local depletion may be serviceable, active depletion is not. Support must probably go along with measures, calculated, like leeches and blisters, to keep down local action. The diffused character of the inflammation and effusion forbids on the one hand lowering remedies, and gives little encouragement to anticipate benefit from any.

Perhaps, the best lesson we can draw from an acquaintance with the affection is this to be chary of operating on such persons as likely subjects for it— and to sustain, by diet and by other means, those on whom we do operate.

Spirit of the British and American Periodicals.

KILL OR CURE.

THE following Case, recently published by Mr. Hastings, will shew the fine effects of sudden cures by Hydropathy.

"A Case of Gout, in which the Water-Cure was followed by Diseased Heart, Dropsy, and Death. By CHARLES HASTINGS, M.D. F.G.S.

"There exists no doubt in my mind that one great cause of the spurious celebrity of the Silesian peasant, Priessnitz, is that he has cunningly succeeded in turning the love of the marvellous, which is known to be a principle inherent in the human breast, to his own selfish ends. Every unprejudiced account which we receive from Graefenburgh confirms this opinion, by shewing that there is little faith to be placed in the reputed cures there performed.

"The cures said to be effected by the Hydropathists are as wonderful as those of Prince Hohenloe, and somewhat of the same faith which distinguished his disciples animates the hydro-maniacs.

Dr. Pfeufer, directing physician of the Universal Hospital at Bamberg, thus describes the scene of operation of this princely priest, and the rush of the infatuated sufferers from disease to his presence:- Let us then (he says) imagine thousands and thousands of human beings under such circumstances, to each of whom every day brings new sufferings, new c'espondence, and who have but one wish remaining release by death from their nameless pangs. Electrified by the news that at Bamberg and Würzburg there is help and salvation for them through the grace of God, a new life glows within them, and already they feel the term of their misery. With the same longing as that of the leper for the pool of Bethesda, they hurry to the place where all grief vanishes, and where the stream of health and deliverance flows. In ever increasing expectation, and with breasts full of hope, wholly occupied in anticipating the enjoyment of re-established health, dead to every other thought, they approach the scene of healing grace. At every step are announced to them the great wonders that take place there every minute. Scarcely arrived at the place of deliverance, they throw themselves at the foot of the altar, confess their sins, and, reconciled and united with God, hasten to the chosen priest. All the streets they find filled; with great trouble and anxious palpitation they reach their desired residence. Some one carries on his back an old woman into the house; she has been, says report, from her childhood crooked, and unable to stand or walk. A few minutes pass away, the door of the Prince's dwelling opens, and the same woman walks without support out of the house, thanking and praising the Lord God. Every one presses around her; each one will with his own eyes, and from herself, learn what has happened to her. Man lives for the present time; of the past nobody has time to think; no one, therefore, concerns himself about the former situation of the person cured. Often, also, he who is not lucky enough to see or speak with her, still asserts, in order to please the crowd, and to appear of some consequence, that, with his own eyes and ears, he has convinced himself. For who is not gratified in being the bearer of wonderful news? And now, in an incredibly short time, the new miracle spreads through town and country; each narrator vies with the other. If the cured person limped at first, he is soon dead lame, and soon after sees him struggling with death; and the story becomes No. LXXVIII.

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