III. On Mercurial Disease and Syphilis. By Prof. LORINSER. (Wien Med. Wochenschrift, Nos. 19-21.)

Professor Lorinser observes, that ever since mercury has been employed in the treatment of syphilis, practitioners have never been wanting who protested against its use as something worse than the disease itself. Still, whatever its opponents might advance, mercury has always emerged anew after the contest, this arising, on the one hand, from the arguments opposed to its employment not being clear and incontradictable, and on the other, from its supporters being able to point to the apparent success of their mode of treatment. Two important discoveries, however, of the present time may assist in the scientific solution of the problem. The first is that of Melsens, who has shown that iodide of potassium is a means by the agency of which lead or mercury that may have lain concealed in the system for even years becomes excreted; and the other is, that the minutest traces of quicksilver may be detected in the urine, sweat, or saliva by means of the electrolytic test, so ably handled by Professor Kletzinsky. The author's attention had been already attracted by the fact of the extremely rapid influence exerted by the iodide in certain cases of pains in the bones, and optic and serpiginous cutaneous ulcers; and while certain experiments in treating syphilis were being carried on in 1856 at the Weiden Hospital, he had the opportunity of investigating the subject closely, and has continued so to do, the conviction becoming forced on his mind that the benefit derivable from the iodide is really due to its expelling mercury previously given, perhaps years since. The following are the conclusions he arrives at :

1. That mercury, whether administered internally or externally, may remain for years within the body, without a trace (under ordinary circumstances) being detectible in the urine. Numerous trials made upon patients to whom mercury had been given amply proved this; but it is not meant to be stated that where large quantities of mercury have been thrown in, that this may not be sometimes detected in the urine or sweat, as it is also in the saliva during salivation. 2. By the employment of the iodide of potassium the mercury contained in the body is expelled in the urine, so as to become detectible by means of the electrolytic chemical analysis. The expulsion does not always take place immediately, several days sometimes first elapsing. 3. All those forms of disease which exhibit a rapid decrease proportionately to the excretion of the mercury, and which disappear when this is entirely expelled, can only be regarded as mercurial disease, which can only be said to be completely cured when no more mercury appears in the urine under the continued use of the iodide. All the symptoms which thus can be referred to hydrargyrosis disappear with remarkable rapidity under the use of the iodide; while in other cases, when no mercury can be detected, the iodide exerts no effect. 4. The symptoms gradually produced by the long sojourn of mercury in the system differ essentially from those which immediately result from recent mercurialization. The symptoms of this chronic hydrargyrosis are indeed far less known than those of the acute form; one very remarkable thing is, that the symptoms of chronic hydrargyrosis may be thrown in the background, and seem for a length of time to have undergone improvement through the occurrence of a new and acute mercurialization. 5. The symptoms of chronic hydrargyrosis have hitherto for the most part been mistaken for those of syphilis, and sometimes for those of gout, or the ordinary nervous and abdominal affections; and only very rarely has their true nature been apprehended. 6. As hitherto chronic hydrargyrosis has not been clearly distinguished from syphilis, both conditions having been usually treated alike, all the cases of secondary syphilis on record are only of doubtful value; and new observations, founded upon a physico-chemical diagnosis, so as accurately to distinguish between hydrargyrosis and syphilis, are required.

IV. Observations on the Treatment of some of the Symptoms of Syphilis. By M. HERVIEUX. (Bulletin de Thérapeutique, tome liv., pp. 441 & 529.)

1. Phagedanic Chancre. M. Hervieux observes that it is very natural that a disease which produces such rapid local destruction should have been met by means rivalling it in energy and celerity of action, such as the butter of antimony, the various forms of caustic, the actual cautery, &c. But although all those means have been successful in some cases, it is certain that they have still oftener failed, or they would not have been so generally abandoned. There is one means, however, which, in the hands of M. Ricord, has proved of indubitable advantageviz, the carbo-sulphuric paste, prepared by mixing sulphuric acid with powdered vegetable charcoal, in sufficient proportions to form a semi-solid paste. When applied to the chancre this soon dries, forming a black crust, which intimately adheres to the tissues, and only falls

off after several days, leaving a clean sore, or even, in some cases, a cicatrized surface. In the author's practice, pure tincture of iodine, applied at the commencement, has proved to be the best means of arresting the progress of the disease. It induces generally a burning pain, the intensity and duration of which are in proportion to the extent and depth of the chancre, as also to the sensibility of the individual and of the parts affected. Very well borne by some patients, the pain induces in others the most horrible torment. Chloroform would in such nervous and irritable subjects save this suffering. The pain, upon an average, lasts half an hour. In simple, uncomplicated cases, two applications, made by means of a pencil after an interval of twenty-four hours, generally arrest the progress of the blood. If, however, the chancre be complicated with gangrene, hospital gangrene, or diphtheria, four, five, or even six applications may be required. But when two or three of these seem to be without any effect, there is no use going on with the iodine, and a solution of nitrate of silver (five parts to thirty) should be substituted. When the iodine treatment has been followed, M. Hervieux has never known the worst form of phagedæna persist beyond a week.

2. Suppurating Bubo. The author has never himself treated bubo by small, single, or multiple openings, but he has met with cases which have been so treated, and which, two or three months afterwards, have exhibited fistulous tracks, extensive detachment, thinning and changes in the skin, together with an utter indisposition to heal. After waiting two or three weeks in vain for the spontaneous closure of these fistulæ, he has had to lay them freely open. The prevention of deformity by these small apertures, as proposed by Vidal, is frequently not attained, for not only may fistulous tracks become established, but the apertures themselves may become transformed into chancrous ulcerations. As a general rule, M. Hervieux makes a large opening, and that as early as possible, cicatrization taking place most rapidly under these circumstances. When the opened bubo is transformed into a strumous or chancrous ulcer, or the two combined, with the possible complication of phagedænism, he treats it by the application of the tincture of iodine or solution of the nitrate of silver, washing it out also with chlorine lotions several times a day; and he has never found any ulcer resisting treatment longer than six weeks, the majority becoming healed in from eight to fifteen days. 3. Condylomata (Plaques muqueuses). Although the author believes the practice he recommends under the former heads may require additional confirmation from more extensive practice than his own, in the matter of condylomata he can speak more positively. If the solution of nitrate of silver is not an actual specific, it acts with such rapidity, certainty, and efficacy, as to call for the highest recommendation. However confluent they may be, and whatever extent of surface they may occupy, however infectious the discharge they give out, and even when they have attained a certain amount of thickness, provided that they are not too hypertrophied and have not undergone some of the transformations they are susceptible of, they will wither, die away, and disappear in the course of some days, if every part be painted daily with pencil dipped in a solution of the nitrate, five parts to thirty of water. Baths should be simultaneously used, seeing the part which dirt habitually takes in the production of this accident. Repeated trials have convinced the author that this success is quite independent of internal treatment. When, however, the condylomata have become transformed into a vast vegetating surface, of great thickness, the nitrate ceases to be of avail; and in one aggravated case mentioned, the pure nitric acid, repeatedly applied, was of service. 4. Syphilides. Under this nead the author gives the resalts of his trial, in ten cases, of M. Cullérier's plan of treating syphilitic eruptions by blisters applied to the chest. Although at first prepossessed against it, he now speaks highly in its favour. Excluding the slight roseolar forms, which get well of themselves, the author oftenest employed blistering in the papular form of the disease, and that is the form in which the remedy best succeeded. A single blister will exert a notable modification on chronic papular syphilides, which have existed during several months. One case of syphilitic lichen, which had lasted a year, and for which all kinds of active internal treatment had been tried, disappeared in the course of a week, during which three large blisters were successively applied to the anterior and posterior surfaces of the thorax. The squamous form resisted their action more, but still in two cases of psoriasis undoubted amendment was observable, and in a fortnight the scales were detached. In the pustular form, some cases of syphilitic acne were rapidly cured. M. Hervieux has not tried blistering in syphilitic impetigo of the face and hairy scalp, having found the application of the nitrate of silver solution, after poulticing off the crusts, very efficacious, even in very inveterate cases.

V. On the Treatment of Sprain by Friction and Shampooing. By M. GIRARD. (Moniteur des Hôpitaux, No. 140.)

In this paper, laid before the "Académie de Médecine," M. Girard states that his attention was first directed to the plan of treatment he describes, by the manipulations of an empiric.

So successful were these in a bad case of sprain, that he determined to investigate the subject, and as the result of numerous trials, he now proposes what he believes to be a very effectual and a rapid procedure, for the treatment of what too often proves a very tedious and serious affection.

No matter what the severity of the sprain may be, its treatment should be commenced by the gentlest friction, the points of the fingers scarcely touching the skin. After practising such frictions from below upwards for from ten to twenty minutes, it will be almost always found that a certain amount of pressure can be borne, and this is to be increased or diminished according to the sensations of the patient.

It is very rare that we can proceed in this manner for half-an-hour without the patient declaring that his pain is notably relieved. Arrived at this point, when the patient can bear the weight of the hand, we proceed to the shampooing. This is performed not only with the fingers (which, kept close together during the frictions, are now to be separated, so as to pass into the various sinuosities of the part,) but also with the palm of the hand, so as to embrace the entire joint and surrounding parts. The hand in both this and the former part of the procedure should be smeared with some fatty body, such as almond oil, so as to render its movements more soft and easy. The shampooing must be performed in the gentlest manner, without shocks, directed from below upwards, and acting not only on the painful points, but upon all those that are tumefied.

If pain is excited by an attempt at moving the joint, we must return to shampooing until new trials have proved that flexion and extension cease to excite painful sensations. Such movements would be very painful, or even dangerous, if performed at an early stage of the treatment. They do not, however, constitute any part of the treatment itself, and are only resorted to as a means of appreciating the results derived from shampooing. In several cases in which the cure had been considered as complete, the pains have returned next day, accompanied by more or less febrile reaction. A single re-application of the shampooing has sufficed to dissipate them, and in most cases, twenty-four hours' rest and the application of a bandage moistened with spirit of camphor, has sufficed for this. This bandage, indeed, is useful in all cases, and should be worn for two or three days.

This procedure is applicable to both old and recent sprains, and even when there has been present also a fracture of the fibula, shampooing has effected a remarkable diminution of pain and swelling, enabling the surgeon sooner to ascertain the exact nature of the case. Several cases of severe, recent, and old sprains are referred to, in which two or three hours of this shampooing process have effected an entire cure.

VI. On the Treatment of Burns by the Permanent Warm Bath. By Dr. PASSAVANT. (Deutsche Klinik, Nos. 36, 38, and 39.)

The occasion of this communication was furnished by the explosion of a firework factory at Frankfort, which gave rise to the loss of fourteen lives. Thirteen persons were taken to the hospital exhibiting almost every stage of burn, some of them scarcely aware, in the excitement of the moment, that they had been burned, although their sufferings after admission soon became excessive.

All the cases admitted were treated by the permanent warm bath where this could be applied, and where it could not, compresses dipped in warm water were substituted. This course was pursued in consequence of the success of former experiments made by the author, and the analogy prevailing between burns and other surgical affections in which the baths have proved so efficacious in the hands of Langenbeck.* The limb was placed in a suitable vessel, which was filled with warm water kept at a temperature of 27° R.; the water being usually changed twice a-day, and in the event of excessive discharges, oftener. If after some weeks maintenance in the vessel the patient's position became irksome, moistened compresses were substituted. The first effect produced by the bath was an immense abatement, soon to be followed by a complete cessation of the excessive pain-constituting in fact the completest anodyne-an advantage of sufficient moment, even supposing no other was derived. Besides this, however, the dried and hardened tissues became completely penetrated with water and thoroughly softened, and the destroyed parts were more easily separated and cleansed away. The wound was thus kept constantly clean and free from all sources of irritation, and the danger of absorption of pus and of pyæmia was diminished. The healing of the wound, too, takes place more rapidly under water, being promoted probably by the equable temperature and moderate compression of the water, and by the greater activity of the metamorphic and endosmotic processes.

* See British and Foreign Medico-Chirurgical Review, vol. xvii.

VII. On Calculous Diseases in Hungary. By Prof. BALASSA. (Wien Medicinische Wochenschrift, Nos. 25 and 26.)

This communication formed an answer to a circular sent out by Professor Gross of Louisville, U.S., for the purpose of obtaining statistical information relating to calculous disease. Nearly all the examples of this affection that occur in Hungary are brought to the Pesth Hospital and during Professor Balassa's twelve years (1843-55) officiating in the surgical clinic he has met with 135 cases of stone. In regard to age, 21 of the patients were between one and seven years old; 32 between eight and fifteen; 47 between sixteen and twenty-five; 27 between twenty-six and fifty; 6 between fifty-one and sixty; and 2 between sixty-one and seventy. It is thus seen how large a proportion of the cases occur among the young, 100 of the 135 being less than twenty-six years of age; while a large proportion of the cases having been long neglected, might be referred back quite to childhood. We may add to these, 49 cases of stone treated at the Children's Hospital during the same period of time; so that stone in Hungary chiefly occurs in childhood and youth. Of the 135 cases, 82 occurred in the peasant class, and 39 among mechanics, the inhabitants of the country, therefore, much preponderating. Their especial prevalence amongst the poorer classes is farther shown by the experience of the author in private practice, he never meeting it among the children of the wealthier classes. This can only be attributed to difference in mode of life and alimentation, the wholesome food of childhood being frequently replaced by carboniferous food of difficult digestion. This view is farther borne out by the analysis of 83 of the calculi that were removed. A long account of these is given; but we have only space to state that great preponderance of the oxalates and urates was observable, especially of the former. The prevention of such calculous formation would be best sought by an amelioration of the regimen of the classes amongst which the disease almost exclusively prevails in Hungary.

Professor Balassa observes, that according to his experience catarrh of the bladder never accompanies the oxalates or urates; but in the case of phosphatic calculi it is always met with to a considerable and obstinate extent, the urine being acid in the former and alkaline in the latter case.

Of the 135 stone cases, in 13 no operation was performed on account of an extreme degree of consecutive disease of the urinary organs, and a disordered condition of the general system. In 122 cases operations were resorted to, although in some of the instances under very unfavourable circumstances, inasmuch as chronic nephritis, obstinate catarrh of the urinary passages, and various other ill consequences of the presence of calculus were present. Whenever by proper care and treatment the symptoms of these diseased conditions were ameliorated, and the state of the general health became materially improved, the operation was undertaken upon the old maxim, anceps remedium melius quam nullum, in several cases with success, but in 5 others with a fatal issue. In 2 of these cases there was found a high degree of eccentric hypertrophy of the calices of the kidney and ureters, and in two others renal atrophy. In 1 case the right ureter, excessively dilated, had become affixed to the cæcum through prior exudation; an intercommunication had formed between the two parts, and through this aperture a lumbricus had passed along the ureter into the bladder. That a diseased condition of the urinary organs should not always contra-indicate an operation, the Professor has had many opportunities of learning in the course of his practice. Even abundant purulent deposit may indicate disease of only one kidney, and the individual be saved by the operation, through the other kidney still performing its functions.

The neglected and complicated conditions of the cases that usually are brought to the author's clinic have led to his resorting to lithotrity in a comparatively small number, being compelled to abstain from it on account of the excessive hyperæmic irritability of the bladder, and the frequent attacks of inflammation. For the same reason his lithotrity operations have been less successful than the general statistics of the operation would lead us to expect.

Of the 122 operations, 92 were lithotomy and 20 lithotrity; 11 of the former cases (11.95 per cent.), and 5 of the latter cases (16.66 per cent.) dying. Of the 11 deaths after lithotomy, 5 took place from chronic disease of the kidney, and 1 from epidemic typhus, the remaining 5 succumbing to inflammation of the bladder and peritoneum coming on from the third to the fifth day after the operation. Strictly speaking, these were the only cases which died as the immediate consequence of the operation when performed in suitable cases, reducing the mortality in fact to 5:43 per cent. Of the 5 deaths following lithotrity, 1 took place from phthisis, 2 from chronic renal suppuration, and 1 from recent nephritis; 2 of the deaths alone were in fact directly referrible to the operation, giving the mortality of 6.66 per cent. Fistulous openings into the rectum, or infiltration of urine, did not take place after any of the lithotomy operations; but extraction, on account of the large size of the stone, being very difficult in several cases, peritoneal and vesical inflammation not infrequently followed, and in

5 instances terminated fatally. With the exception of 7 cases, the stone was extracted entire in all. The diameter of the largest stone in the collection measures two inches five lines, in 5 calculi it was somewhat above two inches, and in 24 it varied between one inch and one inch and a half. The heaviest stone extracted weighed 3 iss. gr. x., and the lightest gr. xvii. It may be noted that among the 135 cases, 1 only was a female, and she was treated by lithotrity.

Professor Balassa recommends, after all bleeding has ceased, the application of some oiled strips of linen rag along the track of the wound, he having found it a good precautionary measure for the prevention of infiltration of urine, or the irritation of the lips of the wound by this fluid, especially when they have been much contused during the extraction of a large stone.

VIII. On the Treatment of Hernia by Electricity. By Dr. CLEMENS. (Deutsche Klinik, No.34.)

This paper is the first of a series the author intends publishing upon the therapeutical application of electricity-a subject that has engaged his attention for some years past. He first employed this agent in the treatment of inguinal hernia in 1850, and has frequently had recourse to it since then. The hernia being reduced, and the patient placed in the semirecumbent position, the ball of the conductor is carried as far into the hernial canal as possible, and the application of the electricity continued during five minutes, its power being increased day by day. After a few séances the mouth of the ring becomes diminished in size, the finger is introduced with more difficulty, and the hernia will not descend so easily as heretofore. The electricity, too, exerts a very beneficial effect upon the peristaltic intestinal motions, augmenting and regulating these, and thus preventing the same relaxed portion of intestine from always lying opposite the hernial aperture. A state of obstinate constipation becomes changed for one of regular action, and many old disordered conditions of the abdominal cavity become relieved. When the hernia has been recently produced, no means act with so much certainty and rapidity; and a case is referred to of a young man who acquired double inguinal hernia during an effort to raise a heavy burden, and which was completely cured after twenty séances, although these were not commenced until a week after the accident. Under its agency recent hernia is rapidly returned; but the author has not yet tried it in a case of complete incarceration. Among the 27 cases in which it has been resorted to, none have manifested the slightest ill consequences. Dr. Clemens prefers static electricity to galvanism, and adminsters it by means of the Leyden phial.

Another application of electricity by the author consists in a galvanic hernia truss, for a description of the construction of which we must refer to his paper. By its agency a feeble but constant galvanic stream is kept applied to the ring, and large hernias soon become easily retained which before had resisted the largest trusses and the strongest springs. Of late the author has constructed a pile of silver and copper coins, and the effects of so small an apparatus have often surprised him.

IX. On Diphtheritis of the Palpebral Conjunctiva. By M. MAGNE. (L'Union Médicale,

No. 100.)

M. Magne, in this paper, calls attention to the affection described under the same name by A. von Graefe,* and which seems, like other diphtheritic diseases, to be acquiring prevalence of late years. Thus, M. Magne describes four cases that have occurred to him since 1853, while a thirty years' practice at a well-frequented clinic has furnished no other examples; and M. Sichel, during the same period of time, amidst the thousands of cases of ophthalmia that have come under his notice, only recollects two instances of pseudo-membranes forming in the palpebral conjunctiva, independently of the action of heat or caustics. M. Magne believes that the comparative frequency with which MM. Chassaignac and A. von Graefe are said to have met with the disease arises from a confusion in names. The affection they describe was not, in fact, characterized by a true pseudo-membrane, but by a mere mucous or muco-purulent concretion, which was so slightly adherent as to admit of removal by injection, sponge, forceps, or even the fingers, forming a juxtaposition rather than an adhesion. The concretion removed, the conjunctiva is red and sometimes granular, but its surface is always uniform. In the affection now described, however, which may be justly styled palpebral croup, there is a true pseudo-membrane, an albuminoso-fibrous tissue intimately blended with the conjunctiva, and which cannot be removed in a single piece, but must be scratched or scraped off, leaving the conjunctiva bleeding at the points whence it has been removed. It

*See British and Foreign Medico-Chirurgical Review, vol. xx.