have the work completed as soon after the termination of my attendance as possible, are the only apologies I have to offer for so hurried and imperfect a performance. I have endeavoured, however, to give a faithful detail of all the cases of importance, appending to them such observations as they naturally suggested and, at the same time, I have made an unreserved disclosure of all the adverse occurrences which I have met with in Hospital, and, when the subject admitted of it, even in private practice. All the operations which proved fatal are candidly recorded, and the causes of failure pointed out, from a conviction that by such details science is more likely to be benefited, and the surgical student improved and instructed, than by merely disclosing the cures,' however numerous or brilliant. These Reports embrace but a very limited period; they include, however, the whole time of my attendance as junior and senior surgeon, viz. from 1st May to 1st August, 1826, when only one surgeon officiated, and the attendance was limited to three months; from 1st November, 1826, to 1st May, 1827, when the period was extended to six months, and two surgeons acted; and from 1st May, 1831, to 1st May, 1832, when the time of attendance was increased to one year, which arrangement is at present followed.

It cannot be denied, that the public at large, by whom our Hospitals are so munificently supported, and especially the medical world, are entitled to look to the Physicians and Surgeons of such establishments for the results of their experience, whether fortunate or adverse, in the shape of a periodical publication. Were such documents regularly furnished by the attendants of British hospitals, as is occasionally done upon the Continent, and thus made available to the profession, a mass of invaluable materials would be soon accumulated, which would far exceed in value and importance all the isolated papers and cases with which the journals of the day abound. It is not, however, in the power of the surgeons to the Glasgow Infirmary to furnish any thing like an extensive Report, the pe

riod of their attendance being so limited as to prevent any single individual from obtaining that ample experience, or making that extended series of observations, which close and assiduous practice in an hospital for years can alone render important. Nevertheless, it is their duty to communicate the results of their experience, limited though it be; and should they not be able to give to the public much that is interesting or valuable, they may at least show that they have not been inattentive to the duties of the important office to which they have been appointed.”

The volume before us is rich in facts, and those of the kind which we require. We have failures presented as well as successes, and the profession can judge of surgery as it is, and not as vanity would wish that it should be. It is such men as Dr. Macfarlane who are calculated to serve the real interests of truth, and to raise the moral character of the profession. How noble a contrast does his plain and manly conduct present to that of the shuffling advo cates of a special remedy. The present Number of this Journal will afford discerning men the means of comparison. We shall lay this volume under an embargo, in order that we may rifle it of its valuable contents. Dr. Macfarlane will be pleased to see his cases made far more extensively useful, than the limited circulation of a medical monograph could possibly permit. As the book is a mass of arranged cases, we are not tied down to an analysis or a review, but may suck, at our convenience or caprice, the honey from its numerous and varied flowers.

I. LUPUS.

"This disease is met with in two different forms. The first and most common variety commences in a slight papillary enlargement of one or more of the sebaceous glands and follicles of the nose, cheek, or lip, which parts soon assume a dark red or livid colour. They are at first indolent, but gradually become itchy and painful, ulcerate on the surface, and discharge a thin ichorous fluid, which, on exposure to the

air, becomes concrete; thus forming, over the whole affected surface, crusts or scabs of a yellowish or dark brown colour. These soon separate, and new ones are reproduced; and if the disease is not checked, it gradually extends, and more complete ulceration ensues, by which the original characters of the affection are modified, and in some measure obscured. The ulceration, however, is generally superficial, being rarely deeper seated than the skin, or accompanied with much swelling of the surrounding soft parts; and it seldom produces the ravages or deformity of the second species, which I shall now shortly describe. The sebaceous glands and follicles are here also the seat of the disease; but in general there is only one tubercle, which enlarges slowly, assumes a purple or violet colour, has a broad, firm, and indolent base, and presents many of the characters of a small carbuncle. This lupoid tubercle is slow in its progress, and may remain for a considerable time discoloured and indolent before ulceration takes place. In one case that came under my notice, the tumour, which was the size of a walnut, resisted every kind of treatment, for fourteen months previous to the occurrence of ulceration. When this process does commence, however, it spreads deeply, and produces great destruction of the soft parts, as well as of the cartilaginous and bony structures with which it comes in contact. I have seen the nose, the upper and lower lips, the cheek and the right eye, completely destroyed by it, with the nasal, and a portion of the superior maxillary bones."

CASE 1.-Lupus affecting the Nose, &c. cured by Arsenic.

C. M'K., æt. 9, was admitted into the infirmary on Jan. 4, 1831, under Dr. Perry. On the 1st May she became the patient of our author. The upper lip, and apex and alæ nasi were covered with yellowish scabs, under which the ulcerated surface had a florid papillary appearance, and discharged a thin matter; a part of the septum and alæ nasi was destroyed.

There was some difficulty of swallow ing from great swelling and irregula

rity of both tonsils, which were much thickened, superficially ulcerated, and tuberculated; the uvula also enlarged, adhered firmly to the left. The ointment of the iodide of mercury had been used for several weeks without advantage. A solution of the white oxide of arsenic in water, grs. vj. to the oz., was ordered to be applied to the ulce rated surface twice daily, was continued for several weeks, together with small doses of Fowler's solution of arsenic internally. The parts cicatrized several times, but in a few days the ulcera. tion returned. At length two applications of the actual cautery, followed by the arsenical lotion, produced a more permanently healthy action, and she left the infirmary cured on the 17th September.

"I have great faith in arsenic as a local application in lupus, and am in the habit of employing it for two different purposes. When used as a stimulant, it must be applied in solution, but when an escharotic effect requires to be produced, the white oxide mixed with an ointment, or made up in the form of paste, is laid over the affected surface. Dupuytren has frequently observed, that when the arsenical paste is applied to lupous ulcerations, extensive erysipelas of the surrounding integuments is not unfrequently produced, and he therefore prefers applying the proto-chloride of mercury in powder, which he says is free from this objection, and gradually but steadily changes the morbid state of the parts, acting more as a specific than a caustic. Although I have never seen the arsenical paste give rise to erysipelas, yet in two cases in which the ulcerated surface was extensive, its application was fol lowed by severe inflammation of the gastro-enteritic mucous membrane, apparently in consequence of its absorption into the system; and in another case, the slough which it produced penetrated so deeply as to expose the cartilage of the nose, a portion of which exfoliated. When, however, the diseased surface is small, and the lupus exists in the form of tubercle, the arsenical paste may be employed, not only with safety, but also with marked

advantage, for it destroys the ulcerated surface and the surrounding induration more completely than can possibly be effected by applying it in solution. But in every other state of the disease, the latter formula is the safest and most efficient,-its strength being so regulated as to produce either a stimulant or escharotic effect. I have employed it for the latter purpose in several cases, and have never seen the most concentrated solution, even when applied to irritable and extensive surfaces, produce local mischief or constitutional disturbance.

The other stimulating applications which I have employed with most advantage, are the actual cautery, and a solution of mercury in strong nitric acid. The red-hot iron has a powerful effect in changing the morbid action, producing healthy granulations and speedy cicatrization. I have employed it in several cases of lupus with decided benefit, and am in the habit of doing so with similar good effects in other forms of ulcer, both indolent and irritable. I have only once employed the nitrate acide de mercure,' which Richerand and Cloquet have found so frequently useful when other applications had failed. It produced a slough, which was three times removed, when a cure was accomplished. In this case the right nostril was nearly shut up by an enlarged, ulcerated, and granular state of its mucous membrane. This diseased state was removed, and occlusion of the external aperture prevented by the introduction of sponge."

In the following case the obstruction of both nostrils was complete, and the deformity required removal by an operation.

CASE 2.-Lupus affecting the Nose, &c. and producing obliteration of the Nostrils removed by an operation.

W. M., æt. 18, was admitted March 21, 1826, under Dr. Young. The disease had commenced 18 months previously on the nose, cheek, and centre of the upper lip, by dark redness, tumefaction, and itchiness, slowly succeeded by ulceration; the parts then becoming covered with thick yellowish-green

or dark brown scabs, extending along the septum nasi, and accompanied with a purulent discharge from the nostrils. Three applications of the actual cautery and the use of resinous ointment seemed to effect a cure; but on the 1st of May, when Dr. Macfarlane took charge of the case, the diseased parts were covered by a delicate, smooth, and shining cuticle, and were elevated, irregular, and apparently unsound. In a few days ulceration recommenced, scabs forming, dropping off, and being speedily renewed. Under the arsenical lotion and Fowler's solution internally a gradual improvement took place, and the patient was dismissed cured on the 26th June. On the 24th August the disease re-appeared after the reception of a smart blow on the nose. On Feb. 16, 1827, he re-applied at the infirma ry. The external parts were healed, but the opening into both nostrils was completely obliterated by the firm union of the alæ with the septum. The adhesions, which were firm and extensive were divided by a narrow bistoury, and sponge tents were afterwards introduc ed. When these were discontinued the parts healed under the application of the nitrate of silver.

Although lupus may be purely local in its origin, yet it sometimes happens that its continuance is prolonged, and the cure materially impeded by constitutional causes. I have seen, both in the Infirmary and in private practice, several children labouring under this disease, who had been subject for years to psoriasis, tinea capitis, or other cutaneous complaints. It has been also observed to prevail most obstinately among those of a scrofulous diathesis, especially while labouring under enlargement of the lymphatic glands, affections of the bones, chronic ophthal mia, tabes mesenterica, &c. According to M. Rayer, it has been at times particularly prevalent among the poor in some parts of France, from scanty and unwholesome nourishment; and in this city, during the years 1818 and 1819, when the working classes were exceedingly ill fed, I had occasion to see a greater number of cases among the poor in the district which was then

under my care than at any former or subsequent period. These facts are sufficient to shew the necessity of combining constitutional with local treatment. With this view I generally order Fowler's solution of arsenic in small doses; but I have sometimes found it necessary to prescribe the muriate of mercury, dissolved in a bitter tincture, such as that of cinchona, colomba, or gentian, so as to produce a mildly-alterative effect."

CASE 3.-Tubercular Lupus mistaken for Cancer, cured.

W. P., æt. 44, was sent from the Highlands to undergo an operation for cancer. On the 14th June, 1826, the following was his condition. Two inches of the central portion of the upper lip were destroyed by ulceration—the sore looked angry—its edges were thin and ragged-its surface irregular, and covered by a greyish secretion through which small purple granulations were visible -the discharge was bloody and fetidand the surrounding integuments were livid, indurated, and the seat of darting pains. The nose was covered with a number of small, prominent tubercles, to the apices of which were attached hard yellowish scabs. The disease had existed for nearly two years, ulceration having occurred eight months after the first appearance of the tubercle in the lip, during which time several of the lymphatic glands on both sides of the neck became enlarged and painful. The arsenical lotion was used by Dr. Macfarlane, at first as an escharotic and afterwards as a stimulant, whilst small doses of the hyd. mur. were given so as to affect the gums. By these means the morbid action of the parts was arrested, and in less than two months a complete cure was effected. Though much of the lip was destroyed, yet, as granulations formed, the parts were gradually approximated by means of sticking plaster and a double-headed roller, and ultimately re-union took place with but little deformity.

"Sometimes the progress of a lupoid tubercle may be arrested, and its ulceration prevented, by the application of leeches around its base, especially when

the tumour is painful and covered by inflamed integuments. This followed by evaporating lotions, and alterative doses of calomel, will not unfrequently subdue the inflammation upon which the progress of the disease depends, and reduce it to that indolent and chronic state, in which friction, with an ointment containing the ioduret of zinc or mercury, may be beneficially employed to promote its absorption.'

We have given all the cases of lupus related by Dr. M. as well as the practical remarks accompanying them, because we know how important it is to understand the treatment of this most distressing complaint. We might offer some observations of our own, but as we are anxious to place before our readers as much as possible of the valuable matter contained in the present volume, we will not stop to indulge in any. We will merely say this, that in lupus, as in other maladies, the practitioner must not neglect the general principles which regulate all treatment, even the most specific. He must see what is wrong in the general health, and endeavour to set it right, and he must recollect that the state of the parts in lupus is liable to variation. Occasionally we find them inflamed— occasionally indolent. When scabs form it is better to apply a light bread poultice until they are separated, and then resort to the applications determined on.

II. LUMBAR ABSCESS.

Dr. Macfarlane remarks that lumbar abscess has become a more manageable disease since the general adoption of Mr. Abernethy's practice-that of opening the tumor frequently by a small puncture, healing the wounds, and allowing the sac to contract. This perhaps is not so certain as Dr. Macfarlane imagines, indeed we suspect that at present Mr. Abernethy's method is rather declining in general estimation. At St. George's Hospital, for instance, where free openings, and punctures, as recommended by Mr. Abernethy, have been tried extensively and compared together, the latter are nearly aban.

doned. Mr. Brodie, whose opportunities have of course been great, and who has paid no inconsiderable degree of attention to the subject, prefers free openings and the subsequent application of a poultice, in order that the matter of the abscess may drain out. Mr. Brodie has been led to give a preference to this practice from having observed that, after closing a small wound, the contents of the sac became putrid under the admission of a little air, when sulphuretted hydrogen gas was generated, and the usual remarkable symptoms of a putrid abscess ensued. We remember, ourselves, having witnessed a case of this description. A patient had psoas abscess, which presented in the thigh. It was opened, but at this monent we do not remember how, and after the puncture the wound closed. On the next or ensuing day peculiar symptoms of prostration with fever of a typhoid character set in. The wound was immediately broken open, when coagula of blood that had been locked in and putrid gas escaped. We believe that the patient died. But we return to Dr. Macfarlane.

Dr. M. observes that before puncturing the cyst, which, it will be recollected, he does in the Abernethian manner, he has derived much advantage from establishing an issue over the lumbar spine; he has also irritated the depending part of a lumbar abscess by the moxa, when, from non-adhesion of the puncture, there was reason to fear that inflammation of the cyst would supervene, and this has been attended in several cases with decided advantage.

CASE).-Lumbar Abscess successfully treated by Issue, Moxa, and repeated puncturing.

W. J. æt. 18, admitted July 14, 1826. The abscess presented below Poupart's ligament on the left side. He complained of pain in the left iliac and fumbar regions, but no tenderness, nor alteration of the spinal column could be detected. He was of strumous aspect his strength reduced-there were frequent dry cough, hurried breathing, and night sweats-he could not stand erect, or walk without keeping the

trunk bent forward at a considerable angle-pulse 120-pyrexia. The tumour had been first observed at the upper part of the thigh five weeks previously, but for several months he had been subject to pain in the back, and weakness of the limbs.

"A small caustic issue was formed on the left side of the spinous process of the second lumbar vertebra; and after the eschar had separated, and the discharge was established by the insertion of peas, the abscess was punctured, and about eight ounces of well-matured pus (being apparently about two-thirds of its contents) were evacuated. The edges of the wound were brought accurately together, and adhesion effected. He was allowed a milk diet, with a small quantity of wine, and six grains of quina daily; his strength and appetite gradually returned, his pulse fell to eighty in the minute, and the diarrhoea and perspirations ceased. The sac was punctured again in ten days, and the wound closed; but, on repeating this operation for the third time, about a fortnight after, adhesion did not take place; there was, therefore, a daily discharge of pus from the opening for about three weeks, when it completely closed. On the third day after the last puncture was made, he had a rigor, which was followed by pain in the lower part of the abscess, and by a fetid and brownish-coloured discharge. The application of a moxa over the most depending part of the cyst, and of another over Poupart's ligament, checked these symptoms, and restored the purulent secretion to a more natural appear

ance.