of mercury, the therapeutic qualities of the latter are completely neutralized hence we should always prescribe it in an uncombined form. Notwithstanding the great and important advantages to be derived from the mercurial preparations in the treatment of the syphilides, it is but fair to add that in some cases they do not succeed. Whether from idiosyncrasy, the patient will not bear the medicine long enough, or from a repugnance to it, he will not allow it to be prescribed, or from morbid irritability of the digestive organs, the remedy cannot be administered at all; from whichever of these causes it occurs, there is no doubt but we are sometimes baffled in our attempts to relieve the patient. Other remedies have been recommended when the foregoing fails, but our faith in their efficacy is not great. Acids. In some of the milder syphilitic affections, as S. roseola, S. papula, the exhibition of the acids is not unfrequently followed with benefit. The author orders nitric acid (dilute) in doses of four minims, three times a day, in barley-water or orgeat. In the severer forms it may be tried when the preceding medicine fails. Gold. The preparations of gold are not of much service in the secondary forms of syphilis, and the author has very little faith in their remedial powers in the treatment of the syphilides. The preparations of silver, so strongly recommended by M. Serres, of Montpellier, have been frequently tested by Biett and M. Cazenave in these complaints, but always without success. The author recommends sudorifics as useful auxiliaries to the mercurial preparations, and has even found them occasionally beneficial when unaided by other medicine. Iodine in its simple form, although extolled by many writers for its efficacy in syphilitic secondary diseases, has invariably failed in the hands of M. Cazenave. But there are combinations of iodine, other than those already described, which are extremely useful in many cases: these are the iodide of iron and iodide of potassium. Iodide of iron has been recommended by M. Ricord in secondary syphilis, and the author's experience leads him to believe that it may be sometimes useful, but not so frequently as M. Ricord imagines. This preparation appears to us to be objectionable from the chemical changes which it is liable to, for it is almost impossible to keep it from undergoing a certain degree of decomposition in the solid form, and even the solution, with a coil of iron wire to preserve it, cannot be kept long undecomposed. In our own practice we use a syrup of the iodide of iron, which continues for several months without undergoing any change. This preparation is made by several London chemists. Iodide of potassium. M. Cazenave has found the iodide of potassium to be only second to the iodide of mercury in its valuable therapeutic effects in the treatment of the syphilitic eruptions. Indeed, he seems to think that in some instances it is fully as efficacious as the mercurial preparation. Although he has occasionally observed it to cause considerable pain at the epigastrium and posterior fauces, it can generally be continued. six or seven weeks, or longer, with impunity. The author uses two formulæ, a stronger and a weaker, which are prescribed according to the condition of the patient, the irritability of the constitution, and the duration and severity of the particular eruption present. Dose to begin with one spoonful, then two, and subsequently three in the twenty-four hours. Such are the various modes of treatment which Biett and Cazenave have found to be attended with most benefit at the Hospital of Saint Louis, in the venereal diseases of the skin. As a general rule the author preferred the mercurial preparations to all other remedies, and only had recourse to the different remedial agents noted above, when he could no longer administer the protoiodide or in cases when it was inadmissible from the first. The powerful effects of this remedy are more strikingly displayed in the tubercular forms, and those complicated with tumefaction of the soft parts and periostosis, than in any of the syphilides. Its efficacy in removing those unsightly protuberances of both skin and bone which characterize the tubercular syphilides, is oftentimes truly wonderful. We have repeatedly seen them vanish, as if by magic, and were as much astonished at the rapidity as the completeness of the cure. While we have such an agent at our command, we do not despair of alleviating, if not curing, the most inveterate form of this hideous disease, provided the patient will bear the medicine; and our past experience justifies us in all that we have said in favour of this heroic remedy. The practitioner must always be guided in the selection of the treatment by the nature and form of the eruption, its duration, the particular constitution of the patient, and the anterior treatment. The acids are indicated in the semiacute varieties, especially in S. exanthemata, S. vesiculæ, and one or two forms of syphilitic lichen. Sudorifics are mostly of use in the pustular, but particularly the squamous eruptions, and, as we have before stated, the mercurial preparations are specially applicable in the most severe forms of the syphilitic eruptions. Whatever may be the treatment adopted, it should always be preceded for a certain time by what we may call preparatory measures, both hygienic and medicinal. This observation applies in particular to those cases where the mercurial preparations are to be administered. Biett always gave opium in small doses for a week or two before he prescribed the protoiodide of mercury, and generally with good effect, and during the administration of the latter, he recommended the occasional use of the vapour-bath, and sudorifics. M. Cazenave has not much faith in topical remedies in the treatment of the syphilides. He seldom uses ointments, unless to dress an ulcerated surface, and then employs this formula: Protoiodide of mercury, ǝj; The author has sometimes employed with benefit the following ointment in cases of syphilitic lupus, with the view of modifying the parts of the skin: Biniodide of mercury, gr. xij; Prepared lard, 3j. Mix. The author has never found any benefit attend the use of escharotics, except in one form of syphilitic tubercle (tubercule plat) which he has occasionally modified by the application of nitrate of silver. In these cases aromatic vinegar has also been applied with advantage; but as a general rule escharotics are useless and frequently dangerous in the treatment of the venereal eruptions. Baths are extremely useful auxiliaries in the treatment of the syphilides. The vapour-bath and douche, are particularly serviceable in the papular, tubercular, and squamous varieties. Tepid baths, rendered emollient by the addition of starch and gelatine, are beneficial in certain forms of the exanthemata, in lichen, and in impetigo syphilitica. Alkaline baths are also useful in these forms, and in certain stages of the pustular syphilides, when the dryness of the scabs seem to indicate that the ulcers are cicatrized. Cinnabar fumigations are often very serviceable in the tubercular eruptions, when administered directly by means of an apparatus to the diseased parts. It is peculiarly applicable in cases of tubercle on the scrotum and about the anus. Dr. Burgess recommends a preparation of iodine and sulphur in the form of vapour in these and similar cases:* R. Sulphuris ziij; Hyd. sulph. rubri Dij; Iodinii gr. x. M. ft. pulv. sex. Dr. Burgess states that he has found this remedy exceedingly beneficial in the squamous and tubercular eruptions. It should be applied in the form of vapour, by means of an apparatus, to the parts affected. M. Cazenave considers it indispensably necessary that the treatment should be continued for some time after the eruption has disappeared. It is impossible to lay down any precise rules as to the limits of this period, which it is evident must be regulated by the character of the preceding disease and the tact of the physician. If the eruption was mild, of short duration, and yielded easily to the treatment, say in the course of a month or six weeks, it should be continued for a month longer, at the same time, gradually diminishing the dose. If the disease, on the contrary, was of a severe and obstinate character, of considerable duration, and the treatment had occupied a period of several months, the patient should be allowed to repose for about a fortnight after the disappearance of the disease, and then the treatment may be recommenced, and followed in the same manner as before for a given time, then discontinued and begun again as in the first instance. It is sometimes necessary to discontinue the medicine three different times before we have done. It is a singular coincidence, and one worthy of being remembered, that a patient who may have borne the mercurial remedies well for several months without intermission, will suddenly, and after a discontinuance of the treatment for a few days, evince an almost invincible intolerance of the remedy employed. This is a sure indication that the treatment is complete. We have now concluded our analysis of the Traité des Syphilides.' The importance, as well as the novelty of the subject in its present form, has led us to give as copious a review of M. Cazenave's work as our limits would permit. Still we have not been able to do it the full amount of justice which it deserves. M. Cazenave is, beyond all dispute, the first dermatologist of the day. His works on cutaneous pathology are models of their kind, alike remarkable for their clearness of arrangement, lucid * Translation of Cazenave's Manual of Diseases of the Skin; with Notes and Additions. By T. H. Burgess, M.D. descriptions and practical character; and amonst these the monograph before us takes a prominent position. The Traité des Syphilides' is the first attempt that has been made to collect and publish in a separate and complete form the various syphilitic eruptions. It is, in fact, an elaborate extension of Biett's well-known article on the Syphilides,' published in the author's Manual of Diseases of the Skin,' enriched by the author's own experience, and copiously illustrated by cases and coloured plates. We could point to more than one English work on 'Diseases of the Skin,' which has received the approbation of a considerable portion of the medical press, for the excellence of the chapter on the Syphilitic Eruptions, which has been borrowed partly or wholly from the article on that subject in M. Cazenave's Manual. The dauntless hardihood and recklessness of consequences displayed by the author of one of these piracies forbids us to shut our eyes on one of the most heroic achievements in plagiarism that has, perhaps, ever occurred in the history of medical literature. The 'Compendium of Diseases of the Skin' by Dr. Jonathan Green, published as an original work, contains an article on the Syphilides which, with the exception of two or three lines at the beginning, is a mere translation of M. Cazenave's article. How any man, pretending to a literary reputation, or to a reputation of any kind, could have been guilty of such wholesale appropriation of another's property we cannot pretend to divine. But so it is; and there it will remain, a lasting stigma on the author, and on the press, which not only tolerated but lauded it. We most cordially recommend the Traité des Syphilides' to those of our readers who are familiar with the language in which it is written. They can judge for themselves of the merits of the work from the analysis with which we have furnished them; and we have merely to say, in conclusion, that it has been our text-book in the treatment of the Syphilitic Eruptions for some time past, and we have always found it a safe and faithful guide in practice. ART. III. Par Mémoires et Observations Cliniques de Médecine et de Chirurgie. THIS Volume consists of memoirs on scrofulous ophthalmia, on hernia, on diphtheritis, &c., together with a series of reports of the more interesting medical and surgical cases that have occurred in the practice of M. Morand, a surgeon of Tours. To these is added a description of two new instruments invented by the author-an obstetrical forceps and a gumlancet. Although the majority of the essays contained in this work are neither, in point of novelty or of practical importance, of a higher order than the average run of "Original communications" to journals-in which several of them have already appeared-yet as some of them contain facts that may be interesting to our readers, we will give a succinct analysis of the principal papers, taking them in the order in which they are presented to us by M. Morand. Scrofulous ophthalmia. The first essay in situation as well as importance is on the coincidence of scrofulous ophthalmia with inflammation of the pituitary membrane, and on the necessity of treating the affection of the nose before undertaking the cure of the disease of the conjunctiva. This memoir, it appears, was laid before the Royal Academy of Medicine of Paris, and was favorably reported upon by Velpeau, who was appointed to examine into its merits. It consists of an account of an epidemic ophthalmia that broke out in 1841, amongst the children inhabiting some model-farms at Mettray. In the course of this epidemic, M. Morand's attention was especially directed to the state of the pituitary membrane, which he uniformly found to be in a congested or even inflammatory condition; and so intimately was this state of the mucous membrane of the nose connected with the conjunctivitis, that he could foretell the probable supervention of the latter disease on finding the nasal cavities reddened or irritated, and the Schneiderian membrane congested or inflamed. Before being affected with ophthalmia, many children likewise suffered from the ordinary symptoms of coryza. The continued observation of these facts led M. Morand to the conclusion that this condition of the nostrils preceded the inflammation of the conjunctiva, of which it was, as it were, the starting-point, and occasioned by its persistence the numerous relapses that his patients suffered from. "It results, from my observations," says M. Morand, "that in scrofulous ophthalmia the olfactory membrane participates with the conjunctiva in the inflammation that is set up; that it is especially about the turbinate bones, and in the anfractuosities of the nasal fosse that the inflammatory action resides, and that this shows itself in the form of an oedematous engorgement precisely similar to what is observed in the eyelids. The more I study this disease the more convinced am I that it is so. A little attention suffices to show that the redness and tumefactions of the pituitary membrane almost always precede or accompany that of the conjunctiva. This can be more positively determined by means of the speculum auris. On examining attentively the interior of the nasal fossæ, one cannot fail to observe that the redness and swelling of the nostrils, and even of the upper part of the lip, that are so commonly observed in persons of a scrofulous habit, are merely an evidence of the inflammatory action going on in that membrane. It is by proceeding in this way that we can best appreciate the degree and extent of this inflammatory action, the extension of which to the palpebral and ocular mucous surfaces is often very rapid; sometimes, however, it remains for a long time stationary, without showing any disposition to extend." (p. 3-4.) From the repeated observation of the coexistence of the inflammations of the Schneiderian membrane and of the conjunctiva, M. Morand was led to adopt a new mode of treatment, which appears to have been pretty successful. Instead of applying his remedies to the eyelids or eyes, he attacked the disease existing in the interior of the nose. Before making the observation that has just been referred to, M. Morand had tried a variety of general and local means; two oculists of eminence had been consulted, but without avail; the ophthalmia resisted most obstinately, and cases continued to occur with a frequency that caused considerable uneasiness to the directors of the farms at Mettray. From the time, how ever, that he determined to attack the disease in the nostrils, the inflammation of the eyes speedily subsided, and relapses were much less frequent than before. The plan adopted by M. Morand was to cauterize the interior of the nostril of the side corresponding to the affected eye with |