The bodies of two patients were examined on Monday, who had died, the one on Saturday, the other on Sunday morning; the one about 40, the other about 60 years of age. Both had been received into the hospital within 24 hours of their decease, immediately after inflicting wounds in the throat for the purpose of self-destruction. In each case the incision had been made in the front of the throat, between the thyroïd cartilage and the os hyoïdes; and in neither had any artery of importance, not even the thyroïd, been divided.

Mr. Mayo observed, that instances like the present are far from uncommon, in which death, after the attempt at suicide, proceeds not from the injury, but as a consequence of the previous phrenitic state of the patient. On examining the brain in each of these cases there was considerable effusion upon the surface, and in the ventricles; and it appeared a remarkable coincidence, that in both, the choroïd flexures contained numerous large hydatid-like cysts. In one brain there was a cyst, holding serum, as large as a hazel-nut, situated in the corpus striatum of the left side: this patient was described by those who brought him as having been subject to

fits.

In one of the two cases the incision had penetrated the fauces, and had cut off the upper two-thirds of the epiglottis : the patient had, notwithstanding, been able to swallow with facility, scarcely any liquid being forced out, or coughing produced during deglutition.

PARIS HOSPITALS.

Method of treating an Abdominal Tumor, supposed to contain Hydatids. A MAN, about 34 years of age, was recently admitted at the Hôtel Dieu, who, for the last 18 months, has complained of tumor in the situation of the liver, which increased very gradually, but at present occupies the whole of the right hypochondrium. Attentive examination shewed that it is connected with the liver. It is perfectly free from pain, even when pressed upon; has not produced

the part, and gives rise to no other inconvenience than that of preventing the man from pursuing his usual avocations. He has had advice from many different medical men, and has tried a great variety of internal and external remedies, to no purpose. It so happens that M. Recarnier, about a year ago, treated a tumor somewhat similar to this, which proved to contain hydatids; and as the means he then employed were perfectly successful, he determined to adopt them on the present occasion. The tumor in the present instance is, however, much larger than the former one; and, although some thought they could perceive that sort of crepitation which hydatids cause when pressed against each other, yet the diagnosis is by no means very clear. However, M. Recarnier proceeded, as in the former case, to puncture the tumor with a very fine trochar, in order to ascertain the nature of its contents. The fluid which flowed out, as had been anticipated, was limpid and colourless, and did not coagulate by heat. After having extracted a small quantity of this fluid, the puncture was carefully closed and healed; and a week after, when the tumor was again distended to its former size, the caustic potash was applied, so as to form an opening into this method answered admirably, as great the cavity of the cyst. In the former case, numbers of hydatids were extracted. sufficient quantity of water was then injected, to fill the space they had occupied, in order to avoid the introduction of the air; the external wound was dressed in the usual manner, and the patient recovered rapidly. The object in applying caustic, rather than making an opening by incision, is to produce adhesions between the cyst and parietes of the abdomen, so as to form an uninterrupted canal from the tumor to the external parts. Large Fibrous Tumor removed from the

Uterus.

A

of delicate health, and rather emaciated, had A woman, of from 50 to 60 years of age, complained for a long time of pains in the loins, shooting down to the fundament and thighs; she had also occasional hæmorrhage from the vagina, proceeding from a tumor of the womb, which she had had for some years. She never had been pregnant. M. Dupuytren discovered, upon examination, a large, smooth, hard, round tumor, very moveable, which, together with its size, induced him to believe that it originated from the cellular tissue immediately beneath the mucous membrane of the uterus, but he was not able to discover either through the rectum, or by the vagina, whether or not it was affixed to that organ by a peduncle.

The woman being desirous of having an operation performed, was placed in the position for the operation of lithotomy: when

the labia were opened the tumor was perceptible: a pair of forceps were then introduced upon the finger, and the tumor was gently drawn downwards: the patient was recommended to assist this by making efforts to evacuate the bowels, and an assistant

made

on pressure

the hypogastrium. When fairly drawn down, M. Dupuytren gave the first pair of forceps into the hands of an assistant, (retaining their hold of the tumor) whilst with a second pair he attempted to draw it entirely out, making pressure with his finger introduced into the anus, but the perinæum became so much distended as to make him fear that it would be ruptured. Seeing that the size of the tumor rendered this accident almost inevitable, M. Dupuytrendetermined to make an incision in its upper part by means of a button-pointed bistoury immediately: the efforts to draw it forth being renewed, it was entirely extracted: it was about the size of a new-born child's head, and was attached to the internal and posterior part of the neck of the uterus by a narrow stalk, which was cut with a pair of curved scissors.

A few spoonsful of blood only were lost during the operation, which the patient bore admirably. At the instant when the tumor was removed there was a discharge of a few ounces of violet-coloured blood. On inspecting the tumor, which weighed about eight ounces, it was found to be covered with a very vascular mucous membrane; on removing this, a white and dense substance presented itself; its surface was covered here and there with slight ulcerations. The hemorrhage had doubtless proceeded from the outer and very highly vascular membrane: the white substance, when cut into, appeared perfectly analagous to the structure of the inter-vertebral substance.

OMNIA.

WE hear that Mr. Lawrence has communicated to the Council of the College of Surgeons, through his friend Mr. S. Cooper, an offer to make a Catalogue of the Museum in six months.

It is said that Mr. Wardrop has applied to be made Professor to the College of Surgeons.

[We give both the above merely as on dits.]

Mr. Bennet has been appointed Demonstrator of Anatomy to the London University. He is about to go abroad, to purchase anatomical preparations.

We believe it is not finally decided that

Mr. WARD, for the best set of Hospital Reports, a silver medal.

Mr. DENNE, for the best Anatomical Preparations, a silver medal.

Mr. MARTIN, for the greatest Anatomical Knowledge, a set of books, in quarto, handsomely bound.

Mr. FERRON, Mr. DAVIS, and Mr. B. TRAVERS, are each to have a set of books, for their knowledge of the anatomy of the bones and muscles. They were examined three times without it being possible to decide that any one of them was superior to the other, and then cast lots for the prize, which was drawn by Mr. Ferron.

NOTICES.

Owing to the absence from town of the Gentleman who regulates the press, at the time the second sheet of last number was printing, it was not noticed that the case of Periodical Contraction of the Extremities, at page 805, had previously been published, though in a less complete form, in No. 18.

The lines on Mr. L. are not fit for insertion.

The account of the operation of tying the brachial artery, at St. Bartholomew's, ought to be substantiated by the signature of the writer.

"M. D." has been received.

An Abstract of a Lecture came to hand too late for insertion in the present number.

BOOKS RECEIVED FOR REVIEW.

A Treatise on Gout, Apoplexy, Paralysis, and Disorders of the Nervous System. By A. Rennie, Surgeon, &c.

Hints to Young Medical Officers of the Army on the Examination of Recruits, and the feigned Disabilities of Soldiers. By Henry Marshall, Surgeon to the Forces.

ERRATUM.

In our last number, p. 808, for cervex uteri," read "cervix uteri."

W. WILSON, Printer, 57, Skinner-Street, London.

ESSAYS ON SYPHILIS.

BY JOHN BACOT,

Lately Surgeon to the First Regiment of Guards.

THE appearance of another publication on syphilis may demand some apology, It will, perhaps, be urged that the subject is exhausted-that pamphlets upon particular points of doctrine, and elaborate treatises, comprehending both the theory and practice in every form of the disease, have become so common, that nothing remains to be gathered by the industry of the most attentive gleaner in this field of inquiry.

In answer to such assertions, it may be suggested that the mass of information thus admitted to exist, is scattered through a vast variety of publications; that few writers are agreed as to the theory of the disease, or even respecting the practice to be adopted; that the late doctrine of the multiplicity of venereal poisons has materially contributed to unsettle the opinions of practitioners; and that the whole question remains at present in a state of doubt and uncertainty, which must be extremely perplexing to the younger members of the profession.

The essays now offered to the public are the result of much reading, and of an extensive experience in this class of complaints; and it is hoped that they may materially tend to save much of the valuable time of the student, by presenting to him, in one view, the result of the opinions of most of the principal writers on syphilis; by enabling him to form some conclusions as to the justice of the peculiar views entertained by Mr. Carmichael and others, as well as of those opinions respecting the nonVOL. II.-No. 28.

[VOL. II.

mercurial plan of treatment, advocated so freely in this country of late years.

It may be proper to observe, that the style adopted is necessarily plain and colloquial, having originally been delivered in the form of lectures; this will also account for the want of references to the various quotations, which, however, are faithfully given, and may be depended upon; finally, it is hoped that if these essays should be found to be free from any practical imperfections, and calculated, by the information they contain, to supply the student with a full and sufficient guide to the treatment of all the varied symptoms of the disease, the absence of all pretensions to fine writing will be pardoned.

South Audley-Street, 1st June, 1828.

It has often been remarked, that those who have been long engaged in any particular study or pursuit, are too much inclined to claim for the object of their choice, a greater degree of consequence than it really merits; and to expatiate upon its importance with a warmth of zeal that appears ridiculous in the estimation of the impartial or indifferent spectator. It must be my endeavour to avoid this common error; but that I consider. the subject of syphilis as one of peculiar interest, demanding a greater share of attention than is usually bestowed upon it in the course of a surgical education, is sufficiently evident by my venturing once more before the public in the character of an author.

The veteran practitioner, fully aware of the extent and difficulty of the undertaking, may, perhaps, rather be dis

Ꭰ

posed to censure the temerity, than applaud the courage, of one who, fully sensible of the difficulties that surround the subject, has voluntarily imposed upon himself so arduous a task; whilst the tyro in surgery, who has, perhaps, imbibed the notion that the cure of syphilis is comprised in one simple precept (the administration of mercury), may be disposed to think that I am engaged in a most unnecessary and uncalled for pursuit. If, however, I should be so fortunate as to satisfy those whose experience and knowledge entitle them to judge of the merits or defects of my performance, it will, I trust, be no difficult matter to obviate the objections of the junior part of the profession. Never, surely, since syphilis became an object of professional inquiry, has there been a period when some positive and determinate doctrines were more imperatively called for, than the time in which we live. In proof of this assertion, I may ask the practitioner to take a survey of the present state of opinion, both public and professional, relative to this disease: scarcely can we find any two surgeons agreed as to the most simple points, either of its theory or practice. If we turn to the recorded opinions of modern writers, the confusion is not lessened: one teaches us that there are three or four venereal diseases; another, that scarcely any thing but pseudo-syphilis is now to be met with; a third goes a step farther, and asserts, that there is not now, and never has been, such a disease in existence, and that for upwards of three centuries we have been prescribing for a phantom of our imaginations; a fourth would fain persuade us that we have only been mistaken in our means of cure, and that mercury is not necessary for any form or symptom of the disease; whilst, of those who adhere to the old remedy, some are advocates for a thorough saturation of the constitution at all events, and at all hazards; whilst others think, that as an alterative, mercury may be admitted into the number of our auxiliaries, but that it is not to be relied upon alone: in short, if any one should seek for an illustration of the often quoted apothegm of the father of physic, that "art is long, and life is short," he cannot choose any more appropriate than the venereal disease, which, after the lapse of more than 350 years, appears to be less un

derstood now than at any period since it became an object of inquiry and interest.

But if the theoretical views entertained respecting this class of diseases have so materially changed, it is no less certain that the practice has undergone, within the last 20 years, a most extraordinary revolution: that good may not eventually result from the conflict of opinions, it is far from my intention to deny, or even to doubt; but it is only very recently, indeed, that the enthusiasm of novelty appears to have expended itself, and that something like a rational and systematic line of conduct

begins to be followed.

In adverting to the increased, and still increasing frequency of some of the secondary forms of the venereal disease, I must, however, be allowed to explain, that although these are unquestionably the result of the recent inquiries that have been made into the natural history of the disease; yet those who set the inquiries on foot are not responsible for the evils that have ensued. Those inquiries were commenced in the true spirit of philosophical research, and if they have been too implicitly or generally acted upon, the blame must attach to those who adopted the conclusions without due discrimination. Having once suffered their faith in the powers of mercury to be shaken, they lapsed into the opposite extreme, and became infidels at once with respect to the necessity of its employment. Such, indeed, is the nature of mankind; and it is not only in the science of medicine that we may look for an illustration of this truth.

If every field yielded fruit in proportion to the labour bestowed upon it, little, indeed, would remain to be done with respect to the venereal disease. A writer of the last century has told us, that in his day upwards of 400 Treatises had been written on this disease from the period of its first invasion; and I verily believe that the number has been more than doubled since. But when we come to look over this list, and to examine the share of merit belonging to each individual author, we shall find, that when we have rejected the dreams of superstition, the plagiarisms of some authors, and the perverse attachment to system of others, that the number of standard works will be very much reduced, and the stock of our actual

knowledge brought within a very narrow compass indeed.

I shall not consume any more time by prefatory remarks, but proceed at once to explain the course I intend to pursue in treating this subject. I shall first devote one or two essays to the remote history of the disease, and then take the modern doctrines into consideration having disposed of this question, and stated my own opinions, I shall commence with the symptoms of gonorrhoea, and then go regularly through the primary and secondary symptoms of syphilis itself, together with the treatment best adapted to each form of the complaint. The name by which a disease is designated is not, perhaps, a matter of much importance; but it may be as well to observe, that I shall generally make use of the word syphilis, as denoting the primary affection; and apply to the constitutional symptoms the term of secondary syphilis; for although I may occasionally speak of the venereal disease, or lues venerea, for the sake of varying the expression, still this latter phrase appears to be too vague and general: the etymology of the word syphilis is indeed doubtful, and, after all, not very obvious; yet still it is pretty generally understood, and is liable to no misconception.

In examining into the history of syphilis, two questions have particularly attracted the attention of authors: the first relates to the antiquity of the disease-the second, to its origin. It may, perhaps, be thought by some, that this discussion is superfluous, and that it can have no other result than that of affording an opportunity of heaping quotation upon quotation, and obtaining for me the reputation of a little reading, at the expense of a great deal of time; but I trust that it will be admitted, upon reflection, that this inquiry is one of absolute necessity, tending to complete the character of the liberalminded and well-informed practitioner, to whom no species of knowledge should be wanting-who should never be content until he is enabled to give a satisfactory solution to all suggestions or doubts that may arise in his mind upon this or any other subject on which he may be engaged. It is by means of this knowledge that he will be enabled to obviate objections, and to surmount difficulties; or to avoid the imputation of plagiarism, by fancying he is suggesting

something new, when, in fact, he is only relating or reviving what has been said or done a thousand times before.

The belief that the venereal disease was known long before the period usually assigned for its invasion, has of late been revived by a modern writer of great experience in the practical part of his subject, and whose labours have latterly made a great impression in this country. The view that this writer has taken of syphilitic complaints has rendered this belief almost a matter of necessity to him, since it smooths many of the difficulties, and explains most of the anomalies, that would otherwise encumber his path; it is, therefore, on this account also, more incumbent upon us to notice the historical part of the subject, and to give a glance at the evidence which is afforded to us by the ancient writers in support of this side of the question.

Of this evidence there are two kinds : that which we derive from the medical writers of antiquity, and that which is to be found in the works of the poets and philosophers of the same period; for I can scarcely suppose it to be necessary to do more than to allude to the opinion that has been broached more than once, that the diseases recorded in the Bible as having affected David and Job, as well that which is the object of some of the legal ordinances of Moses, were nothing less than lues venerea. Never, certainly, was there an assumption made upon more feeble grounds: it may have afforded some scope for critics and commentators to exercise their ingenuity, and to display their learning, but nothing can be elicited from these meagre and scattered passages that might not be as well applied to many other diseases, or that ought to arrest the attention of the candid inquirer for a moment.

Among the Pagan authorities we find, froin certain passages in Hippocrates, Pliny, Celsus, &c., but more especially the latter, that ulcers, both on the male and female parts of generation, were not uncommonly met with; and Celsus, in particular, gives us many directions for their cure. before I proceed to quote one or two of these passages, I must observe that there is no allusion whatever, in either of those writers, as to the diseases they mention being solely or constantly the product of impure connexion between.

But