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too little; and you may be taken unawares by the patient's gums becom ing all at once excessively sore." In the review of Mr. Parker's work on Syphilis, in our preceding number (p. 456,) we expressed a similar opinion. The following remarks, with which this Lecture is concluded, are so true and practical that we cannot forbear quoting them :

"I have spoken of the necessity of administering mercury, not only till the symptoms are relieved, but for a considerable time afterwards. But you may ask whether a long course of mercury be not more likely to injure the constitution than a short one? Undoubtedly it is; and that is the very reason why you should prefer a long course. If the course be a short one, the disease is sure to return; you have then to repeat it, and again the disease reappears. Thus you have repeated courses; and not only is the system weakened by the mercury, but the disease, whenever it does return, assumes a more formidable character than before. But if, on the other hand, you put the patient through a long course in the first instance, such a frequent recurrence to the use of mercury will be unnecessary. A patient who takes mercury for a chancre, for a month or five weeks, may probably never want it again; but if he take it only for a fortnight, he has secondary symptoms, and then it will be required for at least six weeks, perhaps for ten; so that that which is a short course at first becomes a long one in the end." P. 249.

Tic Douloureux, or facial neuralgia, forms the subject of Lecture XIII. The symptoms are briefly but graphically described. It is worthy of notice that the disease effects only one side of the face. Sir B. Brodie has never met with a case in which it affected both sides. Diseased teeth have been supposed to give rise to this painful affection, but he never knew a case in which a patient was relieved of a genuine tic douloureux by the extraction of a tooth. Cases in which it appeared to depend on diseased bone are mentioned, but these are rare occurrences. "It is a great mistake to suppose that diseased or dead bone is an ordinary cause of this disease." Various other sources to which the disease may be traced are noticed, as hysteria, disorders of the digestive organs, and or. ganic disease in the brain. Sir B. Brodie observes :—

"There are many cases in which you cannot trace the tic douloureux to its real source. There is something or another, somewhere or another, in the system, which acts as a source of irritation to the nerves of the face; but where that something is, and what it is, we cannot discover. Indeed, generally speaking, I should say that to trace local nervous affections to their origin is one of the greatest difficulties that we meet with in the practice of our art. The disease may be in one part of the body, and the pain or spasm which it produces may be in another. I have known a patient have neuralgia of the foot, which depended on a stricture of the urethra, and which, whenever it occurred, was invariably relieved by the use of a bougie. I have known another patient have neuralgia of the foot depending on internal piles, which came on when the piles were protruded through the anus, and went away when they were reduced. I have known a spasmodic wry neck, or a nervous pain in the back, to alternate with insanity." P. 259.

He adds, that there is good reason to believe that the seat of those nervous communications on which such sympathies depend is for the most part not in the nerves themselves, but in a higher place in the brain, or in the spinal cord.

In the treatment of this painful affection, Sir B. Brodie strongly objects

to operations for dividing the trunks of the nerves; observing, that the irritating cause, whatever it may be, manifestly acts not on the extremity of the nerve, but on its origin; and both reason and experience prove that the division of the nerves below the origin is of no service. It is altogether an unscientific operation. After making some excellent practical observations on the treatment of neuralgia in cases where the disease may be referred to some obvious causes, and in those in which the disease cannot be traced to its real source, the question is asked

"But having tried all ordinary means without benefit, are you to go on ad infinitum tormenting the patient with medicine? The first rule of our art is to do no harm, and if you have had recourse to all reasonable expedients without benefit, it is not advisable for you to go on making further experiments. No one can be dosed constantly with medicine without the health being ultimately injured by it; and if you have not some reasonable grounds for giving medicine, you have no right to run the risk of doing harm by its continued exhibition. It is much more wise, as well as much more honest, when you do not know what to do, to do nothing, and to advise your patient to wait and take the chance of the pain subsiding of itself, as in fact it does in a great many instances." P. 265.

Sir B. Brodie has no great faith in the veratrine ointment; and the extravagant manner in which this application has been lauded as a remedy for neuralgia, leads him to conclude this Lecture with the following seasonable observations:

"The statement of its effects which had been published promised a great deal too much, and I should have expected more if it had promised less. I shall take this opportunity of observing, that I am not disposed to try indiscriminately all the new remedies which in these days are being constantly brought before society; nor can I think well of this modern fashion of resorting on all occasions to novel methods of treatment. I advise you, if you wish to succeed in your profession, and to be useful to society, to pursue a different course. Make your selves masters of the old remedies. Learn how to handle them, and what good they will do, and, as a general rule, have recourse to them in the first instance. If the old remedies fail, and you are at a loss as to what you should do, then, and not till then, have recourse to the new ones. If you always begin with new remedies, you throw away the valuable results, not only of your own experience, but of the experience of those who have gone before you. You have to begin, as it were, de novo; and the first consequence of this will be, that you will not cure your patients; and the second, that you will have none to cure. I should be very sorry to see the march of science impeded by an unjust apprehension of experiments and innovations; but, surely, there is a broad enough line between a discreet and prudent use of new remedies, and that indiscreet and hasty use of them which we find to prevail at present in the practice of our profession, and especially in that of its junior members." P. 268.

Lecture XIV. consists of practical observations on fatty or adipose tumours. Mention is made of a kind of fatty tumour which occurs occasionally, but which has not been described by surgical writers.

"In the cases to which I allude, the tumour is not well defined; in fact there is no distinct boundary to it, and you cannot say where the natural adipose structure ends and the morbid growth begins. I will relate to you the history of one of several cases of this kind that I have met with, and this will explain as much as I know of the matter. A man came to this hospital several years ago having a very grotesque appearance; there being an enormous double chin

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(as it is called) hanging nearly down to the sternum, and an immense swelling also on the back of his neck formed by two large masses, one behind each ear, as large as an orange, and connected by a smaller mass between them. He said that the enlargement had begun to show itself three or four years before, and had been increasing ever since. They gave him no pain; nevertheless they made him miserable, and in fact had ruined him. The poor fellow was by occupation a gentleman's servant, and having so strange an appearance no one would take him into his service. I gave him half a drachm of the liquor potassa three times daily, and gradually increased the dose to a drachm, dissolved in small beer. When he had taken the medicine for about a month the tumours were sensibly diminished in size. He went on taking the alkali, and the tumours continued to decrease. It was just then that iodine began to have a reputation, much indeed beyond experience has proved it to deserve, for the cure of morbid growths, and I left off the liquor potassa, and prescribed the tincture of iodine instead. The effect of this change of treatment was remarkable. The patient lost flesh, while the tumours increased in size. Of course I omitted the iodine, and prescribed the liquor potassa a second time. Altogether he took a very large quantity of the latter medicine, and left the hospital very much improved, with directions that he should continue to take it with occasional intermissions. I had lost sight of him for some time, when it happened that I was requested to visit a patient in Mortimer Street. I did not observe the servant who opened the door, but as I was leaving the house he stopped me, saying that he wished to thank me for what I had done for him. It was this very patient. He was so much improved in appearance that he was enabled to obtain a situation as a footman. There were still some remains of the tumours, but nothing that was very remarkable. I have seen some other cases of the same kind, in which the exhibition of very large doses of the liquor potassæ appeared to be of great service. But I have not had the opportunity of trying it, or of knowing the results in every case; and I am informed that in some cases it has been given to a considerable extent without manifest advantage." P. 276.

These tumours feel like fat; but they may be distinguished from common fatty tumours by their having no well-defined boundary, and by their being less soft and elastic. Such deposits may probably take place in any part of the body, but our author has seen them more frequently in the neck than anywhere else. Sir B. Brodie describes another kind of tumours, which also, as far as he knows, are not described by surgical writers. "They are situated in the sub-cutaneous adeps, give no pain, and are not tender to the touch; they have a well-defined margin, and are of a somewhat firmer consistence than common fatty tumours, to which, in other respects, they bear a great resemblance. They grow to a certain point, then remain stationary, while others show themselves elsewhere; until, at last, there is no part of the trunk or extremities in which they are not to be met with, varying in size from that of a pea to that of a small walnut." If any of these tumours attained a large size they might be removed with the knife, but as they are numerous it would be absurd to think of removing the whole in this manner. In these cases he has given the liquor potassæ in large doses with service. In one case, the tumours nearly or quite disappeared under its use. He thinks it probable that, in cases of fatty deposits, the liquor potassa operates in the following manner: the oily part of the tumour combines with the alkali, is taken into the circu lation and thus carried off. He gives as much as a drachm and a half, in a large quantity of fresh small beer. It seems to act better in this than when given in any other liquid, and the beer does not disagree with the

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stomach because the alkali neutralizes every drop of vinegar which it contains. Sir B. Brodie agrees in the opinion of Sir Astley Cooper, that a fatty tumour will sometimes take on the action of a malignant disease, and become a malignant tumour. The case, however, related in confirmation of this opinion, does not seem to us a satisfactory example.

In the next six Lectures the subject of Mortification is very fully treated of. They contain the best account of this process, and of its causes and treatment, that we know of. Our notice of the volume has been so full, that we have only space for a few remarks and extracts of an important practical character, or that may be new to our readers. In reference to the use of ammonia in mortification Sir B. Brodie remarks, "It is a temporary stimulus; but alcohol, prudently administered, is much better; and my observations lead me to suspect that large doses of ammonia, if persevered in for a considerable time, tend to depress the vital powers, and lessen the chances of recovery." Whenever putrid matter is pent up round a slough of the cellular membrane, the system is poisoned by it. The sulphuretted and carburetted hydrogen gas evolved during the decomposition of dead animal matter, seem to pass, in part at least, into the circulation, producing the most dangerous symptoms. The incisions which relieve the tension of the skin allow these noxious gases to escape, and the relief which this affords to the patient is very great. The following is a remarkable example :

"I was called, some few years since, to see a gentleman, who appeared to be actually on the point of death. His extremities were cold; his pulse barely perceptible. It was doubtful whether he was sensible or not. He made, on being roused, several imperfect attempts to speak, but could say nothing intelligible. Below the right hypochondrium there was a considerable tumour, the skin being of a dark red colour, on the verge of mortification. On examination with the fingers, I perceived a sort of emphysematous crackling, and an imperfect fluctuation. Having made a free incision, I discovered, underneath the discoloured skin, what might be called a quagmire of slough. A small quantity of putrid matter escaped; but there escaped also such a quantity of noisome and offensive gas, apparently sulphuretted hydrogen, that I could scarcely bear to remain in The stench pervaded the whole house, and even could be perceived in the garden round it. Within two minutes after the performance of this operation, so trifling in appearance, but so important in reality, the patient looked up, and said, quite distinctly, "What is that you have done which has made so great a difference in my feelings?" At the same time the pulse returned at the wrist; and from this moment he recovered, without any further unfavourable symptoms. After a few days sloughs came away, probably of muscle, cellular membrane, and peritoneum, in a confused mass, and, with them, a gallstone of moderate size; explaining, to a certain extent, at least, the origin of the disease." P. 299.

the room.

In Lecture XVII. there are some valuable observations on the use of the different kinds of Caustics. In bites by rabid dogs, the depth of the wounds being uncertain, Sir B. Brodie observes :

"The best caustic, I apprehend, for you to use on these occasions is the caustic potash; and for this reason: that it dissolves the parts with which it comes in contact, and that afterwards the dissolved caustic penetrates still further beyond the part to which it has been actually applied. If the tooth penetrate to the cellular membrane, by the time that you are consulted some of the saliva may

have reached the cells beyond, and if you apply the nitrate of silver, or the nitric acid, these will coagulate the fluids and harden the solids, while the caustic potash becaming diffused will follow the course of the saliva. A convenient way

of applying the caustic on these and on some other occasions is this: melt it in a silver or platina spoon, and, when melted, dip into it the blunt end of a probe. It will come out with a varnish of the caustic upon it; dip it in again until the button of caustic has attained a sufficient size. By means of a probe thus armed you may carry the caustic even into a very narrow wound, so that you are sure it will penetrate wherever the dog's tooth has penetrated; after which, from the particular nature of the caustic (as I have just explained) you may be certain that it will penetrate still further, and as far as the poison can have reached." P. 325.

Caustics, it is remarked, may often be used very advantageously for the purpose of destroying diseased lymphatic glands, forming the base of illconditioned ulcers in the groin, which are indisposed to heal. A kind of caustic is required which will lie in the substance of the diseased glands, and destroy their internal structure, as well as their outer surface. The following caustic, used by the late Mr. Pearson, answers this purpose. "It consists of one ounce of crumb of bread, two drachms of the bichloride of mercury, and one drachm of red oxide of lead. These are to be mixed together, kneaded with the fingers, and formed into a sort of paste. The paste should be rolled into little conical troches, and these, if left to dry, become hard, like what are called bread seals. These troches may be stuck into the enlarged gland like pins into a pin-cushion. In the course of a little time they begin to act, as the patient knows from the pain produced. The pain lasts for some hours, and if a sufficient number of the troches be employed, the whole of the gland is at once destroyed. If any portion remains, it is easy to destroy it by repeating the process. In the removal of small nævi and small morbid growths of different kinds, Sir B. Brodie prefers the caustic to the use of the knife. He states, "a wound always heals much more readily after the application of caustic, than after the use of the knife. Take two cases: if you destroy one tumour of a given size by the knife, and the other, supposed to be of the same size, by caustic, in spite of the time occupied by the separation of the slough, the sore in the latter case will be healed sooner than that in the former." It is less formidable to the patient than the knife, and is likewise attended with less risk. For example, an attack of erysipelas seldom follows the use of caustic; certainly much less frequently than after the use of the knife. The application of caustic to tumours on the scalp must be made with great caution, as appears from the following case :—

"A surgeon applied the caustic potash to the scalp, with the view to make an issue in a man's head, who was labouring under a head-ache and nothing else. When the slough had separated a piece of the occiput was exposed, as large as half-a-crown, or larger. The patient was soon seized with a set of strange symptoms, and died. It was found that the dura mater had become detached from the inside of the bone, just opposite the part where the pericranium had been destroyed on the outside; and it was clear that the sloughing of the dura mater was the cause of the man's death." P. 337.

When caustics are used, it is prudent to have some counter-agent at hand to stop their action on the sound parts around. "Acids may be neutralized by alkalies; caustic potash may be neutralized by vinegar, or