25. He is much better; there is some sebaceous matter about the neck of the glans. To wash this well with soap-and-water, and afterwards apply a zinc lotion; the mixture to be continued.

30. He is just well, and has only had three seminal emissions the last week. He has removed all the sebaceous matter, and the prepuce is seen to be very red inside. To continue. As complete a cure ensued as ever does in these cases, a seminal emission at night occurring from time to time.

Case 8. Night and Day Discharges.-H., a pale, delicate young man, applied, June 25, 1853, with gleet and seminal emissions, occasionally in the day, but mostly at night. He complained of great weakness, pain in the back, and cough. An opium plaster to the loins, quinine twice a day, meat diet, and volatile liniment to rub on the chest; morning exercise. During the latter part of July he had a few days' sea-bathing, which did him a great deal of good; the opium plaster relieved the pain in the back, and was accordingly repeated as soon as it fell off. By the 12th of September he was so far improved that he had had no seminal discharges for three weeks; but the gleet grew so much worse, that I was obliged to order him injections. Having left off his medicines, he had a slight relapse, but on resuming them, was rapidly cured of all but an occasional discharge at night.

Case 9. Day Discharges.-Mr. J., applied, November, 1852. He had two to six times a day faint erections, and immediately after a thin discharge. The urethra was red, and there was a strong smell from the glans. He was pale, nervous, and so weak, that he thought he could not live, and he was tormented by a constant cough, with indigestion and costiveness. Salines, containing a little syrup of red poppies, and five grains of nitrate of potass, three times a day; mustard poultices to the perineum; veratria ointment to the testicles. Soon after quinine was commenced. He gradually recovered, and at the end of ten weeks was so far advanced towards a cure that he gave himself no further trouble about the matter.

Case 10. Spermatorrhea and Congenital Imperfect Erections.Mr. J., applied, August 12, 1852. Erections never had taken place, and there was a constant discharge from the urethra, which was in an inflamed state, of rank, thin fluid. He was, and always has been, very weak. Cauterization had been tried, and failed. He was the type of this class of patients. Every secretion and every sense was at fault, as if the whole constitution suffered from the struggle to establish the defective virile power. Blisters, quinine, and nitric acid, &c., were all tried in succession, with little improvement in either the spermatorrhoea or the erections.

Lastly, I would only urge the patient to banish from his mind the idea that a perfect absence of seminal emissions at night is compatible with health and continence. Those who tell him so deceive him, or are deceived; and I cannot conclude better than by quoting a part of

Mr. Curling's letter. "I assume," he says, "the cure of spermatorrhoea to mean, not the arrest altogether of involuntary emissions, but the prevention of their frequency to such a degree as to weaken the powers and impair the health.-Lancet, March 4 and 11, 1854, pp. 243, 269.

121.-Treatment of Congenital Syphilis.-The continued administration of mercurials to infants is a matter often involving some difficulty. By simply giving the drug to the mother, and trusting to its influence on the mammary secretion, the effect is often not produced with sufficient rapidity; and if the ordinary preparations as hydr. c. cret., &c., be given, they are very apt to produce diarrhoea, and run off by the bowels. To obviate this, we observe that Mr. WORMALD, at St. Bartholomew's Hospital, is in the habit of ordering a piece of flannel smeared with mercurial ointment to be worn constantly over the child's belly, never omitting, however, if the little patient be at the breast, to administer mercury to the mother also. The daily experience of the Skin Hospital proves, that small doses of the bichloride may be given without risk of any evil consequences, even at the most tender age. The dose usually given to an infant of from one to two months is about one ninetieth of a grain in solution three times daily; and it is usually combined with as much of the tincture of opium as may be necessary to relieve the extreme restlessness which often attends the disease. Under this treatment, illustrations of the truth of Abernethy's observation as to "fattening courses of mercury," are often afforded.-Med. Times and Gazette, Nov. 12, 1853, p. 502.

122.-Case of considerable Sprouting of Warts on the Glans Penis. Under the care of HENRY HANCOCK, Esq., at Charing Cross Hospital. [Ricord believed that warts upon the penis were non-syphilitic, other eminent surgeons think they are; but there can be no question that these excrescences may be implanted on the organs of generation in the same way as they are present upon the fingers. From the narrow space in which they grow, they are liable to produce great irritation and inflammation, and their removal rendered a matter of anxiety. The patient, in the case of Mr. Hancock, was a married man, aged 35, and stated positively that he had never had any venereal affection whatever. He had never noticed anything the matter with the penis until four months before admission, when the warts began to grow.]

The patient has congenital phymosis, and noticed, at the time just mentioned, that some tumour was developing between the glans and the prepuce in the neighbourhood of the corona. The pressure from within soon caused slight pain in the prepuce, and inflammarion ensued, marked with a vivid redness on its external surface near the corona glandis. The patient applied poultices; ulceration and perfo

ration took place, and the mass of warts, which had been the exciting cause of all these symptoms, protruded through the ulcerated opening in the prepuce.

The verrucæ having thus obtained room, seemed to grow more rapidly than before; the aperture just mentioned became larger, and the warts grew to such an extent as to cover the glans almost completely, and to double its size. The extremity of the prepuce was, in the meanwhile, almost separated by ulceration from the rest of that process, abundant suppuration had set in, and the parts looked, to an unpractised eye, as if the organ had been suffering from carcinoma. Very little or no pain accompanied these changes, and after the poor man had exhausted the means advised by neighbours and friends, which means irritated the parts considerably, he applied for admission at this hospital.

On the 22nd of November the patient was brought into the operating theatre, and when he had been rendered insensible with chloroform, Mr. Hancock begun to remove, with the scissors, the enormous crop of warts which had sprung up about the part, as also the thickened semi-detached pieces of prepuce which were giving to the organ a misshapen aspect. When the whole mass of verruce had been excised, the penis was surrounded with lint dipped in cold water, and the patient placed in bed. The progress has been most satisfactory since the operation, and the parts are now quite cicatrized.—Lancet, Dec. 17, 1853, p. 576.

AFFECTIONS OF THE SKIN.

123.-ON REVIVAL OF THE ANCIENT TREATMENT OF CALLOUS ULCER BY EXCISION OF THE MARGIN. By JOHN HAINWORTH, Esq., late Surgeon to the Lincoln Dispensary and City Gaol.

[In a paper read before the North London Medical Society on this subject, Mr. Hainworth thus describes the disease:]

The apparently sunken, nearly circular or oval, ulcer, varying in diameter from one-third of an inch to three, four, or five inches, having a level, pale-red, glassy surface, void of granulations, excreting a thin, scanty, unirritating fluid, with a hard, precipitous, white or dusky edge, surrounded by integument, thickened and indurated by infiltration of lymph and serum, even now occupies too many a bed in our great hospitals, and too frequently exhausts the patience of sufferer and surgeon, dresser and nurse.

From this description it will be seen, that those ulcers are purposely excluded from consideration which are either inflamed or irritable,— which depend simply on a varicose state of the veins,-which are

complicated with diseased bone, or with any special local or constitutional cause.

I have said, "apparently sunken" ulcer, because I hope to satisfy you that it is not really sunken, but that the surface is made to assume that appearance by the elevation of the margin, not by actual loss of substance.

[Mr. Stafford calls this kind of ulcer the "deep and excavated ulcer." Mr. Syme believes that the depression is more apparent than real, the margin being elevated by the effusion of serum and lymph. Mr. Critchett concurs in this view. Mr. Hainworth says,]

That considerable thickening by effusion exists in the surrounding integument is undoubted and unquestionable; but the like effusion will be found present to nearly an equal extent beneath the ulcer itself, forming the firm substratum on which it rests; and if this be the case, we must look elsewhere for the explanation. Here our authorities fail us; for though many surgeons, from the earliest period till at least the close of the last century, directed their remedial measures to the removal of the callous margin, yet I have been unable to find in any writer a description of its actual structure—that is, of the tissue of which it is composed. To this omission may probably be ascribed the disappointment experienced by nearly all who have made assay of the various modes of treatment suggested by numberless surgeons, any or all of which have been most successful in the hands of the proposers. Dr. Adams, of Banchory, justly remarks:-"One cannot but entertain the most painful feelings of distrust in all modes of treatment where one cannot recognise some reasonable bond of connexion between the remedy applied and the effects produced."

In the present day, none dispute the axiom, that correct pathology is the only solid and permanent basis of sound practice.

Yet, strange as the assertion may be deemed, the ancients in this class of cases appear to have known more than the moderns, even in this point of view; for they affixed to the margin of these ulcers the same name which they gave to the common corn on the feet (callus); and with sufficient reason, for in each case the indurated parts are composed of the same tissue, namely, a gradual accumulation of effete cuticle, secreted layer beneath layer, under the stimulus of a morbid action or an abortive effort at reparation;-to use Mr. Paget's form of expression, under an arrest or error of development.

The mode of formation of the callous margin scarcely admits of accurate description, because it usually takes place while the ulcer is not under surgical treatment, but while exposed to the many circumstances of neglect in dressing and cleanliness, errors in diet and excesses, over-exertion and fatigue, or some of the many other injurious influences to which the patient may have been subjected. Any one of these may induce the degeneration or death of the granulations at a time when the cutis is vigorously forming new skin; and

this process being suddenly arrested, the cuticle at the margin may continue to be formed more rapidly than in health, just as, under the irritation of unusual pressure, callous cuticle or a corn is rapidly formed on the hands or feet.

But it is not within the scope of this paper to enter on the full history of the callous ulcer, but rather to deal with it when fully formed and established, as usually presented to the surgeon for treatment.

In this state the callous margin of accumulated cuticle forms a hard, solid ring, pressing injuriously on the parts beneath, and strangulating to a certain extent the vessels of the cutis immediately around the ulcer. I believe that all pathologists, without exception, are agreed, that the new skin for the formation of the cicatrix is derived from the vessels of the cutis at the margin. Hence it must be apparent, that, if these vessels be subjected to a pressure which amounts to constriction, the formation of new skin must be arrested. Further, surgeons accustomed to the daily observation of numerous cases of this class of ulcers will, I doubt not, call to mind not a few instances where, even under careful and judicious treatment, this ulcer has slowly, indeed, but steadily—become larger, the surface of the sore retaining the pale, glassy aspect, and the sides their hard precipitous appearance. Now, this seems precisely the effect likely to ensue on the firm and steady, but unirritating pressure of a foreign body.

As a result of the suspension of cicatrization by the construction of the vessels at the circumference, the ulcer ceases to granulate, consent of parts being wanting; a preparation on the part of the ulcer to accept union with the skin being utterly useless so long as the vessels are constricted whose office is to form new skin.

This, then, is the condition of the parts which the very ancient operation by excision was intended to remedy; a dense ring, composed of compact layers of accumulated cuticle, acting as a foreign substance, by pressing and constricting the living structures beneath.

Some few other methods of treatment have been directed to the exclusive object of removing this ring, as a necessary introduction to other treatment; but I hope to convince you that the most safe, easy, and expeditious method, is that by excision of the callous margin.

To some this assertion may appear paradoxical, but I trust not so to those who have followed the description given above. Mr. Critchett indeed says:-"Chelius recommends these callous edges, when much raised, to be shaved off with a scalpel previous to commencing other treatment-a plan (says Mr. Critchett) I have never tried, and one that I imagine would be deemed somewhat too heroic by English surgeons."

Now, this is rather an unfortunate expression of opinion on a plan which the writer confesses he has never tried, for the ground stated