nicating the matter to it by the finger or other means. External primary sores of the nose have their seat usually upon the ala nasi, or lower part of the septum, and often proceed with great rapidity to the destruction of the skin and even the cartilages, unless arrested by a vigorous combination of internal and external remedies.

The mucous lining of the septum is frequently the seat of consecutive sores, which, unless arrested, usually penetrate the septum. When the ulceration is in the vault of the nostril the bones become carious, and great deformity is the consequence: when necrosis or caries takes place the cure is always tedious. Exfoliation, we have frequently observed, interferes with the action of the remedies, so that it is only after the removal of the diseased bone, that they can be employed with advantage. Sometimes ulcers attack the floor of the nostrils and penetrate to the mouth. If this opening be large, the voice is injured, and the aliments are apt to get into the nostrils. These disadvantages are in some degree remedied by wearing a metallic plate in the opening. The constitutional treatment of these sores consists of mercury and the sudorific woods. The length of time which they may require to be continued will depend upon the oldness of the affection, and upon the remedies previously administered. The local treatment consists of emollient and anodyne injections and fumigations. The author says he has often derived advantage, when the ulcers were not far from the anterior opening of the nose, from the application of some simple cerate, with the addition of an eighth part of calomel.

Chancres occasionally appear upon the lips, gums, and cheeks. Those upon the lips are sometimes primary, and are easily cured. When consecutive, however, they become very obstinate, and their true character is apt to be mistaken. They have hard edges and a thickened base; they often become the seat of sharp lancinating pains, and assume something of a carcinomatous appearance. They yield to mercury in conjunction with the sudorific woods. Consecutive ulcers of the gums take place with caries of the edges of the alveolar process. No remedies are applicable until the carious portion of bone comes away. Scorbutic is known from venereal ulceration by its having its seat upon the soft flesh at the neck of the teeth, by having some degree of thickening without hardening, and in place of being of a greyish colour, deep, and more or less circular, is of a livid red, superficial, bleeding from the slightest touch, and with very irregular edges. Aphthous ulceration, arising from irritation, often exists between the gum and lip, and even upon the tongue, but it is easily distinguished, and usually

disappears at the end of six or seven days without any treatment. Ulcers of the tongue are usually consecutive, and when depending upon a very old pox are generally very hollow, and contain a thick slough, but their base is neither hardened nor engorged like other venereal sores.

The THROAT is very frequently the seat of consecutive sores, and here they seldom manifest any remarkable degree of local sensibility. On this account they are often for a considerable time mistaken for sore throat from cold, or some other cause, until the ulcers, becoming more extensive, put on an appearance, which renders the origin of the disease no longer doubtful. It is to be remarked, says our author, that syphilitic sore throat often exists without ulceration, and then it is always of a very chronic nature. The throat becomes of a deep copper colour, and secretes a very viscid mucus, which cannot be detached without difficulty. We are not recommended, unless other more unequivocal symptoms exist, to adopt a very rigid anti-venereal

treatment.

The throat is a part of which the sympathies are very numerous and important. It is the business of the medical man, therefore, to endeavour to ascertain if ulceration of it does not proceed from some of these sympathies, instead of being venereal, We think there can be no doubt, that even excoriations, or any other irritation existing about the genitals, especially in females, is capable of producing sore throat, particularly if the system be in any way disordered at the time. By removing the irritation of the parts, and calming the state of the system by cooling or other remedies, as may be indicated, the ulceration in the throat disappears. There is no necessity in these cases to use mercury. When the bowels become torpid and the stools black, we often see excoriations and other affections of the throat. Indeed, so far as we have observed, we are of opinion, that ulcerated sore throat, even when its venereal origin is the least unequivocal, is accompanied with disorder of the digestive system, and above all others requires, that the state of the general health should be attended to. The stools are almost uniformly black. Mild, purgative medicines repeated daily, or every two days, according to circumstances, produce the most beneficial effects upon these affections of the throat; and even should they fail to cure them completely, the system is at least brought into a state which admits of mercury being administered in smaller doses, and with less risk of every kind. As the skin also sympathises with the throat, and vice versa, the state of this organ, in all affections of the throat, claims particular attention.

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Chancres of the PALATE are sometimes very rapid in their progress, destroying in a short time the substance of the soft parts so completely, as very much to injure the voice and deglutition. If the loss be not great, custom soon enables the patients to speak clearly and to swallow as perfectly as before. If the velum is perforated, but not to any great extent, there is some hope that in process of time the opening may nearly close up ; but if the velum be completely divided, the patient must make up his mind to submit to the inconveniency for life, unless indeed the operation recommended by Professor Roux, of incising the edges and bringing them into apposition by means of sutures, be not found successful.

Chancres upon the TONSILS are very frequently met with. They are sometimes apt to be confounded with the excavations left by angina, and with the natural hollows and irregularities, which are found on the tonsils of some people, even in health. They are to be met with very deep in some individuals, and filled with a white tough matter of a very offensive odour, very similar to what we sometimes observe in the venereal sore of those parts. This white matter is easily removed by the end of a probe. Chancres of the tonsils are often exceedingly rapid in their progress, and require to be opposed with the most vigorous treatment, and even then they often run on to the complete destruction of the parts, especially if the practitioner have been late of being called, in which case M. Lagneau thinks it may be advisable to attempt altering their malignant action by the free application of the nitrate of silver.

Chancres of the PHARYNX are not unfrequent, though they often exist for a long time without being detected, when they happen to be concealed by the pillars or by the velum. They are most frequently the result of a very old latent venereal affection, often not appearing till twenty years after the primary disease. One lady had ulceration of the pharynx, with nocturnal pains, twenty-nine years after she had been cured of the primary complaint, which had been communicated to her by her husband. She applied leeches to the throat by the advice of physicians, and used other remedies on the supposition that it was simple angina. Her case is not unuseful in showing that this affection, like many others of a venereal origin, is capable of occasioning great irritation during the night; she had been deprived of sleep for many months. Softening gargles, rendered more or less anti-venereal towards the end of the treatment, with an addition of a quantity of the liquor of Van Swieten, the phagedenic cerate, or calomel, are the chief local means to be

depended upon. These ulcerations often occasion caries of the vertebræ of the neck.

We have, in some cases, seen the whole of the superior part of the pharynx, from the anterior edge of the velum, as far down the throat as could be seen, the seat of a very foul unmanageable ulceration of a syphilitic origin. The danger of this kind of ulceration is very great, especially if it threatens to attack the epiglottis, or to descend into the trachea. In one case we saw mercury used by a judicious surgeon, till the patient's mouth was affected, but it produced no change whatever on the character of the ulceration. As it is usually attended with symptoms of great debility and languor of the system, tonic remedies, such as bark, wine, and opium, are the most likely, we think, to be useful.

Chancres of the LARYNX and aspera arteria are amongst the most rare though dangerous symptoms of syphilis. Nicholas Massa mentions his having cured an ulcer of this kind in a French prince, who commanded the citadel of Milan, and in whom it had formed a fistula, opening upon the anterior part of the throat. Laryngeal phthisis from a venereal cause is probably often dependant on ulceration, and that indifferently, whether the alteration of the mucous membrane has, or has not, preceded caries of the cartilages. This opinion is strengthened when we perceive anti-venereal treatment to cure these affections, which it seldom does when the cartilages have become diseased. Much prudence is required in the treatment of venereal ulceration of the air passages; the employment of the mildest mercurial preparations, with sudorifics, the inhalation of emollient vapours, the application of leeches, blisters, and even a seton in the neck.

LARYNGEAL PHTHISIS from a venereal cause, can only be distinguished from the same complaint from other causes, by attending to the history of the case; but fortunately this circumstance alone is generally sufficient to enable us to acquire an accurate notion of the complaint. In those venereal cases which we have. seen, there was always less or more of cough, with scanty purulent expectoration, feverish excitement, loss of the natural clear voice, more or less complete, emaciation, nocturnal perspirations, and generally more vascularity than natural of the mucous membrane of the pharynx, with pain, and occasionally slight external tumefaction about the larynx and top of the trachea-the pain always sensibly encreased by even slight pressure of these parts. The action of mercury, in moderate doses, in this complaint, is almost equally interesting with what is observed in the inflamed or thickened iris. The progress of the cure is rapid.

But it is to be aided by general bleeding if necessary, leeches to the front of the throat, blisters, and gentle purgative and sudorific medicines. The inhalation of cold air is above all things to be avoided, until the cure be completed, and even then relapse takes place from very slight causes, more especially from exposure to cold and moisture.

With regard to venereal sores of the SKIN, they occur in those situations most frequently where it is thinnest and most delicate, as about the nipples, eye lids, or around the nails; and also in those parts which are moistened by continual transpiration, as the umbilicus, perineum, (especially in women), the region of the pubes, between the fingers and toes, in the arm pits, behind the ears, and at the superior and internal part of the thighs. But as sores in these situations present little peculiar either in their nature or treatment, we shall not at present enter into their consideration.

SCHMIDT ON THE ERYSIPELAS OF INFANTS *.

THERE are three diseases of new born children which are with difficulty to be distinguished: erysipelas; induration of the cellular tissue; and trismus nascentium. The first affects the skin; the second the subjacent cellular tissue; and the third the muscles. The causes of the difficulty felt in discriminating these diseases, are the rarity of their occurrence, which is almost confined to public institutions; neglect from the deficiency of proper attendants, and the incapability of the subjects to express their complaints; the similarity of the symptoms, and the rapidity of their progress; and inattention to the results of anatomical examination.

The ERYSIPELAS OF INFANTS has received many different names. By Sennert, Schulz, Storch, &c. it was called Macula Volatica, Purpura Volatica, Macula Convulsiva, Erysipelas cutis ambulatorium, Cutis tensa, Oedema concretum, Erysipelas neonatorum, &c. It remains a question whether there be any real difference between this disease and that described by the French writers, under the term; "endurcissement du tissu cellulaire," though it is very probable, that the varieties observed are unimportant and dependant on accidental circumstances. Some

* Disquisitiones Physiologico-Pathologica de Erysipelate Neonatorum ejusdemque a nonnullis similibus Morbis differentia. Auctore, FRID. ADOLPH. SCHMIDT. M.D. Lipsia, 1821. 8vo.