"I have now seen two cases of constitutional erysipelas treated upon this principle, and as far as two cases well marked will go to authorise a conclusion, mine must be greatly in favour of the practice.

"The first was that of a healthy young woman, upwards of twenty years of age, seized with rigor, followed by smart fever, and on the second day by a complete erysipelas of the face, extending to the hair on the forehead. The fever continuing with a further extension of the inflammation, after bleeding, purgative and saline medicines, and a small vesication having arisen on the cheek, it was judged necessary on the third day, to apply the caustic over the whole extent of the erysipelas. The patient's own account was, that she suffered considerable pain for ten hours: but from that time, the feverish symptoms ceased, and the inflammation was arrested and subdued.

"When I saw her the fourth day after the application of the caustic, there was neither fever, nor any remains of erysipelas. The face was as black as that of an African, but in a few days more I found her free from all symptoms of disorder, the epidermis peeling off, and the complexion underneath quite natural.

"The other was a fine healthy boy of sixteen months old, who after a feverish attack had erysipelas on one hip and thigh, and extended partially to the leg. In this case also the fever and inflammation had subsided in forty-eight hours and upwards, after the application of the caustic. The account of the child's mother was that it cried very much for one hour after, then fell into a long and calm sleep, out of which it waked without fever, and calling out for food. In three days afterwards when I saw the child it was quite well, and the scarf skin of the inflamed parts separating.

"This is the extent of what I have observed of this novel mode of treating erysipelas, and which has surprised as it has satisfied me. Sincerely wishing success to your endeavours to improve the practical part of your profession,

"I am, &c. JOHN STORER." 42.

To this letter we may subjoin one from Dr. Marshall Hall, on the efficacy of the nitrate of silver in subduing inflammation of the absorbents.

"I have had an interesting opportunity of watching the influence of the nitrate of silver in a case of inflammation of the absorbents, and I will endeavour briefly to state the obvious effects of this remedy. The case was that of a young lady, aged twelve years; it began by a chilblain upon the heel; inflammation of the absorbents up to the groin followed; suppuration took place in twenty-four spots. The nitrate of silver was not applied during the first five weeks; this was very much regretted after its effects had been observed. The patient was seen by Mr. Lawrence and Mr. Wardrop, who both expressed themselves much interested in it.

"As the case would be long, I shall simply enumerate the effects of the application of the nitrate of silver in this case, as they presented themselves to my observation:

"1. It prevented suppuration in many places where the redness and tenderness were recent, yet such as before had inevitably led to the formation of pus.

"2. If suppuration had taken place, the tenderness was still promptly removed and the pus from being thick, white, and opaque, was rendered first thin and somewhat limpid, and perhaps streaked with blood, and then by degrees perfectly watery and limpid.

"3. When the pus approached the surface, a small opening formed, by which it exuded, and it became unnecessary to use the lancet.

"4. The abscess was far more disposed to heal than any of those to which the nitrate of silver had not been applied.

"I may add that in several other cases I have seen the application of the nitrate of silver early, along the course of the inflamed absorbents, subdue the disease at once, rendering all other remedies totally unnecessary. I believe this would have been the case in the instance mentioned, had this remedy been applied very early.

"I am, &c. MARSHALL HALL.

"P. S. It may be well to subjoin the outline of another case, in which the nitrate of silver was useful.

"A little girl fell and cut the ring-finger. The joint became permanently inflamed and swollen. The affection had subsisted three months when I saw it, preventing the little patient from attempting the piana-forte. The nitrate of silver was applied every fourth or fifth day, so as to form an eschar over the whole inflamed surface, but not so as to give pain. The finger was quite well in a few weeks.

"The powers of this remedy in subduing external inflammations are altogether very remarkable, and, I think, not at all generally known." 57.

The objects in the application of the nitrate of silver in punctured wounds, are to secure a free exit for pus, and to subdue inflammation. We have only space for the following cases.

Case 18.-A servant, aged twenty, slightly wounded the fore part of the index finger, at the first joint, by a bone of a hare, in dressing it. The wound healed in a day or two, and no notice was taken of it. A few days afterwards the finger became swelled and painful, and affected with diffused inflammation of an erysipelatous character, extending to the back of the hand, and there it was bordered by a ring of a more vivid colour. I applied the nitrate of silver nearly all over the finger, and upon the back of the hand, upon and beyond the inflamed border.

"On the following day the swelling remained as before, and the patient complained of heat of the parts to which the application had been made, and a small part of the finger which had not been touched was very painful. I applied the nitrate of silver to this point.

"On the succeeding day, the swelling had become puffy, and the whole finger and hand were free from pain. A few days afterwards, the hand was quite well. No medicine was given, nor was the patient prevented from pursuing her usual avocations.

"This case was the more interesting because I had two similar ones a short time before, which had been occasioned by wounds received in cutting dogs' meat, and which, under the ordinary treatment, had been several weeks in getting well." 69.

"Case 25.-This case illustrates the mode of treatment by the nitrate of silver, of some of those terrible effects of punctured wounds, which have been neglected in the beginning.

"B. Unwin, aged forty, washerwoman, applied to me on July 10, 1820, with severe inflammation and ulceration of the middle finger, arising from a puncture by a pin or needle, some time before. There was much painful tumefaction, and the integuments had burst along nearly half the length of the finger, on the ulnar side, and over the middle joint, on the radial side. The probe did not, however, pass to the bone, or into the joint. I applied the nitrate of silver deeply in every part, and over the whole surface, and enveloped the finger in a cold poultice covered with cold water.

"On the eleventh, she reported that she had slept well for the first time for a whole fortnight. There was scarcely any pain, but she complained of soreness, the swelling had greatly subsided. The nitrate of silver was again applied, and the poultice and lotion continued

"On the twelfth there were still swelling and pain; there was considerable bleeding from the wound, so that I did not apply the caustic well.

"On the thirteenth the swelling and pain were nearly gone. I repeated the application of the nitrate of silver, which induced bleeding from a fungous growth.

"On the fourteenth the swelling had nearly subsided, and the cuticle was separated all over the finger. The nitrate of silver was applied extensively over the wound, and abraded parts. It induced little bleeding, or pain.

"On the fifteenth the fungus was nearly removed; the wounds presented an appearance of slough over their surface. The nitrate of silver was applied to the fungus, which still remained.

"On the seventeenth the wound was much smaller, and the slough was separating. The nitrate of silver, and cataplasm were applied as before.-A similar report was made on the succeeding day.

"On the twentieth the slough was separating. The nitrate of silver and cataplasm were applied.--A similar report was made on the twenty-second.

"On the twenty-fourth, the slough having separated, the integuments over it were found to be flabby and loose.-The nitrate of silver was applied to them.

66

'By a continuation of this plan the wound gradually contracted, and at length, when there was no further use for the cataplasm, the eschar became adherent, and the ulcer healed underneath. It appeared highly probable to me, that under any ordinary treatment, the finger in this case, would have been lost." 80.

The chapter from which these cases are extracted, treats of simple, inflamed, neglected, and large punctured wounds,-of wounds received in dissection, and of the bites of animals. It consists of a detail of cases in exemplification of the efficacy of the treatment by the nitrate of silver.

The succeeding chapter treats of simple, inflamed, and severe bruised wounds, and of bruised wounds with slough. The following is an example of the last of these.

"Case 47.-As two men were carrying a heavy bundle of iron rods, it slipped from the hands of one, and fell on the toe of the other. The blow was so severe, as to cut through a strong shoe, and to shatter the nail of the great toe, and drive it into the surrounding integuments, and to cause a slight fracture of the bone of the first phalanx of the great toe, which was exposed. The case was so severe that I almost resolved to remove the toe; but finding the integuments underneath in so bruised a state, that I could not depend upon them as a covering, I wished to try my new practice, with the nitrate of silver. After removing the portions of loose nail, I applied this remedy over the whole skin of the toe, and on as much of the wound as was exposed after the parts were closed by the hand of an assistant. I then applied the adhesive plaster, so as to retain the parts together; and over it two or three folds of linen, moistened with cold water.

"The patient complained of some pain for three days, and then became easy. I did not examine the wound for nine days. I then found it in a quiet state, and free from inflammation; the surface of the sore appeared to be covered with a layer of coagulable lymph. I again applied the nitrate of silver, and over the eschar, first lint, then a plaster of the neutral ointment, and then adhesive plaster.

"In other three days the sores were nearly healed except the part occupied by the nail, which had been removed at my first visit.

"I applied the nitrate of silver every third or fourth day, for four times, when the wound was quite well. A new nail was making its appearance about the end of three weeks after the accident." 109.

The fifth and sixth chapters treat of the healing of ulcers. The treatment by the nitrate of silver is so successful, yet the directions required to be followed so minute, that we must refer to the work itself for them. We think it will amply repay those who have such cases to treat, to observe Mr. Higginbottom's directions; indeed, we do not conceive it would be right to do otherwise. We insert one case only illustrative of this subject.

"Case 61.-M. Bosworth, aged sixty-nine, has had ulcerated legs for the last thirty-five years, and, during that interval, has had the ulcers healed several times, but for short periods only. The present ulcers on both legs are about twenty in number; two are of the size of a crown piece; the others from the size of sixpence to that of a pea; the veins are in a varicose state, and the legs are extensively inflamed; his sufferings have been very great; his nights have been entirely restless from excessive heat and pain. He has been scarcely able to follow his employment, of a framesmith, for many years, and he has almost always been obliged to sit to his work. I applied the nitrate of silver on the whole ulcerated and inflamed surfaces, after he had rested in bed, with poultices on the ulcers,for twenty-four hours; and I gave him a blue pill and purging powder.

"At my next visit he said that he had not suffered more pain from the application of the nitrate of silver, than from some of his former dressings; that, on the following day, he had experienced scarcely any pain, and that he had had better nights than for many

years.

"I examined the sores on the fourth day, and found them in a healing state; the inflammation was gone, and my patient suffered no pain. The nitrate of silver was reapplied, with the addition of Mr. Scott's mode of bandaging.

"This case was dressed every third or fourth day, for ten weeks, when all the ulcers were perfectly healed. During the whole of this time he followed his employment with more ease than he had done at any former period for thirty years.

"I directed the patient to continue to come to me twice a week, for a few weeks, that I might examine the bandages and apply the nitrate of silver to any tender or slightly inflamed spot, if any such should make their appearance." 142.

The last chapter upon burns and scalds is not the least interesting; but we must pass it over very briefly, extracting only one short paragraph.

"I have found that, by slightly passing the nitrate of silver once over a burnt surface, the pain is increased for a short time, but then totally subsides, vesication appearing to be prevented; the black cuticle peels off in a few days, leaving the part well. In cases in which the cuticle has been removed, the nitrate of silver applied on the surface, induces an adherent eschar, and prevents the consequent ulceration. In cases in which a slough covers the surface, I have removed it with the scissors and forceps, and applied the nitrate of silver, and have cured them by the unadherent eschar.

"In one case, in which, after a burn, the part was healed over, and a considerable cicatrix formed resembling a fungus, and attended with severe pain, the nitrate of silver, applied as in external inflammation, removed all inflammation and pain.” 150.

From Mr. Webster's letter, in the appendix, we take the following interesting observations on the use of the nitrate of silver as a blister.

"I understand that Mr. Higginbottom has thought of using the nitrate of silver as an Epispastic. Having observed the vesicating properties of this remedy, when applied merely to produce blackness of the skin, I was induced to apply it as a blister, and from the numerous trials I have given it with this view, I have no doubt that were it generally applied by the profession it would supersede the use of cantharides; of warm water, as proposed by some; and of the heated metallic plates of Sir Anthony Carlisle.

"The advantages of the nitrate of silver over cantharides, the usual epispastic, are fivefold.

"1. It acts much more quickly, requiring generally only from one to three or four hours.

"2. It produces very much less pain in its action, independently of lessening the duration of that pain.

"3. It causes scarcely any constitutional irritation, even in children.

"4. It does not affect the bladder, nor bring on strangury.

"5. It heals much sooner.

"The mode of application is simply to wet or rather moisten the space to be blistered, with water, and then to rub a stick of the nitrate three or four times over the part, according as the cuticle is thin or otherwise. Once or twice is sufficient to blister the skin of children, or where the cuticle is thin and loose. In a few minutes the part begins to smart a little, which generally does not last long, and in the course of from two to four or five hours the blister insensibly rises. The serum is to be discharged and the part dressed, as in a common blister, but as it heals sooner, any application to keep up a discharge, must be applied at the first dressing, and for this purpose the cuticle must be entirely removed when the serum is discharged.

"It may perhaps be objected by some to this new mode of blistering, that there is a dread of the nitrate of silver producing a deep eschar-but this is not the case, the cutis vera is not affected in this way, at least when the nitrate is only applied to the cuticle, nor do I believe that nitrate of silver ever produced a deep eschar under any circumstance, however freely applied.

"Whether the nitrate of silver produces any specific or peculiar effect on internal extensive inflammations I am not prepared to state, but I believe that it is capable of producing all the beneficial effects of the common blistering plaster, without its troublesome ones."

199.

We have now but to sum up our remarks in a short character of this little work. We would say, then, that Mr. Higginbottom has done a most essential service to the profession by thus tracing out the virtues of the nitrate of silver, and so adding, as it were, a useful remedy for inflammation, wounds, and ulcers, to those which we possessed before; for, in these points of view, we regard this little work as perfectly original. The author has, moreover, proved himself capable of pursuing a new train of ideas -a new course of investigation; and we think, with him, that more useful facts will still flow from further inquiry into the effects of this remedy, especially in regard to some internal diseases. We cordially recommend Mr. Higginbottom's labours to the consideration of our readers.

XIV.

A RATIONAL EXPOSITION OF THE PHYSICAL SIGNS OF THE DISEASES OF THE LUNGS AND PLEURA; ILLUSTRATING THEIR PATHOLOGY, AND FACILITATING THEIR DIAGNOSIS. By Charles J. B. Williams, M.D. 8vo. pp. 192. 1828.

SINCE the great work of Laennec was published, several attempts have been made to abridge the study of auscultation, by means of manuals; but none of them have answered the purpose. They were too brief. Dr. Williams has come to the task with much acoustic science, and has endeavoured to explain the causes of phenomena, with more precision and on more fixed principles than his predecessors. As we mean to dedicate a long article to affections of the pleura in the next number of this Journal, we shall then have an opportunity of reverting to Dr. Williams' work. At present, we shall do little more than announce and recommend it, offering one or two specimens of the execution.

"The Traité de l'Auscultation Mediate,' and the perfect translation of Dr. Forbes, are at length generally appreciated, even in this country, slow to award its meed of praise. The homage paid to the talents of the author, gives me a gratification that almost seems personal; and I doubt not that this feeling is shared by others of his pupils, in whom his urbane and amiable deportment created a sincere regard for the man, as his great mental abilities excited our respect. His great talents are known to the public through the medium of his writings; but those who attended his clinique can alone appreciate the wonder