and destruction of the bone; at other times leaving the joint intact. He alludes particularly to the frequently committed mistake of supposing the first stage to be an attack of common rheumatism, and earnestly urges upon his readers the importance of comparing the lengths of the two limbs, before they determine their diagnosis. In rheumatism no change is to be perceived, but whenever there is inflammation of the caxo-femoral joint, he assures us, from an extensive experience for the last thirty years, that there is invariably an elongation of the limb. However severe may be the pain, if only the swelling around the joint, and the elongation of the limb be absent, M.D. is satisfied that there can be no inflammation of the articular surfaces, and consequently no grounds for alarm. The seat of the inflammation at first is always exterior to the joint; it is neither in the bone itself, in the synovial membrane, fibro-cartilage, nor in the synovial glands, but invariably, according to the experience of M.D. is in the outer surface of the articular capsule, in the fibrous structures about it, and in the periosteum of the bone round the circumference of the acetabulum, and of the upper part of the femur itself. The limits within which the inflammatory process is usually at first circumscribed,are about one inch in extent all round the rim, or edge of the acetabular cavity; but the whole of this space is not generally affected simultaneously; the irritation may be concentrated either at one part of the capsule, or of the periosteum of the os ilii, or of the cervix femoris, or round the border of the acetabulum, or on the great trochanter.

By far the most common exciting cause is the local application of cold; and hence it is that in children it may frequently be traced to lying down on the damp grass when they are heated by play. A scrofulous diathesis indeed is often the root of the evil; but in very many cases there is not the slightest taint of that disease.

If accurately recognized and judiciously treated at first, we may almost always calculate upon a cure. Conjoined with entire rest, local bleedings,

&c. M. D. urgently recommends the internal employment of emetic tartar in this, and indeed in all diseases which are induced by exposure to cold, and checked perspiration. He regards it as by far the most heroic of all antiphlogistic remedies. It is to be given in full doses and repeated every quarter of an hour, till the desired effects are obtained. He usually dissolves eleven grains in six ounces of water; and of this solution he orders one large tablespoonful at a time. Sometimes the addition of opium is necessary to induce the tolerance of the drug, or to counteract its effects upon the bowels.-Algemeine Medic. Zeitung.

PURULENT OPHTHALMIA OF INFANTS. The treatment of this common and most

dangerous affection adopted by M. Sanson at the Opthalmological Clinic in the Hôtel Dieu, consists in the application of leeches and the use of other anti

phlogistics until the purulent secretion commences; he then trusts chiefly to the external employment of astringents; and of these he prefers the nitrate of silver.

It is most effectual in the solid form; let the eye-lids be everted, and over their surfaces, after being wiped dry, let the caustic be freely applied. There is no occasion to wash the eye afterwards; the small quantity which may adhere will be dissolved in the tears, and will form an excellent collyrium. During the day, the following wash may be used frequently.

B. Argenti nitrat. gr. iij.
Liquor plumbi,

vj.

Aquæ distill giv. M. The system must be supported with mild, but nourishing food.

Mr. Wishart of Edinburgh praises highly the use of a solution of sulphate of zinc as a local application. His formula is

B. Zinci sulphat. gr. xxiv.
Aquæ distill. 3x. solve dim.
Adde Liquor plumbi, 38s.

Tinct. camphoræ, 3ss.—j. Coletur, ut fiat collyrium. Other British surgeons prefer an alum wash, containing from two to four grains of the salt to an ounce of water.

ON THE RELATIONS OF THE CRANIUM TO THE ORGAN OF HEARING.

Professor Mojon, of Geneva, in a memoir lately read before the Royal Academy of Medicine, has suggested some novel and very interesting speculations on this subject. Hitherto we have been led to view the cranium only as a safe recipient of the cerebral mass and of its appendages; but M. M. ingeniously supposes that it serves at the same time as an harmonic case, or drum, to the auditory organs. Treviranus, Esser, and others had already observed that the tympanum is not essentially necessary to the transmission of sounds, and that the sonorous undulations may be conveyed to the nerve of hearing by the medium of the cranial bones; but no one, before our author, had attracted the attention of physiologists to the curious relations which seem to exist between certain states of the crianial bones and the power of discriminating musical sounds.

The post mortem examination of Dr. Bennati, first suggested to M. M. the following speculations, and they arose from his observing that the bones of the cranium were much thinner than usual, translucent at many points, and soldered together along the line of the

sutures.

A similar condition of the cranial bones has subsequently been found by him in the body of another celebrated musician.

This coincidence of cranial attenuation, and musical endowments, led M. Mojon to consider whether it was possible that the one might be related to the other as cause and effect; and he has been induced by numerous observations to infer that the cranium is by no means quite passive, in the perception of sounds, that differences in the thickness of its walls may have very considerable influence in determining the degree of acuteness of the faculty, and therefore that it may be regarded as a sort of harmonic case which communicates its vibrations to the organs of hearing.

In confirmation of these views our author alludes to the cases of deaf peo

ple, who often can perceive very distinctly the sounds of a piano, or organ, by applying one extremity of an iron rod to their forehead, and the other to the instrument; and who may be made to hear what is said to them if only the voice is directed by a speaking trumpet upon some part of the forehead. It is not unfrequently also that a person whose hearing is indistinct, and who chances to wear a wig, can listen with much greater facility when the head is quite bare, than when it is covered.

The curious observations of M. Perier, on patients who had been trepanned, and who were found to hear quite distinctly any sound directed upon the cicatrix, even when both ears were ef fectually plugged, (vide our last No.) may also be mentioned as illustrative of M. Mojon's speculations.

Comparative anatomy shews that in a number of animals the transmission of sounds to the organ of hearing is assisted by numerous large sinuses, hollowed out in the bones of the cranium. To us it seems by no means improbable that the musical endowments of the feathered tribes may be in some degree at least modified, or influenced by the very attenuated condition of their cranial bones, and by the existence of the elastic lamellæ, which are found between their supernumerary cavities, as well as the passages of canals which extend into the labyrinth.

The only practical deduction from the preceding views, regards the assistance which may possibly be derived from attention to them, in our diagnosis of deafness, when we wish to discover whether it is owing to a palsied state of the auditory nerves themselves, or merely to some defect or injury of the adjunct members of the auditory apparatus. The every day occurrence of a person squeezing his head with both hands to deaden any very loud noise, may very probably effect the desired purpose, as well by interrupting the cranial vibrations, as by the direct obstruction of the auditory passages. -Journ. Hebdomad.

THE Venereal condyloma does not appear to me to have received so much attention as it merits. It is commonly considered to be merely the result of acrimonious secretions, or of want of cleanliness and personal attention, with simple remedies, are usually considered, sufficient for its cure. When it does not yield to means of this description, escharotics are frequently applied with freedom, but many practitioners appear, if I may venture to make the observation, to be destitute of definite ideas of its nature, and of any appropriate system of management.

It is my object in this paper to lay before my readers, in as clear and concise a manner as possible, the most important facts connected with this subject to endeavour, from the phenomena, to determine the nature of the venereal condyloma-to distinguish its varieties, if such exist-and to aim at founding, on something like determinate arrangement, a definite, or, at least, consistent mode of treatment. There are numerous difficulties in the path of the inquirer, and perhaps I may hope to stimulate others, possessed of greater powers of analysis, to effect their removal more successfully than myself.

It is a rule, I believe, in logic, that disputants agree in the definition of the name and nature of their subject. The neglect of this precaution has occasioned much dispute in the world of medicine. It is therefore necessary to acquaint my readers with what they are to understand by the term venereal condyloma. I mean by it an interstitial thickening of the cutis, more or less disposed to circularity, smooth, or, at least, not fissured nor lobulated like warts upon the surface, and possessed of considerable vascular organization. The distinctions between this and wart are apparent, but they glide into each VOL. XXI. No. 41,

other, and instances occur in which it is not easy to assign the preponderating character.

It may not be out of place to exhibit the imperfections of the common descriptions of venereal condyloma. Mr. Cooper's Surgical Dictionary, which is generally admitted to contain an epitome of the actual state of surgical knowledge, disposes of this affection in a summary manner. The whole of the article is comprised in three sentences.

"Condyloma," says Mr. Cooper, "is a small, very hard tumor. The term is generally applied to excrescences of this description about the anus. The practitioner may either destroy them with caustic, tie their base with a ligature, or remove them at once with a knife: the first is generally the worst ; the last, the best and most speedy method."-Sixth edition, 1830.

It will probably appear, that brief as the foregoing description is, inadequate as it must be to portray an affection so frequent and so singular, it is long enough to contain some serious errors. No reference is made to the complaint in the work of Dr. Titley, which purports to treat of the venereal diseasenor in that of Mr. Carmichael-nor in others to which it is unnecessary to allude. It is sufficient to observe that, so far as I know, there is no good description of the condyloma, and that what I am about to offer is exclusively drawn from personal observation. This must be received as an apology for its defects.

The venereal condyloma, or that condition I have endeavoured to define, appears under three varieties of form. It is probable, however, that they are rather degrees of the same complaint, than strict and separate varieties. The division is necessary for convenience of description and methodical arrangement, but the practical surgeon disre

gards at the bed-side these artificial separations of phenomena naturally

connected with each other.

The most simple form of condyloma is a flat, superficial, nearly circular deposit in the cutis. It is soft, and smooth upon the surface-it varies in thickness from that of a sixpenny to that of a penny-piece-in circumference it seldom exceeds the former, and is often little larger than a split-pea-it is evidently vascular-and its tint is usually redder than that of the surrounding skin.

Like the other varieties, it is much more frequent in women than in men, indeed I have seen few examples of it

in the latter.

Its situation in both is that which is most favourable to the production and maintenance of heat and moisture, and to the lodgment of discharge from the urethra or vagina. In females, for instance, the lower half of the labia, especially their internal surface-the perineum-the nates were opposed to each other, and contiguous to the anus -the thighs where they join the perineum, are the parts where condylomata luxuriate. In the male, the lower surface of the penis, where it hangs against the scrotum-and the sides of the latter, where they meet the thighs, are the usual situations for their growth. A male out-patient of the hospital had so numerous an array of these formations that his genital organs wore a singular appearance; the scrotum presented a ridiculous resemblance to those antique shields, which are closely studded with flat circular bosses.

In either sex this form of condyloma is accompanied with discharge from the urethra or vagina. It is more than probable that it never occurs except as a consequence of such discharge. The circumstances, the habits, and the conformation of the female render her more liable to profuse secretion from the genital organs than the male. In the lower class of women that infest the streets, and form the majority of the inmates of the hospital, this form of condyloma is extremely frequent. The accounts which they give of their com

plaints can seldom be depended on, yet they usually admit that discharge preceded the appearance of the condyloma. Yet the latter would seem to occur more readily in some individuals than in others. It may be presumed that in such instances the secretions are peculiarly acrid.

The discharge that attends condyloma is commonly yellowish, profuse, and thin. It is, in fact, chronic gonorrhoa, and the more severe symptoms of that complaint are comparatively rarely present.

Perhaps it would be better to dispose of this, before I proceed to the other varieties. The treatment is the only point which requires farther notice. It consists of two items-prevention and cure: prevention of all that excites the morbid growth-removal of that which has been formed.

The preventive treatment is simple and obvious. Cleanliness-the regular use of the hip-bath-a mild, unirritating diet, comprising little animal food, and no stimulating fluids-aperientsastringent injections thrown into the vagina or urethra. A remark may be made with respect to aperients and injections. It is usually better to commence the former with some doses of calomel or blue pill. This may be given every night for a few times, and may then be continued on alternate_nights for a week or ten days: a draught containing senna and the sulphate of magnesia being taken on the following mornings. Afterwards, aperients, not containing mercury, must be steadily exhibited. The combination of rhubarb and magnesia, or that of the sul phate of the latter with the carbonate generally answers very well.

I think that astringent injections are preferable to those of a stimulating nature. The injection of lead and decoction of poppies, or of alum and decoction of oak bark, is commonly more ef fectual than that of the sulphate of zinc, of the oxymuriate of mercury, or even of the nitrate of silver, much as the lat ter has been lauded.*

*The reader may refer to two papers on Gonorrhoea, published in the

The removal of the condylomatous deposites that are formed is a matter of importance, and at times, of difficulty. It is singular that they yield much more readily in some cases than in others. Excision is almost impracticable, certainly improper-the ligature cannot be applied-powerful escharotics are usually unnecessary, and therefore,from the pain they occasion, reprehensible. Sometimes the steady use of cloths dipped in powerful saturnine lotions is sufficient, when combined with the remedies already pointed out. At other times this will not succeed. In most cases the lotion of the oxymuriate of mercury answers remarkably well. It forms the staple application of the hospital. At first it may be used of the strength of half a grain of the oxymuriate to the ounce of distilled water; the proportion of the former being gradually augmented,according to circumstances, to two grains,or even to three. The condylomata may be bathed with this wash twice or thrice in the day, and lint dipped in it should be constantly applied to them. I should state that I have seen this occasion salivation.

The second variety of condylomatous affection would appear to be merely an advanced degree of the former, and yet there are attendant circumstances which render both it and the succeeding peculiarity worthy of attention. They constitute a frequent form of venereal sore, and are often followed by secondary symptoms. I suspect that the descriptions of the elevated sore, contained in the works of some writers on venereal diseases, are partially derived from the kind of condyloma to which I shall now draw attention.

The second variety of condyloma is distinguished from the first by the fact of ulceration having taken place upon the surface. Each particular condylomatous deposit is a sore. On some, the ulceration is very superficial, the surface resembling mucous membrane, or

38th and 39th Numbers of this Journal. They contain the author's views upon this subject, although they require rearrangement.

very fine cuticle, in appearance; on others it is distinct flat ulceration; and on others, again, the ulceration may be rather cupped. The tint is generally red, seldom, except in the cupped ulcerations, yellow. The base, or substra tum, of all is firm, for the obvious reason that each is a condylomatous deposite. For the same reason all the ulcerations, or sores, are raised above the level of the neighbouring integuments, all being, therefore, more or less elevated sores. The elevation depends on the existence of the condyloma, not on changes dependent on the sore itself, a distinctive fact which should not be forgotten.

The essential features of these condylomatous sores may be briefly recapitulated-their number, size, and situation following the laws alluded to in the description of the simple condylomatheir elevated character-the flatness of their surface.

These condylomatous sores at times affect a form which is rather peculiar. A row of ulcerations may be seen on the free edge of either labium, extending from the upper to the lower commissure, corresponding upon either side, and looking not unlike a row of beads. This form of sore is usually small, not exceeding, perhaps, hardly equalling in size a silver twopenny-piece.

The ulcerated condyloma is palpably possessed of high contagious properties. Opposite surfaces infect each other, and wherever the discharge descends, fresh sores will usually spring up. I have seen them, in uncleanly women, stretch in scattered order, down the inside of the thigh to the knee. The bead-like sores upon the labia are evidently de-. pendent on the power of infection possessed by the discharge.

The ulcerated condyloma, like the simple form, is much more frequent in women than in men. Probably, the majority of the women received into the hospital display this kind of ulcer

ation.

It is usually attended with profuse vaginal or urethral discharge. I was tempted, in many instances, to examine the interior of the vagina with the speculum. I must own that, with the