organic body, or simply an atmospheric element in some peculiar allotropic state, or whether it needs some atmospheric condition for its diffusion, or is connected in some way with the electricity of the earth and atmosphere. We shall, however, defer these inquiries, as we are anxious to devote our few remaining lines to a parallel between influenza and the disease which most closely resembles it, viz. Asiatic cholera.

In comparing these two diseases, it is necessary to remember that their habitats are not the same, and that though each may spread over the world, yet that cholera is, for the most part, an affection of tropical climates, and influenza of the colder regions. Cholera in Asia must then be compared with influenza in Europe.

Each malady seems to originate in several places in the localities favorable and native to it. Influenza most commonly in Northern Europe, or in North America; cholera in the plains of India and of China. Each, when produced, is endowed with a power of movement, and passes over more or less of the space which may be considered as the ordinary sphere of its action; at intervals it passes over the whole world, or over a great part of it. Each then pursues a nearly identical track, and is probably therefore impelled by an analogous force. Each, in its purest course, viz. in that followed in its proper locality, and with the fewest disturbing circumstances, has a rapid development to an acme, and then a gradual decline. Each seems to act primarily on the blood, and secondarily on particular mucous membranes; in the one case, on that of the nasal and pulmonary organs; in the other, on that of the digestive canal. Each may occasionally be reproduced by the human body, but neither can possibly owe its diffusion to this single property.

So far these are important resemblances; the differences are no less important.

The cholera poison is infinitely less volatile or less diffusible; consequently, perhaps, its movement is slower; it is influenced in an extraordinary degree by soil and conditions of locality, and is capable of being detained in places distant from its habitat for a variable time. Although it affects all nations, it attacks only few individuals, for it requires a peculiar predisposition. It recurs much less frequently than influenza, and may even apparently be absent for a long term of years.

Although most closely allied to influenza, cholera shows also closer marks of alliance to diseases produced by other morbid poisons, as to yellow fever, and perhaps to typhus, than influenza exhibits. Both the Registrar-General and Dr. Peacock allude to the coincidence between the appearance of influenza and cholera. This is a very interesting point, although, from the frequent recurrence of influenza, it may be accidental.

But, after all, many more facts must be accumulated, before the alliances and distinctions between influenza and cholera can be properly determined. It is, perhaps, hazardous even yet to draw a parallel, although the attempt to do so cannot be considered unphilosophical. Of one thing we are certain, that if the laws which govern any morbid poison can be distinctly made out, we shall have a much better chance of knowing in what direction to look for the laws which govern any analogous agent. Now, influenza returns so frequently, that proper investigations can easily be made, and would infallibly lead to conclusions of great interest and value. We shall hope, then, that the next epidemic will find us ready prepared systemati

cally to recognise the phenomena. And among those to whom we shall look forward for future contributions on this subject, we must place the author of the dissertation on the present epidemic. We have differed from Dr. Peacock on some points; but as we hope that, in his useful and honorable career, he may live to record many epidemics of influenza, we shall have future opportunities of showing him that we are not too stubborn to be convinced of being in error, if he brings additional evidence to bear on the points of difference.

ART. V.

1. Lectures on the Causes and Treatment of Ulcers of the Lower Extremity. By GEORGE CRITCHETT, Esq., F.R.C.S., Surgeon to the Royal London Ophthalmic Hospital, Assistant-Surgeon to the London Hospital, and Lecturer on Practical Anatomy, &c. &c.-London, 1849. 8vo, pp. 121.

2. A Treatise on the Cure of Ulcers by Fumigation, in which a Rational Treatment is deduced from the Physiology of Ulceration, and Proofs afforded that the New Method produces more Speedy, Certain, and Permanent Effects than any other in General Use, &c. &c. &c. By GEORGE ALFRED WALKER, Surgeon, Member of several Learned and Scientific Societies, and Author of Gatherings from Grave-yards,' &c. -London, 1848.

AFTER perusing the title-pages of these two works, our readers will not be surprised to learn that, though treating of the same disease, ulcers of the lower extremity, they differ as widely from each other as if they referred to totally distinct subjects. In one circumstance, however, they do resemble each other: both their authors commencing by regretting the imperfection of existing methods of cure, and both of them expressing a confident hope that they are adding something to our stock of knowledge. Beyond this there is no parallel between them. Mr. Critchett adopts a method of classifying ulcers; Mr. Walker considers "all ulcers (not specific) under one common head." Differing so greatly as they do, we must notice each treatise separately.

At the request of the pupils of the London Hospital, Mr. Critchett, the assistant-surgeon, undertook to deliver a course of lectures on ulcers of the lower extremity, which were published in the Lancet,' and are now collected together in a very readable and interesting volume. The main object which Mr. Critchett has had in view, has been to advocate the use of regular strapping and bandaging from the toes upwards in most of the forms of ulcer, and in so doing, to place "the principle of mechanical support in the treatment of ulcers of the lower extremity on a correct and scientific basis." In this he does not profess to be original; to quote his own elegant and striking language, "he claims not the high honour of having discovered a new window whereby light may be admitted into our surgical temple, but simply to have rendered transparent one that had become obscured and useless." Our author divides all ulcers into two great classes-simple or local, and specific or constitutional. Each of these is again subdivided into varieties: thus, the simple or local class includes the acute or spreading ulcer, the subacute, chronic, healthy,

irritable, and varicose; whilst the class of specific or constitutional ulcers comprehends the strumous, syphilitic, phagedenic, periosteal, menstrual, oedematous, and malignant.

Each of these different forms of ulcer is graphically described by Mr. Critchett, and their treatment scientifically discussed. It may suffice, however, to state that all of them are capable, at some period or other of their progress, of being benefited by regular mechanical support. Concerning the share which Mr. Baynton had in the introduction into practice of the plan of strapping ulcers, Mr. Critchett makes several statements, which briefly resolve themselves into the following:

1. That Mr. Baynton advocated the practice on a false principle-that of bringing the edges of the ulcer nearer together by means of strips of adhesive plaster, instead of doing so to facilitate the return of blood through the limb; 2d, that he limited his plan to old ulcers; and 3d, that by applying his strapping merely to the surface of the sore, and to two or three inches above the diseased part, he very imperfectly realized the advantages of mechanical support, and in many cases did a great deal of harm, inasmuch as his strapping often acted like a tight garter, and directly impeded the circulation through the limb.

On these accounts the credit due to Mr. Baynton must be very considerably limited; and we must here seek the explanation of the fact, that some surgical authorities reject the proposal altogether, while almost all in recommending it speak dubiously, and inculcate great caution in its employment. The full advantages of mechanical treatment can only be reached by affording complete support to the entire limb, by strapping and bandaging it from the toes up to the knee, and occasionally beyond this, in a manner very clearly described by Mr. Critchett. The credit of this improvement is due to Mr. John Scott, and is described in his work on the treatment of diseased joints; and the London Hospital is the only institution, we gather from Mr. Critchett, where this method has been understood and properly carried out. To this statement we must take exception. It is probably true that Mr. Scott was the first to give a written account of this improvement on Mr. Baynton's proposal; but with respect to its application, we can assure Mr. Critchett that it is a plan which, to our own knowledge, has been effectually, fully, and efficiently carried out for years past in some of our provincial hospitals; the applicants to which, from among a badly-nourished and over-worked population, are more than ordinarily subject to ulcers of the legs. This is not perhaps a matter of much consequence, and is not stated with a view of detracting from the value of Mr. Critchett's labours, but rather as affording confirmation to them, in the shape of independent testimony to the value of the treatment he recommends.

As affording a good example of Mr. Critchett's style, and also as containing in itself some very valuable information, we subjoin his remarks on the acute form of ulcer, extracted from the third lecture.

"The acute form of ulcer is almost invariably attended with severe suffering, which is aggravated to an intolerable degree when the limb is placed in a depending position; there is a sensation of great heat and tension, and the pain is of an aching gnawing character. The ulcer looks uneven and glassy, the edges are irregular and undefined, sloughs varying in size are often seen on the surface; the discharge may be slight or abundant, but it is invariably thin and ichorous, sometimes mixed

7-vi.

8

up, however, with the débris of the ulcer; the surrounding parts are of a bright red colour, or sometimes of a peculiar speckly red-and-white aspect, difficult to convey in words, but very characteristic of this condition: the swelling may be slight, or it may extend over a considerable portion of the limb. On making continued and firm pressure upon the parts in the neighbourhood of the sore, they pit, showing a state of local edema, which I have almost invariably found to exist in acute ulceration of the lower limb, and which is very rarely found in the subacute and chronic stage, except when there is general anasarca-a condition of things which does not belong to the present inquiry. Some authors speak of applying pressure to get rid of the oedema of old ulcers; I can confidently affirm that such a condition rarely, if ever, accompanies chronic sores; it is a sure indication of acute inflammation and ulceration, and becomes a very useful and unerring guide in practice, more particularly in determining the point as to whether the limb will bear mechanical support, inasmuch as wherever this state is found, support is contraindicated. The bright red colour of the surrounding parts is another important indication; when these inflamed vessels are pressed upon and emptied, they refill with such rapidity that the interval is scarcely appreciable. It will be useful to contrast this with a similar experiment during the chronic stage, which I shall hereafter allude to. I dwell upon these diagnostic marks, because they are most important in practice. Any attempt to apply mechanical support during the acute stages of ulceration is invariably attended with most injurious effects, and has a tendency to bring a remedy that is of the utmost value when judiciously selected into unmerited discredit. In regard, then, to treatment: the recumbent position must be constantly maintained, and is in general the only one that can be borne; additional benefit is sometimes derived from the use of the inclined plane, by which the limb is elevated more or less above the rest of the body, thus facilitating still further the return of blood through the limbs. Soothing applications are the best suited for this condition; water dressing, either warm or cold, as is most agreeable to the patient. Poultices of various kinds (though it is the fashion for young surgeons to condemn them wholesale) often afford relief when all else fails to do so, and are still, I am convinced in some cases-in spite of the obloquy and ridicule now cast upon them by the modern school-by far the best method of obtaining uniform warmth and moisture to an inflamed surface. If the sore be foul and sloughy, a solution of the chloride of lime, or soda, is a useful application; the strength must be regulated by the feelings of the patient, the object being to produce a slight tingling sensation, not amounting to pain. I generally commence with half an ounce of Fincham's solution of the chloride of lime to a pint of water; in foul, angry, sloughing sores, I have met with no application so useful; it rapidly removes all unpleasant odour, and produces a healthy granulating surface. In ulcers of an acute character, with a considerable amount of surrounding inflammation, some surgeons recommend local depletion, applied to the circumference of the sore, either by means of leeches or small lancet punctures. I do not recommend this plan of treatment. I do not deny that occasionally temporary benefit and relief from pain may result from it; but, on the other hand, I have so frequently scen cases in which these artificial wounds, slight though they seem, have become troublesome sores, and in which no improvement has been produced in the original ulcer, that I am convinced that the possible advantage is very much more than counterbalanced by the probable injury that may result from this plan." (p. 39.) The following passage occurs further on:

"Mr. Skey's pamphlet, emanating from so high a quarter at St. Bartholomew's Hospital, promised such great things, and with so much confidence, from the use of opium in the treatment of ulcers, that I was surprised to find, after a prolonged and extensive trial, that in no one instance was I able to trace the slightest benefit from its use. I have carefully administered this drug in above forty cases of the kind, and I have been compelled to arrive at the conclusion that it is utterly valueless as a healing agent in the treatment of ulcers of the lower limb." (p. 51.)

In this, and in a statement made further on, that he has not found black wash useful unless the ulcer were a specific one, Mr. Critchett's experience differs from our own; and of the taste with which the passage we have above quoted has been written, we cannot altogether approve.

We have not space for copious extracts from this work; but we feel it incumbent upon us to express our dissent from Mr. Critchett's doctrine respecting the menstrual ulcer. His axiom is "Heal the ulcer, and the uterine function will speedily be restored to health and regularity." Common sense and common experience teach the opposite of this. Here our author is riding his hobby a little too hard.

To conclude our notice of Mr. Critchett's work, it only remains to express the gratification which its perusal has afforded us. As an example of patient observation, legitimate induction, and praiseworthy diligence, it is deserving of high commendation; and as a manual of practice, and, above all, as a model of the true and enlightened mode of conducting an original investigation, we can cordially recommend it to students, for whose benefit principally it has been written.

Mr. Walker's work, which rejoices in a crimson cover, and a large gold label, "Geo. Alfred Walker, on the Cure of Ulcers," is about the same size as Mr. Critchett's, but presents greater pretension to originality. This credit, to which it is fairly entitled, it will probably long retain. We do not think the author need be under much apprehension of the envious. pilferings of the would-be discoverer; his claim to having produced an original book is undoubted.

The "application of the fumes of sulphur and iodine to the surface of the ulcer, and to the adjacent tissues," a process to be effected through the medium of mahogany boxes of a peculiar construction, which communicate with the "engine-room" of Mr. Walker's establishment,—has produced results beyond the expectation of the most unreasonably sanguine. For the details of these cases, and for some remarkable drawings which illustrate them, we must refer our readers to the work itself. They truly afford examples of what may be called surprising cures. We have before hinted that Mr. Walker thinks very little of the ordinary treatment of ulcers; and he considers that we are all wrong, when we rejoice to see the surface of an ulcer covered by granulations. "They are," he says, "the product of an artificial stimulus, and spring from an ill-conditioned soil." Their unmanageableness affords an opportunity to introduce the following elegant and appropriate simile: "Between stimulants to elevate, and escharotics to depress, the surgeon finds himself nearly in the same predicament as the perplexed petit maître, who employs straps to keep down his inexpressibles, while he has recourse to braces to keep them up."

Mr. Walker is not fond of poultices-but our readers shall judge for themselves of the forcible style in which his book is written. "Linseed meal is used in very considerable quantities in many hospitals, for making that disgraceful, filthy, and non-scientific combination called a poultice— a mess better suited for the stomach of a pig than for the leg of a human being."

There's no mistake about this. Dear reader, is it not an original book?