most part individuals from 12 to 20 years of age that consult us concerning them. 2. They do not possess an unlimited power of increase. Arrived at a certain size they cease to grow, and I would risk stating that their growth ceases with that of the bones. 3. In comparing them with each other after they have acquired all the development they are susceptible of, their size seems in relation to that of the bone affected. They are generally larger in the femur than the humerus, greater still upon the bones of the pelvis, while they continue for a very long period small at the last phalanx of the great toe. So, too, with reference to certain tumours of the soft parts, such as lipoma and encysted tumours of various kinds, their power of growth seems very much dependent upon the size of the region of the body they occupy. 4. These tumours are not united to the bone by a pedicle properly so called, but only a certain degree of narrowing of their base. The principal part of the tumour is usually irregularly spherical, having an irregular and semi-cartilaginous surface. The central part of its substance may be somewhat spongy, but the tissue becomes much more compact as we approach the narrower base. 5. The connection of these tumours with the parts that surround and cover them is various. When the exostosis is covered in part by a muscular layer, it is sometimes separated from it by a slightly condensed cellular tissue which yet allows the muscles to slide over the exostosis; while, at others, a small sac is formed containing fluid. In some cases, again, the exostosis and the muscles become firmly joined together, so as to render all motion of the latter over the former impossible; and, if an operation were undertaken upon parts so situated, the pedicle being divided without the tumour having been previously exposed, it might happen that this could not be removed without removing a portion of the substance of the muscle. Considered as changes of organs, these osseous tumours assuredly form the simplest of diseases. They give rise to no inherent phenomenon or symptom; they have no particular tendency to degenerate; each is, as it were, as a little bone attached to the larger, and at most only susceptible of undergoing the same changes as this last. But as the exostosis approaches the surface it produces more or less deformity, and where it compresses or distends the soft parts it may give rise to more or less suffering, while situated within a cavity (e. g. the orbit or pelvis) it may induce most important functional disturbance or obstruction. In the limbs, the action of the muscles may be rendered painful or imperfect by them. One thing has always struck me in respect to these tumours seated beneath the muscles, namely, that the inconvenience and pain they occasion diminish, doubt. less from the effect of habit, in proportion to the length of time the exostosis has existed. It is a good reason for exhorting our patients to have patience, and not yielding too readily to their desire for undergoing an operation." M. Roux furnishes at some length the particulars of the various cases calling for operations and the mode in which he performed these. These are too long for extract, and we can only subjoin his conclusions upon this point. "1. With the exception of some whose position renders them inaccessible, it is almost always possible to remove these tumours. 2. In almost all cases such ablation is indicated, either for the removal of a great deformity, the relief of continual suffering, or the re-establishment of the deranged functions of certain organs. 3. In the great majority of cases we can proceed to the ablation without a preliminary exposure of the tumour, and without having any great difficulties to overcome. 4. Such an operation may lead to unfortunate results, in consequence of some peculiarity in the seat or relations of the tumour, or from the bad constitution of the patient; but generally it is crowned with success."-Revue Medico-Chirurgicale, Nos. 2 and 3. [The above extract from the pages of our new contemporary and namesake is taken from a paper furnished by M. Roux from among the materials he is now engaged in arranging for his long-expected work on "Clinical Surgery." His 1847] Iodide of Potassium in Syphilis. 265 well-known candour in stating the results of his experience, whether favourable or unfavourable; and the long period during which he has been accumulating facts furnished him by an extensive private and public practice, naturally give rise to the highest expectations.-Rev.] ON IODIDE OF POTASSIUM IN SYPHILIS. By Dr. ARAN. In this paper, Dr. Aran enters into a critical examination of the most remarkable writings which have recently appeared upon this subject, as those of Dr. MoijSisovics, of Vienna, Dr. Hassing of Copenhagen, Drs. Gauthier, Payan and Bassereau. (Med. Chir. Rev. No. IX. p. 267). His appreciation of these seems to us to have been very conscientiously and carefully made, and we really hope that it will be for some time to come considered as final, for important as the subject is, it seems to us to have been at least sufficiently insisted upon of late. The following are Dr. Aran's conclusions. "1. Frequently repeated experience has indubitably established the fact, that iodine and its preparations taken internally possess valuable anti-syphilitic properties. 2. The iodide of potassium is far preferable to the other preparations, and deserves a preference to them in almost every case. It is easily given, does not nauseate, frequently increases the appetite, accelerates nutrition, and is endowed with valuable curative properties. 3. It is not indiscriminately applicable to all the periods of syphilis, or the different symptoms which characterize it. As a general rule, we may say it especially succeeds against what Wallace has termed the pustular or deep-seated form of chancre; it is of remarkable efficacy, and nearly always heroic, against tertiary symptoms and those of the secondary ones which are tending to tertiary. 4. It is precisely in those cases in which mercury shows itself powerless, or of only feeble efficacy, or when the symptoms are of very long standing, that the substitution of the iodide for mercury best succeeds, and that especially when these symptoms occur in a more or less shattered constitution. In this way the iodide fills up a lacuna which was heretofore painfully evident in the therapeutics of syphilitic diseases. 5. The utility of the union of the mercurial and iodic treatment is at present an undecided question. At all events this mixed medication seems to be without inconveniences. 6. The iodide is equally efficacious in whatever vehicle it be administered. Experience has shown that, from 10 to 15 grains per diem suffices at the commencement, and that this may be gradually increased to from two to four scruples. 7. The occasional inconveniences which this medicine gives rise to (such as cutaneous irritation, and inflammation of the conjunctival, nasal, or buccal mucous membranes), must not prevent our employing it, especially as they may be in part prevented, or moderated, by careful administration." We may here add the account M. Aran furnishes of the treatment pursued for several years by M. Moij-Sisovics senior physician to the Vienna Imperial Hospital, and described by him in his work upon "A rapid and certain Mode of treating Syphilis by preparations of Iodine;" and which, if the author's statements can be relied upon, certainly surpasses all others in prompt efficacy. “Half-a-drachm of iodide of potassium, dissolved in water and divided into three doses, is given the patient daily, the quantity being gradually increased until four scruples are reached, beyond which it is never extended. Baths of iodine and marine salt are simultaneously employed (salt 2 lbs., iodide of potassium 6 scruples, pure iodine, added when the patient is in the bath, 4 scruples) for an hour at a time, the patient lying in a hot bed afterwards until transpiration is excited. These baths are continued for three days until some irritation of the skin is induced, the quantity of iodine being then augmented. On the 10th or 11th day a febrile state comes on, itching of the skin is felt and a scarlatinoid eruption, or one resembling zoster, is produced. On the 15th, 17th, or 21st day a general desquamation occurs, which, with the previous eruption, indicates the saturation of iodine has reached it maximum, and the author declares he has never seen a relapse in a case in which the eruption and desquamation have pursued the regular course. For the exostoses, condylomata, and pustules, Dr. M. employs a strong local application formed of iodine, the iodide and water. He orders alimentary substances of easy digestion, taking care to avoid those of an amylaceous nature, and keeps the patients warmly clad in a room having a mild temperature. This treatment he employs against every description of syphilitic disease, primary or secondary, and he declares it is followed by a cure in from fifteen to twenty-two days." ON THE USE OF ASSAFOETIDA, AS A MEANS OF PREVENTING the Death OF THE FŒTUS IN UTERO, DURING THE PREGNANCY OF Delicate WOMEN. By Dr. LAFERLA of Malta. The author, from an early period of his professional career, has directed his attention to those cases in which the fœtus having reached its period of development dies prior to birth, the mother in this way sometimes bringing forth a succession of dead infants. In reflecting upon the subject, he felt disposed to attribute the occurrence to debility or inertia of the uterus, and in searching for means to invigorate the condition of this organ without inducing its contractions, he remembered the commendations bestowed by Sydenham upon assafœtida in hysteria, and especially in cases of debility of the womb. His employment of this in several cases has led to excellent results, which it is the object of the present paper to detail. The foetus may die at three different periods of pregnancy-before the sixth month, during the two first months of the third period, and when arrived at full term, independently of the nature of the labour. When a pregnancy is so menaced, there are several symptoms which should excite attention. At first there is a feeling of languor, general uneasiness, restlessness, horripilation, and a sense of great cold. The countenance becomes pale, the head heavy and confused, and the tongue loaded, vomiting or nausea even sometimes occurring. The spirits are low and the nervous system very excitable. The movements of the fœtus are languid, and at last only its cardiac pulsation can be perceived. There is numbness of one or both legs, and severe pains of the loins, belly, and pubis come on. The child feels a heavy weight in the pelvis, and a few days prior to its expulsion, a whitish-yellow or sanguinolent discharge takes place from the vagina. The causes of this state of things are usually depression, passions or frights, venereal diseases, a lax constitution, amenorrhoea, leucorrhoea, menorrhagia, hysteria, or a neglected miscarriage. In apportioning the medicine the temperament of the woman and the period of her pregnancy must be taken into account. "To those of sanguineous or bilious temperament, from two to four grains per diem less should be given than to others; and I always take care that a pregnant woman, before arriving at the period at which she has already lost a child, shall have taken from 10 to 15 scruples of the medicine in all. At first I employed the tincture, but finding the pills more easily taken, I have since combined the powder of assafoetida with extract of chamomile, so as to make 2-grain pills. Of these I give one fasting, and another in the evening, five hours after dinner. This dose may be gradually increased as we approach the critical epoch; so that, if in prior pregnancies the child died during the first period, this should be done every second day; if on the second period, every four or five days; and if at term, every six or eight days. We have best chance of succeeding when we commence the treatment 1847] Devergie on Squamous Diseases of the Skin. 267 even before the pregnancy has begun. I then prescribe from 6 to 8 grains per diem, divided into two doses, until certain signs of pregnancy manifest themselves. After these are present, I then give but the simple 2-gr. pill night and morning, and if the movements of the foetus are of normal strength, and the pregnancy does not offer the same deviations as the former, I continue the same dose to within about a month of the period at which death usually takes place. The continuous use of assafoetida gives rise sometimes to a burning sensation in the stomach. In this case I suspend it for some days, substituting some decoction of gentian until the heat is dissipated. Great attention to moral agents is requisite, and the strength must be well maintained by a succulent diet." Dr. Laferla has met with about twenty cases in which he has tried this medication with success, and seven of them are here detailed. In some of these, three, four, five, and even eight unfortunate pregnancies occurred prior to the successful use of this drug.-Revue Medico-Chirurgicale, No. 3, pp. 129-137. [M. Laferla has directed attention to a very important point and one too much neglected. We cannot agree with him in his opinion that a special corroborative power is exerted by the assafoetida upon the uterus, but believe that it may frequently be useful in counteracting that nervous susceptibility which women prone to this accident so commonly manifest. In another and a large class of cases the loss of successive children is referable to a syphilitic taint existing in either parent, which is removable by a mercurial course.-Rev.] CLINICAL OBSERVATIONS UPON THE TREATMENT OF SQUAMOUS DISEASES OF THE SKIN AT THE HÔPITAL ST. LOUIS. By M. DEVERGIE. Arsenic. Although the various squamous affections of the skin present sufficiently distinct characters to require that they should be nosologically distinguished from each other, yet, in a therapeutical point of view, they may be considered in a more general manner. Arsenic may be given in the form of pills or of solution. The pills, known under the name of Asiatic, are thus composed; Arsenious Acid 1 gr., Black Pepper 12 gr., Gum 2 gr., Water q. s. to form 12 pills. One pill, or at most two pills, should be given daily for 6 or 8 weeks; but this mode of administration is so uncertain and so frequently induces irritation of the digestive organs that M. Devergie now never has recourse to it. Among the Solutions, that of Fowler (Liq. Potassæ Arsenitis, Phar. Lond.), furnishing a very soluble arsenite of potash, is best known. When I first came to St. Louis it was customary to give only one drop of this every 24 hours for a certain number of days, increasing this at very long intervals to 2, 3, 4 and even to 12 or 16 per diem. I found, however, that by giving 1 drop the first day, 2 the second, and thus increasing by a drop daily until the maximum (12 to 16) was attained, the duration of the treatment might be much abridged without any injury to the health. We have accounts of as much as 40 drops of this substance being given, but this must be erroneous, and a careful investigation has convinced me that we cannot give more than 20 or 22 per diem without producing injurious effects, and that 14 form the ordinary limit. This substance exerts its action both on the skin and upon the general economy. Action on the Skin.--After a certain time the scales fall off, and although the ointments which are used detach these, it is the arsenic which prevents their reproduction. The skin gradually assumes its proper level, and the affected parts, from being red, become brown and smooth. This is of great importance, for it is only when we have obtained this brown colour of the skin we can be assured of the cure. It is the proof of the efficacy of the medicine and the measure of the quantity required. So certainly is this brown colour of the spots a sign of cure, that, if there is a relapse of the disease from a recurrence of its causes at the end of a year, or even of three months, it never re-appears upon the portions of the skin originally affected, but always on one side of them. The disease is cured when these spots are seen: but they require some months or even a year to disappear. Action upon the Economy.-The first effect of arsenic is a general falling away of the whole body, and a brown leaden coloration of the face; from which it results that patients who have completed the course of treatment and feel themselves very well in all respects, have just the appearance of convalescents from serious disease. With no pain or other disorder of the economy, and possessed of a good appetite, they continue so thin as still to seem very ill. Arsenic would seem to exert a modifying power upon the formation and secretion of fat and on this account I have prescribed it for the resolution of adipose tumours, and several times with success. : Arsenic sometimes gives rise to certain accidents which it is important to bear in mind. All persons cannot bear the same dose. In some, eight drops will produce anorexia and other disorders of the system, and in such cases we must suspend its use for some days, and only resume it very cautiously. It sometimes happens that when we have again reached six drops all the ill-effects are reproduced, and in this case we must definitively renounce it, for not only may it do much mischief but it will not cure the disease against which it is employed. There are other subjects in whom 12 drops produce accidents which show that the drug has acted sufficiently, and must be left off. These are symptoms which have not been hitherto indicated by authors. Some patients will tell you they suffer from dyspnoea, others from partial loss of strength, as in a limb, others from colic or diarrhoea, from numbness of a limb-in a word, from one of a varied series of more or less strange nervous phenomena-none of these being symptoms characteristic of poisoning by arsenic. Of all these dyspnoea is the most constant. Symptoms of true poisoning may, however, occur, these arising when too large a dose has been given. The presence of this medicine in the urine would prove that the system is saturated with it, and that its therapeutical action had reached its limits. The arsenic is best given in two doses per diem in a julep or sugared water. M. Devergie employs a far weaker solution of arsenic than Fowler's, so that 22 drops of it represent 1 drop of the latter. He does this because the quantity can thus be more easily measured out; and accidents are less liable to occur from a mistake in the number of drops. Pearson's Solution, which contains an arsenite of soda, is less easily supported by patients than the above. Antimonials. These may be also administered in two manners. In a pill, (Plummer's Pill), each pill containing one grain of calomel and of the sulphuret. Of these we may give from two to six daily; but, as with respect to arsenic, the pilular form is a bad and uncertain one, on account of the insolubility of the materials, I therefore much prefer tartar emetic. I mix half-a-grain of this with from half-a-drachm to a drachm of cream of tartar, and give them mixed up in preserves, the patient swallowing a glass of sugar and water directly after. It is remarkable that, given in this way, these medicines produce no vomiting, and scarcely any purging. The toleration is indeed surprising, and it is as much as there is a little nausea the first few days. In those cases where vomiting or purging is caused it must be left off. This treatment requires to be continued in general for two months, and is not evacuant but alterative in its operation. Ås M. Devergie considers external treatment of these diseases as of compara tively little use, we need not detail the various means at any length. Of these he seems to think the application of tar (melted down with at first 40, and then |