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may also be deduced, à fortiori, by the fact,that even one local action may survive ano-ther, by habit, of which we have a familiarexample in gleet.As we cannot limit the quantity or dura-

tiou of such local manifestations, so, like-wise, with respect to the general disposi-tion, we cannot define their quality, which,in addition to the quality reflected from theconstitution, with variety of period, maycombine a specific quality, from the natureand specific action of the parts. Henceperishes the dilliculty which is suggestedby the learned Mr. S. Cooper, viz., how wemay have hectic so late in cancer, whichwe shall answer when we discover hotv longtwo specific actions shall continue indepen-dent of each other, and u’llen they shallmutually react ; but, in the present state ofour knowledge, we cannot assume that con-stitutional sympathy shall be always pro-portionate to the quality of local lesion, anymore than to its quantity ; nor, therefore,that hectic should speedily supervene in thecase of cancer.

In a similar manner may we explain Mr.Hunter’s question,-Why the absorption ofthe venereal matter does not produce hectic.Nay, with greater facility, as in this casethe first cause is evidently ab externo. Thismay meet a good constitution; and we shallanswer Mr. Hunter’s query when we ascer-tain the nature and modus oyerancli of thespecific, and the amount of its capability,in different constitutions, to effect the hecticdiathesis.

Finally, with respect to the disproportionof local indices, I may remark two sourcesof the most serious mistake.

First,—they may be fortuitous, the resultof injury, &c., and, by their irritationmerely, may provoke an action which hashitherto been lateitt being, however, totallyunconnected with the real cause, exceptingas provocatives. To such the hectic hasoften been erroneously referred. In anotherform, also, of sympathy, viz., the irritativefever, I believe, in numerous instances, theviolent constitutional symptoms have beenabsurdly ascribed, by the astonished narra-tor, to slight incentives, as real causes.

Secondly, these local aS’ections may existfor a time, and then assume the action ofdiathesis ; and being the only obvious indicesto these, which are but a part, may theaction of the whole be erroneously referred.A very remarkable instance of this mis-

take came, a few weeks since, under myobservation :-A patient, labouring undersevere hectic, had a very small abscess nearthe axilla, which he originally attributed toan injury ; he had no appreciable hecticsymptom previous to the formation of thisabscess. He was examined by one of the ,,

best auscultators in this city, who pro-nonnced him to be labouring merely underit slight bronchitis. The hectic was, of

course, referred to the abscess. An ifsi-duous convalebceuce had occurred, and thephysician actually declared the patient to bebetter. As the case was connected with thesubject of this paper, f made a most carefulexamination, and when I had arrived at theinferior lobe of the right lung, immediatelydiscovered the existence of a cavity, by theusual stethoscopic phenomena. In this opi-nion the gentleman alluded to fully concur-red, being previously led into a seriousmistake by a partial examination, and in-ferring the absence of phthisis because itappeared not in its usual site.From this case we derive the common-

sense lesson, that no eflect can be dispro-portionate to its cause ; and that that causeis not necessarily simple, but may be a com-pound of various constituents, the latentcondition of a portion of which shouldstimulate us rather to increase our researchthan to resort to rash inferences and absurdtheories.

*** The publication of the cnnctudingportion of Mr. Edwards’ paper has been de-layed to this time by circumstances whichit was found impossible to remedy.

DR. CLANNY’S CASE TREATED WITHCARBURETTED HYDROGEN GAS.

To the Editor of THE LANCLT.SIR :-In the last nnmber of your valu-

able Journal there is a case of phthisis pul-monalis recorded by Dr. Clauny, of Sunder-land, in which he states that a cure wasetlected by the inhalation of carbnrettedhydrogen gas. That this patient was eventhe victim of consumption, remains to beproved. In relating the case, Dr. Clannycontents himself with stating a few veryequivocal symptoms, such as "nocturnalperspiration, heavy tenacious sputa, jerk-ing pulse," &c. That these isolated andstraggling symptoms are frequently con-

comitants of phthisis pulmonalis, there canbe no doubt, but their presence alone by nomeans proves the existence of that disease.Every one who has attentively studied atlec-tions of the lungs and their membranes, andhas been in the habit of invariably nsiug thestethescope in eliciting the symptoms ofdisease aflecting those organs, must beaware of the fallacy, and, in many cases, theimpossibility, of forming a correct diagnosisupon physical symptoms alone, which seemsto have been done in the case of Dr. C.’spatient, as, had he used that instrument, hewould certainly have mentioned it. He

states, that the female was a" coney cutter,"or a cutter of down from the skins of rab-bits. Now, it is well known, that personsfollowing either that occupation, or anyother which exposes them to the habitual

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inhalation of various kinds of dust, or otherirritating particles, are frequently the sub-jects of chronic bronchitis ; and from thesymptoms mentioned by Dr. C., it is evi-dent that his patient was labouring underthat disease, and not phthisis, as was sup-posed. In severe cases of the former com-plaint, the sputa are mixed with pus, givingout a variety of odours ; at the same timethe pulse assumes the jerking feel, andthe cheeks show the hectic tint," mentionedas existing in Mr. C.’s case. Besides, thelong continuance of chronic bronchitis in-duces changes in the pulmonary organs,which sometimes renders it very difficult tobe distinguished from phthisis pulmonalis.

It is mentioned that Dr. Clanny’s mode oftreating phthisis, by inhaling carburettedhydrogen gas, is new. A very little re-search will prove that this is far from beingthe case. I have the honour to be, Sir,yours, &c.

A CONSTANT SUBSCRIBER.

EXTERNAL EMPLOYMENT OFCREOSOTE.

By Sir FRANCIS SMITH, M.D.

1 determined in the spring of 1836 to usecreosot.e in any cases in which I could best ’Itest its efficacy; and my first trials were sosatisfactory, that I have continued its occa-sional use up to the present time, alwaysexternally. One source of discrepancy inresults will exist in the difference of speci-mens used ; the strength differing much,from the mode both of preparation and ofpreservation. I have always used it ofspecific gravity 1,064, and nearly colourless.

Venereal Ulcers.—A gentleman appliedto me with venereal disease in its primaryform, phymosis, a penis dreadfully swollen,and the prepuce covered with ragged pha-gedenic ulcers, with a good deal of consti.tutional disturbance. Blue pill, with mor-phia and tartar emetic, were prescribed,with soothing applications to the parts, andthe recumbent posture; this diminished thetension. But every mean was tried in vainto heal the ulcers, which threatened the de-struction of the prepuce. Under these cir-cumstances I applied creosote, pure, with adelicate pencil, to the ulcers, and my plea-sure was not greater than my surprise, tofind the next day that the sores had actuallycontracted a full third of their diameter;and in six days more, being lightly touchedeach day, were entirely healed. The pain,vivid only for a few seconds, produced butlittle irritation in the surrounding tissue.

Fistula in ano -This occurred in a gentle-man, ared 21, of a very broken down con-stitution, having but just recovered from

bubo in the groin, of four months’ duration,and in which I had made seven openings atdifferent periods, to give exit to matter.Considerable irritation now existed aboutthe anus, and the abscess had been evacuatedby a natural opening. At the opposite vergeof the anus an inflamed pile existed. Underthese circumstances I employed and con-tinued the soothing system, hoping thatnature might effect a cure by her own of-forts. This expectation was not realized,as the discharging sinus continued to presentto the probe the same condition as to depthand parietes as at first. At this stage of thecase, feeling reluctant to subjecta debilitatedpatient to an operation, the name of whichis so terrible, I mentioned it to Dr. W.Gregory, who strongly advised creosote; Iaccordingly carefully introduced to thebottom of each of two cul de sacs to whichthe sinus led, a very small dossil of lint,smeared with creosote. The pain was ex-cessive, but very rapidly subsided. Thepatient was placed in a large linseed poul-tice, and on seeing him again the followingday I was delighted to find that the spongy,irregular bottom which distinguished onecul de sac was succeeded by a more firmstructure. In two days I again introducedthe creosote as before, and in a week thefistula was diminished to one-half the depth ;both cul de sacs were merged into one, theprobe not going within three lines of thegut. Four more applications, spread overa fortnight, brought down the sinus to thesurface, the health of the gentleman gradu-ally improving, and two applications of redprecipitate to the surface of the now granu-lated sore, produced a complete cure.

Ulcers on the S’eptum Narium.—Theseulcers often prove very intractable, and inthe following case they had existed for somemonths, having appeared towards the con-clusion of a very copious catarrhal defluxionfrom the Schneiderian membrane. The lady,a scrofulous subject, had been subjected tothe influence of iodine, and had had theulcers touched with solutions of sulphateof copper and nitrate of silver, and at lastwith the solid nitrate. I abstained in thisinstance from every treatment except withthe creosote. The ulcers varied in sizefrom a pin’s head to a large pea; three onone side of the septum, and one on the other.They appeared to entirely sink through tothe cartilage or bone. With a wash, of onepart creosote, and sixty of water, at the endof two days I had made no progress. I thenapplied the pure creosote, pencilling theedges of the ulcers with a brush, and direct-ing the patient to inhale the fumes of aceticacid for a few seconds, immediately after,first, because acetic acid is the proper solventof creosote, and would have the effect ofequalising its action; and, secondly, becausethe odour would counteract the flavonr of