or elsewhere. Dr. McClellan himself seems to have visited Yankton in November, 1874, in quest of further information from the emigrants themselves, and states "By some of intelligence, it was admitted that the districts of Russia from which they had departed were cholera-infected, and many instances corroborative of published reports as to the prevalence of this disease in the southern provinces of Russia were obtained. One man of much intelligence and refinement recounted interestingly the frequent arrivals of the disease at the city of Odessa, and another man from the vicinity of the city of Taganrog confirmed the cholera reports published from the Crimea during the past few years" (p. 464). The remarks of all these persons, as well as the last, must have referred to the past few years, and not to 1873, to which the inquiry in the present case should be limited. The men who described frequent arrivals of cholera sick at Odessa must either have been mistaken as to the facts, or must have been thinking of a previous year, for, according to the Russian government returns, in 1873 there was no attack or death from cholera in the government of Cherson, in which Odessa is situated, and in Bessarabia, the next province to the west, there were in 1873 only fifty-three attacks, the first on 20th June, and two deaths. The governments of Taurida and Ekaterinoslav, the former embracing the Crimea and the latter Taganrog, were altogether free from cholera in 1873. Indeed, this disease was met with to a notable extent that year in Southern Russia, in the governments of Volhynia and Grodno only, where the mortality was 6 and 18 in 10,000 respectively, and in a lesser degree in those of Minsk and Mohilew, where it was 3 and 1 in 10,000; and the nearest point to Odessa and Taganrog where it occurred (except Bessarabia, already referred to) was the government of Kiew, where fifteen cases occurred, the earliest on August 1st, of which ten proved fatal. We presume Dr. McClellan could not have had an opportunity of perusing these returns, but with the information they convey before us we can attach no weight to the statements made to him regarding cholera in Southern Russia in 1873, or to the inference he draws from that evidence, viz. that the emigrants imported the cholera poison from these districts in their clothing or bedding. The route followed by these emigrants from New York to Yankton is not specified, but an inspection of the map will show that it must, for a long distance down the valley of the Ohio and up that of the Missouri, have passed through districts in which cholera was epidemic at the time, and they might have contracted the disease which broke out at Yankton while on their journey thither; this point, as in the case of the Have family, does not seem to have engaged the author's attention, though it is clear he could not have established his inference as to fomites being the cause of the disease at Yankton until he had excluded the possibility of its having been contracted on the way to that place. We have examined these three instances at such length not only because they form the most salient features in Dr. McClellan's history, but also because, could they have been established satisfactorily, they would have placed beyond doubt the portability of the cause of cholera to great distances, and have confirmed much that is now in dispute. On the other hand, had they, from insufficient examination of the facts, been taken as proved, they would have exercised a most injurious influence on our future advance in the knowledge of the causes of this disease. Had Dr. McClellan's view been correct, for instance, Dr. Hubbard's supposition that the emigrants from Germany introduced the cholera poison into New Orleans would have been possible, and would even have acquired some degree of probability, devoid of proof as it is; but with the refutation of the former the latter becomes nothing better than an à priori speculation, and the opinion of the Board of Health that the disease was intimately connected with local causes is strongly corroborated. Taking all the circumstances together, we are inclined to believe this American epidemic of 1873 is destined to throw much light on the nature and causes of cholera, for, springing up as it did without immediate connection with a previous one, without any proof of importation, and under conditions which induced a large number of medical practitioners, spread widely over the country and acting independently of each other, to think they had to deal merely with the ordinary cholera nostras, a little more aggravated than usual, it points out a relation between cholera nostras and malignant cholera which has hitherto been persistently ignored by writers on epidemic cholera, but which we apprehend must be fully examined into as the first step in any real advance. III.-Lectures on Syphilis and on some Forms of Local Disease affecting principally the Organs of Generation.1 THE recent discussion on syphilis at the Pathological Society has revealed a considerable variety of opinion and doctrine even among those best versed in the study of the disease; it has also made manifest the paucity of our knowledge on several important questions connected with it: so that the debate may at least have the good effect of helping us towards that first essential for any real and scientific progress in our study of the subject-a clear comprehension of the limits of our knowledge, and a separation of what is, from what is not, certainly known. Some of the differences of opinion are, however, seen on examination to be more apparent than real. For instance, it seems of but little consequence whether we say that there are two kinds of venereal poison, one of which produces the local, the other the constitutional disease; or that the venereal matter sometimes contains, and sometimes does not contain, the germs of the infecting syphilitic poison. Surely the presence or not of the contagium which gives rise to constitutional syphilis makes a very essential difference between two secretions. Mr. Lee's recent lectures place the different kinds of venereal inoculations in a very clear manner before us. Mr. Lee is a reverent student of Hunter's works, and he points out with evident satisfaction the clearness of Hunter's distinctions between the different actions of animal poisons. "Morbid poisons," Hunter observed, "are many, and have different powers of contamination. Those which affect the body, either locally or constitutionally, but not in both ways, he called simple. Those which are capable of affecting the body both locally and constitutionally he called compound." "A poison may affect only the part in contact with it, and may act either mechanically or chemically, or may affect the vital action of that part. Thus, powdered glass acts mechanically, corrosive sublimate acts chemically, and the matter of cancer acts only on the living principle of the part. Another mode in which a poison acts is upon the constitution of an individual. This constitutes it a morbid poison; as examples may be cited jail fevers, and different forms of secondary inflammation where there has been no open wound. A third form in which a poison may act is on the nervous system; and, as examples, Hunter cites the occasional effects of poisoned arrows, honey, mussels, nux vomica, and probably the bite. of a mad dog, which produces no specific effect on the injured part. 1 Lectures on Syphilis and some forms of Local Disease affecting principally the Organs of Generation. By HENRY LEE, Professor of Surgery at the Royal College of Surgeons of England, Surgeon to St. George's Hospital, &c. 115-LVIII. 3 Those poisons which are liable to affect the body both locally and constitutionally Hunter calls compound or mixed." "This mixed action is of two kinds-first, when it produces inflammation of the parts, and at the same time affects the whole constitution, as in the venereal disease; and, second, where a local disease, as the itch, is followed by some secondary complication, such as erysipelas; or like jail fever, which acts first on the constitution, and may be followed by certain local diseases; or like the vaccine inoculation, which produces a local disease, followed by a general constitutional influence." Having set forth these Hunterian doctrines, Mr. Lee goes on to show that Hunter believed that there was a syphilitic poison which did, and one which did not, infect a patient's constitution. We think that Mr. Lee has done well in recalling our attention to Hunter's observations, and we agree with him in thinking that "if those who followed Hunter in his investigations had also remembered what he had said, much intricate confusion, much fierce controversy, and many a laboured volume, both in French and in English, might have been spared." The different forms of primary infection are excellently described by Mr. Lee, but the great merit of his work consists in the explanations which he gives of the way in which the characters of the different sores may be modified or concealed, and therefore mistaken. The local suppurating sore "Commences as a pustule and runs a definite course. When artificially inoculated, the inoculated point becomes red within the first twenty-four hours. From the second to the third day it becomes slightly raised, and is surrounded by a red areola. Between the third and the fourth day it contains a fluid more or less turbid. From the fourth to the fifth day the pustule becomes fully formed, and from this time to the termination of the disease the secretion consists of well-formed pus. Sooner or later the cuticle covering the pustule is detached, and in some instances it may be removed at the time of the inoculation, whether artificial or natural. "This alters the appearance of the affection, but in no wise interferes with its essential characters. As soon as suppuration commences there is a loss of substance in the part, and an ulcer forms which has peculiar characters. When not interfered with by any accidental causes, it increases equally in every direction, so as to form a more or less perfect circle. The edges of the ulcer are cleanly cut, and present a sharp outline. The appearance presented is often that of a piece of skin having been removed by a punch. The edges of the ulcer are frequently slightly undermined and everted. The surface of the ulcer is irregular, sometimes presenting granulations, at other times presenting the appearance of having been worm-eaten. Often the bottom of the ulcer is covered by an adherent greyish tough matter, which probably is a part of the natural texture, which has undergone a kind of molecular necrosis, and is in process of being separated from the subjacent living parts." Such is the typical form of non-infecting chancre, which, having attained these characters, remains unchanged for a time, and then gradually heals. This kind of sore, says Mr. Lee, has never in his experience been followed by secondary symptoms. But the typical characters of the sore may be altered in various ways. If in its progress it invades different kinds of tissues, its shape and appearance may vary somewhat according to the tissue wherein it is situated. For instance, if it invades the areolar tissue there will be some amount of inflammatory exudation around it, which may be increased to a considerable amount of induration by irritation of the parts by friction or caustics. This induration will produce a certain amount of resemblance to the infecting form of chancre; but as Mr. Lee points out, this inflammatory induration usually fades gradually into the surrounding tissues, instead of having the abrupt termination of the hard sore; and we would add, it has not the cartilaginous hardness which pertains to the typical Hunterian sore. Yet when the suppurating sore happens to extend across two different kinds of tissue the exudation may cease so abruptly as to make it very difficult to distinguish it from the infecting sore, especially when it is remembered that the latter, when situated on the glans penis, has usually very little hardness. The secretion of the soft sore is seen under the microscope to consist of well-formed pus, whereas that of the infecting sore consists of epithelial débris mixed with serum and a few globules of lymph. But unfortunately this means of diagnosis is but seldom available, because an infecting sore may be made to furnish pus from its surface if irritated. Mr. Lee maintains, in direct opposition to Ricord, that the soft sore is auto-inoculable, and that the secretion of the infecting sore is not auto-inoculable, excepting when it has become purulent, as the result of irritation, or in its very earliest stage, before the induration has appeared. An important point insisted upon by Mr. Lee is the modification of any inoculation by its taking place upon a syphilitic constitution, and he quotes a case (No. xxxv) of a syphilitic patient who was inoculated "With the pus taken from a wound left in a child after an excision of the knee-joint. The pus was apparently perfectly healthy, but, falling upon a syphilitic soil, it produced, after a time, suppuration and ulceration. The appearances, as represented in a drawing, could not, at the time it was taken, be distinguished from those resulting from an ordinary syphilitic inoculation." The infecting form of syphilis begins, says Mr. Lee "With some adhesive form of inflammation, such as a papule, a |