REMARKS ON THE CLIMATE OF THE PERSIAN GULF; WITH A GLANCE AT THE CHIEF DISEASES PREVALENT THERE; AND A BRIEF ACCOUNT OF THE PRINCIPAL PLACES ON THE COASTS

Abstract

I Ax desirous of correcting, through the medium of the AssOcIATION MEDICAL JOURNAL, an error to which publicity has been given in an original article, published by Mr. Henry Lee in the October number of the British and Foreign Afedico-Clihrurgical Review. The point in question refers to the indications for the employ of mercury in primary venereal sexual sores. It is exceedingly probable that what I wished to be understood has not been expressed in language sufficiently clear; and this I endeavoured to correct in a clinical lecture, published in the AssocIATION JOURNAL for March 185i. That lecture contains my doctrine, as clearly expressed as I know how to express it, in reference to this important subject. With regard to the point more immediately in question, I say " that the employ of mercury specifically is indicated in cases of well marked indurated chancre;* but this would have been better expressed if I had said, in sores presenting a well marked "sub-chancrous induration." Again, I say "1that this indication is still more pressing, if such sores are accompanied by bubo." What I mean here is, that when such sores arc, as they most commonly are, accompanied by distinct enlargement of one or more glands in one or both groins, which glands are hard and tender, but which have not suppurated, and do not apparently contain matter, the use of mercury is still more strongly indicated. I do not mean, and never said, " in suppurating bubo"; for, without believing implicitly in the dogma of Ricord and his school on this point, it is well known that a bubo which suppurates at all freely is not commonly followed by secondary symptoms, though this is not true in all cases; and, in such instances, it would be well to wait for the appearance of secondary symptoms before mercury is employed at all. I use the term "sub-chancrous" induration, as synonimous with the so-ca1led " specific induration" of a primary syphilitic ulcer. By it I mean a hard lump, movable under the skin, which comes on between four and fourteen days after the first appearance of the ulcer; this induration is situatedaunder the sore, or at one side of the sore, and at time it appears the glands of one or both groins become hard and tender, but very rarely suppurate. This specific induration, or sub-chancrous induration, is the transition state between the local and the constitutional disease, and marks the commencement of constitutional infection. There is another condition of a primary syphilitic ulcer to which the term " induration" has been applied; and it is of the first importance to distinguish between these two. After the continuance of a primary ulcer for a longer or shorter period of time, it frequently happens that its edges become hard and elevated, surround it as it were by a little hard ring; or the skin upon which it is situated, and which at first was perfectly healthy, becomes infiltrated with serum or lymph, and thus elevates or raises the sore higher than the surrounding parts. This infiltration or exudation renders the skin or tissues in the neighbourhood of the sore more or less hard; and such a condition might be confounded with specific induration, from which it very widely differs. And it is in this sense that some modem authors have said that all primary syphilitic ulcers were more or less indurated.