10 the boundary of the elevation, and then separates gradually half an inch in diameter. In this region the cuticle covering from the surface beneath; the central piece separating to- them was dry and corrugated, and in some few instances wards the centre of the convexity of the papule ; the peri- exfoliation had commenced. pheral piece separating towards the sound skin, and forming On the back of the neck, and between the shoulders, were- a kind of frill around its margin. A crop of papules may about fifty of these papules, for the most part isolated; some- sometimes be seen presenting every gradation of this process few, however, were grouped in pairs, and in two instances, a of desquamation at the same moment. There are some in pair had become blended together. They were all exactly which the crack has just taken place; others, in which the circular, and more prominent than those of the neck, but the edge of the central piece has been worn away, and has become most prominent, even here, measured only three-quarters of a. reduced to a small disk, occupying only the central part of line in elevation. In breadth, the extremes of measurement the convexity; others, in which the central piece is- entirely ranged between one line and six (half an inch), the size of gone; some, in which the peripheral position is distinct; others the greater number was five lines; the next common size in which it is partly, and others again in which it is wholly, measured two lines and a half; while below these, were a gone. The papule may now be left quite smooth, or secondary number of smaller papules scattered among the rest, and re exfoliations may commence. The latter, however, are for presenting either the common papules of syphilitic lichen, or the most part irregular and partial, and are not to be con- the early stage of growth of the larger kind. As on the neck, founded with the primary exfoliation now described. When the developed papules presented all the stages of completion ulceration occurs, a crust is formed on the ulcerated surface; and decadence mentioned in my description of this form of and, in proportion to the quantity of pus secreted by the eruption; some were smooth, others wrinkled, others beginning ulcer, or the care with which it is kept, the crust may be- to desquamate, and others again, where desquamation had come very thick, or be a mere scale. advanced some stages. woman the This form of papule occurs most commonly on the back of I prescribed for this young ten grains of iodide the neck and between the shoulders; and it sometimes of potassium, in two ounces of the compound decoction of appears upon the face as well as in the former situation. sarsaparilla, and directed her to keep perfectly quiet. This I now come to the pathology of these papules. This appears medicine, as it frequently does, acted like a charm: her spirits to me to be identical with that of lichen. Their anatomical improved in the course of a few days, the muddiness of her soreness throat the seat, as in lichen, is the vertical capillary plexus of the fol- skin vanished, the of the diminished, licles ; and the only difference between them, that several tumid glands subsided, and the eruption shrunk, faded, and, follicles are involved instead of one. Hence, the large size disappeared, terminating in an exfoliation of yellowish scales which the papules under consideration sometimes attain; but, of epiderma, and leaving behind them dead-leaf-coloured at their first appearance, they are often as small as the stains, which shortly dispersed. smallest pimple of lichen. Occasionally, some few retain this At the end of a fortnight I reduced the dose of the iodide small size, and mark the alliance which subsists between to five grains; and at the completion of a month was enabled them and the lichenous eruption ; while others present every to suspend its use altogether. stage of growth up to the large convex circular tubercle, I was unable to obtain a satisfactory account of the nature measuring three-quarters of an inch in diameter. of the primary disease in this patient; but I have every reason The circular and flat papule of the syphilitic exanthem is, to believe that it originated in a poison, modified by its pas- then, nothing more than a modification of lichen of the most sage through the organism of another individual; in othelt simple kind ; and on this account, as well as for the sake of words, in a modified poison. simplicity, it appears to me desirable that it should be known Henrietta-street, Cavendish-square. by the same generic name ; and for this reason I have termed the eruption, lichen syphiliticus lentiformis. The following is a case in illustration of this form of disease. COMMENTS ON THE LICHEN Sg$HILITICgS ETTIEOR14IIS. INUTILITY OF RESORTING TO THE ITALIAN CLIMATE FOR THE CURE OF PULMONARY to me CASE 12.-A single woman, aged twenty-two, applied CONSUMPTION. at the beginning of last year for an eruption of flat papules, which covered her face and neck, the upper part of the back (FROM PERSONAL OBSERVATION IN ITALY.) and the arms. The eruption was confined to these regions, BY THOMAS BURGESS, M.D., was abundant on the the and the and most face, head, back; TRANSLATOR OF "CAZENAVE’S MANUAL OF CUTANEOUS DISEASES," AND on the arms there were only a few isolated spots. AUTHOR OF "THE REGIONAL PATHOLOGY OF THE SKIN." She informed me that the eruption appeared first on her forehead, next on the face and head, and that by degrees it No. II. to observed at the time of seemed spread downwards. She ROUTE TO ITALY THROUGH THE SOUTH OF FRANCE. the outbreak of the disorder that her skin became remarkably discoloured, and that all her efforts failed in removing what Provence. she considered to be a yellowish brown dirt from its surface. i THE favorite route to Italy of the consumptive invalid has She perspired a good deal at night, was restless and depressed hitherto been via Languedoc and Provence, the climate of in spirits, and felt ill, without being able to explain the cause which, for a long period of time, enjoyed a celebrity scarcely of her illness. After the eruption had been out for the space inferior to that of Italy itself. of a month, she began to complain of soreness of the throat, Although the towns of Aix and Montpellier afforded con- and it was at this time that I first saw her. venient resting-places for the exhausted pilgrims to refresh The throat was of a dark-red colour, the mucous membrane themselves when half way on their long and fatiguing journey, and tonsils were swollen and congested, butthere was no ulcera- -if indeed the boasted sanative influence of the climate did tion. There was also some enlargement of the sub-maxillary and not induce the invalids to remain altogether,-I am yet utterly sub-lingual glands, and the sub-occipital and cervical glands at a loss to conceive how either of those places ever obtained were swollen and tender. Her face presented a very remark- a name for salubrity; as I really know of no place more un- able appearance; it was suffused with a yellowish brown pig- favorable for patients suffering from organic disease of the ment, swollen, particularly in the region of the eyes, nose, and lungs, than the far-famed and much-frequented depots of con- mouth, and studded over with the perfectly circular, isolated, sumption-Aix and Montpellier. and lentil-shaped elevations of secondary syphilis. There In this part of France, there is generally a clear blue sky, were several of these papules on the upper eyelid near its but then, the air is sharp and biting, especially in the spring, margin, several at the angle of the eye, a considerable number and the frequent recurrence of the noxious winds-the bise by the side of and at the aperture of the nose, five or six at and the marin-one cold and cutting, the other damp, irri- each angle of the mouth, and some upon the ears. On the tates weak lungs, and excites coughing. No atmosphere, forehead they formed a complete corona veneris; they were of however pure, if occasionally keen and piercing, can prove a dull red, almost livid colour, for the most part smooth, and beneficial for pulmonary consumption, and this is the true of pretty uniform size-namely, a quarter of an inch in dia- character of the air of Montpellier. Provence is, moreover, meter. At the angles of the mouth were one or two fissures the land of dust, from the nature of the soil. Indeed, there produced by the escape of the saliva, and these were covered are parts of this " Province of the Sun," popularly so called, with slight incrustations. which might vie, in whirlwinds of dust, even with the banks On the neck the papules were less numerous, but a little of the Nile, the most recent foreign fashion for consump- more prominent and larger, one or two measuring more than tion. 11

The Mistral. Italy. The territory where Nice now stands, near where the Var falls into the Gulf of Genoa, was part of the ancient The south of France has been, ever since the earliest period Liguria, and lies close to the Roman road called the via Au- famous for violent which from of history, and impetuous winds, amongst relia, passed Rome to Arles, through0 Tuscany and which the north-west wind, or mistral, enjoys an unenviable over the maritime Alps. pre-eminence for its injurious character. This wind, or The character of the climate of Nice is in great measure plague, as it is called by the inhabitants, forms the subject determined by the manner in which the town is almost sur- of an ancient Provencal proverb, which says :- rounded and protected on every side, excepting the south, by "Le parlement, le J1!ist,.al, et la Durance part of the maritime Alps, called Amenes. On the south side Sont les trois fleaux de la Provence." it is open to the Mediterranean and its capricious winds, and, And the of it Strabo has not been in- as might be inferred from the geographical position of Nice, description given by the climate resembles that of modifi- validated by time, for it is now the same as when he described very closely Provence,the it thus: " The whole of that region situated above Marseilles cation depending mainly upon the circumstance of the former and the mouths of the Rhone is exposed to impetuous winds. being screened from the north wind by the surrounding The north-west (mistral) precipitates itself with intense heights; hence the cause of the luxuriant vegetation in the violence in the valley of the Rhone, driving stones before it, neighbourhood, which in some parts quite equals that of the overturning men and their vehicles, and stripping them of tropics. their clothes and arms." (Georg. lib. iii.) The valley or basin in which Nice is situated has been M. a recent writer on the southern There is not, throughout all Europe, so arid, so monotonous, compared by Carriere, to an the arch of which is formed the in so unattractive a for climate, open fan, by and every way region consumptive and the the where the Var dis- invalids as the Provence of Radcliffe and De Stael, when mountains, point by shore, entering from Italy by the treeless, dust-enveloped road. In charges itself into the sea. The beach has a southern aspect, and the semicircle of mountains and hills in the rear the midst of a region of low, calcareous undulations, pro- protects dust in stands the the valley, in great measure, from the east to the west, in- ducing astonishing quantities, Aix, capital the different intermediate is in of Provence. From Aix to extends the cluding therein points. It this Arles, barren, stony the hills and with which it is of the a of utter desolation, basin, amongst valleys studded, plain Crau, presenting picture more than Italian without whatever to the horizon. This that vegetation flourishes with profusion any variety interrupt and luxuriance. The mountainous semicircle in which Nice seems, a violent contrast to the seducing picture doubtless, is embosomed is or indented in some descriptions we have been accustomed to read of the " smiling unfortunately interrupted and verdant of parts, which admits the wind when blowing from certain vineyards, olive-groves, limpid streams, valleys and these the most unfavourable for in- sweet Provence," but the fact is not the less true. Leaving points, consumptive valids. once the these winds roads and arid and dust-covered fields even out of Having passed barriers, sweep the dusty down the ravines and with so that the the rapid and extensive variations of temperature valleys great impetuosity, question, as well as soon shows marked of their met with in Provence are more than sufficient causes to vegetation, invalids, signs effects. make that part of the continent shunned by consumptive in- injurious valids. The most frequent winds at Nice are the south-east, the the east, and the north-east. Their annual For several in the climate may no doubt be north, duration, days spring to is as follows:-The 125 too warm about according Roubaudi, south, days; delicious, although, however, always mid-day, the the and when the of evil to blow. east, eighty; the north, fifty-two; west, fifty; the suddenly mistral, celebrity, begins the occasional winds which visit It is difficult to an idea of the or of south-east, thirty. Amongst give adequate change, is one which the the effects of the climate under the influence of this this district, there mountains of Provence injurious cannot whose baneful influence I have de- The same sun shines in the same blue keep out,and already scourge. bright sky, scribed. I allude to the or the of but the is The sun is there to north-east, mistral, scourge temperature glacial. only glare the Mediterranean shores of France and Sardinia. This wind and and seems to have no more in dazzle, power producing is considered as the most violent and of all the warmth than a the boisterous winds which impetuous rushlight against winds in the in which Nice is situated. It chill the very marrow in one’s bones. the prevalent valley During prevalence continue for or nine at a or it of this wind it is to stir out of doors without may three, seven, days time, impossible getting in its duration be- the mouth and nostrils filled with dust. All nature seems may disappear twenty-four hours, varying and In order of shrivelled and dried under its baneful influence. tween these periods, is always uncertain. the up the autumn and winter the mistral The district of the mistral is confined to the of frequency during seasons, nearly valley a In it blows as the Rhone. The baneful effects of this wind are occupies prominent place. winter, frequently dreadfully as the the and the the felt at at Aix and in a less north-east, west, north-west, north, Marseilles, Montpellier degree, winds of the season. In the mistral blows but still sufficient to cause much mischief to the class of prevailing autumn, more than the two other autumnal the under consideration. Aries seems to frequently winds, patients Although be north and east. The of the north-west its the vast of the Crau and the great prevalence wind, head-quarters, plains Camargue or in winter and exercises a most afford full to its The character of mistral, autumn, injurious scope fury. general the effect the and shows the of climate of Provence and upon climate, folly consumptive is, then, hot, dry, irritating, subject to invalids at Nice the of a mild sudden and extensive variations of and therefore seeking advantages temperature temperature, and calm these seasons. to and atmosphere during highly injurious phthisical patients, those suffering The north and north-east winds, in the cold from irritation of the stomach and For nervous frequent air-passages. are not like the but still and invalids, the and seasons, impetuous, mistral, they par- hypochondriacal dryness bracing take of some of its defects. The north is dry and piercing, qualities of the air of Provence may be, perhaps, useful, pro- in The north-east is also and vided their are but if there is the ten- especially spring. cold, perhaps lungs sound; slightest more injurious to health than the former, as it does not, like to tubercular disease, no should ever go to dency patient the north wind, pass over the to its cold- that for I know of no district in of the valley temper biting country, any part ness in the waters of the Mediterranean. The British isles so so of southerly unfitted-nay, injurious-for patients winds, with the exception of the south-east, (libeccio,) are this class, as the parched and dusty plains swept by the soft, humid, and The south, south-east, and analogous mistral. There is no of France where gentle. actually part phthisis winds, when blow the same effects at is so the native as in Mont- they strongly, produce prevalent amongst population Nice as are the coast of the and in the latter where the developed along Genoa, during pellier Marseilles ; especially, of the sirocco in the summer or warm season. this the of both are prevalence ravages by disease, amongst youth sexes, These winds, happily of rare occurrence, are, M. Roubaudi very great. truly observes, as injurious to man as to vegetation. Delicate a small near and within a mile and a Hyeres, town, Toulon, of a nervous females and half of the is considered to be less to persons, temperament, especially Mediterranean, trying hypochondriacs, are profoundly affected by them, as the whole consumptive patients than any other part of Provence, because system becomes relaxed, and overwhelming feelings of languor vegetation is more luxuriant, and there is little dust; but still and oppression seize the invalid. In the winter of 1838, they the mistral extends its baneful influence to the olive and the olive cauterized the arrested the circu- of blighted trees, stem, erange plantations Hyeres, as well as to the arid plains of lation of the and caused the olives to fall from the trees. the Crau. sap, The south-east or so and Nice. wind, sirocco, depressing injurious on the continent of Italy, becomes singularly metamorphosed It has long been a disputed question whether the Var or during its transit across the Mediterranean to Nice. This wind, the Alps form the real separation between France and Italy, which is the scourge of Italy, is here changed into a mild, and, consequently, whether Nice forms part of Provence or of Favonian breeze, and generally ushers in the fine weather as 12 summer approaches. It is always cool and gentle, and instead when undisturbed by violent winds, it preserves a certain of being injurious, appears beneficial to the climate of Nice. degree of equability, so unlike that which obtains morning In winter, it modifies the cold; in summer, it tempers the and evening. M. Carriere cannot understand why the English heat and dryness of the air. During the latter season, the prefer Nice to other parts of the continent of a milder and south-east wind prevails periodically at Nice. In short, the more favoured climate, unless it be from the circumstance sirocco seems to be here so altered and modified, by some in- of the English disease being generally of a scrofulous nature." explicable cause, as to present the ordinary characters of the Nevertheless, he adds, the mortality annually amongst the west wind. Indeed, the enthusiasm of Risso, and especially English colony at Nice is sufficiently discouraging to deter of Roubaudi, would lead one to view it as a veritable "alize other hectic invalids from going there. For persons of a Mediterranee," soothing to the patient’s feelings, and tem- ’,, nervous temperament, this author considers the climate of the summer pering heat. , Nice decidedly injurious. Hence he recommends the French But one of the greatest vices characterizing the climate of to proceed farther south, to a soil and clime more adapted to Nice, if not the greatest, is the remarkable variation of tem- their organization; but, at the same time, expresses his perature noticed between day and night-in the sun and in astonishment that Sir James Clark has not mentioned the- the shade. The land or continental winds prevail during the beneficial effects of the climate in those " cases of the spleen night; the southerly or maritime during the day. The former and melancholy so peculiar to his countrymen!" are cold and the soft and humid. As there- dry; latter, soon, La Croix de lfIarb1’e. fore, as the former subside, and the sun rises in the horizon, The suburb of inhabited the is called the humidity commences to show itself in the atmosphere; Nice, by English, the a more selection could not which, on the contrary, when the diurnal winds cease and the Croix de Marbre, and injudicious sun sets, the above hygrometric condition of the air disappears. be made for the site of a residence for invalids labouring These alternations of cold and warm winds, and their influence under diseases of the respiratory organs. This locality runs upon the moisture of the atmosphere, explain the regular in a line with the beach of the Mediterranean, on the side appearance of those evening clouds which accompany the nearest to France. It is exposed to the libeccio, and the period of sunset, tinting the sky in the western horizon with winds blowing from France drive before them the vapour so many rich and varied hues. ! and dense fogs which rise along the banks of the Var. But M. Roubaudi estimates the annual mean fall of rain at the most formidable antagonist the consumptive invalid has twenty-six inches, the greatest fall in his observation being to contend against is the blighting effects of the mistral, to forty-five inches. He observes on this point: "It is by no which the Faubourg of the Croix de Marbre is completely The means rare, at certain periods of the year, especially towards exposed. long and magnificent terrace inhabited by is wind it enters the the equinoxes, for immense quantities of rain to fall con- the English swept by this whenever of reminds the traveller at tinuously, so as to give five inches in the space of twenty-four basin Nice, and of the quay Naples, and a wind hours. The rain is sometimes so dense, so rapid, and copious, where consumptive invalids winter, where similar blows sometimes the cold season with the violence of as to give half an inch in the space only of ten minutes. during- During the winter of 1837-38, fifteen inches fell in fifty hours, a hurricane. as much as sometimes falls in an entire year." We have A more favorable locality than the Croix de Marbre might thus seen that the mornings and evenings are much colder easily be selected in the environs of Nice. At the foot of ther than the middle of the day - change which cannot be heights which shut out the north wind, there are shady beneficial to consumptive invalids. valleys, open to the south, the air of whicli remains calm and There is another circumstance connected with these temperate, even when the upper strata of the atmosphere are changes of wind which augments the evil. A violent struggle violently agitated. Here we may find a climate different from frequently occurs between the maritime and continental that of the town, and in many respects equal to the most winds at the period of transition. This is often aggravated by favored spots of northern Italy. But still this climate, in the accidental concurrence of and the result my opinion, is in no way adapted for consumptive patients. auxiliary winds, " is a violent atmospheric commotion, disturbing the elements, " There are," says M. Valery, certain maladies against which the effects of which are felt in every part of the valleys the climate of Nice, far from being efficacious, as imagined, is around Nice. During the existence of this phenomenon, the mortal; thus every year’s experience tends to prove that it temperature becomes as much disturbed as the elements hastens the end of persons attacked by pulmonary consump- themselves-capricious as the winds, which are struggling for tion. The public promenade inspires feelings of melancholy. preponderance, it indicates, within a short space of time, heat I saw many young English ladies there, who were charming, and cold with all the intermediate changes. The transition and of a fair complexion, but pale, and on the confines of is sometimes accompanied by a perfect hurricane, during death." which violent explosions of electricity take place, and the de- Dr. E. Meryon has kindly favored me with the following made Dr. clivities and adjacent valleys are swept by impetuous gusts of extract from observations by his uncle, Meryon, wind. As soon, however, as the northerly wind gains the as- during his residence at Nice, and which corroborates the pre- cendancy, all is quiet in an instant; the heavens become per- ceding remarks:—" You know how treacherous the climate of fectly serene, and for the moment nature seems at rest. Nice is, alluring you out of doors with a brilliant sun, and then A third form of this transition state, still more injurious to attacking you with a cold piercing wind, that neither cloth nor invalids, as M. Carriere truly remarks, is worthy of notice. flannel can keep out, making the south side of a house so warm, During the alternations from heat to cold, and from cold to that you want no fire in it, and leaving the north side so cold, heat, morning and evening, the humidity suspended in the at- even with a fire, that a well is not colder. Had I leisure, I mosphere, and precipitated on the earth, produces the follow- would collect facts to prove that there are more natives (not ing effects:- strangers, but inhabitants born and bred in the place) who die The dew which falls in the evening is often extremely chilly of consumption in Nice than in any town in England of the -so much so as to penetrate the clothing in the same same amount of population. I am surprised, as I prosecute manner as occurs on part of the Italian coast. The hoar-frost my inquiries, to find how little faith in its virtues the Nisand’s which covers the earth in the early part of winter continues have; and their bills of mortality give one seventh of the for some time after sunrise, producing a hazy state of the deaths from phthisis." atmosphere, and impregnating the soil with moisture; where- It were easy to multiply evidence of a similar kind, to show which a fore exposure to the open air should be carefully avoided by that the climate of Nice is the last to foreigner, the consumptive invalid until the temperature is sufficiently labouring under tubercular phthisis should resort. But elevated to dissipate the hoar-frost, dry the earth, and soften enough has been shown, I think, respecting that climate, to the sharpness of the air. The mornings and evenings are demonstrate that one more favorable for consumptive often treacherous, even when the climate seems otherwise in patients might easily be found within the British Isles. its most favourable condition; and if persons of strong consti- The third paper will contain observations on the climate, and diseases to the tution can expose themselves with impunity at these periods, peculiar Lombardo-Venetian Kingdom. invalids should guard against following such examples, as they Half-Moon-street, Piccadilly, June, 1850. may undo in a moment whatever benefit they had previously derived. VETERINARY PRIZE IN FRANCE.-The Minister of The climate of Nice is not so essentially dry as it is described Agriculture and Commerce founded, on the 30th of May last, to be by some writers. The continental winds which prevail a prize of .C400, to be awarded to the discoverer of an effica- during the night are no doubt dry, but then the maritime cious remedy against the contagious peripneumonia of horned winds of the day are humid. The temperature is moderate; cattle. The Committee is composed of eleven, among the and between the hours of eleven and four in the afternoon, leading men in medical, political, and veterinary science.