• A PRACTICAL TREATISE ON VENEREAL DISEASES; OR, CRITICAL AND EXPERIMENTAL RESEARCHES ON INOCULATION, APPLIED TO THE STUDY OF THESE AFFECTIONS, WITH A THERAPEUTICAL SUMMARY AND SPECIAL FORMULARY, BY PH. RICORD, M. D. 111 SURGEON Or TUB VENEREAL HOSPITAL OF PARIS, CLINICAL PROFESSOR 00 SPECIAL PATHOLOGY, ETC. ETC. TRANSLATED FROM THE FRENCH, BY HENRY PILKINGTON DRUMMOND. M. D SECOND AMERICAN EDITION. PHILADELPHIA: LEA AND BLANCHARD. 1845. c / MKRRIAM ANL COOKS, PRINTERS, WEST BROOKFIELD, IIASS. TRANSLATOR'S PREFACE. In preparing the following translation of M. Ricord's work, I have been stimulated by the following motives. First, to present to those medical men, who have not the advantage of being able to read the original, a faithful translation of a work of so acknowledged a merit. Secondly, to enable the English student, who may visit Paris, more immediately to follow the lectures of M. Ricord; having myself ex- perienced the difficulty attending the study of the somewhat peculiar style in which the work is written, and knowing that (ew have had the opportunity of acquiring a sufficient knowledge of the French language, previous to visiting France. It has been my object to adhere as nearly as possible to the origin- al, and should the style be considered defective, I must appeal to the forbearance of the public, and only plead, in my justification, the pe- culiar idiom employed by our author, which all who have heard his lectures will easily appreciate. It will be perceived, that I have throughout translated M. Ricord's term " blenorrhagie," by gonorrhoea. This may, I am well aware, appear to some objectionable, but as M. Ricord makes do distinction between it, and simple leucorrhoea, I did not think myself called upon to adhere to this term, more especially as I was desirous of rendering the work intelligible to junior students, as well a3 to those better ac- quainted with foreign literature. iv I have omitted several of the cases contained in the original, par- ticularly amongst those relating to the inoculation of the pus of bu- boes, as many were precisely similar in all the details, and would only have proved tedious to the reader. I feel myself however bound to state it, as M. Ricord might otherwise be accused of drawing his conclusions, from too scanty a number of observations. AUTHOR'S PREFACE. The various motives which induce men to write, do not allow us to place on an equal degree of confidence all of them. The truth of this assertion is incontestible as regards the history of sciences in gen- eral, but more particularly in that which is about to occupy our atten- tion in the following pages. If we survey the works which we alrea- dy possess on the inoculation of venereal diseases, we shall soon find that either the interest of some theory, the speculations of some quacks, or, not unfrequently, vexatious criticism and misrepresenta- tion, have mostly dictated the assertions of authors who have written on this important subject. If we then compare what we find with the results of honest experience, we shall too frequently be convinced of the error of some, the ignorance of others, and the want of good faith in most of them. As regards myself, I have pursued my researches without precon- ceived notions, and with the sole object of discovering the truth amongst so many contradictions. My numerous cases will enable me to furnish a material proof of every point I advance. Since the time of Hunter, the experiments of inoculating syphilitic diseases have been made:— I. To prove the existence of the specific cause of syphilitic dis- eases; the venereal virus. II. To distinguish between diseases which resemble each other. III. To fix the differences which exist between the symptoms of primary infection, and those of general infection. IV. In a therapeutical view, either to prove the efficacy of pro- phylactic agents, or to modify, by a new infection, a former obstinate vi syphilitic affection of old standing, or by combining syphilis with a disease which being incurable, may by this admixture, yield to a specific treatment. V. And lastly, in a medico-legal point of view. These are divisions I have adopted, and I shall presently proceed to review them generally and critically, which will form the first part of this work; in the second, I shall produce the practical observations from my clinical wards, followed by remarks on the methods of treat- ment; to which is added a Special Formulary, as I have used in the Hdpital des Vene"riens. A PRACTICAL TREATISE ON INOCULATION', APPLIED TO THE STUDY OF VENEREAL DISEASES. PART THE FIRST. CRITICAL RESEARCHES AND GENERAL REMARKS. CHAPTER I. THE EXISTENCE OF THE SYPHILITIC VIRUS, PROVED BY INOCULATION. " If an evident connection exist between cause and effect, in any class of diseases, it is undoubtedly in the venereal,"* and this constant and regular connection is proved by inoculation. Since the time of Alexander Benedictus, a Veronese physician, who was the first who admitted', as a contagious principle, a venereal .taint produced in the sexual organs of women by the corruption of the humors which they exhale, and which being recognized by Femel, re- ceived the name of lues venerea, poison, venereal virus, &c. most writers on syphilis remained convinced of the existence of a specific cause, or peculiar deleterious principle. Yet this cause, which is easily recognised at its source, and so reg- ularly to be traced in its course, was overlooked by the ancients, un- til the terrible epidemic of the fifteenth century; and, in modern times, we find a few who are sincere in their incredulity, and many more in- terested disbelievers. It is not my intention in this place to review all the arguments that have been brought forward to prove or disprove the existence of the ve- nereal virus; but as inoculation has by turns been appealed to by each party, my aim will be to shew its definite value; and that we mr.y omit nothing concerning this important question, let us first see what has been advanced by the authors opposed to the existence of a virus. Bru, whose experiments have been cited by the opponents of the virus, and who was so under the influence of a strange theory, that it may be justly questioned if he saw what he relates in its prop- er light, and who, we may confidently assert, did not know how to appreciate the circumstances under which he made his experiments, expresses himself thus:—f * Petit Radel, preface, a traduction de Nisbet. t Methode nouvelle de trailer des maladies veneriennes par lea gateux toniques mer- curiels> par Bru, tome i, chap 3, p. 45. Paris, 1789. 2 10 CRITICAL RESEARCHES AND GENERAL REMARKS— u Is the virus inoculated with its venereal action, or only with a disposition? Is the pus of chancres, gonorrhea, and bubos, conta- gious, and can it inoculate syphilis? " To proceed with order and perspicuity, in this important ex- amination, it must be proved, first, that what is understood by vene- real virus, is not inoculated, and that it is only the mode which is in- oculated, and that the virus or pus is only the result of the neutraliza- tion of the mode. Secondly, that the mode is only inoculated by vir- tue of a kind of electrification, after having manifested its action by the immediate contact of the affected part with the healthy, which leads us to examine the mechanism of the venereal act. Thirdly, that the venereal mode may exist in a fixed state, and that then it does not inoculate, but must first pass into a state of expansion. Fourthly, that the communicating mode is nothing else than the modified electric fluid, or some other analogous matter in an expanded form. " The venereal virus, according to the received acceptation, is a something deleterious, which is combined with the pus. It is com- monly, says Hunter, in the form of pus, or combined with it or some secretion of that kind. " We are far from admitting this definition of the venereal virus; we think, on the contrary, that what is understood by virus, does not contain the deleterious matter which we shall call venereal mode,* and we*think we shall be able to prove this fact. I have inoculated with the point of a lancet on the glans and interior of the prepuce, pus from chancres of every kind and in all stages, and the disease never appeared. " I have made the same experiment with the matter of a gonorrhea with as little success. I have also employed that of bubos at the mo- ment of their being opened and always without effectf. Finally, I have conveyed pus, procured from these three symptoms, a consider- able depth into the canal, and nothing has appeared. I have formed ulcers by means of blisters upon the glans penis, and prepuce, and when they were in a state of ulceration applied lint, impregnated with pus, produced by every variety of venereal affection. I have also re- peated my experiments upon various parts of the body. I have placed it in the vagina of several bitches, and under the prepuce of several dogs, and all this without any result. I was thus led to con- clude, that the pus produced by the several venereal affections, was not the virus; that it was not even combined with it, and that this pus was consequently only the result of its neutralization. " This is an incontrovertible proof, and we only want to establish it in a perspicuous manner, which will be done in the following sec- tion. But before I proceed to the facts which belong to it, a ques- tion presents itself, which must first be answered, that there may oc- cur no vacancy. It is necessary to determine what is the venereal * By mode, is to be understood, what it has been intended to express by leven, &c [To avoid confusion, I have found it necessary to translate the word. H. D.] t In this case it cannot be expected that inoculation should produce any result INOCULATION OF THE SYPHILITIC VIRUS. 11 mode of which the suppurations it excites are but a result; for under this supposition, which is clearly demonstrated, this mode cannot in- oculate with the venereal action. Upon this hypothesis, as it is of a corrosive nature, not only ought it to shew it at the instant of inocula- tion, or at least very soon after, but always in the same place as it has been inoculated; this, however, only happens in the case of chancres. Moreover we see this supposition is not exact, as only a small point of the parts which have been in contact ulcerate, which proves that it is less the effect of an immediate than of a subsequent action. In the inoculation of the smallpox, we very plainly see this effect of the im- mediate action, for the spot soon inflames after the pus has been in- ■troduced. The effects of the virus are far more evident in this place than elsewhere; for the small-pox is often cured while the wounds from the inoculation are yet in a state of suppuration, and are always a source of infection, as the pus taken from these wounds a month af- ter the desiccation of all other pustules, is still capable of communi- cating the disease. In the inoculation of the venereal mode, there is only the chancre which can be suspected as the point of contact with the virus, for surely this is impossible in gonorrhea, which has gener- ally its seat in the beginning of the canal, or in bubo when its exists alone. " Another proof that the venereal mode does not inoculate with the venereal action, results from a very familiar circumstance, withw hich .most persons are acquianted. A man has had connection with an in- fected woman, but does not yet feel any effects of the infection. In this state he has connection with a healthy woman, to whom he does not communicate any disease; yet the action is established in him, the disease declares itself in a few days, and sometimes on the same day. It would therefore appear that the venereal disease can only be com- municated after the mode has acquired its action; for when the symp- toms have once shewn themselves, it has the property of being com- municated, but the product of these symptoms is not contagious. In vain they inoculate pus of all kinds by all possible methods, infection does not take place. This pus then is not a requisite of the conta- gious property of the mode, it can only be the result, and a sign of its action; we must therefore seek this principle elsewhere. Thus, as the venereal mode cannot be inoculated by immediate contact in the act of coition b'efore it has manifested its action; (which does not take place till some time has.elapsed,) we ought to conclude, first, that the venereal mode is not inoculated with venereal action, but only with the disposition. Secondly, that this action is the result of its combination with a substance, over which it has some power. Thirdly, that this substance, such as it is supposed to be, must be of a nature to set the phlogiston in action, since its first product is inflammation. Fourthly, that, to preserve its contagious principle, it ought neither to be expos- ed to the air nor disseminated in the purulent excretions. Fifthly, and lastly, that only inoculating itself with a venereal disposition by actual contact, where there is friction and heat, and after having manifested 12 CRITICAL RESEARCHES AND GENERAL REMARKS— its action, one cannot suppose but that the venereal mode is electric fluid, or some modification of elementary fire, in an expanded form." After Bru, I think 1 ought to quote what Caron* says of the vene- real virus, and its manner of infecting. " If one may say that the impregnation of females is in fact a con- tagion, a kind of nervous virulence, we may with equal right affirm that the origin and contagion of the venereal virus are a species of conception, and not the result of a simple intersusception, or absorp- tion of a virulent fluid. What has led into error, and caused the vene- real pus to be confounded with the virus, although it was only the con- sequence of it, was, seeing the contagious principle communicated dur- ing the purulent secretion which it has caused. Deceived, moreover by the manner in which variolous matter inoculates, and by its suppos- ed analogy to the venereal matter; deceived further by the progress of syphilis in the economy, it was easy to regard the venereal pus as the virus, and as contracted by absorption, and travelling through the sys- tem by means of the general circulation. This manner of regarding the process appears so natural, and is so sanctioned by time and cus- tom, that we are startled by a contrary opinion. We may say yet more; there is so great a prepossession in its favor, that one is as- tonished, without being convinced, on finding, by numerous simple and easy experiments, that the inoculation of the venereal matter remains without effect. . " If it be remembered that even in mechanical lesions there is no purely physical or chemical process in the animal economy; if we re- flect that it is impossible to conceive any morbid action without a fore- going disturbance in the vital powers, we shall soon be convinced that the venereal virus is not a substance, and that it cannot be inoculated as such; but that it ought to be regarded as an animal process, de- pending upon a disturbance or modification of the pecular functions of the system. In fact it is the natural susceptibility of the vital prin- ciple, the sympathy of the capillary and nervous systems which devel- ope it. Thus its primary cause is as little known as that of the other vital actions. All that we can comprehend of contagion is, that the virulent principles must have common properties with the bodies which contract them. Without being able to explain the nature of the vene- real virus, or rather the principle of its conception in the system, we shall assume, as an incontestible truth, that it only takes place by a specific irritation; a peculiar sensation of the vital principle, as friction and heat, or a certain disposition in the parts in which it is situated, are necessary, and as the venereal secretion, having in itself nothing contagious or irritating, is not capable of developing it. " In vain does the author of an excellent recent work, in declaring the result of the inoculations of the venereal pus, exclaim against the conclusions which are naturally deduced; they must either be refuted or more justly drawn; for singular and paradoxical as they may seem, * Nouvelle doctrine des maladies veneriennes. INOCULATION OF THE SYPHILITIC VIRUS. 13 they ought to be admitted, if approved by reason and comfirmed by ex- perience. " But it is asserted, that it is only during the voluptuous excitement of the venereal act that the virus can be materially inoculated with the pus. Is it possible that the absorption of a purulent liquid should take place at a time when the exhalation and fluxion inherent to the venereal orgasm are diametrically opposed to this function? Moreover, how can the venereal pus, which has no virulent property, irritate the sound surfaces which it touches, even when they are excited by coition, unless this matter be rendered more energetic or more contagious, by the irritation of the parts which secrete it? For, supposing that the active or virulent principle resides in the pus before copulation, it is proved that this passive admixture deprives it of its contagious proper- ties, and that if the venereal infection can be received, during coition, it is by a new act of the system which reproduces it. Indeed the syphilitic matter being without the domain of life, or sensibility, how should it acquire new properties? Further, granting it some irritating quality during coition, or even supposing that it could contribute to the contagion of the venereal principle, this could only be in a secon- dary and instantaneous manner, and favored by a far more powerful cause. " Thus it is not a virus which is inoculated in the venereal conta- gion, but an occult vice, which is developed in us: it is nature or life which produces the syphilitic constitution, and not the pus, which is only the sequence. In short, the material principles of contagious dis- eases, like that of life itself, are inseparable, abstract essences; they can neither be conceived nor studied as substances, and the idea of their existence has only reality, in as far as they are united to effects, of which they are regarded as the cause. " The venereal infection has at first only a local action, which ex- tends itself in succession to certain parts; but it is always subordinate to the powers of nature, or subjugated by the essential organs of life, as the heart, stomach, brain, lungs', &c. never feel the effects of it. If the generating organs of the venereal virus, the skin and the exte- rior lymphatic ganglions, and more especially the organs of sense, re- ceive it first, it is because a peculiar sympathy exists between these organs, and because the functions of the dermoid system are more or less the same in all exterior sensations; and lastly, because the whole capillary system of the cutis, as we have seen above, partakes of the venereal irritations. The veneral mode being once received into the system, it must, if its action be developed, establish itself on the skin, nose, mouth, eyes, ears, or pharynx, &c. as besides the natural dis-^ position of these organs to contract it, the contact of the garments, air, light, and all exterior irritations can only favor its development. " A powerful and repeated irritation may disorder the natural sensi- bility of the skin, and produce some disease in the irritated parts, but it never causes the voluptuous sensation procured by the parts of genera- tion, and those which are analogous to them. Thus the delightful 14 CRITICAL RESEARCHES AND GENERAL REMARKS— sensations in coition, suckling, chafing the lips and eyelids, which agi- tate and excite the sensative principle, with so many charms and so much energy, are also the only means of contagion. However great the voluptuousness of kisses, and the sucking of the nipples, it may yet be thought that these organs, which so easily contract the venereal disposition, when its action is well developed, could yet never give rise to it of themselves, or conceive it primarily. Thus observation proves that the syphilitic affection is more or less wavering, degene- rate, and dangerous, according as the act which gave rise to it is re- moved from coition, its true origin." " After these statements, it appears easy to reconcile the apparent- ly contradictory facts which the syphilitic infection of new-born infants, nurses, and nurslings, presents. We see that it has been justly as- serted, from very exact observations, that the venereal virus was not materially contained in the semen, milk, or saliva; but, on the other hand we find the conclusion false, that the aura vitalis of the two for- mer humors, and particularly of the sperma, acted upon by the I know not what, which constitutes the syphilitic principle, might affect the foetus or nursling: although the venereal disposition, weakened or re- pressed in its action by the vital powers of father or nurse, did not present any indication of its existence. Certainly we must not con- clude, from the experimental inoculations which have been instituted, that the matter of recent gonorrheas and primitive chancres, inoculat- ed under particular circumstances, and with certain vital conditions, is alwavs innocent; but we may be sure it will not impregnate with the syphilitic essence which it does not contain. Indeed, if by merely irritating the skin, we can produce a consecutive affection, will not the purulent matter of a phlegmon or a primitive chancre produce a peculiar action? But what will be its nature?—a purely local affec- tion, according to the nature and energy of the inoculated fluid,"and of the irritation. After what has just been stated, it is evident that Bru has only brought forward his experiments, to support a theory which was op- posed to the positive results of inoculation. And, as my researches will soon prove, either Bru did not know how to make experiments, or he was not candid. I should rather believe the former of these suppositions, considering the small number of experiments he made, and the long intervals between, them. As to Caron, his arguments are so vague and unfounded, that they do not deserve a serious refu- tation; and the manner in which he expresses himself on the results of inoculation, proves that he has not only never practised it, but that he is not even capable of judging of it. Let us now hear what M. Jourdan says against inoculation, which is a strong argument against the school to which this able writer be- longs. " It is pretended, says he, that the venereal virus belongs exclu- sively to the human race. This assertion rests principally upon some experiments from which Hunter and Turnbull have concluded that INOCULATION OF THE SYPHILITIC VIRUS. 15 neither dogs, rabits, nor asses, are susceptible of having the syphili- tic infection communicated by inoculation. But if the syphilitic vi- rus cannot be communicated by inoculation to animals, neither can it always even to men. But real venereal aflections are very frequently observed amongst brutes. Dogs and bitches often present very une- quivocal traces of inflammation of the mucous membrane of the ge- nital and urinal organs, followed by gonorrhea, chancres, phimosis, paraphimosis, swelling of the scrotum, &c." After citing negative experiments, M. Jourdan adds,* "that Mr. Evans declares he has several times tried the inoculation of a gonorr- hea upon himself, without success, and the inutility of these attempts, which have also failed in the hands of other experimentators, is very remarkable, as it shews that the efficacy of the venereal pus is in this respect very inferior to that of hydrochlorate of ammonia. u\et, says M. Jourdan, positive as these assertions are, other ex- periments prove that the insertion of pus of chancres or gonorrhea, can produce ulcerations followed by swelling of the neighboring lym- phatic glands. But there is much contradiction on this subject amongst authors. According to Hunter, this result is rare: he states, that he has often applied venereal pus to ulcers, and only once succeeded in producing a venereal ulceration. On the other hand, it is very com- mon and almost constant, according to M. Cullerier, jun., who, hav- ing made several experiments and repeated them several times on the same patient, has always seen ulcers, similar to those which" furnished the pus, develope themselves upon the spot where the insertion of the syphilitic pus was made with the lancet upon the penis, whether by puncture or erosion of the surface. The same writer states, that three pupils of the venereal hospital have had, in consequence of simi- lar experiments, ulcerations of long duration, and which have caused swelling of the axillary glands; the symptoms yielded to antiphlogistic treatment. Another, who made the same experiment some time after, produced no local irritation. But it is of little importance, whether the symptoms, inconsequence of these kinds of inoculation, be rare or common. They are not suf- ficient to prove the existence of a peculiar virus, because we fre- quently see similar and even more severe results from a simple punc- ture. Upon this point, Mr. Shaw's recent observations have thrown much light. The possibility, or at least the facility, of inoculating syphilis, is by no means admitted by all who believe in the existence of the virus. M. Lagneau doubts, whether the disease be inoculated by introducing a bougie covered with the gonorrheal matter into the urethra, and thinks that when a discharge follows, it is owing to the mechanical irritation of the canal, by the bougie. This is also the opinion of M. Cullerier, sen. who expresses himself thus upon inoc- ulation in general. We think we may assert, that the fluid which serves as vehicle for the virus must possess a certain degree of warmth * Traite complete des maladies venerienees, 2 vols. 8vo. Paris, 1826. 16 CRITICAL RESEARCHES AND GENERAL REMARKS— a kind of life, which preserves to the virvus the power of attaching it- self to the new bodies, to which it has been transmitted."" It would have been more correct to have said, that the parts ex- posed to the contagion must be in a certain condition, in order to re- ceive it. Upon an attentive perusal of the preceding pages it is evident, that the arguments of M. Jourdan cannot stand the test of reason and ex- perience. Indeed, experience proves, that, as Hunter and Turnbull have stated, the animals they have mentioned are not susceptible of being infected by syphilis as met with in the human subject, by means of inoculation, which by no means prevents their having inflammation of the mucous membranes, and ulcerations on the organs of generation; as all inflammations and ulcerations of these organs are not necessarily syphilitic in brutes, more than in men, even though consequent on coition, of which we have ample proofs. As regards Bru's want of success in the inoculation of syphilis in man, we know the cause, and the experiments I have made, leave no more doubt on the point, than on those of Evans, which, although well performed, necessarily pro- duced the consequences which followed without detracting from the value of inoculation of the pus of chancres, as we shall see hereafter. As to the refutation of the positive results obtained by M. Cullerier, jun. the doubts of M. Lagneau, and the opinion of the late Michael Cul- lerier, and also the remarks which follow, (and to which M. Jourdan should have added the note to the treatise on the different kinds of gonorrhea by Hecker,f) their value will be better estimated, after having seen the result of my researches. But to pursue the course I have adopted, and that we may know all that has been said on each side, let us see if M. Richond des BrusJ has been more fortunate in his refutation of the facts relative to in- oculation. " We must conclude, says he, that the contagion of the venereal diseases does not prove that they depend upon a specific virus. "Let us examine whether the developement of ulcers and swelling of the lymphatic glands, after the inoculation of the venereal pus, can prove the existence of this essence. " The results of these inoculations are far from being so confirmato- ry of the syphilitic theory, as its defenders think. In many cases the insertion of the venereal pus under the skin, remains without any ef- fect, and where some inflammatory symptoms are locally developed, ■* Dictionaire des Sc. mf heat and sensibility, which renders the absorption more easy, and the * The want of a successful result in this case, only proves, that certain conditions of tissue are necessary in order that the venereal virus may act, and experience has shewn me, that vesicated surfaces are particularly difficult to inoculate. Indeed, I daily use blisters on virulent bubos, even after they are opened, and when they afford the specific pus; and whilst this can be inoculated with the lancet on every other part of the skin, the vesicated surface, over which it flows, is not infected; I have had but two or three excepuons to this general rule. t Experience de M. Dubled. Extrait des annales de la medecine physiologique No. d'Avril, 1S24. 20 CRITICAL RESEARCHES AND GENERAL REMARKS— excitability of the part rriost exquisite. But the symptoms, which might result from an inoculation, made under these circumstances, would nevertheless, not be venereal. " I think, with M. Dubled, that the venereal pus may cause an ul- cerative inflammation; but that in that case it would only constitute a purely local affection, which, like other inflammations, might cause, either by sympathy, or continuity of tissure, divers disorders in the neighboring, or remote organs. " In opposition to what I have related, without doubt, the result ob- tained by three young; men fromjnoculation upon themselves, will be cited. All three are said to have made a puncture on their arms with a lancet, laden with syphilitic pus. In one of them, there followed a swelling of the axillary glands, which, being treated by simple anti- phlogistic means, suppurated and produced a considerable destruction in the axilla. In the second, the puncture became inflamed, ulcerated a chancre with all the venereal characters presented itself, and extend- ed its ravages. But see to what extent the desire of the marvel- lous may be carried! It is pretended that this young man, after hav- ing consulted a professor of the Ecole de medecine, who told him that the ulcer was venereal, returned to the hospital and opened one of his crural veins."* Whilst we pay M. Richond the tribute of praise due for services he has rendered to science, can we admit one of his arguments against the positive facts of inoculation, and the proofs of which, he himself furnishes? I think not; for if I rightly understand him, his objections amount to the following propositions. I. The results of inoculation are negative or uncertain. II. The secondary symptoms of syphilis, more virulent than the primary, ought alone to inoculate themselves and the contrary takes place. III. If constitutional syphilis and general infections exist, individu- als saturated with the venereal principle, ought not to be susceptible of a new infection, and yet Hunter found it otherwise. IV. The contagious property of the venereal secretions does not depend upon the essence of the pus, but upon the degree of inflam- mation in the part which furnishes it. V. The pus of gonorrhea, which many authors regard as a simple affection, ought not to inoculate, and yet Hunter has found the con- trary. But how can M. Richond support such propositions? May they not be answered, as he will soon be convinced? I. That the uncertainty of the results of inoculation, depends upon the want of precision in the experiments; II. That it does not follow, that because they are-owing to a spe- cific cause, the secondary symptoms should inoculate like the primary, or be more virulent than the latter; * This is a fact, he was one of my friends. Note of the Author. INOCULATION OF THE SYPHILITIC VIRUS. 21 HI. That the possibility of inoculating primary symptoms, as he has observed it, does not preclude the existence of a general affection, as one infection does not prevent a second; IV. That chancres can never be produced by the pus of a gonorr- hea, leucorrhea, or of a simple coryza, although it may cause an irri- tation, or even excoriations; V. That when the pus of a gonorrhea produces a chancre, there is something else with it. VI. Lastly, that his experiments have deceived him, and that those of Bertin were badly performed, and that M. Dubled has since told me, that he has entirely changed his opinion? M. Devergie,* to whom physiology is much indebted, not adding anything to the preceding contradictions, will not require a separate refutation. He asks, whether experience is in favor of inoculation? And says, it has been often attempted, but has never produced any decided result. In many cases, according to him, it has been follow- ed by no effect, either when made with the pus of primary sores, or of secondary affections. Sometimes local symptoms have appeared in the neighboring or remote glands. The following is according to M. Devergie, the result of the experiments of several practitioners. M. Percy tells him, he often failed, especially with the pus of bu- bos, whilst he thought he had succeeded with the matter from chan- cres and gonorrhea. " I myself made some experiments, he adds, but they led to nothing satisfactory." M. Desruelles expresses himself, as follows, in the work he has just published on this subject, and in the spirit of the new doctrine.f " Authors, says he, not being able to determine, a priori, the par- ticular and distinguished characters of ulcers, have recourse to means which are uncertain and cannot guide them in the diagnosis; thus they affirm, that a leison of the parts of generation or others is syphilitic, when accompanied by another lesion; when caused by coition or any circumstance which would lead them to suspect, the origin from these complaints; if these investigations do not satisfy them, they inoculate the pus of the ulcers. " A more vicious means of diagnosis cannot be proposed, than the inoculation of the pus collected from the surface of ulcers, which some of late have not hesitated to extol. What is the result of this practice? The patient has an ulcer or two more, and the chances of general infection are augmented in proportion, so that they give a man constitutional syphilis, who would perhaps otherwise not have had it. It is true, that the partizans of this experimentary operation, think that there is no more difficulty in curing a double syphilis than a simple, by means of mercury. The ulcer which results from inoculation will not possess more characteristic marks for those who were unable to recog- nize them on the ulcer which developed itself at first; and if by any * Clinique de la maladi esyphilitique par M. N. Devergie. Paris, 1826. t Traite pratique des maladies vtneriennes par H. M. J. Desruelles, p. 167. Parit, 1836. 22 CRITICAL RESEARCHES AND GENERAL REMARKS— chance, through the inadvertence or negligence of the operator, the operation should not succeed, the complaint would then be declared to be unconnected with syphilis, and the patient, having received a clean bill of health, would quietly go his way and communicate dis- ease to persons with whom he might have connection. To such an extremity may a false opinion, whose consequences have not been foreseen, lead. " During the eleven years, that we have studied experimentarily the venereal diseases, at the Val de Grace, we could never resolve to in- oculate any of the syphilitic diseases. " Our position, we thought, did not permit us to subject the sol- diers of the army entrusted to our care to the uncertain chances; moreover, we hold similar opinions on this head with M. Cullerier and Ratier. On the other hand, M. Ricord, surgeon to the Hopital des Veneriens, has no doubt good reasons for not partaking of our fears and scruples. " We do not presume to blame M. Ricord, we shall profit by the experiments which he makes, with so much perseverance, to decide this important question; and if he obtain the results he expects, we shall be grateful to him for the zeal he displays in obtaining them. " These are the principal results at which he is already arrived, we give them as we have them from M. Ricord himself. " A chancre can always inoculate durirg its period of ulceration. " The suppurated bubo, from absorption, can always inoculate. " The inoculated pustule can be reproduced by its pus, ad injini* turn. " The pus of an urethritis, where there is no ulceration, can ne- ver inoculate." " From the above it seems that only the ulcerative form, and in the acute stage, is capable of inoculating. We shall wait before we judge of the value of M. Ricord's experiments, till he has completed all those he proposes to make, and has published an account of them. 'f From what has just been stated, we may draw the following con- clusions:—There is, properly speaking, only one kind of primary ve- nereal disease, the irritation of a sensitive surface, which has been touched by the contagious cause. " The other diseases, such as ulcers, bubos, swelled testicle, and excresences, &c. are only affections, whose developement is secondary to the erythematous form which is primary, and whose appearance al- ways precedes that of all other forms. Those under which are rang- ed the consecutive affections, also depend upon the erythematous form. Whatever the kind of venereal disease may be, no character can be assigned to it so defined, that no uncertainty shall remain in the mind of the observer as to its cause. " Inoculation has not yet thrown sufficient light upon the diagnosis, to remove all the difficulties with which it is surrounded." Here we see M. Desruelles does not deny the results of inocula- tion; but it is very remarkable, holding the opinion he does, that he INOCULATION OF THE SYPHILITIC VIRUS. 23 should express his doubts upon the uncertain chances to which it would subject the patients confided to his care. As to the opinion which M. Desruelles also holds of the evils of experiments, I cannot let it pass unrefuted. It is possible that men, like M. Desruelles, notwithstanding the opinions of venereal diseases which they profess, have not thought it right to make experiments, and even if they blame them, it is an opin- ion one ought to respect. But that those who have made them, and who do not fear to do it from a diseased to a healthy person, should have expressed themselves as we have seen, is difficult to understand, especially when the same persons, since the article quoted appeared, have again made inoculations. Let me here be permitted, whilst I acknowledge the merit of the works of my learned colleague M. Cullerier, to cite the article Diag- nosis, from a thesis by one of my pupils.* Diagnosis.—" In the beginning of the work we showed how insuffi- cient the ordinary means of diagnosis are. The seat can prove noth- ing, as the organs of generation are subject to ulcerations or mechanical lesions, which cannot possibly be traced to chancre: which, besides, is found with its unquestionable characteristics in every part of the cuta- neous or mucous tissue. The form affords nothing more definite; we have seen that it can vary according to the seat or some complication unconnected with the disease. Some authors have recommended the progress of the disease as the best means of diagnosis. This appears to us very insufficient. In the first place, we can mostly only see part of it, and out of a hundred cases, taken promiscously, it will scarce be found regular in two of them, influenced as it will be by idiosyncrasies and accidents, which may veil it. The more or less painful or inflammatory state sometimes varies from one extreme to the other, without our being able to account for it. The treatment cannot be appealed to ; for, as we have said, ulcers and sores which are become atonic, or presenting such appearance in consequence of bad treatment, demand, in all its details, that treatment which some have regarded as | robatory. Lastly, let us hear the authors of the article Syphilis, in the dictionary in 15 vols, who, after having com- bated every means of diagnosis for chancre, even in part that which they consider the best are obliged to content themselves with writing these words. We are much mistaken or the diagnosis of chancre, regarded from the point of view in which it has just been presented, gains something in certainty and utility. Undoubtedly it is sad to see science not only little advanced, but still encumbered with errors; but is it not better to stop and return, than to follow the apparently beat- en and easy path which leads to nothing positive, or open a new one at a hazard without knowing whither it will lead?" " We will also transcribe what M. Blandin says in his excellent article upon ulcers in general, in the Dictionary in 15 vols. ' The ♦Consideration sur le chancre, par M. le doctuer Doussaint de Gand, 14 mars, 1837. Paris, these, No. 68. 24 CRITICAL RESEARCHES AND GENERAL REMARKS— characters of syphilitic ulcers are not so defined as some persons think. Ulcers depending upon a different cause, have often the greatest re- semblance to them. However, in general, syphilitic ulcers are round, with violet, hardened, raised and abrupt edges, the ground is hollowed and greyish; the suppuration which they furnish is bloody, and in small quantity. The collateral circumstances, the position of the ulcers in the places where they generally show themselves, greatly aid us in the diagnosis; but we must confess, ihat in certain cases where the patients have an interest in concealing the truth, a distressing obscurity may exist as to the nature of the disease.' " To these two important testimonies, which pretty justly appreciate the proposed means of diagnosis, we shall add the propositions laid downby M. Ricord. ' The unequivocal,incontestible,pathognomonic signs of chancres, are the production of certain symptoms of general infection, which never happen without this antecedent, and especially the constant and regular results of inoculation, during the period of progress.' " After having long attended the clinic of M. Ricord, and seen all his experiments repeated, we partook of his opinion; for it seemed to us rational to consider, as chancre, the primary symptoms existing alone in a patient, and which, in case it was followed by secondary symp- toms, presented what all enlightened practitioners recognize as be- longing to syphilis; and which also, at a certain period of its existence, presented the regular character of inoculation. What are the argu- ments that are opposed to this latter criterion, which we think of the utmost importance, as M. Ricord's first means will only do in certain cases? M. M. Ratier and Cullerier seem to have summed them up in the article Syphilis, of the Dictionnaire en 15 vols."* But we will let Messrs. Cullerier and Ratier refute, by the article inoculation in the same work, this accusation, which we must say would attach infamy to all who may dare to come within its reach. In reply to the first part, in which it is said that inoculation is the most faulty means of diagnostic, let us quote a (ew lines from the above article, by the same authors. " The pus of the primary ulcers taken at any period whatever of their existence, (but principally when they are not of old-standing, and the product of the morbid secretion has not been changed by contact with the air or any substance which acts chemically upon it,) and inserted under the epidermis or epithe- lium with a lancet, or only applied to a cutaneous or mucous surface, deprived of the protecting membrane, causes, on the point of inser- tion, an inflammation of peculiar form, and which appears to us char- acteristic. " The reproach, as to the faultiness of the diagnosis by inocula- tion, cannot stand against the answer they themselves give, when they say, that a chancre ought, in all its stages, to produce, by inoculation, an inflammation of a characteristic form and nature. • See p. 21, the articles of M. Desruelles already quoted. INOCULATION OF THE SYPHILITIC VIRUS. 25 " The patient has generally one or two ulcers the more, and the chances of general infection are augmented in proportion, so that they have given constitutional syphilis to a man who would perhaps never have had it." The accusation is serious; but Messrs. Cullerier and Ratier reply, a (ew pages further (article Syphilis.) " We have no hesitation in saying, that the affections consequent on chancre are owing to the negligence of the patient, as well as to the ignorance of the surgeon, who, not understanding the treatment, and imbued with the opinions of the schools, neglected the local affection which was before his eyes, to remedy evils which he saw in a distant perspective, and which he might easily prevent. When patients have applied to us soon after the infection, we have always been able, if they were docile, to put an end to the disease in its primary seat, and guarantee them from ulterior consequences." As to the double syphilis, that has been mentioned, we confess we were at a loss to understand it, and nowhere do we find this species described, not even in the classifications of Messrs. Cullerier and Ra- tier. However, as we have just seen, that according to these gentle- men, the primitive affections are in the power of the practitioner, one might prevent it at pleasure. Lastly, all difficulties would be remov- ed, if, as they think, inoculation produced in animals the same results as in man, for there could be no blame attached to such experiments; but, unfortunately experience has proved their assertion completely false. " Moreover, the ulcer which results from inoculation, will not pos- sess more characteristic marks for those who were unable to recognize them on the ulcer, which developed itself at first." The answer is to be found in the article Inoculation, where we read, as we quoted, that the pus of a chancre being inoculated, causes, upon the point of insertion, an inflammation of peculiar nature and form, which appears characteristic. Then, a page further, after hav- ing said that the different kinds of venereal pus yield nothing by inoc- ulation which can be characteristic, except the chancre or primitive ulcer, Messrs. Cullerier and Ratier add: " when we say that the pus produced by divers morbid surfaces may be inoculated with impunity, we do not pretend to deny that it has often produced a sore; but we assert, that it acts then like acrid and irritating substances, whilst we understand by inoculation the production of a morbid affection, after an inoculation, constant in its form, and regular in its progress and du- ration, and in its turn furnishing a pus susceptible of being inoculated." Then inoculation will distinguish chancre from every syphilitic ul- cer, either secondary or other. As to the latter objection, founded on the case in which the inocu- lation does not succeed, through the inadvertence of the operator, be- side the simplicity of the practice which will hardly admit of such conjectures, the passages in which Messrs. Cullerier and Ratier bear testimony to the tendency of the pus of chancres to inoculate, although 4 26 CRITICAL RESEARCHES AND GENERAL REMARKS— the circumstances be little favorable, have appeared to us so very nu- merous, that we did not think it necessary to report them. Lastly, as to the question relative to the patient who receiving a clean hill of health, will go his way and communicate a grievous dis- ease to those with whom he has connection, what surgeon would dare to permit or advise coition to a patient with ulcers on the organs of generation, even if he were certain that the disease was not syphilitic? Would it not be exposing him in the most favorable condition for in- fection, or at least by the irritation produced, to transgress all the rules which the authors of the Dictionary have laid down, with so much care, for the cure of the most simple ulcers? After these quotations from Messrs. Cullerier and Ratier, which seem to furnish us with the most victorious arguments against the principles they have promulgated, let us sum up all these arguments,( adding some remarks upon what we have seen. How can Messrs. Cullerier and Ratier treat inoculation as the most faulty means of diagnosis, when they lay down as a certain and invariable rule, that the pus, furnished by all kinds of ulceration which are considered venereal, even that secreted by the papula mucosa (papule muqueuse) the most characteristic symptom of syphilis, does not, by being introduced under the epidermis or epithelium, produce an inflammation of characteristic form and nature, whilst chancre or primary ulcer alone possesses this property? When we see, accord- ing to the passage we quoted, Messrs. Cullerier and Ratier declare that inoculation is necessarily the true means of diagnosis, thus to dis- tinguish, by the trial of its pus, the ulcer resulting from the inoculation of "chancre from any lesion, which may in certain cases be produced by other pus, tried in the s:.me manner, is not that which they consid- er as a means of diagnosis, and to which they appeal in case of chan- cre inoculated with a lancet from the pus of a primary and therefore inoculable ulcer, consequently also probatory for the latter ? Thus, according to the opponents of inoculation, must we not admit that when the pus of an ulcer produces certain symptoms which are constant in thfir form and developement, and presenting certain char- acteristic conditions, the ulcer, whose pus has been inoculated, was a chancre, and consequently that the necessary character, without which an ulcer ought not to be called chancre, is to furnish a pus capable of being inoculated under the given conditions ? As to the uncertainty of the results obtained by inoculation, and tha consequences to be drawn from them, I reply, that badly performed or ill appreciated experiments can lead to nothing ; and that if these authors were prompted by the interest of science in their experiments, the same interest and the welfare of humanity induced me to verify their works, add new facts, and rectify gross errors. To most persons, who will examine with unprejudiced minds, it must be clear from the study of the phenomena of general contagion, and as I have before said, from the constant and regular connexion between cause and effect, that the syphilitic diseases depend on aspe- INOCULATION OF THE SYPHILITIC VIRUS. 27 cific agent or deleterious principle, which is only to be considered an entity in the same degree as the peculiar principle of hydrophobia, the venom of the viper, the specific cause of the small-pox, &c. &c. &c. And those who will search for this cause, ascertain its effects, and endeavor to neutralize its principle, or its consequences, will, I think, deserve some encouragement, and they will throw back upon their an- tagonists the accusations of indolence, ignorance, and quackery, which appear to me more applicable to those who foster a doctrine which has thus been summed up.* " Physiological medicine ought to con- fine itself in syphilitica! affections to the study of the forms and de- grees of irritation in the different parts of the bod) , and note the mod- ifications it can oppose to it."f Well convinced that the subject was not exhausted, and that I had another mission to fulfil; encouraged by the most celebrated names and the greatest authorities, I commenced the researches, whose re- sults I am now about to relate. It has been asserted, that the venereal virus is a chimerical and in- tangible essence; that the effects imputed to this imaginary cause only depend upon the nature of the seat, the peculiar vitality of the dis- eased parts, the different degrees of inflammation, and the sym- phathetic reactions which may result from it. I had, therefore, to endeavor to materialize this cause, to coerce this pretended imaginary essence, assign it definite and specific char- acters, which should not allow it to be mistaken, but by ignorant and uncandid persons; and to prove that the seat, vitality, and functions of the organ, have only a secondary influence upon it, and that it was not the more or less fortuitous consequence of inflammation. If we are to study a body, and distinguish it from those with which it may be confounded, must it differ from them in every point? Are all the characters of each order, genus, and species different in phy- sics, chemistry, or natural history? Is not one often sufficient to dis- tinguish the difference? In our medicinal substances, for example, is it always easy to point out the essential condition which gives a sub- stance a propert}', not possessed by another, which is nevertheless in many respects analogous to it? And does this property, although in- visible, immaterial, and not separated from the substance which pos- sesses it, constitute an entity? Undoubtedly not. The incontestable existence of the venereal virus is proved by a peculiar property of a distinct morbid secretion, and therefore the pus furnished by certain syphilitica! affections has the constant and regular property of repro- ducing a pus similar to itself, by an action similar to that which first secreted it. We may, by this essential character, distinguish from each other different animal physiological and morbid secretions, with the same precision as we do chemical substances. If we inoculate the venom of the viper, the saliva of a mad dog, the pus of variola, * Desruelles, Traite pratique des maladies veneriennes. Paris, 1836. f Broussais. 28 CRITICAL RESEARCHES AND GENERAL REMARKS— vaccine or syphilis, we shall have specific effects, which will leave no doubt of the difference and peculiarity of the causes which produced them. Syphilitic pus may present globules more or less resembling those of other kinds of pus. It may, according to the locality, be com- bined with other morbid or normal secretions, particularly with mucus, in form of muco-pus. According to the locality or its combinations, it may remain alkaline or become acid, it may contain animalculi or be devoid of them; but, as distinguishing and specific character, it can inoculate itself and produce characteristic results. Convinced, nevertheless, as 1 have before said, that syphilis is one of the most serious diseases which can afflict mankind, 1 was obliged to exercise the greatest prudence and reserve in my researches, yet without being deterred by pusillanimous fears. I still feel convinced, that it is not allowable for a surgeon, under any pretext whatever, to communicate to a healthy individual a disease, the consequences of which cannot be foreseen; and if in consideration of the interest of science, which undoubtedly influenced them, we might find some ex- cuse for those who have thus experimented, their example cannot now le followed without culpability. Although the experiments upon animals were negative in their re- sulis, even in the hands of the most experienced men, I felt it neces- sary to repeat them. Public experiments have been made in my clinic, at the Hopital des Vcn'eriens, upon dogs, rabbits, guinea-pigs, cats, and pigeons, and in all cases with negative results. All the experiments repeated in every possible way of infection and inoculation, without neglecting any necessary precautions, were each time made with pus, which at the same time produced in man positive results; so that after these experiments, joined to those which we already possessed, we may conclude that the inoculable principle of syphilis is peculiar to man, and cannot be transmitted to brutes. This, however, as we have seen, does not prevent them from being subject, under the influence of irritating causes, to inflammations of the sexual organs, which, as in all other tissues, may be followed by suppurations, ulcerations, &c. without these lesions being connected with the syphilis of man. Let it, however, be remembered, that even if any one should be able to transmit true syphilis to an animal, that would not detract any- thing from the specific nature of the syphilitic principle, any more than the possibility of transmitting the vaccine of the cow to man, disproves the peculiar nature of this virus. Hitherto, then, syphilis can only be inoculated in man; but, as we said above, not being allowed to pursue the researches from a diseas- ed to a healthy individual, my observations were necessarily confined to the patient himself—they were founded upon the following proposi- tions. I. A venereal affection already cured, or still existing in whatever INOCULATION OF THE SYPHILITIC VIRUS. 29 period it may be, does not prevent others being contracted, and the number of possible successive infections are without limit. II. No individual actually infected and under the influence only of primary symptoms in one region, ever sees symptoms similar to the first developed in other parts of his system, except by a new conta- gion from contact with the pus of the first, or communicated by an- other individual. III. Secondary symptoms, or general infection, never prevent the patient from contracting other primary. IV. The frequency of constitutional syphilis, is in nowise depend- ant on the number of primary symptoms developed at one time. Do not the observations of former times unite with every-day expe- rience, to corroborate the experiments of Hunter, which prove that one infection does not prevent a second; not only in the development of symptoms different in form and principle, but also of those which are owing to a cause of the same nature? Do we not continually see patients who have a gonorrhea contract a chancre in a fresh sexual in- tercourse; or having at first a chancre, are attacked with gonorrhea, after a fresh coition? I should think no candid person would attempt to deny so well known a fact. But the manner of the production of every symptom which follows the first, might be contested. Those who think there cannot be a primary infection without general symp- toms, look upon all those which follow as in consequence of a first symptom, without the necessity of a new, contagion. Thus they at- tribute distinct diseases, contracted at different times, to the same cause. But it must be evident to all accurate observers, who will take the trouble to distinguish primary from secondary symptoms, that the primary can only be produced by the direct application of the conta-' gious pus to the part, or by the conveyance of this pus by the vasce lymphaticce efferentes to the ganglions in which they terminate, without ever passing them. The experiments I have made on this subject are very numerous, and to verify them at any time, it will suffice to know the intention in which they were made. It is thus that in all individuals affected with primary reputed venereal symptoms of all kinds, artificial wounds, or operations per- formed at a distance from the venereal lesions, have never assumed the syphilitical appearance, nor any of the characters of venereal af- fections, when proper precautions have been taken to prevent their be- ing soiled by the contagious pus. Many examples have been cited, of wounds having assumed the character of primary ulcers, evenomed by the general infection, and nothing is said to be more common in leech-bites. Yet in all these cases where the real explanation was overlooked, the true cause might have been found. Thus we often see, where a number of leeches have been applied on and around the penis, some of the wounds assume the appearance of chancre, whilst others heal at once. If we search for the cause of this difference in wounds of similar nature in the same region, we shall soon see that 30 CRITICAL RESEARCHES AND GENERAL REMARKS— those alone are attacked with which the penis could come in contact, whilst those which are out of reach remain uninjured. A woman in one of my wards, at the Hjpital des VcnCriens, had a number of chancres on the vulva; these chancres were primary, and at the pe- riod of development they furnished an abundant suppuration, when she was siezed with a rheumatic pain in the right maleolus exturnus, to which some leeches were applied. Some days after, the patient, who had at first been much relieved by the leeches, complained that the bites were very painful; she was examined, and they appeared inflam- ed and like pustules of ecthyma, to which succeeded ulcers, having all the characters admitted to belong to true chancre. The part where the leeches had been applied, the distance of the situation of the primary ulcers of the vulva sufficed for most of the gentlemen who attended my clinic, to regard this accident as a consequence of a general infection, or a bad disposition in the subject. 1 ordered some more leeches to be applied to the other leg, and also some fresh ones to the same leg, taking care to prevent any consequence to these new wounds by isolating them from all contagious contact; and then whilst two punctures, made with a lancet, one with the pus taken from the chancres of the vulva, and the other from the ulcerated leech-bites, produced ulcers like those which furnished the pus, the wounds which had been guarded from soil healed without any accident. But it sometimes happens that leeches, applied to bubos, cause ul- cerations of a malignant nature, without the origin being traced to the application of contagious pus. In these cases, either the leech-bites, are simply irritated or inflamed, and have been followed, as it often hap- pens, by a kind of furnicle which suppurates, and then the pus which they furnish does not inoculate; or having become true inoculable chan- cres, the infection was communicated from within outwards—i. e. that being placed upon a virulent suppurated bubo, the pus of the gangli- onary chancre has inoculated the leech-bites in passing them, to make its escape. This is the same with every analogous wound, whether accidental or artificial. Fabricius Hildanus relates, that a man affected with the itch, was, in 1609, infected with syphilis, of which he died, from having slept in sheets in which several syphilitic persons bad sweated. But he has omit- ted to state in what condition these latter were, and whether they had any ulcers. It is more than probable that some such affections exist- ed, and that the pus which flowed from them, having adhered to the sheets, afterwards came in contact with some points of the skin which were deprived of the epidermis. I have stated, as has been proved by experiment, that the cessation or persistance of a primary symptom, in whatever period of its exist- ence it may be, does not prevent the patient from being susceptible of contracting another. But the most important point, and which alone would authorize us to pursue our researches, sanctioned as it is by Messrs. Fricke, of Hamburgh, Lallemand, of Montpellier, Ruef, of Strasburg, and Blandin, surgeon of the Hotel Dieu, of Paris, &c. is, INOCULATION OF THE SYPHILITIC VIRUS. ol that the number of secondary symptoms stand in no relation to that of the primary symptoms developed at one time. That there are not more symptoms of general infection after two, three, four or five chancres, contracted at the same time, than after a single one, is proved by observations during six years, and cannot now be doubted. These facts being once established, I reviewed all the ruptured ve- nereal affections, whether primary or secondary. All the normal or morbid secretions, of persons reputedly syphilitic, have been examin- ed by means of inoculation, and only one form has given uniform and constant results, and this form is the primary ulcer or chancre, which is to constitutional syphilis what the bite of the mad dog is to hydro- phobia, does not nevertheless produce a specific pus, but a at certain period of its existence; and it is evident, that it is from not having paid attention to this simple fact, that the results of inoculation have been contested, or appear uncertain. The primary syphilitic ulcer cannot always be the same in all its stages, and it cannot cicatrize, without first becoming a simple ulcer by the destruction of the cause which served to maintain it. Simi- lar characters and results cannot be required from these different pha- ses; it is in the period of developement or statu quo of the ulceration, whilst there is no effort of cicatrization, that a chancre secretes the ve- nereal virus. The specific nature of the secretion of chancre, as we have before said, does not depend upon the organ affected, nor the vitality, func- tions, or sympathetic reaction of this organ, nor upon the degree of inflation which may attend the ulceration. The locality has so little influence upon the peculiar nature of chan- cre, that it cannot justly be regarded as proper to the sexual organs. Indeed there is no part of the skin which may not become the seat of it; no part in the necessary condition and being accessible is secure from it. If it be devoloped on other regions than the sexual organs, it yet maintains, without exception, all its characteristic marks. Thus a chancie, on the end of a finger, on the thigh, foot, or the tip of the tongue, will (if it has not been modified) produce pus capa- ble of producing a similar chancre by inoculation, without the partici- pation of the sexual organs; whilst no other affection of these organs, ichatever its form or extent, or the degree of inflammation which may accompany it, can reproduce a chancre. One circumstance, however, is undoubtedly true, and may have in- duced the error, viz. that the sexual organs are most frequently affect- ed, like certain bones, which, from their texture and situation, are more frequently fractured than others. The delicate tissues of these organs, the facility of erosion of the epidermis or epithelium, the number and exposure of their follicles, the intimate and prolonged connection they maintain between a healthy and a diseased individual, are the conditions which permit the cause also to act with so much more effect. But, as experience proves, it is not the organ that gives to the disease its peculiar and specific nature; for no artificial leison. 32 CRITICAL RESEARCHES AND GENERAL REMARKS— whatever the agent employed may be, can produce it; and whilst a finger deprived of epidermis, contracts a chancre by contact with the pus, the sexual organs being entire in every point, may be soiled with it unharmed. Thus we have established this fact, that chancre, whatever its seat, is the consequence of a specific pus, which it alone secretes, and which justly termed, true leven (veritable levain, ferment special,) re- produces an identic disease tokerever it is suitably deposited. But this peculiar leven, which has only a peculiar action when it produces an ulceration,, is only generated during a certain period of a chancre, which, as we have seen, has two very distinct stages. The first, to which the name peculiarly belongs, is that of increasing or stationary ulceration, this is the one which furnishes the specific pus; at the second, which is the stage of reparation, it can only arrive by first becoming a simple ulcer; this is capable of cicatrizing, and no longer furnishes the specific virulent secretion. The importance of the distinction of these two periods of chan- cres will easily be seen, for without it, all is confusion; and the same ulceration which produced a chancre by inoculation, not yielding con- tagious pus a few days later, one would conclude the experiments to be uncertain, where, in fact, they are of the greatest value. If a little of the matter secreted by a chancre, during the period which we have pointed out, be taken upon the point of a lancet, and inserted upon the epidermis, we shall find the following result. During the first twenty-four hours the punctured point becomes red, as in vaccination; the second to the third day, there is a slight swell- ing, and it has the appearance of a small papula, surrounded by a red halo; the third to the fourth day, the epidermis, elevated by a more or less turbid fluid, often assumes a vesicular form, with a blank point on the summit, caused by the drying of the blood of the little punc- tures; the fourth to the fifth day, the morbid secretion increases, be- comes purulent, the pulsatory form is more defined, and its summit becoming more depressed, gives it an umbilicated appearance, which makes it resemble the pustule of the small-pox. At this period the aureola, which had increased in extent and intensity, begins to vanish or diminish; but from the fifth day, the subjacent tissues which have often'hitherto remained unaffected, or were slightly oedematous, be- come infiltrated and hardened by the effusion of plactic lymph, which gives to the touch a sensation of resistance and elasticity, like certain cartilages; lastly, from the sixth day, the pus becomes more thick, the pustule cracks, and crusts soon begin to form. If these are not detached, they increase at their base, and rising in layers, assume the form of an imperfect cone, with a depressed summit. If these crusts be detached, we find beneath, an ulcer which being seated on the hard base we have mentioned, presents a ground whose depth is equal to the entire thickness of the skin, and whose greyish surface is formed of a fatty sub-tance, or sometimes a pseudo membrane, which cannot easily be detached. The edges of the ulcer at this period cleanly INOCULATION OF THE SYPHILITIC VIRUS. 33 cut, as if by a perfectly circular punch, are yet undermined to a great- er or less extent, and viewed with a lens, present slight indentures, and a surface similar to that of the ground; their margin, the seat of a similar engorgement and induration as the base, presents a kind of a red-brown, or more or less violet circle, which more projecting than the neighboring parts, raises the edges and reverses them a little, which in the first period gives a funnel-like appearance to these ulce- rations. These regular and constant signs, which form a general rule, the rare exceptions to which are easily explained, lead to the following propositions. I. A chancre is not to be recognised, a priori, in all cases, either by its virulence or because it was contracted in a suspicious coition, or from its seat, the induration of its base, its color, the consistency of the ground, the cut, undermined or callous edges, or the tint of its margin, but by the pus which it secretes, and the vitiation of the sys- tem to which it may give rise, as all the above-mentioned conditions may vary, the secretion, and its general consecutive effects, remaining alone the same. II. The pus of a chancre alone produces a chancre. III. The best method of producing a chancre is by inoculation with the lancet. IV. To produce a cb/mcre, neither the orgasm of the venereal act, nor previous excitation of the part about to be inoculated, is necessary. V. Inoculation never fails if the pus be taken in the proper state and well applied. VI. The pus taken from a pustule, produced by inoculation, repro- duces a chancre in the same manner, and so on from one to another, without limit. VII. If several punctures be carefully made with pus from the same ulcer, each produces a pustule, and then a chancre. VIII. The pustule and the chancre which succeed it, are develop- ed upon the precise point of inoculation. IXv. Whatever varieties and complications the chancre from inocu- lation may-present at a later period, its progress in the commence- ment is always the same as we have just described; the pustulous pe- riod is wanting only when the infected parts are denuded of epidermis, and it is only preceded by inflammation and abscess, when the viru- lent matter has been introduced into the subcutaneous cellular tissue or the lymphatics. X. There is no incubation in the sense in which this word is gene- rally used; for the evolution of the chancre commences at the mo- ment of contact with the infecting pus, and continues till the formation of the ulcer. XL Chancre is at first a local disease. XII. The symptoms of general infection, which can only occur when preceded by chancre, never appear when they do occur, except it has lasted a certain period. 5 34 CRITICAL RESEARCHES AND GENERAL REMARKS— XITI. To arrive at this important result we must distinguish the real from the apparent commencement of the chancre, viz. not reck- oning from the day on which the patient first perceived it, but from the time of infection. XIV. In making observations for this purpose, it will be found that ulcers, completely destroyed by caustic or otherwise, in the first three, four, or five days subsequent to the application of the cause, do not expose the patient to secondary inflammation. XV. The induration of chancres only begins about the fifth day. Mostly they are indurated chancres which are followed by secondary symptoms, and this induration would seem to indicate that the vene- real principle has penetrated the system, and as long as it does not take place, we may conclude that the disease is superficial. It appeared to me very important to ascertain whether the specific matter produced by chancre, preserved its contagious properties for a certain time, like vaccine. Numerous observations, and amongst others, those of Hunter,* one would think no doubt left upon this subject; but this, however, is not the case, as we see by what the late Cullerier says upon it, in the great Dictionaire des Sciences Medicales. MEANS OF PROPAGATING SYPHILIS. When it was first known that the disease was contagious, it was thought that it could be communicated by breathing the same air, com- ing in contact with the syphilitica!, or even their clothes, that the meetings of christians for worship, &c. were frequent means of con- tagion. For this reason, no one concealed being affected with this disease; thus we hear of it being observed in virtuous princes and holy abbots. The most common means of propagating syphilis, is undoubtedly that by the sexual organs in the intercourse between the sexes; be- cause the virus generally has its seat in these organs, and because they are always moist, and the epidermis which covers them is deli- cate and thin, the organs remain in contact, and friction renders ab- sorption more easy. The organs of the mouth are often the propa- gaters of the contagion by a lascivious kiss, by the application of the lips or tongue to some part of the mucous membrane, by suction of the breast, and especially in suckling. If the mouth of an infant can infect a nurse, the breast of a nurse can infect a child. These alternative infections are only too frequent. Hence arises a question—Is there any means of determining whether the disease has passed from the nurse to the child, or from the child to the nurse? * Petit Radel says: This same deleterious matter, taken from the svphilitic pus fur- nished by chancres, being dried and preserved in a case, in the same manner as that of variola, and inoculated on the arm with a lancet long afterwards, produces venereal ul- cers, preceded by all the symptoms of syphilitic inoculation. A soldier undermined by .an old and obstinate syphilis, was thus cured. INOCULATION OF THE SYPHILITIC VIRUS. 35 If the disease exists in both individuals at the same time, and is ar- rived at the stage of consecutive disease, one can only form a probable opinion from the state of health of the father and mother, the child, and husband of the nurse, and from the time at which the disease showed itself in one or other of them, which is sometimes very diffi- cult to ascertain. But one may be certain that the child has commu- nicated the disease to the nurse, if it has ulcers in the fossce nasales, tubercular pustules, in a scaly or ulcerated state in any part of the body, with marks of a disease already of longstanding. On the other hand, we may be certain that the nurse has infected the child, if she has ulcers at the anus, pustules on the body or exostoses, and the child simply ulcerations of the mouth, nose, or anus. A glass, spoon, or pipe, used by several individuals, may also be the intermediate means of contagion; but it is requisite that the contact with one should be immediate after the other; that the pipe left by the infected individual should have been directly afterwards taken by the healthy one ; that the glass be not placed on the table, but passed from one to the other, or the spoon from one mouth to the other with- out being wiped. We have seen several indubitable instances of these different methods of communication. The eyes may also be directly infected by a moist kiss upon the eyelids, or by a vehicle projected from a certain distance. The pus which spirts from a suppurated bubo when it is opened, if it touches the conjunctive, may produce syphilis and disorganize the eye. The touching the hands or cheek of a healthy person by an infected individual, does not communicate syphilis; the skin is too compact, the epidermis is too thick for the virus to penetrate; but this would not be the case if there were any little ulcers, or a simple excoriation. Young surgeons dressing in the public hospitals, examining pregnant women by the touche, or aiding childbirth, have caught the disease with which the women were affected, by having slight excoriations from the little prolongations of the epidermis near the nail. We think we may assert that the fluid which serves as vehicle for the virus* ought to possess a certain degree of warmth, or kind of life which gives the virus the power of attaching itself to the new bodies to which it has been transmitted. We confess our incredulity as to con- tagion, by means of a seat of a privy or a chamber-pot, which no one had used for several hours; or a sponge not used since the previous day; or by clothes which had been laid off a whole night by the wear- er. Nevertheless we will not absolutely deny the possibility, if it be only to explain things which otherwise are inexplicable. I took pus from some chancres and inoculated pustules, which had been eight days in tubes, similar to those used to preserve vaccine. I have found that pus from chancres and inoculated pustules, after having been kept eight days in such tubes, produced the same result as recent pus. In the same manner I found that muco-pus of a gonorfliea, a phlegmon, simple ulcers, and non-virulant bubos, kept in the like man- ner, produced negative results. 36 INOCULATION OF THE REPUTED It is beyond all doubt, that women who have had connection with diseased individuals, have afterwards communicated the disease to other men, without becoming infected themselves. I have often met with such cases, and were they not so common, they might lead to the supposition of the spontaneous generation of syphilis between healthy individuals. I lately saw a young man who had connection with a woman affect- ed with chancres, and also the same day with his mistress, who be- came infected with the disease. The young man had not washed himself after the first connection, and his prepuce was very long, but he himself remained unaffected. CHAPTER II. INOCULATION SERVES TO DISTINGUISH FROM OTHER THE REPUTED PRIMARY SYMPTOMS OF SYPHILIS. Whoever has taken the pains to study syphilitic diseases, has no doubt found that no affection is so ill defined, and no diagnosis so un- certain. What is syphilis? What are the symptoms? What symp- toms are quite unconnected with it? These questions have not yet been settled, and are subjects of eternal dispute; until they are solved, no progress can be made with any certainty. Must we include, under the head of syphilis, the symptoms enume- rated by Astruc and adopted by Capuron? But then it would be im- possible to admit a unity of principle, cause, and results. From hav- ing thus jumbled everything together, we remain in error. What con- clusions can we draw from the observations of older authors and re- cent statistics of venereal diseases, as to the cause, effect, and treat- ment, when we see thrown together, under the name of syphilitical diseases, gonorrhoeas balanitis, (external gonorrhoea of the glans pe- nis,) orchitis, phimosis, paraphimosis, and many others, which have no connection with syphilis? The only conclusion we can arrive at is, that the diagnosis of syphilis is not only difficult, as Fabre and Peyrile have said, but impossible. Let us see if inoculation cannot lead to something more positive than anything has hitherto done. In the first place, we will adopt the very natural distinctions made by Fernal between primary and secon- dary symptoms, or those with which the disease breaks out, and the consequences which it may afterwards produce. Let us first examine the symptoms which are called primary. They are:— I. Gonorrhoea in its different situations. II. Chancre or primary ulcer. III. Bubo, considered as primary symptom. IV. Mucous tubercle, or flat, humid, mucous pustule, said to be primary, &c. PRIMARY SYMPTOMS—GONORRHOEA. 37 What has caused these affections to be admitted as primary symp- toms is, that they have been supposed to have been as the first symptoms which have shown themselves after an impure connection, and a conse- quent conviction that they indifferently produced the various symptoms of general syphilis. Identity of cause, identity of effect, is a doctrine prefessed by most practitioners of both the virulent and physiological school. From the connection between cause and effect, Hunter, and then Abernethy and those who followed them, admitted true and pseudo syphilis. Others, like Carmichael, thought each separate form had a peculiar virus, and the so-called physiological school thought every thing depended upon the degree of irritation. Here again we find doctrines founded on bad observations or false explanations. Section I. I asserted and proved, in the foregoing chapter, that chancrealone produces chancre; and yet most authors have admitted the existence of virulent gonorrhoeas which were identic with chancre, of which they might be either cause or effect, and like it give rise to the whole train of symptoms of constitutional syphilis. Whether gonorrhoea is identic with chancre, and whether like it, it constitutes a primary affection, by which syphilis may begin, is a ques- tion to which all authors have justly attached much importance, and it is well known that the most distinguished authorities have differed in opinion. This dissention of opinion induced the Medical Society of Besan- con to offer this as a prize question; and Hernandez, who justly con- cludes as to the non-identity of gonorrhoea and chancre, has so justly summed up all which inoculation can furnish on this point as a basis of differential diagnosis, that I must be allowed to transcribe part of his work.* u Inoculation of the virus of gonorrhoea does not produce chancres. " Andre'e tells us, that a surgeon inoculated himself with gonor- rhceal matter and had a chancre. This isolated fact is of little impor- tance. It depends upon the assertion of an unknown surgeon. It is not stated whether this ulcer required mercurial treatment; and it would appear from this omission that they concluded, as to its syphi- litic nature, merely from its appearance. We shall presently show how little external signs are to be depended upon in such cases. Even admitting the fact, a single case like this is far from not overturning, but even raising a doubt upon a mass of observations. " J. Hunter has furnished a case of inoculation much more fully detailed, but at the same time far less conclusive. He inoculated gonorrhoeal matter upon the glans and prepuce. Chancres made their * Essai analytique sur la non-identite des virus gonorrhoique et syphilitique; par J. F. Hernandez. Toulon, 1812, art. 4, p. 57. 38 INOCULATION OF THE REPUTED appearance on the points of insertion. Thus far it appears that the gonorrhoeal virus produced chancres; but these chancres healed of themselves, which is by no means the nature of chancres and syphili- tic ulcers. " In this case it is true we find fresh chancres appear and vanish of their own accord: symptoms apparently syphilitical, supervene; a bu- bo and after its resolution, ulcers of the throat, which healing, were succeeded by pustules; but the ulcers, the undoubted product of the inoculation, which ought to be characteristic, were not venereal. The bubo might depend upon the irritation of the ulcer on the glans, which we shall prove from Swediaur. The ulcers of the throat and the pus- tules might also depend upon other causes. Moreover, this train of symptoms occupied three years in its development; how can we be sure that a.new infection did not take place without the local affection, which produced these symptoms, being observed? Might not this pa- tient have previously been affected with syphilis? The disease may have lain dormant in the system; an unclean connection may have commu- nicated syphilis to him without any apparent disease. This Hunter does not tell us, nor did he even ascertain it. How can we then rely upon such an observation? Can we then reckon much upon the sy- philitic nature of all the affections brought forward as syphilitical by great surgeons? It is plain that this point is important, in order to es- timate the value of the inoculation, of which we are speaking, and whose syphilitic results only relate to the nature of the consequences it offers. " One tooth being replaced by another, Kuhn observed an ulcer in the mouth, and sometime after, a cutaneous eruption following, he considered it a syphilitical affection. The celebrated Lettsom, to whom he communicated the fact, was of the same opinion. Yet up- on the tooth being extracted, all disappeared. "We see from this circumstance how readily the venereal nature of an affection was admitted at the time the authors wrote, and there- fore how little conclusive the observation of Hunter ought to be con- sidered, and how little it decides the question. " Bell relates, that two young men tried some experiments with in- oculation upon themselves. The glans and prepuce, scarified with a lancet and then rubbed with gonorrhoeal matter, became covered with small ulcers, which had no resemblance to chancres, and healed with- out mercury. " These positive facts contradict the former. They are far more decisive, because some circumstance may have been combined with the inoculations of Andree and Hunter, which may have transformed the result into something, other than would have been the natural pro- duct of the inoculation. In those of Bell, the matter is more clear and less involved in doubt. It the inoculated virus be syphilitical, the ulcer must be venereal, as soon as it is formed. We know nothing which can alter the nature of the ulcer produced by the syphilitical infection, or prevent it assuming its essence and character. It is there- PRIMARY SYMPTOMS—GONORRHOEA. 39 iore evident, that if inoculation produce ulcers which are not syphiliti- cal, neither could the infecting matter be so; and we necessarily con- clude, from the experiment of which Bell speaks, that the gonor- rhoeal virus producing ulcers, which are not syphilitical, has a different and peculiar nature. "Thus far the observations in favor of the production of chancres by inoculation of the gonorrhoeal matter, are few and undecisive. In the host of circumstances, which may complicate the ulcers produced by inoculation of gonorrhoea, and even render them venereal, who would venture to assert that two single indubitable observations, in which the ulcer obtained might be truly venereal, could afford a sure and affirmative solution? But nothing has proved the venereal nature of the ulcers produced by the inoculation in Andree's case, and all unites to show that that of Hunter had no syphilitic result. " By the side of these dubious or even favorable observations, we can place direct and decisive cases, which prove that the ulcers pro- duced by inoculation of gonorrhoeal virus, are not syphilitic. We are therefore obliged to conclude, that the gonorrhoeal virus has a peculiar nature, stirkingly different from the syphilitic virus. " After all these experiments, I shall relate some which I was en- abled to make under very favorable circumstances. The work of Bel! being found on board a prize, was sent to me, in 1794. I took advantage of being in attendance at an hospital for galley slaves, to make some researches. I prevailed upon some convicts, who dread- ed the work at the Arsenal, to submit to some experiments, in which there could be no danger. "Many of the convicts had gonorrhoeas; I selected three to furnish the necessary virus, I kept them several months, during which time I made many experiments. Three healthy men in the prime of life were repeatedly inoculated on the glans and prepuce. Several threads dipt in gonorrhoeal matter were laid upon incisions made with a lancet. Slight ulcerations always followed without having the appearance of chancres, and they healed with the most simple dressings. " Two others, who had great tendency to scurvy, although it had never broken out, bad some obstinate ulcers, which resisted all local applications, and only yielded to exitants combined with acids. One of them had pains all over his body; the pus of the alcer was bloody, and the flesh of a fungous nature. " Four young men, formerly afflicted with scrofula, and still having a scrofolous habit; in three of them, the ulcers were very obstinate; in two they possessed nearly all the syphilitic characters, and an her- petic eruption made its appearance a short time after. In these two, there was some abdominal obstruction, which could only be removed by the internal use of calomel. Nevertheless there was a certainty of the affection not being syphilitic. One had been in the baths three years, the other two, and neither had been allowed to quit the Ar- senal. " A young man, whose parents were afflicted with the gout and who 40 INOCULATION OF THE REPUTED seemed predisposed to it, was inoculated in the spring. An ulcer vyas produced, the damp weather made it yet worse, it was accompanied by vague pains and all the derangement caused by weakness of the di- gestive organs. It resisted all remedies, but the warm weather set- ting in, it healed quickly. " A man about fifty years of age, subject to haemorrhoides, which gradually disappeared, just at this time the inoculation was made and the ulcer assumed quite the syphilitical appearance and only healed when the hemorrhoidal flux returned. " Out of six individuals of a sickly irritable constitution, four had obstinate ulcers, and two had even pains and cutaneous eruptions. These obstinate ulcers, whether accompanied by pains and the erup- tion or not, only yielded after a long course of internal tonics; the other two recovered easily with only simple dressings. " These experiments were made upon seventeen persons, they are the most numerous, and perhaps the most careful that have been made, and furnish important results. In five of these cases, we see that the cure was quick and without internal remedies, and without the ulcers having a syphilitic appearance. In the others, we had obstinate ul- cers, some of them possessing quite the syphilitical appearance, ac- companied with general symptoms, which seemed to confirm it. Surely such proofs did not exist in the cases I quoted, and yet they were regarded as decisive. Yet all depended upon known internal disorders; all the ulcers yielded to means calculated to destroy these disorders, but which have no virtue against syphilis. 1 might have been deceived had I not chosen my patients, and well examined the state of their health. The scrofulous subjects with abdominal ob- structions might have led to error. Here we had the symptoms of ul- cer, cutaneous eruption, and the efficacious effect of mercury! What reasons for admitting the existence of the syphilitic virus, had the dis- ease not been previously recognised, but made its appearance at the same time, or shortly after, and had not other patients, with similar affections without ulcers or venereal symptoms, experienced the good effects of this treatment! " My experiments prove that the ulcers, which are produced by in- oculating the gonorrhoeal virus, are not syphilitic, and at the same time point out the source of errors which may render these experiments, which appear so simple and decisive, of little value. They show how circumstances may change the nature of ulcers or disguise them, and to such a degree that it may easily impose upon inattentive observers who do not foresee these cases of complication." I will here relate some experiments which were made in Philadel- phia. " Dr. Barton, says Dr. Tongue, to whom we are indebted for them, inoculated me on the arm with matter from a very virulent gonorrhoea, and no inflammation even ensued. " My fellow-student, Mr. Rowan, was also inoculated with the same matter upon the right arm, neither did any inflammation result here. The same was the case with Mr. Thompson and a servant. PRIMARY SYMPTOMS—GONORRHOEA. 41 " Three weeks afterwards, the operation being repeated with some fresh gonorrhoeal matter upon Mr. Tongue's fore arm, and a fortnight later, in the same place, upon Mr. Rowan, produced neither chancre nor inflammation. " Two pieces of lint, well soaked in gonorrhoeal matter, of the vi- rulence of which no doubt remained,, were applied behind the glans under the prepuce, and remained there two days and a half, neither chancre nor inflammation ensued." These experiments by Dr. Tongue are exact. Inoculation, far from producing a chancre, did not even cause any inflammation. Yet the introduction of this matter into the cellular tissue, in the midst of this net-work of absorbents, which are here so plentiful, placed it in the most favorable position for its action. But perhaps it may be objected, that this is not the ordinary man- ner of the transmission of syphilis, and that it is this which has caus- ed it to fail in its effects. We know that an excoriation or incision particularly favor the ac- tion of the venereal virus, of which we give numerous proofs in this work. But we have upon this subject, and by the same means, some very decisive experiments by Dr. Tongue. He inoculated his fellow-student, Mr. Wotton, on the right arm with syphilitic matter, taken from a chancre an hour previous. The part gradually inflamed, and a complete chancre was formed in the space of four days. He inoculated a person with pure syphilitic matter, mixed with an equal quantity of a solution of gum arabic, the proportions of which were two drachms of gum to eight ounces of water; the chancre was developed as usual. Having tied up a dog, apparently in good health, during four and twenty hours, he obtained a small quantity of the gastric juice, a part of which he mixed with some pure syphilitic matter, he introduced it into the left arm of a young negro; the chancre was formed in three days. The same experiment was performed upon another individual, with a simikr result. The gastric juice was mixed as soon as possible after having been taken from the stomach. He inoculated a man on the right arm with equal parts of syphilitic matter and a solution of sulphate of copper, in the proportion of a scruple to the ounce of water; the chancre made its appearance. At the same time he inoculated the same person on the left arm with syphilitic matter, and an equal quantity of a solution of sulphate of iron, in the proportion of a scruple to the ounce of water; and here again the chancre was formed. In these experiments, we find the syphilitic virus, mixed with equal quantities of a fluid, (and therefore diluted,) invariably produce chan- cres. In the latter, even when added to medicaments or energetic substances, it was always followed by syphilis. 6 42 INOCULATION OF THE REPUTED Dr. Harrison, also, made some inoculations with chancre pus; an ulcer and syphilitic symptoms were the result. Upon surveying carefully all the experiments relative to inoculation, we find some amongst those we have quoted which might undoubtedly be questioned, or whose consequences have been ill deduced, without however detracting from the regularity and precision of inoculation. The researches I have made in public, during more than six years, must be entirely satisfactory to all unprejudiced minds, and will explain all that may appear somewhat contradictory in different authors. In the first place, I studied gonorrhoea as regards its causes, and I found that it could be produced under the influence of all those which generally preside over catarrhal inflammations; so that once developed, it was impossible, from its own symptoms, to determine to which it was really owing. It may, however, generally be said, that if we can trace a discharge to the source, it has been found that it was produced by another discharge, and that thus the catarrhal muco-pus seemed to be the most efficient irritant to produce the inflammation of the mucous membranes. Yet, the virulent pus, secreted by a chancre, frequently produces a gonorrhoeal discharge; but then it is easliy to be perceived that the action of this cause, differing according to certain circumstances, has not always been well explained, as we shall see a little further on. Nevertheless the most distinguished authors have asserted and been convinced, that one woman having connection with several men, could give chancres to some of them and toothers gonorrhoeas and bubos; whence they have concluded, as to the identity of the nature of these different affections, the principle being always the same in all, and the difference being only in the form determined by the locality and the degree in which the cause acts. If such reasoning has remained for a length of time without refuta- tion, it cannot now be persisted in. Since 1 have applied the speculum uteri to the study of venereal diseases, the hitherto inexplicable enig- mas are reduced to the commonest and most simple facts. With the aid of this instrument, I have found that a woman may be affected at the same time with gonorrhoea and chancres in the depth of the vagina or uterus, and the gonorrhoea alone show itself externally; so that ap- parently affected with gonorrhoea, she could easily give chancres and gonorrhoea, or only one of them, according to the predisposition of the persons who exposed themselves to the infection. But we can affirm, and from numerous observations, that whenever we have ex- amined women, who have communicated disease, we never found that a chancre had been produced by a discharge without ulceration in the sexual organs of the person who had communicated it. Inoculation bas confirmed what observation of ordinary contagion, better made with the aid of the speculum, had established. In women, gonorrhoea in the whole extent of the organs of genera- tion, in its different stages, acuteness, and duration, being inoculated in the same manner as employed for chancre, produced no result, whenever the mucous membrane was not actually the seat of a chancre, PRIMARY SYMPT0MS-G0N0RRHC3A. 43 It is now well known, and proved by pathological anatomy, that, as the speculum shows us every day, gonorrhoea is often accompanied or followed by erosions, or more or less extensive destructions of the mucous membranes; but the ulcerated form of gonorrhoea, if I may thus express myself, does not render it more capable of being inoculated than that which is not; the gonorrhoeal ulcers being essentially distinct from chancre. The observation which my learned colleague, M. Gilbert,* has related, as opposed to my doctrine, in fact proves its validity. " 1 do not think the inoculation proposed by M. Ricord, as a means of diagnosis, can really be had recourse to with advantage; for this inoculation has never succeeded in producing characteristic syphilitic symptoms, either in my hands or in cases, where it seemed no doubt could possibly exist as to the contagious nature of the disease. Late- ly a girl, with an acute urethral and vaginal gonorrhoea, with a granu- lated ulceration of the neck of the uterus, was inoculated with the matter of the discharge in my wards, without success. There were nevertheless all the conditions which, according to M. Ricord, could favor the inoculation." No, here were not all the circumstances likely to favor the inoculation; on the contrary, the granulated ulceration could not inoculate, and this is what occurred; for ulceration in this condition can never inoculate. But if it were proved that a chancre could never be produced by muco-pus taken from the sexual organs of a woman; if it were shown by the speculum that no ulcerations of this kind existed any where, we might conclude, as I have done, from the strictest analogy and the soundest logic, that whenever the urethral gonorrhoea of a man com- municated a chancre to a woman, there must have been something else than a gonorrhoea, and that the urethra was the seat of a chancre in some portion of its extent. Yet this doctrine has been doubted by some uncandid opponents, who would not admit the chancres in the urethra from a curious rea- son, viz. because they bad never seen them, as if each individual could have seen all; but what is still more strange is, that every kind of ulceration has been denied and the power of ulcerating, under the influence of causes which produce ulcers in all other mucous mem- branes, is denied to this canal, because Morgagni never found any ul- cerations in gonorrhoea. Morgagni, who observed chancre, in the mea- tus urinarius and cicatrices in the urethra, which must have resulted from some previous destruction; and because Hunter found no ulcera- tions in the urethra of two men who were hanged, when affected with gonorrhoea; and lastly, because M. Cullerier and M. Philip Boyer, each made a dissection and found an ulcerated mucous membrane. It is but just to remark, thatM. Cullerier has assured me, he never thought of concluding from the dissection he made, that the urethra was not susceptible of this kind of disease. It remained to be shown, * Gilbert Manuel, des maladies, veneriennes. Paris, 1836. 44 INOCULATION OF THE REPUTED by a series of observations, and the aid of pathological anatomy, that this canal, which was so often seen ulcerated at the meatus unna- rius,* and in the anterior portion, might be so in any part of its ex- tent, and apparently afford only symptoms of gonorrhoea. In those casese related by some authors, and which appear to me incontestible, where chancre pus introduced into the urethra produced a gonorrhoea, two things are possible, either the matter of the chancre only acted as a simple irritant, causing a discharge, or in a specific manner, causing a urethral chancre, which, from its situation, could only occasion symptoms of gonorrhoea, constituting what I have term- ed masked chancre; (larve) for if it be true, that with chancre pus a discharge has been produced, yet no other affection can be produced by the muco-purulent secrection of gonorrhoea, from a mucous surface not affected with chancre. Bellf (vol. 1, p. 492) relates the following cases:— " Two young students of medicine, having resolved to settle the point in question, determined to make the following experiments, at a time when neither of them had been affected with gonorrhoea or sy- philis. In these experiments, as in the preceding, the matter was taken from patients who had never taken any mercury. Each of them placed between the prepuce and glans, a bit of lint impregnated with the gonorrhoeal matter, and allowed it to remain in the same place dur- ing twenty-four hours. They expected to see chancres spring up, but in one, a great degree of inflammation followed, with all the ap- pearance of what is called bastard gonorrhoea. A considerable quan- tity of fetid matter flowed from the inflamed parts, and for some days it was feared recourse must be had to an operation to cure a phimosis. However, by means of bread cataplasms, with solution of acetate of lead, laxatives, and, a severe regimen, the inflammation subsided, the discharge ceased, no chancres appeared, and he was soon quite well again. " The other was not so fortunate; the external inflammation was but slight; but the matter having gained access to the urethra, he was at- tacked the second day with a considerable degree of gonorrhoea, which lasted long enough to cause him much agony, and he did not get quite rid of it for a year. " He was thus convinced of the imprudence of making similar ex- periments, and was not tempted to prosecute them, although they were ardently continued by his friend, who shortly after the inflammation from the first experiment had subsided, introduced some gonorrhoeal matter on the point of a lancet, and also into the substance of the glans; but although he repeated this operation three times, no chancres were produced. There only followed each time a slight degree of inflammation, which disappeared without any application to it. His * Astruc, Frank, Bell, Wiseman, Howard, Capuron, Spnngemberg, Swediaur, Traite sur les maladies veneriennes, p. 136, Thomas Bartolin, Lisfranc, Fourcroy, Teytau, &c t Not having the above work to refer to, I was obliged to re-translate the passage. H. D. r 6 PRIMARY SYMPTOMS—GONORRHOEA. 45 last experiment was attended with more serious consequences. He introduced the suppuration of a chancre on the end of a probe, to the depth of three or four lines into the urethra: no symptoms of gonor- rhoea appeared; but in the space of five or six days, he perceived a painful inflammatory chancre on the spot where lie had applied the matter. To this affection succeeded a bubo, which suppurated, not- withstanding the immediate application of mercury, and the wound which resulted from it became very considerable, and healed slowly; ulcers of the throat followed, and he could only be cured by a con- siderable quantity of mercury, and was unable to leave his room for nearly a month. " I was, by these experiments, enabled to produce the most de- cisive proofs that it could be desired, of the difference between the matter of gonorrhoea and syphilis, and Jo show neither chancres nor other general symptoms can be produced by the matter of gonorrhoea, whilst that of syphilis, even to the secreting surface of the urethra, produces chancres, which afterwards introduce the infection into the system." We may add to the facts mentioned by Bell, that one named Val- entin, quoted by Freteau, tried several times without success to inoc- ulate himself with a gonorrhoea, without producing either chancres or even a discharge. It has been thought that the only difference which existed between chancre and gonorrhoea, was owing to the greater or less concentrated degree of the virus; thus forgetting this fundametal law of syphilitic diseases, that the intensity of the symptoms is never dependant on the acuteness of the disease in the person who infects, but in the person who is infected. Supposing variations in the strength and power of the virus, and the existence of superficial* and more penetrating syphi- lis, the virus of chancre in losing its strength would only be capable of producing gonorrhoea, which would be contrary to the opinion of Swe- diaur, who considers ulceration as the consequence of a less degree of irritation; but in this case, how can the virus, weakened in these, in its turn reproduce a chancre? In a more absurd explanation, it has been thought that the mucous membranes, affected with gonorrhoea, did not ulcerate, because the virus was envoloped in mucus. (Hufeland.) It is very possible that virus, thus incarcerated, might have no action up- on a healthy mucous membrane, but that it should produce ulcerations precisely there, without affecting those which had secreted it, or at least the neighboring or contiguous parts, is far too irrationable. M. Lagneau's theory, according to which a gonorrhoea only produces con- stitutional syphilis, when a part of the mucous membrane remains sound, to absorb the virus which is secreted by the infected part, is indeed not more admissible, particularly as experience leaches that the syph- ilitic virus cannot flf-w* over the skin or a healthy mucus membrane, without infecting it directly. As regards Swediaur's opinion, that gon- orrhoea ulcerates the tissue to produce general infection, it may-be re- * Some other authors, and amongst others M. Lagneau, give this synonym to gonorrhoea. 46 INOCULATION OF THE REPUTED duced to this proposition: that chancere alone can produce secondary symptoms. , . It has been thought that the cause of chancre and gonorrhoea being the same, the difference in the form depended upon the tissues affect- ed, and that thus the syphilitic virus applied to a non-secreting surface produced a chancre, and the pus of chancre upon mucous membranes only, produced gonorrhoea.* We know that gonorrhoeal matter never produces chancre on the skin, and that applied to mucous surfaces, when it acts, it only produces a discharge. The gonorrhoeal secretion, applied to the mucous membrane of the eye, has never produced chancres of the conjunctiva or eyelids, nor has the muco-purulent secretion of gonorrheal ophthalmia (ophthalmie blennorrhagique) ever produced chancres by inoculation or otherwise, although the eyelids are susceptible of being infected by chancre. We may add, that the muco-pus of a balantis, &c. the consequence of an impure coition, or produced artificially by an irritant, has never fur- nished a result by inoculation, and that these affections therefore can- not be followed by symptoms of constitutional syphilis, whenever they have existed, without chancres. Without, in this place, entering into the discussion and history of all the symptoms which have been attributed to gonorrhoea, there are two which are pretty frequent'and regular, as consecutive symptoms; these are buboes, (yet far less frequent than after chancre,) and swell- ed testicle (epididymite). I have ascertained by inoculation, that the pus from buboes which are consequent on gonorrhoea, does not inoculate, even should they terminate in suppuration, which is rarely the case, they otherwise par- take only of the nature of an engorgement or simple abscess, whose characters frequently correspond to strumous, and not syphilitic affec- tions. As to swelled testicle which, still more rarely suppurates, the pus never produced anything by inoculation. The observations made upon gonorrhoea, during my researches upon inoculation, lead to the following propositions—■ I. The matter of a gonorrhoea, applied to a healthy mucous mem- brane, causes gonorrhoeal inflammation so much the more easily the nearer it approaches the purulent form, and therefore, contrary to the opinion of Wathely, the less mucous its nature. II. Under no circumstances can it produce chancre; but as an irri- tating matter, like that of coryza for instance, it may excoriate the skin, with which it remains some time in contact, but it never produces a specific ulcer. Convinced of these truths, which were so often veri- fied, one of my pupils, M. Leon Ratier, often inoculated himself with * The pus furnished by a well established chancre, is sometimes sufficiently abundant to spread to the neighboring parts; when it is situate at the glans or interior of the pre- puce, it inflames and sometimes excoriates these parts, causes even new ulcerations, which soon produce fresh symptoms, in particular phimosis. PRIMARY SYMPTOMS—GONORRHOEA. 47 the muco-pus of gonorrhoea upon the skin of the fore arm, without any results. III. The consecutive, undoubted, and regular symptoms of gonor- rhoea, do not furnish an inoculable pus. IV. The symptoms of constitutional syphilis, are not the conse- quence of gonorrhoea. In all the cases in which authors mention that it was an antecedent, the frequency of which precisely corresponds with that of masked chancres, (chancres larve's,) the diagnosis was not correct; the diseased surfaces not having been examined. V. Lastly, the only correct means of diagnostic, in the present state of science, is inoculation. Every gonorrhoea which is tested by inoculation in its various periods, without producing any result, is only a simple affection, and incapable of communicating syphilis, whether primary in another subject, or constitutional in the one first affected. After having proved that gonorrhoea and chancre are two entirely distinct diseases, as regards their cause, form, and consequences, it remains for me to examine the other reputed primary syphilitic symp- toms. Section II. Chancre, the inevitable consequence of the application of the syphil- itic virus, either to the skin or mucous membranes in the proper state for inoculation, often presents such varieties in its material aspect, that it seems to constitute different diseases. These differences in chancre, being ill known, or not duly appre- ciated, have been for some, an argument against the identity of the venereal virus and its unity of action, and for others, the proof of the existence of a pleurality of the virus; but if well studied in its cause, which always remains the same, in the manner of its development and its consequences, in regular and uncomplicated cases, the apparent differences are easily explained, and all contradictions disappear; for, whatever may be the actual form of the chancre from which the pus is taken," provided it be taken during the period which I have before pointed out, a regular characteristic pustule is obtained, when the viru- lent pus is inserted under the epidermis or epithelium, an immediate (d'emblee) ulcer when it is applied to denuded tissues, or an abscess when it is introduced into the cellular tissue, a lymphatic vessel, or ganglion. Always keeping in mind the difference produced by the seat, and the particular tissues affected, we yet find an identity of appearance and regular characteristic features in the ulcer at its commencement; and that too, whether it be the consequence of the rupture of the pus- tule, the opening of a virulent abscess of the cellular tissue or lym- phatic ducts, or whether it have arisen immediately (d'emblee.) The deviations or peculiar forms only develop themselves after, and under the influence of circumstances foreign to the specific cause, such as: —the peculiar constitution of the patient, his former or concomitant 48 INOCULATION OF THE REPUTED diseases, and the general and local treatment to which he has been subjected. From this cause we see patients affected with phagedenic chancres, who have contracted their disease with persons who had ap- parently only benignant ulcers; and the vulgar opinion entertained by many practitioners, that a virulent affection must have been contracted with a very diseased person, is entirely false. Inoculation has placed the regularity of the commencement of chan- cre in its different forms beyond" all doubt, and explained its deviations. It is, as we have seen, inoculation which has enabled me to distin- guish these two very distinct periods of chancre, viz., the period of ulceration, which may be still increasing or arrived at a stationary state, in which there is a balance between the nutrition and source of ulcera- tion; and the period of reparation, either by passing to the state of a simple ulcer, or to the transformation in situ, or to secondary symptoms on the spot (symptome secundaire sur place.) The period of the specific ulceration is unlimited in its duration, pre- serving the characters of the primary ulcers; thus I was enabled to inoculate the pus furnished by ulcers which had already existed eigh- teen months. The different periods of chancre may always be deter- mined by inoculation. If inoculation has already furnished us curious and important results, the history of buboes will be yet more interesting. Section III. The bubo, so frequent a symptom of venereal diseases, and which was so well described by Guillaume de Plaisance,* although Astruc considered it as one of the symptoms which has only been attendant on syphilis from a recent epoch, was not always well known to the an- cient writers on syphilis, which explains the singular assertion of As- truc, nor even to the authors of our own times, as may be seen by the writings of modern authors, and the objections which have been made to my researches.f * Guillaume de Plaisance wrote in 1343. t " The pus formed in the buboes which accompany ulcers, whether primary, or sec- ondary, or gonorrhoea, may be introduced under the epidermis, or epithelium, with im- punity." M. M. Cullerier et Ratier, article Inoculation, Diet, en 15 vols. " Inoculation has been proposed as a means of diagnostic between sympathetic and syphilitic buboes; most experimentators, amongst others M. Cullerier, obtained nothing by the inoculation of the pus of buboes, which it was most natural to regard as syphilitic. M. Ricord. on the other hand, says he has obtained th^e characteristic pustule whenever the bubo was united with a chancre, or a vaginal discharge, which took its sourse from ulcerations of the neck of the uterus. The few experiments I have made, or seen per- formed by my friend and colleague. Dr. Manec, afforded, like those of M. Cullerier, a negative result. As most of the buboes in women terminate by resolution, the cases in which inoculation would be practicable, are very limited." M. Gilbert, manuel des ma- ladies venfriennes. Paris, 1836. M. Ruef, of Strasburg, has also said that all buboes were not capable of being inocu- lated, without mentioning the cause of this difference, although he was present at my ex- periments, which he probably did not recollect. PRIMARY SYMPTOMS—BUBO. 49 Inoculation, applied to the study of this symptom, has established, by experiment, the following species:— I. A bubo may be simply inflammatory. (a) By propagation of the inflammation by continuity, without re- gard to the particular nature of the primary affection which produced it, whether this was a gonorrhoea, a chancre, or other lesion. (6) By sympathetic reflection. II. Virulent, that is, owing to the direct absorption of the specific pus of syphilis, and in this case, it is strictly the consequence of chan- cre, the pus of chancre alone can produce it. III. Superficial or profound, or present these forms at the same time. IV. Seated in the cellular tissue, the lymphatic vessels, or ganglions, separately or. differently combined. V. Chronic or acute. VI. Preceded by other symptoms termed primary, or show itself immediately (d'emblee). VII. When other symptoms have shown themselves before it, it may succeed them immediately, and then be only a successive symp- tom, or only manifest itself at the period of general symptoms of sy- philis, and constitute the secondary bubo. After having convinced oneself of the truth of the divisions which I have just established, we are astonished to hear otherwise learned and candid men say, that my experiments of inoculation, as regards buboes, have no value, as they have found them sometimes succeed and sometimes fail; and, consequently, as a bubo does not always in- oculate, inoculation is an uncertain means, either of proving, as we have said elsewhere, the existence of the virus, or of diagnostic; not perceiving that this pretended uncertainty of inoculation, was what es- tablished its absolute value. Whenever an inflammation of the cellular tissue, or lymphatics of the inguino-crural, or other region, have been the consequence of any other cause than chancre, if suppuration has supervened, it has never produced anything by inoculation, in whatever may have been the pe< riod or the conditions in which the pus was taken. Thus it is, for ex- ample, that when a bubo had been preceded by a gonorrhoea, it never, when it came to a state of suppuration, as we before said, furnish- ed an inoculable pus; only when a bubo is preceded by a chancre, can it furnish a specific pus capable of inoculation. But because a chan- cre has preceded a bubo, it does not follow that it will afford a speci- fic pus; in this case, the bubo must not be the result of a simple in- flammation from sympathy or succession, but there must have been ab- sorption. Absorption, when it takes place from a chancre of the sex- ual organs, only occurs in the superficial glanglions, and most frequent- ly in one at a time, although several ganglions, either superficial or deep seated, may be inflamed or swollen at the same time,* so that * If the name of bubo be applied to every glandulary engorgement, which may occur in the neighborhood of parts actually affected by a reputed venereal affection, the division 7 50 INOCULATION OF THE REPUTED one ganglion presents all the characters of a virulent bubo, whilst the neighboring ganglions, in which the inflammation may come to sup- puration, as well as in the surrounding cellular tissue, only present a simple and non-virulent character. . I was some time in recognizing these conditions, and in explaining to myself why all buboes did not inoculate, as asserted by those who have repeated my experiments, without being well acquainted with them; and how it happened that a bubo, whose pus did not inoculate one day, often did the next; or that in a bubo with separate centres, and which might be called multilocular, one of these centres furnished an inoculable pus, and the others not. I then began to make my experiments more precise, and I first in- oculated all the buboes at the moment of opening them, with the first pus which escaped, and the result was negative, which explained to me the assertion of M. Cullerier, who had perhaps only made his ex- periments under these circumstances, or in cases of simple buboes. I then took pus from the same buboes, two, three, four, five days and more, after the opening, and then it gave, in many instances, posi- tive results, and in others, inoculation continued to produce nothing. In the first case, the centre, (foyer,) as well as the edges of the open- ing, soon assumed the character of chancre, whilst in the second, the abscesses followed the march of simple phlegmonous or lymphatic ab- scesses, progressing towards healing. However, there remained an important question for me to decide, viz., whether in the cases where the pus of the bubo did not inocu- late at the moment of being opened, it would acquire its inoculating quality by contact with the air, or by becoming subsequently mixed with the pus of a pre-existing chancre, or in any other manner. The solution still appeared very difficult, when a patient presented himself to my notice, with a bubo consequent on a chancre, and a copious sup- puration. I opened the abscess ; but after having evacuated the pus of the cellular tissue, I found, in the midst of the centre, a very large lymphatic ganglion, with evident fluctuation in its centre. I opened it, and made with the pus it contained an inoculation, and a similar one with pus taken from the surrounding parts, viz. the cellular tissue; and, whilst the pus taken from the ganglion produced the characteris- tic pustule, that from the cellular tissue remained inert. 1 was then convinced that the difference did not depend upon chance, or things which only occurred after the opening of the buboes, but upon the pus not having been sought where it was situated. After this observation, I made a series of experiments, which left no further doubt as to the results of inoculation. of buboes into superficial and profound, is correct; but if only those be considered sy- philitic buboes, which are the result of the direct absorption of pus, there only exist su- perficial buboes, and the opinion of my colleague and friend, M. Phillippe Boyer, is cor- rect. (De la syphilis. Paris, 1836.) As in the study and treatment of buboes, there are other things to be attended to beside the syphilitic virus, this distinction of profound and superficial buboes, upon which M. Desruelles particularly insists, ought to be adher- ed to and studied with care. PRIMARY SYMPTOMS—BUBO. 61 I then selected some buboes in which the suppuration was well ad- vanced, and which had been preceded by chancres. I made an, inoc- ulation with the first pus which escaped at the moment of opening, and then emptying them as completely as I could, I sought in the depth, by the help of a great opening and in suppurated ganglions pus, to in- oculate in its turn. The results were like the first: with the superfi- cial pus, nothing; with the deep seated pustule. However, it is easy to be imagined, that in a case where suppura- tion has existed a long time, the virulent ganglionary pus may become to the surface, or be mixed in sufficient quantity with the surrounding phlegmonous pus, for this to inoculate at the moment of the opening, which in one observation seemed to be the case. Thus it being diffi- cult to separate the layers of simple from those of virulent pus, it is easily to be understood that apparently contradictory results might be found; but the number and regularity of the experiments I have made, more than suffice to remove every doubt. The same results have been obtained with pus taked from the origin of the lymphatic vessels. We frequently see the lymphatic vessels inflamed in their whole extent, between a chrancre and the ganglions, in which they terminate. The disease of the lymphatic vessel may take place without the ganglions being necessarily affected. A chan- cre may even exist on one side and occasion a bubo on the other; in which case, the absorbent vessels may remain healthy or become en- gorged, marking their course from one side to another, crossing the median line. Whenever the inflammation of the vessels terminate in suppuration, and is the consequence of absorption of chancre pus, it has in its turn furnished an inoculable pus. We have already seen that the phlegmonous bubo, or the simple suppuration of the cellular tissue, if the source did not afterwards be- come infected by contact with virulent pus, proceeding from some part and generally from the opening of a contaminated ganglion or lympha- tic vessel. There may be, however, abscesses of the cellular tissue, primarily virulent; they are generally situated very near the chancre and are produced by the infiltration of the pus underneath the skin and subcutaneous cellular tissue. An indurated corde is in this case often felt between the chancre and the abscess, which might be taken for a lymphatic, but is in fact only indurated cellular tissue. These absces- ses inoculate the very moment of their being opened, and with all the pus they contain, without distinction. When the profound ganglionary engorgement, called deep seated buboes, suppurate, which is far more rarely the case than in superfi- cial ganglions, the pus they furnish never inoculates, unless they be subsequently soiled with matter from a neighboring chancre, or an in- fected superficial ganglion; but in this case, the deep ganglions are never infected by way of absorption. It may be positively asserted, that the absorption of the virulent pus, preserving its capability of be- ing inoculated, does not pass the first ganglion by direct means of ab- sorption from the chancre, to which the bubo succeed*!. 52 INOCULATION OF THE REPUTED A question of the greatest interest, which has not always been an- swered in the same way, is the existence of bubo, as primary symp- tom (d'emblee.) Do primary syphilitic buboes, in the strictest sense of the word, re- ally exist; that is, without any antecedent than an impure coition, and without concomitant symptoms, to which they might be attributed. Men of equal celebrity have replied in the negative, and in the affirma- tive to this question. If the patient be closely and minutely questioned, one will soon be convinced that the reputed primary buboes are very rare; for most frequently in those which were supposed to be such, we find the cause so evident that we are surprised that the patients themselves did not perceive it; thus patients, who have only become aware of their dis- ease by the development of a more or less painful tumor at the anus, will only speak to you of this tumor, which they only perceived the day previous, or even that day. If you interrogate them, they state the last coition to have been a fortnight, a month, or more, previous; if they be then examined, a chancre will be found; often pretty ex- tensive, upon the penis, prepuce, or some neighboring part. Yet, after an unclean connection, the engorgement of the ganglions, situate near the sexual organs, become, though rarely, primarily diseased. There are some circumstances in which it is impossible to find any suspicious antecedent or concomitant, and we are then obliged to admit the existence of the primary non-consecutive bubo, (bubo d'emblee). If these engorgements be attentively examined, without being led into error by those which may resemble them, it will be found that they generally make their appearance in the deeper ganglions, and not unfrequently even in those of the fossa ilica, or at least the subapone- vrotic of the thigh; that their progress is often chronic; that they are a long time indolent and have little tendency to suppuration; but what is most remarkable, is that when they suppurate, the pus they furnish does not inoculate: hitherto I have never found a bubo with all the rational signs of a nonconsecutive bubo, (d'emblee,) which furnished an inoculable pus. If to this important observation be added, that after very careful researches, I have never found that a strictly speak- ing non-consecutive bubo has been followed by symptoms of general syphilis; the importance of inoculation in this case will be apparent. Moreover, as regards absorption in general, the lymphatic vessels must have orifices, opening on the mucous or cutaneous surfaces; for under the hypothesis, according to which absorption must be preceded by a kind of imbibition, the tissues which are impregnated with pus would be first infected, as this pus necessarily produces ulcerative inflamma- tion wherever it penetrates, except in the lymphatics, when their in- ternal membrane is entire; for if this be not the case, we see them at- tacked, as in the case of lymphitis, to which we have already alluded. In the present state of science and our experience of inoculation, applied to the study and diagnosis of bubo, we may conclude:— I. That the virulent bubo, or that from the absorption of the pus of PRIMARV SYMPTOMS—MUCOUS TUBERCLE. 53 chancre, is analagous to chancre, as regards its nature, and only differ- ing in its seat. II. That the virulent bubo is the only one which inoculates. III. That the signs, without exception, which have been pointed out by authors to distinguish virulent buboes, from the engorgements with which they might be confounded, only serve in most cases to es- tablish a rational or probable diagnosis; and that inoculation alone can be considered as an unexceptionable and pathognomonic sign. IV. That if in a great many cases of supposed non-consecutive bubo, an exact diagnosis were not absolutely necessary to regulate the treatment, and determine the prognosis of the future chances of the patient, when suppuration does exist, it ought to be tested at every period of its duration; experience having shown that buboes, which do not inoculate, (when the experiment is properly made,) are never followed by secondary symptoms, and that they are therefore not syphilitic; whilst other causes, which often escape our notice, and without being connected with syphilis, may give rise to engorgements of the lymphatic system of one region of the body, as well as of another; and that it would be absurd to conclude, that a bubo is neces- sarily syphilitic, because it appeared soon after a coition. Section IV. One reputed primary symptom remains to be examined: the mu- cous pustule, (pustule muqueuse, pustule plate, humide, tubercule muqueux papule muqueuse). At whatever period we have examined it, or whatever may have been the antecedents of the mucous pustule, it never produced any- thing by inoculation. The morbid secretion which it produces, has been inoculated with a lancet, applied to vesicated or rubbed upon de- nuded surfaces, retained on points of the skin from which the hairs had been plucked out, but all without any result; and yet the contagion of mucous pustule seems to be proved, and in some individuals it seems to be the first symptom with which syphilis makes its appearance. But contagious, by an intangible vital process, which cannot be ex- plained, the mucous tubercle cannot be transmitted by means of in- oculation. This curious symptom, so obscure in its commencement, and so insidious in its progress, forms the connecting link between the regular and characteristic point of commencement of syphilis, chancre, and the symptoms of general infection. Apparently similar to chancre in being thought like it, contagious, and perhaps the beginning of syphilis, it differs from it in the results of inoculation. Resembling the secon- dary symptoms inasmuch as like them it succeeds to chancre, and can propagate itself by way of inheritance, and furnishes nothing by inoc- ulation. However, the mucous tubercle, which some authors have wished to divide into two species, the primary and the secondary, and which is 54 INOCULATION OF THE REPUTED evidently the same in its nature and source in all cases, only differing in its antecedents, which are often very difficult to determine, is also one of those symptoms which, although very characteristic of syphilis, have not been well examined. If examined with regard to its causes, seat, form, progress, concom- itant symptoms, and consequences, it possesses so much interest, that we may be excused if we pause a moment to consider it. It may be confidently asserted, that the regular and constant ante- cedent and specific cause of the mucous tubercle, is chancre. In an individual, actually affected with mucous tubercles, we find either that they have been preceded in himself by chancre, or that he has con- tracted them from an individual who has had chancres; in short, we find, if we do not rest satisfied with a superficial examination, that there has been, either in one individual or other of those who have apparently transmitted the mucous tubercle, a chancre as the starting point. But an incontestible fact in the history of the causes which preside over the developement of mucous tubercles is, that all individ- uals are not susceptible of them; if they can be situated on the mucous membranes, yet all parts of the skin are not equally susceptible, and must naturally or by a morbid process be related to the nature of the former, in order ro become affected by it. Thus persons of a lym- phatic habit, women, and children, are most subject to it; the mucous membranes of the genitals, anus, and mouth, are most frequently attacked; and the skin is seldom affected by it, except around the sex- ual organs, anus, or umbilicus, in the meatus auditorius externus, be- hind the ears, &c. In its material form, or in the lesion of the tissue which constitutes it, the mucous tubercle, especially when isolated, is very often diffi- cult to distinguish from chancre during the period of unhealthy granu- lation, (reparation vicieuse,) in most cases the remains of the abrupt edges of chancres distinguish them from the less defined base and cir- cumference of the mucous tubercle; but in chancres, which have re- mained superficial, and which quickly pass the state of granulation, or into one of the varieties of ulcus elevatum, the distinction is no longer possible. It is very evident, that the mucous tubercle is far more common, as secondary symptom, than as reputed primary. If, on the other hand, it be considered that in the latter case it is far more frequent in women and children, where the chancres to which they owe their ori- gin may have remained unperceived or concealed; that the time at which the patient complains of, and we are called to observe them, is more or less remote from the time of infection, and at the time when true secondary symptoms may already have developed themselves, it will be easy to admit that a chancre has preceded it; the more so, if a patient only presents one or two mucous tubercles upon the parts generally subjected to contagion, without other antecedents than con- nection with an infected individual. To accurate observers, it must be clear that these are only chancres in an unhealthy state of granula- PRIMARY SYMPTOMS—MUCOUS TUBERCLES. 55 tion or transformation in situ. We also often find, in the midst of a knot of mucous tubercles, an untransformed chancre, which affords an inoculable pus. In other cases, the tubercles are in great number, often upon different parts of the body at once, or accompanied with other symptoms, which leave no further doubt as to their characteris- tic and specific form, and their nature as symptomatic of constitutional syphilis. We must not, in this place, forget, that of all the secondary symp- toms the mucous tubercle can appear the soonest; and, as before said, not only at a distance from the point of infection, but also on the same spot as the primary ulcer, and by an insensible change, in situ, from inoculable chancre to tubercle not possessing this property. We must now examine whether the mucous tubercle can succeed to a gonorrhoea. The following are the results I obtained. A gonorrhoea, properly so called, i. e. a muco-purulent discharge, uncomplicated with chancre and therefore not inoculable, was never followed by mucous tubercles, or either there existed at the same time a concealed chancre, (chancre larve,) or it was only one of those discharges which are concomitant or consecutive to mucous tubercles, and which superficial observers might then regard as the primary cause of them. I confess I was long before I discovered this fact, that, where the mucous tubercles develope themselves, they not only gen- erally furnish a peculiar morbid secretion, but also cause a cattarrhal flux of the mucous tissues on or near which they are seated. From the foregoing, I have drawn the following conclusions— I. That the mucous tubercle never inoculates; II. That it ought to be placed with the secondary symptoms, and is a proof of constitutional syphilis; III. That the secretion which it may produce, acting like irritating matter, causes inflammation of the tissues with which it comes in con- tact; IV. That when syphilis has been transmitted to an individual from mucous pustules, there must have been other specifically contagious symptoms at the time of the infection; V. That like the other secondary symptoms, the true mucous pus- tule can only be transmitted by inheritance. CHAPTER III. INOCULATION DISTINGUISHES PRIMARY FROM SECONDARY SYMPTOMS.* The celebrated Hunter had already established, by accurate and * My clinical observations have led me to the following classification of the symptoms of syphilis. I. Primary symptom, (accident primative,) chancre from the direct action of the virus 56 INOCULATION DISTINGUISHES PRIMARY learned experiments, the fact, since confirmed by a great number of other experiments, that the symptoms of constitutional syphilis cannot be inoculated. , Notwithstanding the authority of such a master, and adhering to the principle I had adopted of raising rational and philosophical doubts upon every point, I have examined one by one all the reputedly sec- ondary symptoms of syphilis, and the results have been in conformity with the facts established by Hunter. But from this great and acknowledged difference between the pri- mary affection, chancre, and its secondary symptoms, can it be conclud- ed, as M. Richond and the fosterers of the doctrine he supports have done, that the principle of syphilis cannot be identic and peculiar; since when it produced its most decided and characteristic effects, it then ceased to possess its most energetic qualities, the possibility of inoculating? My researches having made me better acquainted with the primarty symptom of syphilis, its true commencement, I arrived at this conclu- sion, which has been established by most good observers, that all the reputed secondary symptoms are far from being specific. That the which it produces, and by means of which it propagates itself by contagion from a dis- eased to a healthy individual, either by inoculation in the same manner, or in the indivi- dual himself from one point to another, without being transmitted by inheritance with its principal character—the possibility of inoculating; but capable of producing the pri- mary infection of the infant, at the moment of its birth or afterwards. II. Successive symptoms, (accidents successifs,) or those which arise from contiguity of tissue, or by simple extension of the first local symptom, as new chancres; simply in- flammatory, or virulent abscesses, or adenitis, &c. III. Secondary symptoms, or symptoms of general infection, in which the virus has undergone a modification and produced the syphilitic temperament ; symptoms devel- oping themselves upon the skin, the mucus membranes, the eyes, testicles, &c. and seldom happening before the two first weeks of the duration of the primary affection, chancre ; but generally after the fourth, sixth, eighth, or even much later; never being capable of inoculating, if we are well able to re&egnize them, and if we do not allow ourselves to bo deceived by the patients. These secondary phenomena can be trans- mitted by way of inheritance, and that in a most incontestable manner, from mother to child, which then presents after its birth general symptoms corresponding to those of tho mother, without previous primary affection, and without their being attributable to the previous or subsequent action of the sympathies upon them, by the sexual organs of the father or mother, two or three months after birth. IV. Tertiary symptoms, (accidents tertiaires,) occurring at indefinite periods, but generally long after the cessation of the primary affection ; only showing itself in most subjects, after secondary symptoms have occurred, and still exist or have disappeared, which ought not to be neglected for the diagnosis ; symptoms which not only no longer inoculate, but which are no longer capable of propagation by inheritance, with the spe- cific characters of syphilis, like the secondary, and are perhaps a frequent cause, by gen- eration, or the production of scrofula, which often is but degenerated syphilis. Under the head of tertiary affections, we must place nodes, deep seated tubercles, tubercles of the cellular tissue, periostoses, exostoses, caries, necrosis, syphilitic tubercles of the brain, which I have described and shown to the Acadtmie de Medicine ; internal affec- tions which have been hitherto ill defined, (Sanchez,) &c. V. Lastly, other diseases, unconnected with syphilis, which however may have favor- ed their development, such as cancer, phtisis, scrofula in the individual primarily affect- ed, which must be distinguished from the transmitted scrofula, which we mentioned above, scurvy, various acute or chronic inflammations, which possess no specific quality, and which, from the apparent antecedent, might be attributed to syphilis, and would thus become the source of serious errors and obstacles in the treatment. FROM SECONDARY SYMPTOMS. 57 infection by the venereal virus may produce in the system disturbances, lesions, and the development of morbid symptoms, resembling those which another non-specific cause might have equally produced, but which independently of these symptoms may be the most common, and which afford a fallacious support to the doctrine of the non-specific na- ture of syphilis, or the non-existence of»the virus; there are some, regular and characteristic, occurring as necessary and invariable con- sequence of the primary infection, and which are the result of chan- cre, under one of the forms we have above assigned to it, or the pro- duct of inheritance, which only military surgeons can deny, for want of a proper field for observation. In following the pus of the chancre in its penetration into the sys- tem, if I may so express myself, we have seen that as long as it was only imbibed by the cellular tissue, at whatever depth it might arrive, it preserved its characteristic, property, the possibility of inoculating. The same was the case with the vasoe lymphaticag afferentes, which run from a chancre to the first ganglion, in which they terminate, and that beyond this point, where the mixture with the circulation and other organic materials by this kind of ganglionary digestion, which takes place in the lymphatic system, begins, the virulent pus under- went a transformation which without depriving it of its specific nature, with regard to the symptoms it produces in the system, destroyed the possibility of its inoculating. That it was only by this modification that the syphilitic temperament could establish itself, so as to give rise at a future period to the diathesis, by the development of secondary symptoms; that, without passing through the lymphatic system, this result was the consequence of venous absorption: it not being requi- site for the development of the symptoms of constitutional syphilis that the virus should pass through the lymphatics, or that the produc- tion of buboes should precede it. But if absorption of the venereal virus does undoubtedly take place in two ways, first, by the lymphatics without alteration in the primary qualities till it arrives at the first ganglion; secondly, by the veins thus directly infecting the system and so easily producing cutaneous affec- tions, as we observe in ail cases in which deleterious substances are injected into these vessels; it is very remarkable, that we have never found inoculable pus in the veins, however near or remote from the chancre;* once united with the blood, the virulent pus no longer in- oculates. * M. Jourdan says, in his treatise on venereal diseases, vol 1, p. 499, (Traite des maladies veneriennes: " The blond of an individual affected with syphilis is not more infected than it is in variola, according to Darwin; or in hydrophobia, according to M. M. Trollier et Berthold. " The blood of a syphilitic patient, says Hunter, is not contagious. It may be inocu- lated without fear of the disease; for if it were capable of irritating a simple wound and producing in it a venereal inflammation, every individual in whom this matter circulates, or who is attacked with svpeilis, must necessarily have a venereal ulcer wherever he might wound himself, or oven scratch himself with a pin, the part thus ulcerated, would become a chancrj." Bell thinks that this happens sometimes, but he particularly insists that it is in the very advanced period of the disease. I think Bell did not well observe the circumstances in which this happened. 8 58 INOCULATION DISTINGUISHES PRIMARY &c. We must be careful not to be imposed upon by what frequently oc- curs in men affected with chancres on the glans, or prepuce; I mean, those engorgements like a cord stretched along the dorsum penis, and which is commonly called dorsal phlebitis of the penis. I have fre- quently had an opportunity of observing this symptom, and of prov- ing that it was owing to an inflammation of the lymphatics and not of the veins; observing that this kind of cord, which is frequently knot- ty, runs from the chancre to the ganglionary regions, without ever pass- ing them, and that it does not present the uncertain course as regards its limit, extending itself towards the centres of the circulation, which the venous inflammations so unfortunately do, we are led to acknow- ledge that the lymphatics alone can present these conditions; but if, as I have done, the diseased parts be dissected, pathological anatomy leaves no further doubt. When they suppurate, which is not very rare, and the abscesses open or are opened, we find pus not mixed with the blood, as is the case, either in clots or otherwise, in phle- bitis. If, however, all good observers are agreed, as to the impossibility of inoculating with the lancet the pus or morbid matter produced by the secondary affections, as well as the different normal or abnormal secretions of individuals reputedly affected with constitutional syphi- lis, some men may have been misled by symptoms which, from their seat and the time at which they were developed, might, upon a super- ficial examination, be attributed to general affection; thus I have found primary ulcers of the lips, tongue, and even of the pharynx, which had been contracted directly and by illicit means, and which necessa- rily furnished an inoculable pus; symptoms, whose true cause, or the manner in which they were infected, the patients sought to conceal : this is perhaps still more the case with diseases of the anus. In indi- viduals affected with the itch or prurigo, during the existence of a chancre, and who in scratching themselves inoculate themselves on different points of the skin, and cause, in the midst of the other erup- tion, the production of the primary pustule of chancre, one might be- lieve in the existence of secondary syphilitic ecthyma or rupia, which would present in this circumstance, if ill appreciated, the apparently contradictory fact of the possibility of the inoculation of general symp- toms. From the facts relative to inoculation of the secondary sym toms, we must conclude. I. That it does not follow that because a symptom does not inocu- late, it is not syphilitic, whilst the virus, modified by venous absorp- tion and susceptible of poisoning the system, loses this quality, and retains that of propagation by inheritance alone. II. That whenever a symptom, whatever may be its seat and ap- parent form still inoculates, it is necessarily the produce of a direct contagion, and not the result of a general infection, owing to absorp- tion from another point, and does not indicate the actual venereal tem- perament, or in received terms, constitutional syphilis. INOCULATION SERVICEABLE IN THE THERAPIA. 59 CHAPTER IV. INOCULATION SERVICEABLE IN THE THERAPIA. Section I. Dishonesty and the speculation of quacks, which continually make the most sacred science subservient to their purposes, have availed themselves of the inoculation of syphilis, like every other means of success and celebrity; but if there be men who are reckless of con- sequences, there are some too whose actions are guided by the inter- est of science alone, and whom no imputation can affect. Thus inoculation has been employed in the study of the prophylaxy of syphilis; in this study, which cannot be too much encouraged, and which we do not doubt will one day arrive at the discovery of an ab- solute neutralizing substance, for the specific principle of syphilis; but in this case it is apparent, inoculation neither has been, nor can be employed, like that of vaccine to prevent variola, and it has been only used to prove the efficacy of any preservative. With this intention, Luna Calderon* made his experiments, which, though they were so ill received at a time when the search for a pre- servative against diseases sent by Heaven to punish libertinism, was perhaps still regarded as a sacrilege, the facts which he has furnished, which are favorable to inoculation, and the demonstration of the re- sults of prophylaxy, ought to be mentioned in this place. A com- mission, appointed by the Socif'te du cercle medical, and composed of M. M. Capuron, de Mangeon, Gardien, and d'Olivera, assembled in the venereal hospital of the capital for this purpose. " First Experiment, with previous resolution to permit the infection. 11 November the 7th, 1812. The assistant surgeon selected, in the public receiving rooms, a well characterized venereal chancre, and dipt a lancet in it. I scratched myself with this instrument on the ex- ternal part of the right side of the prepuce, without making it bleed. Five days after I went to the hospital, accompanied by the members of the commission, and made them observe a slight ulcer upon the scratched part, and a discharge of pus between the prepuce and glans, (gonorrhee externe); the glands in the left groin were a little swollen. The surgeon-in-cbief declared he would determine if the infection was truly venereal, and that we must wait some days before curing me. I consented to it, and waited till the ninth day; I then presented myself again: the ulcer was become a well defined chancre. There were al- so three other little chancres surrounding it. All present declared the * Demonstration pratique de la prophylaxie syphilitique, par le docteur Luna Calde- ron publieo 4 Paris, en 1815. 60 INOCULATION SERVICEABLE venereal infection perfectly characterized. I then undertook to cure myself, and in thirty days, nothing more remained. " The object having been fully attained, the experiment was cer- tified by the commissioners, and entered in the register of the hos- pital. " -Second Experiment, with the previous determination of protecting myself. " December 18th, I again scratched my prepuce with a lancet, dipt in a venereal chancre, chosen with the same precision and the same circumstances as in the first experiment. Immediately after, I applied the preservative to it. At the end of five days, I went to the hospital to have the result certified; neither an ulcer nor lesion of any kind was to be seen upon the prepuce. " The object of preserving myself was attained. The experiment was certified, &c. " Third Experiment^ with previous determination to protect my- self. " December 30th, I made a similar trial, and presented myself, January 9th, 1813; the prepuce was well and showed no mark of infection. " Fourth Experiment, with previous determination to protect my- self. " On the 9th of January, after having had the former result certified, I scratched another place on the prepuce, under similar circumstances, and applied my preservative to it. Eight days after, I again present- ed myself without having perceived the least sign of ulceration on the prepuce. " Fifth Experiment, icith a bloody incision. " Having gone before the commissioners, on the 17th of January, I prepared to make an incision instead of a scratch; but at the instant of making this incision, I foresaw that the wound might afford too slight a suppuration for the experiment to appear decisive; I then determin- ed to annul this trial and to vary it in the following manner, so as to obtain a decided result. " Sixth Experiment, with a double incision: the one simple, without (.ntagion, the other contagious. " My aim in this experiment was to show the contagious incision, cicatrized in the same time as the non-contagious incision, by prevent- ing the development of the infection in the inoculated point, by means of my preservative. The 10th of February following, I made two in- cisions: one contagious, on the left side of the prepuce, with a lancet dipt in the virus; the other non-contagious, on the right side, with a clean lancet. I also scraped the part between the two incisions till it bled, with a lancet dipt in the virus; I applied my preservative to the two inoculated points. " I presented myself at the hospital on the 17th of the same month; the two points that had been inoculated, and that which had not, were all three equally cicatrized. IN THE THERAPIA—PROPHYLAXY. 61 " This double and threefold experiment has proved, that by means of the preservative the contagion did not develope itself in the inocu- lated points; for the contagious incision, and the part scraped till it bled, would not have cicatrized in the same time as the simple inci- sion, if the infection had developed itself; thus the object was attain- ed. l' Seventh Experiment, of a double contagious inoculation, in two different points, ivith the design of protecting the one by means of the preservative application, and permitting the developement of the disease in the other, by not applying the preservative. " February 17th, I scraped the left side of my prepuce till it bled, with a lancet dipt in the virus, and I made in the same manner, a con- tagions incision on the right side; I applied the preservative to the scraped part and not to the incision. On the third day, the scraped spot showed no lesion, and the incision presented a characteristic ve- nerial ulcer. u Eighth Experiment, with the determination of preserving myself. " March the 24th, I took a lancet that had been dipt in the virus, and scraped the left side of the prepuce, in the same manner as before. Five days later, I presented myself without the least mark of disease on the scraped point. " Ninth experiment, two points scraped, with previous determination to protect the one and not the other. " On the 12th of May, I scraped each side of my prepuce, in the same manner as befrre. I then applied my preservative to the right and not to the left side; but stated beforehand, that if the preservative spread by chance from one side to the other, the two points would be equally preserved, and consequently the infection on the left side could not be obtained. Seven days after, I presented myself at the hospital, without the least mark of disease. My conjecture being realized, the experiment was certified, &c. u Tenth Experiment, contagious incision, ivith determination to pre- serve myself. " March* the 19th, T made an incision on the left side of my pre- puce, in the same manner as before. On the 26th, I presented myself, without the least sign of disease. " Eleventh Experiment, double incision, both contagious en each side of the prepuce, with a previous determination of preserving one side and permitting the infection on the ether. " June the 3d, I made three slight and contagious incisions, very near each other, on the right side of the prepuce, and three, also con- tagious, on the left. 1 applied the preservative on the right and not nn the left side; and to avoid the inconvenience which had prevented our aim being attained in the ninth experiment, I placed some lint between the sides, to prevent the preservative spreading from one side to the other. On the third day, the wounds, where I had applied the preservative, were cicatrized; but the wounds on the left, presented a well marked * Quere—May. H. D. Q2 INOCULATION SERVICEABLE chancre; a bubo also appeared in the left groin. I was cured of all in less than twenty days. , "The object of this experiment was accomplished, as well as that of all the others. ... " During the intervals between each sitting, 1 presented myselt at the houses of each of the commissioners. " More than a year has elapsed since these experiments terminated; I have still the cicatrices on the left arm, remaining from other experi- ments made many years since. No one ever knew me in better health, than I now enjoy." Luna. To the researches and experiments of Luna Calderon, to whom the just reproach is made of having kept his preservative secret, and which in all probability in some kind of caustic soap, may be added the experiments made with different agents, such as the product of normal and morbid secretions, chemical and medicinal substances. The pus of chancres mixed with— urine, vaginal mucus, muco-pus of gonorrhoea, . belanitis, . vaginitis, saliva, fecal matter, perspiration, semen. In all these mixtures, the virulent pus of chancre underwent no modification, which could change its nature or decompose it; but it must be observed, that to secure its action, the pus must not be too much diluted, for if mixed in too small a quantity, it cannot communi- cate its contagious property to all the liquid which serves as a vehicle for it. Whenever I have inoculated the virulent pus of a chancre, mixed with a caustic alcali, or a w7eak acid, the results of the inoculation have been negative, the chemical substances decomposing it, not that they have peculiar specific virtues, as some have thought, but by their property of destroying matter or organic products without distinction; thus sulphuric, nitric, hydrochloric, and acetic acid, and the pure chlor- ides, mixed with virulent pus, have constantly prevented it from acting by inoculation; and whilst the pure pus inoculated in the same subject produced a pustule, the pus altered by one of the above-named sub- stances always remained without effect, when placed side by side with the former and in the same condition, except the neutralizing agent; the same was the case with the caustic alcalies, potass, soda, volatile alcali, wine and alcohol; a concentrated decoction of oak bark, pro- duced the same results. But if these substances, from the consequences they produced after inoculation, have been considered as prophylactics, it must be under- IN THE THERAPIA OF THE SYPHILIS. 63 stood that the results only followed when the mixture was made be- fore or at the instant of the inoculation; for as soon as the virulent virus has been implanted in the tissues, if we may be allowed the ex- pression, and these infected, even in the first days, unless the parts be destroyed by a real cauterization to a greater depth than those which have been contaminated, the neutralization does not take place, and the chancre is developed. From very exact experiments with in- oculation, we find that the efficacy of any of the above-mentioned prophylactics cannot be depended upon for destroying the virulent pus, which has even only just been put upon an entire surface, or momen- tarily to destroy a virulent secretion of an individual who could other- wise communicate disease. As to mercurials, a proof of whose specific action some persons have thought to find in advancing, that mixed with virulent pus they destroyed its contagious property,* they only act in two ways, either as caustics or coagulants, as corrosive sublimate does, either in powder or in solution, and this is here only a chemical action; or being mixed with fatty substances, which then only oppose themselves mechanical- ly to the application of the virus, and even this does not always take place. A fact, perhaps not without some interest, ought not to be passed over unnoticed. M. Mala part, in his Theorie du treatcment du bubon par le vcsica- toire et la solution de sublime corrosif, says, " that the mercurial pre- paration used as a caustic, had also another beneficial action, in neu- tralising the virus on the spot, and thus transforming a virulent into a simple or benignant bubo." We have found, however, that buboes which were treated in this manner, and according to the indications the author has himself given, and which were arrived at suppuration, have furnished an inoculable virulent pus, like that of the chancre which preceded them, and simi- lar to the pus of virulent buboes, which were not treated in this man- ner; mixed with fatty substances, the virulent pus undergoes no change and remains inoculable. Inoculation cannot be of great service employed with the view of ascertaining the curative or anti-syphilitic effects of theraputical agents. We might certainly, if we wished, determine, during a general or lo- cal medication, the moment when a primary ulcer ceases to furnish a contagious pus, and tends towards healing; but the transition from the ulcerative period, to that of reparation or cicatrization, could not, in all cases, be the proof of the neutralization of the virus by the effect * Petit Madel, in his Traite des maladies syphilitiques, says, p. 17: " The syphilitic deleterious principle, so well known by its effect on our system, is far from being so well understood in its nature. Ever united with a mucous or purulent matter, which serves it as matter, all experiments which may be made upon it, are ineffectual. However little experiments on it can effect, they have nevertheless served to establish; viz. that the deleterious principle, if triturated with an oxide of mercury, or any mercurial salt, loses its intecting property, although it preserves it, after a long contact with the most energetic caustics." This assertion is absolutely false. 64 INOCULATION SERVICEABLE of the medicament actually employed, as this result may, in some cases, be spontaneous. Section II. Inoculation has however been seriously employed as a therapeuti- cal agent, with the view of modifying an obstinate or reputed incura- ble affection of old standing. 1 may here be permitted to quote the observations of Percy, who seems 1o have been the first who attempted syphilitic inoculation, as a therapeutical agent; but who is not, as Deguerre thinks, the first that tried the inoculation with another view.* The following is what has been quoted from Percy by Petit Radel, Deguerre, and others. lt A drummer of the regiment de Rouergue had in vain tried all remedies at Landau and Besaneon for a syphilitic complaint, whose symptoms were a bubo in the right groin, a deep chancre of the glans, near the frenum, pains in all his limbs, and a sort of universal icterus. The desire of being cured rendered this man very docile and exact, during the two treatments, one of which was without success, and the other only with that of cicatrizing the chancre, without affecting the jaundice or bubo, for which the patient used mercurial pills and emol- lient plasters, till his patience was worn out; he contracted a second syphilitic affection, which a fortnight after the infection declared itself by a multitude of warts on the penis, a chancre on the prepuce, and the renewal of the old one; the inflammatory increase of his bubo and augmentation of the pains, which still remained in all his limbs; the jaundice alone appeared not to feel the effects of it. In this state, he returned to the hospital at St. Louis, at Besangon, where received twenty frictions, which dispersed his former and latter symptoms at the same time, and restored him his health, which he has ever since maintained. " In 1777, an employe aux fermes du roi, underwent a treatment for a chancre of the velum palatinum, two others on the penis, and a number of excrescences at the anus. After a careful preparation, he received eighteen frictions of two drachms each; he was salivated at the fifth; but the salivation having suspended the frictions but a short time, the above number was completed in about six weeks. He dis- continued the treatment without having reaped any other benefit than the cicatrization of the two chancres of the penis; that of the throat still existed, and the excrescences, which had been cut and cauteriz- ed, were not long in springing up again; besides this, he had a kind of aphonia, accompanied with a continual buzzing in the ears. One of his relations placed him under the hands of an old surgeon-major of artillery, who made him undergo a new treatment, which was as inef- fectual as the first. This surgeon cut away the excrescences, which * Deguerre Essais sur l'inoculation du virus syphilitique. Paris, 1804. IN THE TRERAPIA OF SYPHILIS. 65 soon returned again; the throat remained the same ; the buzzing in the ears and loss of voice persisted. Thus he did not cure this patient, even after six months treatment. Then ennui and the solicitations of his friends having again brought him amongst debauched women, he evidently got a new infection, which, in less than eight days reopened the old chances, produced a third, as well as a bubo in the right groin, and ulcerated the anus in almost its whole extent. The cure of this fresh disease was confided to M. Percy, sen. After having properly prepared the patient, he gave him sixteen frictions ; there was no appearance of salivation; the bubo dispersed itself; the excresen- ces fell off of themselves : the patient regained his health, which has hitherto remained good. " M. Percy returning home to spend the winter of 1778, found at his house a soldier of the artillery of Grenoble, who, having formerly been his servant, was come there with the consent of M. Percy, sen. to be cured of a dissSse which he said he had taken in Strasburg. This disease consisted in a dreadful syphilitic affection; the symptoms of which were a chancre, which had destroyed the left tonsil; another chancre occupied two thirds of the corona glandis, a cutaneous affec- tion of the perinaeum, scrotum, and upper part of the left thigh, a lead- colored tint and violet pimples upon the forehead. He had already twice undergone a course of medicines and taken an immense number of drugs for his complaint. After some preliminary preparation, and Ihaving in vain tried the tisane de Felz, M. Percy inoculated the vene- real virus upon this patient, in the presence of many medical men; af- ter having diluted the chancre pus with a little saliva upon a glass plate he loaded with it the point of a lancet, which he carried horizontally on the part of the right arm at the insertion of the deltoid muscle; he there made, between the epidermis and corpus reticulare, a puncture without blood being drawn; then, having recharged the same instru- ment, he made a second, and then a third: he made an equal number on the left arm in the same part and in like manner; he applied no bandage to these punctures; the patient was put upon vegetable diet and ordered copious draughts of sudorific tisane. Five days, passed without anything particular appearing; on the sixth, about noon, the patient fell a sharp pain in the left arm; at two o'clock, he felt the same in the right arm; the puncture became gaping; in the evening, a red zone surrounded each arm; the patient had then some slight hor- ripilations; during the night, he had headache, and an alternation of heat and cold. The next day, the seventh day from the inoculation, the punctures were inflamed and painful, the arms swollen in almost their whole extent, some axillary glands swelled; the throat was burn- ing, the patient feverish all the day, and in the evening about nine o'clock he complained that his cutaneous affection caused him much pain. The eighth day from the inoculation, the throat was in the same state as the preceding day; the puncture formed but one suppu- rating wound; the cutaneous affection and the chancres had increased but little. The ninth and tenth, things seemed to be in the same state; 9 66 INOCULATION SERVICEABLE the eleventh, the left groin swelled, several glands presented signs re- sembling a bubo; but there was not one. The fourteenth, the wound on the right arm was perfectly cicatrized, that on the left had become enlarged; the throat was belter; the pains caused by the cutaneous af- fection and chancre had subsided. On the eighteenth, there scarcely appeared anything; the patient was brought back to his former state, except that the chancres of the tonsil and the corona glandis were more extended; and a deep ulcer remained on his left arm. At this period, M. Percy being obliged to rejoin his regiment, he left the care of the treatment to his father, who began the preparations a month and half after the inoculation: he gave him sixteen frictions. This treatment had all the success that could have been desired." If it be true, that M. Percy had reason to be satisfied with the ex- periments he had made, and if we sometimes see patients, under treat- ment for some recent affection recover from symptoms of older stand- ing, which had till then resisted, these results afle not sufficiently reg- ular and certain to authorize a similar practice. Nothing can be more proper than to take advantage of a new disease, which the patient has himself contracted, to free him from another which he had before; but to advise him to submit to a new infection, whose primary chances cannot be exactly foreseen, cannot, at least in the present state of science, be regarded as a rational method. Inoculation of a new gonorrhoea had been advised, and is still per- petrated by many practitioners, either to cure a chronic discharge, or to combat by revulsion, symptoms which gonorrhoea may produce, such as epididymitis, opthalrnia, arthritis, &c. Some in this case are content with advising anew infecting coition; others make a kind of inoculation with the muco pus of gonorrhoea, carried on a probe into the urethra, or applied to the mucous mem- brane it is vyished to infect, by means of a bit of lint, which is im- pregnated with it. The matter of gonorrhoea can never be inoculated with a lancet, like chancre, either, as we have said, so as to produce an ulcer, or even cause a discharge; so that if it be certain that the mu- co-pus of gonorrhoeae's contagious, and may be considered as the most effectual agent of a disease similar to that which produces it, most fre- quently the result obtained is owing to the mechanical action alone of the instruments employed, as Broomfield and the late Cullerier insist- ed. However, were I not convinced that the cases in which it is useful to recall an old discharge, or develope a new one, are as rare as some persons think them frequent, and that they have either aggravated the disease they wished to combat, or given if a new complication, I would not apply the mocu-pus of a gonorrhoea of one individual to another, before having ascertained upon the one from whom it is to be taken, that it produces nothing when inoculated with the lancet; otherwise,. without this precaution, a patient, with gonorrhoeal symptoms, might, being affected with concealed chancres, (chancres larves,) communi- cate to an individual, who till then had only had a simple catarrhal af- IN THE THERAPIA OF SYPHILIS. zj7 fection, without further consequences, all the formidable chances of syphilis. Section III. Not only has inoculation been tried in the cure of venereal and sy- philitic diseases themselves, either as a prophylactic, or in the curative treatment during the stage of either primary or secondary symptoms, but has been by some applied to the treatment of diseases, quite dis- tinct from syphilis, and which often, incurable when uncomplicated, seemed, being combined with syphilis, to yield to a treatment reputed to be specific for the latter. Indeed, what practitioner, in a mass of cases of obscure aetiology and insidious progress and refractory to the ordinary therapeutical agents, has not diligently sought in these cases to find some syphilitic element, and thus obtain a pretext for a specific medication, which is so fre- quently crowned with success? But if these cases are so frequent and of daily occurrence, are there not some circumstances in which diseas- es, quite independent of syphilis, and which had yielded to no treat- ment, have yet, after a syphilitic infection, undergone a modification, by which they became accessible to the anti-syphilitics, and have been cured and disappeared with the venereal symptoms which had super- vened? I have frequently shown to myelinic, severe cutaneous affec- tions of an old standing, and till then incurable, which have had, under these circumstances, these happy results. After similar observations, Dr. Martini, of Vienna, had commenced some very interesting researches on this head, when a serious illness interrupted his labors. If the medical use of the venereal virus might, like so many other poisons from which benefit is derived, be allowed in therapeutics, it could only be with extreme caution, and after accurate observations; for it must not be forgotten, that the consequences of a syphilitic affec- tion cannot be foreseen, and that generally syphilis is serious, in pro- portion to the antecedent or concomitant disease with which the pa- tient, who contracts it, may have been affected. Section IV. But can the artificial inoculation of venereal diseases be of service in determining the choice of the method of treatment? If it were proved, that every syphilitic affection, inoculable chan- cre, or truly primary syphilis, were only to be cured by mercury, and that it was hurtful in contrary cases, as Hunter and his followers have thought; or if every inoculable chancre were followed by secondary syphilis, and mercury or any other medicine possessed prophylactic properties against general infection, inoculation would be of great ser- vice. But, as observation shows every day, the primary symptoms often heal of themselves, with proper attention to cleanliness, or with 68 INOCULATION SERVICEABLE IN THE THERAPIA. different kinds of local applications, without all being supposed to possess specific virtues. . It is however proved, that all primary symptoms, (chancres,) capa- ble of being inoculated, do not produce general infection; and that in the circumstances in which secondary symptoms would show them- selves, the mercurial treatment, for instance, employed during the ex- istence of primary symptoms, is so far from preventing them in all cases, and in an invariable manner, that some superficial observers of the physiological school have not hesitated to declare, that the pre- tended secondary symptoms of syphilis were only the result of the employment of mercurials, although continued or employed after their use having been suspended, they still remained the best curative treat- ment of the symptoms, of which they were accused of being the cause; that in the cases in which they had not prevented their development, we can easily admit that they were not properly employed; and that the greater number of characteristic secondary symptoms of syphilis, showed Uiemselves, under favorable circumstances, far more frequent- ly in patients whose primary symptoms have not been treated with mercury. To sum up, for those who remain convinced that there can be no radical cure of syphilis, unless the primary symptoms have been treat- ed with mercury; and those who, on the other hand, without entering into all the exaggerations of the antagonists of mercury, yet are con- vinced that this medicament ought not to be uselessly employed, inoc- ulation is incontestibly the only unexceptionable touchstone, whenever it may not be too late to employ it. That if one day the definite value of mercury should be better understood, or if an absolute spe- cific for syphilis should be discovered, its value must be proved, or its employment indicated, by inoculation. If, at the present time, inoculation does not serve to fix the indica- tions for the treatment, for those persons who are yet uncertain in their therapeutics, it is of great value as regards the prognosis of the future chances of the patient, for every individual who has had inoculable symptoms remains positively susceptible of general infection, andliable afterwurds to symptoms of constitutional syphilis. CHAPTER V. INOCULATION MAY BE APPLIED TO SANATORY REGULATIONS AND FORENSIC MEDICINE. When Celsus treats of the diseases of the sexual organs, before entering upon the subject, he thinks it necessary to excuse himself for the indecency of his subject, as if a reproach could be made to a medical man occupied in soothing suffering humanity! As well might INOCULATION SERVICEABLE IN FORENSIC MEDICINE, ETC. 69 it have been said to Mascagni, that there were indecent things in anato- my. When treating of inoculation, in a sanatory point of view, I ought not to fear that I should, in my turn, be accused of immorality. It must be evident to whoever sees men as they are, in the cabinet of the practitioner, and without that disguise of morality, which socie- ty requires, that there are circumstances in which sexual intercourse becomes indispensable, under pain of the most serious moral and so- cial consequences in case of denial. Undoubtedly whenever a patient consults us, having suspicious symptoms, contracted in circumstances in which syphilitic symptoms are generally contracted, he must abstain and far from (as the authors of the Dictionary, in 15 volumes, have published) giving clean bills of health to our patients, upon ill-founded convictions, we should take care not to affirm that such and such symptoms, which has been found contagious, is quite innocent, as they have done for bubo; but we deliver this clean bill of health, in serious and urgent circumstances, to every individual with an ulceration which shall furnish a pus not capable of being inoculated, and who is not actually under the influence of an abundant secretion, which can, as a cause of irritation, produce an inflammation of the healthy tissues, with which it may come in contact. Now, if we pass to the cases in forensic medicine, which have reference to the venereal diseases, we shall be startled at the difficulty of the questions, which too often present themselves, and the careless manner in which they have been decided by professional men. In questions of rape, for instance, the consequence of syphilitic in- fection are often brought forward as a proof. Well! what practitioner would not, in the present state of science, seeing a man affected with gonorrhoea, accused of having violated a woman actually infected with chancre, have regarded this pretended coincidence, as a proof of great value? But when it is incontestibly shown, that chancre alone can pro- duce chancre, if the gonorrhoeal muco-pus of the individual, who is sup- posed to be guilty, produces nothing upon inoculation, after having been properly tried, will it not be evident, in a case of recent infection, that he cannot be convicted? And again, would it not be proved, by the same way of experimentation, that individuals accused of having communicated syphilis, which must aggravate the position of all per- sons thus accused, have only caused by mechanical violence, or by the action of some morbid or normal secretion, simple inflammations? Should we not then, by the certainty of the diagnosis, frequently be able to remove grievous imputations, or discover the truly guilty, under circumstances in which, without this means, the conscientious man would have remained in doubt, which, although unjustly, is not ex- pected in a man of science? Such results, whose whole force cannot yet be seen, would alone suffice to justify the numerous researches I have made, had they not already served greatly to elucidate questions which had hitherto re- mained insoluble, and to overthrow a host of prejudices, sanctioned by time and powerful authorities. PART THE SECOND. PARTICULAR OBSERVATIONS. Section I. INOCULATION OF THE PUS OF CHANCRE, SIMPLE AND COMPLICATED, ITS VARIOUS FORMS AND PERIODS. Case I. Regular chancre, with symptomatic bubo, and suppurat- ed lymphatic, inoculation producing the characteristic pustule in every case. Maison-----, aged 31, entered, August 2, 1836. The date of the appearance of the chancre on the edge of the prepuce could not be accurately determined; but twenty days previous, a bubo had shown itself on the right side, and at the same time the course of a lymphatic vessel on the dorsum penis, running towards the anus, was marked by redness and a hardened point about the middle of the dor- sal surface of the organ. Ten days since, having uncovered the glans, the patient not being able to replace the prepuce, a paraphimossi was the result. We found the chancre of the frenum still in the period of increase, as well as that on the edge of the prepuce, which had extended itself, inoculating the division of the skin, caused by pressure of th? band of the paraphimosis; the reversed mucous membrane of the prepuce, formed a had collar, upon which were some ulcerated points. The little lymphatic tumor had suppurated and opened spontaneously the previous day; the bubo was in full suppuration at the summit. August 3rd. The pus taken from the collar of the paraphimosis, was inoculated with a single puncture on the right thigh. The ulcer- ation having destroyed the band of the paraphimosis", some lint mere- ly was applied, dipt in aromatic wine;* the same dressing was used for the chancre of the frenum, and cauterization with argent, nitr. The 6th. The inoculation of the 3rd had produced the characteris- tic pustule. The 8th. The pustule was cauterized; and the pus of the ulcer resulting from the spontaneous opening of the lymphitis on the d jrsum penis was inoculated; the bubo was opened and furnished much pus. The 9th. The pus of the bubo was inoculated on the left thigh. * See Formulary, CLINICAL AND EXPERIMENTAL RESEARCHES. 71 The 12th. The inoculations made on the 8th and 9th had succeed- ed and produced a fine pustule; the first pustule from the inoculation, which was cauterized and dressed with aromatic wine, was almost well. The bubo was indurated at its base, it was dressed with ung. mer- cur, and cataplasms. Aug. 29th, The chancre of the frenum was healed, that of the prepuce was cicatrizing; the surface of the bubo presented some fleshy granulations; the engorgement of the base was decreased. On the left thigh, the pustules resisted the cauterization; they were dressed with the aromatic wine. Sept. 10th. The chancre on the prepuce was almost healed. The same dressing of aromatic wine was used, with an additional tannin. 20th. The chancre of the frenum was cicatrized; the inoculations on the thigh were in a fair way of reparation. 30th. The thigh was healed, and the bubo covered with fleshy gran- ulations; it was slightly cauterised to make it cicatrize. Oct. 3rd. All being well, the patient was dismissed. Case II, Primary chancre and gonorrhoea; inoculation positive in the first case, negative in the second. Jean Bart-----, aged 17, received May 23, 1836. Five weeks previous, the patient having torn the frenum in a coition, the wound became chancrous; two days later, a gonorrhoea appeared; it seemed, however, that here were two infections, for the patient had connec- ted with a woman eight days previous to the appearance of the gon- orrhoea. He had been treated for these two infections by an apothe- cary. May 29th. The pus of the gonorrhoea was inoculated on the left thigh, and the pus of the chancre on the right; injections of nitrate of silver and four drachms of cubebs per diem were ordered for the gon- orrhoea; the chancre was dressed with aromatic wine, and cauterized with nitrate of silver. June 1st. The puncture made with* the pus of the chancre had produced the characteristic pustule; the pus of the gonorrhoea had produced nothing; ordered emulsion of copaiva. 10th. The gonorrhoea was cured, the chancre of the penis had disappeared, and the pustule from the inoculation was destroyed by the caustic. 17th. The patient was dismissed cured. Case III. Chancre and gonorrhoea; the inoculation of the chan- cre productive, that of gonorrhoea negative. Cour-----Claud, aged 26, entered June 19, 1835. In this pa- tient the gonorrhoea made its appearance three days after a suspicious connection; two days later, chancres appeared at the base of the glans. The gonorrhoea was very painful, and the discharge very copious at the commencement. The matter flowing from the urethra was still 72 CLINICAL AND EXPERIMENTAL RESEARCHES— bloody; but the patient did not suffer in passing his water; the chan- cres were still at the period of ulceration; the chancre pus was inocu- lated on the right thigh, and that of the gonorrhoea on the left. June 2nd. The puncture on the right thigh had produced the char- acteristic pustule, that on the left was cicatrized. These' results were shown in the clinic held in the amphitheatre of the Ecole de Medecine, and then cauterized with nitrate of silver; the gonorrheea was treated with injections of acetate of lead and copaiva; the chancres by caute- rization and aromatic wine. The patient was dismissed cured, July 18th. Case IV. Chancre, inoculation of a wound of the finger, axillary bubo, engorgement of the plica brachii; inoculation with positive result. Gou-----, aged 34, entered August 12, 1836. This patient had contracted chancres on the glans about four weeks ago. About a fort- night since, the forefinger of the right hand, was torn in three or four places by accidentally being under a cask of wine. Duriig the first day, the wound had a good appearance; but the patient, who used the wounded hand to apply the dressings to the chancres of the penis, soon found his finger ulcerate, the wound become dark and greyish, and lymphatic engorgements develope themselves in the axilla and plica brachii. We found the chancres of the penis almost healed; the lymphatic engorgements hard and of considerable volume, but not painful when touched; the pus gathered from the surface of the- wound of the finger was inoculated; the chancres were dressed with aromatic wine, and cauterized with nitrate of silver. August 21st. The puncture with the pus of tbe finger had produc- ed the characteristic pustule; the bubo did not seem to progress to- wards suppuration; they were dressed with ung- bydrarg. and cata- plasms, Sept. 6th. All was healed except the ulceration on the thigh, which had been allowed to take its course, but it was m a fair way towards reparation. Sept. 10th. The patient was dismissed cured. Case V. Encysted chancre, on making its appearance by an ab- scess of the scrotum; inoculation with a positive result. Boucl-----, aged 60, received April 25, 1835. A few days after an impure connection, the patient perceived two chancres on the skin of the penis. We found some points of the surface of the cfremcres at the period of reparation, each of them was about the size of a shilling; toward the middle of the scrotum, about an inch from the penis, there were two hard knots, situate in the substance of the skin with induration of the surrounding parts; the larger appeared suppurated b its centre; PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. 73 it was opened and the thin, bloody pus inoculated on the right thigh; the ulcers were dressed with opiated cerate. The 27th. The puncture, made with the pus of the encysted chan- cre of the scrotum, had produced the characteristic pustule, it was allowed to develope itself. The second chancre was opened; the ul- cers were cauterized, and dressed with the opium cerate. June 2nd.* The chancre on the thigh was dressed with aromatic wine; those on the penis were healed, and those on the scrotum were in the way of reparation; and the patient was dismissed cured on the 20th. These chancres, which commence by an abscess, whose pari- eties become indurated, so as to form an actual cone before they are opened, in all respects deserve the name of encysted chancres. Case VI. Chancres and acute gonorrhoea, contracted in a single coition; inoculation yielding a result positive for the pus of the chan- cre, and negative for that of the gonorrhoea. Cor-----Edward, aged 21, entered June 20, 1835. The commence- ment of this disease was six weeks previous. The day after the con- nection, chancres appeared on the frenum and prepuce; two days la- ter, an acute gonorrhoea declared itself, and occasioned much pain. The chancres had been treated with precipitate and dressings of ung. mer.; further, he had been cauterized with arg. nitr. and had tak- en 60 mercurial pills, from another hospital. The chancres were still in.the period of increase, the gonorrhoea afforded a greenish and bloody matter; the chancre was inoculated with two punctures on the right thigh, and the gonorrhoeal pus on the left; the chancres were cauterized with arg. nitr. and dressed with vin. arom. and an injection of acet. plumb, was ordered. June 24th. The two punctures ma e with the pus of the chancre bad produced the characteristic pustule; the upper was cauterized, and the other allowed to develope itself; the punctures made with the pus of the gonorrhoea had produced nothing; the same treatment was con- tinued; the gonorrhoeal pus was again inoculated. 28th. The inoculation of the gonorrhoeal pus, made on the 24tb, had produced nothing; the chancres were in the stage of reparation; the gonorrhoea discharged little whitish matter; the inoculated pustule, which had been allowed to remain, had produced a chancre on the thigh; it was cauterized and dressed with vin. arom. July 14th. The gonorrhoea had disappeared under the treatment with injections and copaiva with magnesia in the form of bolus; the chancres were cicatrized. 18th. The patient was dismissed cured. Case VII. Superficial and follicular chancres, producing the characteristic pustule by inoculation. Bour-----, aged 20, entered August 25, 1836. The commence- • Qu«r«=-May 2d. H. D. 10 74 CLINICAL AND EXPERIMENTAL RESEARCHES— ment of the disease dated from about twenty-four days since: after a difficult sexual connection, erosions formed upon the glans, whose base was surrounded by a crown of small round ulcers, occupying the depth of the follicles; the edge of the prepuce presented superficial ulcera- tions, which are called superficial chancres. He has hitherto had no treatment. In consequence of the irritation, there was a phimosis, which allow- ed the diseased organ being partly uncovered; there was no discharge from the urethra; there were small ulcers in the period of progress, upon all the surface which could be perceived; the suppuration was copious. The pus gathered from a superficial ulcer, which had scarce destroyed the thickness of the mucous membrane of the glans, was in- oculated. On the left thigh, the pus from a follicular chancre, whose orifice was scarce as large as a pin's head, wTas inoculated. There was no lymphitis; but there was an engorged ganglion on the left side, which was movable and indolent. This patient had never received any medical treatment; he was treated according to M. Serres, with iodide of silver, a twelfth of a grain per diem; an emulsion of gum arabic as diet drink. The chan- cres were washed and dressed with a decoction of mallows. Sept. 1st. The inoculations having produced the characteristic pustule on both thighs, they were cauterised with nitrate of silver. 7th. The pustule on the left thigh had disappeared, after being cauterized; that on the right, was still red; it was dressed with aro- matic wine, and the fleshy granulations were cauterized; six doses of a twelfth of a grain of iodide of silver were given, without obtaining any therapeutical action. Till the 1st of October, the dose of the iodide was gradually in- creased, without the patient feeling any effect; the disease was neither better nor worse than if left entirely to itself. The dose was four grains of the iodide per diem. It was determined to suspend a medicine which produced no result, and the ulcerated surface was cauterized, and then lint dipt in aroma- tic wine applied. The 4th. The superficial ulcers of the glans were almost dry, the ground of the ulcerated follicles was raised and projected like granula- tions at their commencement; they were cauterized and dressed with the wine. The 6th. All was nearly well, only one or two points remaining uncicatrized on he margin of the prepuce; and the patient was dis- missed cured on the 10th. Case VIII. Regular chancre; inoculation with a result. Jos-----Emillie, aged 24, entered May 27th, 1834. The appa- rent commencement of the disease was about eight davs previous. On the internal surface of the greater labia and the entrance of the vulva, some little pimples made their appearance four days after a sus- picious connection, and soon, as by regular inoculation, chancres form- PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. 75 ed; there was neither pain in passing the water nor vaginal discharge. The ulcerations were in the period of increase. On the 23th, pus gathered from the surface of a chancre of the great labia, was inoculated on the right thigh, and that taken from the vulva on the left. It was observed that the induration on the great labia gradually extended, and caused acute pains; emollient dressings were ordered. On the 29th, the inoculated points were red and vesicular, and on the following day the vesicle was well formed on both thighs. June 1st. The inoculated' pustule was full of pus, flat and broad. The 6th. The inoculated points were cauterized with nitrate of silver. The ulcerations of the vulva remained in the stage of increase and were very painful; ihey were touched with a brush dipped in creosote. Half an hour after the application, the patient had acute darting pains; but by the following day they had subsided. The 18th. The ulcerations were touched each day with creosote; they appeared arrived at the period of reparation; but their base was indurated all around, as well as the tissue of the labia. The 22nd. Pills of hydrarg. iodid. were ordered as a resolutive. There only remained brownish spots instead of the chancre from in- oculation. At the anus there was some degree of irritation, and a rhagas; it was dressed with lint dipt in liq. sodae chlorinatae, and sprinkled with calomel. July 10th. All the ulcerations had disappeared, the still existing induration was much diminished, and on the 22nd, the patient was dismissed quite cured. Case IX. Chancre of the cervix uteri, vaginal gonorrhoea; in- oculation with characteristic result. Haul----- Catherine, aged 23, entered April 8, 1834. Scarce cured of one infection seven months since, when having again exposed herself, contracted chancre and a gonorrhoea, of a person affected with onlv a chancre. She had undergone no treatment. It ought to be remarked, that this patient had long been affected with a chronic discharge, which gave a gonorrhoea to each of her new lovers, then, if after being cured they continued their relations with her, by a sort of acclimation, they resisted the contagion. On her entering the hospital, she had a chancre on the left labium, and another on the corresponding nympha. When examined with the speculum vaginae, puriform secretion, uterine catarrh, ulceration of the anterior lobe of the cervix, with a greyish ground, irregular and raised edges were found. Till the 10th, emollient injections were made and the chancre was dressed with opium cerate. The 18th. The acu'e stage had disappeared, the matter of the discharge was whitish and less abundant; the appearance of the ulce- ration of the cervix had undergone no chaige; some pus taken from its surface was inoculated on the right thigh, then some muco-pus was 76 CLINICAL AND EXPERIMENTAL RESEARCHES— collected at the base of the cervix, in the pori-uterine cul-de-sac, and by means of a puncture inocu'ated on the left thigh. The different ulcerated points were cauterized with nitrate of silver. The 19th. The inoculated points were red and elevated. The 20th. The vesicle was well formed, bolh on the right and left thigh, and the pustule was on the 22nd well filled with pus. May 1st. The inoculations having been allowed to take their course, had produced well characterized chancres, with abrupt edges and a greyish ground. They were cauterized and dressed withung. calom. c. opii. The Chancre on the nympha had disappeared, under the in- fluence of the cauterization; that of the labium was in progress towards reparation. Injection and tampooning with decoct, alb. eau blanche* were ordered. The ulceration of the cervix, having been cauterized six times, was much diminished; the portion which remained, present- ed a granulated surface, which was inclined to cicatrize. The 10th. The chancre of the anterior labium had healed. The spots inoculated presented granulations; the base of the ulcers was become indurated. The 20th, The induration around the different chancres had increas- ed. The wound of the cervix was healed; the gonorrhoea had disap- peared. Pills of hydrarg. iodid, were ordered, and sudorific syrup and tisane, to overcome the induration. The 30th. There had been rapid amelioration. The inoculated points were healed, and the induration had almost disappeared. June 7th. All was well; on the thigh only some brown spots re- mained. Case X. Chancre and symtomatic bubo, inoculated with result. Bou-----, aged 21, entered March 7, 1833. The complaint was of five months standing, at that time a chancre had appeared upon the skin of the prepuce; a few days afterwards a bubo showed itself on the right side; the progress of the ulcer, which had at first been regu- lar, assumed the phagedenic character; a considerable portion of the prepuce was destroyed, and a third of the thickness of the glans itself eaten away; the bubo quickly came to suppuration, and opened spon- taneously. A course of bichloride of mercury was administered, in- the form of pills; a considerable salivation ensued, which was counter- acted by gargarisms. On the above-named day, the patient presented himself with a widely ulcerated bubo, the surface of which was two inches and a half in diameter. The glans was almost detached, and the corpora cavernosa present- ed a loss of substance down to the urethra, there was also much general irritation. The characteristic signs of the period of increase were every where visible. Dressings, with a concentrated decoction of opium were applied, and general antiphlogistics prescribed. By the 18th, the inflammatory state seemed to have yielded to the treat- ment; dressings of calomel cerate were then applied. On the 21st, the chancre of the groin was better; its ground was * See note to Formulary, at the end of tha work. PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. 77 becoming clean; some healthy granulations showed themselves on the penis. April 1st. The chancre of the glans was cauterized with nitrate of silver, and the dressings with colomel cerate were continued. 10th. The circumference of the ulcer of the groin was diminished; yet in the centre, the characters of the ulcerative period were per- ceived. 21st. Some pus taken from the centre of the wound in the groin was inoculated on the left thigh. 24th. The inoculation had succeeded, and the pustule was formed. Some spots of the commencement of an irruption being perceived upon the skin, the pills of hydrarg. iodid. were prescribed, with su- dorific syrup and tisane. May 7th. The bubo was cicatrizing; but the chancre on the penis remained in the stage of ulceration. It was cauterized with arg. nitr. 20th. The chancre of the groin was cicatrized, without leaving any marked induration. The inoculated chancre on the left thigh was at the period of reparation. A lenticular syphilide appeared, but developed itself but little; and on the 30th, presented only a few brown spots. June 20th. The syphilitic eruption had quite disappeared. Notwithstanding the different dressings employed, such as the mel. iodat. cerat. plumb., wine, cerat. belladon., decoct, opii concentr., solution of sublimate, cauterization with arg. nitr. and hydrarg. nitr. applied alternately, according to the more or less inflammatory state of the parts, the ulcer of the penis remained at the period of increase; all the superior portion of the prepuce had been destroyed, and the glans eaten away four lines beyond the meatus urinarius; the canal ap- peared as if dissected all around. July 10th. The progress of the ulceration appeared much slower; it was cauterized and dressed with calomel and opium cerate. 20th. More defined; the anterior half of the chancre began to cicatrize. 30th. At the inferior part towards the f enum, the remaining por- tion of the prepuce was covered with granulations; but on the superior, the chancre continued to destroy the corpora cavernosa. Aug. 20th. The cicatrization had retrograded. The 30th. Pus was taken from the surface of the corpora cavernosa, and inoculated an insh below the cicatrix of the first inoculation. Sept. 4th. The pustule from inoculation was formed. The ulcer was dressed with the calomel and opium cerate, and cauterized. 20th. The characters of the period of repiration showed themselves in several points of the surface of the chancre: The chancre of the thigh, resulting from the inoculation on the 30th of August, was dress- ed with cerat. opiat. Oct. 1st. The chancre was reduced two-thirds; pus was taken from its centre, and inoculated by two punctures on the right thigh. The 6th. The inoculation had produced nothing. 20th. The ulceration had seized upon an indurated band, near the enum it resembled an intersticial gangrene. 78 CLINICAL AND EXPERIMENTAL RESEARCHES— Nov. 1st. The ulcer, which had for some days appeared stationary, appeared better. 27 th. All is nearly well; on the corpora cavernosa, there was a ci- catrix more than an inch in extent. The wound of the left thigh, from the last inoculation but one, was nearly cicatrized. At length, Dec. 21st, the patient was dismissed. It is worthy of remark, that during all the time of the treatment, the general health remained pretty good; only twice toward the latter part of the time, at an interval of two months and a half, there was a slight diarrhoea, which soon yielded to a mixture of rice water, and gum ar- abic sweetened with syrup, symphyt. The patient was of a sanguine and irritable temperament; during all the time of his being in the hos- pital, he appeared very melancholy; being continually hungry, he often procured himself food besides his regular rations. Case XI. Phagedoenic chancre, partly gangrenous; inoculation producing a pustule from the ulcer in a progressive stage, but without result from the pus of the gangrenous part. Pers-----, aged40, entered April 13, 1834. The commencement of the disease was two months and a half previous; in consequence of an erosion of the prepuce during coition, a chancre appeared; its course was at first regular; but after repeated excesses, an attempt at cauterization with a burning cigar, the ulcer assumed an acute inflam- matory and phagedenic form. At the time of his entry, nearly the whole surface of the prepuce was affected, but two portions appeared distinctly separated; all the parts touching the roll at the base of the glans presented a gangrenous ring; the remainder presented the characters of a phagedaenic chan- cre, properly so called; all was in the progressive stage. The 14th. Some pus, taken from the ring at the base of the pre- puce, was inoculated on the right thigh; an application of a concen- trated decoction of opium was ordered. The 18th. The inoculated puncture had produced nothing; the gan- grene seemed checked. Some pus was taken from the surface of the prepuce, towards the margin, beyond the limits of the gangrene, and inoculated on the left thigh. Dressings of calomel cerate were order- ed, and the ulceration, from the destruction by the gangrene of a part of the glans, and that produced on the frenum by the phagedaenic chancre, was cauterized with arg. nitr. The 21st. The inoculated puncture had produced the characteristic pustule. The 26th. The progress of the inoculation, hitherto regular, ap- peared to assume the phagedaenic form; it was profound and rapidly destroyed the tissues. Dressings of calomel and opium ointment were used, with cauterization with arg. nitr. The 30th. There was an improvement, the chlorinated soda was used as a wash and calomel was sprinkled upo.i the part. May 9th. The penis was nearly well; the inoculated chancre was in a fair way of reparation. PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. Case XII. Chancre and gonorrhoea; inoculation positive in the first case, and negative in the second. Cha-----, aged 20, entered August 9, 1836. This patient, affect- ed with gonorrhoea, which at the commencement was very painful, and with chancres at the base of the glans on the under part, presented himself five weeks after the commencement of the disease. He had already undergone several treatments, but only with antiphlogistics. At the time of his entry, there was a very considerable gonorrhoeal discharge, and a balanitis; the chancres of the corona glandis present- ed several points in a state of reparation. The pus of the gonorrhoea was inoculated on the right thigh, and the pus taken from a point on the base of the glans, still presenting the characters of the period of ulceration, on the left thigh. August 14th. The inoculation of the pus of the chancre, on the left thigh, had produced the characteristic pustule; the puncture made with the pus of the gonorrhoea had produced nothing. Emulsion of copaiva, and injections of nitrate of silver, were prescribed, and the chancres ordered to be dressed with vin. arom. The patient was dismissed cured, Sept. 7th. Case XIII. Chancre and gonorrhoea; the pus of the inoculated chancre producing the pustule; the pus of the gonorrhoea, a negative result. Depl-----, aged 22, eniered April 29, 1836. After a balanitis, for which the patient received no treatment, some vegetations develop- ed themselves on the glans; they were cut, and three days afterwards, after a coiton, chancres showed themselves on the spots where the vegetations had been. At the same time a gonorrhoea, which occa- sioned acute pain, developed itself. May 1st. The pus of the ulceration of the glans was inoculated on the right thigh, and the pus of the gonorrhoea on the left. The 4th. The puncture on the right thigh was red and slightly ve- sicular; that on the left, was entirely cicatrized. Dressings with aro- matic wine were used, and the chancres were cauterized. For the gonorrhoea, which no longer caused the patient any pain, an injection of nitrate of silver and an emulsion of copaiva were ordered. The inoculated pustule was cauterized with nitrate of silver; and the patient was dismissed cured, on the 16th of May. Case XIV. Chancre oj the prepuce, with concealed chancre, (larve) and abscess of the canal; inoculation with positive results in all cases. Bel-----, aged 19, entered July 18, 1836. This patient, who had been affected for four years with a gonorrhoea, which he several times renewed, and brought back to the acute stage, by impure connection, had contracted several chancres on the prepuce, three weeks since. The gonorrhoea, which only furnished a serious pus, had increased and occasioned acute pains. At the time of his entering, the cana] SO CLINICAL AND EXPERIMENTAL RESEARCHES— presented several indurated points in its extent, principally towards the fossa navicularis. The chancres of the prepuce were in the stage of increase. July 20th. The pus of the gonorrhoea was inoculated on the right thigh. 22nd. The puncture was red, but its progress was slow. 23rd. The pus of the gonorrhoea was inoculated on the right thigh, below the former puncture, and the pus of the chancre of the prepuce on the left thigh. The ulcer on the prepuce was dressed with vin. arom., and cauterized with argent, nitr. 25th. The puncture made on the 20th with the pus of gonor- rhoea, had produced the characteristic pustule; it was cauterized with argent, nitr., and injections of vin. arom. were ordered: the two latter inoculations were red. On the under side of the penis, near a point which corresponded to an induration of the canal, some fluctua- tion was perceived. The 27th. The punctures made with the pus of the chancres of the prepuce, and the second time with the pus of the gonorrhoea, had produced the characteristic pustules, which were then cauterized with the nitrate of silver. The tumor on the side of the canal was about the size of a nut; the skin was become thin; being opened, a pus flowed from it similar to that of the gonorrhoea. The cavity present- ed all the characters of surfaces affected with chancres; moreover, from some drops of urine which flowed through it when the patient passed his water, it was clear that it communicated with the canal. To be certain that it was not a chancre of the urethra, which had pro- gressed outwards from within, the pus which flowed from it, upon opening the abscess, was inoculated on the left thigh. The punctures of the first inoculation had disappeared after the cauterization with ni- trate of silver; the chancre on the penis was almost healed; but the canal was indurated to the backwardest part of ihe penis. The in- jections of vin. arom. were continued, and the interior of the canal was cauterized by means of Lallemand's caustic holder. The pills of hydrarg. iodid. were prescribed. Aug. 3rd. The pustules resulting from the inoculation of the pus of the abscess of the canal were cauterized; the induration was much diminished. Aug. 9th. The pustule was healed; the abscess of the penis nearly closed; and no more urine passed. Aug. 20th. There was scarcely any more induration in the canal, and the discharge had nearly ceased; four drachms of cubebs were prescribed, and Sept. 12th the patient was dismissed cured. Case XV. Concealed chancre, (larve,) with symptomatic bubo; inoculation producing positive results in each ca:e. Dum-----, aged 26, entered Nov. 11, 1835. Was not able to fix accurately the time of the commencement of his complaint. He stat- ed that he had six weeks previous felt a slight pain at the meatus uri- PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. 81 narius, when he passed his water ; but paid little attention to it till a fortnight previous to his entry, when a bubo appeared on the right side. Its course was very acute ; but the patient had not undergone any treatment. Upon his entry into the hospital, some induration was perceived at the meatus urinarius, and towards the fossa navicu- laris. Upon separating the edges of the aperture, no ulceration was perceived ; upon pressure, a little pus came ; the canal of the urethra appeared sound beyond the above mentioned point. The patient nev- er, at any time, perceived a gonorrhoeal discharge. The only pains he felt were in the meatus urinarius, and in the fossa navicularis. The bubo was extensively suppurated; it was opened, and a large quantity of reddish pus was discharged. Nov. 23rd. The pus from the meatus urinarius, was inoculated on the right thigh, and the pus of the bubo on the left. The lips of the incision made on the bubo were ulcerated. The bubo was cauterized with nitrate of silver ; some threads of lint, covered with calomel and opium cerate, were introduced into the canal ; cataplasms were appli- ed to the groin. 28th. The inoculated punctures have taken and produced the pus- tules; they were allowed to take their course. Near the frenum, a small hardened tumor was perceived. The same dressings were con- tinued. Dec. 1st. The chancres of the thighs, from inoculation of the pus from the urethra and from the bubo, were cauterized with nitrate of silver, and dressed with calomel and opium cerate. 12th. A small abscess, the consequence of the suppuration of the tumor, perceived on the 28th ult., was opened, and the pus inoculat- ed, by a puncture, on the right thigh. 17th. The inoculated puncture, made with the pus of the chancrous abscess, opened on the 12th, had produced the characteristic pustule. 20th. The pustule, from inoculation, which broke the day previous, was inoculated. Little induration remained at the meatus urinarius. The bubo was better; it was cauterized with nitrate of silver. 27th. Altogether better. The chancres on the thighs were nearly healed, under the influence of the cauterizations and dressings with the calomel and opium cerate. 30th. The patient being cured was dismissed. Case XVI. Chancre and gonorrhoea, with an ulcer of the canal; inoculation producing the characteristic pustule. Fouc-----, aged 19, entered July 19,1836. The apparent com- mencement of the disease was eight days before his entrance into the hospital; the chancre was situated at the posterior and superior part of the glans, and from this point an inflamed lymphatic ran to the right, towards an engorgement which began on the same side, and which appeared to affect the superficial ganglions of the groin; the tu- mor, though small, was painful, and the skin very red. The gonor- rhoea, which had only appeared eight days previous, afforded but little 11 82 CLINICAL AND EXPERIMENTAL RESEARCHES— pus; the patient refers the pain, which he felt during the emission of his urine, to the end of the penis. 20lh. Twenty-five leeches were placed upon the bubo, and the camphor and opium pills were prescribed. Upon separating the lips of the meatus urinarius, the mucous membrane was found ulcerated. 25th. The gonorrhoeal pus was inoculated, by a puncture, on the rio-bt thigh. The development of the bubo appeared arrested; emol- lient cataplasms were ordered. The chancre was cauterised, and dressed with the vin. aromat. The nitrate of silver was introduced into the urethra, to cauterize the ulcerations of the meatus. 23th. The pustule, from the inoculation, being formed, was de- stroyed with the nitrate of silver. Towards the posterior part of the penis, a leech-bite having become inoculated, it was cauterized. The bubo had not developed itself; the chancre was half healed, and the granulations appeared on several points. Aug. 6th. The chancre on the glans was healed; scarce any thing flowed from the urethra; cauterization with nitrate of silver was pre- scribed. 10th. Nothing remained in the urethra; the bubo had disappeared, under the influence of compression, and applications of the decoct. alb. The patient was dismissed cured, on the 16th. Case XVII. Gonorrhoea, urethral chancre, and inoculation icilh positive result. Pri-----, aged 20, entered Oct. 28, 1836. This patient had had a gonorrhoea for six weeks, which, after being acute for some days, soon became chronic; since this time, having again had a sexual con- nection, he perceived a chancre about a fortnight previous to his en- try, which was visible upon separating the lips of the meatus urinarius. Upon examining him, we found the matter of the discharge whitish, and streaked with brown; there was no induration in the urethra, ex- cept at the meatus, where it was easy to detect the characters of the chancre with an indurated base. Upon separating the lips of the ori- fice, the ulcer was perceived, small in its extent, but presenting the characters of the period of increase. 29th. The pus collected at the meatus, mixed with the secretion of the chancre and gonorrhoeal matter, was inoculated on the right thigh, by a single puncture. The chancre was cauterized with the nitrate of silver, introduced to the depth of an inch into the canal, and then a piece of lint dipt in vin. arom. was inserted. 31 sL The inoculation had taken and produced the characteristic pustule, which was large, and distended with pus; it was opened and well cauterized with nitrate of silver. The whole surface of the ure- thra was cauterized with Lallemand's caustic holder; for the chancre, the same dressings were continued. 6th. The chancre was almost cured; tin induration of its base was diminished; there was but little discharge from the gonorrhoea; a fresh general cauterization was made. PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. 1 lth. All was well, except that the induration seemed to continue at the seat of the ulcer at the meatus. Case XVIII. Chancre, concealed chancre, and symptomatic bubo; inoculation producing the characteristic pustule. And-----, aged 29, entered April 26, 1836. The patient could not exactly fix the time of the commencement of his disease; for a long time, at short intervals, he had contracted chancres; the last chancre, which was seated on the frenum, had its origin about six weeks previous to his entrance. Twenty-six days since, after some very fatiguing work, an acute bubo appeared in the left groin. The patient did not abstain from sexual relations till within the last fort- night; about that time, he felt a tickling sensation at the meatus urina- rius, then a smarting upon making water; he at length perceived that on pressing against the inferior side of the canal, he caused several drops of pus to be discharged. When we examined him, we found the chancre on the frenum was partly at the period of reparation; the bubo had suppurated; its seat was in the superficial ganglions; the tumor was conical and fluctuating. Upon opening the lips of the meatus urinarius, the mucous membrane appeared red, but not eroded; he had little pain in passing his water; a hardened point was felt a few lines behind the fossa navicularis. 27th. The bubo was opened, and afforded much thin and bloody pus. The pus from the urethra was inoculated on the left thigh, and that taken from a point of the surface of the chancre, which still ap- peared stationary, on the right thigh. 29th. The inoculated punctures had produced the characteristic pus- tule on both thighs; the pustule on the right thigh, from the inoculation of the pus of the chancre, was cauterized with nitrate of silver; that on the left, from the pus from the meatus, was allowed to take its course. The chancre and the bubo, whose ulcerated opening showed its chancrous nature, were dressed after cauterization, with aromatic wine; the induration of the canal had increased, as well as that at the base of the chancre; the syrup, acid, hydrocjan. with syrup, gentian, in an infusion of hops were ordered, on account of the lymphatic tempera- ment of the patient. June 3rd. Upon separating the lips of the meatus urinarius, the mucous membrane was found ulcerated; the nitrate of silver was in- troduced into the urethra, then injections of aromatic wine were made. The pustule from inoculation on the left thigh, had produced a chan- cre, which was cauterized and dressed with aromatic wine. 10th. The chancre of the frenum was almost healed, and the bubo tended towards reparation. 15th. The induration on different points soon became softened; the surface of the bubo became covered with granulations. The cau- terization and the dressings with aromatic wine, were continued. The patient was dismissed quite cured on the 25lh. 84 CLINICAL AND EXPERIMENTAL RESEARCHES— Case XIX. Chancre, concealed chancre, and inoculation pro- ducing the characteristic pustule. Bal-----, aged 20, entered January 3, 1837. This patient con- tracted a chancre of the frenum, in consequence of a rupture of it during a connection, a month previous to his entry; eight days later, a gonorrhoea appeared; it first caused a few drops of a bloody discharge, which increased for some days, every time that the patient committed an error in his diet. We found the chancre of the frenum in the stage of reparation; the discharge was small in quantity and bloody, and there was some pain on passing the water. The 4th. The pus of the urethra was inoculated on the left thigh by a puncture; the chancre of the frenum was cauterized and dressed with vin arom. The 6th. The inoculation had succeeded and the pustule was form- ed; an inch and a half in the interior of the canal an indurated point was perceived. The interior of the canal was cauterized, and injec- tions of the wine with tannin ordered. The 12th. The chancre of the frenum was healing; its course had been regular since the cauterization of the urethra; the induration was much diminished; the discharge was the same in quantity but less bloody. The pustule on the thigh, produced by the inoculation of the pus from the uretha, had progressed, notwithstanding a cauterization on the 10th; but on the 13th, the character of the ulcer was no longer chancrous; there remained a deep wound from the cauterization, which was dressed writh vin. arom. The 24th. The chancre of the frenum had healed without leaving any induration, with the application of the nitrate of silver and dress- ings with the wine; the urethral discharge had nearly disappeared. The 30th. Nothing remained, not a single drop of the discharge, and on the sixth of February, the patient was dismissed cured. Case XX. Gonorrhoea, concealed chancre; a positive result from inoculation, during the period of ulceration, and negative, during that of reparation. Br-----, aged 19, entered March 9, 1833. Three days after a suspicious connection, this patient perceived a discharge of some drops of pus from the urethra; the secretion gradually increase!; he had acute pain on passing his water, irritation of the glans and phimosis, which however allowed of the organ being two-thirds uncovered, when a slight redness was perceived on it, but no excoriations. March 11th. The pus of the gonorrhoea was inoculated upon the right thigh by three punctures. The pil. opii. c. camph. were order- ed, and emollient lotions. 15th. The inoculations had produced the pustule; but it was not much developed. The gonorrhoeal pus was again inoculated on the left thigh. The 17th. The pustules, both right and left, had furnished the PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. 85 pathognomic character. On the right thigh, the first inoculation had produced chancres with abrupt edges, which had pierced the whole thickness of the skin. Upon pressing the canal, near the fossa navi- cularis, an induration was perceived, indicating the seat of a chancre; the treatment was continued. The 22nd. The appearance of two buboes was perceived, and leeches were applied to each tumor. Two days previous, the patient chafed himself near the frenum, the pus from the urethra had inoculated the wound, and caused a severe irritation; the prepuce became cede- matous, and a phimosis ensued. The chancres on the thighs were dressed with cerat. opii. The 17th. Pills of hydrarg. iodid. were ordered, to combat the induration, and injections of acet. plumb, for the gonorrhoea. April 6th. The chancre inoculated on the chafed part had nearly destroyed the frenum. The discharge was much diminished, and the matter had lost its greenish color. The 10th. The patient complained of soreness of the gums; the mouth was irritated, but there was no salivation; the gums were touch- ed with acid, hydrochlor. as a prophylatic. The muco-pus of the urethra was inserted by three punctures on the left thigh, below the second inoculation, which was cicatrizing. The 18th. The puncture had produced nothing; there was less in- duration in the fossa navicularis, and the urethral chancre was found to be arrived at the period of reparation. May 1st. The chancres on the thighs were nearly healed, and little discharge remained. 3rd. There was no more induration; the chancre of the frenum was healed; the pills were omitted, and the patient left the hospital on the 14th. Case XXI. Chancre and symptomatic bubo; inoculation produc- ing a positive result. Leg-----Leonard, aged 18, entered October 12,-1835. For about a fortnight he had perceived some chancres on the glans; four days after their appearance, a bubo developed itself on the right side; its course was acute, and it was opened October 14th. The 16th. The pus of the bubo was inoculated on the left thigh, and that of chancres on the right. The 21st. The two punctures had succeeded and the pustules were formed; some of the pus taken from the pustule on the left thigh was inoculated on the right; the first inoculation had been destroyed with caustic; the chancre of the penis and the bubo were dressed with aro- matic wine. The 24th. The puncture made with the pus of the pustule on the left thigh had produced the characteristic results; it was allowed to take its course. The 29th. The chancres of the penis were healed and the bubo in a fair way of reparation; the chancres of the right thigh, or the last inoculation, were dressed with aromatic wine, and cauterized with arg. 86 CLINICAL AND EXPERIMENTAL RESEARCHES- nitr.; the two former inoculations had disappeared, under the influence of the cauterization. , . , , It was remarked, that the inoculation made on the right thigh, by means of the pustule from the first inoculation of the pus taken lrom the bubo, had made rapid progress. The patient was dismissed cured • M. Cullerier has seen these inoculations, and observed their devel- opment, and also publicly acknowledged that the pus of a bubo is ca- pable of being inoculated. Case XXII. Primary chancre of the anus, inoculated with a re- sult. Tomb-----Barbe, aged 23, entered April 2, 1833. A month pre- vious, this patient had had intercourse, d preepesterd venere, with her husband who was affected with chancres; the raphe was torn, and the cbancrous pus directly inoculated: on the lateral portions, two other abrasions became ulcerated by the same action. A fortnight previous, she had consulted a surgeon, who ordered an application of six leeches; the leech-bites being soiled by the pus from the anus, became inocu- lated. April 4th. The different chancres were dressed with opium and calomel cerate. 26th. The chancres, from the inoculation of the leech-bites, had healed, as well as the lateral chancres of the anus: but the ulcer of the raphe, in the depth of the fissure, presented all the characters of the period of increase; its pus was inoculated on the left thigh. The 28th. The inoculation had succeeded; the pustule was de- stroyed by cauterization with arg. nitr. The anus was dressed with a bit of lint, the lower end having been dipt in sod. chlorinat.; the edges of the fissure of the raphe were separated, and some threads of lint, covered with calomel ointment, were introduced. May 6th. The cauterization had destroyed the inoculated pustule. The chancre of the anus was nearly healed, and it was only superfi- cially cauterized. The patient being cured, was dismissed on the 10th. Case XXIII. Chancre, rhagades, mucous pustules; inoculation with positive results in the two former cases, and negative in the latter. Pier----- Clodtilde, rged 16, entered April 2, 1833. This pa- tient had been affected with chancre of the vulva and a gonorrhoea lor nearly six months; for the last six weeks, some abrasions around the anus having become inoculated, they formed deep rhagades; about the same time some mucous papulae developed themselves around the anus. April 8th. Pus taken from an ulceration of the fourchette, was in- oculated on the right thigh, and the pus of the mucous papulae on the left thigh. Cauterization and dressings with calomel and opium cerate were prescribed. PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. 87 The 12th. The inoculation made with the pus from the chancre of the fourchette, had produced the characteristic pustule; that of the pus of the ulcerated mucous papulae, had produced nothing; the pus of a deep rhagas of the anus, all points of which appeared in the ulcera- tive period, was inoculated. The 16th. The inoculation of the 12th had succeeded, and produc- ed the pustule; the anus was dressed with the chlorinated soda and calomel; the chancres were cauterized with nitrate of silver. The 19th. Better defined; almost all the ulcers had assumed the characters of the period of reparation. The 21st. Better; almost cicatrized; the mucous pustules had dis- appeared. The same dressing was continued; and the patient was dismissed cured on the 28th. Case XXIV. Chancre; inoculation by the nails; inoculation with pus preserved in a tube, with positive result. Tang-----, aged 32, entered Sept. 20, 1836. Seven weeks pre- vious, this patient had contracted chancres on the margin of the pre- puce, which he left without treatment; the ulcers soon became conflu- ent, the aperture of the prepuce contracted, and thus almost formed a phimosis, causing a slight balanitis. During the previous ten days, the patient had had a little spot, re- sembling an ulcerated mucous tubercle, upon the left commissure of the lips. It was thought that the disease of the lip was the conse- quence of the irritation produced by using a pipe, to which the pa- tient was much addicted. On his entry, the chancres were still in the period of increase, their base was not indurated. The cyanuret of silver was given in doses of three-tenths of a grain per diem. The dressings were made with simple cerate. The 26th. The dose of the cyanuret of silver was increased one- tenth. The 28th. An increase of two grains was made; the state of the chancre remained the same; the patient felt nothing that he could at- tribute to the medicine. The 30th. The dose of the.cyanuret was increased to eight-tenths of a grain. Oct. 5th. A pustule, perfectly similar to those which result from in- oculation, was perceived on the left thigh, at the lower part of the su- perior third on the inner surface. The patient said, that it came from a scratch with the nail. The state of the chancre of the prepuce re- mained the same; on the other hand, the patient felt no effects of the cyanuret of silver; the dose was increased to three grains. Some pus was taken from the pustule of the left thigh, and inoculated, by a puncture, on the right thigh. The 8th. The inoculated puncture had produced a well filled pus- tule, from which a glass tube, open at both ends, was filled. The na- ture of the inoculation by the nails of the patient being known, it was cauterized with nitrate of silver. R3 CLINICAL AND EXPERIMENTAL RESEARCHES— The 10th. The pus preserved in the tube was inoculated, by a punc- ture, below the first inoculation on the left thigh. The 11th. The inoculation of the preserved pus had produced the characteristic pustule. The patient was taking four grains of cyan- uret of silver; the chancres were better, and produced fleshy granula- tions. 12th The pustule, from inoculation of the pus in the tube, was very large. Six grains of the cyanuret were given, without the patient perceiving any effect. The 14th. The pustule, from the pus preserved in the tube, was cauterized. The first inoculation made with the nails had progressed, although it had been cauterized; it was dressed with cerate. The se- cond pustule, inoculated on the right thigh, had progressed and pro- duced a chancre, which was dressed with cerate. The 27th. The first and third inoculation were healing; the first especially was nearly cicatrized. At the base of the inoculation on the right thigh, which had not been cauterized, an indurated knot was perceived. Thus, although the cauterization with nitrate of silver had not arrested the progress of the inoculations subjected to its action, they had been so modified in their nature, that being brought back to the state of simple wounds, they tended towards cicatrization, whilst the inoculation, which had not been cauterised, had gone on increas- ing. In order to promote the cicatrization, dressings of vin. arom. were used. Nov. 4th. The patient was dismissed cured. Case XXV. Chancre, gonorrhoea; inoculation with positive result for the pus of the chancre, and negative for that of the gonorrhaa; inoculation of the chancrous pus with hydrochloric acid and negative result. Vill-----, aged 28, entered September 19, 1836. This patient, who had a natural phimosis, could not precisely state the period at which he had contracted chancres; only that six weeks since, he had perceived a balanitis with swelling of the prepuce. The gonorrhoea, which showed itself nine days after an impure connection, had lasted three weeks, it still remained acute; the patient had not received any treatment. Upon examining him, we found an abundant greenish yellow dis- charge from the gonorrhoea; upon uncovering the glans, two ulcerated spots were perceived at its base, and some excoriated points on the prepuce; the ulcers presented an appearance of unhealthy granula- tion. The 21st. The gonorrhoeal pus was inoculated on the left thigh; there was no induration in the canal. Some pus was taken from the surface of the chancre, and divided into two portions; the first was inoculated on the right thigh, and the second mixed with acid, hydro- chlor. was also inoculated on the right thigh, below the puncture made with the unmixed pus. The chancre and balanitis were cauterised, PRACT/CAL OBSERVATIONS—INOCULATION OF CHANCRE. 89 and then dressed with aromatic wine; injections of the nitrate of silver were ordered. -*v The 24th. The puncture made with the gonorrhoeal pus had pro- duced nothing. At first, on the second day, it became a little red, but the next day it had disappeared. The inoculated puncture, made with the pus of the chancre, had produced the characteristic pustule; but that made with the chancre pus, mixed with hydrochloric acid, had produced nothing, and was healed the following day. The same treatment with cauterization and injections of nitrate of silver. The 26th. The pustule from inoculation, whose base was somewhat indurated, was cauterized; to the above-mentioned treatment, six drachms of cubebs per diem were added for the gonorrhoea. Oct. 7th. The chancres were healed; the balanitis had disappeared three days previous; the gonorrhoea flowed but little, and without oc- casioning any pain. The 10th. The pustule from inoculation, which had not been de- stroyed by the cauterization, was dressed with vin. arom. and cauteriz- ed. The 18th. The chancre on the thigh was almost healed, there was no more discharge from the gonorrhoea, and no induration remained where the chancres had been on the penis. On the 21st of October, he was dismissed cured. Case XXVI. Chancre and symptomatic bubo, inoculated with positive result; chancre pus, dried by the heat of boiling water, then being diluted with water, was inoculated, icith negative result. Dern-----, aged 29, entered Sept. 20, 1836, had contracted chan- cres six weeks previous; they were situated on the superior internal part of the prepuce. About a fortnight since, a bubo had shown itself on the left side. We found the chancres partly at the period of reparation. The bubo was seated in the superficial ganglions; it was very large, and the fluctuation at its summit doubtful. The chancres were cauterized with nitrate of silver, and dressed with vin. arom. A blister was placed on the bubo, which was ordered to be dressed the following day with a solution of sublimate, twenty grains to the ounce of wa- ter. 26th. The fluctuation was become evident; the bubo being1 opened, afforded a bloody and thin pus; it was immediately inoculated on the right thigh. The chancres were quite modified, and tending towards cicatrization. A cataplasm was placed upon the opened bubo, and the same dressings were continued for the chancre. 28th. The inoculation of the pus of the bubo was without result; yet the wound of the opening had become rounded, and its edges as- sumed a chancrous appearance. A new inoculation was made on the right thigh, with the pus of the bubo. The 30th. The pustule from inoculation was developed; it was cauterized with argent, nitr. Some chancre pus was collected and 12 90 CLINICAL AND EXPERIMENTAL RESEARCHES— dried in a capsule exposed to the heat of boiling water, some drops of water were then mixed with it, and an inoculation made on the thigh. Oct. 3rd. The inoculation of the dried pus had produced nothing. The chancres of the prepuce were healed; the bubo was much di- minished; dressings of ung. mercur. had been used the last two days, in order to promote the resolution of the base. The 10th. Dressings of aromatic wine were applied to the bubo, and its surface was cauterized with argent, nitr. No engorgement was felt at the base; and fleshy granulations were produced. On the 25th, the patient was dismissed cured. Case XXVII. Chancre at the period of reparation; inoculated without result. Bign-----Alexandre, aged 24, entered June 13, 1835. About the first days of May, this patient contracted chancres around the glans near the corona, on the frenum and prepuce; those on the glans had healed with applications of calomel and opium cerate, and caute- rization with nitrate of silver. There only remained a chancre with a rose-colored ground situated on the prepuce, and another with a granulated ground, occupying the region of the frenum; they were dressed with opium cerate. The 18th. The ulcerations, which appeared to remain without modification, were cauterized with nitrate of silver, and dressed with calomel and opium cerate. The 24th. There was little alteration; the pus from the ulcer, with a rose-colored ground, was inoculated on the right thigh, and that col- lected on the one with a granulated ground, upon the left; dressings with vin. arom. were ordered. The 29th. The chancres had made some progress towards healing; the inoculated puncture had produced nothing; the chancres were cauterized and dressed with vin. arom. The patient was dismissed cured, July 3rd. Case XXVIII. Phagedenic diphteritic chancre, inoculated by the nails in the subclavicular region; inoculation without result with the pus of this latter ulcer, which had arrived at the stage of reparation; sympathetic bubo. Tug-----, aged 23, entered May 10, 1836. Three weeks previous, he had contracted a chancre on the frenum, which at first made little progress; but after an excess in drinking and several nights spent with- out rest, the ulcer became inflamed, and passing to the phagedenic state, destroyed the frenum and a portion of the substance of the glans; at the same time as the chancre became phagedenic, a bubo de- veloped itself in the right groin; its progress was very indolent. We found the chancre presenting all the apparent characters of phagedenic chancre; the wound it had caused was'deep and its ground cove/ed with a greyish, pulpy, pseudo membrane, resembling the pus PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. 91 of hospital gangrene; upon the large and indurated bubo, blisters were placed, which were dressed with the opiated solution of sublimate. The chancre was cauterized and dressed with vin. arom. May 31st. The chancre was better; but some pseudo-membranes still existed on some points of its surface; the bubo had diminished but little; the same dressing was continued; the syrup, hydrocyan. was prescribed. June 6th. The chancre appeared modified; several points of its surface were at the period of reparation; the bubo had diminished to half; compression was applied by means of a spica bandage; the pa- tient complained of a scratch near the clavicle, which he had made with his nails at the beginning of his complaint, and which since that time had not cicatrized; the wound was about the size of a sixpence, and resembled a chancre, during the period of reparation; the pus it furnished was inoculated on the right thigh; it was then cauterized and dressed with aromatic wine. The 10th, The inoculation of the pus from the ulceration of the clavicle had produced nothing. The bubo was almost levelled, and but little indurated; the chancre was cicatrizing. June 30th. The chancre was healed; very little induration remain- ed in its place; the bubo had nearly disappeared. The patient left the hospital cured, July 18th. Case XXIX. Gonorrhoea, chancre in a state of reparation; in- oculation without result. Marti-----, aged 28, entered June 27, 1836, had been affected with a gonorrhoea of an intermittent nature for more than a year, for which he had never received any regular treatment. A month since, he contracted a chancre on the frenum; we found the urethral dis- charge whitish; he had no pain in passing his water. The chancre was every where at the period of reparation, and no induration was perceived at its base. From the commencement of the disease, no symptom had been no- ticed, which could be referred to a secondary syphilitic affection, and the general health had always been excellent. The 29th. The pus of the gonorrhoea was inoculated by two punc- tures on the right thigh, and that of the chancres in the same manner on the left. Injections of acetate of lead and copaiva in the form of bolus, were ordered for the gonorrhoea. The chancre was cauterized and dressed with vin. arom. July 3rd. The inoculation had produced nothing, either on the right or left side; there was no pustule; the gonorrhoeal discharge was much diminished; and the chancre was almost dried. The same treatment was continued. 6th. The discharge had ceased; the chancre was perfectly cicatriz- ed, without leaving any induration. The patient was therefore dis- missed. 92 CLINICAL AND EXPERIMENTAL RESEARCHES— Case XXX. Phagedenic indurated chancre in the stage of repa- ration; inoculation without result. Bouli-----, aged 20, entered August 19, 1836, had contracted a chancre on the prepuce, by an erosion of the margin, about two months previous. The ulcer at first of little extent, inflamed in con- sequence of some errors of diet, and extended to nearly the whole of the margin; a remarkable induration was formed at the base of the ulcer, and its surface assumed the appearance of a phagedenic chan- cre, destroying the tissues by a kind of instersticial gangrene from ex- f cessive induration. Five or six days after its passing from the regular to this latter form, ^ the body and limbs became the seat of a lenticular syphilitic eruption, .* and some patches of mucous tubercles developed themselves at the anus. In the right inguinal region, the tension of the ganglions pro- duced some hardness; he had received no treatment whatever. We found his general health good; the digestive functions regular; the tem- perament was inclined to be lymphatic. The whole surface of the chancre appeared in the stage of reparation; the syphilitic eruption was still in the acute stage; the papules were raised. The 20th. Some pus, taken from the chancre, was inoculated on the right thigh. Pills of the iodide of silver were ordered, according to the formulary of M. Serres de Montpellier, beginning with a twelfth of a grain pro dose per diem; the patient took a mucilaginous fluid for drink, and the chancre was dressed with cerate. ' The 27th. There was no change in the general health, the inocu- lated point had produced nothing. The close of the iodide of silver was gradually increased to three-twelfths of a grain. Sept. 1st. No effect could be observed which it was possible to re- fer to the action of the medicament; five-twelfths were given. The 9th. Not the slightest modification was perceived, and the dis- ease followed the usual course, as if it had remained without treat- ment. The digestive functions were good; the chancre tended towards cicatrization; only the induration at its base remained in statu quo. The dose of the iodide was increased. The 9th. Seven-twelfths were given; on the 12th, a grain; the 20th, fifteen-twelfths; the 26th, seventeen-twelfths; and at length, Oct. 2nd, still without any modification, the dose had been increased to fift)j-four-twelfths. Six grains of the iodide were ordered to be taken in the morning, fasting. The 7th. Eight grains-were given in the same manner; on the 10th, the patient took twelve grains of iodide of silver, without experiencing the least action. The syphilitic eruption progressed; the mucous pa- pules at the anus had extended themselves; the induration of the base of the chancre, which was not quite cicatrized, remained. It was then thought proper to abandon M. Serres' treatment, which had so long been followed with such exactitude and without any success. The pills of iodide of mercury were prescribed, the tisane of hops, the anti-scorbutic syrup, and fumigations with cinabar, every second PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. day. The mucous papules of the anus were dressed with calomel and soda chlorinata. The 14th. An improvement was already perceived; the papulae were less raised; the secretion which took place upon the surface of the mucous papulae, had nearly ceased. Two pills were ordered to hasten the cure; the functions continued quite regular. The 19th. But few squamae remained. On the legs, scarce any- thing remained, but a few brown spots on the thigh, there was nothing more to be seen. The papulae at the anus were dry; the induration of the prepuce was diminished by half; the ganglionary hardness in the groin had disappeared; the dose of iodide of mercury was increas- ed to three pills. The 27th. Only a few brown spots remained upon the body and limbs, which became effaced by degrees; the papulae at the anus had disappeared, as well as the induration on the seat of the chancre on the prepuce. Nov. 1st. The patiant was dismissed quite cured. Case XXXI. Chancre at the period of reparation; inoculation without result. Quan-----, aged 24, entered July 1, 1835, had been affected five weeks with a gonorrhoea, which was very painful at the commence- ment, and which showed itself three days after a coition. On the skin of the prepuce, towards the base of the glans, he perceived two ulcerations. He had received no treatment; but a phimosis having supervened, in consequence of the increase of the chancre on the pre- puce, the patient entered the hospital, at which time he felt no pain on passing his water, but suffered much at the end of the penis, which was greatly swollen. The skin of the prepuce was of a violet red color; on the underside, two indurated points were perceived, corres- ponding to the seat of the chancres of the mucous membrane, as pointed out by the patient; leeches were applied to the penis; some pus was taken from the aperture of the prepuce and inoculated on the right thigh. July 4th. The inoculated puncture had produced nothing; the pa- tient took bolus of copaiva; the glans and prepuce were cauterized with nitrate of silver; the phimosis was no longer in the inflammatory stage. The 11th. A fresh inoculation was made; pills of hydrarg. iodid. were ordered, on account of the induration which remained at the base of the prepuce; the chancres were cauterized and dressed with vin. arom. The 12th. The inoculated punctures had produced nothing; the chancres were almost healed; the gonorrhoea had disappeared, under the influence of the copaiva and the injections of acetate of lead. Aug. 13th. All was healed and the circumcision was made. The patient left cured Sept. 15th. 94 CLINICAL AND EXPERIMENTAL RESEARCHES— Case XXXII. Chancres at the period of reparation, gonorrhoea in the acute stage; inoculation without result in both cases. Lev-----Pierre, aged 26, entered June 3, 1835, had been affected three weeks with chancres situated on the frenum and corona glandis, for which he had had no treatment. The ulcers, which were in the stage of reparation, appeared much irritated and caused great pain; the patient attributed this state to a cc ition two days previous to his entering the hospital: fomentations, with a concentrated decoction of opium, were ordered. The 5th. An acute gonorrhoea had developed itself; the patient suffered much; the gonorrhoeal pus was inoculated on both thighs; and twenty leeches were applied to the perinseum. The 8th. The inoculations of the gonorrl ceal pus had produced nothing; some pus was taken from the surface of the chancre in the stage of reparation, and inoculated on each thigh; the ulcers were dressed with calomel and obium cerate. The 10th. The punctures made on the 8th with the chancre pus had produced nothing: the gonorrhoeal pus was again inoculated on the left thigh, and the pus of the chancre on the right; injections of ace- tate of lead were ordered; the chancre, which still remained, was cauterized: those on the corona glandis were healed. The 12th. The chancre wTas fully cicatrized; the gonorrhoeal pus was again inoculated on the right thigh; the inoculations of the 10th having produced nothing. The 13th. The puncture from the last inoculation was red and in- flamed; there was little discharge; the patient experienced no pain on passing his water; the injections were continued, with copaiva in fci.n of bolus. The 18th. The false pustule, caused by the inoculation on the 12th, had dried up and disappeared; the gonorrhoea was nearly cured. The 24th. The patient left quite cured. Case XXXIII. Chancre of the prepuceat the period of reparation, gonorrhoea, sympathetic bubo; inoculation icith negative result in each case. Fourn-----, aged 20, entered Nov. 21, 1835, had contracted a gonorrhoea and chancre of the prepuce, about three months previous; he had received no treatment. A fortnight since, a bubo had devel- oped itself in the right groin; its course had been acute; the gonor- rhoea had caused some pain on passing his water. Upon separating the lips of the meatus urinarius, some points of the mucous membrane were found eroded, similar to those which are found in balanitis; the chancre of the prepuce presented all the characters of the period of reparation; its surface was covered with fleshy granul^tiouc; the bubo had suppurated; no more engorgement remained at its base, than at that of the chancre; it was opened and much creamy whitish pus was dis- charged. The 23rd. The pus of the gonorrhoea was inoculated on the left thigh, that of the bubo on the right, and that of the chancre in the PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. period of reparation by punctures made on the right thigh below that from the bubo. For the gonorrhoea, injections of sulph. zinc, were ordered; the chancre was cauterized and dressed with calomel and opium cerate, and cataplasms were placed on the bubo. The 28th. None of the inoculations had produced a result; the pus of the gonorrhoea was again inoculated on the left thigh; the same treatment was continued. Dec. 6th. The inoculation made Nov. 28th had produced nothing; the discharge from the gonorrhoea was less; the chancre was almost cured; the bubo, the aperture of which was not at all ulcerated, was healing; some resolutive frictions had been made with ung. mer. The 18th. The chancre was healed, the almost entirely closed bubo no longer furnished pus; some granulations at its aperture were cauterized with nitrate of silver; the gonorrhoea only furnished a white mucous fluid. The injections and -copaiva were continued. Being completely cured, he left the hospital on the 30th. Case XXXIV. Chancres at the period cf reparation; inoculation without result. Franc-----, aged 20, entered August' 1, 1S36. This patient had seven weeks previous, contracted chancres at the base of the glans, which inoculated themselves by contiguity of tissue on all its circum- ference and on the corresponding part of the prepuce; some points had passed to the period of reparation, and vegitations had developed themselves. On the scrotum, an ulceration formed itself, which in- creased by degrees; no particular treatment had been used. There remained, at the time of his entrance, upon the corona glan- dis only some vegetations, with ulcerated points in their interstices; in the meatus urinarius a chancre was perceived, with all the characters of the period of reparation. On the anterior and superior parts of the scrotum, an inch below the penis, an ulcer was seated with irreg- ular reverted and jagged edges, and vermillion ground; the whole thickness of the skin was perforated; the general form of the ulcer was irregular funnelshaped; all parts seemed at the period of repara- tion. The 3rd. The pus collected from the surface of the ulcer of the scrotum was inoculated by two punctures, on the right thigh. Dress- ings of aromatic wine were applied to the intersticial ulcerations of thQ vegetations, as well as to the chancre of the meatus urinarius, which was also cauterized with nitrate of silver. The 7th. The inoculated punctures had produced nothing; the in- tersticial ulcers were healed, and the chancre of the meatus was al- most dry; it was cauterized and dressed with vin. arom. The 10th. The vegetations were cut; the chancre of the meatus was cicatrized; the ulcer of the scrotum was covered with the granu- lations of the period of reparation; the skin seemed fringed all around; the circumference had diminished, and the ground was more raised. On the 15th. All being healed, without any induration remaining, the patient was dismissed. 66 CLINICAL AND EXPERIMENTAL RESEARCHES- Case XXXV. Chancres, balanitis, symptomatic bubo, inoculat- ed with result. _ .. , , Alex-----, aged 22, entered Nov. 14, 1835. The disease had commenced five weeks previous, with chancres on the glans and in- ternal part of the prepuce. A balanitis soon developed itself in con- sequence of an incomplete phimosis. He had, till then, rece.ved no treatment. Three weeks previous, a bubo had made its appearance on the left side; we found it suppurating; there was also a considera- ble gonorrhoeal discharge. The 17th. The day after the opening of the bubo, its pus was in- oculated on the left thigh, and the pus of the balanitis, mixed with the pus of the chancres of the glans, was inoculated on the right, lor the balanitis, a cauterization was made all around with nitrate of sil- ver, and it was dressed with vin. arom.; cataplasms were applied to the bubo. The 19th. The inoculated punctures had produced the pustule on the right and left thigh; that on the left had developed itself with more rapidity than that on the right. The'21st. The inoculated pustules were well cauterized, in order to destroy them; the centre of the bubo was cauterized in the same manner; its edges being too much undermined to cicatrize, had been removed; dressings of vin. arom. were applied. Dec. 1st. The chancres on the glans and prepuce were healed; the pustules from inoculation had disappeared, under the influence of the cauterization with nitrate of silver; the centre of the bubo was m the stage of reparation; the dressings with aromatic wine and the cau- terizations were continued. The patient was dismissed cured on the 15th. Case XXXVI. Balanitis, with superficial chancres; inoculation with positive result. Bonj-----, aged 40, entered Aug. 23, 1836. This patient, who had a natural phimosis, perceiving a swelling of the prepuce twelve days after a suspicious connection; for three or four days he felt some itching at the end of the penis; but at the abovementioned time, after a long walk, he suddenly experienced, at the same time with the swell- ing, very sharp pains, and a copious discharge flowed over the mar- gin of the prepuce. We found a slight oedema of the parts; no in- duration could be perceived. Upon separating the edges of the con- tracted aperture of the prepuce, some ulcerations were found upon the glans, which had eaten through the thickness of the mucous membrane; the matter of the discharge was greenish and bloody; the urethra did not furnish pus upon pressure, otherwise the patient had not suffered, and the pain he felt on passing his water, were stated by him to affect the glans and prepuce only at the moment when the urine passed over these excoriated parts. The 24th. The pus which appeared at the aperture of the prepuce, was inoculated by a single puncture. The diseased surfaces were PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. cauterized with nitrate of silver, carried rapidly round between the glans and prepuce; injections of aromatic wine were made, and a few threads of lint were introduced to prevent the two mucous surfaces from coming in contact. The 26th. The inoculated point had produced the pustule; the same treatment was continued; there was already a decided improve- ment. The 27lh. The inoculated pustule was cauterized with arg. nitr. The aperture of the prepuce permitting the introduction of a bit of dry linen, a fresh cauterization was made, and the parts again separat- ed. Sept. 10th. The balanitis had completely disappeared; the ulcera- tions of the glans and prepuce were cicatrized; no induration remain- ed on the seat of the disease; the circumcision was made. The 20th. The wound from the operation was almost entirely united; some fleshy granulations were cauterized, and the patient dismissed. Case XXXVII. Superficial chancres, balanitis, phimosis; inocu- lation with positive result. Bor-----, ae;ed 19, entered May 3, 1836. A few days after an impure connection, this patient, who had a natural phimosis, perceived a slight swelling and felt a smarting on the glans during the emission of his urine: at length, an abundant discharge took place upon the open- ing of the prepuce. We found the mucous membrane red and presenting here and there ulcerated patches, resembling superficial chancres; no pus was pro- duced by pressure on the canal of the urethra; no induration could be felt through the swelling of the prepuce. He had for some time been treated at another hospital. The pills of hydrarg. iodid. were pre- scribed. May 4th. The pus collected at the orifice of the prepuce was inoc- ulated, by a puncture, on the right thigh; the balanitis was cauterized all around by introducing the nitrate of silver between the glans and the prepuce. Injections were made with vin. arom. to wash the surfaces, and a few threads of lint introduced upon a probe, to prevent the con- tact of the inflamed mucous membranes. The 7th. The inoculated puncture had produced the characteristic pustule of the chancre; it was destroyed with nitrate of silver. For the balanitis, the cauterization and injections were continued. Nearly all the glans could be uncovered. The 10th. The cauterized inoculated pustule had disappeared; on- ly one or two ulcers remained upon the glans, and they presented the characters of the period of reparation; they were cauterized and dress- ed with aromatic wine. The 18th. All was healed, it was remarked that the phimosis was partly caused by the length of the frenum, which extended nearly to the meatus urinarius, and thereby prevented the prepuce from being drawn back; it was therefore cut, and the small wound dressed with 13 98 CLINICAL AND EXPERIMENTAL RESEARCHES— opiated cerate. No induration remained on the site of the superficial chancre. The patient was dismissed, May 24th. Case XXXVIII. Transformed chancres, gonorrhoea; inocula- tion without result. Cha-----Louise, aged 19, entered April 1, 1834, had been affect- ed with the above symptoms for five weeks; the person from whom she had contracted them had a chancre only. On the internal surface and margin of the great labia, some knots showed themselves, which following the regular course of the inoculated pustules, became filled with pus, opened and presented as many chancres as there had been pustules; a vaginal gonorrhoea showed itself at the same time; during ten days it was very acute and painful, and then became chronic. Al- though she had used no treatment, the ulcers appeared at the period of reparation, their ground was raised, and their surface covered with a greyish albuminous secretion, not easily to be detached, secreted a serous pus. The matter of the gonorrhoea was whitish; there was no pain on passing her urine. The 2nd. A bath was ordered and emollient lotions. The 5th. The pus taken from an ulcer on one of the great 'labia was inoculated on the left thigh; cerate dressings were used. The 7th. The inoculation had produced nothing; the pus of one of the transformed chancres, which furnished the most purulent matter, was inoculated on the left thigh below the former puncture. Injections of decoct, alb. were used. The 8th. The inoculated punctures were red; but little elevat- ed. The 9th. The redness of the inoculated points had disappeared and nothing had taken. The chancres were dressed with calomel and opi- um cerate. The 18th. An examination was made with the speculum; the cer- vix was healthy; its antero-posterior diameter was eleven lines, and the transverse diameter the same; the vaginal secretion was like that from the uterus, transparent; the ulcers of the great labia were nearly all heal- ed. Injections were made and tampoonings with decoct, alb. The 28th. All was well, and the patient was dismissed. In concluding the observations upon chancres, we think we ought to quote the remarks published in the thesis of M. de-Lavergne.* " Has not M. Ricord proved, by the two pathological anatomical specimens, which he presented to the academy, that urethral chan- cres exist; chancres which have been indicated by inoculation, and which I have found before and after death, and upon which I have been able to make the following observations. Obs. I. " Boisseau, aged 20, entered the Hopital du Midi, April 2, 1836. He had had four different gonorrhoeas at periods which he was unable to fix precisely; they had all been quite cured. The last, * De la non-indentite de la blenhorrhagie et du chancre p. 24, 1837. PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. 99 which had caused him much pain, was followed after having lasted two months without treatment, by an orchitis, for which the patient was received into the hospital; the orchitis had existed eight days when he was admitted. After some applications of leeches, the swelling of the testicle had decreased a little, M. Ricord pointed out a complication with a hydrocele in an acute stage, which he punctured successfully. The pains which had much decreased in consequence of this puncture, returned on the third day, at the same time as a new infusion of fluid into the tunica vaginalis. A fresh puncture had the same result; M. Ricord made a third puncture and a vinous injec- tion. Notwithstanding the acute stage, all went en as if it had been in the simple stage. " May 30th. The patient was cured of his orchitis and hydrocele; but the gonorrhoeal discharge, which upon being inoculated at first produced the characteristic pustule, had remained notwithstanding the employment of balsams and revulsives. In this state, the patient left the hospital to resume his employment; he soon returned with an or- chitis complicated with hydrocele, as in the affection of the first testi- cle. The hydrocele was then punctured with a bistoury; but the go- norrhoeal discharge had progressively increased; the bowels became confined; manna in whey was prescribed; at length a progressive marasmus, which nothing could arrest, terminated his life. " Autopsy. The genito-urinary organs having been removed, and the urethra, as well as the bladder, being laid open from the superior part, ulcerations were perceived, which had destroyed the prostate gland, and the corresponding part of the urethra in its entire thickness. In the forepart, a flap of the mucous membrane of the urethra, de- tached from the subjacent parts, and only adhering by the anterior portion, was slightly hypertrophied; posterior to this, there was ano- ther flap which was hypertrophied and indurated; several rounded ul- cerations, with the characteristic form of syphilitic ulcers, perforating the whole thickness of its mucous membrane, appeared on the surface of the bladder. The vesica seminalis of the left side, presented an extensive abscess and some ulcerations; that of the right side was un- injured; but the canalis ejaculatorius and vas deferens of the left side established a continuity of disease from the urethra to the suppurated epididymis, which presented in its interior an abscess which had almost ready penetrated a part of the testicle; in the same organ, the pallia- tive puncture, which had been made, had sufficed to produce pseudo- membranes, forming a band of union between the two surfaces of the tunica vaginalis. In the right testicle, which had been subjected to the vinous injection, the adherence was complete during life, as well as after death, and no indication, unless it be inoculation, could have led us to the knowledge of the lesion we have just described. It ought to be observed, that the patient had never had a catheter passed or used injections. __„... ,T... Obs. II. " Jean Bourdon, aged 17, entered the Hopital du Midi, towards the end of September, 1836. He had contracted a chancre of the glans six months previous, for which he at first had no treat- 100 CLINICAL AND EXPERIMENTAL RESEARCHES— ment; soon he perceived a slight discharge from the meatus urinarius, which increased although slowly. After some very fatiguing work, he was attacked with a very inflammatory phimosis, for which a surgeon wished to make the inferior section, but the parts were drawn to one side and the edges of the wound became inoculated. Notwithstand- ing all the treatments employed, the disease could not be cured; in this state he entered the hospital. " He was much emaciated, although the functions were regular; the glans and the flaps of the ulcerated prepuce were so blended as to offer the appearance of a penis with three heads. The chancre pos- sessed all the characters of the period of increase; and notwithstand- ing the various local applications and attention to diet calculated to fa- vor the internal treatment, very little amelioration could be obtained. The gonorrhoeal discharge was frequently bloody, and accompanied with pain; upon inoculation it produced the characteristic pustule, which was then destroyed. Thus after many months suffering, with- out any instrument ever having been introduced into the depth of the urethra, an incontinentia urinae supervened, which led M. Ricord to refer it to ulcerations in the neck of the bladder and canal of the ure- thra; the incontinentia urinae did not cease till the death of the patient, which took place December 20, 1836, and which was accelerated by a diarrhoea which nothing could control. Although upon the post- mortem examination, the intestinal canal presented no more alteration than the other abdominal organs, which were in their normal state, ex- cept the bladder. In the chest there were some adhesions of old standing; on the right side there were some small cysts of matter, most probably from tubercles. " The genito-urinary organs being separated, and the bladder and the canal of the urethra laid open, its sides were several lines in thickness; hard and callous; its capacity was diminished one half; the fundus presented many fleshy granulations. Besides the chancre at the meatus urinarius, there was an ulceration of the pars spongicsa urethra;, an inch in depth and eight lines in length, perforating the en- tire thickness of the mucous membrane; but behind the region of the bulb in the pars membranosa and prostatica, the neck and cavity of the bladder, traces of a vast phagedaenic chancre were perceived. And especially on the lateral parts of the prostate, two large excava- tions in its substance were found separated from each other by a hy- pertrophied and indurated tongue, at the inferior part, the reversed prepuce showed traces of the operation and inoculated edges. " On the corona glandis, a large chancre was seen; on"the lateral parts, the two wounds from the operation which had become chancroLs; and lastly, a chancre of the meatus and corpus spongiosum. Obs. III. "-----Florence, aged 19, entered the Hopital do Midi, January 17, 1836. She had previously twice had a gonorrhoea, which yielded to injections of decoct, alb. Upon her entry, she I ad a vaginitis of a fortnight's standing; she had only felt acute pains on passing her water at the eight day of her vaginitis, and this determintd PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE. her to enter the hospital. The pus from the vagina, in which the speculum showed nothing, being inoculated, had a negative result; that from the urethra, produced the characteristic pustule of the chancre. M. Ricord then declared the existence of an urethral chancre, whose existence was soon demonstrated by its apparition at the meatus uri- narius. A month's treatment sufficed to cure it completely." Section II. INOCULATION OF THE MUCO-PUS OF GONORRHOEA, SIMPLE AND COM- PLICATED, AND IN ITS VARIOUS SEATS. Case I. Acute urethral gonorrhoea; inoculation without result. Caf----, aged 46, entered June 27, 1835. The disease appear- ed three days after a connection and had exisied five, accompanied with very acute symptoms; the matter of the discharge was greenish, streaked with blood. Twenty leeches were applied to the perinaeum; a purgative enema was ordered, as the bowels had not been relieved for four days, and two camphor pills per diem. The 29th. There was a little less pain; no induration was perceiv- ed in the course of the canal; the gonorrhoeal pus was inoculated with two punctures on the left thigh. July 3rd. There was some little irritation in the inoculated punc- tures; the skin was red and raised, but there was no pustule. The 4th. The red spot produced by the inoculations faded without developing the pustule; the gonorrhoea no longer caused pain during the emission of the urine. Cubebs and injections of sulphate of zinc were prescribed. The 6th. The gonorrhoeal pus was inoculated on the right thigh, with two punctures; the matter of the discharge was whitish. The 10th. The same elevated spot was observed, as was produced by the inoculation on 27th, and it disappeared in the same man- ner, without producing a pustule. The 11th. A fresh inoculation was made by two punctures on the left thigh; the discharge was less in quantity, and contained less pus. The cubebs and injections were continued. The 14th. The inoculations made on the 11th, had produced noth- ing, not even the inflamed spot; the gonorrhoea yielded only a mucous discharge. The patient left cured on the 22nd; the discharge had quite ceased since the 17th. Case II. Urethral gonorrhoea; inoculation without result. Mar-----, aged 22, entered April 13, 1836. The disease had lasted a month; at first very acute, it socn became chronic from using baths without any other treatment. On his entry, we found the mat- ter of the gonorrhoea whitish; no induration was perceptible in the course of the urethra, there was neither pain in the emhsion of the urine nor during erection; the inoculation was made by two punctures on the right thigh. The cubebs and iron were given. 102 CLINICAL AND EXPERIMENTAL RESEARCHES- The 18th. The inoculations had produced nothing. The treat- ment was contiuued. . The 21st. The purulent matter of the discharge had much dimin- ished. May 1st. Little more than a mucous secretion remained. The 10th. No more discharge remained; only in the morning, a single drop of transparent fluid was perceived at the meatus urinarius. The 16th. The patient was dismissed cured. Case III. Urethral gonorrhoea; inoculation without result. Bous-----, aged 28, entered April 15, 1836. The affection, which was of eight days standing, had made its appearance four days after a connection; he had much pain in passing his urine, with tension of the canal, but no indurated point in its extent. Upon separating the lips of the meatus urinarius, the mucous membrane appeared red and the discharge was thin and bloody; the gonorrhoeal pus was inoculated by two punctures on the right thigh. Five-and-twenty leeches were ap- plied to the perinaeum and pil. opii. c. camph. were ordered with cu- bebs and iron. The 18th. The inoculations had produced nothing; the discharge appeared modified; the same treatment was continued. The gonor- rhoeal pus was inoculated by two punctures on the left thigh. The 28th. The inoculation had produced no result? the discharge was losing gradually although slowly its reddish tint; the dose of cu- bebs was increased, and injections of sulphate of zinc were used in- stead of those of acetate of lead. The 30th. The discharge was whitish and without pain. The same treatment being continued, only a slightly increased mucous se- cretion remained on the 6th of May, and on the 16th, the patient was dismissed cured. Case IV. Acute urethral gonorrhoea; inoculation without result. R-----, aged 18, entered May 13, 1836. The disease was fifteen days from its commencement; it had appeared eight days after an im- pure connection; the pain in the emission of the urine was very acute; the matter of the discharge was greenish, with many streaks of blood; the urethral canal was not indurated, but very tense. May 14th. The gonorrhoeal pus was inoculated on the right thigh, by two punctures. Five-and-twenty leeches were applied to the pe- rinaeum; the bowels not having been moved for four days, the patient was ordered a bottle of sedlitz water. The 17th. The inoculated punctures had produced nothing; the pain on passing his urine was less; but the discharge was still very copious. Injections of nitrate of silver were ordered. The 21st. The matter of the discharge was no longer streaked with blood, its color was whitish; and there was a tendency towards the mucous state. Cubebs, four drachms per diem were ordered, and the injections of argt. nitr. continued. PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA. JQ3 The 23rd. Only a super-secretion of mucous remained; the same treatment was pursued, and on the 7th of June, the patient left cured. Case V. Urethral gonorrhoea; inoculation without result. Mau-----, aged 28, entered April 23, 1836. The disease, which was at the eleventh day of its duration, appeared eight days after a connection. There was at the commencement no pain, and the dis- charge almost immediately became whitish, with the characters of a gonorrhoea. An induration was perceived on the prepuce, marking the seat of a chancre, cured a month previous. The 27th. The gonorrhoeal pus was inoculated on the right thigh. Injections of. nitrate of silver and cOpaiva in emulsion were ordered. The 30th. The inoculation had produced nothing; the discharge was diminished. May 1st. The canal was cauterized with the caustic holder. The 2nd. The discharge was augmented; it was purulent and streaked with blood. The 4th. The gonorrhoea had almost disappeared, and only a little mucous discharge remained. The patient was dismissed cured on the 11th. Case VI. Acute urethral gonorrhoeal inoculation without result. V-----, aged 28, entered May 30th, 1835. The disease, which appeared eight days after an impure connection, had lasted ten days, and presented all the symptoms of the greatest acuteness. He had taken, by the advice of a gardener, a tisant of stravvberry roots. Thirty leeches were applied to the periuaeum. June 8th. The gonorrhoeal pus was inoculated on the left thigh, with two punctures. The 10th. Injections of sulphate of zinc were ordered, as the gon- orrhoea was far less painful, yet some streaks of blood were still re- marked in the discharge. The 11th. The inoculated punctures had produced nothing; the matter of the discharge was whitish yellow; but its quantity was some- what less. The 21st. The inoculation of the 15th, not having produced any- thing, a fresh inoculation was made. Cubebs were ordered, two drachms per dose. The 30th. The last punctures were without effect; the discharge Avas much less. July 6th. There remained only an increased secretion of mucus. The 11th. The patient left cured. Case VII. Urethral gonorrhoea; inoculation without result. Lez-----, aged 26, entered May 31, 1836. A month previous, a gonorrhoea had appeared eight days after a connection. At first it was very painful, but the acute stage lasted only eight days, although the patient underwent no treatment. Upon his entry, the rather co- 104 CLINICAL AND EXPERIMENTAL RESEARCHES— pious discharge was of a yellowish white color; there was neither pain nor induration in the canal of the urethra. The gonorrhoeal pus was inoculated on the left thigh, by two punctures. Injections of argent. nitr. were ordered, with an emulsion of copaiva. June 3rd. The inoculation had not succeeded; the same treatment was continued. The 6th. The discharge had much decreased; the mucous matter prevailed. The 10th. The injections of nitrate of silver were suspended. On the 12th, scarce any discharge remained; and the 10th, the pa- tient left cured. Case VIII. Acute urethral gonorrhoea; inoculation without result. M-----, aged 18, entered April 26, 1836. The affection had commenced five days previous; the patient was suffering much; the discharge, which was very copious, was of a yellowish green color and streaked with blood; the canal of the urethra was painful when touched and very tense; but no induration was perceived in any part of its extent. The 27th. The gonorrhoeal pus was inoculated by two punctures on the right thigh; thirty leeches were placed upon the perinceum; a camphorated enema was ordered for the evening, and bleeding, if the state of the fever should require it. The 29th. The fever still continued, and the patient was therefore bled, as had been directed on the 27th. The 31st. There was less pain; the inflammatory stage seemed to be calmed; the inoculated punctures had produced nothing. Injec- tions of nitrate of silver were prescribed. May 6th. The discharge had diminished, its yellow color had dis- appeared; the secretion was white and rather mucous than purulent. Four table spoonsful of the emulsion of copaiva per diem were ordered. The 11th. A litttle mucous discharge in the morning remained; the dose of the emulsion was increased to six spoonfuls; the injections were discontinued; and on the 24th, the patient left cured. Case IX. Acute urethral gonorrhoea; inoculation without result. Far-----, aged 24, entered Dec. 27, 1836. The affection had ex- isted a fortnight, it made its appearance three days after a connection. At the commencement, the patient had suffered much; there was a cordee. There was tension, but no induration of the canal; the acute stage still existed; the matter of the discharge was of a yellowish green color; the mucous membrane of the urethra appeared red and tumified. The gonorrhoeal pus was inoculated on the left thigh with two punctures. Thirty leeches were applied to the perinaeum. The 30th. The acute stage had nearly disappeared; four spoonfuls per diem of the emulsion of copaiva were ordered. Jan. 10th. The discharge was diminished; the matter was whitish and mucous. ■■#. PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA. 105 The 13th. The discharge was still copious; injections of the iodide of iron were ordered; by the 16th, all had disappeared, and the pa- tient left cured the following day. Case X. Acute urethral gonorrhoea; inoculation without result. Che-----, aged 22, entered Sept. 13, 1836. The disease had com- menced four days previously, eight days after a connection. The mat- ter of the discharge was greenish and purulent; the patient suffered much in the emission of his urine; the gonorrhoeal pus was inoculated on the right thigh with two punctures. The 16th. The inoculated punctures had produced nothing. The canal was cauterized with the aid of Lallemand's caustic-holder, and two pil. opii c. camph. were ordered. The 17th. There had been much discharge- from the gonorrhoea since the previous day, there were some streaks of blood, but no pain. The 18th. The discharge had much decreased, it was white, and almost wholly mucous. The emulsion of copaiva was given in doses of four table spoonfuls per diem. The 19th. Scarce any discharge remained; the urethra was cau- terized. The 20th. The same phenomena appeared as after the former cau- terization. The 28th. Only a drop of muco-pus in the morning remained The 29th. The discharge had ceased, and the patient left Oct. 4th. Case XI. Acute urethral gonorrhoea; inoculation without result. Ois-----, aged 20, entered Oct. 4, 1836. The commencement of the disease was six days previous to his entry, and had showed itself four days after a suspicious intercourse. The' pains upon passing his water, had been very acute; the acute stage still continued; the mu- cous membrane of the urethra, which was red and tumified at the mea- tus, did not appear ulcerated. The matter of the discharge was very copious, and of a yellowish green color; it was inoculated by two punctures made on the right thigh; twenty leeches were applied to the perinaeum, and pil. opii c. camph. prescribed. The 8th. The inoculated punctures had produced nothing; the emulsion of copaiva and injections of nitrate of silver were ordered. The 10th. The pain on passing the water had ceased; the discharge was whitish. The 12lh. Perceptible amelioration : an enema of sulphate of mag- nesia was prescribed for the constipation. The 18th. The gonorrhoea was almost cured; an emulsion of co- paiva was ordered, and in a few days the patient left cured. Case XII. Acute urethral gonorrhoea; inoculation without re suit. 14 106 CLINICAL AND EXPERIMENTAL RESEARCHES— Vas-----, aged 19, entered July 5, 1836. This was the fourth day of the duration of the disease, which had made its appearance four days after a suspicious intercourse; at first, the patient had felt acute pains in passing his water, and the discharge became very copious. Upon his entry, the gonorrhoea was still in the acute stage, the patient suffered much"; the muco-pus was bloody and greenish, and the mu- cous membrane of the urethra appeared superficially excoriated; the canal was tense, but not indurated; pressure caused some pain. July 6th. The gonorrhoeal pus was inoculated by two punctures on the left thigh; the pil. opii campb. were ordered, with thirty leeches to be applied to the perinaeum and an enema with two ounces of mel. mercur. The 10th. The inoculated punctures had produced nothing; the gonorrhoea was less painful, and the discharge less decidedly marked with streaks of blood. The pills were continued, and injections of nitrate of silver ordered for the following day. The 15th. A fresh inoculation of the gonorrhoeal pus was made, in the same manner as before, on the left thigh. The matter of .he discharge appeared modified in a remarkable manner; its color was whitish, slightly tinged with yellow. The pain having entirely disap- peared, the pil. camph. were discontinued; the injections were con- tinued and copaiva in bolus form with magnesia was added. The 17th. The discharge had decreased; the inoculated punctures had produced nothing. The 21st. Only a little mucous secretion remained; and by the 27tb, the patient was cured and left the hospital. Case XIII. Acute urethral gonorrhoea; inoculation without re- sult. Bic-----, aged 17, entered April 12, 1836. The Gonorrhoea, with which this patient was affected, made its appearance two days after a connection; the course of the disease had been very acute and painful; by rest and the use of baths, the acute stage had disap- peared; copaiva had been given and the discharge had stopped; but in consequence of the fatigue of a journey undertaken just as the dis- ease had ceased, the discharge reappeared very copious, of a whitish color and occasioning very little pain. The above named day was the third from the return of the gonorrhoea; the mucous membrane, upon the lips of the meatus being separated, appeared excoriated; the passing of the urine occasioned at this point pretty sharp smarting; the patient had chafed himself in using the syringe; the gonorrhoeal pus was inoculated by two punctures on the right thigh. lujections.of sulphate of alum were ordered. The 22nd. The inoculated puncture had produced nothing; the discharge had much diminished; the redness of the meatus had disap- peared. The potion de Chopart was prescribed. The 27th. The discharge had nearly disappeared; the potion was continued. The patient left cured on the 29th. PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA. JQ7 Case XIV. Urethral Gonorrhoea; inoculation without result. Lau-----, aged 26, entered Dec. 16, 1836. This disease was of three weeks' standing; in the beginning of it, there had been much pain and a cordee. Nn induration was to be perceived in the canal of the urethra, nor pain upon pressure; but there was a slight itching during the emission of the urine; the mater of the discharge was whitish. An indolent tumor was perceived in the left groin. The 17th. The gonorrhoeal pus was inoculated on the left thigh; injections of nitrate of silver, a fourth of a grain to the ounce of wa- ter were ordered. The 19th. The inoculated puncture had produced nothing; the discharge was less; cubebs were ordered, four drachms per diem; the injections were continued: afresh inoculation of the muco-pus was made on the right thigh. The 20th. The inoculated puncture had produced nothing; the go- norrhoea only furnished a very mucous matter mixed with streaks of pus. The left thigh was inoculated. The 24th. The last inoculated puncture had produced nothing; there was no more discharge from the gonorrhoea; the ganglionary en- gorgement had not progressed. The patient left cured on the 29th. Case XV. Urethral gonorrhoea; inoculation without result. Blan-----, aged 17, entered June 20, 1835, had been three weeks affected with gonorrhoea; eight days previous, without any apprecia- ble cause, a bubo developed itself in the left groin, and the discharge had nearly disappeared; when the canal was pressed, a few drops of clear and whitish muco-pus appeared; the patient had undergone no treatment; leeches were placed upon the bubo, which presented no point of suppuration, and had followed a sub-acute march. The 24th. The gonorrhoeal pus was inoculated on the right thigh; injections of sulphate of zinc were ordered, and mercurial frictions made upon the bubo, which was very hard. The 28th. The inoculated punctures had produced nothing; there remained but little discharge; the bubo was somewhat resolved. July 10th. The bubo, to which compression had been applied, had quite disappeared; there had been no more discharge for six days. Case XVI. Acute urethral gonorrhoea; inoculation without result. Andr-----, aged 26, entered Aug. 16, 1836. This patient could not exactly fix the time at which the gonorrhoea had commenced; only he remarked that eight days after the last sexual connection he had suffered much and that the discharge had greatly increased. At the time of his entry, the gonorrhoea was in the acute stage; and the dis- charge was bloody and thick. Twenty leeches were applied to the perinaeum, and an enema with mel. rnercur. The gonorrhoeal matter was inoculated by two punctures on the right thigh. The 19th. The inoculated punctures had produced nothing; cam- 108 CLINICAL AND EXPERIMENTAL RESEARCHES— phorated pills were ordered; but little pain remained; a cauterization was made with Lallemand's caustic holder. The 21st. Little discharge remained; injections of nitrate of silver were ordered; and the patient left cured on the 30tb. Case XVII. Acute urethral gonorrhoea; inoculation without result. Dan-----, aged 25, entered Nov. 11, 1836, had been affected with a gonorrhoea eight days after a connection; in the commencement, it had been very painful; the canal of the urethra tense, and very pain- ful on being touched, presented all the symptoms of a cordee; the acute stage was in its greatest intensity; the matter of the discharge was greenish and bloody; however upon separating the lips of the swollen meatus urinarius, no ulceration was perceived; neither was there any induration in the whole course of the urethra, but a general tension; there was a large indolent engorgement in the left groin; but the patient said it existed before the gonorrhoea. The 12th. The gonorrhoeal pus was inoculated on the right thigh; twenty leeches were applied to the perinaeurn; two pil. opii camph. were ordered with fomentations of decoct, malvae. The 15th. The patient suffered less; the discharge was less bloody and the erections less frequent; the engorgement in the groin remain- ed stationary; the inoculations had produced nothing. The gonor- rhoeal pus was again inoculated on the left thigh; the bowels being confined, an enema of magn. sulph. was ordered; the pil. opii camph. were continued. Injections of nitrate of silver, a grain to four ounces of water, were ordered. The 18th. The inoculated punctures of the 15th, had produced nothing; the gonorrhoea was far less abundant and without pain; the matter of the discharge was whitish. The injections were continue^ and four drachms of cubebs were ordered. Dec. 14th. The patient left cured. Case XVIII. Urethral gonorrhoea; inoculation without result. Ceint-----, aged 24, entered July 18, 1336. This patient had been affected with a gonorrhoea eight days; it had developed itself six days after a connection; the discharge began without pain, and on the above named day the disease had quite the appearance of a gonor- rhoea; upon separating the lips of the meatus urinarius, which was a little red and swollen, the mucous membrane was seen a little eroded; in the matter of the discharge there were a few streaks of blood; there was no induration in the canal; only at the depth of two inhes a point was found painful to the touch. The 19th. The urethral secretion was inoculated on the left thigh; copaiva was prescribed and injections of arg. nitr. The 20th. The inoculated punctures had produced nothing; the dis- charge was much diminished; a cauterization with nitrate of silver was ordered. PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA. J09 The 21st. The injections and copaiva were resumed; and the pa- tient left on the 24th. Case XIX. Acute urethral gonorrhoea; inoculation without result. Guil----, aged 24, entered May 13, 1836. The affection had existed eight days and had been very painful in the beginning; the matter was on his entry very copious and bloody. The 14th. The gonorrhoeal pus tinged with blood was inoculated on the right thigh; twenty leeches were applied to the perinaeum. The 17th. The inoculated puncture had produced nothing; the acuteness of the gonorrhoea was much diminished; the patient had no mere pain on passing his water. Injections of nitrate of silver were ordered. The 19th. Cubebs were ordered, two drachms three times a day. The 20th. There had been a little diarrhoea; cubebs were ordered with syrup, diacod. and the injections of nitrate of silver were con- tinued. The cure being complete June 3rd, the patient left. Case XX. Acute urethral gonorrhoea; inoculated without result. Kel----, aged 22, entered May 31, 1836. The affection had lasted twelve days; it made its appearance three days after a connec- tion, and from the commencement it had occasioned very violent pains, both on passing the water and during the erections. The matter of the discharge was greenish and bloody; upon separating the lips of the meatus urinarius, some superficial erosions were perceived in the canal; leeches were placed upon the perinaeum; camphor pills were ordered, and the gonorrhoeal pus was inoculated on the left thigh. June 4th. The inoculated punctures had produced nothing; injec- tions of nitrate of silver were prescribed. The 8th. The gonorrhoea was much decreased; the bolus of co- paiva were prescribed. The patient left cured on the 22nd. Case XXI. Acute urethral gonorrhoea; inoculation loithoutresult. Leg----, aged 18, entered may 31,1836. Three days after a suspicious intercourse, this patient felt very acute pain upon passing his urine, and a very intense gonorrhoea showed itself. Eight days later, he presented himself at the hospital; the discharge was puriform and greenish; he suffered much, both during the emission of his urine and in the erections. June 1st. The gonorrhoeal pus was inoculated on the right thigh; five-and-twenty leeches were applied to the perinaeum, and two pil. opii camph. were ordered. The 4th. The inoculation had produced nothing; the pain was somewhat less; injections of nitrate of silver were ordered and the pills to be continued. The 10th. The discharge was whitish and free from pain; a cauteri- zation was made with nitrate of silver, by means of the caustic holder. ] 10 CLINICAL AND EXPERIMENTAL RESEARCHES- The 12th. Scarce any discharge remained, and the patient left on the 20th. Case XXII. Urethalgonorrhoea with erosion; inoculated without TCSXllt* Yi-___, aged 22, entered Oct. 7, 1836. The affection had exist- ed seventeen days; at iis commencement it had occasioned very acute pain. The patient had had all the symptoms of the most intense go- norrhoea with cordee. The pain was still very acute; the matter of the discharge was purulent and bloody; the lips of the meatus were ero- ded as well as the urethra as deep as could be seen; the canal appear- ed to the touch as if stretched on a probe; but there was no partic- ular point indurated. Twenty leeches were applied to the perinaeum and two pil. opii. camph. were prescribed. The 8th. The pus taken from the meatus urinarius was inoculated; injections of argent, nitr. were ordered. The 9th. The discharge appeared a little modified; the pain was much diminished. The 10th. The inoculation had produced nothing; the injections were continued and four drachms of cubebs were ordered. The 18th. The gonorrhoea, which was much better and the discharge which was whitish and flowed without pain, had returned to the acute siage, in consequence of the imprudence of the patient who had drank two glasses of wine. The injections were suspended and the pills con- tinued. The 19th. The acute symptoms had yielded: the whole surface of the urethra was cauterized with argent, nitr. The 21st. The discharge was modified and much diminished; the pills were continued. The 24th. The discharge had nearly ceased, and a fresh cauteri- zation was made, and Nov. 11th, the patient left quite cured. Case XXIII. Urethral gonorrhoea; inoculation without result. Fin-----, aged 19, entered April 19, 1836. Eight days after a sus- picious intercourse, this patient became affected with a gonorrhoea, which in the commencement was very painful. The acute stage still existed; the erections were very frequent and painful. Five-and-twen- ty leeches were applied to the perinaeum; the bowels being confined, a bottle of the sedlitz water was ordered. The 27th. The pain had disappeared; the erections had yielded to the pil. camph.; the discharge was not very abundant; but it contain- ed much greenish pus, some of which was inoculated on the right thigh; injections of nitrate of silver were ordered. The 29th. The inoculated puncture had produced no result; the dis- charge had become whiter. May 10th. There was no more discharge from the gonorrhoea, and the patient left on the 24th. PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA, m Case XXIV. Acute urethral gonorrhoea; inoculation without result. , Pay-----, aged 21, entered July 5, 1836. Six days after a suspi- cious intercourse, this patient was attacked with a gonorrhoea which had caused him much pain. When he entered the hospital, on the eighth day after the appearance of the discharge, the matter was greenish, and he had much pain in the emission of his urine. Twenty leeches were applied to the perinaeum and an enema of the magn. sulph. was ordered. July 8th. The pus of the gonorrhoea was inoculated on the right thigh. The 11th. The puncture had produced nothing; the discharge was less copious, and the pain on passing the water less acute; injections of arg. nitr. were prescribed. The 14th. The matter of the discharge was whitish and almost se- rous; the injections were continued and two drachms of cubebs twice a day ordered. This treatment was continued; till the 27th, when the patient left quite cured. Case XXV. Acute urethral gonorrhoea; inoculation without result. Dub-----, aged 18, entered Oct. 24, 1885. Five days after a suspicious intercourse, this patient was attacked with gonorrhoea, the discharge from which had gradually increased, and at the time of.his entry had become very copious. The patient felt acute pain on pass- ing his water; he had undergone no treatment; the discharge was greenish and bloody; no induration was to be perceived in the canal of the urethra. Oct. 26th. The gonorrhoeal pus was inoculated by two punctures on the left thigh. The bowels not having been relieved for three days, an enema with two ounces of sulphate of magnesia was prescribed with pil. camph. and fomentations with decoct, malvae. The 27th. The inoculated points were slightly reddened. The treatment was continued. The 28th. The two punctures were cicatrized; the inoculation had produced no result. Nov. 1st. The inflammation was decreased. The 2nd. A fresh inoculation was made by two punctures on the right thigh; the discharge was still a little bloody. The 6th. The inoculation of the 2nd not having produced any re- sult, a fresh inoculation was made on the left thigh. The 8th. The punctures were cicatrized. Emulsion of copaiva was prescribed with injections of nitrate of silver. On the 25th, the patient Jeft cured. Case XXVI. Urethral gonorrhoea become acute; inoculation with- Lien-----, aged 22, entered June 28, 1835. For six weeks this X12 CLINICAL AND EXPERIMENTAL RESEARCHES— patient had been afiected with a gonorrhoea, which he appeared to have renewed several times. He had never undergone any treatment; a few days rest and a warm bath or two, had sufficed to remove the acute and bring it back to the chronic stage. At the time of his en- try, the discharge was very copious, in consequence of some excesses he had committed; he had pain upon passing his water and the bowels were constipated. The gonorrhoeal pus was inoculated on the left thigh; a bottle of sedlitz water, cauterization with arg. nitr. and pil. camph. were prescribed. July 18th. The discharge had much decreased; the inoculated puncture bad produced nothing; four drachms of cubebs were order- ed. The patient was in a few days time dismissed; when he present- ed himself at the hospital eight days later, the discharge had not re- turned. Case XXVII. Balanitis, acute urethral gonorrhoea; inoculation without result. Gui-----, aged 27, entered Nov. 1, 1836, had contracted an acute gonorrhoea six weeks previous, for which he had had no treatment. Three weeks later, after fatigue, a balanitis, favored by a natural phi- mosis, developed itself. Upon his entry, the gonorrhoea was in the acute sta?e, in consequence of an inflammation which had lasted eight days; the purulent secretion was much augmented; the pains were very intense during the emission of his urine; there was no in- duration in the canal of the urethra; the discharge was a little tinged with blood. The balanitis appeared super-excited, some very red spots were perceived on the glans, distinguishing so many points which were deprived of the epithelium. The 4th. The pus from the gonorrhoea was inoculated on the left thigh by two punctures; injections of aq. goulard. were ordered for the gonorrhoea. The 12th. The inoculated punctures had produced nothing. A fresh inoculation of the gonorrhoeal pus was made on the right thigh; the balanitis was cauterized with argent, nitr. by carrying the caustic around between the glans and the prepuce; some fine lint was then in- troduced to prevent the contact of the mucous surfaces. The ure- thral surface was cauterized with nitrate of silver, by means of the caustic holder. The 18th. The balanitis had disappeared, and but little discharge remained. The punctures inoculated on the 12th, had produced nothing; the urethral cauterization was continued; four drachms of cubebs per diem were prescribed. The 24th. The urethral discharge no longer presented the charac- ters of a mucous super-secretion; on the 30th, the patient left quite cured. PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA. J 13 Case XXVIII. Utero-vaginal gonorrhoea, ulceration of the cer- vix uteri; inoculation icithout result. Sal-----Caroline, aged 28, entered June 16, 1835. For seven years this patient had been affected with a discharge which had several times relapsed into the acute stage; she had often communicated gon- orrhoea, but never chancres; moreover she stated she had never per- ceived any such ulcers on herself. She bad never had any symptoms which could be attributed to a secondary syphilitic affection. At the time of her entry, the gonorrhoeal discharge was very abundant and of a greenish color; upon examining the sexual organs with the spec- ulum, a purulent secretion was seen to proceed from the orifice of the cervix, whose posterior lip presented an ulceration in the form of a blister, and the left commissure an ulcerated fissure; the vagina was red and the mucous membrane granulated by the inflammatory tume- faction of the follicles. Some pus was taken from the ulceration of the commissure and inoculated on the right thigh by two punctures; then the pus collected from the surface of the vagina was inoculated on the left thigh in like manner. The 19th. The inoculations had produced nothing; the discharge was whitish and indicated a tendency to return to the chronic stage. The 24th. Upon examining with the speculum, the vagina was pale; the granulations had disappeared; the ulcer of the commissure was granulated on all its surface; the ulcerated points were cauterized and the caustic was carried rapidly over the mucous membrane from the cervix uteri to the vulva. Injections and tampooning with decoct. alb. were ordered. The 27th. Little discharge remained; the superficial ulcer of the posterior lip of the cervix had disappeared, and the epithelium was become smooth. The 29th. All was cured, the patient left the hospital. Case XXIX. Utero-vaginal gonorrhoea, ulceration of the cervix, inoculated without result. Plais-----Anne, aged 39, entered July 21, 1835. The com- mencement of the malady was two years previous, at which time a chancre at the anterior of the vulva and a gonorrhoea made their ap- pearance; the chancre was dressed with ung. mer. and cerat. saturn. and a cure obtained after two months treatment; three months later, a lenticular syphilide showed itself, but disappeared after a month's treatment with pills of iodid. mercur. sudorific syrup and tisane. Upon her entry she had a gonorrhoea, which without completely stopping, had frequently become again acute. Upon examination with the spec- ulum, a copious utero-vaginal discharge was found; the cervix present- ed several points which were deeply eroded, and whose surface was greyish and covered with an albuminous adhering secretion. Injec- tions and tampooning with decoct, alb. were ordered. Aug. 5th. The discharge had decreased, but the ulcerations of t"be cervix were nearly in the same state. Some pus was taken from 15 114 CLINICAL AND EXPERIMENTAL'RESEARCHES— their surface and inoculated on the right thigh; a general cauterization was then made with argent, nitr. The injections and tampooning were continued. The 12th. The inoculation made on the 5th, had produced noth- ing; a fresh cauterization was made with arg. nitr. The 20th. The discharge had nearly disappeared; most of the ulcerations of the cervix were cicatrized; those which remained on the posterior lip were rose-colored and granulated; a cauterization was made with argent, nitr. The 25th. But little discharge remained; the injections and tam- pooning were continued. The 3lst. The mucous membrane of the vagina was pale and heal- thy; all the surface of the cervix presented a smooth and well organ- ized epithelium. The patient left the hospital cured. Case XXX. Urethral gonorrhoea epididymitis; inoculation with- out result. Eno-----, aged 21, entered June 6, 1835. The gonorrhoea had in this case lasted a mont'i; it made its appearance eight days after a suspicious connection; during the first part of the time, the complaint proceeded with great acuteness and occasioned violent pain, which soon disappeared, the patient having submitted to a strict diet and per- fect rest; a fortnight af er the appearance of a gonorrhoea, he had re- course to the treatment with armenian bolus and vin. sarzae; at first the discharge decreased a little, but an obstinate constipation soon follow- ed; the urine became red; at length, to use the expression of the pa- tient, he was seized with a great heat, after which an epididymitis appeared, which induced him to come to the hospital; we then found but little discharge, which was slightly tinged with green; there was no induration in the canal, nor pain in passing his urine, nor on pres- sure; on the right side there was an acute epididymitis; the affection was only sympathetic; the funiculus and corpus testis were healthy, but the epididymis was four times its usual size; thirty leeches were placed upon the course of the funiculus and an opiated cataplasm ap- plied to the scrotum. A bottle of sedlitz water was prescribed to evacuate the rectum. The 8th. The acute symptoms of the epididymitis had somewhat abated: however, five-and-twenty leeches were applied to the course of the funiculus; frictions of half a drachm of ung. mer. were made upon the scrotum. The discharge seemed a little increased. The muco-pus from the urethra was inoculated by two punctures on the right thigh; cataplasms were applied to the scrotum. The 12th. The inoculated punctures had produced nothing. The epididymitis had much decreased; the frictions were continued, and injections of zinc, sulph were ordered for the gonorrhoea. The 21st. Only an indurated knot remained on the epididymis; the treatment was continued. Little discharge remained; four drachms of Cubebs were ordered. PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA. J The 27th. Compresses imbibed with decoct, alb. were applied to the scrofim. The injections were suspended and the cubebs continued. July 11th, he left cured. Case XXXI. Urethral gonorrhoea, epididymis; inoculation without result. Mor-----Edouard, aged 18, entered Oct. 10, 1835. This patient, who was affected with a gonorrhoea, the date of whose commencement he could not accurately determine on accountof the numerous relapses he had bad, entered the hospital to be cured of a sympathetic epididy- mitis, which had followed an excess at table. At the time of his entry the gonorrhoeal discharge was nearly suppressed from the irritation of the epididymitis, and only in the morning a few drops of a whitish matter were perceived at the extremity of the penis; leeches were ap- plied along the course of the cord, and cataplasms to the scrotum. The 17th. The inflammation of the epididymis was much diminish- ed, but the gonorrhoea had reappeared in a large quantity; injections of acetate of lead were ordered and mercurial frictions made on the tes- ticle. The 28th. The gonorrhoeal pus was inoculated on the left thigh. The 30th. The puncture had produced nothing; the injections wer» continued, and copaiva in bolus was ordered. By Nov. the 20th, the patient was cured and left the hospital. Case XXXII. Urethral gonorrhoea, sympathetic epididymis; the pus of the gonorrhoea inoculated without result. Resk-----Nicolas, aged 21, entered May 24, 1835. This patient had been affected with a gonorrhoea for two months; it had shown itself two days after a connection, and at the commencement was very pain- ful; the patient had been under no treatment; an epididymitis had ap- peared four days before his entry. We found the discharge whitish and small in quantity; it had nearly disappeared on the second day af- ter the development of the epididymitis; the cord was healthy, thirty leeches were applied on its course; frictions with ung. mercur. and ap- plications of cataplasms were made to the testicle. June 8th. The epididymitis was far less intense; the gonorrhoea discharge had again become copious; some of the pus was inoculated on the right thigh, and injections of acet. plumb, with bol. copaiv. were prescribed. The 12th. The inoculation of the gonorrhoeal pus was without re- sult; and the patient left cured on the 27th. Case XXXIII. Urethral gonorrhoea and sympathetic epididymi- tis; the gonorrhoeal pus inoculated without result. pa[J-----Julien, aged 18, entered May 30, 1385. The gonorrhoea had lasted six weeks; it first made its appearance eight days after a suspicious connection; about a week previous to his entry, an epidi- dymitis appeared on the left side, in consequence of over exertion; 116 CLINICAL AND EXPERIMENTAL RESEARCHES— the patient suffered much at the commencement; he had colic, nausea and headache. Upon his entry we found the testicle little developed, the epididymis large, but with little tension; the cord was healthy. Twenty leeches were ordered to be applied along the course of the cord and cataplasms; for the gonorrhoea, injections of sulphate of zinc; but previous to any treatment, the whitish pus proceeding from the urethra was inoculated on the right thigh. June 8th. The puncture had produced nothing; a fresh inoculation was made on the left thigh. Half a drachm of ung. mercurwas rub- bed in on the testicle. On the 9th, there was a great improvement; the copaiva bolus was prescribed. The lOih. The inoculated punctures had produced nothing; and the patient being cured left on the 20th. Case XXXIV. Utero-vaginal gonorrhoea, bleeding ulceration of the cervix; inoculation without result. Bu-----Sophie, aged 10, entered July 28, 1835. A fortnight previous, this patient perceived a copious discharge and smarting of the vulva. Upon he entry, the examination with the speculum show- ed the existence of a purulent uterine catarrh; the vagina presented here and there some red seemingly excoriated spots; on the anterior and internal surface of the posterior lip of the cervix, a bleeding ul- ceration was discovered. The pus collected on its surface was inoc- ulated on the right thigh. The 30:h. The inoculation had not taken; the ulceration of the cer- vix was cauterized with arg. nitr. and injections and tampooning with decoct, alb. ordered. Aug. 6th. The discharge was much diminished. A fresh cauteri- zation and the same treatment as before were ordered. On the 26th, the patient left cured. Case XXXV. Urethral gonorrhoea, indurated bubo; inoculation without result. Jac-----, aged 18, entered May 10, 1836. This patient had had a gonorrhoea for two months, nearly all the time it had an indolent character. A fortnight previous to her entry, a bubo had developed itself on the right side; its progress had been slow, there was no pain upon pressure; its volume was small and appeared for some days to have remained stationary. We found a copious discharge of whitish, mostly muco-pus. May 12th. The gonorrhoeal pus was inoculated with two punctures on the right thigh; compression and compresses dipt in decoct, alb. were applied to the bubo; for the gonorrhoea, the cubebs and iron in doses of four drachms per diem were given. The 16th. The inoculated punctures had produced nothing. The bubo seemed to vanish; the gonorrhoeal discharge had decreased. The 18th. The bubo and discharge had nearly disappeared. PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA. 117 On the 24th, the patient left quite cured. Case XXXVI. Urethral gonorrhoea, sympathetic bubo; inocula tion without result. Br-----, aged 32, entered July 11, 1835. This patient had for three months been afflicted with a gonorrhoea, which was very painful in the commencement; he had received no treatment up to the time of his entry; six weeks previous, a bubo had developed itself in the left groin; its progress had been subacute, but it was suppurating. The gonorrhoea had caused a copious whitish discharge; there was neither pain nor induration in the course of the canal of the urethra. The edges of the bubo appeared much undermined at the base; there ap- peared to be an indurated engorgement, embracing some of the pro- found ganglions. The 12th. The bubo was opened, and cataplasms applied to it. The 18th. The pus of the bubo was inoculated by two punctures made on the left thigh, and the same upon the right. To promote their solution, frictions of ung. mercur. were ordered to be made upon the bubo. The gonorrhoea was treated with injections of zinc, sulph. The 19th. None of the inoculated punctures had taken; the gonor- rhoea remained little decreased. The 21st. There was much pus from the bubo; but its base was a little'diminished; the treatment was continued. For the gonorrhoea, two drachms of the copaiva bolus per diem were added to the injec- tions. The 30th. There remained but little induration around the bubo, which had nearly disappeared as well as the gonorrhoeal discharge. The treatment was continued. Aug. 4th. The bubo had disappeared; the applications of ung. mercur. were discontinued and replaced with decoct, alb. On the 10th, the patient was dismissed. Case XXXVII. Urethral gonorrhoea ; lymphitis and sympathetic bubo; inoculation without result. Nob-----, aged 20, entered Jan. 3, 1836. This patient had a gonorrhoea of three weeks duration; at no period had it occasioned any pain. Ten days previous to his entry, a lymphatic on the dorsum penis was irritated, and its course was marked by a red line, running towards the groin, at the same time a bubo developed itself. Till the above day, no treatment had been had recourse to; the gonorrhoeal discharge was copious, and the matter of a greenish white color. The red line from the lymphatic had nearly disappeared, but the vessel ap- peared indurated to the touch. The but slightly developed ganglionary engorgement was very indolent and made no progress. The 4th. The gonorrhoe-d pus was inoculated on the right thigh. The 8th. The inoculation was without effect, a fresh one was made. The 18th. The inoculation made on the 8th, had produced noth- ing. Cataplasms were applied to the bubo, as the patient had felt some pain. 118 CLINICAL AND EXPERIMENTAL RESEARCHES— The 23rd. Injections of iodide of iron were ordered; half a drachm to eight ounces of water. Feb. 10th. The discharge was somewhat less; the dose of the iodide of iron was increased to a drachm to the same quantity of wa- ter. The 13th. The discharge still remained; the matter was still mu- co-purulent. The iodide was increased to two drachms. The 17th. Only a mucous discharge remained; the patient felt no pain in the canal. The iodide was increased to three drachms to the eight ounces of wrater. March 3rd. The patient was dismissed cured. Case XXXVIII. Urethral gonorrhoea, sympathetic bubo; inocu- lation of the gonorrhoea without result. Mel----, aged 20, entered August 30, 1836. The gonorrhoeal af- fection had lasted eighteen months; the patient had undergone no treatment; three weeks previous to his entry, eight days after a con- nection and excesses at table, a bubo developed itself on the right side; its progress was indolent. Blisters were ordered to be applied to the bubo, and dressings of sublimate, twenty grains to the ounce of water. Sept. 10th. The pus of the gonorrhoea was inoculated on the left thigh. The 16th. The puncture made on the 10th, had produced nothing; the bubo had much decreased under the influence of the blisters and dressings of sublimate. Injections of iodide of iron were ordered for the gonorrhoea. The 22nd. The discharge had ceased; the bubo had nearly disap- peared, and on the 27tb, the patient was dismissed cured. Case XXXIX. Urethral gonorrhoea, sympathetic bubo; inocula- tion without result. Des----, aged 32, entered Nov. 1, 1836. This patient had been affected with a gonorrhoea two months previous, which had soon yielded to antiphlogistic treatment. Six weeks before his entry, after some very fatigueing work, a bubo developed itself in the left groin; its progress was subacute, and it opened spontaneously some time previous to his entry into the hospital, at which time he found the gonorrhoea completely cured; there was some fluctuation at the base of the bubo, and the skin which covered it was undermined at several points and of a livid red color; there were two or three openings having an appearance of fistulous passages. The 2nd. The pus collected at a point, which seemed in the ulce- rative stage, was inoculated on the right thigh; the canals were divid- ed and some flaps of skin taken away. The 4th. The inoculated puncture had produced nothing; the bu- bo was cauterized and dressed wilh aromatic wine. The 8th. Cataplasms and ung. mercur. were applied to the bubo. By the 18th, the patient was cured and left the hospital. PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA. ng Case XL. Urethral gonorrhoea, and sympathetic bubo; inocula- tion without result. Chauv----, aged 28, entered April 19, 1836. The gonorrhoea had lasted nearly two months, and the bubo a fortnight. We found a copious whitish discharge; the patient felt no pain on passing his wa- ter; the pus from the urethra was inoculated. The 21st. The inoculated puncture did not take; injections of arg. nitr. were ordered, one grain to four ounces of water, and copaiva in emulsion. May 4th. The bubo was opened, and cataplasms applied to it; the treatment for the gonorrhoea was continued. The 7th. The puncture made with the pus from the urethra had produced nothing; the gonorrhoea had disappeared. The patient left cured on the 17th. Case XLI. Urethral gonorrhoea, followed by a ganglionary en- gorgement; inoculation of the gonorrhoeal pus with negative result. Col----, aged 22, entered May 31, 1836. Eight days after a con- nection, this patient was affected with an acute gonorrhoea, for which he underwent no treatment. Upon his entry, we found the disease had existed two months and a half; there was no pain from the discharge, which was very copious and puriform. There was a slight ganglionary engorgement on the left side, which had not progressed in the last month. June 3rd. The gonorrhoeal pus was inoculated on the right thigh; injections of arg. nitr. and two drachms of cubebs night and morning were ordered. The 10th. The gonorrhoea had nearly disappeared; the inoculation was without result; the injections and cubebs were continued. July 1st. the patient left cured. Case XLIT. Urethral gonorrhoeal, indolent buboes; inoculation of the gonorrJiceal pus without result. Ferr----, aged 22, entered Sept. 19, 1836. The gonorrhoea had been contracted a month previous; it developed itself eight days after a connection. At first very painful, it soon became chronic; two sub- inflammatory buboes developed themselves on the right and left, and were at the time of his entry of considerable size. The patient had never had any chancres; no traces of any cicatrized ulcerations were to be seen upon the penis; the gonorrhoeal discbarge was very copious. Prescribed injections of acetate of lead; blisters to be applied to the buboes and dressings of solution of sublimate, twenty grains to the ounce of water. Sept. 21. The gonorrhoeal pus was inoculated upon the right thigh, before commencing the treatment. The 24th. The punctures were cicatrized. The 29th. The buboes were much decreased; a fourth blister was applied; four drachms of cubebs per diem were given and by the 12th Oct. all was welh 120 CLINICAL AND EXPERIMENTAL RESEARCHES— Case XLIII. Urethral gonorrhoea; inoculation without result. Del----Leon, aged Unentered May 3, 1S36. This patient was for the first time affected with gonorrhoea, two weeks and a half be- fore his entry, and he had been treated for it by another^ surgeon. For five weeks, his treatment had consisted in copaiva in various forms; the complaint was declared cured, and the patient left the hospital. But three days afterwards, without sexual intercourse or having committed any excess, the gonorrhoea reappeared, but without pain. Prescription: injections of arg. nitr. one grain to four ounces, of water. The gonorrhoeal pus was inoculated on the right thigh. The 6th. The puictures had produced nothing. Prescription: in- jections of nitrate of silver; cubebs in two drachm doses night and morning. The patient was dismissed cured May 9th. A week later, he presented himself again at the hospital, when the gonorrhoea had not returned. Case XLIV. Gonorrhoea; chancre from a new infection; urethro- genital gonorrhoea; granulated ulceration of the cervix; inoculation upon the patient herself, and upon a healthy individual without effect. Soy-----Pole, aged 23, entered June 16, 1835. This patient contracted a gonorrhoea in the beginning of Feb. After twenty days in the acute stage, the affection became chronic without any treatment; front that time the patient, who thought she had only an increased se- cretion of fluor albus, having again had sexual intercourse, brought back several times a state bordering on the acute stage; at length, having several times communicated a gonorrhoea, she determined to come to the hospital to be treated for some chancres which she had contracted about a week previous. We found confluent chancres at the entrance of the vulva, and a very copious discharge. By an ex- amination with the speculum it was found, that the acute gonorrhoea was urethro-genital; the finger being introduced into the vagina, upon pressing the convexity of the urethra, pus was seen to proceed from the interior of the canal, whose surface, as seen through the meatus urinarius, appeared swollen, hut not eroded; the mucous membrane of the vagina was red and granulated; the cervix, over which the pus of the uterine gonorrhoea passed, presented at the aperture, the anterior and posterior labia, deep ulcerations, having quite the appearance of chancres; their ground was covered with a pultaceous greyish mem- brane; at the commissure of the labia on the left, there was a super- ficial granulated ulceration, penetrating into the cavity of the cervix. The 17th. A bath and emollient injections were ordered. The 20th. The chancres of the vulva were dressed with calomel and opium cerate. The 23rd. The speculum was applied, and the crvity of the uterus and cervix were cauterized; the nitrate of silver was applied to the ulcerations, then carried gently over the surface of the cervix and va- gina; the patient felt no pain upon the application of the caustic; the vagina was tampooned with dry lint. PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA. J21 The 24th. The discharge had become much less since the cauteri- zation. The 25th. The matter of the discharge was less charged with pus; the ulceration of the cervix had nearly freed themselves of the pulpy crust which covered their surfaces. Injections of decoct, alb. had been ordered on the preceding day. The 30th. The chancres of the vulva appeared to tend towards the period of reparation; the erosions of the cervix presented a rose- colored ground, covered with granulations; the suppuration was very active on their surface; the edges were no longer raised; pus taken from the posterior labium was inoculated by two punctures on the right thigh; a general cauterization was made with the nitrate of silver, and lampooning with dry lint. July 7th. Tht discharge had much decreased; the surface of the vagina appeared healthy and no longer red nor granulated; the mucus which passed over the cervix was transparent; the ulcerations of the posterier lip were almost level with the surrounding parts; their sur- face was in full progress towards reparation, they still furnished much pus; the anterior lip was cauterized; only an ulceration covered with granulations remained; that of the commissure had disapeared under the action of the cauterization carried into the interior of the cervix. No more pus came from the urethra, only a super-secretion of mucous. Some pus was taken from the ulceration of the posterior lip of the cervix, and inoculated on the internal surface of the left arm of a healthy individual; then some of the same pus was inoculated on the left thigh of the patient. The inoculation made June 30th, had produced nothing. By means of the speculum, a general cauterization was made, particularly upon the ulcerated points. July 10th. The inoculations made upon the healthy individual had produced nothing, nor had that made upon the thigh of the patient. The discharge had nearly ceased; injections of decoct, alb. were or- dered. The 17th. An examination was made with thespeculum; the ulcera- tions of the cervix had disappeared; the chancres of the vulva had been cured six days. The patient was discharged cured. Case XLV. Chancre, bubo, vaginal gonorrhoea, with superficial erosion of the cervix; inoculation without result. Gentil-----Marguerite, aged 19, entered May 19, 1835. The af- fection had lasted tour months; chancres showed themselves at the orifice of the vulva at the same time as a copious gonorrhoeal dis- charge; a fortnight later, buboes appeared on each side, their progress was acute; they were opened and then assumed the appearance of svmptomatic buboes. We found the chancres and buboes in the pe- riod of reparation; the matter of the discharge was greenish and charg- ed with pus. The speculum being applied, the cervix was seen to be eroded at several points, as in some cases of balanitis; the vagina was 16 122 CLINICAL AND EXPERIMENTAL RESEARCHES— red and covered with a thin purulent secretion; the mucus, proceed- ing from the uterus, appeared transparent. The granulated surface of the chancres was cauterized, as well as the buboes, which were also in the period of reparation; dressings of calomel and opium cerate were ordered. The 21st. The pus collected from the surface of the vagina, was inoculated by two punctures made on the right thigh. The 26th. The inoculated punctures had produced nothing; the same d/essings were continued, with injections of decoct, alb. The 30th. The chancres of the vulva were healed, as well as the bubo on the right. As the discharge still remained copious, injections of alum sulph. were ordered. June 7th. The surface of the cervix and vagina was cauterized with arg. nitr. The 10th. The dischai^e had nearly disappeared, and on the 14th, the patient was examined with the speculum; the cervix and the vagi- na were perfectly healthy. The patient was therefore dismissed. Case XLVI. Chancre, gonorrhoea, abscess of the epididymis; in- oculation without result. Dae-----Victor, aged 20, entered June 30th, 1835. This pa- tient, who had been affected for two months with a gonorrhoea, which showed itself six days after a connection, and a chancre of the frenum, contracted in consequence of a rupture of this part, and hitherto made some attempts at treatment, but void of regularity, and thus had re- ceived no benefit. Four days before his entry jnto the hospital, an epididymitis supervened. We found that the urethral discharge was without pain; the matter was whitish; on the frenum was a chancre in the period of ulceration; the cord was engorged in its whole extent, and the epididymis was very large. For the,gonorrhoea, injections of sulphate of zinc and copaiva in bolus form were ordered; cataplasms were applied to the scrotum and frictions made with ung. mercur. The chancre was dressed with calomel and opium cerate. The bow- els not having been relieved for three days, an enema of magnes. sulph. was administered, and to combat the inflammation of the epididymis, twenty leeches were applied to the funiculus. The 27th. The gonorrhoeal discharge had decreased; the chancre of the frenum had been cauterized with arg. nitr.; the inflammation of the epididymis was less, and a raised hardened point was perceiv- ed upon it. July 1st. The gonorrhoea had nearly ceased; the chancre still re- mained; and one half of the surface was still in the period of progress; the raised point on the epididymis appeared inclined to suppurate. The 13th. The patient had only a few drops of gonorrhoeal pus in the morning; the chancre was cicatrizing; the abscess on the epididy- mis was open, and its pus was inoculated on the right thigh. The 17th. The puncture made with the pus from the epididymis bad produced nothing; the gonorrhoea was cured; the chancre almost PRACTICAL OBSERVATIONS—INOCULATION OF GONORRHOEA. 123 cicatrized; the abscess furnished little pus; compresses with decoct. alb. were placed on the scrotum. Aug. 8>h. The patient left cured. Case XLVII. Phimosis, balanitis with erosion; inoculation with- out result. Reed-----, aged 21, entered May 9, 1836. Without being able definitely to state the commencement of the complaint, this patient stated that for about a fortnight, he had felt a smarting on the glans. He had a congenital phimosis, which allowed of the glans being partly uncovered. The prepuce had become oedematous, and the pains had greatly increased; he felt no pain upon passing his urine, which he could in any way attribute to the canal of the urethra; he only suffer- ed from the contact of the urine with the excoriated margin of the prepuce. As far as could be ascertained, the pus which flowed from this aperture, did not proceed from the urethra. The pus taken from the eroded parts of that portion of the glans which could be uncover- ed, was inoculated on the right thigh; twenty-five leeches on the penis, and emollient and opiated applications were ordered. May lllh. The puncture was red, but not vesicular; tbecedemaof the prepuce had much decreased; the existence of a balanitis was as- certained, with erosions of the glans in patches and stretching to its base; the internal part of the prepuce was also eroded in large spots; the whole surface was cauterized with arg. nitr. and a bit of dry linen placed between the glans and prepuce. The pain which at first was very sharp, entirely ceased in half-an-hour. The 12th. The prepuce was no longer oedematous; the diseased surfaces were almost dried up and free from pain; the inoculated punc- ture was rather vesicular and pointed. The 16th. All was healed and the patient left. Case XLVIII. Balanitis with erosion, sympathetic bubo; inocu- lation of the pus of the balanitis and that of the bubo, with negative result. Laut-----Antoine, aged 22, entered Nov. 21, 1836. This patient also having a natural phimosis, was unable to state the time at which the balanitis had commenced; he only said that for a month, the pains had been very violent and the prepuce had become oedematous. A forin'ght previous, a bubo had appeared on the left side; its progress had been subacute and little painful. At the time of his entry, he was able to uncover the glans, which was eroded in several places, some of the erosions were deeper, and seated on the left side of the frenum. The 23rd. The pus of the balanitis was inoculated on the right thigh; all the diseased surfaces was cauterized with arg. nitr. and a piece of dry linen placed between the glans and the prepuce. The 26th. Only a few of the eroded points near the frenum remain- ed; the inoculated puncture, which at first appeared to follow a regular course in its development, dried up without any result; the bubo had been treated with cataplasms. 124 CLINICAL AND EXPERIMENTAL RESEARCHES— Dec. 12th. The bubo was opened; the glans was healed. On the 14th, the pus of the bubo was inoculated on the left thigh. The 17th. The inoculation had not succeeded; the cavity of the bubo was cauterized, and the patient left cured on the 30th. Case XLIX. Balanitis with erosion, gonorrhoea, bubo; inocula- tion^without result. Lem----, aged 34, entered Nov. 14, 1835. This patient had perceived twenty days previous, an erosion at the base of the glans; soon after a gonorrhoea followed, and then a bubo showed itself in the right groin. We found part of the surface of the eroded glans heal- ing; the gonorrhoea, whose progress had been very acute, atiorded a copious and bloody discharge; the bubo had suppurated. The 18th. The bubo was opened and the pus inoculated on the left thigh; the pus of the vesicular ulceration, seated upon the glans, was inoculated upon the upper part of the left thigh, and that from the gonorrhoea on the lower part of the same thigh; the erosions of the glans were cauterized, and some lint dipt in decoct, alb. applied to it; cataplasms were placed on the bubo; for the gonorrhoea, the interior of the canal was cauterized with Lallemand's caustic holder. The 21st. The inoculation had produced nothing, and the patient left cured. Case L. Chancre at the period of reparation, balanitis; inocula- tion without result. Lerg----, aged 26, entered May 24, 1836. This patient had a natural phimosis; he was unable exactly to fix the time at which the chancres at the base of the glans and internal superior part of the pre- puce made their appearance. He had perceived them about a month previously, after having with much difficulty uncovered the glans, since which time the prepuce became oedematous and a balanitis succeeded. Ten days before his entry, some spots of a lenticular syphilide show- ed themselves on the body and extremities; at the seat of the chan- cre, some induration was perceived; there was no gonorrhoea nor in- duration in the canal of the urethra. May 27th, The pus of the balanitis was inoculated on the left thigh, to ascertain if the chancres of the glans and prepuce were still in the period of ulceration. The usual treatment was ordered for the bal- anitis. June 3rd. The inoculation had produced nothing; the lenticular syphilide had made little progress. The pil. hydrarg. iodid. and the sudorific syrup and tisane were ordered. The 25th. The eruption began to fade. By July 12th, the patient was cured and dismissed. PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. 125 Section III. INOCULATION OF THE PUS TAKEN FROM BUBOES. Case I. Chancre and symptomatic bubo; inoculation with positive result. Mich-----, aged 18, entered Oct. 3, 1835. The patient could not tell the precise date at which the infection had taken place, but thought two months must have elapsed; twenty days previous to his entry, a bubo showed itself on the right side; on the right side also near the frenum, the chancre was situated, nearly all its surface presented marks of the period of reparation; there was no induration at its base. The progress of the bubo was slow; a little fluctuation was felt near its summit; the tumor was superficial; the fluctuating point seemed to be seated in one ganglion alone; the surrounding cellular tissue, and the inguinal glands were engorged. The chancre was cauterized and dressed with vin. arom. A blister was applied to the bubo, and dress- ed with ung. mercur. This dressing was continued till the 21st. The 22nd. The bubo was opened and afforded a pretty large quan- tity of reddish pus. The cavity was deep and round; the pus was inoculated by a puncture made on the right thigh. The chancre of the frenum had healed. The 24th. The inoculation made on the 22nd had succeeded, and the pustule was large and well developed; it was opened, and the pus from it inoculated on the left thigh. The 27th. The inoculation on the 24th had succeeded, the pustule was formed; it was ruptured, and beneath it, a chancrous ulcer was seen piercing the entire thickness of the skin. Both inoculations were dressed with vin. arom. and cauterized with arg. nitr. The suppura- tion appeared to extend in the indurated mass which enveloped the suppurated ganglion; the swelling had decreased, but the skin was left undermined. Nov. 1st. The inoculated points were healing; the skin which cov- ered the bubo, was destroyed by a rapid ulceration, and the cavity laid open. Aromatic wine was applied. The 10th. The period of reparation bad commenced. The dres- sings were continued, and the patient left cured on the 30th. Case II. Chancre, symptomatic bubo; inoculation at first without result, then producing the characteristic pustule of chancre. March-----, aged 27, entered June 18, 1835. The chancre situ- ated near the frenum, made its appearance five weeks previous; he was first treated with sarsaparilla. Twelve days before his entry, a bubo appeared on the left side. We found the chancre healing; the bubo had suppurated, it was opened, and the pus inoculated immedi- ately by two punctures made on the left thigh. The pus of the chan- cre was inoculated on the right thigh by a single puncture. 126 CLINICAL AND EXPERIMENTAL RESEARCHES— The 19th. The inoculated punctures had produced nothing; the lips of the incision made in the bubo had become ulcerated. A fresh inoculation of the pus of the bubo was made on the left thigh. The chancre was cauterized and dressed with vin. arom. The 24th. The punctures made on the 19th had succeeded, and the pustules were very fine; the chancre was healed; the bubo was cauterized and dressed with vin. arom. The 26th. The lower pustule was cauterized with arg. nitr.; the bubo was a little better. July 3rd. The pustule cauterized June 26th, was nearly destroyed; the chancre from the superior pustule, which had been allowed to take its course, was well cauterized, and then dressed with vin. arom. There was still some induration at the base of the bubo; it was dress- ed with calomel cerate. The 12th. The chancre on the thigh was modified by the cauteri- zation; its ground was rose-colored, and there was no induration at its base; it was dressed with the wine. The 20th. The bubo was better; the ground was becoming clean- er, and the induration decreasing; the treatment was continued till Aug. 4, when the induration had disappeared; the chancre of the thigh was healed and the bubo was rapidly cicatrizing; some fleshy granulations were cauterized. On the 8th, the patient left quite cured. Case III. Chancre, symptomatic bubo; inoculation with positive result. Rich——, aged 36, entered Oct. 24, 1835. This patient had on the posterior part of the glans some but slightly developed chancres, most of which were in the period of reparation. He was unable to state the exact time at which the disease had commenced; but he said the suppurated bubo on the left side, had first made its appearance a fortnight previous to his entry; its progress had been acute and pain- ful; the skin was red and adherent; there was no induration at the base of the tumor which had its seat in the superficial ganglions. On the dorsum penis, a lymphatic was to be remarked, forming a hardened line running from a considerable chancre on the left side of the glans towards the bubo on the same side. Oct. 27th. The bubo, which contained much pus, was opened. The chancres of the glans were cauterized and dressed with calomel and opium cerate. The 30th. The edges of the opened bubo appeared ulcerated. Pus was taken from the bottom of the cavity and inoculated on the right thigh. On the glans, only the chancre on the left side remained; the others had disappeared under ihe treatment with the ointment and cauterization with arg. nitr. Nov. 1st. The two inoculated punctures, made on Oct. 27th had furnished the characteristic pustules. The inferior pustules were cau- terized with argent, nitr. The chancre of the penis was healing. The PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. 127 cavity of the bubo whose ground was becoming gradually raised, was cauterized. The 8th. The second inoculated pustule, which was already cover- ed with a thick crust, concealing the chancrous ulceration, was cauter- ized. Aromatic wine was applied to the bubo, which was also cauter- ized with arg. nitr. The 12th. No trace of the inoculation, cauterized Nov. the 1st, remained; that which had been allowed to take its couse till the 8th, had resisted the cautery; it was dressed with vin. arom. The bubo was better; its ground was raised and covered with fleshy granulations. The same treatment was continued, and the patient dismissed cured on the 27th. Case IV. Chancre, gonorrhoea, symptomatic bubo; inoculation with positive result. Fay-----, aged 22, entered Sept. 30, 1836. This patient had contracted a gonorrhoea two months previous to his entry. A fortnight later, he perceived a chancre on the inferior and left side of the fre- num. Lastly, a fortnight after the appearance of the chancre, a bubo developed itself in the left groin; its progress had been subacute. We found the gonorrhoea but slight; yet the discharge was .greenish, and he had pain on passing his water. The chancre, in one part of its surface, presented the characters of the period of reparation; there was no induration at the base. The bubo, which had attained a con- siderable volume, appeared to be seated in the superficial ganglions, and on its summit there was evident fluctuation, although there appear- ed to be but little pus. The bubo was opened, and the pus inoculated on the left thigh; the gonorrhoeal pus was inoculated on the right thigh. The chancre of the frenum was cauterized and dressed with vin. arom. For the gonorrhoea, injections of arg. nitr. were ordered and cubebs. Oct. 3rd. The inoculated punctures made on the 30th of Sept. had produced nothing, not even redness; yet the edges of the incision into bubo were ulcerated and presented a chancrous appearance. The pus of the bubo was again inoculated on the left thigh. The same treatment was continued. The 7th. The inoculated puncture made on the 3rd, with the pus of the bubo, had produced the characteristic pustule, which was then destroyed by cauterization with arg. nitr. The gonorrhoeal discharge bad much decreased; the chancre was healing; the bubo was better; the engorgement at the base had disappeared; the purulent secretion was less; the cavify was cauterized. The 12lb. The chancre was nearly healed; the gonorrhoea yielded a whitish matter, and he passed his water without pain. The ground of the wound being raised, the bubo presented the appearance of an even wound; it was cauterized and dressed with vin. arom. The 20th. The gonorrhoea had disappeared, and the chancre had been healed three days. The bubo was granulating; the treatment was continued. 123 CLINICAL AND EXPERIMENTAL RESEARCHES— The 27tb. The bubo was nearly healed; it wrs superficially cau- terized to dry up the wound. Nov. 1st. The patient was dismissed cured; no induration remained at the base of the bubo. Case V. Chancre, symptomatic bv.bo; incculaticn with positive result. Bast-----, aged 18, entered Oct. 24, 1835. Six weeks previous to his entry, eight days after a connection, a chancre was formed on the skin of the penis; its appearance had been noted from the third day; it began by a pustule which was only broken on the eighth day, as we have said above. Nearly at the same time, a bubo made its appearance on the right side, and was treated with leeches and blis- ters; it disappeared and left only a little slightly indurated engorge- ment. The chancres were healed by cauterization; but twelve days later, the bubo became inflamed, and the suppuration evident on the fourteenth day. At the time of his entry, no more induration remain- ed on the situation of the cutaneous chancre. The bubo was ex- tensively suppurated; it was opened on the 25th, much reddish pus flowed from it; the cavity was large; there was some engorgement at the base, to which cataplasms were applied. The 28th. The pus of the bubo was inoculated by a single punc- ture, made on the right thigh; the edges of the incision made in the bubo, appeared ulcerated. The 30th. The inoculated puncture had succeeded, and furnished the characteristic pustule. Nov. 1st. The inoculated pustule was destroyed with arg. nitr. The cavity of the bubo was cauterized and dressed with calomel and opium cerate. The 10th. Powdered cantharides were put into the cavity of the bu- bo, to obtain die reunion of the undermined skin. The 15th. There was a decided improvement; the fleshy granula- tions were developed. A superficial cauterization was made. The 18th. The cicatrization of the bubo progressed. Dressings of aq. Goulard, were used, and by the 30th, the patient was cured and dismissed. Case VI. Chancres, sxjmptomatic buboes; inoculation without re- sult the day of the opening, but furnishing the pustule by inoculation made the folloicing day. Car-----, aged 27, entered Sept. 7, 1836. Nearly a month had elapsed, since this patient had contracted a chancre, but he only noticed its presence on the skin of the prepuce, eight days after a con- nection; eight days later, buboes appeared on the right and left, and were acute in their progress. We found the chancre at the period of reparation; the suppurated buboes did not appear engorged at their base, and seemed quite superficial; on the dorsum penis," a hardened line was felt, resulting from an inflamed lymphatic, which, according PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. J2Q to the statement of the patient, was red and swollen at the time of the commencement of the buboes, and extended lo the left groin. Only a little induration or lymphatic tension remained; the bubo on the left side had opened spontaneously, three days previous to the entry of the patient. The apertures had rounded edges, and appeared ulcerated. The 10th. The bubo on the right side was opened, and its pus in- oculated on the right thigh. The chancre on the flap of the prepuce, was cauterized and dressed with vin. arom.; cataplasms were applied to the buboes, the edges of which were much undermined. The 12th. The inoculation made on the left side, with the pus of the bubo, which had opened spontaneously, had produced the charac- teristic pustule. O.i the right thigh, the inoculation made with the pus of the bubo on the right side the day it was o. enecl, had produced no- thing. A fresh inoculation was made on the right thigh, with the pus of the bubo on the right side. The 13th. The pustule from the first inoculation was cauterized; the second made on the 12;h, had succeeded. The same dressing was continued for the chancre. The 16th. Pulver'zad cantharides were placed in ihe cavity of the bubo is, to promote the formation of gianulations, and thus obtain the adhesion of the undermined edges; by Nov. 4th, the patient was quite cured and left the hospital. Case VII. Chancre, symptomatic bubo; inoculation with positive result. Bip-----, aged 30, entered Sept. 16, 1836. Tlrs patient could not exactly state the time at which he had contracted the chancres of the frenum; he had received no treatment; twenty days previous to his entry, a bubo had developed itself on the right side; its course bad been very acute, it had suppurated, and opened spontaneously. The 17tb. The pus of the bubo was inoculated on the right (high; the chancres of the frenum were cauterized, and dressed with vin. arom. The bubo was treated in the same manner. The 21st. The inoculated pustule was cauterized; the chancre of the frenum had healed, and on the 23rd of Nov. the patient left cured. Case VIII. Chancres, symptomatic bubo; inoculation with posi- tive result. Bml----, aged 25, entered July 2nd, 1835. Three weeks after a connection, this patient perceived two little chancres near the fre- num; and nearly at the same time, buboes were developed on the right and left sides. It appeared, according to the statement of the patient, that he only examined his penis at the time he felt the pain in the groin, when he found the ulcers, which at the time of his entry were heaiing, of little extent. Without having undergone any treat- ment, we found upon his coming to the hospital, a fortnight after the appearance of the buboes, that they were suppurated, and the skin was much undermined, especially on the right side. 17 130 CLINICAL AND EXPERIMENTAL RESEARCHES- The 4th. The bubo on the right side was opened; the chancres were cauterized, and dressed with vin. arom. * The 8th. The bubo on the left side was opened, an inch and half above the ligament. Poupart. on the abdomen, a tumor, painful to the touch, was found. The 14th. The bubo which had formed on the abdomen was open- ed; and a slightly brownish thin pus flowed from it, similar to that of the two other buboes, whose apertures had become rounded and ulce- rated; they were dressed with cataplasms. The I8ih. The pus of the abdominal bubo was inoculated on the left thigh; and the pus of the bubo of the right side, on the right thigh. The22nd. The inoculated punctures had produced the character- istic pustule; the pustule on the right thigh, resulting from the inocu- lation of the pus of the bubo of the right side, was destroyed by cau- terization with argent, nitr.; the pustule on the left side, was allowed to take its course; the buboes were dressed with calomel and opium carate. The 26th. The pustule on the left thigh, was destroyed by the ni- trate of silver; there was some induration at the base of the buboes, and also at the seat of the chancres; the cavities of the buboes had the appearance of extensive chancres in the ulcerative period; on the left, the edges were much undermined; the pus did not escape freely; the liq. Van Swieten. and the sudorific syrup and tisane were given. Aug. 3rd. The indurated points were somewhat diminished; some part of the chancrous surfaces were healing. The 8th. The buboes were dressed with wine and tanin. There was a decided improvement. The 18th. The induration had nearly disappeared; the abdominal bubo was cicatrized; the bubo on the left side, presented some fistu- lous canals; that on the right, was cicatrizing. The 20th. The Vienna paste was applied to the left bubo, in order to destroy the portions of undermined skin, which prevented the free discharge of the pus; dressings of wine and tanin were applied. The 29th. The bubo on the right side was healed, and the left was in the period of reparation; its rose-colored ground was covered with fleshy granulations, which were cauterized. The patient left the hospital cured Oct. 19th. Case IX. Chancres, symptomatic buboes; inoculation producing the characteristic pustule. Ducel-----, aged 20, entered Feb. 16, 1835. This pat"ent had contracted chancres on the glans and prepuce a month previous; the ulcerations had been dressed with opiated mercurial ointment, and afterwards with cerat. plumb. A fortnight before his entry, buboes developed themselves on the right and left sides, with no other appa- rent cause than the ceasing of the ulceration and healing of the chan- cres; .their ^course had been acute; the bubo on the right side, present- ed a little more engorgement than that of the left. We found the PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. chancres healed, and the two buboes suppurated; the cavity appeared large and the surrounding skin mnch undermined; upon both being opened, a thin brown pus flowed from them. Cataplasms were then applied. The 18th. The pus from the buboes were inoculated, that on the right side, by two punctures made on the right thigh; that on the left, by a single puncture on the left thigh; the margin of the incisions ap- peared ulcerated, and the secretion of pus copious. The inoculation was made in the presence of M. Desruelles. The 20th. The punctures had produced the characteristic pustules on both thighs. The 22nd. The result of the inoculations were shown to M. Des- ruelles. One of the pustules on the right thigh, and that on the left, were allowed to take their course. The lower pustule on the right thigh, and the cavity of the buboes were cauterized with argent, nitr. y dressings of vin. arom. were ordered. March 4.h. The inoculated pustules, which had been allowed to take their course, had produced chancres; they were cauterized with a:"g. nitr. The pustule which had been first cauterized, had disap- peared. The buboes were better. The 11th. The chancre on the left thigh progressed, notwithstand- ing the cautery, but it appeared modified. It was dressed with vin. arom. and cauterized. The 19:h. The chancre on the left thigh had healed, without leav- ing any induration; the buboes were almost cicatrized, especially the left. The dressings were continued, and the patient left cured on the 30th. Case X. Gonorrhoea, superficial chancre, symptomatic bubo; in?- oculation producing a positive resu t. Maig-----, aged 24, entered Oct. 10, 1835. The patient had for three months been affected with a gonorrhoea, and superficial ulcera- tions on the prepuce and base of the glans. He had received no treatment. About a fortnight previous to his entry, a bubo appeared on the left side; its progress had been acute, and it was suppurated. The little discharge that remained, was white and mucous;, the patient suffered no pain on passing his water; on the prepuce and glans, were some ulcerated spots covered with healthy granulations; the bubo was opened. Injections of plumb, acet. and two drachms of cubebs, three times a day were ordered; the ulcers were dressed with vin. arom. they were cauterized with arg. n'.tr. and cataplasms were applied to the bubo. The 17th. The margin of the incision made in the bubo was ulcer- ated; the reddish pus taken from the depth of the cavity, was inocu- lated on the left thigh; the injections and the cubebs were continued for the gonorrhoea; the ulcers of the glans were nearly healed; a cau- terization and dressings of vin. arom. were ordered. The 20th. The inoculation made with the pus of the bubo, bad 132 CLINICAL AND EXPERIMENTAL RES3V1CHE3- furnished the characteristic pustule; the gonorrhoeal discharge still con- tinued; the muco-pus was inoculated on the left thgh; only a single uncicatrized point remained on the prepuce; cauterization and dres- sings of vin. arom. were ordered, and the same treatment for the cavity of the bubo, which had a greyish color. The 22nd. The inoculation made with the gonorrhoeal pus, had produced nolh n°;; the pustule from the inoculation of the bubo, was well cauterized. The 23th. The gonorrhoea had ceased; the chancres had disap- peared; the inoculated pustule had been destroyed by the cautery; the bubo was healing, it was cauterized, and dressed with vin, arom.; there was no engorgement at its base. Case XI. Chancre of the urethra, symptomatic bubo; inoculation producing the characteristic pustule. Vac-----, aged 41, entered Sept. 13, 1836. Three weeks had elapsed since this patient, without having any gonorrhoea or wound on the penis, observed a bubo, develope itself in the right groin. The progress of the affection, had been subacntely inflammatory, and sup- puration ensued, notwithstanding an application of leeches. At the time of his entry, the bubo had suppurated and much undermined tlie surrounding skin; no trace of ulceration was to he perceived on the penis; there was no gonorrhoea; at the depth of two lines in the urethra, by separating the lips of the meatus urinarius, a spot of the sizi of a lentil was perceived, whose granulated surface indicated the seat of an ulcer in a stage of reparation. The 16th. The bubo was opened, and the pus taken front J be depth of the cavity, was inoculated on the right thigh. Cataplasms were applied. The 19th. The inoculated puncture was red and vesicular; the cav- ity of the bubo was cauterized, and dressings of vin. arom. applied. The 21st. The inoculation had succeeded; the pustule was then destroyed with arg. nitr. Oct. 15th. All was well, the patient was dismissed. Case XII. Concealed chancre, symptomatic bubo, inoculated with positive result. Marc-----Jean, aged 17, entered May 23, 1835. Five or six days after a connection, and a fortnight before his entry, this patient perceiv- ed a slight discharge; he felt no pain except at the extremity ofthe penis, where there was an indurated spot. Having been obliged to do some fatiguing work, the pains increased, and a bubo showed itself on the left side; its course was acute. On h:s entry into the hosp'tal, there was no discharge, but the induration still remained. Tie bt bo wrs opened, and its pus inoculated by two punctures, made on the right thigh. The 23rd. The punctures had cicatrized; a fresh inoculct'on was made on the right thigh; the margin of the incision in the bubo, had assumed a chancrous appearance. PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. 133 On the 8th of June, the inoculation had taken; the pustule was opened, and the pus inoculated on the left thigh, and the chancre from the inoculation was cauterized. The 19th. The inoculation of the pus from the pustule on the right thigh, had produced a pustule on the left thigh; it was well cauterized. The first inoculation, which had not been entirely destroyed hy the cau- tery, had been dressed with vin arom.; it was nearly healed; but the bubo, which was extensively open, did not unite its undermined edg- es with the subjacent parts, and had all the appearance of malignant chancre; its surface was grey and pulpy, and the cavity appeared in- clined to increase. It was well cauterized, and then dressed with vin. arom. June 26th, there was a decided improvement, and by July 24th, all was well. Case XIIL Chancre, symptomatic huho, the pus from which le* ing inoculated after having been preserved and dried in the air; the result was negative. Some of the same pus preserved fluid in an Open tube, produced the characteristic pustule. Caill-----, aged 24, entered Sept. 13, 1836. Five or six days af- ter sexual intercourse, this patient was affected with chancres on the glans and margin of the prepuce. Eight days later, a bubo appeared on the right side; it was subacute in its progress, but yet there was much pain. We found on his entering the hospital, the tumor consi- derable, but no fluctuation could be perceived. Seventeen days elaps- ed since the appearance of the affection; the chancres had healed. A blister to be applied to the bubo, and dressings of sublimate, twenty grains to the ounce of water were ordered. The 15th. A little fluctuation was perceived at the summit of the tumor. The same treatment was ordered, as on the 13th. The 30th. The bubo had opened; the pus was inoculated on the right thigh. Oct. 1st. The puncture had produced the characteristic pustule; it was destroyed by the cautery. The 3rd. Some of the pus was put in a cppsule, red allowed to dry, exposed to the atmosphere. On the following day, having been moistened with a small quantity of water, it was inoculated on the Jeft thigh; two days later, it had produced no effect. 'The 10th. Some pus was taken from the bubo, and preserved in an open tube; two days later, having lemained fluid, it was inoculated on tire left thigh. The ICtli. The puncture made on the 12th was red, raised and pustulous; it was allowed to take its course, that the result might be th'doubted. The 20th. The pustule had burst, and the chancre was perfectly characterized; it was cauterized, and dressed with vin. arom. Cata- plasms and ung. mercur. were ordered to be applied to the bubo. In a short time, all was healed, and the patient left the hospital quite cured. 104 CLINICAL AND EXPERIMENTAL RESEARCHES— Case XIV. Chancre, bubo on the right and left side; that an the right, sympathetic, and Icing inoculated, producing no result; that on the left, symptomatic, and yielding the characteristic pustule on inocu- lalion. No-----, aged 18, entered Jan. 17, 1837. This patient was una- ble precisely to state the period at which he had contracted a chancre on the internal and superior part of the prepuce, but he thought that it was about six weeks previous to his entry; at which time, two buboes had been developed about three weeks; one on the right side, which appeared to have its seat in the deeper ganglions, and was only sup- purated at the summit; the other on the left, suppurated in its whole ex- tent, and only affecting the superficial ganglions. At the time of his en- tering the hospital, the chancre was cicatrized; both buboes were opened, and the pus from the right bubo, was inoculated on the right thigh, and that of the left on the left thigh. After the evacuation of the pus, tlie left bubo nearly disappeared; on the right, the tumor still remained large; to promote the resolution, an application of ung. mercur. was ordered for the following day. Cataplasms were applied to the left side. The 20th. None of the inoculations had taken; but it was remark- ed in the right bubo, to which the ung. mercur. had not been applied, that the edges of the incision were not ulcerated; whilst that made in the left bubo had become round and appeared chancrous, a fresh inoc- lation was made like the former; the right bubo was dressed with ung. mercur.; the left was cauterized and dressed with vin. arom. The 23rd. The inoculation with the pus of the right bubo, had pro- duced nothing, that of the left, had afforded the characteristic pustule. The 24th. The pustule from the inoculation was destroyed, by an application of P:te de Vienne. The tumor on the right* side, had much decreased in size. The 27th. The wound resulting from the application of the caustic paste, was cauterized. Feb. 6th. The left bubo was cicatrizing; the right tumor had near- ly disappeared. The 14th. The surface of the nearly healed bubo, was slightly cau- terized. The 24th. The patient left; there still remained a little induration on the seat of the chancre on the prepuce. » Case XV. Chancre, symptomatic bubo; inoculation on the day it was opened without effect, but producing the characteristic pustule by inoculation, the following day; a blister not inoculated by the chancre pus. Gued-----, aged 23, entered May 6, 1836. The chancre of the frenum had existed a month, its form was regular; no treatment had been used. The bubo appeared in the right groin, a week previous to his entry; its progress had been acute, it was suppurated, and ap- peared seated in the superficial ganglions; there was also some fluctu- PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. 135 ation in the surrounding cellular tissue. We opened the bubo, and in- oculated, by two punctures on the left thigh, the pus which flowed from it in large quantities. There were some granulations on the chan- cre, which was cauterized with arg. nitr. and dressed with vin. arom. The 10th. The inoculation had produced nothing; the lips of the inci-ion had assumed a chancrous appearance; the negative result was attributed to a large quantity of phlegmonous pus, being mixed with lha pus of the ganglinoary chancre the d:;y it was opened. A fresh inoculation was made on the right thigh. A blister was applied to the bubo, in order to promote the reunion of the undermined edges with the subjacent parts. The 12th. Tlie inoculation made on the 10;h, had produced the characteristic pustule; it was destroyed by means of the arg. nitr. The 20th. The chancre on the frenum was cured; the cauterized pustule had disappeared. It was remarked, that the blister applied to the bubo had not become inoculated, although it had been covered with chancre pus; the cavity was inclined to heco.i e obliterated. • The 28th. A decided improvement, especially since the preceding day; powdered cantharides had been introduced into the cavity. A cauterization and dressings of vin. arom. were ordered. The 30th. The bubo was nearly closed, and yielded no more pus. Compresses imbibed with decoct, alb. were applied. June 3rd.'All was well, the chancre had left no induration. Case XVI. Chancre, suppurated lymphitis, symptomatic bubo; inoculation producing the char act ristic pustule. Lar-----, aged 22, entered July 26, 1836. This patient had per- ceived, only nine days previous, a chancre on the frenum; the ulcer was of litile extent, and appeared to have existed about twenty days, from its being in the stage of reparation, at the lime of his entry. On the dorsum penis, a suppurated tumor was perceived, which appeared to have been produced by a lymphatic engorgement; the vessel was felt tense and slightly indurated from the insertion of the prepuce to the tumor, and beyond it towards the right groin, in which was an incip- ient bubo: this bubo was seated in the superficial ganglions, and not adherent to the surrounding parts, but painful to the touch; there was no gonorrhoea. The patient of a bilioso-sanguine temperament, enjoy- ed otherwise good health; the digestive functions were in perfect or- der. Five-and-twenty leeches were applied to the bubo; the chancre was cauterized with arg. nitr. and dressed with vin. arom. The 29th. The tumor on the dorsum penis, was opened and yielded a thin yellowish pus, which was inoculated by a single puncture made on the right thigh. Notwithstanding the application of leeches, the bu- bo progressed rapidly; it had already become adherent. A blister was applied to it, which was ordered to he dressed with a solution of sub- limate, twenty grains to the ounce of water. Aug. 1st. The inoculation from the lymphatic abscess, had produc- 136 CLINICAL AND EXPERIMENTAL RESEARCHES- ed the characteristic pustule; the cavity presented all the appearances of a chancre; the edges were reversed and indurated, and the ground covered with a greyish pulpy matter. A cauterization was made with arg. nitr. and dressed with vin. arom. A fluctuating point was felt in the bubo; the pustule on the right thigh was cauterized. The 6th. The bubo was opened, and its pus inoculated on the left thigh; the chancre on the frenum was nearly healed ; that on the penis, had a rose-colored ground The 8th. The punctures made on the 6th, had produced nothing, although the margin of the incision made in the bubo was ulcerated; a fresh inoculation was made on the right thigh. The 12th. The inoculation made on the 8th, had produced the pus- tule; it was cauterized. The first pustule which had been cauterized on tlie 1st, had withstood the action of the cautery; it was dressed with vin. arom. The base of the bubo was indurated; the suppura- tion was little; there appeared but little tendency towards reparation; the applications of vin. arom. were suspended, and dressings of ung. mercur. with cataplasms were substituted. The 18lh. The chancre on the penis was a little granulated, its sur- face was healthy and rose-colored; ihe ulcer on the frenum had disap- peared, without leaving any induration. There was a better suppura- tion from the surface of the bubo, and the induration at its base had decreased. The 21st. The cauterization and dressings of vin. arom. were re- sumed for the bubo, but little induration remained; the pustules on the thighs from inoculation had increased, and undermined the skin. The 25th. In order to obtain the reunion of the skin with the sub- jacent parts, from which it had been detached by the action of the chancre pus; a blister was applied to each ulcer on the thighs, and the cavity was filled with powdered cantharides; the lymphatic chancre on the penis was healing, and but a fourth part of its surface remained to be cicatrized. Sept. 10th. The bubo was nearly healed, and the application of cantharides to the ulcers on the thigh, had produced the desired ef- fect; the skin remained but little undermined. The 20lh. The bubo was well; no induration remained; the ulcers of the thighs were slightly cauterized, and by the 27th, all was well and the patient was dismissed. Case XVII. Chancre and symptomatic bubo; pus inoculated pure, and then mixed with sod. chlorin. positive result in the first case, and negative in the second. Vill-----Pierre, aged 28, entered April 23th, 1835. This patient having, twelve days previous to his entry, exposed himself to an in- fection, perceived the following dry an excoriation which soon became a chancre; only eight days had elapsed since the infection, when the patient observed a bubo develope itself on the right side; its progress was rapid, and it occasioned much pain. Upon his entry, the suppu- PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. 137 ration was evident, but not extensive, and only to be perceived at the summit of the tumor; the chancres in the ulcerative stage were situ- ated at the base of the glans on the frenum, where the affection had commenced; they were dressed with aromatic wine, after having been cauterized; cataplasms were applied to the bubo. The 30th. Tlie bubo was opened, and yielded much thin and bloody pus; the chancres were dressed with calomel and opium cerate. Ma) 5th. The pus of the bubo was inoculated on the left thigh by a single puncture, and on the right thigh, the same pus mixed with equal parts of sod. chlor. by two punctures. The 9th. The puncture on the left thigh, had produced the pustule; the two made on the right thigh, had produced nothing; the chancres on the penis were healed. The 18th. The bubo and the chancre on the thigh, which had been allowed to develope itself, were dressed with vin. arom. The 30th. The chancre on the thigh was healed, but some indura- tion still remained at the base of the bubo; there was aiso a little in- duration around the cicatrix of the chancre; applications of liq. Van. Swieten were ordered. June 14th. The indurations were less; the bubo had been treated with cataplasms and ung. mercur. The 20th. The induration on the penis had disappeared; there was a slight salivation, the use of the liquor was therefore suspended; the gums were touched with acid, hydrochlor. and a gargarism with quin- ine ordered. The 30th. The induration of the bubo had disappeared; and on the 11th of July, the patient left quite cured. Case XVIII. Chancre, symptomatic bubo; inoculation of the first pus flowing from the bubo, ivhen opened, without result; production of the pustule from the pus, taken from the depth of the cavity. Bes-----, aged 23, entered Dec. 23, 1836. The chancre, seated on the left side of the frenum, had existed a month; the bubo, in the right groin but a fortnight; the bubo had been acute in its course; the patient had suffered much pain; the superficial ganglions appeared to be the seat of the tumor; the base was but little indurated; the chancre, which had received no treatment, was healing. The 24th. The bubo was opened, and the first pus which escaped, inoculated on the right thigh; then that taken from the depth of the cavity was inoculated on the left thigh; the chancre was cauterized, and dressed with vin. arom. The 27th. On the right thigh, the puncture, made with the first pus which escaped, had produced nothing, whilst the pus from the depth of the bubo had produced the characteristic pustule on the left thigh. The 28lh. The pustule from the inoculation was cauterized, in or- der to destroy it; the bubo had assumed a chancrous appearance, and the skin which covered it, was ulcerated; it was cauterized, and dress- ed with vin. arom. Jan. 10. The chancre had healed; the bubo appeared modified. 16 138 CLINICAL AND EXPERIMENTAL RESEARCHES— The 18th. The bubo, it was remarked, suppurated very little; the base was indurated; the use of the vin. arom. was suspended, and ung. mercur. substituted. The 20th. The suppuration was re-established; the base of the bubo had lost its induration, and was reduced to the level of the sur- rounding parts. The 23th. The dressings of vin. arom. were resumed. The 30th. The surface of the ulcer was cicatrizing; the upper part was already covered with a smooth and rose-colored membrane. Feb. 6th. All was quite well, no induration remained on the seat of the chancre. Case XIX. Chancre, symptomatic bubo; inoculation of the super- ficial pus, and that taken from the depth of the bubo on the day of opening, with positive result. J-----, aged 24, entered Jan. 24, 1S37. The affection had exist- ed two months; the chancres were seated on the left of the frenum, and on the internal surface of the prepuce on the right side. A bubo on the left side, had existed a month; its progress had been subacute. We found the bubo, in which evident fluctuation was perceived, even at its base, had much undermined the surrounding skin. The chan- cres were partly healing. Jan. 25th. The bubo was opened, and a bloody bad smelling pus escaped; the first pus which flowed out, was inoculated by a single .. puncture made on the left thigh, and that taken from the surface of the ground of the cavity, also by a single puncture on the right thigh; cataplasms were applied to the opened bubo; the chancre having been cauterized, was dressed with vin. arom. The 26th. The inoculated punctures on both thighs, were red and swollen. The 27th. The inoculation on both sides had succeeded; the pus- tule was well formed, but of little extent. The same treatment was continued for the chancre and bubo. The 30th. The pustules filled with pus, presented all the charac- teristic signs of the chancrous pustule. The 31st. The pustules were divided, and the skin below was found penetrated in its whole substance by the chancre, whose edges were abrupt; they were cauterized with arg. nitr. Feb. 1st. The nitrate of silver appeared not to have sufficiently destroyed the chancres from inoculation; the Vienna paste was there- fore applied to them; the bubo was cauterized with nitrate of silver, and dressed with vin. arom. The chancres on the penis were nearly healed; they were slightly touched with the caustic, to dry up the surface. The 6th. The Vienna paste had destroyed the chancres from the inoculation and their surface appeared disposed to cicatrize in a regu- lar manner; dressings of vin. arom. were applied; the chancres on the prepuce and glans, were completely cicatrized, without leaving any induration. PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. 139 The 10th. The points cauterized with the Vienna paste, were near- ly cicatrized; the bubo was better, but as the granulations were tardy in their development, powdered cantharides were introduced into the cavity. The 14th. The inoculated points were entirely cicatrized; the bubo had assumed all die characters of the period of"cicatrization, and the extent of its surface was diminished one fourth. The 18th. Cantharides were again applied. The 21st. The progress of the cicatrization was rapid, a superficial cauterization and dressings of vin. atom, were ordered. The 25th. The bubo was nearly cicatrized, without leaving any in- duration at the base. March 2nd. Compresses with decoct, alb. were applied, and in a few days the patient was quite cured. Case XX. Chancres, symptomatic bubo; inoculation of the super- ficial and deeper situated pus, the day of iis being opened; negative re- sult in the former case, and positive in the latter. Quinl-----, aged 22, entered Dec. 2, 1826. Ten days after the appearance of chancres on the glans, a bubo showed itself en the left side, its progress had been acute, notwithstanding two applications of leeches. The cavity was extensive, and the skin become vejy thin. The 7th. The bubo was opened, and the superficial pus was inocu- lated on the left thigh, and then that pressed out of the depth of the wound on the right thigh. The 10th. The puncture made on the left thigh with the first pus which escaped, had produced nothing; but on the right, the inocula- tion of the pus taken from the ulcerated surface, which formed the ground of the cavity, had produced the characteristic pustule. The 12th. The pustule from inoculation was cauterized; the chan- cres of the glans which had been cauterized with arg. nitr. and dressed with vin. arom. were healing; they were dressed with opiated cerate. The 17th. The chancres on the penis were healed; the bubo was treated with cataplasms and ung. mercur. The 26th. The bubo was ordered to be dressed with vin. arom. after being cauterized with arg. nitr. Jan. 9th, 1837. The patient left cured. Case XXI. Chancre, symptomatic bubo; inoculation of the pus of the bubo the day it was opened, producing the characteristic pustule. Bern-----, aged 22, entered Nov. 22, 1836. In this case, the chancres had existed nearly two months; they showed themselves six days after a sexual intercourse; at the time of his entry, the bubo had been developed a fortnight, and up to that time, he had undergone no treatment. We found the bubo had suppurated; on the right side, and near the base of the glans, a chancre was perceived, some points of whose surface w:ere healing. The 23rd. The bubo was opened, and yielded much bloody pus, which having been cleared away, some pus was taken from the ground, 140 CLINICAL AND EXPERIMENTAL RESEARCHES— of the cavity, and inoculated on the left thigh; at the same time, some of the chancre pus was inoculated on the right thigh. Cataplasms were applied to the bubo, and the chancres were cauterized and dress- ed with vin. arom. The 26th. The puncture made with the pus of the bubo, taken from the ground of the cavity, had produced the pustule, as also that made with the pus of the chancre. The 27th. The patient had scratched the pustule; the chancre on the glans had healed; the bubo, whose opening was ulcerated, was cauterized and dressed with vin. arom. The 29th. The pustules from the inoculation were better; they were cauterized and dressed with vin. arom. Dec. 16th. The patient left quite cured. Case XXII. Chancre, bubo and lymphitis; inoculation of the pus the day of the opening without result, but on the following day, an in- oculation being made, the result icas positive; and the pustule was sub- sequently inoculated with like result. Mass-----, aged 22, entered Dec. 2, 1836. Six weeks before his entry, this patient had contracted chancres on the glans; the form of the ulcers was round and regular; the edges and base slightly indurat- ed. During the first days, there had been much irritation, but the in- flammatory symytoms soon yielded to diet and emollient lotions; no other treatment had been used. About a week previous to his corn- ing to the hospital, a little tumor formed near the posterior part of the penis on the right side, on a lymphatic, whose course was marked by a red line and indurated cord; nearly at the same time, a bubo appear- ed in the right groin. We found the lymphatic tumor had suppurat- ed; but no fluctuation was perceptible in the bubo, whose progress however was very acute; it was seated in the superficial ganglions. Some points of the chancres were at the period of reparation. The 6th. The lymphatic abscess was opened, and the first pus which escaped, was inoculated on the right thigh: the pus from the depth of the cavity, was not inoculated, as it was mixed with much blood. The chancres were cauterized, and vin. arom. applied. The bubo was treated with cataplasms. The 7th. The inoculated puncture was not even red; some pus was taken from the depth of the lymphatic abscess, and inoculated by a single puncture made on the left thigh. The appearance of ihe open cavity, in the course of the lymphatic, was quite chancrous, it was therefore cauterized, and dressed with vin arom. The 10th. The inoculation made on the 6th, on the right thigh, had produced nothing; that of the 7th, had yielded a well developed pustule; it was broken, and its pus was inoculated by a single punc- ture on the right thigh. The 13th. The inoculation made with the pus of the pustule, had yielded a positive result; this pustule was then destroyed. The bubo had suppurated; it was opened, and the first pus which escaped, was PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. inoculation on the right, and the pus taken from the depth of the cavi- ty on the left thigh, above the first puncture; the chancres on the glans were nearly healed, but their base was indurated. The 16th. The inoculation of the superficial pus of the bubo on the right thigh, had produced nothing; that made with the pus from the depth of the cavity on the left thigh, had produced 'the'pustule; the edges of the incision made in the bubo, had assumed a chancrous ap- pearance. To counteract the tendency to induration, the pills of the hydr. iodid. were ordered, with the sudorific syrup and tisane. The 20th. The chancres on the penis were healed; the suppurated lymphatic was in an unhealthy state of granulation; there was little tendency toward cicatrization, on account of the induration at the base of the ulcer. The bubo and the inoculations on the left thigh, were still in the period of increase; they were cauterized, and dressed with vin. arom. The 30th. The ulcers had, under the influence of the iodide, as- sumed a belter appearance; their ground was rose-colored, the suppu- ration was good, and the induration had decreased. The inoculations made on the left thigh, had undermined the skin; to promote the pro- duction of granulations, and aid the cicatrization, they were covered with a blister. The bubo was better ; it was no longer covered with a greyish membrane; its ground was rose-colored and granulating ; the ulceration of the lymphatic had diminished its extent, and its in- durated base was become softened. Jan. 10th. The induration which remained on the seat of the pri- mary chancres of the glans had disappeared; the wound en the poste- rior part of the penis was closed, and very little induration remained around the cicatrix; nearly all the surface of the inguinal bubo, was in a state of healthy reparation. The chancres on the thigh were cica- trized; the base was no longer indurated. The 27th. All was well, and the patient left the hospital. During all the time of the treatment, the patient enjoyed excellent health; the functions remained perfectly regular. Case XXIII. Chancre in the period of reparation; sympathetic bubo; inoculation without result. M-----, aged 22, entered June 6th. 1835. The patient had had chancres during six weeks; then ten days later, a bubo appeared in the left groin; its progress had been subacute. Upon this entry, there were ulcerations with the characters of the period of reparation on the frenum, margin of the prepuce, and the posterior part of the penis; the bubo had suppurated; its base was broad, but yet softened. The 8th. The bubo was opened, and yielded a creamy pus, some of which was inoculated on the left thigh. At the same time, the pus from the chancres of the frenum, which had still some points in the ul- cerative stage, was inoculated on the right thigh, by a single puncture. Cataplasms were applied to the bubo ; the chancres were cauterized, to check the developement of some granulations, and were dressed with ceret. opii. 142 CLINICAL AND EXPERIMENTAL RESEARCHES— The 12th. The puncture had produced no effect. The 13th. The pus of the bubo, was inoculated on the left thigh. The chancres were nearly healed; a superficial cauterization was made, to obtain a cicatrization; the base of the bubo was softened; the edges of the wound appeared ulcerated; but this seemed to de- pend on a want of vitality, in consequence of the thinness of the skin. The 15th. The inoculated punctures had produced nothing; a fresh inoculation was made with the pus, taken from a point on the edges of the incision, which appeared still in the progressive stage of ulceration. The 20th. The inoculation had produced nothing; the incision made in the bubo, the cavity of which no longer secreted pus, was cauterized. The 25th. The patient left cured. Case XXIV. Phagedenic chancre, sympathetic bubo; inoculation without result. Finarg-----, aged 25, entered Oct. 7, 1836. This affection had lasted five weeks; in the beginning, a knot was formed on the anterior and superior portion of the penis; its progress resembled that of a pus- tule from inoculation; on the superior and posterior part of the glans, a chancre was formed in consequence of an erosion. The two ulcers remained nearly in the same state, without perceptible progress for about a week; but after severe exertion and frequent errors of diet, a phagedaenic gangrenous state was induced by an excess of inflamma- tion; the surface of the wounds became rapidly extended; then recourse was had to emollients and opiated cerate. The progress of the disease was soon arrested; but, and especially on the glans, there was a great loss of substance; the ulcer was regularly progressing towards cicatriz- ation; when after some exertion, it became irritated, and on the follow- ing day, the patient felt a pain in the groin, in which a bubo, whose course was very acute, showred itself; it was treated, from the com- mencement, with mercurial frictions, and the chancres had been dress- ed with ung. mercur. At the time of his entering the hospital, ten days after the developement of the bubo, the whole mass had suppurat- ed; there was some engorgement at the base, which appeared to ad- here to a considerable depth to the subjacent parts; the chancres pre- sented all the characters of the period of reparation. The 8th. The bubo was opened, and yielded a greenish bloody pus; some of which was inoculated by two punctures made on the right thigh. Some of this pus was also collected in a tube, the gums were already a little affected by the mercury; they were touched with acid, hydro- chlor. and a gargle of alum, sulph. was ordered lo be used. Cata- plasms were applied to the bubo, and the chancres were slightly cau- terized, and then dressed with vin. arom. The 10th. The inoculation on the 8th, had produced nothing; a fresh inoculation was made with the pus of the bubo on the left thigh, and with that preserved in the tube on the right; the same dressings were continued, PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. The 12th. None of the inoculations made on the 10th, had pro- duced anything; the chancres were rapidly progressing towards cica- trization; the bubo was nearly closed; a little deep-seated engorge- ment remained at its base. A fresh inoculation was made of the pus preserved in the tube, since the 8th. The 17th. Only a small portion of the chancre of the glans remain- ed; that on the skin of the penis was healed; the bubo was closed; compresses imbibed with decoct, alb. were applied, and compression was ordered to be made. The 22nd. AH was cicatrized, no induration remained, and on the 25th, he left the hospital. Case XXV. Gonorrhoea; sympathetic bubo; inoculation without result. Ber----, aged 22, entered Sept. 21st, 1836. This patient was unable to slate at what time the gonorrhoea had commenced, as he had several times, by frequent sexual intercourse, brought it back to the acute stage; a bubo had appeared in the right groin, about three weeks previous To his coming to the hospital, and its course bad been sub- acute. We found the gonorrhoea in the acute stage, yielding a green- ish pus; the bubo was of a considerable size, and but little suppura- ted; cataplasms were ordered to be applied to it. The 22nd. The gonorrhoeal pus was inoculated by two punctures, made on the left thigh. The 29th. The inoculated punctures had produced nothing. The bubo was opened; its pus was white and creamy; but little engorge- ment remained at its base; some leeches applied to the perinseum on the 22nd, had much diminished the inflammatory state. A fresh in- oculation of the gonorrhoeal pus was made on the left thigh; some of the [uts was preserved in a tube. TIh? 30th. The inoculations made on the 26th, had produced nothing; for the gonorrhoea cubebs were ordered, and injections of arg. nitr. Tlie cavity of the bubo was much decreased; the edges of the incision made in it, were not ulcerated. Oct. 4th. The pus preserved in a tube on Sept. 26th, was inocu- lated; the gonorrhoea had ceased; the bubo was closed. The 7th.. The inoculation of the pus preserved in the tube, had produced no result. No induration remained around the closed bubo; the patient left quite cured. Case XXVI. Chancre, balanitis, phimosis; sympathetic bubo in- oculated loithmtt result. Joig-----, aged 21, entered July 31, 1835. Six weeks previous to his coming to the hospital, this patient had contracted chancres, which he observed three days alter a connection; a fortnight later, after severe exertion, a balanitis and phimosis supervened, to which, after four days, was added a bub j on the right side, whose progress had been very slow. We found upon examination, a little fluctuation in 144 CLINICAL AND EXPERIMENTAL RESEARCHES— the bubo; pressure occasioned pain; the phimosis, although not much inHamed, did not allow the glans being uncovered, on which several indurated, points were to be felt through the skin. Aug. ,th. The bubo was opened, and yielded a little pus mixed with blood; an inoculation was made, by two punctures on the right thigh; the balanitis was cauterized, and cataplasms applied to the bubo. # I he 12th. The inoculated punctures had produced nothing; dress- ings of ung. mercur. were applied to the engorgement of the ganglion in the right groin, to promote the resolution. The 20th. The resolution progressed slowly; the edges of the in- cision were not ulcerated. The glans could be uncovered, and show- ed a chancre near the frenum, in the period of reparation; which was ordered to be dressed with vin arom. Ihe 30th. A decided improvement; the bubo had nearly disap- peared; the chancre was healed. Compression, with applica'tions of decoct, alb. were ordered to be made. Sept. 11th. The patient was dismissed cured. Case XXVII. Chancre; symptomatic bubo inoculated without re- sult. Chaimb-----, aged 23, entered May 17, 1836. This patient had chancres near the frenum, and a bubo on the right side, which had ex- isted a fortnight; it had been acute in its course; the suppuration was complete, and no engorgement remained at its base. The 19th. The bubo was opened, and afforded a thick ropy pus, which was inoculated on the right thigh; the chancre was cauterized. The 21st. The result of the inoculation was negative; the edges of the incision had remained closed, and not ulcerat?d; the chancres were dressed with vin. arom. and cataplasms were applied to the bubo. The 28th. The chancres were nearly well, and the cavity of the bubo, three-fourths united. The patient left cured, June 19th. Case XXVIII. Chancre, sympathetic bubo; inoculation affording a pseudo-pustule. Mor----, aged 22, en'ered Dec. 6, 1836. This patient was not able to state the time at which the chancres on the glans had appeared. About three weeks before the lime of his entry, a bubo showed itself in the right groin. We found the chancres healed; the bubo was in full suppuration; the skin had become very thin. It was opened, and the first pus which flowed from it, was inoculated on the right thigh; then pus taked from the ground of the cavity, was inoculated on ihe left thigh, and cataplasms applied to the tumor. The 9th. The inoculated punctures were red and pointed. The 10th. A little pus was perceived at the summit of the punc- tures. The 16th. The pustules were formed on both thighs; around them, PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. there was some redness and fluctuation; the epidermis was ruptured; the purulent cavity was only superficial, and had not perforated the skin, as is the case with chancre pus. Some of the pus was inoculat- ed on the right thigh. The 21st. The first two pustules from inoculation, which were opened on the 16th, had healed without any dressing; the inoculation of their pus, had produced no effect. The induration at the base of the bubo still remained; the skin which covered it, h;.d been remov- ed, as not adapted to cicatrization. Ung. mercur. was applied to promote the resolution of the engorged ganglions, which were perceiv- ed in the depth of the wound, and afterwards cataplasms. The 30th. The bubo was better, but the induration disappeared but slowly. Jan. 10;h. The cicatrization had begun, granulations had made their appearance; the use of the ung. mercur.was suspended and a cauterization with arg. nitr. ordered. The 15th. But little induration remained; some granulations were cauterized, and then compresses with decoct, alb. applied. The 27th. The patient left cured. Case XXIX. Superficial ulcer; sympathetic bubo inoculated with- out result. Caub-----, aged 22, entered Jan. 30, 1837. A month had elaps- ed since this patient first perceived, after a sexual connection, a wound on the interior and superior of the prepuce; at first, there was much irritation, and toward the eighth day, a bubo appeared on the right side; a few days rest, and dressings with cerate, caused the ulceration to disappear; the bubo remained stationary and indolent. The patient then left Montpelier for Paris; during the journey, he had sexual in- tercourse, by which the cicatrix of the wound on the prepuce was rup- tured, and the bubo suddenly increased. We found the wound on the prepuce nearly healed; but the bubo was extensively suppurated. The 22nd. The bubo was opened; and the first p s which escaped, inoculated by two punctures, made on the ri^ht thigh, and the pus from the ground of the cavity on the left. Cataplasms were applied to the bubo. The 23rd. The inoculation was without effect; the cavity was ex- cited by the cautery, and the cataplasms continued. The 29th. Powdered cantharides were introduced into the cavity. Feb. 1st. There was little suppuration; compresses with decoct. alb. and a methodic compression were applied. The 14th. The patient left cured. Case XXX. Chancre; deep-seated mullilocular sympathetic bubo inoculated without result. Gip-----, aged 26, entered Oct. 11, 1836. The affection had ex- isted eight months; the chancres first appeared, eight days after a con- nection; no treatment had been used; the buboes had been develop* 19 146 CLINICAL AND EXPERIMENTAL RESEARCHES— ed two months; their course had been indolent, having attained a great volume, they became softened at the summit. Tlie left bubo had been opened, by means of caustic potass; but some cavities adja- cent to the principal cavity, had also to be opened. We found the suppuration of the right bubo had ceased, and it was nearly closed; its base was indurated, and extending into the depth. The left multilocu- lar bubo had two principal cavities: a superior corresponding with the central line, and an inferior in the plica cruris; the right bubo was treated with blisters, and cataplasms covered with ung. mercur.; inter- nally, the iodide of iron, twelve grains per diem, and a decoction of hops, with antiscorbutic syrup, were given. The 12th. The pus of the left bubo was inoculated by two punc- tures, made on the right thigh: the first puncture was made with the pus from the central cavity; the second with that from the inferior. The 18th. The punctures had produced nothing; the right bubo was somewhat diminished. Two fistulous passages in the left bubo were destroyed, and several granulating points were cauterized. The 24th. The right bubo was nearly healed; the left suppurated little; but at the base, there could be perceived some deep seated in- duration. Compresses with decoct, alb. were applied, and compres- sion ordered to be made. The patient left cured Nov. 8th. Case XXXI. Abrasion of the epidermis of the glans; sympathet- ic bubo inoculated without result. Men-----, aged 19, entered Oct. 3, 1835. About a fortnight pre- vious to his entry into the hospital, this patient, during a coition, chafed the skin off a small point, on the left side of the glans. In conse- quence of a natural phimosis, and a little inflammation of this wound, a partial balanitis supervened; a week later, a bubo developed itself in the superior part of the left thigh below the ligament. Poupart. and some engorgement was felt in the fossa iliaca. We found the bubo, which had been acute in its course, fully suppurated, but still indurated at the base; the wound on the glans still existed, it was therefore cauterized, and a piece of dry linen placed between the glans and prepuce. The 10th. The pus of the bubo was inoculated on the left thigh; the wound and balanitis had disappeared. , The 17th. The inoculation produced nothing, it was repeated on the left thigh. The 21st. The puncture, which at first appeared red and raised had disappeared; a fresh inoculation was made on the left thigh. The 23rd. The last inoculation had produced nothing; the edges of the incision in the bubo, were not ulcerated, and it was healing; the major part of the cavity was reunited; dressings of decoct, alb. were ordered. Nov. 9tb. The patient left cured. PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. Case XXXII. Chancre; symptomatic bubo producing a pseudo- pustule on inoculation. Houz-----, aged 32, entered Jan. 30, 1836. The patient said he had frequently had small chancres, which disappeared in ten or twelve days, with dressings of cerate. The last chancres had appeared three weeks since; ten days ago, a bubo showed itself on the right side; its progress had been very acute. We found the chancres healed, and the bubo suppurated; it was opened on Jan. 31st, and a greenish thick pus flowed from it. Feb. 1st. The pus of the bubo was inoculated on the right thigh; the lips of the wound were red and irritated, but not ulcerated; cata- plasms were applied. The 6th. The inoculated punctures, which from the second day, had been red and pointed, and indurated at the base, disappeared after having yielded a little sero-purulent fluid; a fresh inoculation was made on the right thigh. The 10th. The result from the second inoculation, was the same as the first; the bubo was cauterized and dressed with wine; the se- cretion of pus was very small. The patient left cured on the 22nd. Case XXXIII. Bubo having succeeded to a gonorrhoea; cutaneous abscess on the thigh; inoculation without result; pseudo-pustule. Mit——, aged 20, entered Oct. 5, 1836. This patient had been dismissed from the hospital, August, 1836, perfectly cured of a gon- orrhoea, which had lasted eighteen months; a bubo which had been developed three weeks, was treated with blisters, and a solution of sublimate. At the time of his leaving the hospital, it had aearly dis- appeared; but in consequence of fatigue, and some irregularities in his diet it soon increased, and speedily suppurated. Ten days pre- vious to his re-entry, a superficial abscess had formed in the superior part of the right thigh, a little below the lig. Poupart. The left bubo had suppurated, and opened spontaneously some days; we opened the abscess on the right thigh. Oct. 7th. The pus of the bubo was inoculated on the left thigh, and that of the abscess on the right. Cataplasms were applied to both the bubo and the abscess. The 12th. The two punctures were red; that on the right thigh, even furnished a little pus; that on the left was pointed, but only a lit- tle indurated. The 14th. The puncture on the right thigh, made with the pus from the abscess, and which on the 12th, was full of pus, had opened; that on the left, made with the pus from the bubo, and which had been on- ly red and indurated, was beginning to suppurate; it still remained pointed. The 17th. The puncture on the right, had after breaking, dried up, and was nearly cicatrized; that on the left was full of pus. The ab- scess on the thigh was closed, and the bubo yielded but little suppura- tion . 148 CLINICAL AND EXPERIMENTAL RESEARCHES— The 20th. The last pustule had disappeared without treatment like the first, and without ever having assumed the appearance of a speci- fic ulcer. The bubo was closed, and no induration remained at its base; in a few days, the patient left quite cured. Case XXXIV. Scrofulous bubo; inoculation without result. Lab-----, aged 24, entered May 6, 1836. The patient, with a lymphatic temperament, and tendency to scrofula, had already had ganglionary engorgements of the neck; at the time of his entry, he bad two enormous buboes which we could not attribute to a venereal infection; as he had not exposed himself to it, by sexual intercourse, for mote than four months, he had had no other suspicious affection than a chancre, which had been cured twelve months previous, with- out having left any induration on its seat. The two tumors develop- ed themselves slowly, and suppurated. May 7th. The buboes on both sides were opened; a thick brown pus escaped, which was immediately inoculated; ernolient cataplasms were applied, and a draught of tisane of hops, with baryt. hydrochlor. and sweetened with syrup of gentian. It may be proper to remark, that this patient had been five-and-thirty days in another hospital, in which he had been treated with pills of hydrarg. deuto-iod. without the least amelioration. The 9th. The punctures had produced nothing; a fresh inoculation was made, by two punctures on the right thigh. Blisters were ap- plied to the buboes, to excite them; the mixture as above, was con- tinued. The 15th. The inoculations made on the 9th, had produced noth- ing; the affection appeared not to prog/ess; bnt we could not perceive any improvement; the suppuration was copious. The 30ih. There was an improvement, especially on the left side, compression was ordered to be tried. June 10th. The bubo on the left, had nearly disappeared under the compression; the general health was decidedly improved. The 20th. Compression was applied on the right side; the left bu- bo was cicatrized; very little induration remained in the deep-seated ganglions, which formed the base of the tumor. The 30th. The resolution progressed rapidly; the use of bitters and anti-scrofulosae was continued; the dose of baryt. hydrochlor. was gradually increased to twelve grains per diem, without the patient feel- iny any inconvenience. July 12th. 'I he two tumors had disappeared, and only a little ten- sion on each side remained from the change the tissues, in which the affection had been seated, had undergone. Case XXXV. Chancres, periadenic abscess, inoculated withuct result. Fdcas-----, aged 26, entered Nov. 14, 1S35, This patient was PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. unable to state the exact time when he had contracted the chancres on the glafts, on the right side of ihe frenum, and which we found in the period of reparation. A fortnight previous to his entry, he felt a pain in the left groin, and perceived an incipient bubo; the patient observed the most strict repose, applied cataplasms, and the tumor then appear- ed arrested in its development; but three days later, the cellular tis- sue, which was at first only indurated, appeared suppurated. The 16th. An abscess in the groin was opened and yielded much creamy pus, which was inoculated by two punctures on the left thigh. After the evacuation of the pus, it could be perceived, that the inguin- al ganglions were butvery little swollen, and that the suppuration was only periadantic; the chancres were cauterized, and dressed with calomel cerate. The 18th. The punctures had produced nothing; the tumor had nearly disappeared. The 24th. The chancres were cured, and the cavity of the abscess, nearly obliterated. In a few days, the patient left cured. Case XXXVI. Primary bubo (d^emblie); inoculation without re- sult. Buis-----, aged 18, entered Oct. 7, 1836. This patient had never had either chancre or gonorrhoea; three days after sexual intercourse, he perceived a small tumor in the inguinal region of the right side. Fro n the commencement it was indolent, and developed itself slowly. At the time of his entry, its volume was considerable; it was situated in the deep-seated ganglions, and through the abdominal integuments, an engorgement was felt extending into the fossa iliaca; the same was every where adherent ; at the summit, an obscure fluctuation was felt; cataplasms were applied. The 14th. The fluctuation was evident; the bubo was opened, and the pus from the depth of the cavity, inoculated by two punctures made on the right thigh. Some pus was also preserved in a tube; the patient observed the most absolute repose; mercurial frictions were made on the tumor; the skin having assumed an erysipelatous tint. The 16th. The inoculation had produced nothing; the redness of the skin had disappeared; the engorgement of the ganglion was rapidly disappearing; compression was applied. The 17th. The pus of the bubo, was inoculated on the right thigh; and that preserved in the tube on the left; the cavity yielded little suppuration. The 19th. The inoculation made on the 17th, had produced noth- ing; the wound made in the bubo, was not ulcerated; the rapidity of resolution, was for indolent buboes, very remarkable. No engorge- ment remained in the fossa iliaca. The 21st. The compression was continued with compresses, dipt in decoct, alb. The 27th. The patient left cured; the tumor had nearly disappear- ed; exercise and compression would suffice to remove the slight re- 150 CLINICAL AND EXPERIMENTAL RESEARCHES— maining engorgement. This patient was dismissed, somewhat sooner than common, on account of his lymphatic habit, which was ifl suited to the diet and residence in an hospital. In the month of February, he presented himself again at the hospital, when all had disappeared; scarcely a trace of the wound made in the bubo remaining. Case XXXVII. Primary bubo (Bubon d'emblee,) inoculated without result. Pe-----, aged 17, entered April 26, 1836. This patient had for two months bad no sexual intercourse, when the day after a coition, he felt a pain in the right groin, and a bubo began to be developed, though slowly. He was of a lymphatic sanguine habit; he had un- dergone no treatment; the tumor was of considerable volume; it was seated in the deeper ganglions, and its base was large; some engorge- ment could be felt through the abdominal integuments. The bubo had existed about three weeks; half the mass had suppurated; it was open- ed, and thick creamy pus escaped; that taken from the depth of the cavity, was inoculated by two punctures made on the right thigh; cata- plasms were ordered to be applied to the bubo. The 29th. The inoculations had produced nothing; the engorge- ment was less; the suppuration copious; a flap of skin, which appear- ed unfit for cicatrization, was removed; dressings of ung. mercur. were then applied to obtain the resolution of the ganglionary engorge- ment. The 30th. The suppuration had increased; a fresh inoculation was made on the left thigh. May iOth. The inoculation had produced nothing; the applications of ung. mercur. were discontinued; the engorgement had decreased by half, but the surface of the wound was covered with a kind of pulpy membrane. A cauterization and dressings of cerat. plumb. were ordered. The 11th. The appearance of the wound was very satisfactory; the fleshy granulations appeared rose-colored; a superficial cauteriza- tion and compression with compresses, dipped in decoct, alb. were ordered. The 20th. Scarce any engorgement remained; the surface of the bubo diminished by three fourths, was nearly cicatrized. In a few days' time, he left cured. Case XXXVIII. Primary bubo inoculated without result. Mari-----Francois, aged 19, entered July 4, 1835. Two months had elapsed since this patient, after repeated excess at table, and a fortnight after a coition, observed two tumors develope themselves in the groin; the tumor on the left side was more rapid in its progress, and was opened at the Hotel Dieu, where the affection was treated as venereal buboes, with ung. mercur. and cataplasms for three weeks. We found the left bubo nearly healed, and the right in full suppuration. The 6th. The bubo was opened, and the pus inoculated by two punctures on the right thigh. PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. The 8th. The punctures had produced nothing; the lips of tbe in- cision, which were closed and sound, indicated that the pus of the bu- bo, whose base was free from induration, had not the primary syphilit- ic character; cataplasms were applied. The 10th. No more suppuration remained; the cavity was closed; compresses with decoct, alb. were applied. Case XXXIX. Primary bubo inoculated without result. Hemont——, ag.ed 24, entered Sept, 7, 1836. Three days after a night spent in debauchery, during which the patient had seven coi- tions, a bubo showed itself on the left side; its progress was subacute; the sexual organs being examined with care, did not show a single trace of any ulceration: the canal of the urethra, was healthy; the bubo had suppurated; little engorgement remained at the base of the tumor. The 12th. The bubo was opened, and the greenish! thick pus inoculated by two punctures, made on the right thigh; the'cavity was large, cataplasms were applied. The 16th. The punctures had produced nothing, although the edges of the incision appeared ulcerated; but the little vitality of the tissues become thin from the suppuration, and which at the time of the bubo being opened were bluish, sufficed to explain this state; some pus, taken from the depth of the cavity, was inoculated by two punctures, made on the left thigh: some al. cantharid. was introduced into*the bu- bo, to excite the production of granulations. The 20th. The last punctures had produced nothing; the bubo was better; the oil had produced an excitement, and the cavity was somewhat diminished in extent. The 28th. The bubo was cauterized, its ground was more raised; the same application was continued, and by Nov. 4th, the patient was cured, and dismissed. Case XL. Primary bubo, inoculated without e-ffect; some of the pus being preserved in a lube, did not inoculateT after having been kept four days. T.h----■, aged 22, entered Oct. 4, 1836. The patient assured us, he had never had any other venereal affection than a gonorrhoea, five years previous; it had lasted nearly two months and run through the usual acute and chronic stages; then being properly treated with in- jections and copaiva, it disappeared without leaving any symptoms; which could be referred to a syphilitic affection; the general health having remained in the best state possible. Seventeen days had elaps- ed since a superficial bubo developed itself On the right side; the pa- tient had had no sexual intercourse for seven weeks previous; the base of the tumor appeared indurated, it was opened, the cavity was extensive, and appeared to have invaded the profound inter-ganglionary cellular tissue; an inoculation was made by two punctures on the right thigh. 152 CLINICAL AND EXPERIMENTAL RESEARCHES— The 8th. The punctures had produced nothing; the tumor had abated, but the skin appeared loosened. A fresh inoculation was made on the right thigh; some of the pus was preserved in a tube, open at both extremities. The 11 th. The pus preserved in the tube, was inoculated; the cav- ity appeared to be reuniting; the incision had remained umdeerated. * The 19th. The puncture made with the pas in tlie tube, had pro- duced nothing. Thus in every case, the inoculation had failed; the cavity had diminished; the patient having a scrofulous habit, was or- dered a decoction of hops, with antiscorbutic syrup, and jferri p^oto- iod. twelve grains per diem. The 20ih. Nearly all the cavity was closed and only a few drops of serous pus remained. Nov. 7th. The patient left cured. Case XLI. Chancres, symptomatic bvbo; inoculation with positive result; pustule carried to the fifth generation. Lob-----, aged 18, entered Jan. 5, 1833. Three days after a sus- picious connection, this patient perceived a chancre on the internal part of the left side of the prepuce; the ulcer being neglected, increas- ed, and in a few days, a bubo showed itself on the left side; its pro- gress was sub-acute, and notwithstanding an application of leeches, u"g. mercur. and emplastrum de Vigo, a complete suppuration followed. The 6th. The bubo had opened during the night: the chancres of the penis appeared in the period of progression; they were cauterized', and dressed with opiated cerate. The 21st. The attenuated skin, which covered the cavity of the bubo, had been destroyed by the ulceration; the ulcer had thus he- come denuded, and presented a chancrous appearance; the pus of the bubo was inoculated by two punctures, made on the right thigh: the ulcerated cavity was cauterized, and dressed with opiated cerate; the1 chancres of ihe penis were cauterized with argent, nitr. and dressed with calomel cerate. The 24th. The pustules from inoculation had formed; they were opened, and their pus inoculated by a puncture on the left thigh. The 27th. The inoculations made on the 24th, had produced the characteristic pustule; the first inoculation was dressed with calomel cerate. Feb. 15th. The chancres on the penis had disappeared; the first inoculation was nearly healed, the second was in the period of pro- gression; the bubo was going on well; its surface was granulating. Some pus was taken from the last inoculation, and inoculated on the right thigh. Some induration was perceived at the base of the chan- cres on the thigh, and on the body were some spots indicating the com- mencement of a lenticular syphilitic, eruption; pills of hydrarg. iodiJ. and sudorific syrup, and tisane were ordered. The 17th. The inoculation made on the 15th, had succeeded, and furnished the third generation; the bubo had healed* PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES. 153 The 27th. Pus taken from the chancre of the third generation, was inoculated on the left thigh. March 1st. The fourth generation was produced; the pus from it, was inoculated on the 17th, and in three days time, the fifth was evi- dent; the chancres were in a state of healing, according to the time of their existence. The 30th. The syphilitic irruption had not progressed; the treat- ment was continued. April 1st. Only two ulcers remained on the thighs; their ground was raised; a cauterization and dressings of calomel and sod. chlorin. were ordered. May 17th. The patient was dismissed cured; no induration remain- ing; the general health bad remained excellent, during all the time of the treatment. Case XLII. Chancre of the cervix uteri; symptomatic bubo; in- oculation producing the characteristic pustule. Dur-----Marie, aged 24, entered April 1st, 1834. The patient had for a month been affected with a gonorrhoea, which had occasion- ed no pain; at first, there had been little discharge; a fortnight later, a bubo appeared on the right side; its progress was very acute. We found the bubo completely softened; it was situated in the superficial ganglions; the matter of the discharge from the vulva was whitish; on the external part of the sexual organs, no trace of ulceration could be perceived; the bubo was opened, and much thin and bloody pus escaped. The 2nd. The edges of the incision made in the bubo, appeared to be ulcerated; cataplasms were applied, and emollient injections prescribed. The 10th. The wound in the bubo, had decidedly assumed a chan- crous appearance; some pus was taken from the centre of the cavity, and inoculated on the right thigh; the ulcer was cauterized with arg. nitr. and dressed with calomel and opium cerate. The 14th. The inoculation on the 10th instant had succeeded and produced a fine pustule. Injections of decoct, alb. were ordered; on the cervix were seen, two ulcers with greyish ground, and irregular abrupt edges. The 19th. The pus taken from the centre of the ulcer on the right thigh, was inoculated on the left thigh. The 25th. The inoculation made on the 19th, had produced the characteristic pustule; the ulcers were dressed with calomel cerate. Some pus from the cervix, taken from an ulcer with a greyish ground, was inoculated on the right thigh. The 28th. The last inoculation bad produced the pustule; the bubo was nearly healed; the ulcers of the cervix had become clean, after being cauterized with arg. nitr. on the 24th; that on the labium supe- rius, was granulated at its ground, and appeared to be raised to the level of the neighboring parts. 54 CLINICAL AND EXPERIMENTAL RESEARCHES— May 6th. The first and second inoculations had healed, as well as the bubo; but little discharge remained. The 15th. All was well, only a few superficial granulations re- mained on the posterior labium of the cervix. The 23rd. The patient was dismissed cured. Section IV. INOCULATION OF THE PUS OF THE SECONDARY AND OF OTHER RE- PUTED VENEREAL SYMPTOMS. Case I. Gonorrhoea, chancre in the period of reparation, mucous tubercles; inocuiation with negative result. Che----Elisabeth, aged 20, entered June 23, 1835. Four months previous to her entry, she became affected with a very intense gonor- rhoea, but unaccompanied with great pain; one month later, after fresh sexual intercourse, she perceived a chancre in the vulva; no treatment had been used. We found the discharge had become chronic; the cervix uteri and mucous-membrane of the vagina, were but little red- dened; but several patches of mucous tubercles were observed in the perinaeum, and internal surface of the right thigh; amongst these latter, one was particularly remarked in the plica cruris, whose surface afford- ed a thick and copious pus; it appeared to be owing to a transforma- tion in situ of a primary chancre. On the internal surface of the right nympha was an ulcer, with prominent irregular edges and greyish ground, with all the characteristic signs of a chancre, passing into the period of reparation. The pus taken from the mucous pustule on the right thigh, was inoculated about the middle of the same thigh, and the pus from the ulcer of the nympha on the left. Injections and tampooning of the vagina, with decoct, alb. were ordered. A lotion of sod. chlorin. and calomel in powder, were applied to the mucous pustules, and internally, pills of hydrarg. iodid. with sudorific syrup and tisane administered. July 1st. The punctures had remained without effect, and were perfectly cicatrized. The 15th. The mucous tubercles were nearly dried up, and level with the skin. The 21st. The ulcer on the nympha, was cicatrized, and on the 14th of August, the patient left quite cured. Case II. Gonorrhoea; blenorrhcea occuli (opthalmie blenorrhagi- que,) inoculated without result.* Mas-----1 aged 26, entered Aug. 16, 1834. This patient had been fifteen days affected with gonorrhoea; it had been very acute, and the discharge copious. During four or five days, the left eye had been affected with purulent ophthalmia; at its commencement, there was only a kind of mucous hyper-secretion; twelve hours later, pus * This case ought to have been inserted under the head of gonorrhoea. R. INOCULATION OF SECONDARY SYMPTOMS, ETC. 155 was produced, and acute pain was felt above the eyebrows; the ure- thral discharge continued. At the time of his entry, the eye was much inflamed, the palpebral mucous-membrane, presented here and there granulated engorgements of the follicles; the secretion was greenish and copious. Aug. 17th. A seton was drawn in the neck; thirty leeches were applied to the temples, and an enema of mel. mercur. and ol. ricini was prescribed. Lotion of decoct, malvae and emollient compresses were applied to the eye. The 18th. The affection progressed rapidly; there was a hardened oedema on the eyelids, photophobia, and a sharp and acrid secretion of tears; the secretion of purulent mucous, was very copious; there was an incipient chemosis. A superficial cauterization was made with argent, nitr. on the internal surface of both eyelids. The 21st. The cauterization was discontinued, on account of the increasing induration of the palpebral. The 22nd. Thirty leeches were applied; fifteen on the temple, and fifteen in the mastoid region; an enema, with magn. sulph. was pre- scribed. The 23rd. The indurated oedema continued, but had made less progress; there was no febrile reaction; the urethral discharge was still very copious; the palpebral surface of the conjunctiva was ul- cerated at several points; belladonna and calomel pills were ordered; the cornea was becoming opaque. The 28th. The swollen and indurated eyelids, scarcely allowed the cornea being seen, it seemed flattened; a bloody serous fluid escaped; we thought the eye was perished. The patient having in the previous night laid on his right side, the pus from the left eye had flowed into, and inoculated the right, which till then, had remained unaffected. Sup- puration had already commenced. The pus of the discharge from both eyes, and from the urethra, was inoculated on the right thigh; from the commencement, the mucous-membrane of the right eye had been cauterized with argent, nitr. The 26th. There was a decided improvement; a fresh cauterization and an enema were ordered. The 27th. The inflammation was decreasing; a collyrium of zinc. sulph. was ordered; the inoculations had produced no effect. The 28th. The cauterization with argent, nitr. was repeated. Small granulations were perceived on the conjunctiva; the left eye was sensible to the light. The 30th. The patient could distinctly discern objects; the colly- rium was continued; and injections of zinc, sulph. ordered for the gonorrhoea. Sept. 1st. The right eye was well, only a little redness remained; the patient could see without pain; he could distinguish objects with the left eye. The gonorrhoea was treated with injections, and copai- va in bolus. The 30th. The patient left quite cured. 156 CLINICAL AND EXPERIMENTAL RESEARCHES— Case IH. Chancre, symptomatic bubo, mucous tubercles, ecthy- ma; inoculation with positive result for the bubo, and negative for the ecthyma. Leg-----Louis, aged 18, entered February 27, 1836. Two months previous, this patient had entered the Hospital St. Louis, where he was treated for a chancre, followed by a bubo on the right side. A fortnight after quitting the hospital, after severe exertion, a fresh bubo made its appearance on the left side. We found on his arms aud thighs pustules of ecthyma ; at the posterior part of the penis, were some mucous tubercles ; about the middle of the internal surface of the right thigh, an ulcerated point was covered with a thick crust. In order to ascertain whether this latter ulcer proceeded from a direct application of chancre pus, or solely from the ecthyma, its pus ;vas inoculated on the right thigh. Feb. 28th. The inoculated point was surrounded by a circle form- ed with nitrate of silver, that it might not be confounded with the neighboring pustules. March 3rd. The puncture was cicatrized; the bubo was opened, and on the following day its pus was inoculated on the right thigh; on the 5th, it was red and pointed; on the 7th, the pustule was fully form- ed, and had all the appearances of an incipient chancre; it was caute- rized with argent, nitr.; ordered pil. hydrarg. iodid.; cataplasms to the open bubo; to the mucous tubercles, calomel and sod. chlorin. The 15th. There was a remarkable amelioration; the mucous tu- bercles had disappeared. The 21st. The bubo had begun to cicatrize. April 6th. The crust of the ecthyma was falling off at nearly every point. The 20th. Only a few brown spots remained; the bubo was cica- trized; two ulcers remained, one in the plica cruris, the other on the scrotum, they were dressed with vin. arom. May 19th. The ulcers were not quite cicatrized. June 7th. A fistulous passage, which maintained the suppuration, was laid open. Aug. 19. The patient left quite cured. Case IV. Transformed chancre and mucous tubercles inoculated without result. Lhr-----Josephine, aged 19, entered July 14, 1836. This pa- tient had, seven weeks previous to her entry, contracted a chancre at the entrance of the vulva; at first the progress of the ulcer was regu- lar; it extended itself but little; but about three weeks after its com- mencement, its ground became raised, and passing into an unhealthy state of reparation; it assumed the appearance of ulcerated mucous tubercles; nearly at the same time, an eruption of mucous tubercles appeared at the vulva. We found the transformed chancre in the midst of a patch of mucous tubercles, with which it might easily be confounded; the vagina and cervix were healthy; the abundant secre- INOCULATION OF SECONDARY SYMPTOMS, ETC. 157 tion, covering the introhus vaginae, was produced by the ulcerated tubercles alone. Some pus was taken from the surface of the trans- formed chancre, and inoculated by two punctures made on the left thigh. The pus taken from the surface of the tubercles of the vulva, was inoculated in the same manner on the right thigh; the surface of the chancre was cauterized, and dressed with calomel cerate. To the tubercles, dressings of calomel and sod. chlorin. were applied. The 19th. None of the inoculations had taken effect; the puru- lent secretion was less by half. The 25th. There was no more suppuration; the mucous tuber- cles were dry and began to disappear. The 30th. The skin on which the mucous tubercles were situated, was perfectly supple ; the cicatrix was rose-colored, and well formed on the part of the vulva, which was but slightly ulcerated. Aug. 8th. All was well, and the patient left the hospital. Case V. Chancres in the period of reparation ; mucous tubercles of the anus and labia; inoculation without result. Mic-----Julie, aged 18 months, entered April 24th, 1833. We had no very exact details of the antecedents. The parents stated that they had never had any syphilitic affection, and that the disease must have been communicated by their neighbors, in whose care the child had been left; and indeed, the woman, who was entrusted with the care of the child, as well as her husband, were actually affected with chancres. We found the little girl strong, and well formed; its limbs were more developed, than is usual at this age; the sexual or- gans appeared to have been pulled asunder, by attempts at coition, and upon the whole, there appeared to be an abnormal super-excitation. There was already some hair on the mons veneris, and around the anus. At a considerable depth in the vulva, we perceived some ul- cerations, having the appearance of transformed chancres, and ulcer- ated mucous tubercles: and lastly, at the commissure of the labia, were mucous tubercles. The 24th. The ulcerations of the vulva, were inoculated by two punctures made on the left thigh; dressings of decoct, malvae, and poppy heads, were applied. The 26th. The pus from the ulceration on the labia, was inoculated by two punctures on the right thigh; the inoculations made of the 24th, had produced a pseudo-pustule, which was nearly dried up. The anus was dressed with calomel and sod. chlorin. and pills of hydrarg. proto-iod. broken into a spoonful of sudorific syrup, were given inter- nally. The 28th. The last inoculations had produced nothing; the pus of a mucous tubercle at the anus, was inoculated on the right thigh. May 10th. The inoculation on the 28th of April, had produced no- thing; the ulcerations of the vulva were better, but much irritation was kept up by masturbation; the dressings were continued. The 20th. The mucous tubercles at the anus, had disappeared; only 158 CLINICAL AND EXPERIMENTAL RESEARCHES— a single ulcerated point remained. The vulva was nearly weli; the? ulceration of the commissure of the labia, was touched with mel. rod.; they were nearly cicatrized. The 30th. All was well ; the general health of the child had al- ways remained excellent. On the 10th of June, she left the hospital. Case VI. Chancres; acute ecthymatous syphilitic eruption inoc- ulated ivithout result on the patient, and on a healthy individual. Huh-----, aged 24, entered July 8th, 1835. The patient was unable accurately to state, at what period he had contracted chancres on the anterior and superior part of the glans, and mucous-membrane of the prepuce; he stated he had perceived it at the same time as a gon- orrhoea, which three months previous to the time of his entry, had de- veloped itself eight days after a sexual connection. In the commence- ment, the gonorrhoea was very acute, it was not treated by active means ; the chancres, cauterized with argent, nitr. and dressed with cerate, were healed in a fortnight, leaving induration around the cica- trix. We found still some discharge from the gonorrhoea, of a whitish yellow color. Three weeks previous to his coming to tlie hospital, a ■ pustulous syphil tic eruption showed itself on the body, and in a less degree on the thighs and legs ; the most irritated and largest pustules were on the back. The patient observed, that at the time the erup- tion first appeared, the gonorrhoea became again acute. The 10th. Injections of argent, nitr. were ordered for the gonor- rhoea . The 15th. The pus taken from on3 of the pustules on the back, was inoculated by two punctures made on the left thigh; the pil. hy- drarg. iod. and sudorific syrup and tisane were ordered; the injections were continued. The 17th. The punctures had produced nothing; the gonorrhoea was much diminished; cubebs, two drachms per diem, were given; a fresh inoculation was made on the right thigh, with pus taken from a pustule on the back. Some of the same pus was inoculated by two punctures on the left arm, of a healthy individual. The 20th. None of the punctures had produced any effect- The 28th. Nearly all the pustules of the syphilitic eruption, were drying. The gonorrhoea had disappeared; the injections were discon- tinued, but the cubebs were continued. Aug. 8th. The patient left cured; only the brown spots remained upon the body; indicating the seat of the syphilitic pustules.. Case VII. Syphilitic iritis, deformation of the pupil; syphilitic eruption; mucous tubercles, fyc; inoculation without result. Dura-----Louise, aged 20, entered Dec. 3rd, 1833. This patient, who had been for a year previous affected with chronic gonorrhoea, having several times exposed herself to contagion, by sexual inter- course, was unable to state at what time the last infection had taken place. In the month of July previous, she had felt an itching in the INOCULATION OF SECONDARY SYMPTOMS, ETC 159 vulva, where several pimples had appeared. In October, two tumors developed themselves; one on each side, near the ang. maxill. inf.; an application of leeches caused them to disappear; but nearly at the same time, a syphilitic lenticular eruption, and psoriasis guttata showed themselves. The eyes became very sensible, and the vision was af- fected. At the Hopital St. Louis, she was treated by fumigations of hydrarg. sulph. rub .; and a collyrium of aq. rosar. After this treat- ment had been pursued without obtaining any improvement, the pa- tient was sent to this hospital. Upon her entry, we found the syphi- litic eruption still in the acute stage; there was an iritis; the pupil was oval and drawn directly upwards;* about the anus and vulva, were granulating mucous tubercles; an examination with the speculum, showed a papulous vaginitis; the vaginal secretion was puriform; on the internal part of the middle of the right cheek, an ulceration was observed, resembling an ulcerated tubercle. Dec. 4th. Twenty leeches were applied to the right temple; a pe- diluvium, and compresses dipped in decoct, malvaeto be applied to the right eye, were ordered; the left eye was in a very good state. The 8th. Afresh application of leeches, a blister to the back of the neck, a collyrium of zinc, sulph. frictions of extract of belladonna around the orbit, pills of hydrarg. iod- sudorific syrup, and tisane, and injections wTith conium. The ulcer on the cheek, was cauterized with hydrochloric acid; the menses having been suppressed for three months, emmenagogues and an application of leeches in the fold of ihe thigh, were ordered. The 27th. The vagina was become smooth, no more papulae re- mained; the sight was still dull, but the patient was able to read; the deformities of the pupil appeared to vary in the course of the day. The ulcer on the cheek had disappeared, after the third cauteriza- tion with hydrochloric acid. Feb. 10th. Some traces of the syphilitic eruption, and psoriasis still remained; the pupil was becoming round; it was moveable, and but little morbid sensibility of the eye remained; the vision was be- coming gradually more clear; the frictions of belladonna were contin- ued; the pupil presented the distorted form in the morning, but in the evening it was round. The 22nd. The pupil presented an ellipsis, whose greater axis was directed upward, and outwards; the margin of the superior half seem- ed fringed and condylomatous, whilst the inferior was even; there was no effusion in the chambers; the iris was little changed in its color, which was a little deeper. Fumigations with hydrarg. sulph. rub. were ordered, on account of the syphilitic eruption, which had nearly disappeared. The 27th. All was well in the vulva and vagina; the pupil was no longer deformed; but a few brown spots remained, marking the seat of the cutaneous eruption; some vegetations at the antis were cut off. * The deformation of the pupil downwards and outwards, is far from being constant, as has been pretended. R. 160 CLINICAL AND EXPERIMENTAL RESEARCHES— March 12th. The cure was complete; the morbid secretion from the ulcerated mucous tubercles, had been inoculated without result. Case VIII. Pustulous syphilitic eruption, ulcerated tubercle, ulce- ration of the cervix, and purulent uterine catarrh; inoculation without result, excision of tubercle, before the ramolissement. Coup-----, aged 26, entered Oct. 10th, 1833. At the age of twenty, this patient first contracted an infection, and was treated with mercury for a vaginal discharge, and chancres of the greater labia. The treatment lasted nine months, during which time, frequent mer- curial frictions and the liq. Van Swieten. were employed; notwith- standing all this, a copious discharge still remained. Three months later, some mucous tubercles appeared at the vulva, and a lentic- ular syphilitic eruption on the body; the liq. Van Swieten. was again given, but nevertheless, the affection progressed; the eruption pass- ed from the squamous form to that of ecthyma; on the limbs, some crusts of rupia appeared; at length, the affection seemed to yield to a long continued treatment with pills of sudorifics and sublimate; but some months later, the articulation of the knees became pain- ful and swollen. Soon after, tubercles showed themselves in the calves, and becoming slowly softened, their cavities were laid open ; those on the right leg, June 2nd, 1833, and those on the left, Oct. 8th; there had been a considerable destruction of the tissues, particu- larly of the muscles. Upon an examination being made with the spec- ulum, a granulating ulcer was found upon the cervix uteri; and a pu- rulent catarrhal discharge. Till Nov. 1st, the ulcerations of the calves were dressed with a concentrated decoction of opium; injections of decoct, alb. were or- dered for the purulent vagina discharge; the ulceration of the cervix, was cauterized with arg. nitr. Internally, pills of hydrarg iod. with pulv. conii, and a decoction of hops, with anti-scorbutic syrup, on ac- count of the lymphatic habit of the patient, were prescribed. Nov. 2nd. The pus of the ulcer on the left calf, was inoculated on the right thigh. The 6th. There was no pustule on the point ulcerated; the ulcers were cauterized with argent, nitr. and dressed with cerat. opii. The 28th. The cicatrization was nearly completed on both calves; but about one third down the anterior surface of the right leg, a tuber- cle was felt, which developed itself slowly, and whose extent was al- ready as large as a nut; it appeared moveable; the integuments were divided, and the little tumor was removed entire. Dec. 6th. The wound made Nov. 28th, to extract the tubercle of the leg, was perfectly cicatrized; but the wounds on the calves, which had till this time seemed to be healing, had suddenly returned to nearly their former state; the cicatrix was entirely absorbed. It was found that the patient, thinking herself cured, had neglected the treatment. The vagina was ordered to be tampooned with dry lint; the ulcer on the cervix was healed. INOCULATION OF SECONDARY SYMPTOMS, ETC. jqj The 10th. The ulcers on the calves, were touched with creosote. The 20ih. There was much irritation; the use of the creosote was suspended, and dressings of decoct, opii substituted. Jan. 6th, 1831. Tlie application of creosote was resumed; the in- ternal treatment was continued. Near the malleolus externus of the right foot, the patient pointed out a tubercle, but it could not be re- moved, as its base was already adherent. The 2 3th. The tubercle on the malleolus was suppurated; it was opened, and dressed with cerat. opii. Feb. 1st. There was a general tendency to cicatrization, and an active granulation in the wounds of the legs; a cauterization was made with argent, nitr. and they weve touched with creosote every third day. The 10th. The ground of the ulcerations was raised, and covered with granulations, which were difficult to repress. By the 18th of March, the patient being nearly cured, was able to leave tlie hospital. Case IX. Ulceration of the throat inoculated without result. Nic-----, aged 20, entered May 3rd, 1834. This young man as- serted, that he had never had any previous syphilitic affection, and falsely attributed his disease to an affection from drinking 'out of a glass with another person, who bad ulcers on the iips and throat. It may be well to remark, that in ottr patient, the affection first showed itself at the back of the throat; at first, there had only been difficulty in deglutition; the ulcers appeared s!o.\]y; and only in the latter time a treatment by antiphlogistics had been tried; the pains had in a great measure disappeared, but some deep ulcers still remained in the throat; the tonsils were nearly destroyed; but the general appearance was not clearly syphilitic. The habit of the patient was scrofulous, and he had some ganglionary engorgement in his neck. May 6th. The throat appeared irritated; leeches were applied to the neck; an emollient gargaristn and pediluvium were ordered; some pus was taken from an \ilcer on one of the tonsils, and inoculated by two punctures, made on the left thigh. The 7th. A fresh application of leeches; the pain was much less. The inoculation on the 6th, had produced nothing; the punctures were not even irritated. The 9th, There was a sensible amelioration in the general health; nevertheless at sev.eral points, the destruction of the tissues progress- ed rapidly; but little of the left tonsil remained; on the pharynx were some ulcers, whose ground was covered with a greyish pseudo-mem- brane; their pus was inoculated by two punctures made on the right thigh. The 12th. The inoculations on the 9lh, had produced nothing; a gargarism, with conium, was ordered. The 14th. The pain was still better, but the destruction progressed. Dressings of mel. iod. were used till the 30th, without decided im- provement. 21 162 CLINICAL AND EXPERIMENTAL RESEARCHES— June 1st. A decoction of hops and anti-scorbutic syrup, iodine m xture and gargle were prescribed. The 10th. The disease had rapidly improved under the influence of the iodine; the progress of the ulceration had nearly instantly ceased. The 20th. Rose-colored granulations were produced every where; the ground of the ulcers was raised; on the 23rd, they were touched with nitrate of mercury; the cicatrization progressed rapidly; on the following day, but a single point remained ulcerated on ihe seat of the Lft tonsil. The 27th. The surfaces were become smooth, and the patient left cured. Case X. Secondary ulceration of the throat inoculated wi'.hout result. Bel----Marie, aged 45, entered Jan. 14, 1834. This patient had a year previous to the time of her coming to this hospital, con- tracted ulcers on the greater labia and a gonorrhoea; she was treated with liq. Van Swieten. sudorific syrup, and tisane during six weeks. Being declared cured, she ceased all medication; but after two months in a dubious state, during which time she frequently felt a difficulty in swallowing, she was attacked with a vevy violent pain in the throat. Leeches were applied, and a mercurial treatment ordered, which was continued during five months. As she did not find any improvement, she came to the hospital, where she was treated with pil. hydrarg. iorl. and a gargle of decoction of conium and morel, with sublimate for the ulcers, which she then had in the throat; she stayed three weeks, and left when the symptoms bad disappeared; she returned with ulcers, engaging half the substance of the right tonsil, arcus palat. ant. of the same side, and forming excavations with indurated and irregular edges in the posterior of the throat. The 16th. Some pus was taken from one of the points, affording the most suppuration, and inoculated by two punctures on the right thigh. The same gargle was ordered, as on the previous occasion. The 18th. The punctures had produced no effect; the same treat- ment was continued till F*b. 1st. The ulcers were a little cleaner, but the margin was still raised and indurated; the pills of hydrarg. iod. were prescribed. Feb. 1st. The ulcers were very painful, and still in the progressive stage; they were touched with a brush, dipped in creosote; ten min- utes after the application, the pains were less; it was repeated on the three following days. The 5th. There was a little irritation; ah emollient gargarism was ordered. On the 8th, creosote was again applied; by ihe 12th, the extent of the surface of the ulcers was less, and their raised edges had become reduced. The 24th. The cicatrization was going on well; there was no pain in swallowing. Four days later, the cicatrization was completed, and on the 8th of March, she left cured. INOCULATION OF SECONDARY SYMPTOMS, ETC. 163 April 26th. She returned to the hospital with an extensive ulcera- tion, occupying the whole of the velum palanlinum; its form was tri- angular, and the posterior angles towards the arcus, and its base to- wards the throat; the uvula was much ulcerated at its base, and nearly detached; all around the ulcer was much inflamed; its ground was greyish, and its edges abrupt; some of the pus was inoculated on the right thigh. Twelve leeches were applied totheang. maxill. inf. and a gargarism of decoct, malv. et capit papav. ordered. May 1st. The inoculations had produced nothing; some inflamma- tion still remained; leeches were again applied. The 11th. Pil hydrarg. iod. with pulv. conii were prescribed; the ulceration was very painful. The 17th. The destruction seemed arrested; the uvula was detach- ed, and the arcus had lost much substance. The 20th. The ulcers were touched with mel. iod. A fresh inoc- ulation was made on the right thigh, with the pus taken from the right tonsil. The 30th. The inoculation was without effect; there was a general improvement. June 10th. Nearly all was healed; the margin w'as no longer raised, and the pain had disappeared. The 25th. The cicatrization was complete; in a few days, the pa- tient left the hospital; we saw her a year later, when she had remain- ed free from any return of the affection. Case XL Consecutive ulceration of the throat inoculated without result. Gab-----, aged 34, entered May 30, 1835. This patient had no ulceration on the sexual organs; no pus came from the urethra upon pressure; nor was there any trace of a recent cicatrization; only, near the frenum a white, but not indurated spot was observed, which had been the seat of a chancre, contracted eight years before, and which had lasted about a month; the ulcer had been treated with ung. hy- drarg. and red precipitate. Since this time, there had been no new infection; the patient had not often exposed himself to it. After the chancre was cured, no symptom had appeared, which could be ascrib- ed to syphilis; when about a year previous to his coming to the hos- pital, having been at work in a very damp situation, and living upon bad food, he felt a pain in the throat: at first, there was difficulty in swallowing; then smarting pains, irritation of the mucous-membrane of the pharynx and mouth, pain in the epigastrium and acid eructation. These symptoms soon became less intense; but there remained in the throat on the mucous-membrane of the oesaphagus and left tonsil, an ulcer with abrupt edges, and greyish ground, covered with a pulpy membrane, thus apparently presenting the characteristic appearance of a secondary ulcer. Till this day, the patient had received no treat- ment, he had merely, from time to lime, used a gargle of decoct, mal- vse; the breath was very fetid; the ulceration very extensive and oc- 164 CLINICAL AND EXPERIMENTAL RESEARCHES— cupying nearly the whole of the posterior of the pharynx; the left ton- sil was half destroyed. The state of the digestive organs was suf- ficiently good to allow of mercurials being given. June Sih. The pus of the ulceration of the throat, was inoculated bv a puncture on each thigh. ' The 18th. The punctures had produced nothing; pills of hydrarg. iod. were orde/ed, with sudorific tisane and syrup, and a gargarisni of a concentrated decoction of ccnium, with sublimate. The 23th. There was little improvement; the state of the digestive organs was still good; the treatment was continued; two pills were given; the ulceration was cauterized with nitrate of mercury. The 30th. There was a little improvement; the use of the sudori- fic syrup and tisane was suspended, on account of too great an irrita- tion; the pills were continued; but only one was given per diem. July 6th. Decided improvement; the surface of the ulcer was freed from the greyish membrane which covered it. Anti-scorbutic syrup was prescribed. The 20th. The tonsil was nearly well; the granulations were cau- terized with arg. nitr. The 30th. The ground of the ulcer was covered with healthy gran- ulations; its extent was diminished by half; the digestive organs were in a good state; the patient left cured, Aug. 8th. Case XII. Ulceration of the breast inoculated without result. God-----Eul.ilie, aged 23, entered Mi.rch 22, 1834. '1 his patient stated, thtit she had never had any primary syphilitic affection; that her husband's health had been always good, and that her breasts had never been snre whilst suckling. Four months previous to our seeing her, she took a n.irse-child; it was very thin, but had neither on the mouth, nor any part of the body, any wound or ulceration; three weeks later, pimples appeared on the forehead, and at the anus; their surface became purulent, ^ind covered with cruris; it had on the body, some patches covered with squamae; on the nates and calves of the legs, deep ulcerations; the suckling was continued for six weeks, but as the disease increased every day, the child was taken back to its parents and died. Till that time, the nurse had had no symptoms; but a week later, on both breasts, near the nipples, fissures formed, one on the left side, and four on the right. Nevertheless, she contin- ued for a fortnight to suckle her own child, who had never ceased to enjoy an uninterrupted good slate of health; the breasts was dressed with opiated cerate, and a decoction of hyoscyamus; then ulcerations having succeeded to fissures, and the pains having become very acute, the patient resolved to come to the hospital. On each side on the breast and n'pples, were ulcers, with greyish ground, abrupt irregular edges, and resembling, although simple, syphilitic ulcers. The 25th. The pus from the right breast, was inoculated on the right thigh, and that taken from the left, on the left thigh; dressings with cerat. opii were ordered. INOCULATION OF SECONDARY SYMPTOMS, ETC. 165 The 27th. The punctures were red; but on the following day, no pustule was produced; simple dressings were applied to the ulcera- tions. April 6lh. All was becoming clean; there was a decided improve- ment. The 12th. The ground of the wounds was nearly level with the surrounding parts; the patient was obliged to leave the hospital on bu- siness; and returning some time after, we found only one deep fissure remaining, whose pus was inoculated on the left thigh, but without re- sult; a lotion of sod. chlorin. was applied, and in a week's time, she left quite cured. Case XIII. Ulcerations of the lip; sub-rmaxillary engorgement; inoculation without result. Vil-----, aged 18, entered Nov. 15, 1836. This patient assured us, that he had not for a long time had any sexual intercourse; he had no wound of any kind on the sexual organs; but on his lip, a little distance from the commissure, was an ulceration, which had ex- isted about a month. In the commencement, the patient stated, there had been only a little pimple, which having been scratched (ff, became ulcerated. It ought to be remarked, that the teeth were black, and the gums retracted from them, by the use of the pipe. No treat- ment had been used; the sub-maxillary engorgement had existed about ten days. We found the ulcer of the lip much irritated; the engorge- ment was subacute in its progress; the pus from the ulcer on the lip, was inoculated by two punctures on the right thigh; cataplasms were applied lo the swollen sub-maxillary glands. The 18th. The punctures had produced nothing; the wound on the lip was cauterized with argent, nitr. and dressed with vin. arom. The 21st. The engorgement had nearly disappeared; the ulcer on the lip was half dried up; it was again cauterized. About a week later, the wound was quite healed, no induration remained, and the pa- tient left the hospital. Case XTV. Ulceration of the tongue and finger of a doubtful ap- pearance; inoculation without result. Bel-----, aged 48, entered Dec. 8, 1835. This patient had never had any chancres; at the age of thirty, he had had a gonorrhoea, which lasted three weeks, and then disappeared without any treatment; since then he had felt no symptom, which would lead us to consider the gonorrhoea, as depending on concealed chancres (chancre larvc); there never had been any induration in the canal of the urethra. Four months previous to the time of his entry, without any known conta- gious cause, he became feverish from too severe fatigue; a few pim- ples appeared about the base of the tongue; at first, there had been much pain. We found the superior surface, near the base of the tongue, ulcerated; on some points were granulations, and in the inter- vals between them, deep excoriations; the left side was not so rnucb 16 6 CLINICAL AND EXPERIMENTAL RESEARCHES— affected as the right; there were on the ulcerations, greyish cavities, with abrupt edges; the wounds were much inflamed, and yielded much pus; no indurated knot was perceived in the tissue of the organ. On the last phalanx of the median finger of the left hand, was an ulcer- ated spot, covered with a crust in layers. The 11th. Some pus taken from a wound in the tongue, which ap- peared to be in the progressive or ulcerative period, was inoculated on the left thigh. In like manner, some of the pus from the ulceration on the finger, was inoculated on the right thigh; the surface of the tongue was cauterized, and a gargle of conium and inorchella prescrib- ed; the finger was dressed with calomel and opium cerate. The 14th. The inoculations were without effect; the tongue was much less inflamed; the same treatment was continued. The 16th. A fresh inoculation of the pus taken from the tongue, was also without result. By the 30th, the patient was cured, and left the hospital. Case XV. Tumor and ulceration on the posterior part of the pe- nis inoculated without result. Fo-----, aged 28, entered Feb. 21, 1837. This patient had never had chancres; about five years previous, he had had a gonorrhoea fol- lowed by a bubo, which being treated by active means, disappeared in a short time: from that time he had perceived nothing, which he could attribute to a syphilitic infection. At the time of his entry, three months had elapsed since he had had any sexual intercourse. Incon- sequence of great exertion and fatigue, a tumor appeared at the pos- terior of the penis; it had existed about a week when we saw him; pus had rapidly formed, and the tumor opened spontaneously, and presented a considerable ulceration. The 23rd. Some pus was taken from the depth of the ulcer, and inoculated on the right thigh; dressings with vin. arom. were applied. Four days later, the punctures had produced no effect. The 30tb. The whole surface of the ulcer appeared in the period of reparation; some granulations were slightly cauterized. March 4th. All was cicatrized; no induration remained; the patient was dismissed. Case XVI. Cancer uteri inoculated toithout result. Nev—■— Marie, aged 32, entered May 8, 1834. It was difficult to trace out the evident cause of the actual state of this patient from among the antecedents: she became regular at the age of four- teen, and continued to enjoy a good state of health, till the age of twenty, when she had her first child; two years later, she had a se- cond; from this time forward, there was an irregularity in the menstru- ation, then at long intervals, copious flour albus. A year previous to her coming to the hospital, she contracted a gonorrhoea, which at its commencement caused no pain. Her husband had a chancre, but she had no ulceration, at least not on the external part of the sexual or- INOCULATION OF SECONDARY SYMPTOMS, ETC . 167 gans. Six months later, the discharge, which seemed to have de- creased, returned with great intensity, and a state of progressive marasmus soon ensued. The patient consulted a surgeon, who stated she had an engorgement and hyperthropy of the cervix uteri, and prescribed a bath every second day, and ordered her, to be bled once a week, a mucilaginous tisane, pil. conii, and local baths with morel and mallows : this treatment had been continued with ab- solute rest for six months ; but having obtained no amelioration, she determined upon coming to the hospital. Upon an examination with the speculum, an ulceration was found at the orifice of the uterus of a lardaceus appearance, with a sero-purulent secretion without smell, and general induration without hypertrophy. Some of the pus was taken from the cervix, and inoculated by three punctures made on the left thigh. Injections of decoct, conii c. morchell. pills of hy- drarg. iodid. and fol. conii were prescribed. The 13th. The inoculations had produced nothing; the ulcera- tion progressed slowly, but the destruction and induration were still increasing. The 24th. The carcinomatous nature of the affection was every day more evident. A tampoon, covered with mel. iod. was placed on the cervix. The 26th. The darting pains were very acute. June 11th. A careful examination was made in order to ascer- tain whether the operation would be practicable. Opiated injections were prescribed, and the pil. opii given at bed time; the use of the iodine was suspended. July 6th. The affection still increased, though slowly; the patient was advised to go to the Salpetriere. Case XVII. Chancres, phimosis; dubious pustule at the navel in- oculated without result. Aug-----, aged 20, entered Jan. 24, 1837. This patient had, for the space of a month, been affected with chancres on the prepuce, in consequence of which a balanitis and phimosis resulted; the inflam- matory state had been of short duration. We coulJ easily uncover the glans, on which were some excoriations; some of the chancres were in the period of reparation. About ten days previous to the time of our seeing him, a pustule appeared near the inferior part of the navel, and followed in its development, the course of the prstules from inoculation; at first, red and pointed, it soon became raised, and almost umbilicated; the epidermis broke and showed a small ulcer, which we found, covered with a crust like that of ecthyma; the base was indurated. Upon the crust being removed, the wound presented the appearance of a chancre; the edges were abrupt; the ground appeared in the ulcerative or progressive stage; some of the pus was inoculated on the right thigh. The chancre on the prepuce, was cauterized and dressed with vin. arom.; the excoriations on the glans were also super- ficially cauterized. The 28th. The inoculation had produced no effect; the same treat- 168 CLINICAL AND EXPERIMENTAL RESEARCHES— ment was pursued. Three days later, the excoriations on the glands were healed; the chancre on the prepuce was nearly dried up; it was slighily touched with the caustic; the wxund on the abdomen had be- come much less, and was granulating; its base was but little indurated. In a few days time, the patient left cured. Case XVIII. Chancre, rupia, exostoses, csteocopic pains; inocu- lation of the pus of the rupia without result. Des----- Antoine, aged 36, entered Aug. 22, 1835. The com- mencement of the affection was five years previous to the time of his corning to the hospital; at first, he had a chancre on the glans, which only disappeared after being treated for a month with mercury. A fortnight after the cicatrizaiion of the ulcer, some crusts of impetigo appeared on the scalp, and also a syphilitic eruption; on the arms, were some pustules of ecthyma; these symptoms were treated with pills of mercury, frictions, and fumigations, with hydrarg. sulph. rub. Nevertheless the disease progressed; exostoses were developed on the forehead, and the joints became the seat of violent pains. On the malleolus exter- nus of the right foot, extensive ulcerations were formed; on the back and arms, an eruption of rupia appeared; at length, ihe symptoms had nearly disappeared, and the patient thought himself cured, when scon after his leaving the hospital of St. Louis, the same symptoms return- ed, and also acute osteocopic pains; about the middle of the external part of the arm, tubercles of the cellular tissue formed, and produced extensive ulcerations. Upon his entry, some pus was taken from one of the ulcerated pustules of rupia on tlie deltoid region, and inoculat- 9d on the right thigh, by two punctures; pills of hydrarg. iodid. de- coction of hops and anti-scorbutic syrup were prescribed; the ulcers were dressed with opiated cerate; slight blisters were applied to the forehead and other parts, in which the pains were felt. Aug. 6th. 'I he inoculation of the pus of the rupia had produced nothing; the pains v;ere somewhat less; blisters were ordered to be again applied on the following day. The 10th. Some pus taken from an ulcer on the arm, was inocu- lated by two punctures on the left thigh. The 20th. The osteocopic pains had disappeared; the appearance of the ulcers was improved; the granulations were cauterized. Sept. 10th. The exostoses on the forehead had disappeared; all was going on well, and by the 2nd of October, the patient was quile cured, and left the hospital. TABLEOFTHE INOCULATIONS, MADE IN THE MALE WARDS, 183 1—1 8 37. SYMPTOMS WHOSE PUS PRODUCED THE CHARACTERISTIC PUSTULE. PRIMARY SYPHILIS. Charrcres in the ulcerative or progressive period— On ihe penis ......... 347 At the anus •••....... 9 Concealed in the urethra (larve) ... ..... 21 On the lips ••........ 3 In the throat .......... 1 On other parts ........... 8 Primary pustules—: On different parts consequent on coition, or from artificial inoculation . 59 Virulent abscess or encysted chancier— In various situations •••....... 18 Symptomatic lymphitis, or chancres in lymphatics— Inoculated upon the day of their being opened or later .... 11 Symptomatic bubo, or ganglionary chancres— Inoculated the day they were opened ....... 42 " " following day* ........ 229 IN THE FEMALE WARDS, 183 1—18 36. PRIMARY SYPHILIS. Chancres in the ulcerative period— On the vulva ........ 139 " vagina ........ 2 " ceivix uteri ........ 12 Concealed . . ... . . . .6 At the anus. . . . . , ... 28 On the lips ......... 4 In the throat . . . . . , . .2 On divers seats . . . . . . .6 Primary pustules— On various seats consequent on coitus; on the internal surface of the thigh* or from artificial inoculation . . . . . .27 Virulent abscess or encysted chancre— In various situations . . . . . .8 Symptomatic buboes, or ganglionary chancres— Inoculated upon the day of their being opened . . . .21 " " the following day or later . . . . .46 Of these latter, 214 had been inoculated without result on the day of the opening. 22 170 TABLE OF THE INOCULATIONS. EN TEE MALE AND FEMALE WARDS, 183 1—1837. SYMPTOMS WHOSE PUS PRODUCED NOTHING. SYMPTOMS OF TRANSITION. Chancres in the period of reparation 62 SECONDARY SYPHILIS. Mucous tubercles, or pustules on various seats .... Secondary ecthyma ....... " rupia ........ Ulcers (consequent on mucous tubercles, ecthyma, rupia, or impetigo)— In the fossae nasales ....... On the lips . . . . . " pilate . . . . In the throat ........ At the anus ........ 221 10 9 19 14 4 81 41 TERTIARY SYPHILTS. Tubercles ulcerated in the whole thickness of the skin in various situations . 21 Tubercles i l the cellular tissue or gummy tumors ulcerated, on various seats . 11 Ppriostoses having suppurated ....... 15 Caries .......... 10 VENEREAL AFFECTIONS, NOT DEPENDANT 0I» Spontaneous buboes Sympathetic " Gonorrhoea in the acute stage— Of the glans and prepuce ^ balanitis) In the urethra " vulva '* vagina " uterus At. the anus Ophihalmia Gonorrhoea in the chronic stage, having various seats Ulcerated swelled testicle .... THE STPHILITIC VIRUS. 39 248 82 291 31 82 27 36 6 112 3 NON-CHARACTERISTIC SYMPTOMS WHICH SHOW THEMESLVES AFTER VENE- REAL AFFF.CTIONS, WHETHER SIMPLE OR VIRULENT. Vegetations, either ulcerated or not, having various forms and seats . . 28 AFFECTION NOT DEPENDANT ON VENEAREAL DISEASES. EXPERIMENTS WITH NEGATIVE RESULT. Atonic ulcers of the legs Simple ecthyma Herpes Scorbutic ulcers Scrofulous . Cares Simple ulcerated stomatitis Ulcerated eczema intertrigo Otitis Cancer of the uterus " " rectum " " breast " " penis " " nose Abscess on various parts COMPARATIVE 6 5 4 2 6 4 8 2 2 5 6 2 S 4 15 EXPERIMENTS OF DR. MAIRION. 171 I may here add, in support of these tables, the result of some ex- periments, made with the same view in the hospital at Louvain, by Dr. Mairion. " My experiments, says Dr. M. were made upon 257 patients in the military hospital, at Louvain, in the year 1836; 29 of them could not he submitted to inoculation; of the 228 who were inoculated, 85 had primary ulcers, 24 suppurated buboes, 84 gonorrhoea, 7 excres- cences, 28 constitu:ional symptoms. Primary Ulcers. 11 Of the 85 cases of primary ulcers, 53 produced upon inoculation chancres, whose syphilitic nature was proved by their pus being inoc- ulated, and producing others resembling them, which being also inocu- lated, produced ulcers of the third generation and so on, till the spe- cific, properties of the chancre molecule was destroyed hy chemical applications, or exhausted in the natural progress of the chancre in its course towards reparation. As long as the chancre was in the pro- gressive stage, the pus remained inoculable. " Inoculation, carefully made under the above circumstances, has always succeeded; I never found a chancre, whose pus upon the first trial produced nothing, give a contrary result in ulterior experiments. "• When inoculation is successful, it causes the development of an ecthymatous pustule, whose progress and result I have ever found uniform and constant. " In 32 cases of tdcerations, inoculated in various stages of their existence without effect, the puncture was followed by a slightly in- flamed aureole, having the little wound produced by the lancet in the centre; these symptoms generally disappeared in less than twenty-four hours. Some times I have observed the epidermis a little raised, which by an unaccustomed eye, might be taken for the primary pus- tule of chancre; but this error would soon be rectified, as the raised epidermis soon returns to its natural state, leaving no trace of the in- oculation. " Numerous inoculations were made in the same year, with pus taken from wounds, ulcers, fistulous passages, and always with nega- tive result. Buboes. " From our experiments with the pus from buboes, we arrived at the following conclusions. " I. That syphilitic ulcers are often complicated with buboes, which is less frequently the case with simple ulcers, and they but rarely ac- companying gonorrhoea. " II. That the buboes, which accompany chancres, may be either sympathetic or idiopathic; that the former generally appear before the thirteenth day, and that the latter can appear at any period of the existence of a chancre; but chiefly after the thirteenth day, and dur- ing the stationary period. " III. That the idiopathic buboes always suppurate, whatever treatment may be used. 172 EXPERIMENTS OF DR. MAIRION. " IV. That the pus of buboes, which accompany chancres, and have suppurated, has generally produced the characteristic pustule of the chancre upon inoculation. '* V. That the buboes which have accompanied ulcers, the specific property of whose pus had been disproved by inoculation, have nev- er, even when they have suppurated, produced any result upon inocu- lation. Gonorrhoea. u Of 85 cases of gonorrhoea, which came under my observation, 4 were found by inoculation to be of a syphilitic nature, (concealed chancres, chancres larves.) and produced chancres, which again pro- duced others; 80 submitted to the same test, produced no result, whatever number of punctures were made, or at whatever period the discharge might be. The result of the inoculation in the other case, was omitted to be noted. Symptoms of constitutional syphilis. " Having inoculated 28 cases of constitutional syphilitic affections without effect, I felt convinced, by this small, but varied number of tests, that none of the constitutional symptoms are susceptible of in- oculation." PART THE THIRD- THERAPEUTICAL SUMMARY. CHAPTER I. EXPOSITION OF THE METHODS OF TREATMENT, WHICH HAVE PROVED MOST SUCCESSFUL AT THE HOSPITAL FOR VENEREAL DISEASES. GENERAL REMARKS. As this title shows, and as I announced in the commencement of the work, it is not my intention to furnish a complete treatise on the therapeutical treatment of venereal diseases; but merely to point out the means, which have appeared to me most efficacious, and which I generally employ. I shall always point out as clearly as I can, the indications which have directed me in the choice of the methods I have employed, without entering into the history of the symptoms, which will be under- stood from the sketch which I have traced Out, In the first place, by venereal diseases, are to be understood, all those which are generally contracted in sexual or venereal intercourse, and which generally commence in the sexual organs, although they may originate in other circumstances, and other regions. This great class is divided into two distinct orders; the first com- prising chancre, and all its consequences from infection of the system, and whose cause is the venereal virus; for this order, the term syphi- lis ought to be retained; the second embracing the non-virulent affec- tions, such as gonorrhoea, and its consequent diseases, which never de- pend on the constitutional infection, as well as a great number of other symptoms; simple ulcerations, phimosis, paraphimosis, gonorrhoea, orchitis, &c. To this order, the name of pseudo syphilis might be applied. I shall now proceed to the consideration of this third part, com- mencing with a short exposition of the prophylactic treatment in gen- eral. PROPHYLACTIC TREATMENT OF THE PRIMARY VENEREAL DISEASES. If the art of preventing disease ought to rank highest, negligence or prejudice, causing prophylactic cares to be omitted, deserve the greatest reproach, especially where affections so terrible in their con- sequences are concerned. 174 PROPHYLACTIC TREATMENT OF THE But what contradiction in science, and those who practice it ! for whilst on one side, the greatest encouragement is given, on the other, blame, or at least ridicule, are the sole rewards; thus, whilst every year, a number of medals are conferred, by the Acad mie Royale de M'decine, on those who, by propagating vaccination, have opposed the ravages of small-pox; we see the same body startled, when any remedy to arrest a still more frightful scourge, is submitted to its judgment. Undoubtedly, most of the preventives of syphilis hitherto have been culpable mercenary speculations of quacks; but does it therefore follow, that this was and will still be the case with all? No, undoubtedly not, and in the present age, the foolish prohibitions of false morality, no longer compel us to regard venereal disease as a punishment reserved by heaven for libertinism, and which man ought to respect. The creator of all things, who has so lavishly beitowed the principle of preservation in opposition to all things, which attack our existence, has certainly not desired that man's ingenuity, other- wise so prolific in its resources for preservation, should remain inac- tive in face of the greatest danger, threatening life at every moment, and even at its source. No, the truly wise, virtuous, and philanthropic moralist will say with Home, that he must be considered as the tn.ie benefactor and preserver of ins race, who should discover the true secret of preserving us from the most terrible contagion, which ever threatened mankind. To the honor of the Soer't6 des Sciences Medicales de Bruxelles, it has not been afraid to offer, as a prize question, the following im- portant inquiry. "What measures of medical police are most adapted to arrest the propagation of the venereal disease?" I hope this example may not be lost, and that similar questions may be proposed, and less circumscribed; for the most efficacious means must be beyond the jurisdiction of a medical police. In the present state of science, what prophylactic means can be op- posed to the primary aflections? It is not my aim to examine all the various means proposed by credulity and ignorance, or eminating from more learned than useful theories of men of just celebrity. It must be apparent, that it is necessary, by all known and justifia- ble means, to isolate the patients, warn them of their danger, and of the harm they may produce; that it is the duty of the surgeon who un- dertakes so delicate a mission, to examine with the most scrupulous attention, those who can become the source of infinite infections, as the* filles publiques (or licensed prostitutes). The examination ought here to be neither slight nor illusive; not only ought the external parts of the organs to be examined, but also the internal and more concealed; for the source of the poison, which it is wished to avoid, often lays in the depth of the vagina, on the cervix of the uterus, or even in its caviiy; and in these cases, neither an ex- ternal examination, nor the toucher would suffice, and the speculum alone could warn them of the danger. I think that I have rendered y PRIMARY VENEREAL DISEASES. 175 some serv-ice to science, by applying the speculum in the study of ve- nereal diseases, and more especially, as a measure of medical police; but in order that the visitations of the filles publiques, either with the aid of the speculum, or otherwise, may serve as a guarantee, they must at least be repeated every third day; experience having shown me, that the chancre pus is contagious on the third day after inocula- tion, and sometimes even on the second. From the foregoing, it must be evident, that the examinations, as at present conducted, are very insufficient; one class being examined once a month, and another ev- ery eighth day. Under the head of prophylaxy, must be included every means which, by destroying the focus, diminishes the propagation : and therefore, amongst others, the hospitals and gratuitous consultations, which are provided by the judicious administration of the Paris hospitals. By facilitating the means of cure, and pointing out those which can pre- vent the disease, the greatest success is to be looked for. The fear of evil, restrains less; and most frequently, corporal, or moral punish- ments, have only produced bad results; for neither the confinement in the castle ( f St. Germain des Pr s, nor the whip at the Bicetre had beneficial results in the good times, when they were practised; far from this being the case, the number of victims to be exiled, and the rank of those who ought to have been whipped, were become such, that these punishments naturally fell into disuse. The prophylaxy is to he considered under two distinct heads; the first concerns the individual who may infect, and the second, the one who may become infected. For the former, beside the before-mentioned visitations, cleanliness, the use of lotions and injections, ought to be recommended, with chlo- rides and soap, and the other means best calculated to clean and dis- infect by chemically changing the morbid secretions. If, in general, women were more cleanly and careful of themselves, the venereal dis- eases would be far less common. How many women have received the contagious matter, and transmitted it without becoming infected themselves! For the latter are to be advised, a scrupulous examination of the organs, to ascertain that no lesions exist. Here the alcaline lotions, &c. are hurtful,, as they are liable to wound the surface, and thus cause a peculiar liability to infection; but astringent lotions on the contrary may have a beneficial effect. And amongst the most effica- cious may be mentioned, a solution of alum, acetate of lead, wine alone or with tannin, provided they be well applied, and for a sufficient time. Fatty substances are much less to be depended upon. Every lesion of the sk n, which may be discovered after a connection, ought to be immediately cauterized to prevent further consequences. 176 TREATMENT OF CHANCRE. CHAPTER II. TREATMENT OF VIRULENT AFFECTIONS. PRIMARY SYPHILIS. Section I.—Chancre. Before commencing the study of curative treatment of chancre, we must mention, that the primary syphilitic ulcer, undoubtedly often heals without any treatment, and often, notwithstanding bad treatment. Yet, as the spontaneous healing of chancres is most frequently uncer- tain and slow, and the patient remains all the time of its duration, ex- posed to general infection, and to the chances of serious local affec- tions, art ought never to remain inactive; and all its efiorts ought to be directed towards destroying it in its outset, or at least shortening its duration. But unfortunately, although all agree, that in case of any other poi- son, as that of the viper, or of any rabid animal, for instance, it is ne- cessary to destroy it at once; yet, in the case of chancre, which is in all respects so analogous to it, absurd theories, supported by great names, throw a doubt over the means, which ought to be adopted for its treatment. Properly to judge of the treatment required by chancre, we must consider it under its various forms, in its regular or irregular state, and with or without complications. Whatever form a chancre may assume in its commencement, it ought to be treated hy the abortive method; for there is no authenti- cated instance of ulcers destroyed within the first five days after in- fection, having afterwards given rise to secondary symptoms. If how- ever it be acknowledged, that chancres ought to be destroyed as quickly as possible; it is equally clear, that the same means will not be proper in every case, and the indication for those which have been proposed, as excision, direct and mediate cauterization, deserve a mo- ment's consideration. Hunter, who was of opinion that chancres ought promptly to be de- stroyed, says, without distinguishing the forms they may at first assume, that cauterization is preferable to extirpation, when they are situated on the glans, whose less acute sensibility excites less pain, and ex- poses less to haemorrhage, whilst excision is better calculated for those cases, in which the skin is affected; and the whole extent of the dis- ease, could hardly be reached by the caustic. Valuable as are the precepts of Hunter, we may yet more exactly fix the indications for their employment, by regarding the difference which chancres present at their commencement. TREATMENT OF CHANCRE. 177 I. Commencing by a pustule. This form, which in ordinary con- tagion is most rare, and which may be easily confounded, during the first days of its existence, with eczema, or herpes, yields, when at- tacked at an early period, to a single cauterization, when well made. Therefore, whenever in the first days, after a suspicious connection, a pustule is found upon the organs, exposed to the contagion, whatever its nature may be, and without an exact diagnosis being requisite, it must be ruptured, and its ground well cauterized; for no bad effects would be felt, even were a mistake made, and pustules of eczema or herpes cauterized; the caustic to be preferred in this case, is a pointed piece of nitrate of silver, with which all the parts can be reached. In this case, if the pustule be seated on moveable tissues, which can ea- sily be removed; the excision might be made, did not the patients gen- erally manifest great repugnance to an)7 operation of this kind, how- ever slight. When, however, recourse is had to the excision, it is al- ways better to remove, rather more than less than necessary, as the sound tissues will rapidly heal; I usually use the curved scissors for the operation. II. Ulceration, or original chancre. This form, which is the most common on account of the general conditions of the infected parts, and the facility with which the newly formed pustule breaks, ought, as well as every suspicious ulcer, under similar circumstance, to be cauteriz- ed, or excised. III. Virulent abscesses. A chancre can succeed an abscess in con- sequence of a phlegmonous jrocess, and be seated in a follicle, the cellular tissue, a l)mphatic vessel or ganglion. Whenever, in conse- quence of one of these conditions, the parts exposed to infection, pre- sent an engorgement of one or more follicles, the excision must be practised without hesitation, and followed by an application of nitrate of silver. When we have alreadj to deal, with a follicular abscess, and the dis- eased parts are yet limited, the same course must be adopted; in the contrary case, an opening must be made, to allow the pus to escape, and the cavity must then be well cauterized. The same tnust be done, with regard to the small circumscribed abscesses of the cellular tissue, which are developed by means of imbibition, near a chancre, or by one of the processes we have already described. When the disease is seated in the lymphatic system, (vessels or ganglions,) the means we have just pointed out, are not applicable, and we must have recourse to those which are employed to destroy buboes, as we shall see under that head. But either from being consulted too late, or from the means which we have just pointed out, not acting sufficiently deep, it often hap- pens, that there is difficulty in destroying at once, ail the infected part, and the chancre is developed. Then, at whatever period of its dura- tion it may he, or under whatever form it may have commenced, it ought to be destroyed as promptly as its seat and extent will permit. This precept, which we cannot too often repeat, and against which 23 178 TREATMENT OF CHANCRE. unfortunate prejudices in vain contend, is, as may be easily ascertain- ed, the result of daily observation. I have found in the subjects af- fected with constitutional syphilis, who have come under my observa- tion, that the chancres had" never lasted less that ten, twelve, or fifteen days, and in the majority, their existence had been prolonged to three, four, five, and six weeks, and longer. If to the preceding we add, that certain conditions are requisite, in order that general infection should take place, and that these conditions may at first be wanting, and show themselves later in the course of the duration of the chancre; it must be evident, that so long as it is allowed to remain, the chances of constitutional infection will exist. And we may further add, that contrary to received prejudices, if the liability to secondary symptoms does not depend on the rapidity of the healing of the primary affection, neither does the treatment applied to it, exercise any influence upon it; and therefore, that treatment, by which the local affection is most quickly cured, is the best anti-syphi- litic. In those cases, where the tissues, in which the chancre is situated, are engorged, or when if has acquired considerable extent, the nitrate of silver no longer acts with sufficient energy, and then, imitating the effect of gangrene, which it is known when it attacks a chancre, brings it to the state of a simple lesion, I have obtained very success- ful results by employing caustic potass, and yet better by the Pate de Vienne. This latter escharotic, must however be employed with caution, in order not to remove more than the diseased parts, or at most, only a very small portion of the healthy parts beyond. One ob- jection to this method is, that in many cases from the extent requiring to be cauterized, some of the adjacent parts, which ought to be care- fully treated, would be too much exposed; otherwise where it is ap- plicable and properly applied, it will produce the most beneficial re- sults. It ought also not to be omitted, that the parts cauterized, of- ten become oedematous, and greatly swollen; wherefore, they ought to be rejected, for cauterizing chancres on the internal surface of the prepuce or glans of an individual, with any symptoms of a phimosis. A chancre that cannot be attacked by these means, or which, not- withstanding their employment, still retains its specific character, re- quires other treatment. I. Although in general, ulcers or wounds ought not too frequently to be dressed, for fear of disturbing the process of cicatrization, yet this is not the case with chancres; for here the secretion becomes a permanent cause of the disease, and ought not to be allowed to remain long, and therefore the dressings should be renewed three or four times a day, according to the quantity of the secretion. II. Care must be taken, not to allow the cutaneous chancres to become covered with a crust, as the pus will collect and undermine the neighboring parts. III. As long as a chancre remains in the period of ulceration, the cauterization with nitrate of silver must be repeated, as often as upon the TREATMENT OF CHANCRE. 179 eschars coming away the characters of this period are found either on the ground or edges; but as soon as the reparation commences, the use of the cautery, on the parts which are healing, must be suspended. IV. All greasy substances, are generally hurtful in ihe treatment of chancre; but mercurial ointment is still more so, except in a few cases. Nothing is more common, than to see chancres multiply, extend, or become inflamed, when in the absence of induration, they are dressed with mercurial ointment. V. As we have before said, the pus secreted by a chancre, ought not to be left in contact with the surface; and it is also advisable to check the secretion. Dry lint, by forming a kind of sponge, fulfils one of these indications; but I have obtained the most rapid results from the use of the aromatic wine of the Pharmacopoeia (French,) used in the following manner:—The ulcer is to be well washed with this liquid, but yet without fatiguing it, or making it bleed; it is then to be covered with a little fine lint moistened with it, but not so as to run out; for when it is too wet, the kind of maceration, which results, retards its good effects. Care must be taken before removing the dressings to moisten the lint with the same liquid, so as not to rend the parts to which they may adhere from drying. Every one who has attended the Hopital des Vcneriens, must have had an opportunity of convincing themselves of the good effects of this treatment, which if well applied, is never followed by successive chancres, as is so often the case with other dressings. The aromatic wine diminishes the purulent secretion, and by modifying its surface, tends to promote the cicatrization of the virulent ulcer, and by acting as an energetic astringent on the neighboring parts, rendeis them in- capable of inoculation. In some cases, the secretion continued very copious, and I then found the vinous decoction of tan succeed perfet t- ly. If there be pain, or if the application of the wine causes it, an addition of eight or ten grains of opium to the ounce, will he found to answer well. We ought to remark, however, that in some subjects, who still continued to suffer, the pains disappear upon the dose of opium being augmented,whilst in others, it must be decreased. In some cases, however, the use of the wine ought to be suspended for a time, or relinquished altogether; thus in some patients, upon the suppuration ceasing, the ulcer remains stationary; dressings with an emollient decoction, or with opiated cerate, ought to be substituted for some days; in other cases, the ulcer being accompanied with indu- ration, it only increases it, and cicatrization cannot ensue: otherwise it is the usual dressing which I employ. VI. When the period of reparation arrives, as long as it goes on regularly, the dressings with wine must be continued, and the cauter- ization only resumed, when it becomes necessary to repress the exu- berant granulations. Often, only the epidermis is wanting to complete the cure; the surface of the ulceY become level with the neighboring, parts, remains red and yields scarce any secretion, but yet does not heal; then the superficial application of the nitrate of silver, so as just 180 TREATMENT OF CHANCRE. to whiten the surface without cauterizing deeply, suffices to terminate it. VII. The local treatment suffices, when the chancres are regular and free from complication, and leave no induration on their seat. It will suffice, if the patient, during the treatment, is made to observe the most strict repose, and the treatment suited to the constitution; in ro- bust subjects, antiphlogistics, and weakening regimen, may unrequir- ed, which in weak and lymphatic habits, would prove most injurious; but here, on the contrary, a moderate tonic regimen, and in general, whatever will correct the disorder of the habit, or remedy a state of concomitant disease, ought to be employed; for it must be remember- ed, the vicious course which chancres may assume, results from a bad constitution, or actually existing diseases. When the regular chancre is cicatrized, and the tissues on which thev were seated, are returned to the normal state, the patient may again be permitted sexual intercourse; but this is not the case, if indu- ration remain upon the seat where the cicatrices formed, and which by breaking, give rise to relapses; in these cases, absolute continence must be insisted upon, until the cure be quite complete. Let us now examine the treatment, which each of the principal va- riety of chancre requires. I. Concealed chancres (chancres larvCs.) When the urethra is the seat of the chancre, and it is complicated with symptoms of acute gonorrhoea, recourse must first be had to antiphlogistic treatment: leeches on the perinaeum and penis; emollient opiated fomentations; baths and copious draughts of mild fluids. I give every evening, two opium and camphor pills; to prevent the erections, which distend the diseased surfaces, and cause them to crack, thereby augmenting the ulceration. If small abscesses form on the points of the canal, occu- pied by the chancre, they must be opened early; as soon as the in- flammation has subsided, injections must be made with aromatic wine at first, mixed with equal parts of a decoction of poppy heads, and afterwards used alone, if no irritation be produced. Often when the gonorrhoeal symptoms are not too intense, the cauterization with ni- trate of silver, by means of Lallemand's caustic holder, may be used from the commencement; it acts in this case in the same manner as upon external chancres. If the ulcer be perceptible, and seated at the entrance of the canal, the treatment indicated for other chancres, is quite applicable to it; only where it can be borne, it is advisable to keep a small bit of mois- tened lint between the lips of the meatus urinarius to prevent their touching. The gonorrhoea, which under these circumstances accom- panies the chancre, disappears with it, when it alone is the cause, or yields when it is only a concomitant affection to a treatment for gonor- rhoea, which must be employed at the same time. When the chancres are seated in» the depth of the vagina, on the cervix uteri, or in its cavity, the speculum ought to be applied each time they are dressed, that they may be cauterized, and the necessary TREATMENT OF CHANCRE. 181 topical applications made. -Those situated in the lower part of the rectum, and at the anus, require to be kept particularly clean, and to be frequently dressed. Th£ bowels ought to act freely, and it is advi- sable to give a small mucilaginous enema, to prevent any hard matter from scratching the diseased parts; but should the passing of the India rubber canula, cause more pain than the feces, this must be omitted; the dressings must either be applied by a small piece of lint laid over the ulcers, or by injections, as the presence of a foreign substance in the sphincter, might cause too much spasm and pain. Care must be taken not to mistake these ulcers for simple fissures, as we have seen done, and make an incision in them, which would unavoidably cause the disease to extend. II. Superficial cliancres. In the majority of cases these chancres present no particular indication. When they are seated on the glans or prepuce, with symptoms of balanitis at the same time, they may, if free from induration, be confounded with the simple erosions which often accompany it. In this case a superficial cauterization and a piece of fine dry linen placed between the glans and prepuce will suf- fice to make them disappear in a few days; but if they still remain, the whole treatment indicated above must be applied. III. Phagedaenic chancres. When a phagedenic chancre, of what- ever variety it may be, has destroyed the frenum, produced a fistulous passage, or detached portions of the soft integuments, they must be divided or excised; for they are not in a condition to allow of adhe- sion. Thus, for instance, when the frenum is perforated, it ought first to be divided, and then the small portion which adheres to the pre- puce cut off; the whole should then be well cauterized, particularly the subjacent ulceration. A. Phagedaenic pulpy chancres. We must here carefully examine the circumstances which may have given rise to them. Frequently the dwelling of the patient is unhealthy, cold, and damp, in which case the disease becomes better as soon as he changes it. From this cause, chancres contracted in warm countries, and then carried into a more northernly climate, often become aggravated in a frightful degree, and, on the other hand, ir. contrary circumstances, they often have a rapid and happy termination. In this variety of chancre there is generally some visceral derange- ment under whose influence it seems to develope itself, in which case our principal efforts must be directed against this cause; if it be allow- ed to remain, or if it be increased by injudicious treatment, we cannot hope to cure the syphilitic ulcer which is 'dependant upon it. We must be careful not to fall into a common error of attributing the dis- astrous and rapid course of this variety of chancre to the nature of the specific cause or greater intensity of the virus, and thus be led, like the partisans of the old school, promptly and energetically to have re- course to the use of the pretended specific, and administer mercury in doses proportionate to the strength of the specific cause they wish to neutralize. Let it be remembered, that the principle of the syphilitic 182 TREATMENT OF CHANCRE. diseases is always the same, as in variola, and the differences only de- pend upon the individual peculiarities. I can confidently assert, that, except "in a very few cases, the so common employment of mercurial preparations, either as dressings, or internally, are most hurtful in phagedaenic chancres, and the more so, as not being accompanied by induration, there is much inflammation and nervous irritability. It is by no means uncommon to see these ulcers, when approaching the period of reparation, relapse under the influence of mercury into their former state, and chancres which were at first limited and regular become phagedaenic, simply from the em- ployment of mercury. Whatever may have been the origin of the variety now under our consideration, whether it has succeeded to a chancre on the skin, the mucous membranes, or to a virulent bubo, the most advantageous treatment, and that which has been most frequently and promptly fol- lowed by success, has consisted in the employment of cauterizations, joined with dressings of aromatic wine: in these cases, the cauteriza- tions ought to be deep and repeated, in some cases twice a-day, to follow the disease in its progress: the same ought to be the case with the dressings; for the morbid secretion being very copious ought to be frequently removed. Care must also be taken not to crack the edges of the ulcer in renewing the dressings; for every erosion be- comes inoculated, and favors the imbibition of the virulent pus and the progress of the disease. It has been advised, when the local inflanrnttion is very acute, to apply leeches in these chancres. I am very cautious in this respect, the result by no means according with the expectations which some practitioners have of it; for, heside the difficulty of making them bite on ulcerated points, the ulcer will immediately increase in the depth of the wounds they make. Nor is it proper to apply leeches in the neighborhood of a syphilitic ulcer, as each bite which is touch- ed by the pus becomes a new chancre. When the local inflamma- tion requires an evacuation of blood, the leeches ought to be applied at some distance, and on parts which are not likely to have the pus flow over them: the wounds ought then to be guarded by compresses dipped in the decoct, alb. until they are perfectly cicatrized. In these cases, complicated with inflammation, the greatest advantage is to be derived from dressings of emollient and narcotic decoctions, bread and milk cataplasms, and warm fomentations with mucilaginous or ge- latinous substances. The diet ought to be proportionate to the gene- ral state of the health and the local affection, at the same time abso- lute rest must be observed. If these chancres be accompanied with much pain, which may exist with or without much inflammation, opi- ates must be employed locally or internally. The local application I generally use is an infusion of opiu n. In this case, too, the cauterization with arg. nitr. forms a potent auxiliary. It is frequently the most efficacious sedative and certain antiphlogistic which can be applied, and often the patients themselves TREATMENT OF CHANCRE. 183 earnestly desire its re-application. The acute pain it excites at the moment of its being applied, soon abates, and gives place to an im- provement, which is sought in vain from other applications. To this rule there are but few exceptions, where these combined means must instantly be discontinued, and recourse be had to dressings with fatty substances, and more particularly with cerat. opii. The phagedaenic chancre may, however, progress or remain station- ary. In these cases, where the cause cannot be discovered, some- times cataplasms made with carrots, melted wax, or ung. digestiv. have been found to succeed. The most powerful caustics have been employed, also the acutal cautery. I have found the Vienna paste, and far less violent applications, beneficial, as for instance, blisters and powdered cantharides. Whenever, notwithstanding the use of the nitrate of silver, emolli- ents, antiphlogistic narcotics, or dressing with wine, the chancre con- tinues to progress, or remains stationary, I employ tbe following treat- ment:—If the ulcer be entirely uncovered, I apply a blister to it, or sprinkle it with cantharides; if on the other hand, it be deep seated, or has succeeded a virulent bubo, whose cavity it occupies, if the un- dermined edges of the skin ba sufficiently thick, I have in this case also had recourse to blisters, and at the same time introduce powdered cantharides into the suppurating cavity; this dressing is then allowed to remain twenty-four hours: on the following day, fine lint dipped in aromatic wine is applied and renewed, as in the case of simple chan- cres. Under this treatment, the ulcer soon becomes clean, and healthy granulation appears; thus the cavity becomes filled, and the skin again adherent. Sometimes it may be necessary to repeat the application of the blister and cantharides; the former will only be used when its object was not attained and as soon as the first has healed; but the powder will be renewed every three or four days, until granu- lations appear. Should this treatment not succeed, I prefer the ap- plication of the Vienna paste as a cautery, followed by such dressings as may be required by the state of the local affection. Frequently in this kind of phagedaenic chancre, the edges are so much undermined, and become so thin, that it would only be a loss of time to attempt to procure a re-union. When an ulceration has suc- ceeded an abscess, the skin may have become thin and undermined merely from the pus remaining under it, and without the wound having assumed a phagedaenic character; or it may, on the other hand, have undergone this variation. In the first case, whatever may be the ex- tent of the integuments to be removed, I prefer the curved scissors to give them the form most adapted for cicatrization; but, in the second case, nothing can be more hurtful than the use of a sharp cutting in- strument, which, far from limiting the affection, aggravates and aug- ments it; unless the new-made wound be immediately cauterized; therefore it would be far better in this case merely to have recourse to the use of caustic. Here, also, I prefer the Vienna paste, for not only can we define the parts we wish to remove, but we may at 184 TREATMENT OF CHANCRE. the same time completely destroy the virulent surface, or, at any rate, protect the new edges of the ulcer from a too rapid inocula- tion, by interposing an eschar and by a kind of vital reaction, the ab- sence of which is frequently one of the principal causes of the progress of the ulcer. In most cases of these affections, mercury, sudorifics, &c. are more prejucicial than useful: there are, however, instances in which they have produced good results; but we are at present unable to indicate the precise circumstances in which mercury is useful, or even indis- pensable. If the disease progress, notwithstanding the means pointed out above, I have then recourse to this medicament, which was so long and often considered as specific; first, in local applications, and then as a general agent internally, or by the skin, according to circum- stances, which I shall afterwards describe. I continue the local or general use separately or combined, according to the effects obtained, if there be improvement; but if the disease increase, T suspend them. As regards the other so called anti-syphilitics, they may be employed where general tonics are required, or those which act particularly upon the digestive canal, skin, urinary organs, &c. B. Indurated phagedaenic chancres. Induration, one of the essen- tial characters of the Hunterian chancre, is a condition which must never be lost sight of in determining the treatment; for though these chancres can be cured by a host of means, and often heal without any treatment at all, yet frequently the induration remains, and w7e know what may then happen; most frequently the induration having a ten- dency to increase, not only prevents the formation of the cicatrix, but may, by the intersticial compression it causes, produce gangrene, and give the ulcer a phagedaenic form. As in the case there is generally little inflammation or pain, our efforts must generally be against the in- duration. In the most simple cases of indolent indurated chancres, the dress- ings ought two or three times a-day to be renewed with fine lint and a thin layer of calomel and opium, or murcurial cerat. Should the suppuration be too great, a lotion of vin. arom. may be applied each time the dressings are renewed; if that be not sufficient, the dressing may consist of the wine alone. When there is much nervous irrita- bility and inflammation, or if the gangrene progresses, a concentrated solution of opium should be preferred, till the affection be brought back to the simple slate, by means of emollients and antiphlogistics simultaneously employed. In indurated chancres of small extent, cauterization, which cannot go beyond the limits of the affection, is much less efficacious than in other circumstances; but yet the nitrate of silver finds its application here also; it modifies the surface, often arrests the progress of the gangrene, and during the reparatory stage, checks the granulations which have sometimes a tendency to become spongy. W hatever may have been the form at the commencement and the seat of the chancre, the induration may remain after the cicatrization, TREATMENT OF CHANCRE. 185 and being generally a sign of future symptoms, requires peculiar at- tention. Delpech and others have advised the excision. Sometimes the result may have been happy, but too frequently, it has been the cause of a fresh venereal ulcer upon the operated spot, therefore it could only be had recourse to where its extent was small and defined, or when the induration had undergone a sort of cartilaginous transfor- mation, independent of the specific cause, and which has rendered it a kind of foreign body adhering to the mucous membranes or skin, but often moveable in the subjacent cellular tissue. , As regards the mercurial ointments used to remove the induration after cicatrization, if they sometimes succeed upon the skin, there are circumstances in which, when applied teethe mucous membranes, they generally produce irritation and return of the ulcerative period, espe- cially if rancid ointment happen to be used. When the induration occupies a great extent, other means may be used with advantage. Caustics which act in the depth, the dissection of the indurated parts, and then the combined use of blisters, dressed with ung. hydrarg. and compression. Unfortunately, this powerful aa;ent is not always applicable, as we shall afterwards see, it is only in those indurations, which accompany or follow buboes, that we can really draw advantage; for in those which are seated on the genital or- gans, and especially on the mucous membranes, we cannot take ad- vantage of its beneficial influence. If a well directed local treatment often produces a complete cure, it requires a long time. The difficulty of radically curing an indurated chancre by ordinary means, and the 'good effects of mercurials in its treatment, have been the principal arguments, which have caused it to be considered the sole type of primary syphilis, and mercury as the only specific to be opposed to it. Without entering into a discussion, which would carry me beyond the limits which I have prescribed myself, I shall merely slate, that if mercury has not incontestibly a specific action in this particular form of chancre, it is at least one of the most powerful agents that can be opposed to it, and hitherto we have discovered no medicament, which works a more rapid cure. If the cure of a chancre be reckoned from the day of its cicatriza- tion, without regarding what remains, it will sometimes appear more rapid with simple treatment; but if we wait, before we pronounce a patient cured, till all induration has disappeared, there will be a great difference in favor of the mercurial treatment; the induration in the first case remaining a very long time, and even till the more frequent production of secondary symptoms. Although I acknowledge the per- haps analogous properties of other medicaments, the mercurial treat- ment being one of the most powerful and certain, I have recourse to it whenever a certain degree of induration accompanies a chancre, and prevents it from cicatrizing, or remains after it is superficially healed, and more especially when, by its excess, it gives it a phagedaenic form. 186 TREATMENT OF BUBOES. As injurious as mercury is in other varieties, so beneficial is it in this case. C. Gangrenous phagedaenic chancre from excess of inflammation. Here the inflammation, which gives the peculiar form to this variety of chancre, is the principal point against which we must direct the treatment, disregarding for a moment the primary cause; the worst re- sults ensue from want of attention to this fact, and an empirical treat- ment of the specific cause with mercury. If however, notwithstand- ing a rational and judicious treatment, gangrene supervene, it must be treated as in ordinary cases unconnected with syphilis; only when this symptom has disappeared, is other medication indicated, and the chancre will have returned to the state of a simple ulcer, which the means already pointed out, will rapidly cause to cicatrize. Section II.—Buboes. Wherever, and at whatever depth a bubo may be seated at the time of its appearance, when only a slight tension of the tissues exists, rest, which may be regarded as the best prophylactic, and a methodic compression as great as possible, without causing pain, suffice in most cases to prevent the development of the affection, especially when it has not been preceded by a chancre. I have very frequently observ- ed, that in individuals who wear well made bandages for hernia, that the buboes are seldom developed on the side of this compressing ap- paratus. When compression cannot be endured, or when nevertheless the tumor increases, we must have recourse to another abortive method, as avoiding the suppuration is of the greatest consequence. If the naissant bubo be not actually the seat of a very decided phlegmonous action, and have been preceded by a chancre, I prefer the following treatment. I cover the tumor with a blister; when it has taken effect, I remove the epidermis, and place upon the denuded skin a bit of lint, dipped in a solution of corrosive sublimate, twenty grains to the ounce of distilled water; this is allowed to remain two or three hours, if required, it can be secured by strips of plaster. This caustic ap- plication, for which a solution of sulphate of copper, two or three drachms to the ounce may be substituted, is not equally supported by all patients, some not being able to endure it more than an hour, on account of the pain it excites. To obtain the desired effect, an es- char must be produced, penetrating part of the dermis. This eschar, generally of a greyish or brown color, and but seldom black, is gen- erally thicker than the part of the skin destroyed, which seems at first to become infiltrated, and then to receive an additional layer of plastic lymph. As soon as the eschar is formed, I cover the parts with an opiated cataplasm for the first day, and on the following I substitute compresses imbibed with cold decoct, alb., and continue them till the eschar falls off; the simple ulcer which then remains is dressed with perforated linen cloth covered with cerate, and over this the decoction TREATMENT OF BUBOES. 187 is continued. I have not found it advantageous to maintain the sup- puration when it was desired to annihilate the affection of which we are speaking. I continue this treatment, repeating the application of blis- ters and the caustic solution as long as the tumor remains, unless acute inflammatory symptoms appear. As the treatment with blisters and caustic solution has the incon- venience of producing great.pain, and in some individuals an indelible cicatrix, it must only be had recourse to when a chancre has preced- ed, and the development of a virulent bubo is feared. When ihe en- gorgement is consequent on a simple gonorrhoea, a non-specific exco- , riation, or is spontaneously developed, as in all these cases there is little tendency to suppuration, we must "employ milder resolutives— compresses dipped in decoct, alb., solution of sal ammoniac, emplas- 4 trum de vigo, iodide of lead, with conium, simple cataplasms, abso- lute rest, and, when pain exists, local depletions by means of leeches, and emollients with sedatives and narcotics, especially laudanum, free- ly applied. By these means many simple engorgements, situated near parts primarily affected with non-virulent symptoms, disappear soon after their commencement. When the abortive method cannot be employed, the treatment must be determined by the acute or indolent state of the bubo, without re- garding the variety. If the local inflammatory symptoms cause a rather intense fibrile action in a robust individual, general and local depletion must be had recourse to; otherwise leeches alone will suffice, but too many ought to be applied rather than too few—twenty; thirty, or forty. In ap- plying leeches, we must not loose sight of the possibility of suppuration, and when there is ground to believe a ganglionary chancre or virulent bubo exists, there must be applied around the base of the tumor; if the danger of suppuration be eminent, they must be applied at a still greater distance. To the use of leeches, must be added general warm baths, emollient cataplasms, rest in a horizontal position, taking care to give the limb on the affected side a slight flexion to diminish the tension of the aponeuroses, particularly when the buboes are deep seated. Low diet, cooling beverage, and saline purgatives, will be found very beneficial. Sometimes the leech-bites become irritated, and also cause an erysipelas, which is not always without benefit in in- dolent buboes; but in acute buboes, especially where there is a phleg- monous tendency or complication, greatly aggravates the disease. In this case, as soon as the skin becomes the seat of redness and pain, mercurial ointment, applied once or twice a-day, so as to cover the erysipelatous surface, will suffice to remove this symptom by acting upon the deep seated inflammation. It will sometimes be found, that poultices of linseed meal, produce an eczematous eruption, in which case bread must be substituted. When the inflammation has yielded to the applications of leeches, and the tumor has not suppurated, the treatment must be the same as in the case of indolent buboes. 188 TREATMENT OF BUBOES. Whether the bubo has been primarily indolent, or becomes so after having been acute, in order to avoid giving unnecessary pain, we must commence by the most gentle resolutives. Although rest ought to be considered as of the first importance, if the patient be obliged to walk, the tumor should, during the day, be covered with empl. de vigo. c. hydrarg. care having been taken to shave the skin; in the evening, the plaster must be removed, and half a dcachm of ung. hydrarg. well rubbed in, and then covered with a cataplasm, if there be any pain; or the compression may be applied either by means of a spica bandage and graduated compresses, a strong hernia truss, or an instrument con- trived for this purpose. If the gums become affected by the mercurial frictions, the ung. pot. hydroid. may be substituted, alone or with iodine. If either ihe mer- curial plaster or ointment has been used, the skin must be well clean- ( ed before the iodideiof the potass ointment is applied, as otherwise a new and very caustic composition will be formed, which may cause considerable inflammation and excoriations. In cases of very indolent engorgements which require exciting, the combined use of mercurial and iodide of potass ointment is very beneficial, and they are more efficient than croton oil or emetic tartar, which have been proposed. When the engorgement resists these means, or if a more energetic and expeditious treatment be desired, blisters and the caustic solution will be found by far the most rapid in their action. In this case, as in the abortive method, the tumor must be covered with a blister, and, twenty-four hours later, lint dipped in a solution of corrosive sublimate applied. When the ebchar is formed, it is to be treated with mercurial ointment, covered with cataplasms, and the suppuration must be maintained after the eschar is removed, by being touched every two or three days with the sublimate. Should it how- ever cicatrize, fresh blisters are to be applied, and this treatment con- tinued till the tumor has entirely disappeared, or till pus is formed. Sometimes, however, it occurs, that after having been pretty rapid, the progress of the resolution is arrested, notwithstanding the continu- ation of the treatment. Then if the suppurating points be not too painful, the mercurial ointment being still continued, the tumor must be covered with compresses, dipped in decoct, alb. and compression ap- plied. In many cases, a cure which is otherwise impossible, is ob- tained by enij loying these means alternately. Whatever may be done, some engorgements do not yield, particu- larly those seated in the deeper ganglions. In some happily rare cases, there is a schirrous or carcinomatous degeneration, into whose history and treatment we cannot now enter; but most frequently the obstinate engorgements and indurations depend on scrofula. Buboes of a scrofulous nature, or whose scrofulous complications have been excited into development by venereal affections, when treat- ed with alcaline and sulphur baths alternately every other day, united with the preceding means, and the general treatment, which we shall soon point out, often come to a successful termination, which must TREATMENT OF BUBOBS. 189 only be waited for with patience. In this case, the cashing of the ganglions might, as a last resource, be attempted, as M. Malgaigne has proposed. 1 have sometimes succeeded by applying every second or third«day, a little tincture of iodine, which may be diluted with water, when it irritates too much or excoriates. In some cases, the excision or extirpation of the ganglions would seem to be the only method; but as the operation is not always easy or even practicable, I have found it better to destroy a third of-the skin, which covers it, with the Pate de Vienne (a very thin layer will suffice). If the eschar is removed, the thus denuded ganglions, are to be cover- ed with ung. hydrarg. and cataplasms; the successful result is often very rapidly obtained. If we are obliged to attack the ganglions themselves, with the paste, we must be very cautious in its application, and only remove very thin layers at a time, redoubling the precaution the nearer the mote important parts are approached. When the induration of the bubo is dependant on that of chancre, we must pursue the treatment recommended for indurated chancre. Acute and indolent buboes may terminate in suppuration, which is more frequently the case when a chancre is the cause. If much in- flammation accompany the suppuration, leeches and antiphlogistic theatment is required. If local depletion does not in all cases produce the resorption of the pus, at least it has the advantage of checking the phlegmonous process, and further development of the abscess. When the inflammatory symptoms are subdued, a question of great importance presents itself to our consideration. Ought we in all cases to attempt tlie resorption of the pus to avoid opening the abscess, or is it belter to give it an issue as soon as it is formed? It has been as- serted, that by employing certain methods of treatment, the sponta- neous or artificial opening of the greater number of buboes might be avoided, of whatever nature they may be; but I can affirm, that when pus is decidedly formed, whatever may be done, resorption takes place but in a very few cases, and that, if it be attempted to procure it, there is great risk of serious consequences. Blisters and the caustic lotion, which are so advantageous before the suppuration has taken place, may still, if the cavity be of little extent without the skin having be- come thin, and the buboes not virulent, produce a complete resolution vviihout opening; but should the suppuration be copious, the cavity considerable, the skin thin, and deprived of its cellular tissue, in which case the solution no longer produces that thickening, which was pre- viously mentioned, this treatment does not prevent the abscess from opening, and far from inducing the absorption of the pus; it favors its escape through the eschar which it produces, and that often by a num- ber of holes like a sieve, which has led to the belief that it is only a simple purulent perspiration. If however, this result were the most frequent, by favoring the re- union of the skin, with the subjacent parts as the pus is evacuated, the method would still be favorable; but unfortunately this is not the case, and whilst this treatment is employed, the cavity extends, the pus accumulates, the skin becomes undermined, till the eschar falls, 190 TREATMENT OF BUBOES. and then it may not be of sufficient depth to allow of the complete evacuation of the pus. From observation, I have been induced to adopt and recommend the following treatment: whatever may have been the treatment pre- viously employed, as soon as we are assured of the existence of pus, we must give it issue. It is not necessary to enter into a description of the signs which denote suppuration, but I must mention that the elastic tension of the ganglions often deceive, and lead to a belief in the presence of pus, where in reality none exists. Sometimes the suppuration is deep-seated, and enveloped in indurated masses, which mask it and prevent its detection; yet if the tumors in which the pres- ence of pus is suspected be carefully examined, a point will often be found, generally on the most prominent part of their surface, soft and fluctuating, and, being pressed, the pus is forced through a kind of indurated ring which forms a communicating passage with the deeper parts. We are sometimes astonished upon opening these buboes to see an enormous quantity of pus escape, when the fluctuation had on- ly indicated the existence of a few drops. In every case, the opening ought to be made in the direction of the greatest diameter- of buboes. In the inguino-crural region, in the di- rection of the plica; the vertical ganglions of the thigh ought to be opened in the direction of the axis of the limb. The incisions made according to these rules do not expose so much to consecutive collec- tions of pus and the necessity of subsequent crucial incisions. When the cavity is of little extent and the skin but slightly changed, a small puncture will suffice; otherwise a large incision ought to be made in the undermined skin. If at the time of making the incision the skin is threatened with gangrene, or becomes thin and blueish, it is incapable of being re-united or cicatrizing, and must, therefore, be de- stroyed. For this purpose either a bistoury or curved scissors may be used; but I prefer the Pate de Vienne, with which we can remove as much as we desire: not only do we by these means remove the use- less parts, but also, as we said when treating of phagedaenic chancres, a healthy inflammation is excited in those which remain, and in virulent buboes a prompt neutralization. It ought lo be understood, that if we have to do with a gangrenous bubo with excessive inflammation, we must first have recourse to antiphlogistics, an incision, and the indica- tions which gangrene in general presents. After opening the bubo it is useless to press out the pus, which causes great pain; fomentations and cataplasms must be applied, and only in case of a small opening, and a non-virulent bubo, is a bit of lint between the lips of the wound necessary, during the first few days. In simple buboes every thing goes on as in ordinary or scrofulous abscesses; but in some particular cases, as especially where there is a ganglionary chancre, the edges of the incision ulcerate, the cavity con- tinues to extend or at least remains stationary. Then after the second day, from the time of the bubo being opened, 1 fill the cavity with powdered cantharides and cover the whole with a blister. The next > TREATMENT OF BUBOES. 191 day, if any induration be present, I apply ung. hydrarg. and dress the cavity with the aromatic wine; otherwise I dress the surface of the blister with cerate and cover it with compresses dipped in decoct, alb. continuing the wine for the cavity. The treatment of virulent buboes, after they are laid open, is the same as that of chancres. We may add, that where the opening has existed some time, as in those fresh made, all the portions of skin which are too much changed ought to be destroyed, and all fistulous canals and accumulations of pus, laid open. Detergent irritating injections, which so often suc- ceed in cases of simple fistules, are little to be depended upon in vir- ulent buboes; compression in the regions in which the pus is situated, is scarce more advantageous, as surfaces affected with virulent ulcers cannot unite, and the parts ought in such cases to be exposed. In all cases when the granulation is tardy and slow, powdered can- tharides, placed in the cavity and covered with dry lint, excites the production of granulations, which when excessive or atonic ought to be cauterized, or stimulated with nitrate of silver, as every wound which is cicatrizing. Should afterwards any induration remain, the treatment which we have pointed out for this circumstance must be employed. If the local treatment of buboes is of the first importance, the gen- eral treatment ought not to be neglected. The acute stage requires, as we have said, antiphlogistic treatment proportionate to the degree of the disease and strength of the subject; but when these indications are attended to, others of not less impor- tance, present themselves. The lymphatic habit and scrofulous com- plication being very frequently met with in individuals affected with buboes, we must use bitters and tonics, and when no contra indication exists, they ought to be combined with a strengthening regimen, par- ticularly when the system is much exhausted by copious secretion of pus. In these cases, I have derived great benefit from the use of pro- tiodide of iron, in doses often, twelve to twenty grains per diem, with a decoction of hops or sapornaria and syrup of gentian. As regards the antisyphilitic treatment, properly so called, the pre- sence of a bubo is no more indication for it than a chancre; it is only required in certain conditions and then frictions seem to be preferable, perhaps as being more direct. Sometimes buboes are complicated with scurvy, hospital gangrene, haemorrhage, fever from resorptions, &c. but we cannot here enter into a detailed examination of these symptoms. CONSTITUTIONAL SYPHILIS. GENERAL REMARKS. From the foregoing considerations, we have seen that we possess 192 TREATMENT OF CONSTITUTIONAL SYPHILIS. an infallible criterion by which we can distingush and diagnosticate the primary symptom of syphilis, but this is not the case with regard to those resulting from general infection. The well characterized and recognized antecedent in the abscence of any other appreciable cause; the form in each case; the peculiar progress; the concomitants, and the results of certain treatment, generally lead to a rational, but often doubtful diagnosis when symptoms are concerned, which other causes than syphilis can produce or considerably modify, such as certain cu- taneous, glandular or osseous affections, &c. However, if the diag- nosis be not always possible, there are yet many affections about which there can be no doubt. For instance, it is impossible to mistake a mucous tubercle after having once seen it, if well defined. Are there any circumstances unconnected with the syphilitic virus which can produce it? Is there any treatment, which acts more powerfully upon it than the mercurial; and of all the hereditary symptoms, is it not, with the lenticular eruption, of ths most frequent occurrence? However they may have explained them by the action of the syphi- litic virus, or by the doctrine of the sympathies, all writers on syphilis are agreed, that the primary venereal affections may give rise to con- secutive lesions of the various tissues of the system, but more espe- cially of the skin, the mucous membranes of certain parts, the cellular tissues, lymphatic, fibrous, osseous system, &c. of the eyes, testi- cles, &c. Except by inheritance, there is no primary constitutional syphilis; in those cases which have been thought such, the primary affections had escaped notice, as is frequently the case in women; or had been con- cealed by the patients, under circumstances, in which it would have been dangerous for them to have acknowledged them, which, in order to avoid being deceived, ought always to be borne in mind, particu- larly in cases of nurses. I shall now proceed to consider, whether there exists a really pro- phylactic treatment for the symptoms of general infection. Section I.—Prophylatic Treatment. The cure of primary affections, which are generally of little extent, and most frequently of little severity, has at all times been the least important question to decide. Whoever will give themselves the trouble to observe, will find, as we before stated, that it may be spon- taneous, or take place under the influence of a host of medications to which no specific properties can be attributed; but a patient who is cured of an indurated chancre is far from being in all cases freed from syphilis. In the treatment of the symptoms with which syphilis com- mences, our endeavor must be to prevent the consecutive (secondary or tetiary) affections. I have stated, from examination of various authors, and more particularly from personal experience, that I do not know of a single instance in which the primary symptom having been destroyed, before the fifth day of its real existence, symptoms of con- PROPHYLACTIC TREATMENT OF CONSTITUTIONAL SYPHILIS. J 93 stitutional infection appeared. I can firmly assert, that as soon as every one is convinced of this fact, syphilis will cease to make the ravages to which it is urged by opposite doctrines. Let every ero- sion or solution of continuity, which appears after a coition, be de- stroyed, not only where the connection is of a suspicious nature, but in every case; for this symptom is unfortunately overlooked by the greater number of patients, whom horrible consequences too frequent- ly undeceive when it is too late, and under circumstances in which the moral and social position would seem to protect from every chance of infection. As however in most cases, the primary symptom is allowed to pro- gress, and the patients only apply for advice at a later period, the chances of destroying this symptom before absorption has been allow- ed to take place, diminish, if not in regular proportion to its duration, at least in proportion to the specific induration with which it may be accompanied. I can most positively affirm, that contrary to an opinion professed by many, and by Dupuytren in particular, that ihe destruction of chan- cres by caustic or other local application cannot be regarded as favor- ing the development of constitutional affections by the repercussion, or throwing of the virus into the system; all we can say is, that when cauterization has been had recourse to too late, it cannot prevent the general infection. The result of my experience in the vast and fertile field of the Hopital des Veneriens, has taught me that in general the best pro- phylactic measure against the constitutional symptom, is the radical cure of the primary affection in the shortest possible time and without leaving any induration, and that whatever method of treatment has been employed, the induration which remains, after a mercurial or other treatment, leaves the patient nearly certainly exposed lo secon- dary affections. But is there any treatment which, beside the specific cause, the pe- culiar poison, favors the development of the syphilitic habit and dia- thesis? Yes, and it is that which does not destroy the virus and rad- ically cure the primary affection. Thus it is not more mercury than sudorifics or antiphlogistics, but the medication having been injudicious- ly or insufficiently administered. Mercury has not only been accused of aiding the production of constitutional symptoms, but some incon- siderate enthusiasts, carried away by the love of novelty, have even asserted, that mercury was the sole cause of all the frightful affections which syphilis produces. If indeed syphilis was of rare occurrence; if it were with us, as the oriental plague, of which many write with- out ever having seen it, there might be some excuse for these para- doxical propositions; but as it is to be met in our streets and fills our hospitals, to refuse to see is voluntarily to forego the use of one of the senses which ought then not to be appealed to in making other obser- vations. To convince me that mercury can produce the bad effects which are imputed to it, I must be shown a subject, who, under itsin- 25 194 PROPHYLACTIC TREATMENT OF fluence alone, and without having had any specific antecedents, has afterwards been attacked with mucous tubercles or lenticular eruption. Such a proof must be easy to furnish, if this medicament could alone cause such symptoms; for it is every day administered in every form, in cases unconnected with syphilis. Amongst the numerous persons affected with gonorrhoea, and who were formerly treated with mercu- ry, as is still the case with some surgeons, how many have been found later to present constitutional symptoms, beside those who have had urethral or concealed chancres? If, on the other hand, the actual population above the age of fifty were interrogated; we should be as- tonished at the number of persons who have, under the influence of the old doctrines, undergone mercurial treatment, without ever having experienced anything of it. This number is indeed so large, that the amount would appear exaggerated, unless we were able to have it ac- tually verified by the individuals. We undoubtedly see every day the most severe cases of syphilis, in patients who have most of them used mercury; but have the expla- nations always been free from prejudice? Do we not generally find, that those patients who are stated to have used a mercurial treatment, have not undergone any influence from it, either from the form in which it was administered, having only had a purgative action, or that the pills being in a manner petrified, like those formerly used in the Hopi- tal des Veneriens, passed through the digestive canal, without losing an atom of their substance. Would it then not be more rational to say, that there are some patients with whom the treatment has been insufficient or badly administered? Is this not proved by the success- ful issue of a more methodic treatment of these same individuals? Are not others completely refractory to any treatment? Do we not also find, that all forms of constitutional syphilis do not yield to the same treatment, more than it can in every case prevent their develop- ment? and lastly, that in some individuals, the most unfortunate of all, but incontestably the least numerous, the disease develops itself nev- ertheless, and becomes the more formidable as the remedy cannot arrest it, and undermines the constitution? These latter circumstances have undoubtedly been better understood of late, and much credit is due to those who have aided the researches by their works, as Thomas Rose, Guthrie, Rust, Bruminghausen, Richond, Jourdan, Devergie, Desruelles, Fricke, &c. although some of them may have somewhat exaggerated the circumstances they observed. The numerous observations which I have been enabled to make, lead me rather to consider a mercurial treatment as curative of certain symptoms than prophylactic. The surgeon who leaves an indurated chancre without general treat- ment, is in a measure responsible for the consecutive symptoms, and mercury is by far the most prompt and efficacious in its action. If a mercurial treatment be indicated, it ought to be pursued till the symp- toms disappear. Whilst speaking of the prophylaxy we ought to mention, that all CONSTITUTIONAL SYPHILIS. 195 persons are not susceptible of general infection, a fact which has been overlooked by many writers; that peculiar conditions are required for it to take place, and that especially after the infection has taken place, in order that its material manifestation may be effected, certain acci- dental or rather assisting circumstances are requisite, which may be tardy in their appearance, or altogether wanting. Thus a sudden change from a mild to an exciting, or from a tonic to a debilitating diet, change of climate, &c. favor its development. The same is the case in the change from foetal to extra-uterine life; from pregnancy and from the time of the cessation of the menses, which has been so well observed by Thiery de Hery. The same influ- ence results from a disordered state of the digestive canal, anterior or concomitant cutaneous affections, habitual irritations of the throat and mucous membrane of the mouth, frequently owing to the use of a pipe irritated hoemorrhoides, scrofula, or other diathesis. Further, a blow, a fall, want of cleanliness, and over exertion of certain parts, produce the same effects. From the preceding general views, into whose details we will not enter, results as the most prominent point, that to prevent further con- sequences, attention ought to be paid to the general health and proper action of the functions and to the rational treatment of any concomi- tant diseases not dependant on syphilis. Section II.—Secondary and Tertiary Affections. All the consecutive affections of chancre may, like the chancre it- self, heal spontaneously, often without any cause being perceived; at other times, in consequence of certain more or less apparent conditions, such as accidental perspirations, change of diet, climate, or occupa- tion, the critical termination of concomitant diseases, &c. But although many curious observations of this kind have been made, it must be confessed that these cases are rare, and that of all diseases, constitu- tional syphilis is perhaps the one which most decidedly requires the aid of art. If difference of opinion exists as to the treatment required by the primary symptoms, there is still greater as regards that of confirmed syphilis. The following is the result of my clinical experience, and the treatment it has led me to adopt. 1. Time at which the treatment ought t.o commence. The first symp- toms which make their appearance after a chancre, ought to be treat- ed as promptly as possible. The serious nature of syphilis depends only on the time allowed it to undermine the system. 2. Conditions. Neither any age nor habit is an absolute contra- indication. As regards women, the period of gestation, far from being an obsta- cle to energetic means being adopted, requires yet more attention and judicious promptitude. I have seen more abortions in syphilitic wo- men who were not treated than in those who had been timely submit- 196 treatment of secondary ted to a methodic medication. The same is the case during the pe- riod of suckling. 3. Climate. Seasons. Climates and seasons are never absolute impediments; undoubtedly a temperate climate and warm season are preferable; but yet under opposite circumstances, when the symptoms are urgent, an immediate treatment is preferable to delay. 4. Syphilis without complication. When constitutional syphilis ex- ists in an uncomplicated state and at its commencement in an individual enjoying a good constitution, and who has never been tormented with injudicious treatment, its cure is generally easy and rapid. 5. Syphilis with complications. When constitutional syphilis is complicated, its complications ought never to be neglected; if they be acute affections of some importance, their treatment ought first to be attended to, so as to reduce the syphilis to the most simple form; the same is the case when new primary syphilitic symptoms have been acquired. When the affections are of a slow chronic nature as some diseases of the skin, scrofula, organic affections, &c. the syphilis must be attacked, if its treatment does not aggravate the concomitant dis- ease, which must be attended to at the same time. In short, the most prominent symptom, whatever it be, must be first attended to without neglecting any points, which may furnish a therapeutical indication. The exclusive treatments which regard only a single symptom, whilst there may be many which require to be modified, are the worst which can be pursued, to whatever system they may belong. 6. Antiphlogistic treatment. In like manner anjiphlogosis ought to be considered as the principal means to be employed, whenever any symptoms of super-excitation and particularly inflammation exist. There can be no certainty of success without strict regard being paid to this rule. Whatever the nature of the affection may be, if inflam- mation be present, the antiphlogistic method must first be used accord- ing to the seat, extent, local intensity, and sympathetic reaction. But dangerous as it is to neglect this precept, it is equally so to pursue it as an absolute and curative method in all cases. Doubtless thousands of symptoms of a reputed syphilitic nature may be found which have yielded to it; but the true symptoms of general infection, whose com- plications it may modify, resist it and then constitute those particular cases, which the advocates of this doctrine treat, as we do, by a more powerful and certain medication. 7. Diet. So great is the influence of diet upon the diseases of which we are treating, that it has induced some to make a special treatment of it, under the name of curafamis. The observations I have made have taught me, that whenever the subject affected with irritable inflammatory venerea] symptoms is robust and vigorous, a spare diet will produce a happy modification, and cause a number of symp- toms, which are not dependant on the syphilitic virus, to disappear. But the privation from food, either in part or entirely according to the habit of the patient, applied without discrimination to all cases, is not- AND TERTIERY AFFECTIONS. 197 withstanding the powerful authorities who support it, one of the worst means that can be adopted. Thus in a weak debilitated individual with a scrofulous habit, a spare diet aggravates the disease whilst a gener- ous, tonic diet is a principal condition on which the success of the treat- ment depends. This assertion may be verified every day in the wards of my hospital, where patients who at home were destitute of every thing, will be found quickly to recover their strength and health under the influence of a better diet, whilst others, accustomed to plenty, droop and only become re-established by quitting the abode and nour- ishment of an hospital. The diet must therefore be regulated by the more or less inflammatory nature of the symptoms, strength of the sub- ject, and particularly their former habits. 8. Baths. Are almost always of great assistance as sedatives and adapted to maintain the functions of the skin, so necessary in most af- fections, and especially in those which have their seat in the skin itself. 9. Remarks upon the influence of the digestive canal. If it be re- quisite in the treatment of secondary affections that the functions of the skin should be undisturbed, it is equally important that the diges- tive organs should be perfectly free. Without attributing to them supre- macy of action in the economy and the arbitrary direction of the progress of syphilis, it is not to be denied that their influence is often immense and perhaps more particularly in the ulcerous forms and af- fections of the osseous and lymphatic symptoms. 10. Sudorifics. As a general medicament, sudorifics have been too much lauded, and there seem to be too many cases in their favor to allow of their curative influence being entirely denied. Without, however, fully adopting the views of Cullen, particularly as regards sarsaparilla, 1 must say that in well characterized constitutional symp- toms, this substance or those which resemble it, are far from possess- ing all the power which has been attributed to them, and which com- mercial speculations have sought to maintain. I must nevertheless say, that there are some indications to which this class of medicaments answer, and which render it useful in ration- al practice. Thus when the digestive organs are healthy, and too much general or local irritation does not exist, and the functions of the skin are defectively fulfilled, sudorifics produce good effects as adju- antia to the mercurial treatment. They are moreover indicated and very useful when circumstances forbid the use of mercury; when it has been injudiciously administered and has produced ill effects, or when its use has to be suspended. In the affections of the osseous system, and more particularly when suppuration exists, they are our sole if not active and curative resources, yet as a moral medication, on account of their common reputation, and the confidence most pa- tients place in them. Further, as regards the moral or mental treatment, if we may be allowed to employ the term, we must have recourse to sudorifics, for patients affected with syphilophobia, who being haunted by an idea of a syphilitic affection improperly treated, or as they express it badly 198 TREATMENT OF SECONDARY cured, believe themselves a prey to the most incongruous symptoms of which they really possess no trace; in such cases we may consci- entiously do with these medicaments, giving them the name of correc- tives, depuratives, what it would not be allowable to do with mercu- rials. Amongst the sudorifics, giving the first place to sarsaparilla, although it is not always certain, except from other diaphoretic indications, I greatly prefer the tisane de Feltz;* where not contra-indicated. I usually employ the form communicated by Boyer, who received it from the son of the author. Guaiacum, which is to be ranked third, has succeeded with me better in affections of the osseous system As regards Zitmann's decoction, the results I have obtained from it, are far from equalling the wonders attributed to it, although it may some- times succeed. I administer sudorifics in the form of tisane (diet drink,) when the circumstances of the patient allow of it; otherwise they must conceal their treatment, in the form of syrup. Unless the patients keep in a temperature of from 14° to 16° C. the tisanes are to be given cold during the day, they then act upon the digestive canal and urinary organs. Towards evening and upon going to bed, they are to be given warm and in somewhat larger quantity. I have derived benefit from adding in these cases, a little acetate of ammonia. 11. Tonics, antiscorbutics, tyc. According to the habit or the complications, tonics, antiscorbutics, or antiscrofulosae ought never to be neglected; thus I administer either alone or combined with mercu- rials quinine, bitter and other extracts, iron and particularly the prot- iodide of iron, from which I have derived so much in the treatment of scrofula in its simple form or combined with syphilis, and also iodine, internally or locally, not, strictly speaking, as antisyphilitic, but as a treatment for these frequent and troublesome complications. 12. Remarks on other medicaments. Before we come to the con- sideration of mercury, which has and still does, in spite of all that has been said against it, enjoy so just a celebrity, I must say a w:ord upon some substances which it has been attempted to substitute for it. In the study of the therapeutical history, it is very obvious that if a disinterested love of humanity and science has directed the labors of many, far more have been influenced by other motives. Each has desired a peculiar treatment, a nominal method, which might furnish a pretext for making a book, or publishing a prospectus. I shall not pause to examine those means to which these reproaches may apply ; I shall only relate what I have found from experience, concerning the preparations of gold and silver, &c. I have always found gold as a general method in primary affections useless. In the consecutive constitutional aflections, its effects are most uncertain; most of the symptoms reputed to have been cured by this medicine, are far from being incontestibly of syphilitic nature, * See formulary at the end. AND TERTIARY AFFECTIONS. 199 and where it has been administered in well characterized cases or where other methods, and especially mercury, had failed; it has not appeared to me proved, that it is not rather to the suspension of the medicine, which was in this case hurtful, that the cure is to be attri- buted. Notwithstanding the encomiums which have been passed upon the treatment with gold by its author, and those who have imitated him, 1 only employ it when I have no other resource; but this is only my personal opinion, and I do not attack the interesting works which have been published upon this method. AH the preparations of silver have appeared to me, upon trial, ac- cording to the directions of Professor Serres, of Montpellier, far more uncertain, which all, who have attended my clinical practice, may have observed. In primary affections and confirmed syplilis, com- mencing with small doses and gradually increasing to the enormous dose of fourteen and sixteen grains per diem, I have obtained no result, but a derangement of the digestive organs, which obliged me to dis- continue its use. 13. Mercury. We must then give a preference to mercurial treatment in confirmed syphilis, when not otherwise contradicted. Mercury is not an absolute specific, but it is the most certain and powerful remedy we yet possess, and it will, notwithstanding the ob- jections which have been raised, maintain its rank, as a therapeutical agent. The method of applying the mercurial treatment which I employ in my hospital and private practice, belongs to no exclusive system; the rules by which I am guided, are the result of observation. Without in this place determining to which class of medicaments mercury ought to be referred, some of the effects which it produces are constant and incontestible, and must be admitted even by its great- est opponents. These effects are either pathological modifications, or curative results. But it must not be supposed that mercurials in inva- riable doses for all subjects, will always act; for there are some pa- tients, who are until a certain point unassailable by their action. These propositions which are so simple, that it may seem almost absurd to state them, viz. that in some subjects, mercury is inert and in others hurtful, whilst in others it cures, have not always been acknowledged, and as a proof I may mention, the attacks which have laterally been made upon this powerful medicament. Guided alone by clinical observation, and profiting by this simple and so practically useful condition, we must not conclude that a mer- curial treatment has been unavailing, because it has been continued a long time, or repeated without results; we must not regard it as hurt- ful because being administered in doses, ill proportioned to the dis- ease, or the patient, it may have produced momentary symptoms, nor must we require of it more than it can produce i. e. the cure of symptoms which may actually exist, and of those which may appear at a later period. 200 TREATMENT OF SECONDARY In order to obtain from this medicament the advantage which we have a right to expect, we must employ it in suitable doses, which, as we have before said, cannot be the same for all patients. The pro- portions of these doses for each individual, must be ascertained by gradually increasing them, until a favorable modification of the affec- tion we are treating be obtained, or until symptoms arise which cause us to desist. These increasing doses, which are so necessary in ma- ny cases, have appeared to me still more so when it is done suddenly from a weak to a stronger dose, allowing an interval of five or six days, than when the increase was made daily and by an insensible gra- dation. From the foregoing it will easily be understood, that it is im- possible precisely to fix the daily dose of the medicament, and that great difference of opinion may exist upon this subject. Moreover we must in some manner reckon upon the action of each separate dose, and not upon the total quantity taken, at least not in an ab- solute manner, and that one individual who may have swallowed a hundred grains of sublimate in small doses within a long period, will be less affected than another who has taken upon the whole a less quantity, but in doses better suited to his constitution and within a much shorter. We must reduce to their proper value the symptoms which limit the doses, or require the temporary or entire of suspension of the medica- ment; thus one of the inconveniences of the mercurial treatment which is now pretty generally acknowledged, though formerly considered a favorable symptom, is its action on the mouth. Mercurial stomatitis (ptyalism or mercurial salivation) must be placed foremost amongst the bad effects which mercury produces. If in some rare and exception- al cases, we find the venereal symptoms improve under the influence, we see them more frequently aggravated, especially when they are sit- uated in the cavity of the mouth, or at least in the greater number of cases, they remain stationary during the course of salivation. If, as we have seen, salivation is useless in the cure, the progress of which it sometimes retards, and that it always constitutes a disease, if not most frequently serious, yet always very tedious and painful; the greatest care must be taken to avoid it, by discontinuing the use the agent which produces it, immediately the mouth becomes affected. The use of mercury must indeed be wholly suspended if the stomati- tis is developed to allow this affection to subside, when we may return to the same treatment beginning with weaker doses, which may after- wards be greatly increased without producing salivation. The tenderness of the mouth being in many cases the first sign of the patient receiving an impression from the medicament, and a scale by which to regulate the dose in practice, we ought to be able to take all possible advantage of it, and not be deceived by accidental affec- tions unconnected with it. In order to do this, we must, before we commence a treatment, ascertain the state of this cavity, and take in- to consideration the bad dispositions which, if I may be allowed the expression, too soon excite the action of the medicament in it. AND TERTIARY SYMPTOMS. 201 Next to stomatitis derangement of the stomach and intestines, are most frequently observed under the influence of mercury, especially when administered internally. Here too, taking the previous condi- tions into account, the doses must either be diminished or suspended according to the foregoing rules. The same course must be pursued, in case of the rare and dubious hydrargyriasis or mercurial eczema, when it is not the result of a local action of the mercury in consequence of frictions; the like will be the case in the wandering pains, tremors, fever, and in short, every morbid symptom unconnected with syphilis; but which having been developed under the influence of the medicament would necessarily increase, if its use were continued. If the affection which mercury produces, serves to regulate its employment, its curative effects are a still better guide. Thus, as long as a dose amends the symptom treated, it should be adhered to, and only augmented when its efficacy ceases. The preparation to which I now give the preference, not only in the treatment of the secondary symptoms, but also of the primary, is the protiodide of mercury, commencing with a single grain in the form of pills. In some patients, the daily dose has been increased to six grains, and the total quantity sometimes to two hundred, by its being continu- ed till the complete disappearance of the symptoms. My experience has led me to the following conclusion, that the most powerful way of action was by the intestinal canal, and that the application by the skin was far inferior, and ought only to be employed when the bad state of the digestive organs will not allow of the direct introduction of the medicament. In giving however the preference to the protiodide of mercury, 1 ought not, without entering into details foreign to the limits of this work, to omit that there are some cases in which the form in which mercury is administered ought to be changed, when that first employed either without effect or produces inconvenience. 13. Opium. Opium, which some have placed amongst the specifics in venereal diseases, is of the greatest utility in their treatment. Its employment is indicated whenever the nervous symptoms are promi- nent amongst those we have to treat. The extreme irritability of any organ in particular or of the system in general, and pain, either the cause or the product of inflammation, often requires it, either as sole medicament or as adjuvans. We find the use of opium peculiarly re- quired during the employment of mercury, to enable the digestive canal to support it, when it has without it been incapable of bearing it. Opium corrects the tendency mercury has to purge, and prevents colic and the griping in the stomach, which some patients feel, partic- ularly in using sublimate. Its effects, as regards salivation, are not so well ascertained. Its direct action on the mouth is perhaps rather to repress the salivation, or at least to allay the pains which accompany it; but in the digestive canal, by frequently producing constipation, it incontestibly predis- 26 202 SPECIAL TREATMENT OF SECONDARY AFFECTIONS. poses to it, a circumstance which deserves the greatest consideration. As a corrigens, opium is advantageously employed in removing, or even preventing, the tremors which are sometimes observed after the use of mercury. In a word, opium employed in its various forms, either locally or generally, alone or combined with other methods of treatment, ought never to be neglected. Section III.—Application of the general Precepts to Particular Cases. SPECIAL TREATMENT OF SECONDARY AFFECTIONS. Syphiloids. Cutaneous eruptions are the most frequent symptoms of constitutional syphilis, and appear the soonest after the primary af- fection, or wrhen inherited, after birth. These eruptions, which are seated on the skin and certain regions of the mucous membranes, sel- dom occur before the fourteenth cay after the appearance of a chan- cre, and do not develop themselves generally till after the fourth, fifth, or sixth week, or even later. The forms under which the syphilitic eruptions show themselves, are all those which have been admitted in the general classification of the diseases of the skin. But the specific cause of all of them being the same, the differences are only owing to the duration of the erup- tion, the period at which it occured, the seat it occupies, and the in- fluence which concomitant diseases may exercise over it, the habit of the patient, and the treatment to which he may be subjected. The progress of syphilitic eruptions is generally chronic, and the time of their duration difficult to determine. They may terminate by delitescence or sudden disappearance, whilst they are still in the pe- riod of roseola, or simple maculae; by a gradual resolution; by suppu- ration when they give rise to the formation of pustules, which may be followed by ulceration; and lastly by indurated or ulcerated tuber- cles. In the absence of other cause, we must refer to chancre or inherit- ance for a rational diagnosis; and in cases of lenticular, herpetiforra syphiloid and mucous tubercle, to the peculiar appearance which no other affection without these antecedents ever presents. I may here be permitted, without entering into further details, to say that generally the dark coppery color, which is usually considered characteristic, only shows itself very late, and is only well defined in the spots which follow the cure of the forms which have attacked the skin more deep- ly, never leaving any trace upon the mucous membranes. A venereal scabies does not exist. Syphilitic patients may most assuredly be affected with the itch, but the syphilitic virus cannot pro- duce it. When the syphilitic eruptions are accompanied, or preceded by fever or superexcitation, antiphlogistic treatment ought first to be em- SPECIAL TREATMENT OF SECONDARY AFFECTIONS. 203 ployed; then recourse must be had to mercury, aided by antiphlogistics, if the irritation still exist, otherwise by sudorifics. If inflammation be still present, gelatinous baths are very useful; if the disease resist, especially in the simple eruptive period, or with formation of squama without ulceration, simple vapor baths; but fumigations with cinabar, are of a great assistance and efficacy. In the squamous, or the pustulous forms without irritation, and when the crusts have dried and still adhere, as well as in the case of the production of tubercles in the period of secondary affections; the frictions recently recommended with ointment of protiodide of mer- cury have often proved successful, united with gelatinous baths. Here also in cases which resist, baths with sublimate, repeated every or every other day according to the effects produced as mercurial agents, are very often useful. In one form in particular, a cure is effected with an astonishing rapidity, I mean that of mucous tubercles or pa- pulae. Whatever its seat may be, at the same time as the general treatment, which it requires as a secondary symptom, is employed, the local medication, which from the rapidity of its result is truly specific, is as follows:— The diseased parts are first to be washed, if they are not indurated, with pure chloride of sodium (chlorure d'oxydede sodium,) and in the contrary cases, or where there is too much irritation, diluted with water, so as to excite a slight tingling without pain. Then after the washings, which are to be repeated twice a day, the diseased parts are to be sprinkled with calomel. Eight or ten days, suffice to cause enormous masses of these eruptions to disappear, which perhaps, situated be- tween the toes, have for many months prevented the patients from walking. Those which are situated in the nostrils, on the internal sur- face of the lips or cheeks, on the edges of the tongue, the palate, tonsils, &c. must not be confounded with the superficial, spongy, and greyish ulcerations, which mercurials sometimes produce, and which always commence on the gums, and particularly the lower, and those of the last molar teeth. Besides the general treatment, which alone almost always suffices, aud the local use of simple or mucilaginous gargles, sweetened with honey, cauterizations with liquid nitrate of mercury, which are less painful than on cutaneous tubercles, greatly accelerate the cure. In the acute pustulous period, with copious sup- puration, we must not be precipitate with the use of mercurials; we must first have recourse to sedatives and antiphlogistics, carefully ex- amining what gives the syphiloid this form, which scarce ever is the sole product of syphilis. Only when all other indications have heen fulfilled, ought the special treatment to commence. Ulcers. When consecutive ulcers exist, having been preceded by one of the forms of which we have been treating, their peculiar state is referable to what we said elsewhere on chancre, which they resem- ble in many respects, especially as regards their treatment. We must here bear in mind, that many ulcers reputed syphilitic, may be main- tained by conditions unconnected with syphilis, and which must by no means be neglected. 204 SPECIAL TREATMENT OF SECONDARY AFFECTIONS. The ulcers which are seated in the throat, are either the consequence of mucous tubercles, or they assume the appearance of an indurated chancre, or follow the course of phagedaenic gangrenous ulcers, from excess of inflammation. In the two first cases, which require mer- curial treatment, gargles of decoctum malvae, with corrosive sublimate will be found very beneficial; cauterization with nitrate of mercury, only succeeds in cases of mucous tubercles; it is less efficacious, when not in- jurious in cases of true indurated ulcer. In phagedaenic ulcers, opiated gargles, and when the inflammation has abated, cauterization with hydrochloric acid, and gargles with quinine ought to be put in the fore- most rank, reserving the general treatment in case other indications should afterwards require it. When the uvula becomes ulcerated, it is often destroyed; when it is nearly detached, it should be removed instead of waiting till it drops; I have seen a patient nearly suffocated by its falling on the glottis whilst he was asleep. When the velum palatinum has been divided by syphilitic ulcers, the state of the tissues, and the nature of the cica- trices, either render the staphyloraphy useless or injurious. In consequence of the ulceration of the mucous membrane of the palate and nose, the bones of the palate, the cartilages and bones of the nose are often exposed. From this exposure, may result ostitis, terminating in caries, or even necrosis; but in this case, the disease of the bones is less acute, and terminates sooner and better than in the tertiary affections where it commences in the bones themselves. Syphilitic irritis. Secondary syphilitic ophthalmia, most frequent- ly accompanying the syphilitic eruptions of the skin. It seldom ap- pears as isolated symptom, and frequently, though not always, presents a deformation of the pupil which becomes elliptic, or rather egg-shap- ed; the greater end being below, and its greater axis directed ob- liquely from the outer corner of the eye upwards and inwards, with al- teration of the color of the iris, which sometimes presents excrescen- ces on its pupilar margin and anterior surface; excrescences which have been regarded as true condylomata. Albuminous effusions often take place in the camerae of the eye; they are either absorbed or form adhesions, which only restrict the movements of the pupil, or induce the formation of pseudo cataracts. The eye may, in ophthalmia, un- dergo all the alterations which occur in cases of non-specific inflam- mation, and from which the symptomatology differs but little. The inflammatory period of this affection, the consequences of which may be so serious, requires an antiphlogistic treatment which must quickly be followed by a general mercurial treatment. The local treatment consists in applying leeches to the temples and mastoid processes, and as soon as the inflammation has a little abated, the pains become less, and the intensity of the photophobia decreased, we must immediately have recourse to blisters in the neck, on the temples, and over the orbita. The suppuration of that in the neck must be kept up, whilst those on the temples and forehead are dressed with ung. hydrarg. and renewed as often as they dry up under this SPECIAL TREATMENT OF SECONDARY AFFECTIONS. 205 treatment. Mercurial ointment may be rubbed in at the base of the orbit, but we must not lose sight of the irritation of the eye and the contraction of the pupil; for these symptoms, belladonna, which is pe- culiarly sedative for the eye, ought not only to be employed as fric- tions around the orbit, but also in the nostrils, and internally combin- ed with the protiodide of mercury, which I here also prefer to calo- mel. Besides these special indications, there are those which simple opthalmia generally presents. Syphilitic testicle. Syphilitic sarcocele, which must not be con- founded with gonorrhoeal epydidymitis. This disease of the testicle, the consequence of symptoms which we have before considered, is seldom found as sole sign of a secondary affection; commonly preced- ed or accompanied by other symptoms of general infection, it frequent- ly attacks only one testicle at a time. When the testicle is affected, it becomes indurated, increases in volume, and is pearshaped; some- times it is unequal, and becomes relatively heavy. The disease is frequently accompanied or preceded by nocturnal pains in the loins. The induration may have its seat in the epididymis or the cord; but it is the substance of the testicle, which is almost invariably affected. A gonorrhoeal epididymitis may be the cause which favors its develop- ment without the gonorrhoea having any other influence over this affec- tion, or being its specific cause. Syphilitic sarcocele may often be complicated, which renders the diagnosis very obscure; in dubious diseases of the testicles, the patient must be examined as to the antecedents, and before amputating this organ, we should recollect the prudent course pursued by Dupuytren, who, before having recourse to the operation, submitted his patients to an antisyphilitic treatment, and thus saved a great number of testi- cles, which others would have excised. To the general treatment which almost always succeeds alone, ought to be added to accelerate the cure, repeated applications of five or six leeches every six or eight days along the cord. If the patient can rest, half a drachm of ung. hydrarg. fort, may be applied to the scrotum, and the diseased parts then covered with emollient cata- plasms; but should there be pain, and if the patient does not rest, the scrotum should be enveloped in emplastr. de Vigo. c. hydrarg. or re- course be had to compression, in the same manner as we advised for the gonorrhoeal affection of the testicle. Falling off of the hair and nails. Although these symptoms are not very frequent, yet they occur often and regularly enough for us to recognize their existence, without depending solely upon the testimony of Fracastor and Fallopius. Generally it is, during an eruption of pustules of impetigo on the hairy portion of the head, or sometimes after the disappearance of a syphiloid, that the hairs fall, and most frequently in patients who have not taken mercury. The nails fall off, particularly when their matrix becomes the seat of the eruption. Here the curative treatment is that of the affection, which precedes or accompanies it. 206 SPECIAL TREATMENT OF TERTIARY SYMPTOMS. For the falling off of the hair, besides the general treatment, the head must be shaved and rubbed with stimulants, ointment with proti- odide of mercury, or tincture of cantharides diluted with alcohol. As regards tho nails, they must not be pulled out, as in cases of simple onyxis, we must wait till they fall off, or detach them partially by applying to their diseased matrix, the local treatment advised for mucous tubercles. Section IV.—Special Treatment of the Tertiary Symp- toms. According as the ravages of syphilis gain in depth, and the consec- utive affections which it causes, are removed from the commencement of the general infection, we find them gradually losing their specific characters, which much less prominent in the secondary symptoms, disappear entirely, or partly in those of which we are about to speak. The diagnosis of the affections of which we are now about to treat, and which may be grouped under the title of tertiary affections, from the order in which they are developed, is very obscure. Most fre- quently they appear only a very long time after the primary infection, and as other causes may produce similar effects, it is sometimes im- possible to distinguish them. Being, as we before stated, non-conta- gious, they are only transmitted by inheritance, in as far as they pro- duce effects in the habit and organization of the children, without any specific character, and which may generally be classed under the head of scrofula. The signs by which we can determine the diagnosis of the tertiary affections, is drawn from their acknowledged frequence, after the ap- pearance of primary syphilis; the absence of all other causes (when under dubious circumstances,) and especially as leading to a more cer- tain diagnosis from the existence of characteristic secondary, either preceding their development, or being co-existent with them. The secondary affections form a characteristic chain between the primary and tertiary symptoms. A careful observer will rarely find periostoses, exostoses, or deep seated tubercles occur, in consequence of a chancre, after the lapse of a longer or shorter period, without some sign of general infection, having been at a prior period develop- ed, or still existing. Recognizing as we do, the syphilitic virus as the regular cause of the tertiary symptoms, we must however confess, that if it undergoes a modification in the secondary symptoms, in consequence of which, as we have seen, it no longer is capable of inoculation, this modifica- tion is here still greater; and if I might hazard an hypothesis to ex- plain some facts, whose immediate cause is difficult to discover, I should be inclined to say, that the virulent cause still exists in the se- condary affection, whose existence it maintains by its presence, but it is completely transformed in the tertiary affection. The more the disease penetrates into the system, losing its specific SPECIAL TREATMENT OF TERTIARY AFFECTIONS. 207 nature, and undergoing the transformations, which tend to assimilate to diseases of another nature, the more difficult does the treatment be- come. The mercurial treatment affords a peculiar interest to those who will attentively observe its action: thus we find it of little efficacy, and indeed often hurtful in the primary affection, during the period of progression or increasing ulceration, it then becomes powerful, as soon as induration manifests itself in the chancre; and shows its greatest efficacy, when the characteristic general infection is in the period of incontestible secondary affections, again losing its curative properties in the tertiary affections, and that the more so, the further they are re- moved in their form from the preceding. Deep seated tubercles of the skin, and mucous membranes, (lupus syphiliticus). These tubercles most frequently affect the alae and lo- bulus of the nose, and sometimes show themselves on the glans, where they may be mistaken for superficial mucous tubercles; 1 have found them on the tongue, cervix uteri, &c. stimulating schirrous, or carcino- matous indurations. Generally complicated with scrofula or cutaneous affections, their progress is slow, and unattended with pain; they deform the parts on which they are seated and are inclined to sink into the depth, becom- ing more and more indurated; then undergoing a kind of ramollisse- ment, which is soon followed by an ulceration, the progress of which is difficult to arrest, and which destroys all the tissues, which the in- duration had attacked. These tubercles, which may appear isolated or in considerable num- bers, and assume forms to which more or less picturesque names have been given, are susceptible of a spontaneous resolution, or a kind of rapid resorption, under the influence of which they soften, wither, and without ulceration, terminate by transforming themselves into a kind ol crust on the skin of a horny nature, which leaves, on falling off, a spot, most freqently depressed. The treatment of the deep tubercles of the skin or mucous mem- branes, ought in the first place to consist in attacking all the complica- tions which may co-exist with the syphilitic element, which is never the sole cause of their production. When all the indications which scrofula, cutaneous, or other concomitant affections may present are fulfilled, we must recur to the mercurial treatment. In these cases, we derive much benefit from mercury, combined wTith conium, and the success is often complete, when it is according to the case aided by other therapeu- tical agents, whose history and rules for their administration we have traced out. The local treatment requires, whenever any irritation ex- ists, the application of emollients and narcotics; opiated cataplasms, fomentations with decoctum papaveris, conium, &c. If any inflam- mation exist, a few leeches ought to be applied at some distance from the indurated spots. Lastly, if the tubercles be in an indolent state, the dressings ought to be repeated once or twice a day with honey and protiodide of mercury, continued as long as it does not produce any irritation. When the disease still persists, a cauterization with 208 SPECIAL TREATMENT OF TERTIARY AFFECTIONS. nitrate of mercury must be employed, but not so as to suddenly ex- tend too deep, in order to avoid the inflammatory action, which is al- ways injurious. This method often produces with the general treat- ment pretty rapid cures, especially when it has been early applied. Dressings of chlorinated soda and calomel, as recommended for mu- cous tubercles, often succeed, even in the ulcerative period, and when there is not too much irritation. Most of the mercurial ointments are injurious, they irritate and pro- duce inflammation. It must be remembered, that the treatment ought to be purely antiphlogistic, as long as any infla mmation exists, what- ever may be the internal treatment indicated, and followed according to the general state, aad the other symptoms which may be present. Osteocopic pains. These pains do not alone constitute a disease, they may however, undoubtedly exist alone, continue a time, and then disappear without leaving any perceptible change of structure in the regions they may have occupied; but most frequently they are the first apparent symptoms, as in most inflammations, of a periostitis or ostitis, and that especially, when they become more confined to one spot. The intensity of these pains, seems to depend upon the difficulty with which the periosteum and medullary membrane distend. They are generally nocturnal, but this is not a specific character with- out exception, for the contrary often occurs, and diseases unconnect- ed with syphilis, may present the same phenomena. The occurrence of osteocopic pains, when other characteristic symptoms of confirmed syphilis exist, ought not to induce us to sus- pend the mercurial treatment; on the contrary, this treatment, far from producing these pains, as has been asserted, soon calms them when properly administered. We must not mistake rheumatic, for esteocopic pains, if we wish to obtain from mercury what we have a right to expect, nor confound them with certain swellings of the joints, which the abuse of the medicament might produce. The direct treatment consists in the local application of leeches, emollients, and narcotics. Antiphlogistics and sedatives often suffice to suspend, or remove these pains entirely. Nevertheless, it is not unusual to see them resist the most methodic treatments, and consti- tute one of the most distressing symptoms, depriving the patients of sleep, and thus disturbing all the functions. It is in these truly despe- rate cases, and also in those which are less intense, that the effect of blisters is quite astonishing. In my clinical wards, patients may be seen, who for six months and more, had not been able to obtain an instant's repose and who have been freed from their sufferings in four- and-twenty or eight-and-forty hours, when no change of structure had taken place. The blisters ought to be applied directly to the seat of the pain: when it has drawn, the epidermis should be opened, but not removed, to avoid giving pain. The dressing of opiated cerate should then be applied, and over it, warm cataplasms, which must frequently be re- newed, so as not to allow them to get cold. When one blister is dry, SPECIAL TREATMENT OF TERTIARY AFFECTIONS. another must be applied, and so on, if the pain return. In cases in which the pain returns too quickly after the cessation of the suppura- tion, perpetual blisters must be employed, instead of those recom- mended above. I can assert that by this treatment, without anti- phlogistic preparation, eight out of every ten patiems may be cured; sometimes however, the pain nevertheless remains, in which case a more energetic local treatment is required, as it only yields to a deep incision into the diseased parts, b) which a true strangulation is re- lieved. The cessation of the suffering in these fortunately rare cases is instantaneous. Periostitis. The uncomplicated and idiopathic inflammation of the periosteum is perhaps more rare than is generally imagined. 'J he losening of this membrane and effusion under it, which thus fjrms tumors adherent at their base, and which are termed periostoses, are most frequently owing to a superficial ostitis. These more or less cir- cumscribed tumors, are generally situated on the superficial bones; tibia, clavicles, cubitus, radius, &c. and where these bones are near- est to the skin. Sometimes ihey are indolent, but most frequently painful to the touch, and present a more or less evident fluctuation. The skin over them may remain for a long time mobile, and without any perceptible alteration. Lastly, they may undergo a spontaneous resolution, or terminate by suppuration and form abscesses. WThen they are opened, the bones are found simply denuded, carious, or necrotic to various depths, and in the most fortunate cases, already presenting a surface covered with granulations. In the first place, we must have recourse to the treatment recom- mended for the osteocopic pains, which accompany them, and under the influence of which they often disappear, often even when a very con- siderable effusion has taken place. If the tumor remain without acute symptoms, an application of diluted tincture of iodine, the strength of which must gradually be increased, has often succeeded with me, as well as the application of blisters and solution of corrosive subli- mate, as in case of buboes. There are some cases, in which, after the resolution has progressed with a certain rapidity, it suddenly stops: then we may substitute a metho- dic compression, as described by M. Lisfranc, axoiding causing an in- crease of pain; its effects may be increased by the simultaneous use of the mercurial plaster, or that of conium with iodide of lead. If however, the periostoses has terminated by suppuration after having endeavored to procure its resolution without opening it, we must not wait till ihe skin has become changed, and the pus has accumu- lated in a large quantity and denuded those points of the bones, which otherwise would have remained sound. An opening should be made with a bistoury in the same direction as the axis of the bones, so as to allow the pus freely to flow out. The opening being made, the same treatment must be pursued as in cases of simple abscesses, or diseases of the bones, where these are affected. Syphilitic ostitis. According to many writers on syphilis, this af- 27 210 SPECIAL TREATMENT OF TERTIARY AFFECTIONS. fection is owing to a combination of the syphilitic virus with mercury; but we have repeatedly seen, in the wards of my hospital, in patients who have had characteristic, primary, and secondary affections, but without their having in any way employed mercurials. In fact, the occurrence of affections of the osseous system, does not by any means depend upon the employment or abuse of mercurials, in the treatment of syphilitic affections; but, as every attentive observer must acknow- ledge, their occurrence depends upon the antecedent syphilitic affec- tion, for it will be found, that in most individuals affected with exosto- ses, either a chancre and secondary symptoms have existed, or a gon- orrhoea, in which case there must have been a chancre in the urethra. Never will the development of these symptoms be found to depend upon the absolute quantity of mercury taken, but on a peculiar idiosyn- crasy, or the faulty treatment of their antecedents. Causes unconnected with syphilis may give rise to ostitis; but whilst syphilis is one of the most frequent, no observations go to prove that mercury alone, except on the alveola, in consequence of a mercurial stomati is, can produce similar effects, without venereal antecedents. Ostitis has generally the same seat as periostitis; it is sometimes circumscribed, sometimes diffuse; it attacks the superficies or paren- chyma of the bones. Slow or chronic in its progress, it often assumes a subacute form, and after remaining sometime as merely a simple os- teocopic pain, the swelling it causes betrays its existence. The tu- mor arising from an ostitis, is either owing to an effusion of the succus ossium, as in the formation of callus h fractures, and then constitutes an epigenic exostosis of various form and volume, with either a brqad or narrow base, and smooth or rugged periphery; or else the swelling depends upon the increase of the whole thickness of the bone, and produces the parenchymatous exostosis or hyperostosis. Ostitis ends in resolution, suppuration, (caries) necrosis, and in induration (exos- tosis eburn:e). Resolution is easy, when the swelling depends on the organic tissue, or an effusion of coagulable lymph. Wnen the disease is seated in the spongy bones, those of the face in particular, suppuration is easy a.jd frequent. Necrosis often caused by the violence of the inflamma- tion, is still more frequent from a sudden effusion in the tissue of the bones, or from the losening and destruction of the soft parts which sur- round them, and which involves that ot their nutritant vessels. Last- ly, the termination in permanent induration takes place whenever the tumor is only owing to an effusion of the saline inorganic matter, which enters into the composition of the bones. The treatment of ostitis in the commencement, must be the same as that of osteocopic pains and periostitis. When theosseous tumor is developed, to the use of blisters, dressings of mercurial ointment on the denuded sir face (about half a drachm per d;etn) may be added. Under this most powerful treatment with the internal exhibition of mer- cury when not contra-indicated, and sudorifics, protiodide of iron (in complications with scrofula,) a.id vapor baths, we obtain results, if op- ortunely employed, such as no other treatment affords. SPECIAL TREATMENT OF TERTIARY AFFECTIONS. 211 In these cases, the other resolutives (iodine, iodides, &c.) locally employed as also compression, are most frequently void of any decid- ed effects. The treatment ought to be continued as long as any pain remains, or the swelling increases or diminishes; but when it becomes decided- ly indolent and stationary, without any other symptom requiring active treatment, we must stop and not exhaust the system by useless, and therefore injurious, medication. In venereal suppuration of the bones, or caries, especially of the bones of the face, mercury, which has hitherto been so serviceable, ceases to be useful, and even aggravates the disease, especially when salivation is allowed to ensue. We do not say its employment must always be avoided, but that its effect ought to be most narrowly watched. Except as regards the syphilitic element, which ought never to be lost sight of, and which in a few cases affords the best indication with- out being the only one to be fulfilled, the treatment required by syphi- litic caries, is the same as is applicable to caries in general. Never- theless in caries, generally complicated with necrosis of the bones, and which must be distinguished from the more superficial and less serious, which follow previous affections of the soft integuments, which we mentioned above, we must not neglect to remove the diseased bones as soon as they are separated from the sound parts. I have seen the worst consequences from the neglect of this precept, and the more so, when at the same time an injudicious mercurial treatment has been used. I am convinced, that caries engenders caries, and that a bone whose organic tissue has been destroyed by suppuration, or has perish- ed, cannot be regenerated by any general treatment, and that we must not wait till the remains are spontaneously thrown out, as they form true foreign substances, maintaining and propagating the suppuration, which by reaching important parts, as the brain, for instance, produce the most serious consequences, and even death. In the frequent cases of destruction af the maxilla superior, the teeth may remain perfectly sound, firm, or loose in their alveola; but when they are attacked above their neck, they ought to be extracted; for they only serve to retain portions of the dead bone, which by re- maining, allow the disease to proceed still further. The destruction of the vomer is generally accompanied by that of part of the palate, where on the median line a tumor appears, which is soon followed by suppuration and ulceration of ihe soft parts. Here also the diseased portions of the bones ought to be extracted as soon as possible. I published some observations in the Gazette de Hopitaux, on a case in which a large portion of ihe superior maxilla become carious, necrotic, and deprived of its teeth, had become loose in the fossae nasafes, the soft parts of the cheek having remained sound. These portions of bone being too large to be extracted through the nostrils, I removed them by first crushing them with the instruments employed in lithotrity. Before quitting this subject, I would merely add, that the continue.! 212 SPECIAL TREATMENT OF TERTIARY AFFECTIONS. use of blisters placed as near to the diseased parts as possible, affords the most advantageous results. When an ostitis has produced an exostosis, which has become per- manently indurated, these tumors must not be touched, except when they produce too great a deformity or interfere with important functions; the epigenic pediculated tumors may easily be removed. The treatment required by necrosis is the same as is applicable to it in general, the special indications are derived from the concomitant symptoms. Gummata, nodus. Deep seated tubercles of the cellular tissue; a kind of chronic furuncle situated in the subcutaneous, or submucous cellular tissue; they only appear very late after the primary affection, and except in a few less severe cases they are the consequence of a deeply undermined constitution, under the influence of syphilitic cachexy. These tubercles, which are rarely isolated, but generally pretty numerous, and on divers parls of the body at the same time, commence by a small scarce perceptible, but hard tumor, adhering to the skin by a kind of footstalk, and moveable on the subjacent and neighboring parts. Their increase is generally slow and without pain, frequently occupying five or six months, or more. They then attain the size of a nut;* still remaining very hard, they become adherent on all points of their surface, and then a kind of fluctuation becomes by degrees perceptible. The skin becomes red, purplish, and then thin, and perforated on several points, from which thin ichorous pus escapes, carrying with it the organic remains. These openings are succeeded by extensive irregular ulcerations, the skin becoming undermined and thin. These ulcers continue as long as the shell of the tubercle, in which the suppuration commences at the centre, is not thrown out, after which, if nothing else be present to keep up the suppuration, they progress towards reparation and produce a cicatrix, similar to those after extensive burns. The evolution of these tumors, seldom occurs everywhere at the same time: most frequently they come in succession, so as to occupy months or years, notwithstanding any treatment which may be em- ployed. They are sometimes distant from each other, sometimes agglomerat- ed. In two cases in my wards, the tubercles were situated in the sub- stance of the tongue. These two patients, both entered for the third time, an interval of five or six months having elapsed between each time. To. the touch, their tongues appeared filled with nuts. The destruction from ulceration ;vas each time horrible, and to unaccustom- ed eyes, resembled cancers; but both have now been cured two. years. The principal aim of the treatment must be to sustain and recruit the constitution. It must be remembered, that we have to deal with a long and serious disease, which no medication can cut short in its development. As these sympioms generally show themselves in pa- tients who have resisted the effects of mercury, it has therefore no power over it„ and if its use be imprudently pushed far enough to pro- SPECIAL TREATMENT OF TERTIARY AFFECTIONS. 213 duce the symptoms, which may attend its administration, the severity of the disease will be increased. In the affection under our consideration, mercury is only indicated, when at the bottom of the cavity, after the escape of the pus, ulcers, with indurated base and callous edges, remain. The general treat- ment which succeeds best, although it frequently does not procure the resolution of these tumors, is the internal exhibition of iodine, either alone, or combined with iron. Bitters and tonics also deserve to be placed in the first rank. In many cases however, these tubercles are the sole remaining symptoms, and all their severity only depends on their purulent secretion, and the ulceration which follows them; so that the most rational treatment is to destroy them in their commence- ment. M. Cullerier has suggested, that they should be attacked with blis- ters, and the caustic solution employed for the treatment of buboes, has with him as well as mysell often succeeded. 1 have also found their extirpation, while yet hard, very advantageous. When suppu- ration is very evident, the pus ought lo be allowed to escape, before the skin becomes too much changed. When suppuration has ensued, and even after the opening of the abscess, as long as inflammatory symptoms exist, emollients and local sedatives; later, for the ulcers which do not become clean, dressing with simple digestive ointment, then those we employ for chancres are required. Frequently exten- sive ulcerations become atonic, as in other cases of this kind, inde- pendent of the antecedents, have been promptly brought to cicatri- zation, by being bandaged with mercurial plaster (Empl. de Vigo c. mere). There are a vast number of diseases, which may be referred to tertiary syphilitic affections, but we are not at present able to deter- mine their diagnosis, we must therefore content ourselves with saying, with Mercurialis, ct Cum videretis morbum quempiam communibus remdiis non curari, putate esse morbum gallicum cognominatum." And thus we must try a treatment, which may succeed, when the more rational have failed. CHAPTER III. TREATMENT OF NON VIRULENT AFFECTIONS. Section I.—Gonorrhoea. The treatment of gonorrhoea ought to be divided into 1st, the prophy- lactic—2nd, the abortive*—3rd, ihe curative, properly so called. * I have preferred retaining the term abortive, although objectionable to substituting another, the sense in which it is used will be evident from the text. H. D. 214 TREATMENT OF GONORRHOEA. The prophylactic treatment having been considered above, we will proceed to examine that which is calculated to prevent the develop- ment of the disease, after it has commenced (abortive treatment.) In the first place, the patient must not only be removed from the causes which may have produced the disease, such as every kind of excite- ment of the sexual organs, but also all possible antiphlogistic means must be used. The following is the result of my experience : when an individual has exposed himself to a gonorrhoeal infection, amongst the hygienic msans then indicated, such as diet, rest, &c. baths and copious refreshing drinks, which are generally considered as so impor- tant, are far from possessing the efficacy, which has been attributed to them. The large quantities of fluid, cause the urine to be passed very frequently, thus fatiguing the canal, and predisposing it to inflamma- tion; with regard to baths, when we find with what facillify they fre- quently recall a discharge, which has ceased for some days, we may easily conceive that they may favor its development. After these general precautions, the diseased surfaces require to be modified; here two methods present themselves, 1st, revulsion,—2nd, direct medica- tion. All varieties of gonorrhoea, requiring modification in each, we shall further develop the following principles in the proper place. The first question which arises is, what is necessary to be done, when the abortive treatment has not been employed, or has failed, and the disease has become confirmed ? As gonorrhoea in the acute stage presents the characters of catarrh, the treatment ought to be essential- ly antiphlogistic. The abstraction of blood will form the basis, and local depletion will be found the most advantageous. Leeches as has before been observed, Ought never to be applied on loose duplicatures of the skin, with intervening cellular tissues, as on the eyelids, skin of the penis, &c. as they may cause oedematous swelling, and a gangre- nous erysipelas; when applied at some distance from the seat of the disease, they are equally efficient, provided their number be in propor- tion to the gravity of the disease. Another no less important point to be observed is, that leeches ought never to be applied upon a declivi- ty, or within reach of the diseased organs, that their bites may not be- come soiled by the morbid secretions; for if the gonorrhoea be com- plicated with chancres, they will be transformed into so many syphilit- ic ulcers. The use of general or partial baths during this period, has been much praised; generally they answer well, but it may not be amiss here to note some peculiarities in their employment. I prefer general baths. The temperature at which they are used, ought to be moderate, as hot or cold baths have very different proper- ties from those properly termed tepid, and which depends upon the impressson, made upon the patient; so that the proper degree of heat depends upon the feelings of each individual, and not upon the ther- mometer. A temperature, which would render a bath exciting, would be very hurful, and it is by no means uncommon to hear a patient complain of having suffered more, either during or after its use, than before. Baths prolonged, during a considerable time, are from the TREATMENT OF GONORRHOEA. 215 relaxation they produce, very favorable in their effects; but in order- ing ibem, we must pay attention to ihe individual disposition; for there are some, in whom they produce an excitment by their action on the nerves. Their efficacy is therefore relative, and sometimes their use must be altogether forbidden. In all cases and whatever may be the mucous membrane which is diseased, it is of great importance to free its surface from the morbid secretion. Washings, injections, and lo- cal baths, will advantageously accomplish this end; but these different means must be judiciously employed, duly weighing the good they produce, with the inconveniences which sometimes attend them. They ought never to be so used as to fatigue the organs. We must also fa- cilitate the functions of the parts diseased, or modify, or even suspend them if possible, when they are the cause of irritation. The patient's drink should be copious, simple, agreeable, and easily- procurable fluids. The diet must be more or less restricted, accord- ing to the intensity of the inflammation and the state of the patient. The utility of perfect rest is not less apparent than in other cases of inflammation. Under the influence of the treatment which we have just described, the symptoms of the acute stage may completely disappear, some- times it has sufficed to allow the disease to exhaust itself, only remov- ing the causes which produced it; but more frequently it becomes chronic, in which case another treatment must be employed. When it is bordering en the acute stage, we must not too soon abandon the employment of antiphlogistics; bul at the same time neither ought we recklessly to coutinue their use, as they often favor its prolongation. A very favorable methodic transition consists in suspending the use of the too relaxing ageuts, and employing direct resolutives, which must be succeeded by revulsives, the properly so called antiblenorrhagics and astringents, either general or local tonics used in the same man- ner, excitants, &c. as soon as the acute symptoms or pain diminish or disappear. We will examine the antigonorrhceal medicaments, as they will best apply to the several varieties. Frequently however ihe gonorrhoea, or the chronic state remain; in which case, we must endeavor to discover the cause which maintains it. Sometimes without enquiring about the existence of any change of structure in the tissues, upon the disease not having yielded to the usual treatment, the acute stage has been reinduced either by means of simple irritants, or by a new infection, if the efficacy of the for- mer of these means is not proved in most cases, the latter is quite un- justifiable. An antisyphilitic treatment has frequently been employed, either in despair or from a conviction of the syphilitic nature of gonorrhoea, and has sometimes been attended with success. In cases in which the discharge is only the consequence of concealed syphilitic ulcera- tions, the results of the treatment are more decided and easier to un derstand. But the antisyphilitics which are employed, may influence 216 SPECIAL TREATMENT OF GONORRHOEA— other diseases beside those dependant on syphilis. May they not, by acting as revulsives or tonics, so modify the system as lo produce a cure? For my own part, I never employ antisyphilitics, nor espe- cially mercury in gonorrhoea, except they be positively indicated, as where every other treatment has been resisted, or true syphilitic symp- toms exist, under circumstances which we have before described. In all cases in which I have found them indicated, I have avoided giving them during the acute stage. Section II.—Special Treatment of Gonorrhoea. First Species: Gonorrhoea in Women. C of the vulva } Varieties.........) — VilSina \ alone or variously combined. J ------- uterus C ' -------urethra ) Women rarely consult a medical man early enough to allow of the gonorrhoea being cut short in its development, either because they do not confesss their disease until it is too late, or because they do not at once perceive it. However, if applied soon enough, that is within the first two or three days, astringent injections and applications would generally be crowned with success, in cases where the vulva, vagma, or uterus are affected; whilst copaiva and cubebs have sometimes suc- ceeded in urethral cases. If slight inflammatory symptoms should already exist, the application of a few leeches to the vulva might be added. But as we before said, we have rarely an opportunity of preventing the development of gonorrhoea in women, and we must therefore ob- tain its cure by a slower and more methodic treatment. In the acute stage, whatever may be the variety or varieties, the most absolute rest possible is of the first importance, and abstemious diet ought to be observed. Baths are most useful, and whenever the state of the parts will allow, vaginal injections should be made, whilst in the bath, with the same water. These injections are peculiarly effi- cacious in vaginitis, and uterine gonorrhoea. Should the acuteness of the symptoms require the employment of leeches, (if no secretion takes place in the fold of the thighs, &c. constituting an extra-genital gonorrhoea,) they should be applied on the exterior of the greater labia, and always nearer to the plica cruralis than to the perinaeum, to shelter them as much as possible from contact with the morbid secretion, which always flows towards the inferior parts, and tends to irritate the wounds they make. In the contrary cases, the leeches must be ap- plied in the fold of the thigh. When the gonorrhoea, and especially where the uterus is affected, is accompanied by a febrile reaction, great benefit will be derived from general depletion. The patient should drink freely of some agreeable beverage, but the qcantity taken, does not require to be so large as in men, as the heat upon voiding the FIRST SPECIES: GONORRHOEA IN WOMEN. 217 urine is by no means so intense. The local treatment is howev- er the most important. Where the vulva and external parts are af- fected, cleanliness, and emollient and slightly narcotic fomentations will be found very beneficial. The parts diseased ought to be isolated; thus the thighs should be prevented from touching the greater labia, which should be separated from each other by a tampoon of fine lint, dipt in emollient narcotic liquids. When the inflammation is very acute, and the introitus vulvae is either naturally very small, or become so from the inflammatory swelling, we must confine ourselves to exter- nal applications, and even avoid injections, as even the introduction of the olive-shaped cannula may produce too great an irritation; but when it can be affected without giving pain, a tampoon of fine lint, dipt in the medicated fluid, and moistened two or three times a day should be introduced, as it supplies, in a manner, the place of cata- plasms. When the uterus is affected, emollient cataplasms should be applied to the body. I never order leeches to be applied on the cer- vix uteri, as in case of the existence of virulent ulcers in the interior of this organ, they would probably be transformed into as many chan- cres. The tampoons ought, if possible, to be renewed two or three times a day, as otherwise they retain the morbid secretions too long and thus increase the irritation. I need scarcely add, that if a pes- sary has been introduced, it ought at once to be removed. Acute urethrisis is seldom accompanied by retention of urine, and when it does exist, it is generally of short duration, and yields to an- tiphlogistic treatment; but nevertheless, sometimes it requires the use of the catheter, which ought to be introduced with the parts exposed, notwithstanding the objections raised, as less pain will be caused, than if the surgeon had to feel his way. I have found in nervous subjects, in whom the strangury seemed to'depend on spasms, that a tampoon, imbibed with a solution of belladonna, sufficed to relieve the symp- toms. , . , , j The swelling of the nymphae and labia, which we have compared to a kind of phimosis or paraphimosis peculiar to women, yields gene- rally to rest and antiphlogistic treatment; but when the swelling is con- siderable, with serous infiltration, incisions must be made in it, as gan- grene from excessive inflammation, only occurs in cases of neglect, and where sufficient blood-letting has not been insisted on. When this unfortunate termination already exists, if inflammation be still present, an antiphlogistic treatment must be pursued, consulting ihe general strength of the patient, and lint, dipped in a solution of extract of opi- um applied. A urethro-genital gonorrhoea may be complicated with simple abscesses, whose detailed history we do not want to enter up- on We may however remark, that as these abscesses are generally the result of a violent inflammation, their development will be pre- vented by the treatment which is used to combat it, and more especial- ly when we avoid any further irritation of the already diseased parts. Thus, in cases of acute gonorrhoea we ought not to use the specu- lum, and I can affirm, that I have never seen a case at the Hopital 28 218 SPECIAL TREATMENT OF GONORRHOEA— des Venoriens, in which these abscesses have been developed, in con- sequence of the use of this instrument, as some have thought. These abscesses sometimes depend upon the inflammation of the cysts, which some women have at the entrance of the vulva; in all cases, they ought to be promptly opened. It ought to be noted, that suppuration here quickly succeeds to inflammation, and if the pus be not allowed to escape, infiltration of the loose cellular tissue, surround- ing the rectum, and lastly, perforation of this intestine, thus forming either complete or incomplete fistules. The vaginal abscesses ought to be opened by a large incision: the pus is often brownish, with the odor of foecal matter from the neigh- borhood of the rectum, without any communication existing with this intestine. When the abscess is the consequence of an inflamed cyst, the matter is mostly stringy. If these fistules are yet in an early stage before their passages have undergone the mucous transformation, compression by means of a tampoon introduced into the vagina, gen- erally suffices to obliterate them. When this means has failed, cau- terization of the passage, with nitrate of silver, either in powder, by means of a director, or better with M. Lallemand's instrument, has often succeeded. I have derived much benefit in some cases from traversing the fistule with a probe, covered with a bit of lint rolled around it in a spiral form, and dipped in nitrate of mercury. After one or two cauterizations to destroy the pseudo-mucous surface, tinc- ture of cantharides has been introduced in the same manner, to excite the development of the granulations necessary to obliterate the cavity. In one case which had resisted these various treatments, I obtained a cure by introducing into the fistulous passage the urethrotome, which is employed to divide the meatus urinarius, and thus scarifying its whole length in several points of its circumference. When the fistules are of but little extent, the shortest method is to treat them like com- mon fistulae in ano. Ovaritis, considered as a complication of gonorrhoea, requires anti- phlogistic treatment, commensurate with the intensity of the symptoms. Leeches applied to the lateral and lower parts of the abdomen, anus and sacral region, general depletion, aided by emollient fomentations and cataplasms, generally succeed. The bowels ought to be kept open by gentle laxatives. Here, as in orchitis, frictions with mercurial ointment made upon the abdomen, may promote the resolution. Whent he acute stage is passed, revulsives, such as blisters, applied to the internal surface of the thighs, frictions with ung. antim. et pot. tart, in the iliac region, will be found very advantageous. I have not found it necessary to employ mercurials internally. But sometimes acute gonorrhoea in women, whether complicated or not, resists the most judicious soothing treatment and is aggravated by the use of mercurials. In some of these cases in which the red and turgid mucous membranes afford a copious purulent discharge, attend- ed with acute pain, which neither rest, depletion, emollients, nor nar- cotics can assuage, I have obtained astonishing results from the use of nitrate of silver. FIRST SPECIES: GONORRHOEA IN WOMEN. 219 A superficial cauterization with solid nitrate of silver, or a solution of it, applied by means of lint, has favorably modified the inflamed surfaces and produced a solution of the disease. After the use of the cautery, a tampoon of dry lint must be employed to prevent the con- tact of the parietes of the vagina. As has been seen, when ihe disease is fully developed, and in the acute stage, we never use the antigonorihoeal medicaments, such as copaiva and cubebs, &c. for if they are not always hurtful, they are at least without effect. When the acute stage has yielded, at the same time as the sedatives are continued, such as diet drinks, regimem repose, and baths, we must hasten the cure, so as not to allow the chronic stale to become established, by employing resolutive applications and injections. The fluid I prefer, is either a solution of crystalized acetate of lead, or sulphate of alum and potass. As the affection becomes removed from the acute stage, the strength of the solution is to be increased to an ounce to the pound of water. By means of these injections and tampoons dipped in the same liquids, sixty out of a hundred patients will generally be cured in the space of from twenty days to two months, including the treatment of the acute period; at least this is the result of the observations made in my wards. The chronic stage is however, far from always yielding in so prompt a manner. When the tissues have undergone no change, we must employ more tonic applications; one which I frequently use, is a de- coction of oak bark, with equal parts of the solution of sulphate of alum. Should irritation exist, I substitute a decoction of mallows with the alum. Zinc, extract of ratanhia, sublimate, alum, &c. may be successively employed. Injections with alcaline chlorides have only appeared to me suitable to some cases, in which the vaginal dis- charge was offensive, or where ulcerations existed. In order to reach the cavity of the cervix uteri, a syringe, such as employed for inject- ing a hydrocele, should be used. Some discharges, which resist all the above applications, seem to be maintained by the contact, even of the mucous membranes, and the depth of the parts continually placed in the unfavorable conditions of heat and moisture. It occurred to me, without knowing that Ambro- sius Pare had proposed it, to isolate the diseased surfaces, by means of a speculum fenestratum, and thereby allow the continued introduc- tion of the external air, as the parts which are most exposed to it heal the quickest. But as I found some difficulty in applying it, I was obliged to relinquish its use. Laterly, the following process has suc- ceeded well with me; I fill the vagina, without much distending it, with dry lint, renewed two or three times a day, according to the quantity of the discharge, which in the cases which terminated suc- cessfully, was white and milky, and proceeded from the vagina alone. But when the chronic stage, or the gonorrhoea is accompanied by a change of tissue, it is that which we have to contend with, in order to 220 SPECIAL TREATMENT OF GONORRHOEA— procure a cessation of the discharge. If any vegetations exist, they must be treated as we shall presently describe. Ulcerations and pa- pulous granulations must be cauterized either with nitrate of silver, which is to be preferred, or with nitrate of mercury, by means ol a bit of lint; the parts to which it is to be applied, having previously been cleaned with a piece of dry lint. Should the mucous secretions, as those on the cervix, be too adherent, they must first be coagulated with the liquid caustic, so that they may be removed with the pincette. Tlie energy with which the caustic is to be applied, must be in pro- portion to the affection. lis efficacy is particularly evident during the granulating period, and when the ulcerations present the appearance of a blister. When the tissues have been destroyed to a certain depth by the ulceration, caution is required in the use of the caustics. Un- der these circumstances, I have succeeded by sprinkling calomel on the diseased parts, and then applying dry lint. After each cauteriza- tion, a tampoon must be applied, moistened according to ihe case with one of the before mentioned liquids. Like other portions of the mucous membrane of the sexual organs, the internal surface of the womb is frequently the seat of ulcerations, which the means hitherto pointed out cannot cure. We must here, as in the ulcerations of other parts, modify the surfaces in a more pow- erful manner; but the greatest precautions are necessary in cauterizing the interior of so delicate an organ, the reaction of which would be so powerful; for whilst the most powerful caustics applied to the ori- fice of the cervix, generally produce no pain, fluids scarce possessing any caustic properties, being introduced into the cavity of the uterus, may cause the most serious consequences. Wearied with the protracted continuance of certain uterine dis- charges, I made some attempts to cure them. I first used an injec- tion of one [art nitrate of mercury, and eight of water. Some pa- tients had very violent hysterical attacks; one of them had a cerebral congestion, which caused a momentary apprehension of apoplexy. These symptoms, which all arose a few minutes after the injections, yielded vevy rapidly to antispasmodics, and in the case with cerebral congestion, on a quantity of blood being .taken from the arm. Al- though the affections submitted to this treatment were either cured or partially so, I was obliged to reduce the doses to avoid the serious consequences. I subsequently obtained some cures with one part of nitrate of mercury, to twelve of water, without producing the symp- toms I before mentioned; but yet the action of these injections was not always unattended with pain, or some nervous reaction of an hys- terical character. I then substituted six grains of nitrate of silver to the ounce of water, and found that in some instances, a chronic puru- lent uterine discharge was cured after two or three injections. I may here remark, that nitrate of silver applied to the cervix and cavity of the uterus, frequently acts as an emmenagogue. We may from the foregoing conclude, that uterine injections of a solution of nitrate of FIRST SPECIES: GONORRHOEA IN WOMEN. 221 silver, ought to form a powerful means of treatment in uterine catarrh, and particularly in uterine gonorrhoea. The antigonorrhoeal treatment by internal medication, is far from possessing an absolute efficacy in utero-genital gonorrhoea, as it seems in women, to act only on some isolated varieties. In like manner, the ergot of rye appears to me, in the few cases in which it has been of service, only to influence uterine gonorrhoea, and to be inert in cases where the vagina and vulva were affected. Copaiva and cubebs appear to have no decided action on the vagina, or uterus, whilsf a urethral gonorrhoea is in women, as in men, powerfully influenced by them, so that what we shall say with regard to urethral gonorrhoea in men, will be equally applicable here. Sometimes, however, a local treatment is required; thus it is not rare to find vegetations originating in the interior of the urethra, constituting what were formerly termed caruncles or carnosities; these maintain discharges, which cease when they are destroyed by incision or cauterization. I lately operated one, which protruded from the meatus urinarius, and occupied the whole extent of ihe urethra, arising from near the neck of the bladder. In many cases, chronic urethral discharges, which are more frequent and obstinate lhan is generally supposed, only yielded to injections made in the same manner and with the same fluids as we shall point out, when we come to treat of gonorrhoea in men. Under some circum- stances, even cauterizations with nitrate of silver, have terminated discharges, which were probably kept up by erosions, whose presence was betrayed by great sensibility during catheterism. After the cure of vaginal and uterine gonorrhoea, I advise injections of cold water to be continued for some time, once or twice a day, taking care to discontinue them four or five days before the period when the menses are expected, and again employing them four or five days after their cessation. As the local treatment of gonorrhoea in females is of the greatest importance, it may not be amiss to give some details as to its mode of application. I. Fomentations and injections ought to be tepid, when composed of emollient liquids; but cold when resolutives, tonics, astringents, &c. are applied. II. The injections may be made with the common female syringe.* The patients should be instructed not to introduce the instrument more than an inch or two beyond the annulus vulvae. In children, or where the hymen exists, a straight cannula with a conic end must be employ- ed. The patients should place themselves in a recumbent posture, with the pelvis elevated so as to allow the fluid to reach the more re- mote parts of the vagina, this position being continued after the injec- tion, causes it to act as a local bath. Vaginal cataplasms can only be applied where the annulus vulva is of sufficient dimensions. • Similar to Clark'i. H. D. 222 SPECIAL TREATMENT OF GONORRHOEA— To administer uterine injection, the patient must be so placed as to allow of the introduction of the speculum. The fluid, whether emollient, astringent, or simply tonic, can be injected by means of a simple syringe, furnished with an elastic rubber tube, the free end of which is to be introduced a few lines into the orrifice of the cervix ute- ri; this portion of the tube must be covered with some fatty substance, and its dimensions must not be such as entirely to fill the orifice, but permit the reflex of the ejected fluid. As the caustic injections ought to be allowed to remain but a short time, I have had a syringe constructed composed of two pumps, with separate pistons, terminating in a double cannula: one contains the caustic fluid, the other water, so that either can be injected at pleasure. I first inject the caustic fluid, which I allow to remain a minute or two, after which the water is forced in so as to wash the surfaces. Urethral injections are made with ihe same syringe as in men. To prevent the fluid entering the bladder, it will suffice to compress the posterior part of the urethra against the pubis, with the finger in- troduced into the vagina. When tampoons are to be applied, an injection must first be used, of the same fluid as is used to moisten the tampoon, made of lint and sufficiently large to fill without distending the vagina, which must next be introduced. Women in applying it themselves, use a finger to push the lint far enough to reach the cervix; but if much of the fluid has been pressed out, a fresh injection must be made. Although it is generally necessary to allow the patients to apply the dressings them- selves, those applied by a surgeon are far more efficacious. When the surgeon places the tampoon himself, he ought to use the speculum, by which means he can carry it with certainty to the cervix, and dis- tribute it to all parts of the vagina. It may be proper to remark, in concluding these observations, that sometimes when a solution of acetate of lead has been employed, its color becomes changed, and in some women the tampoon after remain- ing twelve or fourteen hours becomes quite black; this seems to be owing to the formation of a sulphuret of lead; for this has been most frequently observed in women affected with a fetid discharge, or who have the annulus vulvae greatly dilated, and thereby allowing the easy introduction of the mephitic air, when the bowels are relieved. To apply the solid nitrate of silver, I use a holder, with three blades, having a slightly curved tooth at their extremity, and moving in a can- nula, like the instruments employed in lithotrity. By means of this instrument, the caustic is firmly held and very easily applied. SECOND SPECIES: GONORRHOEA IN MEN. 223 Second Species: Gonorrhoea in Men. C of the glans. balanitis) , . Varieties..?-------prepuce, posthitis 5 Pseudo g°norrno3a (-------urethra, gonorrhoeal urethritis External Gonorrhoea.—Balanitis and posthitis. When the external gonorrhoea is slight, it frequently yields to rest, soothing diet, and cleanliness. The cessation in these cases, is the more easy if the prepuce is still moveable on the glans; but when the disease has become a little developed, the aid of art is required. When the glans can be uncovered, and the inflammation is not exces- sive, the method which I have found to succeed best, is passing the pencil of nitrate of silver gently over the diseased surfaces, so as superficially to cauterize them, after which it will suffice; to place a bit of dry linen around the glans, drawing the prepuce again over it. After this little operation, slightly resolutive fomentations should be applied to the penis, consisting in compresses, either dipped in cold water or diluted liq. plumbi. The linen should be removed twice a day, applying each time a little lead water. The disease frequently yields to a single cauterization with nitrate of silver; but under some circumstances, it has to be repeated two or three times, at intervals of two or three days. Should the inflammation be very acute or complications exist, es- pecially a natural or acquired phimosis, active antiphlogistic treatment will be required; thus leeches must be applied in the genito-crural plica. Emollient local baths of decoctum malvae, linseed, tepid milk, the slightly narcotic decoction of dulcamara, or poppy heads, repeated injections of the above fluids between the glans and the prepuce, are indispensable. When there is much oedema and but little inflamma- tion, one or two slight incisions on the lower part of the prepuce, pro- duce a salutary disgorgement. When an erysipelatous state exists, the incisions seem to hasten the termination in gangrene, whilst deple- tion, as directed above, strict diet, absolute rest, are of the greatest service; gentle laxatives are also frequently very useful. When gan- grene was threatened or already existed, I have derived much benefit from fomentations with a solution of extract of opium, and injections of the same fluid between the glans and prepuce. The internal ad- ministration of opium, has also afforded great relief in doses of a grain, two or three times in the four-and-twenty hours, but more particularly when given in an enema with eight grains of camphor. Mercurial ointment applied between the glans and prepuce, which some have so highly praised, has appeared to me hurtful at some period of the dis- ease in which it was employed; but I have sometimes found it of ser- vice, when, according to my method of treating erysipelas, I have ap- plied it to the prepuce when this complication existed. I ought how- alone or combined. 224 SPECIAL TREATMENT OF GONORRHOEA— ever to observe, that I have found mercurial ointment less advanta- geous in oedematous erysipelas of the sexual organs, than in the other varieties of this affection. But under the circumstances we have just mentioned, and in ihe uncertainty as to the existence of a complication with syphilitic chan- cres, I am never in haste to operate a phimosis, unless there be era- minent danger ol gangrene, or that it already exists; being convinced that the operation frequently adds to the gravity of the disease, as we shall have occasion to point out when we treat of the different kinds of phimosis. Frequently we find an external gonorrhoea maintained by a want of cleanliness, an herpetic affection, alterations of tissue, such as ulcera- tions, of which we have already been treating; the presence of vege- tations and especially by the existence of a permanent phimosis, either congenital or acquired. Generally as the phimosis is one of the most powerful agents in maintaining the discharge, we can seldom hope to cure it until the phimosis be removed. Sometimes however a cure may be obtained whilst it still exists, by using resolutive and astringent injections between the glans and prepuce, aud fomentations of the same fluids on the whole length of the penis. But here also an application of nitrate of silver, either in substance or solution, offers the most favorable chances of success. So efficacious have I found the nitrate of silver, that the first thing I do in treating a case of acute balanitis with an inflammatory phimo- sis, is superficially to cauterize by introducing a stick of this caustic, and carrying it rapidly round between the glans and prepuce. So rapid are its resolutive effects, that a single cauterization frequently suffices, and in four-and-twenty hours, enables us to uncover the glans. In the treatment of balanitis, neither mercurials, copaiva, nor other anti-gonorrhoea 1 medicaments are required. Urethral Gonorrhoea.—Gonorrhoeal Urethritis. We are often consulted by patients who are disturbed after having exposed themselves to infection by a suspicious intercourse. Some- times no symptoms yet exist; in other cases the prodromi have ap- peared : slight itching in the urethra, especially in passing water; a sense of weight in the penis and scrotum; and sometimes a want to pass the water frequently, which is soon followed by a little redness of the meatus urinarius, and an increased secretion of mucous, but not yet altered. These slight symptoms, which a little fatigue and excitement may produce, do not announce the presence of a gonorrhoea, for they fre- quently disappear again; but at least it ought to induce a patient to be on his guard. Where there is an uncertainty as to the future symptoms, an ener- SECOND SPECIES: GONORRHOEA IN MEN. 225 getic abortive treatment would certainly not be indicated; but it ought to be remembered, That many gonorrhoeas, after the ordinary cause which produces them, are only definitely produced by errors in diet, and excitement of every kind, to which the patients sometimes con- tinue to subject themselves. As soon as a person has just fears, he should be advised to submit to a judicious diet; rest, particularly of the parts affected; a mild diet especially avoiding fermented liquors, which tend to produce the dis- ease. In this kind of prophylaxy, we must beware of advising warm baths, as they often suffice to favor the development of the discharge. If however, the gonorrhoea manifests itself with its pathognomonic sign, that is the muco purulent discharge proceeding from the interior of the urethra, whether there be pain or not, it ought to be arrested as soon as possible after its origin. The symptoms which may fol- low a gonorrhoea, are in direct proportion to its duration, and the de- velopment it is allowed to attain, or to which it is urged by bad treat- ment. When a discharge shows itself, it has been preceded, or accompa- nied by pain, or is indolent. In thejvvo former cases, it is more diffi- cult to prevent the development than in the latter. The method which I have found to succeed best, is as follows: when the discharge is quiet at its commencement, from the first to the third or fourth day, and pain, without other signs of a very acute inflammation be present, twenty to thirty leeches ought to be applied to the perinaeum, accord- ing to the strength of the patient. But at the same time, as leeches are applied as a prophylactic against inflammation, or leastwise to pre- vent the increase of it, if it already exist, the discharge may be sup- pressed by the internal use of copaiva, cubebs, or their analogous substances. It is to be observed, that in this case, the doses must be larger, than those required gradually to suppress a discharge, as the end sought to be attained, requires a pertubatory effect, a sudden re- vulsion. The strictest repose ought to be observed with a rigorous diet, unstimulating broths, cooked fruits, and small quantities of dilu- ent fluids. By pursuing this treatment, we have not unfrequently found dis- charges, taken at the proper time, stop in three or four days. If this has not always cut short the gonorrhoea, in the majority of cases, the very acute symptoms have not been developed, and by pursuing the same treatment a short time longer, the disease was terminated by the twen- tieth or twenty-first day. 1 have generally found, that when pain exists from the commence- ment of the disease, injections have not been so serviceable as in the contrary cases. Indeed they have sometimes seemed to me to have been the cause of the failure of the abortive treatment, although in some cases, injections alone either of a resolutive, tonic, astringent, or caustic nature, have checked certain discharges at their commence- ment. Should the discharge commence without pain, or any sign of inflam- 29 226 SPECIAL TREATMENT OF GONORRHOEA— mation, abstraction of blood is unnecessary, and the action of copai- va, or its substitutes, is in most cases sufficient. Under these cir- cumstances, the common empirical method (by drastic purgatives) is very successful. One of the preparations frequently employed, is the vinous tincture of colocynth, but which will be rejected by every ju- dicious practitioner: in this case, great benefit may be derived from the employment of astringent injections alone, when there is little dis- charge, but when more copious, associated with internal medication. A means for cutting short the development of a gonorrhoea, consists, according to the proposition of Carmichael, in injections of nitrate of silver, into the urethra. These injections, which are to be repeated twice a day, are composed of ten grains of solid nitrate of silver, to the ounce of distilled water. I have employed, and prefer the follow- ing method; I introduce into the urethra, Lallemand's caustic holder, and then exposing the caustic, I-withdraw it, at the same time giving it a rotary motion, so as superficially to cauterize the whole of the mucous membrane of the urethra. If after the first cauterization, too much inflammation should supervene, recourse must be had to anti- phlogistics, otherwise a similar cauterization should be made, three or four days after the first. The use of the nitrate of silver deserves great attention, and its em- ployment ought to be more experimented on than hitherto has been done, to ascertain the best mode of its application, and the precise circumstances under which it ought to succeed. The recent research- es I have made, allow me to recommend, as at present most prefera- ble, injections of weak solution of nitrate of silver, commencing with a quarter of a grain to the ounce of water. If after a day or two, there be no increase of pain, nor diminution of the discharge, ihe strength may be increased by a quarter of a grain, till one of these two effects occur. I have also procured the cessation of discharges which were at their commencement, by superficially cauterizing the canal, and then introducing a bit of dry lint into the urethra, by a manipulation, which we shall presently have occasion to notice. Unfortunately we cannot always succeed in the abortive treatment, either from the failure of the medicaments, although judiciously em- ployed, or from the patients not regularly submitting themselves to it, or lastly, from continuing their excesses in diet or sexual intercourse, or any other bodily fatigue which it may be observe.:, may, in a few rare cases, have been of service, but they cannot be quoted as exam- ples to be imitated. More frequently we are only consulted by the patients at a more advanced period of the disease, when a different treatment is required. In ihe acute stage, some otherwise celebrated practitioners have advised recourse to be had in the first instance to the anti-gonorrhoeal medicaments, at the head of which always stand copaiva. This may sometimes succeed, but I think that all who have had the opportuni- ty of seeing a great number of cases and of accurately observing them, SECOND SPECIES: GONORRHOEA IN MEN. 227 will confess that it generally only oppresses the digestive organs, causing them to revolt against a medicament, which at a later period may become necessary; sometimes we moreover find the inflammation increase under their untimely use. The most rational treatment is here that of the symptoms. To the general treatment mentioned above, must be added local depletion in as great a degree as possible; local baths of decoction of mallo.vs and poppy-heads to be used after each emission of urine, for eight or ten minutes at a time; should the pain be very acute, a little laudanum may be added, or a decoction of bel- ladonna may be substituted. As the emission of urine is one of the principal exciting causes of pain, either by distending the urethra by the volume of the jet, or by its irritating properties, we must, especial- ly in men, seek to modify it. The more aqueous it be rendered the less hurtful it will be, and the more frequently the water be passed the smaller will be the jet, as it depends on the degree of contraction of the bladder, which also depends on the distention of this organ. We see, that of two evils we here must avoid the worst, for were it pos- sible entirely, and without danger, to suppress the urine, it would be far preferable. The erections require peculiar attention, whether they are lascivious or simply automic, accompanied with pain or free from it, the patient must be removed from everything which can excite voluptuous ideas. Rest, general and local antiphlogistic treatment, to which the patient is subjected, often act in a powerful manner in repressing this symp- tom, but generally it nevertheless continues or increases. The patient should be recommended to avoid covering himself too much in bed when the erections occur, and also lo apply cold lotions to the penis. Placing the naked feet on the cold floor, is frequently very efficacious. But the most powerful medication is the use of camphor, combined with opium, either in pills or an enema. I have found but few pa- tients who have not experienced benefit from this treatment. Whatever may be the degree of intensity of the gonorrhoea, the treatment just pointed out, will, when it is uncomplicated, suffice to combat the disease, during the acute period of which not only the actual antisyphililics, either mercurials or sudorifics, but the anti-gonor- rhoeal medicaments, as copaiva, cubebs, turpentine, and injections, ought to be excluded. As long as there is much inflammation, injec- tions ought not to be used, even emollient and narcotic fluids produce more inconvenience by their mechanical action upon the urethra, than good by their soothing properties. To the foregoing, but very few exceptions will be found. During the continuance of a gonorrhoea, the patient must never be allowed to expose himself to the least fatigue without wearing a sus- pensory, which ought to fit exactly, so as not to produce any uneasi- ness in the organs which it is designed to sustain. Although mostly urethral gonorrhoea exists without complications, and may be cured by the means we have just pointed out, cases some times occur which require a peculiar treatment.. 228 SPECIAL TREATMENT OF GONORRHOEA— Sometimes a haemorrhage occurs in consequence of the urethra be- ing ruptured during an erection. This haemorrhage, which in some cases proves salutary as a means of local depletion, may have been caus- ed by the patients who, with the intention of removing the painful retrac- tion of the urethra in the erection cordle, break, as they term it, the cord by placing the penis on a flat resisting surface, a table for instance, and then strike it pretty sharply. The haemorrhage is seldom great and stops of itself, without generally requiring any applications. More absolute rest must be insisted on than ever, and emollients and cam- phor to prevent the return of the erections will suffice. In some few- more severe cases, in which the rupture has been either deeper or attained a larger vessel, recourse must be had to cold applications to the penis, the internal surface of the thighs, the perinaeum and hypo- gastrium. Vinegar and water, or especially ice, generally succeed, acidulated drinks,, lemonade, &c. are equally suitable. The quanti- ties of fluid taken should however not be too great, so as to require a fre- quent emission of urine, which by distending the canal, tends to re- call the haemorrhage by opening the lips of the wound. The pel- vis should be raised and the patient not kept too warm in bed. Should the haemorrhage nevertheless continue in a sufficient degree to become alarming, a slight compression might be applied. By com- pressing different parts of the canal, beginning at the posterior part, we might render the diagnostic mere certain. In one case, in which the haemorrhage seemed to proceed from the pars membranosa, it was stopped by placing a rolled napkin between the thighs and compress- ing the perinaeum. A circular and slight compression might be appli- ed to the penis for the pars spongiosa; it often suffices to stop the flow of blood, but frequently the haemorrhage returns the first time the urine is passed. Then, however objectionable it is to place a foreign substance in the inflamed urethra, we must introduce a bougie, which, by compressing the vessels, stays the effusion of blood; sometimes additional circular external compression is required, but great caution must be used in its application. Generally this bougie may be remov- ed after twenty-four hours, but when the haemorrhage has been great and the instrument does not excite much pain, it is advisable to leave it a day or two longer. If the bougie has been removed too soon and the haemorrhage re-appears, it must be re-applied, if it be not merely a slight sanguinolent discharge. A symptom of gonorrhoeal urethritis, which requires peculiar atten- tion, is the dysuria in its different degrees to complete retention. As soon as difficulty in the emission of urine appears, antiphlogistics must be particularly insisted on, leeches in large numbers on the perinaeum, blood from the arm, baths, frictions with extract of belladonna on the perinaeum, and the same extract conveyed into the rectum. As long as the patient passes his urine, we must content ourselves with the means just pointed out, and beware of having recourse to other diuretic drinks than those mentioned above, as the obstruction SECOND SPECIES: GONORRHOEA IN MEN. 229 is not in the kidneys but in the urethra, and depends on the swelling of its tissues. When, however, the retention is great or even complete, catheter- ism must be employed; but it should always be preceded by depletion in order to facilitate it. A curved elastic gum catheter is to be pre- ferred. It has generally been found that a middling-sized catheter was more easy to introduce than a very small one. The instrument lubricated wiih an ointment containing extract of belladonna shotdd be introduced very slowly; it must in some measure make its way by compressing the engorgement. After the introduction of the catheter and the evacuation of the urine, the question arises whether it should be allowed to remain or be removed? The fear of increasing the ex- isting inflammation has caused some to direct that the catheter should be withdrawn as soon as the bladder is emptied and passed again when it becomes necessary. But this practice, which may succeed, is not without objections. Frequently after having once passed the urethra with facility, the inflammatory stricture which required this operation, remaining or even increasing, perhaps from passing the catheter, ren- ders the passing it a second time much more difficult or even impossi- ble; so that I prefer, whenever any difficulty is found on passing the instrument the first time, leaving it in the urethra, and recurring w-ith still more energy to the means calculated to combat the inflammation, and only remove it when it is no longer confined or retained at the point at which the stricture is situated. A complication of gonorrhoea] urethritis of not frequent occurrence, but nevertheless deserving particular attention, is the presence of phlegmonous engorgements, either simple or owing to an infiltration of urine, which may occur in various parts of the urethra, near the fre- nuin, fossa navicularis, the pars spongiosa, or posterior parts. These engorgements, at times of considerable extent, are not generally so and have the form of knots encompassing the canal. They some- times occur singly, sometimes several together, and are frequently ve- ry painful. Those which depend only on an extension of the inflam- mation of the mucous membrane of the urethra, are more limited, their progress less rapid, and their termination in resolution or induration more common. Those on the other hand resulting from infiltration of urine through a rupture of the urethra, follow the course of urinary abscesses, into the history of which we need not enter. These en- gorgements which sometimes, as we have said before, are owing to the presence of indurated chancres, which then depend on the specific cause of syphilis, and are to be referred lo concealed chancres, most frequently in the fossa navicularis, thus explaining the assertion of Wredekind, that the existence of tubercles near the frenum was a pa- thognomonic sign of a virulent gonorrhoea. But as regards ihe treatment of gonorrhoea, complicated with the above named symptoms, as soon as an engorgement is perceived above the urethra, the antiphlogistic treatment ought to be still more rigor- ously enforced. The tumors resulting from the engorgement must be 230 SPECIAL TREATMENT OF GONORRHOEA— carefully examined every day and opened as soon as fluctuation is per- ceived. Sometimes the skin is adherent on the points where the subcutane- ous cellular tissue is also inflamed; but it is also frequently moveable even when pus is already present. After the opening has been made, a bit of lint should be placed in the wound, not only to prevent it from closing too soon, but also to keep the opening in the skin parallel with that made in the cavity beneath. Of course this cannot apply to cases in which a communication exists with the urethra, in which case it will suffice to keep the lips of the wound in the skin apart without inserting the lint deeper. The presence of engorgements and urinary abscesses may produce a retention of urine, and then catheterism may cause the purulent cavity to be opened into the interior of the urethra. I have never seen any serious consequences occur from opening urethral abscesses early, although in some cases, either at the time of opening; or soon after, a certain quantity of urine has escaped, but it soon resumed its course by the proper passage. I have in some pa- tients, where these abscesses have been mistaken, or treated with a hope of obtaining their resolution, seen very serious consequences, such as the rapid propagation of the inflammation, the formation of extensive abscesses, and destruction of a portion of ihe urethra. So long as no pus exists, we ought to endeavor to procure the resolution of engorgements in the acute stage, by the means already pointed out, to which should be added, emollient local applications, and fomenta- tions in preference to cataplasms, which in some cases, cause an oedematous swelling. During the acute period of an urethral gonor- rhoea, an oedematous state of the skin of the penis manifests itself, which may produce a phimosis, or in case of a displacement of the prepuce, a paraphimosis. Not unfrequently a kind of cord is observed running the whole length of the penis generally on the dorsal surface. It is owing to an engorgement of the lymphatics, and very rarely extends beyond the posterior part of the penis; but now and then can be traced to the in- guino-crural region, where it terminates in swollen ganglions. Otherwise these complications of gonorrhoea require antiphlogistic treatment, leeches are particularly serviceable, and should be applied on the penis and in the groin. Either during the acute period, or when it has seemed to yield, the neck of the bladder becomes irritated or even inflamed and the pa- tients are lormented by the frequence of the emission of urine, (tenes- mus of the bladder), accompanied by some few drops of blood; the urine is frequently thick and purulent. The treatment I pursue, and which I seldom find fail, consists in adding to the local and general treatment, friction, with laudanu :i and emollient cataplasms to the perinaeum and abdomen. But a method, the effect of which is imme- diate, consists in administering a cold enema with a little laudanum, and which ought to be retained in the bowels. The food and drink should also be cold and in small quantities- SECOND SPECIES: GONORRHOEA IN MEN. 231 In cases of prostatitis, emissions of blood with half a drachm of mercurial ointment applied to the perinaeum with emollient cataplasms, produce most beneficial results; but the ointment should be renewed twice a day. Tlie other complications which may exist, must be treated accord- ing to their nature, always having regard to the most urgent symp- toms. To sum up the foregoing, we may say, that the most powerful treat- ment in the acute stage of gonorrhoea and its complications, consists, excepting a few particular indications, in the judicious employment of antiphlogistics. If patients would carry out this mode of treatment to its full extent, with sufficient patience, the cure would be, if not the most rapid, yet the most certain. When the acute form has ceded to the chronic, it would not be proper to persevere in the use of antiphlogistics, or reckon upon the powers of nature, aided alone by diet; we should thereby risk not on- ly exposing the patient to a perpetual discharge, but also from the duration of the inflammation to alterations of the tissue. Whenever therefore the acute stage has ceased, although the erec- tions may still be pretty frequent and painful, the glans still red, espe- cially at the meatus, the penis, as sometimes occurs, in a state of se- mi-erection with a feeling of weight, I employ the medicaments more particularly termed antigonorrhoeal, which however, if they produce the least degree of relapse, ought to be discontinued, and antiphlogis- tics again employed. When the patients first present themselves to us in the chronic stage, we do not think it proper, as some have as- serted, always to commence the treatment with antiphlogistics, which here, as in a host of chronic affections, far from curing, only serve to perpetuate the evil. In the treatment of urethral gonorrhoea after the acute period, the quantity of fluid taken into the stomach ought to be limited, and the use of warm baths for the whole body relinquished, as in many sub- jects they maintain the discharge or even recall it. The partial baths should be nearly cold when near the acute stage, and afterwards quite cold. They should not be used long at a time, and seldom employed except as a means of cleanliness, unless requir- ed as tonics or astringents. In some cases of gonorrhoea, with but slight discharge, depending on some error of secretion without alter- ation of tissue, partial baths of cold lead or slightly acidulated lotion, repeated three or four times a day, will be found of great service, as also sea or river bathing, should the season permit. The patient's diet may be a little more substantial and gradually in- creased to a tonic regimen, when the disease only consists in a slight mucous discharge. The use of good wine and generous diet suffice in some cases to put an end to discharges, which have resisted other treatment. The patients should continue the use of the suspensory, and carefully avoid every kind of fatigue, more particularly when near the acute stage, nor commit any error of regimen, as the least fault of 232 SPECIAL TREATMENT OF GONORRHOEA— this kind may produce a renewal of the acute symptoms at the mo- ment when the cure seamed complete. Acidulated drinks are here of great service. Natural or artificial chalybeate waters, the syrups of symphitum, quinces, ratanhia, and tolu, ought more particularly to be employed when the acute stage has long ceased. The bowels should be kept open, but not too free. After the means we have just pointed out, there are other more powerful medicaments, which are employed to remove the morbid discharge. They may be divided into internal or external revulsives, and direct or local medicaments. The internal revulsives consist, as we have already had occasion to remark, in simple purgatives, having no particular action on the urinary organs and in medicaments, which act not only on the digestive organs, but also on ihose which secrete the urine. Copaiva. I shall here relate the observations I have made, as re- gards its use and which confirm those of some of the most distinguish- ed authorities. It is very evident that copaiva has a primary action on the digestive canal. In some individuals, its action on the stomach is more decided, in which case it produces vomiting; but this observa- tion requires a little consideration, as it is of great importance in prac- tice, the vomiting does not always take place in the same manner; in many persons it is only owing to disgust, a purely nervous effect, a want of tolerance, which manifests itself from the beginning; in others on the contrary, after having been borne for a time, it causes an irrita- tion, and the vomiting occurs from a more or less intense gastritis. These different modes of action of copaiva ought to be taken into consideration, for us to suspend its use, and resume it after allowing the organs to repose, and if requisite to treat the morbid state which it has produced, and which sometimes compels us entirely to relin- quish it. It is to be observed that the action of copaiva on the stomach, has generally no influence on the progress of a gonorrhoea, and consequent- ly it is useless or even hurtful to continue it, if the vomiting prevents it from traversing the digestive canal; but when it does arrive in the intestines it may remain inactive or cause frequent stools and even diarrhoea; these two modes of action have not the same result in every individual, and all who have treated many cases of gonorrhoea, must have found that in some individuals, it causes the disease to disappear when it purges, and in others is only efficient when it does not produce this effect. These too kinds of revulsion present yet other differ- ences. Ceteris paribus, when copaiva does not purge, independent of the peculiar action, which it may have upon the bowels, it is quite evident that a certain quantity passes through the kidneys. The urine passed by the patients, contains a portion of it, as is to be found by the powerful smell. In seems to me to be worthy of note, that ure- thral gonorrhoea alone is greatly influenced by copaiva, whilst it is of little efficacy, where the vagina and uterus are affected. In the case in which we are now examining the use of copaiva, that is as proper SECOND SPECIES: GONORRHOEA IN MEN. 233 to stop an urethral discharge, it has seemed to me that it was the more useful to arrest the disease at its commencement, the more its purga- tive action was developed; the contrary was the case in the curative treatment of gonorrhoea in the chronic form. Copaiva, like all oiher medicines, does not produce the same effects, by the like doses in all individuals. In this respect there are a host of varieties depending on the idiosyncrasies of the patients, or the pe- culiar state of the inleslinal canal; so that it is impossible lo determine a priori what dose will be required to produce a purgative effect. Un- der some circumstances, certain additions must, be made to the copa- iva, to de.ermine its action in the manner desired. In the administra- tion of this medicament, I think sufficient attention has not been paid to the practical observations, which have given rise to a host of valu- able fonnuln?, and it seems that caprice rather than a well directed choice, directs the employment of one or other of the preparations. If ii he wished lo obiain the purgative action of copaiva, it must be administered in sufficient doses, or even aided by laxatives or purga- tives. If on the other hand it be desired to avoid this effect, it is then important to graduate the doses and add opium, or actual astringents. If the action is wished lo be more especially directed lo the kidneys, a combination with diuretics must be employed. Beside what we have slated above of tlie action of copaiva, we sometimes bee other effects produced after its use: the excessive vom- iting and hypercuitu.'i'sis, may indeed be considered as such; the pa- tients in these cases have a fee'ing resembling sea-sickness. At oilier times- copaiva produces chotic, and during ihe epideniy at Pa- ris, we found it occasionally the etching cause of cholera. When given in large doses-, copaiva has produced very serious effects on the nervous s\slem: in my clinical lectures 1 showed a woman, in whom its improper adminisiration had produced chorea with semi-paraplegia. I was requeued to see a young woman, in whoin six drachms of co- paiva, administered in an enema, had an hour afterwards produced a severe cerebral congestion, with temporary hemiplegia. Amongst the effects peculiar to ibis medicament, may be tanked a cutaneous eruption of greater or less extent, and a form generally resembling ro- seola, although it may assume that of urticaria, or simple erythema. In a practical point of view it is worthy of remark, that these s) mp- toms which are produced by copaiva, are almost always owing to a bad state of the intestinal canal, and that roseola shows itself most fre- quently when a saburral state exists. It is also generally during cold and wet weather, in spring and autumn, that these eruptions become epidemic, in all persons treated with copaiva. The cutaneous affec- tion is always injurious and never lessens the discharge; but indeed it may be said that on the other hand, it aggravates it so much that its use must be suspended. Copaiva may be administered either by the mouth or rectum, but notwithstanding the eulogiums, which have of late been passed upon its administration in the form of enema, I can positively assert that 30 234 SPECIAL TREATMENT OF GONORRHOEA— its action is as uncertain, as it is efficacious when conveyed into the stomach. Copaiva balsam is frequently administered in substance, in doses of from ten to sixty drops: A.nsiaux and Ribes, have, after the example of Bell and Swediaur, extended the dose to two ouives per diem. Without adopting this practice generally, we will not join with M. Jourdan in his condemnation of it, as without playing with the lives of our patients, there are circumstances under which, after having proved the susceptibility of the individuals, the good effect can only be obtained from this medicament, by giving it in ihe above large doses, continued for several days, if nothing occurs to forbid it. The most common dose is however from a drachm to an ounce, two or three times a day. Copaiva is the more efficacious when it is administered in a liquid form, and unless there be some particular indication requiring a corri- gens or adjuvans, it should be given uncombined. Yet beside the cases, which require other substances to be associated with it, in some subjects it produces so much disgust and nausea when given in a liquid form, that we are obliged to render it solid and give it in the form of pills. Latterly it has been enclosed in divers envelopes or capsules, which have facilitated its administration without disgust, but which does not so effectually prevent the nausea as has been asserted. When copaiva is administered by the stomach, care must be taken that it be given at a certain period after the meals, two or three hours at least, as otherwise the digestion is liable to be disturbed. For this reason the patients generally prefer taking it morning or evening. It is by no means uncommon for persons who are taking copaiva for the first time, especially in the alcoholic form, as given at the end of the work, to find the taste very agreeable; but the illusion seldom lasts long, for the first eructations produce repugnance to take the medi- cine which was formerly pleasing. Most patients can better bear this medicine if an acid draught, as lemonade, be taken at the same time. When it nevertheless tends to produce vomiting, I have found the effervescing lemonade of service. When from the susceptibility of the stomach, uncontrollable vomit- ing or repugnance on ihe part of the patients, copaiva cannot be intro- duced into the superior part of the digestive canal, it must be given in an enema, which is best administered in the evening, for the patients retain it better when in bed. The rectum should be previously clear- ed by a simple evacuative enema, a certain time previous to that con- taining rhe medicine, otherwise it would not be retained as the already excited contractions of the rectum, would be augmented by its action. The dose of copaiva, ceteris paribus, should be larger than if taken by the mouth, and except where a purgative effect is desired, as the medicament ought to be retained, to produce its effect, it should be administered in a small quantity of vehicle and combined with opium. In whatever manner this remedy may be applied, it seldom arrests the discharge at once; generally when it has been suppressed it re- turns, if ,the medicine be disQontinued, and again disappears when it SECOND SPECIES: GONORRHOEA IN MEN. 235 is resumed, so that to obtain a durable effect it must be continued eight or ten days after the entire cessation of the discharge, gradually diminishing the doses. Cubebs. This drug, which the Indians praise so much in the treat- ment of gonorrhoea, and which was then eulogized by the English, is notwithstanding the opinion of the author of the Pharmacopee Univer- selle, an excellent means of suppressing gonorrhoeal discharges. Sometimes less efficacious than copaiva, it has, however, frequently succeeded in cases where the latter had failed. Not unfrequently it is necessary to use them alternately or combined. Cubebs do not act quite in the same manner as copaiva, its power- fully exciting action, influences more particularly the digestive organs, irritating the stomach and small intestines, without so much affecting the urinary organs. Although some instances may be mentioned of its successful employment in the acute stage, it is then generally more hurtful than useful. It is given in doses of a scruple to two drachms, either alone or variously combined, from once to four times a day, it may be given by mouth or in the form of an enema. I have, though rarely, seen it produce the same effects upon the skin as copaiva, so that it ought to be preferred for individuals and in seasons in which cutaneous eruptions are to be feared. Turpentine. I have found the anti-gonorrhceal action of turpentine far inferior to ihe two former substances. As external revulsives in the treatment of chronic discharges in men, blisters applied to the internal surfaces of thighs and hypo- gaslrium, have been of service, and this means has appeared to me particularly serviceable when an herpetic complication has existed. Dry frictions and vapor baths have also arrested obstinate urethral dis- charges. Injections. Much has been said for and against the employment of this mode of treatment. It is evident that in general in the treatment of a disease, local medications are the most effectual where the dis- eased organ is attainable, and the more especially is it the case in an affection, generally admitted to be of a purely local nature. On one side the most rapid cure being the most favorable, and injections being the means by which it is to be obtained, they have necessarily been preferred in a host of cases. To which may be added, that they form so easy and cheap an application, which may easily be concealed and have the immense advantage of not disturbing the functions of any other organ or the general health. The principal objection to injec- tions and that which has caused them to be rejected by those who are averse to them, is the property which has been attributed to them of producing strictures. A modern author, lo whom we are indebted for many excellent pathological works, and amongst others on the dis- eases of the urethra, quotes a case in which a single injection produc- ed a stricture. But upon careful examination it will be found, that most strictures of the urethra only occur in patients who have had a gonorrhoea several times, or one of very long duration, or which re- 236 SPECIAL TREATMENT OF GONORRHOEA— mained unarrested. Many patients have never used injections or have used them at too late a period, when alterations of tissue had already occurred. If strictures have occurred when the injections have been made at a proper time, it is because they have remained ineffectual and have not prevented the disease from continuing, and producing merely by its long duration and progress, morbid alterations, which have falsely been attributed to the remedies. And further, it has not been possible in all cases to ascertain the state of the tissues before using the injections. I have found the judicious use of injections af- fords the most prompt and favorable results, and that the more rapidly they cure, the less the patient will be exposed to organic changes in the tissue of the urethra, which, as we before said, are always in pro- portion to the time of duration of the disease. The symptoms attributed to the repercussion from this method of treatment, are either chimerical or ill explained, at any rate they are not sufficiently constant to authorize us in considering them as effects, necessarily depending on this cause. Most frequently their develop- ment is only a coincidence, or to be attributed to the improper use of the remedy. Thus under some circumstances, irritating injections used at an improper time may have produced a cystitis, orchitis, &.c. in like manner, an inflammation of the urethra may occur, or by their acting suddenly in an astringent manner produce induration, lint in thesn cases, the surgeon or the remedy is to be blamed. Moreover, at the time when the researches, which appeared the most conclusive against the use of injections, were made, this treat- ment being most frequently used, most of the patients affected with stricture, had of course been submitted to it; but if a similar inquiry were instituted at the present day, an equal number of strictures would be found in subjects, who have never used injections. This latter ex- amination would be attended with great difficulty, as the individuals who have strictures, are generally those who have had obstinate discharges, for the cure of which every kind of medication has been employed before an examination was made, which showed the organic alteration. When it is required to suppress a discharge in its commencement, I prefer the alterative perturbatory injections of nitrate of silver. After the acute period, I advise resolutive injections of liq. plumb, to be employed; then if after these have been used six or eight days, no result be produced, the nitrate of silver must again be employed or "replaced by astringents: alum, zinc, laudanum, &c. Where all sensi- bility having disappeared, only a whitish gleet remains, tonic injections of red wine, either alone or combined with tannin, or sugar, some- times suffice. The injections should be used cold, and repeated three or four times a day, a single syringeful at a time forced into the urethra with moderate strength, without hurting the meatus urinarius, with the cannula of the instrument. The patient should be seated on the edge of a chair with the penis raised, the lips of the orifice pressed gently against the cannu- la, to prevent the reflux of the fluid, which should be allowed to run SECOND SPECIES : GONORRHOEA IN MEN. 237 through the whole length of the canal, and be retained in it for the space of about a minute. As soon as the discharge has stopped, the number of the injections must be gradually diminished and soon altogether discontinued; for the treatment which has produced the cure, may recall the disease if injudiciously continued. I cannot conclude my remarks on injections, without saying one word upon a new preparation, which I have lately employed at the Hopital des Vencrieus; I mean the iodide of iron, (iodure de fer.) Iodine had already been employed in the treatment of gonorrhoea, by Richond and Henry; and it occurred tome, that its combination with iron might produce still better effects. The following is the result of my researches:— Where ihe patients were afiected with obstinate gonorrhoea, the in- jections with iodide of iron have arrested the discharge in four or five days. In others, this medicament produced at first some pain, repro- ducing the acute stage and changing the nature of the discharge, which from being muco-ptindent became serou5 and tinged with blood. In these cases, by suspending the treatment, the disease completely dis- appeared in seven or eight days. Some other patients were obliged to discontinue this remedy fjom iis causing too much irritation. The iodide of iron, which bos afforded me a considerable degree of success, deserves to be better examined, in order to ascertain the con- ditions of iis decomposition, which hitherto lias caused its effect to vary. To attain the same end, in some patients, one grain of the io- dide of iron has sufficed, whereas in others, the disproportionate dose of eighteen grains to the same quantity of fluid has been required. Although gonorrhoea in its divers periods, may yield to a variety of treatments, without one being superior lo another, yet it sometimes resists every method which science can devise. In these cases, the urethra should be attentively examined, for which purpose a variety of instruments may be employed, and we shall frequently delect at va- rious depths, either morbid sensibility alone, or some obstacle which announces the presence of an organic change. Where a morbid sensibility exists in any part of the canal, without any other signs being requisite, ihe precepts of Lallemand must be followed; the solid nitra.e of silver must be conveyed to this point, by means of his caustic holder. I apply the cauterization in cases where even no morbid sensibility exists, but where a discharge has resisted every other treatment, 1 introduce ihe instrument as far as the prosta- tic region, and expose the caustic, withdraw it, giving it at the same time, a rotatory motion. Under similar circumstances, I have recently introduced a bit of lint, with a view to keep the parieties of the urethra separate, as in the treatment of balanitis. This strip of lint is introduced wiffi the great- est facility, by means of an India rubber cannula, introduced to the posterior part of the urethra. One of the ends has a loop made with a thread, so as to afford a resting point for a style, which holds it 238 SPECIAL TREATMENT OF GONORRHOEA— whilst the cannula is withdrawn; when this is done, the style is also removed, whilst, the lint remains in its place, where it ought to be kept till the next time of passing the urine. If too much irritability be not present, it should be replaced two or three times in the twenty- four hours; otherwise once will suffice. The use of this strip of lint often succeeds alone, or may powerfully aid the effect of injections, cauterization, or internal treatment. Stricture of the Urethra. Frequently, only a slight hypertrophy ex- ists, and temporary dilatation suffices: an elastic gum bougie should be worn for five or six minutes every evening, beginning with the size which can be introduced with little trouble, and gradually increasing their dimensions as they pass with greater facility. When the mucous membrane is a little softened, which shows itself by easily bleeding, cauterization, combined with dilatation, is an ex- cellent method of treatment. When any ligatures exist, they must be divided. These ligatures, formed by plastic tissues, have a tendency to reproduce themselves after being once divided. Here permanent dilatation would be advi- sable, and at first rather powerful, at least as far as the irritability of the canal will permit. In the case of indurated or callous strictures, and which sometimes exist with a considerable shortening of the canal, it is necessary to ascertain, if the induration be not the consequence of an urethral chan- cre. If the induration be owing to a chancre, the treatment for indu- rated chancre must be applied, and it then yields without mechanical means. When a simple gonorrhoea has caused an induration and callous, un- connected with the syphilitic virus, cauterization imprudently employ- ed, may produce serious consequences. Scarifications prudently made, and combined with a gradual dilatation aided by resolutives, applied both internally and externally, must be employed. If actual excrescences exist in the canal, dilatation combined with cauterization often succeeds. The excrescences which may sometimes be recognized by bleeding from the canal, without the instruments hav- ing made a false passage, and which then yield a sensation, like that which would be felt in passing through the tissue of the spleen, easily yield to calomel, conveyed in substance by means of a bougie, or to a cauterization with alum, according to the method of M. Jobert. When a stricture is irritable to whatever kind it may belong, the irritation must first be subdued, and we must not be rash with the direct appli- cations, and even if possible, abstain from them altogether. When the action of the dilating bodies can be borne, a quicker and better method is that of the permanent dilatation as before described; but where it produces symptoms of irritation in the urethra, testicles, neck of the bladder, febrile reaction, or where the patient is compelled to pursue any occupation, which requires him to rise, we must give the preference to the temporary dilatation made in the evening. In some patients, an interval of a day should be allowed between; in which case SECOND SPECIES: GONORRHOEA IN MEN. 259 there will be less difficulty in passing the instrument, and it will be borne with greater facility. Generally I prefer the instrument made of elastic gum. For per- manent dilators curved bougies are less liable to fatigue and hurt the surface of the bladder. For temporary dilators, very supple conic bougies are required. Gonorrhoeal epididymitis. All diseases of the testicle may exist during, or after the course of a gonorrhoea. Some diseases, although in their nature foreign to gonorrhoea, are influenced by it, or modify it in their turn. But there is one which shows itself as a frequent and regular conse- quence, namely, engorgement of the epididymis, which should be strictly termed gonorrhoeal epididymitis, and which has been improper- ly designated, orchitis, gonorrhoeal testicle, &c. The affection of which we are now speaking, does not occur once in three hundred cases, during the first week of the existence of a dis- charge, generally it is after the second, but especially the third or later, that it becomes developed. Besides the discharge which is in some degree the special cause, the sine qua non, the most constant occasional causes are fatigue, consti- pation, the use of excitants of every kind and the want of a suspensor. According to my observations upon patients affected with epididymitis, about one in twenty of them will be found, in whom it showed itsell after the use of the special anti-gonorrhoeal medicaments, so that it is not absolutely correct to say, that this affection most frequently de- pends on the sudden suppression of a discharge, by the use of the or- dinary medications. The contrary may be maintained, namely that the sooner a gonorrhoea is cured the more speedily is the patient pro- tected from epididymitis. It has at all times been observed, that the left testicle was more fre- quently affected than the right; the reason of this greater immunity of the right testicle is, according to the observations made in my wards at the Hopital des Veneriens, as follows:—all the individuals who car- ry the scrotum on the left side of the seam of the trowsers, and most persons do so,* have the epididymitis on the left side and vice versa. In the last research made relative to the seat of the epididymitis, we found but a single exception to this rule which was in an individual, the seam of whose trowsers did not come up to the perinaeum. In a patient who had had an epididymitis on both sides, and who came to the hospital with the affection on the left side, although he wore the scrotum on the right side, it had commenced on the latter side. There may be some exceptions, but the principal cause which determines the side, is that which we have just mentioned. As regards the symptomatology, the following is what occurs: the first part affected, that in which the disease commences, and in which it may continue without extending further, is the epididymis. No go- • Is not the reverse the case in this country? H. D. 240 SPECIAL TREATMENT OF GONORRHOEA— norrhceal affection of the testicle occurs, wit iiont epididymitis being pre- sent. The engorgement of the epididymis which generally succeeds, but sometimes precedes the pain, is the symptom which is the most obstinate. Next in frequency to tlie epididymis, the cordis affected, and more particularly the canaiis deferens; but the a Gee lion is never confined solely to it, but the epididymis i* always implicated. A fact, important 10 be obseived as regards the disease of the epidid- ymitis and canaiis deferens is. mat there are two varieties of epididy- mitis : ihe one sympathetic, wnen the epididymis alone is aliected, the other from succession,or from continuity of the tffsiie, or by exten- sion of the inflammation, when it extends from the urethra to the ca- naiis ejaculatorius, and thence to the \ esiculus semina.lis, canaiis de- ferens, and lastly to the epidUlyuff, as demonstrated by pathological anatomy. This distinction is by no means unimportant, as regards the prognosis and the treat men i. If the disease increases in intensity, the neighboring parts become affected, either from the exlenlion of the inflammation, or hindrance in their functions; it is thus that the affections of the tunica vaginalis oc- cur; sometimes it becomes inflamed and produces all the symptoms common to the inflammations of the serous membranes; pseudo-mem- branes, serous or albuminous pus, sanguinolent exhalations; at other times, and which is most commonly the case, without partaking of the inflammation, it presents the symptoms of symptomatic dropsies, which arise from a hindrance in the circulation. In all cases, epididymitis is the cause of thc>e symptoms which never exit ah me. The swelling in the epididymis may occur, either gradually or sud- denly; the effusions into the tunica vaginalis, are more rare when the swelling occurs slowly. If the disease continues to progress, the cellular tissue of the scro- tum, and even that of the cord become affected, and the same result occurs as in the tunica vaginalis; either oedema from faulty circulation, or an actual phlegmonous slate. Then the skin of the scrotum, the veins of which may only be swollen, and ihe capillary circulation in- creased, sometimes presents the characters of erysipelatous inflamma- tion. The body of the testicle which most frequently remains intact, and only suffers from pressure, ihe greater and more painful when to the engorgement of the epididymis is added an hydrocele, may how- ever in some cases participate in the disease. Without, in this place, entering into the details of symptoms and their course, which are too well known to require our consideration, we may state that it is the last parts which have become affected, which recover first. Hydro- cele in particular yields the more quickly, when owing to an inflam- mation of the tunica vaginalis; but when it is a passive effusion, it may be produced long after and offer much more resistance. Epididymitis rarely ends in suppuration, but when the cellular tissue of the scrotum becomes inflamed, it is perhaps more frequent. It deserves to be noted, as the contrary opinion generally prevails, that the is charge which is often much diminished, during the course SECOND SPECIES: GONORRHOEA IN MEN. 241 of an epididymitis, never entirely ceases, or at least it does not occur more than once in two hundred cases; the more abundant return of the discharge follows the decrease of the intensity of the inflammation of the epididymis; but the artificial increase of the discharge, during the acute stage of the epididymitis, which is either not influenced, or is aggravated by it. As a diagnostical sign, one of the most constant is the co-existant discharge. The sympathetic epididymitis is less serious than that from extension of the inflammation. The epiphenomena, or less constant symptoms, such as hydrocele, oedema, erysipelas, or phlegmon of the scrotum, &c. add to the serious- ness of the affection according to their intensity. The treatment I have found to answer best is, in the first place, the prophylactic, as the use of a suspensory, the antiphlogistic treatment of the gonorrhoea, and anti-gonorrhoeal medicaments administered at an early period; then, as curative treatment of the epididymitis, rest in an horizontal position, keeping the testicle elevated, general blood- letting, and leeches applied on the course of the cord and the peri- naeum; and at the same time, with the antiphlogistics, the application of compression. By means of compression, we obtain the cure of sympathetic epi- didymitis in five or six days. When well applied, it prevents the de- velopment of hydrocele, and indeed it may permit of the patients con- tinuing to follow their occupation without feeling any ill effects. Compression is applied by means of bandages of emplastr. c. hy- drarg. about half an inch in width. The diseased testicle being then care- fully held, so as not to occasion too much pain, is to be turned towards the lower part of the scrotum without distending the cord, at the same time separating it from that on the other side. The strips should then be applied in circles, beginning by placing the first on the csertion of the cord, and sufficiently firm to prevent the organ from slipping. ■" This being done, the circles should be continued around the testicle, so as to produce a considerable, but uniform pressure, avoiding as much as possible, making any folds in the skin. Beyond this point, separate strips should be applied, so as to exercise a pressure from above below, and thus forming a kind of basket. If this dressing is to succeed, the sufferings of the patient will di- minish from the moment of its being applied, and at length entirely cease. If this be not the case, it must immediately be removed; for if it increases the pain, it has either been ill applied or does not suit. We must not however allow ourselves to be deceived by some little pain proceeding from the first band pressing the skin, and which is generally only felt the following day or later. It will in this case suf- fice to cut the band, in order to allow the patient to support the rest of the dressing. Otherwise the dressing should not be renewed, ex- cept when the organ has decreased, and becomes loose under it. To obtain, by the foregoing means, a radical cure, and to prevent a relapse at the same time as the epididymitis is treated, the discharge 31 242 SPECIAL TREATMENT OF GONORRHOEA— should be repressed instead of excited; for as long as it remains, it continues to be the cause of the disease, which it frequently reproduces. Third Species: Gonorrhoea, common to both sexes. C of the eyes } Varieties____)------anusu ( J -----mouth ( ' -----nose, &c. ) First Variety. Blenorrhcea occnli:—Ophthalmia gonorrhoica. This disease is undoubtedly more frequent in men, than in women, and far more frequent in infants, immediately afterbirth, than in adults; it generally commences in one eye only, although both are frequently attacked, especially in children. Its development must be attributed to the direct application of the gonorrhoeal matter, to the conjunctiva, and not to the sympathy existing between the sexual organs and the eyes. A man is more likely to soil his fingers, which may then con- vey the irritating matter into the eyes, and the infant to come in con- tact with it, in passing through the infected vagina. Were it owing to sympathy, the disease would certainly be more common. Simple catarrhal ophthalmia may develope itself, during the existence of an urethral gonorrhoea, as under any other circumstances, and thus render the diagnosis somewhat obscure or even impossible, as there is no dif- ference between simple catarrhal and gonorrhoeal ophthalmia, except in the cause which is often difficult to determine, and in the more se- rious consequences of this latter variety. The first thing to be urged in the treatment of gonorrhoeal opthal- mia, is prompt and energetic employment of the treatment, as hesi- tation involves most frequently the loss of the eye. After having recommended the patient to avoid every thing that may irritate the organs of vision as touching them with the fingers, soiled with the muco-pus of the gonorrhoea, we ought as soon as the first symptoms of opthalmia show themselves, and without waiting till it becomes fully developed, or for a more certain diagnosis, to pursue the following treatment: if the patient be robust, he should be bled, and a large number of leeches, twenty to fifty, applied at the same time to the temple and around the eye affected, carefully avoiding the eyelids. This being done, the eyelids should be reverted without fatiguing them by too great a pressure, and then a stick of nitrate of silver gently passed over them, so as to whiten the surface of the pal- pebral conjunctiva, and then still more superficially that of the bulb. After this cauterization, which to succeed must not be very ener- getic, an injection of cold water must be made between the eyelids, THIRD SPECIES: GONORRHOEA IN BOTH SEXES. £43 so as not to allow any of the caustic to remain on the cornea. As soon as this little operation is ended the eye must be covered with compresses, dipped in a cold decoction of poppy-heads. But as in this serious ophthalmia, much sympathetic irritability, or even successive inflamma- tion of the deeper seated parts exists; the pain is often very acute and attended with photophobia. This latter symptom and the consequen- ces it produces by the contractions of the pupil, and the adhesions from effusions which sometimes occur, are very advantageously treated by extract of belladonna applied to the basis of the orbit, and the nostril of the side affected. Should a chemosis already exist, a symptom requiring the greatest attention, and which generally involves the destruction of the cornea, by a kind of strangulation, at whatever period the treatment may be commenced, it must without delay be excised by raising the mucous membrane with a small hooked forceps, and removing it with the curved tscissors. When it is only an oedematous chemosis, the chances of success are far greater than when the chemosis depends on an ac- tual phlegmonous and indurated state; in which case the excision generally becomes impossible, and only allows of incisions being made, which are far less to be depended on. Whether a chemosis have been excised or not, stress should be laid on the application of nitrate of silver. When it is applied to a mu- cous membrane, it almost immediately changes the nature of the se- cretion, which from muco-purulent becomes sero-sanguinolent. When an application has succeeded, after this artificial secretion, the oedema- tous swelling of the palpebral decreases, the congestion and inflamma- tion of the conjunctiva become less intense, and the disease progresses towards resolution; to complete which, a derivans in the back of the neck, (a blister or seton) and the use of some collyrium; foremost amongst those to be preferred is nitrate of silver, a grain to the ounce of water. But if the disease still remains, and the puriform secretion continues or increases, we must return to the application of nitrate of silver always with great caution, but without being alarmed by vain fears. These applications should be repeated every day or every other day; and in children at the commencement of the disease, I have sometimes re- peated them twice in the same day. At the same time as this energetic treatment is employed and re- peated as often as the intensity of the symptoms require, and without waiting from one day to another, so as always to be behind the symp- toms, which progress with such rapidity, we must not fail to act upon the intestinal canal, as much to keep it free, and thus diminish the causes of cephalic congestion as to benefit by a powerful revulsion. All the accessory treatment required by catarrhal ophthalmia in gen- eral, is applicable and ought not to be neglected. Anti-gonorrhoeal medicines, as copaiva, cubebs, &c. have no action on this disease, in whatever manner they may be administered. The same is the case with the anti-syphilitics, such as mercurials, &c. 244 SPECIAL TREATMENT OF Second Variety. Gonorrhoea ani. This is unquestionably the most rare of all the forms, yet it often occurs in women and little girls, in consequence of the discharge of gonorrhoeal muco-pus flowing from the vulva. Gonorrhoeal discharges from the anus also frequently accompany, or follow the development of chancres in this region, or are the more frequent consequence of an eruption of mucous tubercles. In the acute stage, antiphlogistic treatment must be used, baths, emollient fomentations, repose, and care be taken to keep the bowels free. As soon as the inflammation is calmed, resolutive fomentations with acetate of lead, or astringents with alum, often succeed. But a still more preferable medication is the application of solid nitrate of silver, to all parts that can be reached, or injections of it in solution in various doses, from one grain to six or more to the ounce of water; in these cases, the fluid should be injected into the rectum with a small urethra syringe. We may say that as regards the anus and rectum, not only do co- paiva and cubebs seldom succeed, but they frequently only serve to maintain the disease by the irritation they cause at the lower extremity of the large intestine, of which many patients who use it in other cases complain. Third Variety. Gonorrhoeal affection of the mouth, nose, &c. It is evident that all mucous membranes may be affected with gon- orrhoea or gonorrhoeal affections; but these affections are very rare, and their treatment when they do exist, requires nothing which has not already been indicated. Section III.—Excrescences, or Vegetations. Excrescences, the forms of which vary greatly, do not seem, strict- ly speaking, to be the consequence of the syphilitic virus, as in the opinion of all good observers, and as may be be seen every day, they are frequently developed under the influence of causes entirely uncon- nected with syphilis. In the treatment of these excrescences, the following conditions must be considered; either there is only an hypertrophy of ffie tissues without epigenic increase, improperly ranged by some writers on sy- philis amongst the vegetations and which constitute the morbid chan- ges of structure, to which the name of condyloma is applied, or else there is an annual production of new tissues, vegetations properly so termed. EXCRESCENCES OR VEGETATIONS. 245 The treatment of condylomata is either that of indurated chancres or mucous tubercles. When we have to do with true vegetations, either indurations de- pending on a chancre, of which they are then the consequence, or they have arisen on unindurated tissues. In the first case the specific in- duration must be removed, as directed when treating of indurated chan- cres, and then if they have not fallen off or withered during the treat- ment they must be excised. When there was no induration at the comir.encement, excision should at once be had recourse to, for which purpose the curved scissors will be found most convenient. The part should immediately afterwards be enveloped in compresses, mois- tened with cold water; rest and simple lotions till cicatrization will suf- fice to complete the cure. In some cases, the little wounds suppurat- ing, they must be dressed either with a little simple cerate or aromatic wine. When the excision, which should embrace the whole thickness of the skin, or mucous membrane on which the vegetations are seat- ed, is well made, cauterization is useless. But it would be otherwise in case of the existence of a chancre in the period of increase, as im- mediate cauterization would be requisite to prevent the inoculation of the fresh-made wounds. When however there are chancres still ca- pable of inoculating, I prefer waiting till they are cicatrized before ex- cising the vegetations. We may undoubtedly destroy, the excrescences by caustics alone, sometimes with nitrate of silver, but especially with liquid nitrate of mercury; but when they are provided with a foot-stalk, excision is far preferable; only in cases where the base is broad, or the patients fear the knife, I have recourse to these, or other means, opium paste, calo- mel, powdered savine, &c. . As regards the strictly speaking antisyphilitic treatment, it is only indicated where the concomitant symptoms require it. Section IV.—Phimosis and Paraphimosis. Phimosis is either complete or incomplete, permanent or tempora- rv. The permanent may be congenial or acquired, it may exist with excess of length of the prepuce, with a prepuce not covering the whole of the glans, with excess of length of the frenum; there may be ad- hesions to the glans, either old or new, complete or incomplete. The temporary may be either inflammatory or oedematous, complicated with erysipelas, considerable tension, gangrene, balanitis, gonorrhoea, chancres, vegetations, herpes, perforations of the prepuce, difficulty of passing the urine, or complete retention. There may have existed a little narrowness of the margin before its developement. Temporary phimosis occurs in individuals who could previously ea- sily uncover the glnns, it easily yields without being operated. Permanent phimosis, with too great a length of prepuce, or with indurations on the margin of this cutaneous covering, requires circum- cision, if it be desired to cure one deformity by producing another. 246 SPECIAL TREATMENT OF When recent adhesions, easy to be destroyed, are present, they must be dissected; when they are too intimate, and especially too exten- sive, we must content ourselves with removing sufficient of the pre- puce to uncover the meatus urinarius. When the frenum is too long, it should be resected; if vegetations be present, they must be remov- ed; if there be chancres, unless there be urgent indications, we must wait till they are cured before operating, so as not to expose ourselves to the risk of increasing their extent, by inoculating the wound which results from the operation. If the operation be performed, the chan- cres still existing, they should if possible be removed at the same time. In this manner the whole disease, which may yet be only lo- cal, may be removed at once. At other times, if they be allowed to remain, immediate cauterization is necessary. When there are per- forations of the prepuce, they ought to be removed in the operation. If the prepuce is short, the section of the superior part according to the old method may suffice. If the prepuce is only straightened by the vegetations which are developed between it and the glans, a slight incision will suffice; otherwise the incision must be carried to the level of the base of the glans. It ought to be remembered, that after making the superior incision and removing the angles, a long strip of skin cor- responding to the frenum remains, which constitutes a real deformity. In some cases, I take a fold of the skin of a certain extent, and thus remove a flap, which leaves a division in the form of a V, with its basis on the margin of the prepuce, and its summit towards the base of the glans. But 1 prefer circumcision, and the following is the method I adopt. The penis being relaxed without stretching the skin which forms the prepuce, I draw with ink aline which follows, in all its circumfer- ence, the oblique direction of the base of the glans and about an eighth of an inch from it. I next draw the prepuce forward, and fix it be- tween the blades of a common dressing forceps, held by an assistant. The portion of the prepuce which projects beyond the forceps is to be held by the operator with his left hand, whilst with his right, he makes an incision with a bistoury, following the line traced with the ink. After the section, the mucous lining, which by its anatomical disposition does not allow of its being drawn forwards like the skin, remains entire and covers the glans; to avoid a secondary phimosis, or paraphimosis it should be immediately divided. I do this by divid- ing this mucous membrane by a single cut with the scissors on the dorsal surface of the glans to its base; then I remove the flaps around to the frenum, and with a single stroke, still holding the two flaps togeth- er, I remove the frenum with them. The cure is complete in twenty or five-and-twenty days, no deformity ever remains, nor is there any fear of a consecutive phimosis, or paraphimosis supervening. After the operation, the artery of the frenum, or some of the pre- putial branches often bleed considerably, they must, in these cases, either be tied or tortion applied. The penis must then be constantly PHIMOSIS AND PARAPHIMOSIS. 147 covered with cold water, to avoid erections and inflammation; to avoid erection, the patients should also have camphor, given in form of pills. Paraphimosis, which is only a phimosis removed behind the glans, which it compresses, and thus producing all the symptoms which result from strangnlation, requires that the parts should be again reduced to their normal position. When the constriction is but slight, it may be re- duced by the common process. Should oedema exist, incisions mnst be made, so as to degorge the tissues before attempting the reduction. But whenever the strangulation is considerable, or there are ulcerations of the strangulating tissues, adhesions, inflammation of the glans, threatened or actual gangrene, and more especially when the paraphi- mosis has succeeded a phimosis, it would be absurd to persevere in reducing it, putting the patient to useless pain, and only substituting a phimosis for a paraphimosis, which would later have to be operated. In this case, I make an incision with a straight bistoury on the dor- sal side of the penis, which divides the whole skin; the mucous lining must also be divided in the same manner. The operation is in fact only the operation of phimosis, excepting the situation; the effects and after treatment are the same as in the preceding case. SPECIAL FORMULARY. Of the Medicaments used in my wards of the Hopital des Veneriens. I.—LOTIONS, FOMENTATIONS, LOCAL OR PARTIAL BATHS. Emollients—Decoction of althaea. Sedatives—Decoctions of althaea and poppy-heads. Narcotics—Decoction of conium, solanum, and belladonna, to which may be added either laudanum or opium. I frequently use the following formula:— Rp. Decoct, conii et solani. . . § viii Extract, gum. cpii . . gr.viii Solutio plumbi acetatis. Rp. Plumbi acet. crist. . . . 5 i Aqi as destill . • • §vm For balanitis, lotions for the vulva and applications to leech-bites. Solutio opiata. Rp. Aquae lactucae . . • §vm Extr. gum. opii . . .3l—" In gangrenous affections. When the irritability increases, the quantity of opium must sometimes be decreased. Solutio ammonia hydrochlor at is. Rp. Aquae . ... § viii Ammonias hydrochlor . . 3u For resolutive applications and fomentations, particularly applicable in the treatment of buboes. Tinctura opii diluta. Rp. Aquae destill . . § iii Tine, iodinas . . • 3i The tincture may be increased to six drachms to the same quantity of water. It is employed in the treatment of buboes, hydrocele accompanying epididymitis, &c. Soda chlorinata diluta. Rp. Sodae chlorin . . § ii Aquae . . . §vi The quantity of soda may be increased till a slight tingling sensation is produced. Used in the treatment of mucous tubercles, &c Solutio hydrargyri bichloridi concentrata. Rp. Hydrarg. bichlor . . gr.xx Aqua? dest . . . § i For the cauterization of vesicated surfaces in the treatment of buboes. SPECIAL FORMULARY. 249 Vinum aromaticum, (Ph. Fr.) Rp. Spec, aromat.* . . . § iv Vin. rubr. .... f£,ii Spirat aromat.* . . . § ii The species to be macerated eight days in the wine then expressed and strained, and the spirit added to it. To the above preparations I add, if it be required to be still more astringent, two scruples of tannic acid, to eight ounces of the wine. Vinum aromaticum, c. opio. Rp. Vin. aromat. . . • S vi» Ext. gum. opii . . . 3SS The foregoing preparations of wine are employed as dressing for chancres and ulcers. II.—INJECTIONS. The emollient, sedative, and narcotic injections, consist of the same liquids as those mentioned above for lotions. Injecto plubi acetatis pro urethra. Rp. Aquae rosar. . . . § vi Plumb, acet. crist. . . J)ii Idem pro vagina. Rp. Aquae .... Jfoii Plumb, acet. crist. . . 3m_§' Gradually increased. Injectio sulphalis aluminis et potassce pro urethra. Rp. Aquae rosar. . . . 3V* Alum, et potass, sulph. . . gr.xviii Idem pro vagina. Rp. Aquae .... fljii Alum, et potass, sulph. . . 31" Injectio c. vino pro urethra. Rp. Aquae rosar. . . § iv Vin. rnbr . . . § ii The quantity of wine may be increased, and if it does not cause any irritation, it may afterwards be used alone. Idem c. acido tannico. Rp. Vin. rubr. , § vi Acid, tannic. . . . gr.xviii Where used for the vagina, the quantity of the tannic acid should be doubled and gradually increased, according to the effects produced. Injectio zinci sulphurici. Rp. Aquae rosar. . . • § v'» Zinc, sulph . . -9' to which a scruple of laundanum may be added. Injectio argenti nitrici. Rp. Aquae dest. . . • ovm Argent, nitr. crist. . . gr.ii The nitrate of silver may be increased, till a favorable result be obtained, if irritation be not produced. If a caustic solution be required:— Rp. Aquae dest. . . . § i Argent, nitr. . . . gr.x * Both the above preparations contain a host of articles. I have found the Sp. rosma- rinee or Sp. lavend. co. an excellent substitute for them. H. D. 32 250 SPECIAL FORMULARY. Injectio ferri iodidi. Rp. Aquae dest. . . z vj . Ferri iodid. . . . er.iii The quantity may be increased to nine grains to the ounce of water, but care is re- quired to avoid irritation. III.—COLL YRIA. For emollient sedative, or narcotic collyria, the fluids must be used as mentioned under No. I. C. zinci. Rp. Aquae rosar. . . . 5 iii Zinci sulph . . . cr.vi To which may be added Tr. opii. gtt.xx C. argenii nitrici. Rp. Aquae dest. . . . § iii Argent, nitr. . . . gr.iii IV.—GARGARISMATA. The emollient, sedative, and narcotic gargles are prepared in the same manner as the fomentations, &c G. c. hydrarg. bichlor. Rp. Decoct, conii et solani . . § viii Hydrarg. bichlor. . . gr.ii__viii This is used in case of ulcerations of the throat, after the acute period. G. aluminis et potass, sulph. Rp. Aquae lactuc. . . . 5 vii Alum, et potass, sulph. . . f^i Mel. rosat. . . • 3 i In cases of apathous affections and mercurial stomatitis, without too great inflammation. G. cinchonim. Rp. Cort. cinchon. rubr. . . 3 ii Aquae . . . . gxii Boil to § viii, to this when strained, add extr. opii gr.v'iu, in cases of gangrene; or 3ii tinct. cochleariae, should there be a scorbutic tendancy, or permanent ramollissement of the gums. G c. acidio hydrochlorico. Rp. Aquas lactucae . . . 3vii Acid, hydrochlor. fort. . . gtt.zx Mel. rosat. . . § i In aphthous affections and mercurial stomatitis. To combat mercurial salivation, I prefer applying acid, hydrochlor. fort, to the gums and tongue when they are ulcerated, repeating the application every day, or every other day. The bleeding of the surface ought not to be an obstacle. The acute pain it pro- duces, soon ceases, and nothing equals its beneficial effects. Of course the peculiar in- dications which may present themselves, must not be neglected. V.—CERATES, &c. Unguent opiaium. Rp. Axung. • • • • ft> Tr. Opii.....| j C. plumbi. Rp. Cerat . • § > Liq plumb, diacet. SPECIL FORMULARY. 251 Unguent hydrarg. opiat. Rp. Unguent, opiat. Ung. hydrarg. . . . aa § i Used in cases where the mercurial ointment is too irritating. Unguentum digestivum. Rp. Ol. terebinte . . • 3» Vitel. ovi. ii 01. hyperic. . . . § ss Unguent hydrarg. chlorid. Rp. Hydrarg. chlorid. . . . gr.vi Cerat. opiat. . . .3" Unguent belladonna. Rp. Extr. belladon. . . .3 s? Axung. . § i U. Hydrarg. iodid. Rp. Hydrarg. iodid. . . -9' Axung . . . § i The quantity of the iodide may be increased to two drachms, if too great irritation be not produced. Mel. iodadum. Rp. Mel. . . . . §iss Hydrarg. iodid. . . . 3' Unguentum. potass, hydriod. Rp. Potass, hydriod. . . .3" Axung. . . . . § i If to the above be added two grains of iodine, it forms the unguent potass, hydriodid. iodatum. The unguent, plumb, iodat. is formed in the same manner as the ung. potass. hydroid. VI.—EMPL ASTRA. Emplastrum. c. hydrarg (de Vigo) according to the codex.* Emplastre. conii. c. plumb, iodid. Rp. Emp. conii. . ■ § \ Plumb, iodid. . • • 3' This is used in the treatment of buboes, and especially in chronic engorgements of the testicles. If twenty grains of antim. et potass, tart, be sprinkled upon a plaster of em- plaster, conii of the size of the hand, it forms an excellent excitant where the buboes are indolent. VII.—CATAPLASMATA. Of linseed meal, bread, rice, oatmeal, made with water, or the narcotic decoctions. They are rendered resolutive by using them cold, and adding the decoctum album, or a solution of sal ammoniac; or narcotic and sedative, by adding laudanum. Emplatre de Vigo. c. mercurio consists of Emplast. simpl. ftiiss Myrrhs . 3v Cerae pur. Pulvis croci Resinse . aa § ii Hydrarg. . Gum. ammon. 01. terebinth. Bdellii Styracis liquid Olibani . aa 3 v Ol. lavend. For this I substitute the emplastr. ammoniac, c. hydrarg.—P 3iii §xii 5» |v. 3" L. H.D. 252 SPECIAL FORMULARY. VIII.—ENEMATA. E. c. copaiva. Rp. 01. copaivae . . . 3"—v' Vitel. ovi . . . i Ext. opii . . . gr. i Aquae . . . § vi Given in cases in which the copaiva cannot be administered by the mouth. E. c. cam^hora et opio. Rp. Cumphorae . . . gr.x Ext. opii . . . gr.i Vitcl. ovi i Aquae . . . § vi To prevent the erections, when the pills do not succeed. IX—ESCHAROTICA. Vienna paste is formed by adding to six parts of caustic potass, five of quick lime. When required for use, it should be made into a paste, by adding a sufficient quantity of alchohol. X.—BATHS. Gelatinous baths are made by adding from one to two pounds of glue; alcaline baths by the same quaniity of subcHrlionute of potass. If sublimate be used, half an ounce should be added to the usual quantity of water, increasing to two or even three ounces, according to the effects produced. XL—PILULE. P. hydrarg. bichlor. co. (Dupuytren.) Rp. Hydrarg. bichlorid. . gr.l-5th—l-4th. Ext. aquos. opii . gr.l-4th—1-half Resin, guaiaci. . . gr.iv P. hydrarg. iodid. Rp. Hydrarg. iodid. Extr. lactucae . . . . aa 3 ss " gum. opii . . . gr.ix " guaiaci . . . § i To be made into 36 pills. In cases of inveterate affections, accompanied with much induration of the tissues, two or three grains of the pulvis fol. conii may be added. These are to be taken at night, four or five hours after the last meal; when the dose is increased, they may be taken night and morning. P. hydrarg. chlorid. com. Rp. Dydrarg. Chlorid. . . • 9' Pulv. fol. conii Sapon. castil. . . aa [)ii To be made into 24 pills. These pills are employed in the treatment of the engorgements which remain after a gonorrhoeal epididymitis, commencing with one and increasing every five days to the number of six, unless the symptoms of mercurialization occur, and then require the num- ber to be diminished, or their use to be entirely suspended. P. opii c. camphora. Rp. Camph. . . . B'n Extr. gum. opii. . . . gr .viii Mucilag. q. s. To be made into 16 pills. SPECIAL FORMULARY. 253 Given in doses of 2 to 3 every evening, to allay the irritation in the neck of the blad- der and the erections. XII.—LIQUOR VAN. SWIETENII. Rp. Hydrarg. bichlorid. . . gr.viii Sp. vini. rect. . . . § iss Aquae dest . § xivss One ounce contains half a grain of sublimate. The dose ia two drachms: per diem, nv- creased to four. To be taken in three or four times at intervals of four to six hours, so as not to interfere with the meals. It may be given in milk or any mucilaginous drink, to which may be added, a small quantity of syrupus papaveris, if it cause pain in the- stomach or intestines. XIIL—TISANES. DIET DRINKS. T. of sarsaparilla and guaicum, similar to the decoction or infusion. Tisane de Feltz. Rp. Rad. sarzae incis. . . § hi Gum. arab. . . . § ss—Qii Antim. sulph.* . . § iv Aquae . . . . ftvi Boil to half. Three or four wine glasses a day, carefully observing the susceptibilities of the patient. This treatment must be continued for five or six months, seldom less than two. The patient's food should consist of roast or boiled meat, and vegetables cooked with- out salt, to avoid the decomposition of the antimomy, (if, as has been doubted, the de- coction holds any of it in solution.) Decoctum Zittmanni. No. 1. Rp. Rad. sarzae Aquae Sacchr. alumin. Hydrarg. chlor. Cinnabaris Fol. sennae Rad. glycyrrh. Sem. anisi. Sem. feniculi. . . . aa § x The sarsaparilla and water should be boiled together a quarter of an hour, and then the sachr. alumin. calomel and cinabar added, enclosed in a linen bag and all boiled down one third. The other ingredients being added and allowed to stand a short time, it should be strained for use. |xii tb» §iss §ss §i 3 in 5 iss This is termed the strong decoction. The weaker is made as follows:— To the residuum of No. 1, add— Rad. sarsas . No. 2. Boil and add— Aquae ftxxiv Cort. Citr. Cort. cannell. Sem. cardam. minor. Rad. glycyrrh . . . aa 3iii On the first day, the patient must take a purgative; each morning he is to take half a pint of No. 1, to be drank warm, and keep his bed. In the afternoon, a pint of the No. 2. And again, half a pint of No. 1 in the evening, the two latter doses to be taken cold. This to be continued for four days, on the fifth, a purgative, the treatment then to be * Enclosed in a bit of cloth. 254 SPECIAL FORMULARY. repeated, and again followed by a purgative. If then after an interval of a week it be re- quired, the foregoing treatment must be repeated. The decoct, alb. frequently referred to is given thus, in the codex Phar. franc. Rp. Phosph. calcici, (cornu. ustum. P. L.) 3n Medullae panis . . 3V' Gum. arab. . . .3" Sacchr. alb. . . • 3i Aquae simpl. . . • §xxu Mix well in a mortar, boil altogether half an hour in a covered vessel. This will yield a pint of the decoction. This is used externally, and also internally as a vehicle. XIV.—SYRUPI. S. sndorificus. Rp. Rad. sorzae Lig. guaiaci . . . aa § vi Aquae .... ftiv Mascerate twenty-four hours, then gently boil down to half, express and add from one to two pounds of lump sugar. The dose is from 2 to 4 ounces per diem. iS. sarza. co. (de Cuisinier.) Rp. Rad. sarzae . . § xxx Aquae .... Jfexxiv Infuse for 24 hours, and then boil down to Ifeviii. Repeat this operation three times. Strain and mix these three decoctions, then add— Flor. borag. off. " rosar. alb. Sem. anis. . . . aa 5 ii Fol. sennae . . . § iss Boil this down to half; strain and add— Sachr. alb. et mel. . . aa Jfoii Two to four ounces may be given per diem. It is suituble for patients who are sub- ject to constipation. When it purges gently, it may be advantageous, but when it gripes or produces diarrhoea, its use must be suspended. To the foregoing syrups may be added mercurial preparations and particularly subli- mate. I prefer the cyanide of mercury, 4 grains to the pound, which is less liable to be decomposed, A drachm should be given night and morning, gradually increasing to half an ounce per diem. Should it purge, I combine with it the sudorific syrup, to whom I add 8 grains of extr. opii to the pound. Syrupus ferri iodid. Rp. Syrupi sudorific . . -ft' Ferri iodid . . . • 3' Dose: 2—6 drachms per diem. S. ferri et ratanhia. Rp. Syr. tolutan. . . • ft>i Ferri sesquicarb. Extract, ratanhiae . . . aa 3ii Dose: 4—6 drachms per diem used in gonorrhoea and mucous discharges. S. caimans. Rp. Syr. papav . . . § iv " amygdal. . . . § xiv To this syrup may be added, two drachms of the nitrate of potass: to be given during the acute stage of gonorrhoea, in linseed tea or water. CONTENTS. Translator's preface ....... Author's preface. ....... PART THE FIRST. CRITICAL RESEARCHES AND GENERAL REMARKS. CHAPTER I. The existence of the syphilitic virus proved by inoculation Means of propagation of syphilis ...... Page Inoculation serves to distinguish ft syphilis Section I.—Gonorrhoea " II.—Chancre . " III.—Bubo " IV.—Mucous tubercle CHAPTER II. om each other, the reputed primary symptoms of 34 36 37 47 4S 53 CHAPTER III. Inoculation distinguishes primary from secondary symptoms Classification of the symptoms of syphilis (Note) . CHAPTER IV. Inoculation serviceable in the therapia.— Section I.—In the prophylactic treatment " II.—Treatment of syphilis » HI.—Treatment of diseases, unconnected with syphilis » IV.—Choice of lh« method of treatment CHAPTER V. Inoculation may be applied to sanatory regulations and forensic medicine PART THE SECOND. CLINICAL AND EXPERIMENTAL RESEARCHES. CHAPTER I. 55 55 59 64 67 67 68 70 Praetioal observations.— ... , Section I.__Inoculation of the pus of chancre, simple and complicated, in Us various forms and periods . . • • - » u,__Inoculation of the muco-pus of gonorrhoea, simple and complicated, and in its various seats ...... 101 " HI.__Inoculation of the pus taken from buboes . . . 125 » IV.__Inoculation of the pus of the secondary and of other reputed venereal symp- toms. ....... 154 A tabular view of the inoculations made 1831—37 Results of Dr. Mairion's experiments 169 171 256 CONTENTS. PART THE THIRD. THERAPEUTICAL SUMMARY. CHAPTER I. Exposition of the methods of treatment, which have proved most successful at the hospital ° for venereal diseases . . . . . . J73 General remarks . . . . . , . j^q Prophylactic treatment of the primary venereal diseases . . . 173 Treatment of virulent affections CHAPTER II. Primary Syphilis. Section I.- " II.- ■Chancres ■Buboes . Secondary or Constitutional Syphilis. General remarks .... Section I.—Prophylactic treatment II-—Secondary and tertiary affections III —Application of the general precepts to particular Special treatment of secondary affections Syphiloids . . Ulcers .... Syphilitic irritis Syphilitic testicle Falling off o( the hair and nails IV.—Special treatment of the tertiary symptoms Osteocopic pains Periostitis . Syphilitic ostitis Gummata, nodus 176 176 186 191 192 195 202 202 203 204 205 205 206 208 209 209 212 CHAPTER III. Treatment of nen-virulent affections Section I.—Gonorrhoea II.—Special treatment of gonorrhoea in women „ men „ TIT _, ' common to both sexes III.—Excrescences or vegetations . " IV.—Phimosis and paraphimosis 213 213 216 223 242 244 245 Special formulary 248 TO THE MEDICAL PROFESSION. rtipr? AJ^D BLANCHARD present a condensed list of Books published and preparing for publication bv nth^r'w W0Uld refer to the °,her ?aSes of t^11 catalogue for a more detailed account. The price's, and aft m ti,V« uimau?n ln relatl0n to ^em, will be given on application, free of postage. Being extensively entraeed S™»r?, ftlon of Medlcal and Scientific works, it will be their effort to furnish them at prices lower man SiH«n/' an. as low :,s they can be afr°rded consistent with correct and well-executed editions. The latest ShpT^LT al.wavs be furmshedj and, to their present extensive list, they will add, from time to lime, such SSI BSto^rek."u^h^^0u££^0fe8,,0,l ma7 Cailf0r' TheiF Publitati0nS m&y be found a' »U the'prin- Anatomical Atlas, by Smith and Horner, imperial 8vo.. nearly 650 figures. Arnott's Elements of Physics, new edition, in 1 vol. 8vo., 484 closely printed pages. American Medical Journal, published quarterly at $5 a year. . Abercrombie on the Stomach, 1 vol. 8Vo., 320 pages. Abercrombie on the Brain, a new edition, 1 vol. 6vo., 324 pages. Alison's Outlines of Pathology, in 1 vol. 8vo., 420 pages. Ashwell on the Diseases of Females, complete in one large vol. 8vo. Andral on the Blood, 120 pages, 8vo. Bird's Natural Philosophy, 1 vol. 8vo., preparing. Budd on the Liver, 1 vol. 8vo., preparing. Bell on the Teeth, with plates, 1 vol. Svo., 351 pages. Buckland's Geology and Mineralogy, 2 vols. 8vo., with numerous plates and maps. Berzelius on the Kidneys ana Urine, 1 vol. small 8vo., 179 pages. Bridsewater Treatises, with numerous illustrations, 7 vols. 8vo., 3287 pages. Bartlett on Fevers, &c, 1 vol. 8vo., 393 pages. Baxtfett on the Philosophy of Medicine, 1 vol. Svo., 312 pages. • Brjgham on Mental Excitement and Cultivation, 1 vol: 12mo., 204 pages. Billing's Principles of Medicine, 1 vol. 8vo., 304 pages Brodie on Urinary Organs, 1 vol. 8vo., 214 pages. Brodie on the Joints, 1 vol. 8vo., 216 pages. Brodie's Surgical Lectures, 1 vol. 8vo., at press. Chapman on Thoracic and Abdominal Viscera, 1 vol Bvo., 384 pages. ' Chapman on Fevers, Dropsy, Gout, &c, 1 vol. 8vo., 450 pages. Ctutty's Medical Jurisprudence, 1 vol. 8vo., 509 large Carpenter's Human Physiology, 1 vol. Svo., 618 pages. with cuts. Carpenter's General and Comparative Physiology, 1 vol. 8vo., preparing. Carpenter's Vegetable Physiology, 1 vol. 12mo., with cuts, 300 pages. > ■Carpenter's Animal Physiology, to4je published here- after. Coqper, Sir Astley, his work on Hernia, imperial 8vo., with plates, 428 pages. Cooper on Dislocations and Fractures, 1 vol. 8vo., with cuts, 499 pages. Cqcper on the Testis and Thymus Gland, 1 vol. impe- rial Svo., many plates. Ctagper on the Anatomy and Diseases of the Breast, 1 voj. 8vo., plates, at press. Gbndie on Diseases of Children, 1 vol. Svo., 651 pages. CoStello's Cyclopaedia of Tractical Surgery, to be pub- lished hereafter. Churchill on Females, 3d American edition, 1 vol. 8vo., 572 large pages, / Churchill's Theory and Practice of Midwifery, 1 vol. 8vo., 519 pages, with cuts. Cyclopaedia of Practical Medicine, by Forbes, &c. Edited by Dunglisoh, in 4 large super-royal vols. Carson's Medical Formulary, in preparation. Dejvees's System of Midwifery, with plates, 10th edit., 6Cp pages. Dewees on Children, 8th edition, 548 pages. Dewees on Females, with plates, 8th edition, 532 pages. Dunglison's Physiology, 5th edition, 2 vols. 8vo., 1304 pstges, with 300 cuts. Dqnglison's Therapeutics and Materia Medica, a new work, 2 vols. 8vo.. 1004 pages. Dunglison's Medical Dictionary, 4th edition, tvol. 8vo., 771 very large pages. Dunglison's New Remedies, 5th edition, 1843,015 pages. Dunglison on Human Health, in 1 vol. bvo., 464 pages. Dunglison's Practice of Medicine, 2d edition, 2 vols. ovo., 1322 pages Dunglison's Medical Student, a new edition, 1 vol. l2mo., 312 pages. Drain's Modern Surgery, 1 vol. 8vo., 534 pages, 2d e&ition, many cuts. Ellis's Medical Formulary, 7th edition, 1 vol. 8vo., 262 page* Etliotson's Mesmeric Cases, 8vo.. 56 pages. Esquirol's Great Work on Insanity, translated by Hunt, 1 vol. 8vo., nearly ready. Fownes's Elementary Chemistry, preparing. Fergusson's Practical Surgery, 1 vol. 8vo., 629 pa«-es Graham's Chemistry, with cuts, 1 vol. 8vo., 750 pajres' Goddard's Dissector's Companion, in preparation Gregory's Chemistry, 1 vol. Svo., preparing Guthrie on the Bladder and Urethra, 1 vol. Svo at press. Hoblyn's Dictionary of Medical ferms, by Hays 1 vol. 12mo., at press. Harris on the Maxillary .Sinus, 1 vol. small 8vo., 105 pages. Horner's Special Anatomy, 2 vols. 8vo., 6lh edition, 1114 pages. Hodge on the Mechanism of Parturition, in 1 yol. 4to. with many plates, (preparing.) Hope on the Heart, 1 vol. 8vo., 572 pages. Harrison on the Nervous System, 1 vol. Svo.,' 292 pages. Jones and Todd on the Ear, 1. vol., preparing Kirby on Animals, many plates, 1 vol. 8vo.,D519 pages. Lawrence o_n the Eye, 1 vol. Svo", 778 pages. Lawrence on Ruptures, 1 vol. Svo., 4S0 pages. Miller's Principles of Surgery, 1 vol. Svo. Medical Botany, with numerous cuts, preparing. Maury's Dental Surgery, with plates, a new work, 1 vol. 8vo., 2S5 pages. Mutter's Surgery, 2 vols. 8vo.,now in preparation, with cuts. Muller's Physiology, 1 vol. 8vo., 886 pages. Manual of Ophthalmic Medicine and Surgery, to be published hereafter. Medical News and Library, published monthly. Meigs's Translation of Colombat De L'Isere on the Dis- eases of Females, 1 vol. 8vo. Prout on the Stomach aud Renal Diseases, 1 vol. 8vo, with coloured plates, 465 pages. Popular Medicine, by Coates, 1 ,vol. 8vo., 614 pages. Philip on Protracted Indigestion. 1 vol., 240 pages. Pereira's Materia Medica, 2 vols. 8vo., 1566 very tense and closely printed pages. Roget's Animal and Vegetable Physiology, with many cuts, 2 vols. Svo., 871 pages. Roget's Outlines of Physiology, 1 vol. 8vo.. 516 pages. Rigby's System of Midwifery, 1 vol. 8vo., 491 pages. Ricord on Venereal, new edition, 1 vol. 8vo., 256 pages. Ramsbotham on Parturition, with numerous plates, 1 vol. imperial 8vo., 458 pages. Robertson on the Teeth, 1 vol. 8vo., 229 pages. Stanley on the Bones, 1 vol. 8vo., preparing. * Squarey's Agricultural Chemistry, 12mo., 150 pages. Select Medical Essays by Chapman and others, 2 vols. 8vo„ 1149 pages, double columns. Taylor's New Work on Medical Jurisprudence, by Griffith, 1 vol. Svo.. 540 pages. Tweedie's Library of Practical Medicine, 3 vols. 8vo., 2d edition, revised, 2016 large pages. Traill's Medical Jurisprudence, 1 vol. Rvo.. 234 pages. Trimmer's Geology and Mineralogy, with many cms, 1 vol. Svo., 527 pages. • Todd's Cyclopaedia ctf Anatomy and Physiology, to be published hereafter. Walshe's Diagnosis of the Diseases of the Lungs, 1 vol. 12mo., 310 pages. Watson's Principles and Practice of Physic, 1 vol. 8vo., 920 very large pages. Wilson's Human Anatomy, with ruts, 1 vol. 8vo., a new and improved edition, 608 pages. Wilson's Dissector, or Practical and Surgical Anato- my, by Goddard, with cuts, 1 vol. 12mo., 444 pages. Wilson on the Skin, 1 vol. Svo., 370 pages. Youatt on the Horse, by Skinner, with cuts, 448 pages, 1 vol. Svo. Vouatt arid Clater's Cattle Doctor, 1 vol. 12mo., with cuts, 2'-2 pages. Williams's Pathology, or Principles of Medicine, 1 vo Svo., 3f-3 pages. Williams's Lectures on Stomach, Brain, fcc, 1 vo Svo., preparing. Williams on Respiratory Organs, by Clymer, 1 vo 8vo., 500 pages. They have other works in preparation, not included in this list 3 JUST ISSUED BY LEA & bi^NCHAR WILLIAMS AND CLYMER ON THE RESPIRATORY ORGANS, ETC. A TREATISE ON THE DISEASES OF THE RESPIRATORY ORGANS, INCLUDING THE TRACHEA, LARYNX, LUNGS, AND PLEURA. t By CHARLES J. B. WILLIAMS, M. D., Consulting Physician to the Hospital for Consumption and Diseases of the Chest; Author of " Principles of Medicine," &c. &c. WITH NUMEROUS ADDITIONS AND NOTES. Br MEREDITH CLYMER, M. D., . Physician to the Philadelphia Hospital. In One neat 8vo. Volume, with Cuts. NOW READY, ANOTHER VOLUME OF THE SERIES OF SIR ASTLEY COOPER'S WORKS. ON THE STRUCTURE AND DISEASES OF THE TESTIS, ILLUSTRATED BY 120 FIGURES. From the Second London Edition. By BRANSBY B. COOPER, Esq. "The republication of this splendid volume supplies a want that has been very severely felt from the ex- haustion of the first edition of it. . .. The extraordinary merits of this treatise have been so long and so univer- sally acknowledged, that it would be a work of supererogation to represent them in our pages. The practical. surgeon who is not master of its contents, cannot be fully aware of the imperfection of his own knowledge oa the subject of diseases of the testicle."-^-British and Foreign Medical Review. AND ON THE ANATOMY OF THE THYMUS GLAND. ILLUSTRATED BY 57 FIGURES. The two works together in one beautiful imperial octavo volume, illus- trated in the best style of lithography, and printed and bound to matcli the author's great work on Hernia, lately published. BRIGHAM ON MENTTuTeXCITEMENT. REMARKS ON THE INFLUENCE OF MENTAL CULTIVATION AND MENTAL EXCITEMENT UPON HEALTH. Third Edition. By A. BRIGHAM, M.D., Superintendent and Physician of the Stale Lunatic Asylum, TJtica, N. Y. In One Vol. 12mo. This popular little worlf has been reprinted in London, Edinburgh and Glasgow. In this third American Edition the author has incl.uded all the improvements of the three British editors, and haa also added new matter which brings it up to the day, and readers it still more worth/ of the favour it has so long epjoyed. MEIGS^S- TRANSLATION OF COLOMBAT DE L'lslRE OK THE DISEASES OF FEMALES, A TREATISE QN THE DISEASES OF FEHALES, AND ON ^ THE SPECIAL HYGIENE OF THEIR SEX, * . WITH NUMEROUS WOOD-CUTS.. BY COLOMBAT DE L'ISERE, M. D., Chevalier of the Legion of Honour; late Surgeon to the Jloapital of the Rue^de Valois, devoted t^t'te Diseases of Females, fyc 8,-c. TRANSLATED, WITH, MANY, NOTES AND ADDITIONS, By C. D. MEIGS, j\LD„ Professor of Obstetrics and Diseases of Women and Children in the Jefferson Medical College, <5^. $$. In One Volume, Svo. The notes and addenda of Professor Meigs are very extensive and valuable, bringing the whole up to the. dav of publication, and giving whatever maybe necessary with regard to American practice. It forms a., large octavo volume of near 70U pages, with numerous wood-cuts. LATELY PUBLISHED. A NEW EDITION O? 7TIIS01PS HTJMAH AHATOMY. MiUCH IMPROVED. A SYSTEM OF HUMAN ANATOMY, GENERAL AND SPECIAL. By ERASMUS WILSON, M. D., SECOND AMERICAN EDITION. EDITED BY PAUL B. GODDARD, A.M., M.D., Lecturer on Anatomy, and Demonstrator in the University of Pennsylvania, <£• c. . WITH OVER TWO HUNDRED ILLUSTRATION'S, Beautifully Printed from the Second London Edition, From the Preface to the Second American Edition. "The very rapid sale of the first edition of this work, is evidence of its appreciation by the profession, and i? most gratifying to the author and American editor. In preparing the present edition no pains have been spared to render it as complete a manual of Anatomy for the medical student as possible. A chapter on Histology has therefore been prefixed, and a considerable number of new cuts added. Among the latter, are some very fine ones of the nerves which were almost wholly omitted from the original work. Great care has also been taken to have this edition correct, and the cuts carefully and beautifully worked, and it is confidently believed that it will give satisfaction, offering a farther inducement to its.general use as a Text Book in the various Colleges,".'. LA.TELY PUBLISHED, A N^W AND MUCH IMPROVED EDITION OF DRUITT'SJUR GER7. THE PRINCIPLES AND PRACTICE OF M.0DERN SURGERY. By ROBERT DRUITT,.Surgeon. FROM THE THIRD LONDON EDJTION. ILLUSTRATED BY ONE HUNDRED AND FIFTY-THREE WOOD ENGRAVINGS. WITH NOTES AND COMMENTS By JOSHUA B\ FLINT, M.M. S. S. , In One Volume, 8vo. "An unsurpassable compendium,.not only o,f surgical but of medical practice."—Lpndon Medical Gazette. '* It may be said with truth that the work of Mr. Druitt affords a complete, ftrough brief and condensed view. of the entire field of modern surgery. We know of no work on the same subject, having the appearance oi a manual, which includes so many topics of interest to the surgeon; and the terse manner in which et-.ch has beerl treated evinces a mpst .enviable quality, of mind on the part of the author, who seems to have an innate power of searching out and grasping the leadingfacls and featuresof the most elaborate productions of the pen Notwithstanding various.weedings and alterations, w.e find that there are nearly fifty pages of additional mat- ter in the present volume, and evidently much has been done by both author and publishers to sustain the reputation already acquired. The wood-cuts have been greatly increased in number, and the pencil and graver of William Ba"g have added brilliancy to this portion of the book. . * * * It is a useful handbook for the practitioner, and we should deem a teacher of surgery unpardonable who did not recommend it to his pupils. In our own opinion, it is adrnirably adapted to the wants of the student; and with congratulations to the author and publishers-ribr the latter deserve much credit for the handsome appearance of the volume—on the success of their, undertaking, we leave the present edition as a piquant proportion of the ample store of knowledge which it is the good fortune of the rising youth in the profession to be so cheaply provided with in the present day."—Provimoial Sited. Journal. 5 NOW AT PRESS, ——~----- ESQUIROL'S GREAT WORK ON INSANITY. MENTAL MALADIES, CONSIDERED IN KELATION TO 'MEDICINE, HYGIENE, AND MEDICAL JURISPRUDENCE. By E. ESQUIROL, • Principal Physician of the "Maison Royale des Aliened ile Charenton," &c. &c. TRANSLATED, WITH ADDITIONS, By E. K. HUNT, M. D., In One Volume, Svo. This great work has long been considered as the highest authority on the important points of which it treats. Tlie notes and additions of the Translator, Dr. Hunt, will be numerous and valuable, bringing the scientific and medical'parts of the treatise up to the day of publication, and embodying the results of the milder and improved American practice in the treatment of the insane. . NOW READY,. ASHWELL ON THE DISEASES OF FEMALES, A PRACTICAL TREATISE ON THE DISEASES PECULIAR TO WOMEN, ILLUSTRATED BY CASES DERIVED FROM HOSPITAL AND PRIVATE PRACTICE. By SAMUEL ASHWELL,, M. D., Member of the Royal College of Physicians; Obstetric Physician and Lecturer to Gay's Hospital, &c. WITH ADDITIONS, By PAUL BECK GODDARD, M. D. In One Vol. Svo. • CONTENTS —Part I.—Functional Diseases. '- Introductory Remarks on the Functional AfFections of the Female System.—Chlorosis, and Illustrative Cases, —Amenorrhcea, and Illustrative Cases.—Emmenagogues.—Dysmenorrhoea, and Illustrative Cases.—Pbr- rhulse of Remedies.—Profuse Menstruation.—Menorrhagia, and Illustrative Cases.—Leucorrhoea, and Illustrative Cases.—Inflammation of the Cervix Uteri, and Illustrative Cases.—Formulae of Remedies.— Affections attendant on the decline of the Catamenial Function.—Hysteria.—Irritable Uterus or Hysferal- gia, and Illustrative Cases. Past II.—Organic Diseases. Of the Organic Diseases of the Internal and External Female Genitals.—General Remarks on the History and Symptoms, Diagnosis, Pathology and Prognosis of the Organic Diseases of the Uterine System.—Of the Tumours of the Walls of the Uterus, characterized by Induration.—On Premature Labour in Preg- nancy complicated with Organ c Diseases, and Illustrative Cases.—Organic Diseases of the Os and Cervix Ujeri.—Congestion of the Uterus.—Acute Metritis.—Chronic Metritis.—Cancer of the Uterus, and Illus- trative Cases.—Simple Ulceration of the Cervix and Os Uteri.—Corroding Ulcer of the Uterus.—Cauli- flower Excrescence of the Uterus.—Occlusion and Rigidity of the Cervix Uteri, and Illustrative Cases. - Part III. Oigsflnic Diseases of the Mucous Membrane of the Cavity of the Uterus.—Polypusof the Uterus, and illustrative Cases.—Displacements of the Uterus.—Diseases of the Ovaries.—Of the Diseases of the External Organs of Generation in the Female. ' Appendix. On the Morbid consequences of undue Lactation, with Illustrative Cases.—Case of Pregnancy complrbalei with Abdominal Tumours.—Induction of Premature Labour, &c. &c. A NEW EDITION OF CHURCHILL ON FEMALES. • THE DISEASES OF FEMALES; INCLUDING THOSE OE PREGNANCY AND CHILDBED, By FLEETWOOD CHURCHILL, M.D., Author of "Theory and Practice of Midwifery," etc. &c. THIRD AMERICAN, FROM THE SECOND LONDON EDITION. With Illustrations. Edited, with Notes. B* ROBERT M. HUSTON, M.D., Ac. &c. In One Volume, 8vo. ■•Ifl complying with the demand ofthe profession in this country for a third edition, the Editor has moch plea- Mire in the opportunity thus allbrtled of presenting the work in its more perfect form. All the additional refe- i and iflustrauons contained in the English copy, are. retained in this." A MAGWTTICEfrT AND CHEAP WORK. SMITH & HORNER'S ANATOMICAL ATLAS, Just Published, Price Five Dollars in Parts. AN ANATOMICAL ATLAS ILLUSTRATIVE OF THE STRUCTURE OF THE HUMAN BODY. BY HENRY H. SMITH, M.D., Fellow of the College of Physicians, $c. UNDER THE SUPERVISION OF WILLIAM F. HORNER, M.D., Professor of Anatomy in the University of Pennsylvania. In One large Volume, Imperial Octavo. This work is but just completed, having been delayed over the time intended by the great difficulty in sivinz to the illustrations the desired finish and perfection. It consists of five parts, whose contents are as follows: Part I. The Bones and Ligaments, with one hundred and thirty engravings. * I art II. The Muscular and Dermoid Systems, with ninety-one engravings. Part III. Tlie Organs of Digestion and Generation, with one hundred and ninety-one engravings. I art IV. Tlie Organs ot Respiration and Circulation, with ninety-eight engravings. Part V. The Nervous System and the Senses, with one hundred and twenty-six engravings. Forming altogether a complete System of Anatomical Plates, of nearly SIX HUNDRED AND FIFTY FIGURES, executed in the best style of art, and making one large imperial octavo volume. Those who da not want it in parts can have the work bound in extra cloth or sheep at an extra cost. This work possesses novelty both in the design and the rxecutioru It is the first attempt to apply engraving on wood, on a larga scale, to the illustration of human anatomy, and the beauty of the parts issued induces the publishers to flatter themselves with the hope of the perfect success of their undertaking. The plan of ike work is at once novel and convenient. Each page is perfect in itself, the references being immediately under the figures, so that the eye takes in the whole at a glance, and obviates the necessity of continual reference backwards aiul forwards. Tlie cuts are selected from the best and most accurate sources; and, where neces- sary, original drawings have been made from the admirable Anatomical Collection of the University of Penn- sylvania. It embraces all the late beautiful discoveries arising from the use of the microscope in the investi- gation of the minute structure of the tissues. In the getting up o'this very complete work, the publishers have spared neither pains nor expense, and they now present it to the profession, with the full confidence that itwill be deemed all that is wanted in a scientific and artistical point of view, while, at the same time, its very low price places it within the reach of all. It is particularly adapted to supply the place of skeletons or subjects, as the profession will see by examining the Kst qf plates now annexed. " Thes§ figures aie well selected, and present a complete and accurate representation of that wonderful fabric, the human body. The plan of this Atlas, which renders it so peculiarly convenient for the student, and its superb artistical execution, have been already pointed out. We must congratulate the student upon the eompletion of this atlas, as )t is the most convenient work of the kind that has yet appeared; and, we must add, the very beautiful manner in which it is ' got up' is so creditable to the country as to be flattering to oi»r national pride."—American Medical Journal. "This is an exquisite volume, and a beautiful specimen of art. We have numerous Anatomical Atlases, but we will venture to 6ay that none equal it in cheapness, and none surpass it in faithfulness and spirit. We i strongly recommend to our friends, bath urban and suburban, the purchase of this excellent work, for which both editor ajid publisher deserve the thanks of the profession."—Medical Examiner. "We would strongly recommend it, not only to the student, but also to the working practitioner, who, although grown rusty in the toils of his harness, still has the desire, and often the necessity, of refreshing his knowledge in this fundamental part of the science of medicine."—New York Journal of Medicine and Surg. <( The plan of this Atlas is admirable, and its execution superior to any thing of the kind before published in 1his country. It is a real labour-saving affair, and we regard its publication as the greatest boon that could be conferred on the student of anatomy. It will be equally valuable to the practitioner, by affording him an easy means of recalling tie details learned in the d'ssecting room, and which are soon forgotten."—American Medi- \ ecd Journal. " It is a beautiful as well as particularly useful design, which should be extensively patronized by.physicians, surgeons and medical students."—Boston I'ed. and Surg. Journal. " It has been the aim of the author of the Atlas to comprise in it the valuable points of all previous works, to embrace the latest'microscopieal observations on the anatomy of the tissues, and by placing it at a moderate price to enable all to acquire it who may need its assistance in the dissecting or operating room, or other field of practice."—Western Journal of Med. and Surgery: lfThese numbers complete the series of this beautiful work, which fully merits the praise bestowed upon the earlier numbers. We regard all the eneravings as possessing an accuracy only equalled by their beauty, and cordially recommend the work to all engaged in tlie study of anatomy."—New York Journal of Medicine and Surgery. " A more elegant work than the one before us could not easily be placed by a physician upon the table of his student."—Western Journal of . Udicine and Surgery. " We were much pleased with Part I, but the Second Part gratifies us still more, both as regards the attract- ive nature of the subject, (The Dermoid and Muscular Systems.) and ihe beautiful artistical execution of the illustrations. We have here delineated the most accurate microscopic views of some of the tissues, as, for instance, the cellular and adipose tissues, the epidermis, rete mucosmn and cutis vera, the sebaceous and perspiratory organs of the skin, the perspiratory glands and hairs of the skin, and the hair and nails. Then tiollows the general anatomy of the muscles, and, \mM\y, their separate delineations. We would recommend this Anatomical Atlas to our readers in the yery strongest terms."—New York Journal of Medicine and Suf LIST OF THE ILLUSTRATIONS EMBRACING SIX HUNDRED AND THIRTY-SIX FIGURES 'IN SMITH AND HORNER'S ATLAS. A Highly-finished View op the Bones of the Head, View.of Cuvier's Anatomical Theatre, . . . . facing the title-page. . . . . vumette PART .1.—BONES Fig. 1 Front view of adult skeleton. 3 Hack view of adult skeleton. ■G Foetal skeleton. 4 Cellular structure of femur. 5 Cellular and compound structure of tibia. 6 Fibres of compact matter of hone. 7 Concentric lamella; of bone. 8 Compact matter under the microscope. 9 Haversian canals and lacuna; of botie. 10 Vessels o% compact matter. 11 Minute structure of bones. 1'2 Ossification in cartilage. 13 Ossification in the scapula. 14 Puncta ossificationis in femur. 15 Side view of the spinal column. 16 Epiphyses and diaphysis of bone. 17 External periosteum. 18 Punctum ossificationis in the head. 19 A cervical vertebra. 20 Tlie atlas. 21 The 7 Occipitc-ultoidien ligaments. ■108 Posterior view of the same. 109 Upper part of the same. 110 Moderator ligaments. • 11 Anterior pelvic ligaments. 112 Poslerior pelvic ligaments. 113 Storno-clavicular ligaments. 114 Scapulo-humeral articulation. 115 External view of elbow joint. 116 Internal view of elbow joint. 117 Ligaments of the wrist. 118 Diagram of the carpal synovial membrane 119 Ligaments of the hip joint. 120 Anterior view of the knee joint. 121 Poslerior view of the knee joint. 122 S ction of the right knee joint. 12.1 Section of the left knee joint. 124 Internal side of the ankle joint. lixi Externi' side of the ankle joint. 126 Posterior vLw of the ankle joint 127 Ligaments of the sble of the foot 128 Vertical section of the foot PART IL—DERMOID AND MUSCULAR SYSTEMS. 129 Muscles on the front of the hotly, full length. 131 Muscles on the back of the body, full length. ISO The cellular tissue. 132 Fat vesicles. 133 Blood-vessels of fat 134 r' '1 Tiembrp e of fat vesicles. 135 Magnified view of the epidermis. 1ustral7di\s^ Amltil'and Horner's JJtlas, continued. pig. 136 137 •168 U9 140 141 142 145 146 147 148 149 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 T71 172 173 175 176 177 178 17'J Cellular tissue of the skin. Rete mucosum, &c, of foot Epidermis and rete mucosum. Cutis vera, magnified. Cutaneous papillse. Intern? 1 face of cutis vera. Integuments of foot under the microscope, Cutaneous glands. 144 Sudoriferous organs. 187 Posterior parittes of chest and abdomen Fig. 180 Side view of abdominal muscles. 181 External parts concerned in hernia. 182 Internal parts concerned in hernia. 183 Deep-seated muscles of trunk. 184 Inguinal and femoral rings. 185 Deep-seated muscles of neck. 186 Superficial muscles of back. Sebaceous glands and hairs, Perspiratory gland magnified. A hair under the microscope. A hair from the face under the microscope, Follicle of a hair. 150 Arteries of a hair. Skin of the beard magnified. External surface of the thumb nail. Internal surface of the thumb nail. Section of nail of fore finger. Same highly magnified. Development of muscular fibre. Another view of the same. Arrangement of fibres of muscle. Discs of muscular fibre. Muscular fibre broken transversely. Striped elementary'fibres magnified. Stria; of fibres from the heart of an ox. Transverse section of biceps muscle. Fibres of the pectoralis major. Attachment of tendon to muscle. Nerve terminating in muscle. Superficial muscles of face and neck. Deep-seated muscles of face and neck. Lateral view of the same. Lateral view of superficial muscles of face. Lateral view of deep-seated muscles of face Tensor tarsi or muscle of Horner. Pterygoid muscles. 174 Muscles of neck. Muscles of tongue. Fascia profunda colli. Superficial muscles of thorax. Deep-sealed muscles of thorax. 188'Under side of diaphragm. 189 Second layer of muscles of back. 190 Muscles of vertebral gutter. 191 Fourth layer of muscles of back. 192 Muscles behind cervical vertebrae. 193 Deltoid muscle. 194 An^rior view of muscles of shoulder. 195 Pot vrior view of muscles of shoulder. 196 Another view of the same. 197 Fascia brachialis. 198 Fascia of the fore-arm. 199 Muscles on'the1 back of the hand. 200 Muscles on the front of the arm. 201 Muscles on the back of the arm. 202 Pronators of the fore-arm. 203 Flexor muscles of fore-arm. 204 Muscles in palm of hand. 205 Deep flexors of the fingers. 206 Superficial extensors. 207 Deep-seated extensors. 208 Rotator muscles of the thigh. 909 Muscles on the back of the hip. 210 Deep muscles on the front of thigh. 211 Superficial muscles on the front of diigh. 212 Muscles on the back of the thigh. 213 Muscles on front of le[. 214 Muscles on back of leg. 215 Deep-seated muscles on back of leg. 216 Muscles on the sole of the foot 217 Another view of the same. 218 Deep muscles j>n front of arm. 219 Defcp muscles on back of arm. Frontview of abdominal muscles. PART III.—ORGANS OF DIGESTION AND GENERATION. 220 221 222 223 224 225 226 227 228 236 244 252 260 266 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 2S4 285 286 287 Digestive organs in their whole length. Cavity of the mouth. Labial and buccal glands. Teeth in the upper and lower jaws. Upper jaw, with sockets for teeth. Lower jaw, with sockets for teeth. Under side of the teeth in the upper jaw. Upper side of the teeth in the lower jaw. to 235. Eight teeth, from the upper jaw. to 243. Eight teeth from the lower jaw. to 251. Side view of eight upper j^aw teeth. to 259. Side view of eight lower jaw teeth. to 265. Sections of eight teeth. 288 Back view of the pharynx and muscles. 289 Under side of tlie soft palate. 290 A.lobule of thPparotid gland. 291 Salivary glands. 292 Internal surface of the pharynx. 293 External surface of the pharynx. 294 Vertical section of the pharynx. 295 Muscular coat of the oesophagus. 296 Longitudinal section of the oesophagus. 297 Parietes of the abdomen. 298 Reflexions of the peritoneum. 299 Viscera of the chest and abdomen. 300 Another view of the same. , to 267. Enamel and structure of two of the 301 The intestines in situ teeth. Bicuspis tooth under the microscope. Position of enamel fibres. Hexagonal enamel fibres. Enamel fibres very highly magnified. A very highly magnified view of fig. 268. Internal portion of the dental tubes. External portion of the dental tubes. Section of the crown of a tooth. Tubes at the root of a bicuspis. Upper surface of the tongue. Under surface of the tongue. Periglottis turned off the tongue. Muscles of the tongue. Another view of the same. Section of the tongue. Styloid muscles, etc. Section of a gustatory papilla. View of another papilla. Root of the mouth and soft palate. Front view of the pharynx and muscles. 302 Stomach and oesophagus. 303 Front view of tlie stomach. =304 Interior of the stomach. 305 The stomach and duodenum. 306 Interior of the duodenum. S07 Gastric glands. . 308 Mucous coat of the stomach. 309 An intestinal villus. 310 Its vessels. 311 Glands of the stomach magnified. 312 Villus and lacteal. 313 Muscular coat of the ileum. 314 Jejunum distended and dried. 315 Follicles of Lieberkuhn 316 Glands of Brunner. 317 Intestinal glands. 318 Valvulse conniventes. 319 Ileo-colic valve. 320 Villi and intestinal follicles. S21 Veins of the ileum. 0 322 Villi filled with chyle. 323 Peyer's glands S24 Villi of the jejunum under the microscope. 325 The csecum. 326 The mesocolon and colon, 927 Muscular coat of the colon. Illustrations to Smith and Horner's JiNms- rorittHUSa9.' Fig. 328 329 330 331 332 S33 384 335 336 337 338 339 340 341 343 344 346 347 348 349 350 351 352 353 354 356 357 358 359 361 362 363 364 365 366 368 370 571 S72 411 412 413 414 415 417 418 419 420 421 422 423 424 425 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 Fg. 3/ 3 Sphincter apparatus of the bladder. 374 Prostate and vesiculse seminales. 375 Side view of the pelvic viscera. 376 The glans penis injected. 377 The penis distended and dried. 378 Section of the same. 379 Vertical section of the male pelvis. Ike. 380 Septum pectiniforme. 381 Arteries of the penis. 382 Vertical section of the urethra. 383 Vesicula; seminales injected. 384 Mus'-les of the male perineum. 385 Inter >r of the pelvis, seen from above. 386. Testis in the foetus. 387 Diagram of the descent of the testis. 388 Tunica vaginalis testis. 389 Transverse section of the testis. 390 Relative position of the prostate. S91 Vas deferens. 392 Vertical section of the bladder. 393 The testicle injected with mercury. 394 Another view. 395 Minute structure of the testis. 396 Female generative organs. 397 Another view of the same. S98 External organs in the foetus. 399 Muscles of the female perineum. 400 Side view of the female pelvis, &c. 401 Relative position of the female organs." 402 Section of the uterus, etc. 403 Fallopian tubes, ovaries, &c. 404 Front view of the mammary gland. 4(»5 The same after removal of the skin. 4D6 Side view of the breast. Copora Malpighiana; 367 Same magnified. 407 Origin of lactiferous ducts. Tubuli uriniferi. 369 Corpora Wolffiana. 408 Lactiferous tubes during lactation. The bladder and urethra, full length. 409 Minute termination of a tube. Muscular coat of the bladder. 410 Ducts injected ; after Sir Astley Cooper. Another view of the same.» PART IV.—ORGANS OF RESPIRATION AND CIRCULATION. Muscular fibres of the rectum. ' Curvatures of the large intestine. Mucous follicles of the rectum. Rectal pouches. Follicles of the colpn, highly magnified. Folds and follicles of the stomach. Follicles, &c. of the jejunum. Villi and follicles of the ileum. Muciparous glands of the stomach. Ileum inverted, &c. Glands of Peyer magnified. Peritoneum of the liver injected. Liver in situ. Under surface of the liver. 342 Hepatic vein. Parenchyma of the liver. Hepatic blood-vessels. 345 Biliary ducts. Angular lobules of the liver. Rounded hepatic lobules. Coats of the gall bladder. Gall bladder injected. Vena portarum. External face of the spleen. Internal face of the spleen. Splenic vein. Pancreas &c, injected. 355 Urinary organs. Right kidney and capsule. Left kidney and capsule. Kidney under the microscope. The ureter. 360 Section of right kidney. Section of the left kidney. Pyramids of Malpighi. Lobes of the kidney. Renal arteries, &c, injected. Section of*the kidney highly magnified. Front view of the thyroid cartilage. Side view of the thyroid cartilage. Posterior of the arytenoid cartilage. Anterior of the arytenoid^artilage. TJr' Ligaments of the larynx Side view of the same. The thyroid gland. Internal surface of the larynx. Crico-thyroid muscles. Crico-arytenoid muscles. Articulations of the larynx. Vertical section of the larynx. The vocal ligaments. 426 Thymus gland. Frbnt view of the lungs. Back view of the lungs. The trachea and bronchia. Lungs, heart, &c. First appearance of the blood-vessels. Capillary vessels magnified. Another view of the same. Blood globules. Another view of the same. The mediastina. Parenchyma of the lung. The heart and pericardium. Anterior view of the heart. Posterior view of the heart. Anterior view of its muscular structure. Posterior view of the same. Interior of the right ventricle. Interior of the leff ventricle. Mitral valve, the size of life. The auriculo-ventricular valves. Section of the ventricles. The arteries from the arch of the aorta. The arteries of the neck, the size of life. 450 The external carotid artery. • 451 A front view of arteries of head and neck. 452 The internal maxillary artery. 453 Vertebral and carotid arteries with the aorta. Epiglottis cartilage. 4l6T)ricoid cartilage. 454 Axillary and brachial arteries. 455 Tlie brachial artery. 456 Its division at the elbow. 457 One of the anomalies of the brachial artery. 458 Radial and ulnar arteries. 459 Another view of the same. 460 The arcus sublimis and profundus. 461 The aorta in its entire length. 462 Arteries of the stomach and liver. 463 Superior mesenteric artery. 464 Inferior, mesenteric artery. 465 Abdominal aorta. „ 466 Primitive iliac and femoral arteries. 467 Perineal arteries of the male. 468 F >sition of the arteries in the inguinal canal. 469 In ernal iliac artery. 470 Femoral artery. 471 Gluteal and ischiatic arteries. 472 Branches of the ischiatic artery. 473 Popliteal artery. 474 Anterior tibial artery. 475 Posterior tibial artery. 476 Superficial *>rteries on the top of the foot. 477 Deep-seat d arteries on the top of the foot. 478 Posterior tibial artery at the ankle. 479 The plantar arteries. 4S0 Arteries and veins of the face and Beck. 481 Great vessels from the heart. 482 External jugular vein. 483 1.ateral view of the vertebral sinuses. 4S4 Posterior view of the vertebral sinuses. 485 Anterior view of the vertebral sinuses. 4S6 Superficial veins of the arm. 487 The same at the elbow. im Uustrations to smith and Horner's Atlas continued. Fig- 488 The veins of the hand. 489 The great veins of the trunk. 490 Positionsofthearteriesand veinsofthetrunk. 491 The vena? cava?. 492 The vena portarum. 493 Deep veins of the back of the leg. 494 Positions of the veins to the arteries in the arm. 495 Superficial veins of the thigh. 496 Saphena vein. 497 Superficial veins of the leg. 498 Lymphatics of the upper extremity. Fig. 499 The lymphatics and glands of the axilla. 500 The femoral and aortic lymphatics. 501 The lymphatics of the Small intestines. 502 The thoracic duct. 503 The lymphatics of the groin. 504 Superficial lymphatics of the Oiigh. 505 Lymphatics of the jejunum. 506 Deep lymphatics of the thigh. 507 Superficial lymphatics of the leg. 508 Deep lymphatics of the leg. PART V.—THE NERVOUS SYSTEM AND SENSES. 509 Dura mater cerebri and spinalis. 510 Anterior view of brain and spinal marrow. 511 Anterior view of the spinal marrow, etc. 512 Lateral view of the spinal marrow, &c. fe 513 Posterior view of the spinal marrow, etc 514 Decussation of Mitischelli. 515 Origins of the spinal nerves. ^ 516 Anterior View of spinal marrow and nerves. 517 Posterior view of spinal marrow and nerves. 518 Anterior spinal commissure. 519 Posterior spinal commissure. 520 Transverse section of the spinal marrow. 521 Dura mater and sinuses. 522 Sinuses laid open. 523 Sinuses at the base of the cranium, 524 Pons Varolii, cerebellum, &c. t 525 Superior facp of the cerebellum. 526 Inferior face of the cerebellum. 527 Another view of the cerebellum. 528 View of the arbor vita;, &c. 529 Posterior view of the medulla oblongata. 530 A vertical section of the cerebellum. 531 Another section of the cerebellum. 532 Convolutions of the cerebrum. 533 The cerebrum entire. 534 A section of its base,. 535 The corpus callosum entire. % 536 Diverging fibres of the cerebrum, etc. 537 Vertical section of the head. 538 Section of the corpus callosum. 539 Longitudinal section of the brain. 540 View of a dissection by Gall. 541 The commissures of the brain. 542 Lateral ventricles. 543 Corpora striata-fornix, etc. 544 Fifth ventricle and lyra. 545 Anotherjview} of tlie lateral ventricles. 546 Another view of the ventricles. 547 Origins of the 4th and 5th pairs of nerves. 548 The circle of Willis. 549 A side view of the nose. 550 The nasal cartilages. 551 Bones and cartilages of the nose. 552 Oval cartilages, etc. 553 Schneiderian membrane. 554 External parietes of the left nostril. 555 Arteries of the nose. 556 Pituitary membrane injected. 557 Posterior nares. 558 Front view of the eye. 559 Side view of the eye. 560 Posterior view of "the eyelids, etc. 56L GlandulK palpebrarum. 562 Lachrymal canals. 563 Muscles of the eyeball. 564 Side view of the eyeball. 565 Longitudinal section of the eyeball. 566 Horizontal section of the eyeball. 567 Anterior view of a transverse section. 568 Posterior view of a transverse section. 569 Choroid coat injected. 570 Veins of the choroid coat. 571 The iris. 572 Thefretina and lens. 573 External view of the same. 574 Vessels in the conjunctiva. 575 Retina, injected and magnified. 576 Iris, highly magnified. 577 Vitreous humour and lens. 578 Crystalline adult lens. 579 Lens of the foetus, magnified, 580 Side view of the lens. 581 Membrana pupillarii. 582 Another view of the same. 583 Posterior view of the same, 584 A view of the left ear. 585 Its sebaceous follicles. 586 Cartilages of the ear. 587 The same with its muscles. 588 The cranial side of the ear. 589 Meatus auditorius externus, etc. 590 Labyrinth and bones of the ear. 591 Full view of the malleus. 592 The incus. 593 Another view of the malleus, 594 A front view of the stapes. 595 Magnified view of the stapes. 596 Magnified view of the incus. 597 Cellular structure of the malleus. 598 Magnified view of the labyrinth. 599 Natural size of the labyrinth. 600 Labyrinth laid open and magnified. 601 Labyrinth,/ natural size. 602 Labyrinth of a foetus. 603 Another view of the same. 604 Nerves.of the labyrinth. 005 A view of thevestibule, etc. 606 Its soft parts, &c. 607 An ampulla and nerve. 608 Plan of the cochlea. 609 Lamina spiralis, etc. 610 The auditory nerve. 611 Nerve on the lamina spiralis. 612 Arrangement of the cochlea. 613 Veins of the cochlea, highly magnified. 614 Opening of the Eustachian tube in the throat 615 Portio mollis of the seventh pair of nerves, 616 The olfactory nerves. 617 The optic and seven other pairs of nerves. 618 Third, fourth and sixth pairs of nerves. ' 619 Distribution of the fifth pair. 620 The facial nerve. 621 The hypo-glossal nerves. 622 A plan of the eighth pair of nerves. 623 The distribution of the eighth pair. 624 The great sympathetic nerve. 625 The brachial plexus. 626 Nerves of the front of the arm. 627 Nerves of the back of the arm. 628 Lumbar and ischiatic nerves. 629 Posterior branches to the hip, &C, 630 Anterior crural nerve. 631. Anterior tibial nerve. 632 Branches of the popliteal nerve; 6.33 Posterior tibial nerve on the leg. 634 Posterior tibial nerve on the foot. NOW READY. TAYLOR'S MEDICAL JURISPRUDENCE. MEDICAL JURISPRUDENCE, By ALFRED S. TAYLOR, Lecturer on Medical Jurisprudence and Chemistry at Guy's Hospital, &c. With numerous Notes and Additions, and references to American. practice and law. By R. E. GRIFFITH, M. D. In One Volume, 8vo. Contents.—toisotvxng—wounds-—infanticides-drowning*- hanging—stran- gulation—'SUFFOCATION--^IGHTNING--COLE--STARVATION—RAPE--PREGNANCY —DELIVERY--BIRTH--INHERITANCE--LEGITIMACY—INSANITY* &C. &C. "The promise of the first parts was so full, and the ability displayed was so unquestionable, that all who felt jealous of the honour of our national medical literkture hailed with delight the e(ppearanc"e of a comprehensive and original work of English growth, on one of the most important and difficvflt departments of our science. Everywhere, indeed, we find evidences of extensive reading and laborious research; the copious literature, both of France and Germany, on the subject of Medical Jurisprudence, is laid under frequent contribution, and we have the pleasure of meeting with the accumulated stores of science and experience on this branch of knowledge, it may be. said of the whole world, condensed and made accessible in this admirable volume. It is, in fact, not only the>fullest and most satisfactory book we have ever consulted on the subject of which it treats, but it is also oneof the most masterly books we have ever perused. So much precise individual know- ledge, under guidance of judgment and critical powers of so high an order, as meet us in every page of Mr. Taylor's work, we have rarely encountered."—London Med. Gazette. "We recommend Mr. Taylor's work as the ablest, most comprehensive, and, above all, the most practically useful book which exists on the subject of legal medicine. Any man of sound judgment, who has mastered the contents of Taylor's 'Medical Jurisprudence,' may go into a court of law with the most perfect confidence af being able to acquit himself creditably."—Medico* Chirurgical Review. "The wotfk of Mr. Taylor-may be regarded as a full systematic treatise on the subject of Medical Jurispru- dence. It certainly presents a very excellent view, which maybe named both full and condensed, of the present state of knowledge'On Medical Jurisprudence. The author has illustrated many of the doubtful points of trn-science by good and*interesting cases. He has, in general, shown much judgment in the examination of the difficult arid ambiguous cases; but the whole treatise is so ably prepared that we have no hesitation in 1 recommending it as a very useful guide to the student."—Edinburgh Med. and Surg. Journal. 4 "The most elaborate and complete work that has yet appeared. It contains an immense quantity of cases, lately tried, which entitles it to be considered now what Beck was in its day."—Dublin Medical Journal. "Medical Jurisprudence ought to be a prominent branch of the studies of every lawyer: but what books shall they/read ? Weliave seen none so calculated to serve the purpose of a text-book as this manual. Mr. Taylor possesses the happy an of expressing himself on a scientific topic in intelligible language. Its size fits it to be a-circuit companion.!"—Law Times. ALSO, NOW READY, THE PRINCIPLES OF SURGERY. B.y JAMES MILLER, -F.R. S. E., F. R. C. S. E., Professor of Surgery in the University of Edinburgh, &c. In One neat Svo. Volume, To match in size with Fergusson's Operative Surgery. "No one-can peruse this work without the conviction that he has been addressed by an accomplished sur- geon, endowed with no mean literary skill or doubtful good sense, and who knows how to grace or illumine his subjects with the later lights of-our rapidly advancing physiology. The book deserves a strong recom- mendation, and must secure itself a general perusal.'*—Medical Times. BARTLETT'S PHTLWum OF MEDICINE. AN ESSAY ON THE PHILOSOPHY OF MEDICAL SCIENCE. IN TWO PARTS. " I trust that I have got hold of my pitcher by the right handle."—John Joachim Beccher. By ELISHA BARTLETT, M. D., ■ * Professor of the Theory and Practice of Medicine in the University of Maryland. In One neat Octavo Volume. "We have not room in the present number of our journal, for such a noticeof this philosophical and etegant work, as its merits justly demand. It is evidently destined to create quite a sensation in the medical world; and we shaH therefore give an extended analysis of its 'conients. accompanied by some comments in our Jan- uary number. In the mean time, we advise all our readers to purchase and carefully read it."—N. Y. Journal of Medicine. ffcj* Gentlemen who receive this Catalogue would much oblige the Publishers, if, after reading it, they would hand it, or tHe following eight pages, to their friends. 12 THE EXPLORING EXPEDITION. LEA AND BLA'NCHARD, PHILADELPHIA, « ARE PREPARING FOR PUBLICATION, AND WILL SHORTLY ISSUE, v THE NARRATIVE OF THE UNITED STATES EXPLORING EXPEDITION during the years 1838, 1839, 1840, 1841, and 1842. By CHARLES WILKES, U. S. N., COMMANDER OF THE EXPEDITION, ETC., ETC. In Five Octavo Volumes, of about 2500 Pages; with over 300 Cuts, and Maps. As the history of the only Expedition yet commissioned by our Government to explore foreign countries, this work must present features of unusual interest to every American. Much curiosity has been excited respecting this enterprise, from the length of time during which it was in preparation, and from the various conflicting re- ports which were circulated during its protracted absence. The Squadron—sixvessels—sailed from Norfolk in, August, 1838, and after making important observations on the voyage, via Madeira, arrived at Rio, when their investigations were successfully prosecuted. Sailing thence for Cape Horn, they examined the commercial capabilities of Rio Negro. Arriving at Cape Horn two of the vessels were dispatched to investigate Palmer's Land, and other Antarctic Regions; whence, after encoun- tering great danger, they returned safely, and sailed with the whole Squadron for Valparaiso and Callao. After mitking important observations on the West Coast of South America, regarding the commerce, political history, &c, of that portion of America, they sailed for Sydney, cruising among the numerous groups of islands of the Pacific Archipelago, where the results were peculiarly important, as connected with the commerce and .Whale Fl4iery of our country, as well as the aid they were able to boing to the various missionary establishments en- gager! in the introduction of Christianity and civilization. After remaining some time at Sydney, pursuing im- portant investigatipns, they sailed for the Antarctic Regions, leaving behind them the corps of Naturalists to exjilore that singular country, the observations on which will be found of great interest. The Squadron then. proceeding South, made the brilliant discovery of the Antarctic Continent, on the 19th Janaary, 1S40, in 160° east longitude, along which they coasted, in a westerly direction, to 05° east, a distance of 1500 miles. On the return of the vessels, they touched at New Zealand, when the Naturalists were again taken on board. They next proceeded to the Friendly Islands of* Cook, the Feejee Group, and reached the Sandwich Islands late in the fall, which precludea them from going to the North-West Coast that season. The Paumotu, Samoan, and King's Mills group of islands were visited, and a particular examination made of the Island of Hawaii, its interesting craters and volcanic eruptions. In the spring, the Squadron proceeded to the Oregon Territory, now exciting so much interest in a political point of view; it was thoroughly examined in regard to its commercial and agricul- tural prospects, &c. Here the Peacock was lost on the dangerous bar of the Columbia river. After the Oregon, llpper California was examined. The Expedition now returned to the* Sandwich Islands, and thence s-ailed for Manilla and Singapore, touching at the Philippine Islands, and passing through the Sooloo Sea, the channels of which being correctly ascertained, will greatly benefit the important navigation to China. Touching at the Cape of Good 1 lope and Rio, this important and successful Exploring Expedition finally, on the l()th of June, 1842, arrived at New York, after an absence of three years and ten months. During the whole Voyage, every opportunity was taken to procure information, investigate unknown or little frequented parts of those seas now reached by our commerce, and thoroughly to institute scientific investigations of all kinds. To illustrate these, a vast number of drawings and maps have been executed; but the chief objects in view were of a practical nature. Numerous regulations have been made with the rulers of various islands, to secure the safety of our commerce, now daily increasing in those seas. In short, every thing has been done which lay in the .power of officers or men to make the Expedition redound to the interest and honour of the Country; and in the volumes to be issued will be found its history and embodiment. 13 EAST'S REPORTS. LEA AND BLANCHARD, PHILADELPHIA, HAVE IN PRESS, AND WILL SHORTLY PUBLISH, REPORTS OF CASES ADJUDGED AND DETERMINED IN THE COURT OF KING'S BENCH; WITH TABLES OF THE NAMES OF THE CASES, AND PRINCIPAL MATTERS. By EDWARD HYDE EAST, Esq., OF THE INNER TEMPLE, BARRISTER AT LAW, EDITED, WITH NOTES AND REFERENCES. By a. M. WHARTON, ESQ., OP THE PHILADELPHIA BAR. In this new and improved Edition, the sixteen original will be com- t prised in eight large Royal Octavo volumes, printed with beautiful Long Primer type, on paper manufactured expressly for the purpose, and every care will be taken, in their passage through the press, to insure perfect accuracy. The price of the work handsomely bound in Law Sheep, to those who subscribe before the day of publication, will be only Twenty-Five Dollars, being a great reduction from Seventy-Two Dollars, the publishing price of the former edition. The publishers trust that this moderate charge will insure a liberal subscription: Twenty-seven years have elapsed since the publication of the last Ameri- # can Edition of East's Reports by Mr. Day, and the work has become ex- ceedingly scarce. 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Watson's Practice of Physic, in my opinion, is among the most compre- hensive works on the subject extant, replete with curious and important matter, and written with great perspicuity and felicity of manner. As- Cal- culated^ do much good, I cordially recommend it to that portion of the profession in this country who may be influenced by my judgment. N. Chapman, M.D., Professor of the Practice and Tlieory of Medicine in the University of PennsyVcarUa. "We know of no .other work better calculated for application of thejapeutic3 to diseases, we are free to being placed in the hands of the student, and for a text 3ay has not appeared for very many years. The lec- book, and as such we are sure it will be very exten- turer proceeds through the whole classification of human sively adopted. On every important point, the author ills, a capite ad calcem, showing at every step an exten- seems to have posted up his knowledge to the day."— sive knowledge of his subject, with the f^bility of com- Attterican Medical Journal. municating his precise ideas, in a style remarkable for '!In the Lectures of Dr. Watson, now republished its clearness and simplicity."—N. Y. Journal of Medi- heTe in a large and closely printed volume, in small cine and Surgery. ^ type, of nearly a thousand pages, we have a body of " The style is correct and pleasing, and the matter doctrine and practice of medicine well calculated, by worth the attention of all practitioners, young and old.1" its intrinsic soundness and correctness of style, to in- —Western Lancet. struct the student and youngerpractitioner, and improve " We are free to state that a careful examination of members of the profession of every age."—Bulletin of this volume has satisfied us that it merits all the commen- Medical Science. ' » dation bestowed on it in this country and at home. It is " We know not, indeed, of any work of the same a work adapted to the wants of young practitioners, size that contains a greater amount of useful and in- combining, as it does, sound principles and substantial leresting matter. We are satisfied, indeed, that no phy- practice. It is not too much to say, that it is a represent- sdciaa, well read and observing as he may be, can rise ative of the actual stat? of medicine as taught and prac- fcora its perusal without having added largely to his tised by the most eminent physicians of the present day, stock of valuable information."—Medical Examiner. and as such we would advise every one about embark- " We regard these lectures as the best exposition of ing in the practice of physic to provide1 himself with a their subjects of any we remember to have read. The copy of it."—Western Journal of Med. and Surgery. author is assuredly master of his art. His has been a " The medical literature of this country has been, en- life of observation and study, and in this work he has richedby a work of standard excellence, which we can given us the matured results of these mental efforts."— proudly hold up to our brethren of other countries as a New Orleans Medical Journal. representative of the natural state of British medicine, "Open this huge, well-furnished volume where we as professed and practised by our most enlightened phy- moy, the eye immediately rists on something that car- sicians. And, for our own parts, we are not only wil- ries value on its front. We are impressed at once with ling that our characters as scientific physicians and the strength and depth of the lecturer's views. He gains * skilful practitioners may be deduced from the doctrines on our admiration in proportion to the extent of our ac- contained in this book, but we hesitate not to declare quaintance with his profound researches. Whoever our belief, that for sound, trustworthy principles, and owns this book, will have an acknowledged treasure if substantial, good practice, it cannot be paralleled by any the combined wisdom of the highest authorities is appre- similar production in any other country. * * * * We ciated."—Boston Med. and Surg. Journal. would advise no one to set himself down in practice, un- '•One of the rrjpst practically-useful books that ever provided with a copy."—British and Foreign Medical was presented to the student—indeed, a more admirable Revieiv. summary of general and special pathology, and of the . 20 , WORKS BY PROFESSOR DTJ1TG-LIS01T. -Lea & Blanchard publish and have for sale the following valuable Medical Works by Professor Robley Dunglison. WITH UPWARDS OE THREE HUNDRED ILLUSTRATIONS, By ROBLEY DUNGLISON, M. D„ PROFESSOR OP THE INSTITUTES OP MEDICI-jTE, &C. IN JEFFERSON MEDICAL COLLEGE, PHILADA.; ATTENDING PHYSICIAN AND LECTURER ON CLINICAL MEDICINE AT THE PHILADA. MEDICAL HOSPITAL: SECRETARY TO THE AMERICAN PHILOSOPHICAL SOCIETY, &C. &C. FIFTH EDITION, GREATLY MODIFIED AND IMPROVED. XWT TWO VOLUMES, OF 1304 LARGE OCTAVO PAGES. In presenting piis new and much improved edition of Professor Dunglison's standard work on Phvsiology, the Publishers begto state, that "although only a short time has elapsed since the publication of the fourth edition df this work, the labours of Physiologists have been so numerous, diversified, and important, as to demand ma- terial modifications and additions in the present edition, and that no little time and industry have been bestowed by the author to introduce these, and to digest the various materials contained in the exprofesso treatises, as well as the various Journals of this country and of Europe. '• To this'edition nearly ninety wood-cuts have been added to elucidate either topics that had been already treat- ed of in the previous editions, or such as are new in this; most of the old cuts have been retouched, and many replaced by others that are superior. Altogether, the author has endeavoured to make the work a ju3t and im- partial record of Physiological science, and to render it worthy a continuance of that favour which has been so liberally extended to it." The size of the volumes has been materially increased, by the addition of over eighty pages, and the illustrations are far superior to those of any former edition. THE PRACTICE OF MEDICINE, OR A TREATISE ON SPECIAL PATHOLOGY AND THERAPEUTICS. ' BY ROBLEY DUNGLISON, M. D., CONTAINING -THE DISEASES OF THE ALIMENTARY CANAL, THE DISEASES OF THE CIRCULATORY APPARATUS, DISEASES OF THE GLANDULAR ORGANS, DISEASES OF THE ORGANS OF THE SENSES, DISEASES OF THE RESPIRATORY ORGANS, DISEASES OF THE GLANDIFORM GANGLIONS, DISEASES OF THE NERVOUS SYSTEM, DISEASES *3F THE ORGANS OF REPRODUCTION, DISEASES INVOLVING VARIOUS ORGANS, &c. &c. In Two Volumes, Octavo. This work has been introduced as a text-book in many <5f the Medical colleges, and the general favour with which it has been received, is a guarantee of its value to the practitioner and student. u In the volumes before us. Dr. Dunglison has proved that his acquaintance with the present facts and doc- trines, wheresoever originating, is most extensive and intimate, and the judgment, skill, and impartiality with which the materials of the work have been collected, weighed, arranged, and exposed, are strikingly manifested in every' chapter. Great care is everywhere taken to indicate the source of information, and under the head of ' treatment, formula? of the most appropriate remedies are everywhere introduced. In conclusion, we congratu- late the students and junior practitioners of America, on possessing in ihe present volumes, a work of standard merit, to which they may confidently refer in their doubts and difficulties."—British and Foreign Medical Review for July, 1842. , " Since the foregoing observations were written, we have received a second edition of Dunglison's work, a sufficient indication of the high character it has already attained in America, and justly attained."—British and Foreign Medical Review for October, 1644. " We hail the appearance of this work, which has just been issued from the prolific press of Messrs. Lea & Branchard, of Philadelphia, with no ordinary degree of pleasure. Comprised in two large and closely primed volumes, it exhibits a more full, accurate, and comprehensive digest of the existing slate of medicine t}ian any Other treatise with which we are acquainted in the English language. It discusses many topics—some of them of great practical importance, which are entirely omitted in the writings of Eberle, Dewees, Hosack. Graves, Stokes, Mcintosh, and Gregory; and it cannot fail, therefore, to be of great value, not only to the student, but to* the practitioner, as it affords him ready access to information of which he stands in daily need in the exercise of his profession. It has been the desire of the author, well known as one of the most abundant writers of the age*. to render his work strictly practxal; and to this end he has been induced, whenever opportunity offered* tbf incorporate the results of his owh experience with that of his scientific brethren in America and Euuope. TV> the former, ample justice seems to have been done throughput. We believe this constitutes the sevanth work; which Professor Dunglison has published within the last ten years; and, when we reflect upon the lajge-amount of labour and reflection which must have been necessary in their preparation, it is amazing how heaould hftys accomplished so much in so short a time."—Louisville Journal. NEW REMEDIES, PHARMACEUTICALLY AND THERAPEUTICALLY CONSIDERED?, Br ROBLEY DUNGLISON, M.D., In One Volume, Octavo—over 600 pages, the Fourth Edition. 21 PROFESSOR DUNGLISON'S WORKS. A NEW EDITION OF SHE STANDARD MEDICAL DICTIONARY. A DICTIONARY OF MEDICAL SCIENCE: CONTAINING A CONCISE ACCOUNT OF THE VARIOUS SUBJECTS AND TERMS, WITH THE FRENCH AND OPHER SYNONY'MES, NOTICES OF CLIMATE AND OF CELEBRATED MINERAL WATERS, FORMULA FOR VARIOUS OFFICI- NAL AND EMPIRICAL PREPARATIONS, ETC. Fourth Edition, Extensively Modified and Improved. By ROBLEY DUNGLISON, M. D., In One Volume, Royal Octavo. " The present undertaking was suggested hy the frequent complaints made by the author's pupils, that they were unable to meet with information on numerous topics of professional inquiry—especially of recent intro- duction—in the medical dictionaries accessible to them. " It may, indeed, be correctly affirmed, thafwe have no dictionary of mediea\ subjects and terms which can be looked upon as adapted to the state/of the science. In proof of this the author need but to remark, that the present edition will be found to contain at least two thousand subjects and terms not embraced in the last edition, and to have experienced numerous modifications. "The author's object has not been to make the work a mere lexicon or dictionary of terms, but to afford, under e'ach, a condensed view of its various medical relations, and thus lo render the work an epitome of the'existing condition of medical science. " To execute such a work requires great erudition, unwearied industry, and extensive research; and we fthow no one who could bring to the task higher qualifications of this description than Professor Dunglison.*>-jl»i«ri- ean Medical Journal. ^ GENERAL THERAPEUTICS AND MATERIA MEDICA, ADAPTED FOR A MEDICAL TEXT-BOOK. Br ROBLEY DUNGLISON, M.D., In Two Volumes, Octavo. » * " The subject of Materia Medica has been handled by our author with more than usual judgment. The greater part oi treatises on that subject are, in effect, expositions of the natural and chemical history of the substances uSed in medicine, with very brief notices at all'of the indications thev are capable of fulfilling, and the" general principles of Ther.apeutics. Dr. Dunglison, very wisely, in our opinion, has reversed all this, and given his principal attention to the articles of the Materia Medica as medicines*.... In conclusion, we strongly recom- mend these volumes'to our readers.. No medical student on either side of the Atlantic should be without them.'' —Forbes' British and Foreign Medical Review. ' LATELY PUBLISHED DUNGLISON ON HCTANHEALTH. HUMAN HEALTH; OR, THE INFLUENCE OF ATMOSPHERE AND LOCALITY, CHANGE OF AIR AND CLIMATE, SEASONS, FOOD, CLOTHING, BATHING AND MINERAL SPRINGS, EXERCISE, SLEEP, CORPOREAL AND INTELLECTUAL PURSUITS, &c. &c. ON HEALTHY MAN: CONSTITUTING v ELEMENTS OF HYGIENE. By ROBLEY DUNGLISON, M. D., A NEW EDITION WITH MANY MODIFICATIONS AND ADDITIONS. In One Volume, Svo. • " We have just received the new edition of this learned work on the ' Elements of Hygiene.' Dr. Dunglison is one of the most industrious and voluminous authors of the day. How he' finds time to'amass and arrange.the immense amount of matter contained in his various works, is almost above the comprehension of men possessing but ordinary talents and industry. Such labour deserves immortality."—St. Louis Med. and Surg. Journal. A NEW EDITION OF > THE MEDICAL STUDENT; OR, AIDS TO THE STUDY OF MEDICINE. " A REVISED AND MODIFIED EDITION. BY ROBLEY DUNGLISON, M.D.,» In One neat 12mo. Volume. " In effect, the author's aim is to teach the tyro what he ought to. and how he may studv to the best advantage both before and Sflerhe has attained the dignityofa medical diploma; and while he give's him much good advice m an agreeable manner and enforced by happyil lustrations, he endeavours to simplify his labours by presenting him with ' a glossary of the prefixes, suffixes and radicals of many of the terms legitimately compounded.' of medical technology, a vocabulary of terms used in prescribing and other useful information."—American Medical Journal. 22 THE CYCLOPEDIA OF PRACTICAL MEDICINE, TO BE READY IN MARCH. Forming Four magnificent super-royal Octavo Volumes of about 3200 unusually 'large double-columned pages, printed on beautiful white paper, with a new and clear type, done up in strong sheep binding, or neat extra cloth; or, in Twenty- four Parts, at Fifty Cents each. LEA & BLANCHARD ARE NOW IGSU^NG" THE CYCLOPEDIA OP PRACTICAL MEDICINE: COMPRISING TREATISES ON THE NATURE AND TREATMENT OF DISEASES, MATERIA MEDICA AND THERAPEUTICS, DISEASES OF WOMEN AND CHILDREN, * MEDICAL JURISPRUDENCE, &c. &c. ^ EDITED BY JOHN FORBES, M. D., F. R. S., ALEXANDER TWEED IE, M. D., F. R. S., AND JOHN CONOLLY, M. D. REVISED, WITH ADDITIONS, By ROBLEY DUNGLISON, M. D. This work is printed on good paper with a new and clear type, and forms FOUR VERY LARGE SUPER-ROYAL OCTAVO VOLUMES, with over three thousand unusually large pages, in double columns. This work has now been in the course of publication for about ten months, and is nearly completed, twenty-two numbers having been issued, and the whole will be completed early in March. The parts already published contain the following valuable articles by distin- guished authors: CONTENTS OF PART I. CONTENTS OF PART III. Abdomen. Exploration of the, Dr. Forbes. Abortion, Dr. Iui Sur. Association. _ _ Cyclopsedia of Practical Medicine continued. "This Cyclopaedia is pronounced on all hands to be one of the most valuable medical publications of the d.iv. It is meant to be a library of Practical Medicine. As a work of reference it is invaluable. Among the contrilm- tors to its pages it numbers many of the most experienced and learned physicians of the age, and as a whole ii forms a compendium of medical science and practice from which practitioners and students may draw the richest instruction."—Western Journ. of Mtd. and Surgery. '• In our last number we noticed the publication of this splendid work by Lea and Blanchard. We have since ,received three additional parts, an examination of which has confirmed us in our first impress'on, that as a work of reference for the practitioner—as a cyclopaedia of practical medicine—it i#adinirably adapted 10 the wants of the American profession. In fact, it might advantageously find a place in the library of any gentleman, who has leisire and taste for looking somewhat into the nature, causes, and cure of diseases."—Western Journalof Med. ■ ami Surgery. "The favourable opinion which we expressed on former occasions from the specimeris then before us, is in no degree lessened by a further acquaintance with its scope and execution."—Medical Examiner. '•In conversation with practising i*ysicians, we have been gratified to find that this work comes fully tip to the high expectations formed ol it from the complimentary notices of the Journals, and that as a work of reference it is regarded as superior to any tiling hitherto published oij Practical Medicine."— W,-stern Journal of Mtd. and Surgery. *#* In reply to the numerous inquiries made to them respect- ing Tweedie's Library of Practical Medicine, the Publishers beg leave to state that its place is supplied, in a great measure, by the Cyclopsedia of Practical Medicine, a work much more extended in its plan and execution. The works are entirely distinct and by different authors. The "Library" consists of essays on dis- eases, systematically arranged. The "Cyclopsedia" embraces these subjects treated in a more extended manner, together with numerous interesting essays on all important points of Medical Jurisprudence, Materia Medica and Therapeutics, Obstetrics, History of Medicine, &c, &c*. by the first physicians of England, the whole arranged alphabetically for easier reference. JUST PUBLISHED^ CHAPMAN ON FEVERS, &c. LECTURES ON THF MORE IMPORTANT ERUPTIVE FEVERS, HEMORRHAGES AND DROPSIES, AND ON GOUT AND RHEUMATISM, DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA. By N. CHAPMAN, M. D., Professor of the Theory and Practice of Medicine, &c: &c. In one neat octavo volume. This volume contains Lectures on the following subjects: , EXANTHEMATOTJS FEVERS. Variola, or Small Pox; Inoculated Small Pox; Varicella, or Chicken Pox; Variola; Vacciir'a; or Varrin^ or Cow-pock; Varioloid Disease; Rubeola, Morbilli, or Measles; Scarlatina vel Febris Rubra—Scarlet T-Vvpr REMORKHAIiKS. • " Haemoptysis. Spitting of Blood: Hasmorrhagia Narium, or Haemorrhage from the Nose; Hamalemesis or Vomt mg ot Blood; Hematuria, or Voidingwf Bloody Urine; Heemorrhagia Uterina. or Uterine Haimorrha-'e- lh™r fiuoi-s or Haemorrhoids; Cutaneous Hemorrhage; Purpura Hemorrhagica. ° ' *Ja-'"ul" DROPSIES. Ascites; Encysted Dropsy: Hydrothorax: Hydrops Pericardii: Hydrocephalus Internus. acute, subacute ai.d chronic: Anasarca: with a Disquisition on the Management of the whole "»»mo, mia GOUT, RHKU.V1AT1SM, &c &c. THEY HAVE ALSO FOK SALE LECTURES ON THE MORE IMPORTANT DISEASES or THE THORACIC AND ABDOMINAL VISCERA. DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA. By N. CHAPMAN, M. D. Professor of the Theory and Practice of Medicine, &c. In one volume, octavo. 26 . LEA & BLANCHARD PUBLISH AND HAVE FOR SALE, • HORNER'S ANATOMY. SPECIAL ANATOMY AND HISTOLOGY. BY WILLIAM E. HORNER, M. D., Professor of Anatomy in the University of Pennsylvania, Member of the Imperial Medico-Chirurgical Academy of St. Petersburg, of the Am. l*liilosophical Society, &c. &c. Sixth edition, in two volumes, Svo. '• Another edition of this standard work of Professor Horner has made its appearance to which many additions have been made, and upon which much labour has been bestowed by the author. The additions are chiefly in the department of Histology, or Elementary Anatomy, and so important are they that the Professor has added the lerm to tlie title ot his work. Every part of tkis edition seems to have undergone the most careful revision, and its readers may rest assured of having the science of Anatomy fully brought up to the present day."—Am. Med. Journals GRAHAM'S CHEMISTRY, THE ELEMENTS OF CHEMISTRY, Including the application of the Science to the Arts. WITH NUMEROUS ILLUSTRATIONS. BY THOMAS GRAHAM, F. R. «., L. anclE.D. Professor of Chemistry in University College, London, Sec. &c. WITH NOTES AND ADDITIONS BY ROBERT BRIDGES, M. D., &c. &c. In One Vol. Octavo. The great advancement recently made in all branches of chemical investigation renders necessary a new text hook which shall clearly elucidate the numerous discoveries, especially fn the department connected with organic Chemistry and Physiology, in which such gigantic strides have been made during the last few years. The pre- sent treatise is considered by eminent judges to'fulfil all these indications, and to be peculiarly adapted to the wants of the medical student and practitidher. In adapting it to the wants of the American profession, the editor has endeavoured to render his portion of the work worthy the exalted reputation of the first chemist of England. It is already introduced as a text book in many of the Colleges, and has universal approbation. "Professor Graham's work is one of the best, if not the best, of all English text books, and is of such recent date as to embrace all the latest discoveries. The appearance of a correct and amended American Edition, under the care of Dr. Bridges, will prove an acceptable thing to both teachers and students of Chemistry in this country." —fUJIimnji}* .Tntjrn.nl PEREIRAS MATERIA MEDICA. WITH NEAR THREE HUNDRED ENGRAVINGS ON WOOD. THE ELEMENTS OF MATERIA MEDICA AND THERAPEUTICS.' COMPREHENDING THE NATUBAL HISTORY, PREPARATION, PROPERTIES, COMPOSITION, EFFECTS, AND USES OF MEDICINES. BY JONATHAN PEREIRA, M.D., F. R. 8. and L. S. From the Second London Edition, enlarged and improved. WITH NOTES AND ADDITIONS By JOSEPH CARSON, M. D. In Two Vols. Octavo. The rtbject of the author has been to supply the Medical Student with a Class Book on Materia Medica, conramiug a faithful outline of this Department of Medicine which should embrace a concise account ol the most important discoveries in Natural History, Chemistry, Physiology and Therapeutics, in so far as they pertain to Pharmaoo- larv and treat the subjects in the order of their natural historical relations. This great Library or Cyclopaedia of Materia Medica has been fully revised by DR. JOSEPH CARSON, profes- sor of Materia Medica and Pharmacy in the '• College of Pharmacy," and forms Two Volumes, octavo, of near WOO laree and closely-printed pages. Tt'may be fully relied upon as a permanent and standard work for tha country?—embodying, as it does,iull references to the U. S. Pharmacopoeia and an account of the Medical Plant* nWigenousto the United States. _ __________________________________ FERGUSSON'S PRACTICAL SURGERY, A SYSTEM OF PRACTICAL SURCERY, BY WILLIAM FERGUSSON, F.R.S E., Professor of Surgery in King's College, London; Surgeon to King's College Hospital, tec. &c WJTH TWO HUNDRED AND FORTY-SIX ILLUSTRATIONS. Engraved by Gilbert, after drawings by Bagg. WITH NOTES AND ADDITIONAL ILLUSTRATIONS BY GEORGE W. NORRIS, M. D., In one volume octavo. The rrttWishers commend this work to the attention of the Profession as combining cheapness and elegant* wah The pntwisners commjcim of every sub ect n surg cil science. No pains or expense have been a*lear, sound andpractical trettmen^oi eve y j b ^ ^ tomatch h di £ >( Wi, ^ 2^,«^™rS^i^™ Wd^fe^" and"'- Carpenter's Human Physiology." It is now extensive* u Jim as a.text book. g» LEA AND BLANCHARD ARE PREPARING FOR PUBLICATION A MANUAL OF ELEMENTARY CHEMISTRY, THEORETICAL AND PRACTICAL. By GEORGE FOWNES, PH. D. WITH NUMEROUS WOOD ENGRAVINGS, ' And Notes and Additions by ROBERT BRIDGES, M. D.„ Professor of Chemistry in the " Philadelphia Medical Association," &c. &c. In one vol. royal 12mo. HOBL1TN S DICTIONARY. A DICTIONARY OF TERMS USED IN MEMCLM AND THE COLLATERAL SCIENCES, FOR THE USE OF STUDENTS. BY RICHARD D. HOBLYN, M. D., &c. , From the Second London Edition, with numerous additions. BY ISAAC HAYS, M.D., &e. InOne Volume, royal 12mo. „ GUTHRIE ON THE ANATOMY OF THE BLADDER AND THE URETHRA, AND THE TREATMENT OF THE OBSTRUCTIONS TO WHICH THOSE PASSAGES ARE LIABLE, From the Third London Edition, In one volume, 8vo. ALSO, ANOTHER VOLUME OF THE SPLENDID SERIES OF THE WORKS OF SIR ASTLEY COOPER. COOPER ON THE ANATOMY AND DISEASES OF THE BREAST. The whole to form one large and beautiful imperial octavo volume, with numerous plates in the best style of Lithography, and printed and bound to match the volumes on Hernia and the Testis-already issued. L. & B. HAVE LATELY PUBLISHED CARPENTER'S PHYSIOLOGY. PRINCIPLES OF HUMAN PHYSIOLOGY, With their chief applications to Pathology, Hygiene, and Forensic Medicine. Especially designed for the use of Students. With over One Hundred beautiful Illustrations on Wood. BY WILLIAM B. CARPENTER, M. D., Lecturer on Physiology in the Bristol Medical School. FIRST AMERICAN EDITION, WITH NOTES BY THE AUTHOR? AND NOTES AND ADDITIONS BY MEREDITH CLYMER, M. D., In one volume, octavo. |CP This ^edition of Carpenter's Physiology has been most carefully prepared by Dr. Cly- mer, at the request of Professor Jackson, for his lectures, at the University of Pennsylvania. ALISONS PATHOLOGY. A NEW WORK. OUTLINES OF PATHOLOGY AND PRACTICE OF MEDICINE. BY WILLIAM PULTENEY ALISON, M.D., Professor of the Practice of Medicine in the University of Edinburgh, &c. &c. In three Parts-Part I.—Preliminary Observations-Part ll.-lnflammatory and Febrile Diseases, and Part III., Chronic or Non-Febrile Diseases. In one volume octavo. Tor nnmerons other works not detailed, see the Two following Pages. 28 WORKS IN THE VARIOUS DEPARTMENTS OP MEDICINE AND SUBGEEY! PUBLISHED , BY » LEA & BLANCHARD. ANATOMY. ANATOMICAL ATLAS, illustrative of the Structure of the Human Body; with over Six Hundred Illustrations; the most complete work of the kind ever issued,— beautifully executed, in One Volume Im- perial Octavo; by H. H. Smith, M.D., un- der the supervision of Professor W. E. Hor- ner. HORNER'S Special Anatomy and His- tology; 6th edition, much improved. 2 vols. 8vo., 1114 pages. WILSON'S Human Anatomy; anew edition (the second) revised, with additions by Dr. Goddard: 207 beautiful cuts. 8vo., 60S pages. WILSON'S Dissector, or Practical and Surgical Anatomy; with additions by God- dard—106 cuts. Royal 12mo., 444 pages'. PHYSIOLOGY. HARRISON on the Nervous System; 8vo., 292 pages. MULLER'S Elements of Physiology ; by Baly, arranged by Bell—8vo., 886 Rages. ROGET'S Outlines of Physiology — 8vo., 516 pages. LOGY. v Heart and Great Vessels, with additions by Pennock. 8vo.,' 57a pages. JONES and T<|DD on the Diseases of the Ear, edited by Dr. Hays ; with numer- ous cuts. 8vo., pages—preparing. LAWRENCE'S Treatise 6n the Dis eases of the Eye, with additions by Hays and numerous cuts. 8vo., 778 pages. PROUT'S Treatise on Stomach and Re nal Diseases, with coloured plate's. 8vo. 466 pages. PHILIP'S Treatise on Protracted Indi gestion. 8vo., 240 pages. RICORD'S Treatise on Venereal Dis eases. 8vo., 256 pages. WALSHE'S Diagnosis of the Diseases of the Lungs. 12mo., 310 pages. WILSON on the Diseases of the Skin. 8vo., 370 pages. WILLIAMS' Principles and* Pathology, with additions by Clymer. '8vo., 384 pages. WILLIAMS on the Respiratory Organs, edited by Clymer. 8vo., 508 pages. CARPENTER'S Human Physiology; with notes and additions by Meredith Cly- mer, arid over 100cuts—in 8vo., 618 pages. DUNGLISON'S Human Physiology; the fifth edition, with numerous additions and 300 cuts—in 2 vols. 8vo., 1304 pages. PATHO ABERCROMBIE on the Brain. 3d edit. ------------on the Stomach. 4th edit. ALISON'S Outlines of Pathology. 8vo., ' 424 pages. ANDRAL on the Blood in Disease. 130 pages, 8vo. BELL on the Teeth, with plates—8vo., 350 pages. BERZELIUS on the Kidneys and Urine. 8vo., 178 pages. BARTLETT on the Fevers- of the United States—8vo., 394 pages. BILLINGS' Principles of Medicine— 8vo., 304 pages. BRODIE on the Urinary Organs. 8vo., 214 pages. BRODIE on the Diseases of the Joints. 8vo., 216 pages. • CHAPMAN on Thoracic and Abdomi- nal Viscera. 8vo., 384 pages. CHAPMAN on Eruptive Fevers, &c. 8vo., 448 pages. HOPE'S Treatise on the Diseases of the PRACTICE OF MEDICINE. ASHWELL on the Diseases of Females, \ CHURCHILL on the Diseases of Fe- by Goddard. 1 vol. 8vo., pages—near- males, including those of Pregnancy and ly ready. Childbed; with additions by Huston. 8vo., CONDIE'S Practical Treatise on the 596 pages. 3d edition. Diseases.of Children. 1 voL8vo., 650pages. < COATES' Popular Medicine. 8vo.5)4pp. LEA AND BCANCHARD'S PUBLICATIONS. DEWEES on the Diseases of Children. 8th edition; 8vo., 548 pages. DEWEES on the Diseases of Females. 8vo., with plates, 532 pages. DUNGLISON'STractice 6*f Medicine. Second edition, in 2 volumes 8vo., 1322 pages. TWEEDIE'S Library of Practical Me- dicine. Second edition, revised ; in3.vols. large Svo., 2016 pages. DiT Any one of the five volumes of the first edition can be had separate. WATSON on the Principles and Prac- ' tice of Physic. 8vb., 920 large pages. SURGERY. COOPER'S (Sir Astley) Treatise on Hernia, with lithographic plates. Imperial 8vo., 428 pages. COOPER (Sir Astley) on the Testis and Thymus Gland, with lithographic plates. Imperial 8vo., 1 vol. COOPER (Sir Astley) on Dislocations and Fractures, with numerous cuts, and a Memoir and Portrait. 8vo., 500 pages. DRUITT'S Modern Surgery. Second edition, with 153 cuts; 8vo., 568 pages. FERGUSSON'S System of Practical Surgery, edited by Nbrris, with 246 cuts. 8vo., 630 pages. HARRIS on the Maxillary Sinus. 8vo., 164 pages. LAWRENCE'S Treatise on Ruptures, ;8vo., 480 pages. , i MAURY'S Dental Surgery, with no. | merous plates and cuts. 8vo., 286 pages. ! ROBERTSON on the Teeth. 8vo., 230 pages. I • THERAPEUTICS AND MATERIA MEDICA. DUNGLISON'S Therapeutics and Ma- teria Medica; a new work. 2 vols. Svo., 1004 pages. DUNGLISON'S Treatise on New Re- medies. Fifth edition^Svo., 616 pages. I ELLIS' Medical Formulary, by Morton. ! Seventh edition, 8vo., 262 pages. \ PEREIRA'S Elements of Materia Me- ; dica and Therapeutics ; edited by Carson, ! with 280 cuts. 2 vols. 8vo., 1566 pages. OBSTETRICS. CHURCHILL on the tfheory and Prac-i 'RIGBY'S System of Midwifery, with tice of Midwifery, by Huston;. 116 cuts, j cuts. 8vo., 492 pages. 8vo., 520 pages. RAMSBOTHAM on Parturition, with DEWEES' System of Midwifery, with figures in lithography. Imperial 8vo., 458 plates. Tenth edition, 8vo., 660 pages. \ pages. CHEMISTRY, MEDICAL PHYSICS AND HYGIENE. ARNOTT'S Elements of Physics, with ? second edition revised, wlith additions. 8voj, numerous cuts. One volume 8vo., 520 j 464 pages. PkSes- ' GRAHAM'S Elements of Chemistry, by DUNGLISON on Human Health; a | Bridges, with numerous cuts. Svo., 750pp. MEDICAL JURISPRUDENCE AND MEDICAL EDUCATION CHITTY'S Medical Jurisprudence—S TRAILL'S Medical Jurisprudence.— 8vo., 510 pages. <8vo., 234 pages. DUNGLISON'S Medical Student; al TAYLOR'S Medical Jurisprudence, by new edition, large 12mo. I Griffith. 1vol. 8vo., 540 very large pages. i DICTIONARIES AND JOURNALS. . AMERICAN JOURNAL OF THE MEDICAL SCIENCES; edited by Dr. Isaac Hays, published Quarterly at Five Dollars a Year. CYCLOPAEDIA OF PRACTICAL MEDICINE ; comprising Treatises on the. nature and treatment of Diseases, includ- ing those of Women and Children, Materia Medica, Therapeutics. Medical jurispru- dence. &.c, &c. Edited by Forbes, Twee- die, Conolly and Dunglison. 4 large Su- per-Royal Octavo Volumes. About'3000 pages in double columns. DUNGLISON'S Medical Dictionary; 4th edition, containing over 40,000 words and synonymes ; large 8vo., of 772 pages, double columns: MEDICAL NEWS AND LIBRARY. Published Monthly at One Dollar a Year. SELECT MEDICAL ESSAYS; by Drs. Dunglison, Chapman and others.—1 vols. 8vo., 1150 pages. iF?Fm^SS?iS^N J0URNAL 0F THE MEDICAL SCIENCES. ISAAC HAYS MB s^,^ w^^" of the American Journal of the Medioal Sciences, Edited by hP Am PWlrf* rn.»f- , •D- , Tulllourot tbe Neck, of extraordinary size, successfully removed. By P. C. Spen- cer, M. D [With two wood cu*] VIII. Surgical Cases. By Edwin Hall, M. D. IX. Cases of Strangulated Hernia. By A. B. fehipman, M. D. . • Rf.VIEWS,~X" PouchH 0I1 the Fecundation of the Mammiferae. Raciborski on Puberty and the Critical Ape m Women, and of the Periodical Discharge of Ova, &c. Bischojfon the Proof of the Periodical Ripening aud Separation ot the Ovaof Mammalia and Man, independent of Coirtfe. XI. Chadwick on Interment in Towns. Bibliographical Notices.—XII. 1. The Twentieth Annual Report of the Officers of the Retreat for the Insane at Hartford. 2. Eighth Annual Report of the Physician and Superintendent of the Vermont Asylum tor the Insane. 3. Report of the Superintendent of the Boston Lunatic Hospital, and Physician of the Public Insututions of South Boston.—XIII. 1. Reports of the state of the Kent. County Lunatic Asylum. 2 State- ments of the Visiting Committee of the County Lunatic Asylum, near Gloucesier. 3. The Report of the Committee of Visitors of the Lunatic Asylum for the County of Leicester. 4. Thirty-third Annual Report of and on Inverted Toe-Nail. XV. Wattman on Means of Preventing the Rapid Occurrence of Fatal Symp- toms in the Accidental Introduction of Air into the Veins. ,XVI. Hennemann on a New Series of Subcuta- neous Operations. XVII. Hvfeland's Enchiridion Medicum. XVIII. Summary of the Transactions of the Cojlege of Physicians of Philadelphia. March to October, 1944. XIX. Chapman on the more important Eruptive Fevers, Haemorrhages and Dropsies, and on Gout and Rheumatism. SUMMARY OF THE IMPROVEMENTS AND DISCOVERIES IN THE MEDICAL SCIENCES. Anatomy and Physiology.—1. Scherer on the Coloraiion of the Blood. 2. Jobert de Lamballe on the Struc- ture of the Uterus. 3. Mulder on the products of the oxidation of Protein in the Animal Organism. 4. Moreau on the causes which determine the Sex in Generation. 5. Mag'endie on the Influence of Heat and of Stoves on Animal Life. 0. Bernard and Barreswil on Alimentary Substances. 7. Schvan on the importance of Bile in the Living Animal Organism. 8. Blaquiere on Gunshot Wound of the Anterior Cerebral Lobes. 9. Boudet on the Chemical Composition of the Pulmonary Parenchyma anil of Tubercies. Materia Medica and Pharmacy.—10. Seidlitz on Cotton as a Dressing to Blisters. 11. Devay on the mode of preparing the Valerianate of Zinc. 12. Bouchardal on Croton Oil Plaster. 13. Millot on the LithoWiptic action of the Gastric Juice. 14. Gumprecht on Cortex Frangulee. 15. Scheidemaudel on the mode of preparing some Narcotic Extracts in small quantities. 16. Burton on a new method of making Medicated Tinctures. 17. Hoffman on Caroub of Judea in Asthmatic Aflections. Medical Pathology and Therapeutics and Practical Medicine.—18. Lossttte on Small-pox in persons who had been Vaccinated. 19. Bertini and Bellingiere on Nitrate of Silver in Chronic Diarrhosa. 20. Bellin- giere on Balsam of Copaiba in Chronic Bronchitis. 21. Druitt on the uses of Pure Tannin. 22. Fourcault on the causes of Albuminuria. 23. Meyer's Researches on Albuminuria. 24. Rees on the PatHblogy and Treat- ment of the Morbus Brightii, and various forms of Anaemia. 25. Gregory on Deaths from Small-pox after Vaccination, in London. 26. Devay on Valerianate of Zinc in Nervous Affections. 27. Ferini on a singular case of Encephalitis. 28. Salvagnoli on Analysis of the Blood of Persons Exposed to Malaria. 29. CEsterlen on the Passage of Metallic Mercury into the Blood and Solid Tissues. 30. Lamothe on Epilepsy caused by a Foreign Body in the Ear, and cured'by its removal. 31. Symptoms of Acute PJeurisy, caused by Intestinal Worms. 32. J. and J. H. Smith on Sulphate of Iron combined with an Alkaline Carbonate, an Antidote for Prussic Acid. 33. Mac Bonnet on the Diagnosis of Empyema. 34. Mondiere on a Tsenia evacuated through aa opening in the Abdominal Parietes. 35. Trousseau on the Signs of Auscuhation in Young Children. Surgical Pathology and Theuapeutics and Operative Surgery.—36. Syme on treatment of Obstinate Stricture of the Urethra. 37. Reybard on Suture of the Intestine. 39. Bodinier on the Nature and Source of the Liquid which flows from the Ear producing OEdema of the Scalp. 39. Danville on Gunshot Wound, where th)s charge passed from the Navel to the Back without fatal consequences. 40. Sandham on mode of Reducing Partial Displacement of the Semi-lunar Cartilages of the Knee-joint. 41. Porter on Operation for the Radical Cure of Hydrocele. 42. Two cases of Luxation of the Iliac Bone upon the Sacrum. 43. Singular cause of Error in Diagnosis of Affections of the Knee. 44. Daniell on Warty Excrescences near the Verge of the Anus. 45. Daniell on Enormous Steiatoma removed from the Shoulder. 46. Jtaffreson on Operations for Removal of Ovarian Tumours. 47. Bird on Removal of a Diseased Ovary. 48. Wiesel on Ununited Fracture Successfully Treated by Acupuncture. 49. Monin on Luxation of the Forearm forwards without fracture of the Olecranon. 50. Segalas on Influence of Traumatic Lesions of the Spinal Cord on Diseases of the Urinary Passages. 51. Wildebrand on the Treatment of Syphilis by Tartar-emetic. 52. Barbiere's case of Recovery from Wound with Hernia of the Lung. 53. Syme on Popliteal Aneurism in a Child. -54. Rognetta on Epidemic Erysipelas. 55. Inman on Mortality attending the operation of Tyiug the Large Arteries. 56. Vanzetti on Fibrous Tumour of the Parotid. 57. Vidal on New Operation for Varicocele. 58. Inman on Mortality attending the Operation for Hernia. 59. Laugier on Immovable Bandages of Starched Paper for the Treatment of Fractures of the Limbs. 60. Cox on Gunshot Wound of the Chest^evacuation of the ball per anum. 61. Wilde on Discharges from tlie Ears. 62. Syme on Bursal Swelling of the Wrist and Palm of the Hann. Ophthalmology.—63. Morant on Epidemic Ophthalmia. 64. Bernard's Method of Curing Lachrymal Fistute and Chronic Lachrymations reputed incurable. 65. Dalrymplt on Cyst atiached to the Anterior Surface of the Iris. Midwifery.—66. Prael on Caesarian operation performed with success both for the mother and child; rupture of lhe uterus and of the abdominal parietes tliirteen months subsequently, during a second pregnancy; delivery of the fetus through this spontaneous opening; complete recovery of the mother. 67. Fischer's case of Gravid Uterus passifig into the Sac of an old Inguinal Hernia.—Csesarian Section. 69. Aubinais on Polypus of the Uterus adherent to the Placenta Successfully Removed. 69. Ginestet on the Juice of the Urtica Urens in Uterine Hemorrhage. 70. Darbey on Prolapsed Uterus— Pregnancy. 71. Lee on Dropsy of the Amnion 72. Lee on the -Causes and Treatment of Uterine Hemorrhage, in the latter months of pregnancy. 73. Lee on Retained Pla- centa. 74. Lisfranc on Diagnosis of Inverted Uterus and Polypus. 75. Murphy's Statistics of Obstetric Practice. Medical Jurisprudence and Toxicology.—76. Olivier on Arsenic in the Earth of Cemeteries. 77. Ramsay on Aconitum Napellus. 78. Jacob on Poisoning by Euphorbia Lathyris,. 79. Rupture of the Omentum. 80. Lis- franc's opinion on some Disputed Points in Obstetrical Medical Jurisprudence. SI. Hereditary Insanity,Ww far, in cases of alleged unsoundness of mind, it may be pleaded. S2. Simpson on Relative Weight and Size of the Male and Female at Birth. 83. Copper Tanks at St. Helena. 84 U'rial for Murder. 85. Case of Suicide. 86. Recent English Law Cases. 87. Obituary of Dr. Abercrombie. ■ American Intelligence.—Original Communications.—Horner on the Preservation of the Human Body for Anatomical Purposes. Proceedings of the Association of Medical Superintendents of American Institutions for the Insane. Perkins's Cases of Congestive Fever. . „, .„ . • _. T T „ . „ . .. Domestic Summary.—Fourgeaud on Mortality among Children m St. Louis. Le Conte on Extraordinary Effects of a Stroke of Lightning. Bowles on Removal of a Diseased Ovarium. Hemck on Rupture of the Spleen. Marthens on Fracture during Pregnancy. Buck and Watson on Opium a Hazardous Remedy m Stran- gulated Hernia. Yellow Fever at Woodville, Miss. Davis on Colon Strangulated by the Meso-colon. Clark on Dweharge of a Lumbricus from the Male Urethra. M'DoweU's cases of Extirpation of Diseased Ovaria. IfewWwk*. Death of Dr. Forry. . J1 AMERIGAN MED1GAL JOURNAL PUBLISHERS' NOTICE. In presenting the first number for the year of The American Journal of thb Medical Sciences, the Publishers must offer their thanks to the profession for the increased favour extended to this long-established periodical, now the oldest Merit. cal Journal in the Union. As an evidence of this patronage it may be stated, that notwithstanding an enlarged edition was printed for last year, at the present time not a single copy of the January or October numbers can be supplied. It is intended to continue the -work as heretofore, with about 264 large pages, quarterly, with such cuts and plates as are essential to illustrate the different papers; arid particular attention is invited to that portion embracing THE RETROSPECT FOR THE QUARTER, Presenting, as it does, the most copious Summary of the Improvements and Dis- coveries in Medicine and Surgery, from all the various Journals published abroad and at home. ' With a view-of extending the circulation of the Journal, the publishers are now furnishing, ,with it— A MONTHLY PERIODICAL,, FREE OF CHARGE,. 7 . f to such subscribers as remit Five Dollars in adyance. Attention is solicited to the following terms:— Those persons who remit Five Dollars by the first of March, will receive not only The Aledicul Journal for 1845, but'the Medical News and Library for 1845, free from any further charge. 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The Medical Xeics and Library for 1845 will contain, in addition to the News of the month, THE SURGICAL LECTURES OF SIR BENJAMIN RRODIE; Thus following Watson's Practice of Physic, (which occupied the Library portion of the News for 1843 and 1844,) with a work on Surgery of great practical value, and by one of the first and most authoritative surgeonsof the day. The pages of the Lectures will be so arranged that, when complete, they can be bound in a volume. The News and Library will be issued monthly, and contain 32 pages, and go by mail as a newspaper. Price One Dollar a year, payable in advance, and in current funds, free of postage. • Postmasters are at liberty to frank remittances in payment for subscriptions. The Publishers beg to present the Contents of the Journal for January 1845, which will be found on the preceding page. U^" This paper may be delivered to any physician if declined by the person to whom it is addressed or if they have removed—-and Postmasters and others will particularly oblige the publishers by furnishing a list of the Physicians and Law- yeVs of their county or neighbourhood. In addition to the business it may bring to the office, a copy of " The Complete Florist," or such other volume, will be sent by mail gratis for any ten or more names furnished free of cost. Philadelphia, Janua)-y} 1845., 32