:y-
A PRACTICAL TREATISE
VENEREAL   DISEASES;
i?"1^
■#**.;.
CRITICAL AND EXPERpENTAL RESEARCH!^
ON INOCULATION,
APPLIED TO THE STUDY OF THESE AFFECTIONS
SSerajjeutical Summars antr Special jForimilarg
            BY PH. RICORD, M.D.,

BURGEON OF THE VENEREAL HOSPITAL OF PARIS, CLINICAL PROFESSOR Or
            SPECIAL PATHOLOGY, ETC. ETC.

    TRANSLATED FROM THE FRENCH,

BY A. SIDNEY DOANE, A.M..M.D.
SEVENTH EDITION.
KEDFIELD,
110 AND 112 NASSAU STREET, NEW YORK.
              1853. 

C  j -z

               Entered, according to Act of Congress, in the yeai 641!,
                              By P.  GORDON,
ii the Clerk's  Office of the  District Court ot the United  States, for the Soutacra District
                                  of New York. 
    ADVERTISEMENT

                 TO THE

FIRST  AMERICAN  EDITION
  Mons. Ricord's reputation has long been known to those phy-
sicians and students who have  had an opportunity of listening to
his  eloquent instructions in Paris, or to whom his French Treatise
on  Syphilis has become familiar.   He  is distinguished for his
sound, and philosophical, and novel views,  upon a  disease which
carries terror with it wherever it appears; the existence of which
has brought a  catalogue of ills upon frail humanity, and whose
consequences are often felt by the innocent as well  as the guilty.
The first part of this book partakes of the philosophical spirit  of its
author, while in the pages devoted to the treatment of syphilis,
M. Ricord has spread out the results  of thousands of cases treated
in the Hopital des Capucins, and which will be  found to be im-
mensely important to every practical man.  With a view to present
a valuable work to the medical profession in America, the Ameri-
can publisher procured a  translation of M. Ricord's Treatise, by
Mr. Drummond, which was printed in London, in 1841.  But on
comparing  this translation with the original,  it was found that
much had been  omitted; for instance, some  forty or  fifty cases, of 
IV                      ADVERTISEMENT.
a highly practical character, and  much too  on the score of treat-
ment.  Hence  it has  been necessary to  revise the  entire work;
and  it will be found that the present translation  is, in fact, a
new one.
  We hope that the exertions of the American publisher may be
duly appreciated by the profession, and that the book may meet a
sale commensurate with its deserts. 
AUTHOR'S   PREFACE.
  The various motives which induce men to wrrite, do not allow
us to place an equal degree of confidence in  all of them.  The
truth of this  assertion  is incontestable as regards the history of
sciences in general, but more particularly in that which is about
to occupy our attention in the following pages.  If we survey the
works which  we already possess on the artificial inoculation of ve-
nereal diseases, we  shall soon find that either the interest of some
theory, the speculations of quacks, or, not unfrequently, vexatious
criticism  and  misrepresentation, have dictated what we  find in
authors who have written on  this important  subject.   If we read
and then compare what we find with the results of honest experi-
ence, in different works on this subject, 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 pre-
conceived notions, and  with the sole object of discovering the truth
amongst so many contradictions.   My numerous experiments will
enable me to furnish a  material proof of every point I advance.
  Since the time of Hunter, the experiments of inoculating syphi-
litic 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. 
Vi                    AUTHOR'S PREFACE.
  HI. 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 ob-
stinate 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 hygienic and medico-legal point of view.
  These are the divisions I have  adopted, and I shall presently pro-
ceed 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 treatment; to which is added a  Special Formulary,
which have used in the Hopital des Veneriens. 
        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 there be a class of disease where an evident connexion ex-
ists between  cause  and effect, it  is undoubtedly  the  syphilitic
class,"* and this constant and regular connexion is proved par-
ticularly by inoculation.
  Alexander Benedictus, a Veronese physician, was the first to ad-
mit,  as a  contagious principle, a venereal taint produced in the
sexual organs of women by the alteration of humors which they
exhale ; this was admitted by Fernel, and received the name of lues
venerea, poison, venereal virus, &c, and  since that time most wri-
ters on syphilis have acknowledged the existence of a specific cause,
of a peculiar deleterious principle.
  This cause, however, which is so  easily recognised at its source,
and the effects of which can  be followed so regularly, was over-
looked by the ancients until the terrible  epidemic of the fifteenth
century; and, in our own times, we find a few who are sincere in
their incredulity, and many more interested disbelievers.
  I dp not intend in this place to review  all the reasons and argu-
ments that have  been brought forward  to  prove or disprove the
existence of the venereal virus;  but  as  inoculation has  by turns
been appealed to by each party, ray aim will be to show its definite
value.   To omit nothing concerning this  important question, let us
* Petit Radel, preface a la traduction de Nisbet. 
 8         CRITICAL RESEARCHES AND  GENERAL REMARKS--

 first see what has been said  by authors opposed to the doctrine of
 a virus.
   Bru's experiments have been cited by the opponents of a virus,
 but he was so much influenced by a strange theory, that it may be
justly questioned if he saw what he relates in its proper light, and
we may confidently assert, that he did not know how to appreciate
the circumstances under  which he made  his experiments.   He re-
marks :—*
  " Is the virus inoculated with its venereal action, or only with a
disposition?  Is the pus of chancres, gonorrhoea, and bubos, con-
tagious, and can it serve to inoculate syphilis 1
  " To proceed  with order  and perspicuity in  this important ex-
amination,  it must be proved, first, that what is  understood by ve-
nereal virus, is not inoculated, and that it is only the mode which
is inoculated, and that the virus or pus is only the consequence of
the neutralization of the mode.   Secondly, that the mode  inocula-
ted is only  by virtue of a kind of electrification, after it has mani-
fested its action by the immediate contact of the diseased part with
the healthy part; which leads us to examine the mechanism of the
venereal act.  Thirdly, that the venereal mode may exist in a state
of fixedness,  and that in this  state it does  not  inoculate, but must
first pass into a state of expansion.   Fourthly,  that the communi-
cating mode of syphilis 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 with 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,f and Ave think we shall be able to  prove  this fact.  I have
inserted 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.
  * Methode nouvelle de traiter les maladies venerieimes par les gateaux toniques
inercuriels, par  Bru, tome i. chap. 3, p. 45.  Paris, 1789
  t By mode, is to be understood what it has been intended to express by leaven 
dOCULATICjN OF THE  SYPHILITIC  VIRUS.
9
   %f 1 have also made  the  same experiment with the matter of a
gonorrhoea writh as little success.  I have  also employed that of
bubos at  the  moment of their being opened, and always without
effect.*  Finally, I have conveyed pus,  procured from these three
forms of disease, a considerable depth into the canal of the urethra,
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  repeated  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 conclude,
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 necessarily only the consequence of its neutralization.
   " This  proof is incontrovertible; and  it only remains to estab-
lish it clearly, which  will be done in the following  section.   But
before I proceed to the  facts which belong to it, a question presents
itself  which must first be answered, that the chain of evidence may
be unbroken; we must determine what  is the venereal mode, of
which the suppurations it excites are but a result; for under  this
supposition, which is clearly demonstrated, this mode cannot inocu
late with the venereal action.  Upon this hypothesis, the venereal
mode ought not only  to show itself at the instant of inoculation, 01
at least very soon after,  as it is of a corrosive character, but always
in the same place as it has been inoculated; this, however, only
happens in the case of chancres.   Moreover this supposition is not
correct, because only a small point of the parts which have been in
contact ulcerate, which proves that it is less the effect of an imme-
diate  than of a subsequent action.   In the inoculation of the small-
pox, this effect of the immediate action is very evident, for the spot
inflames  soon after the pus has been introduced.  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,
because the pus taken from these wounds a month after the desic-
cation of  all other pustules, is still capable of communicating  the
  • In  this case it cannot be  expected that inoculation should produce any result.
                               2 
10       CRITICAL RESEARCHES AND GENERAL REMARKS--
disease.  In  the  inoculation of the  venereal mode the chancre 13
the only part which can  be suspected as the point of contact w;th
the virus,  for surely this is impossible in gonorrhoea, which has
generally its seat in  the beginning of the canal, or  in bubo when
it exists alone.
  " Another  proof that the venereal mode  is not inoculated with
the venereal action, results from a very familiar circumstance, with
which most  persons  are acquainted.   A man has had connexion
with an infected woman, but does not yet feel any effects of the in-
fection.  In this state he has connexion with a healthy woman, to
whom he does not communicate any disease; yet the  action is es-
tablished in him, the disease declares itself in a few days, and some-
times on the same day.   From this it would appear  that the vene-
real disease can  only be communicated  after the mode has  ac-
quired its action;  for when the symptoms have once shown them-
selves, it has  the property of being communicated, but the product
of these symptoms is  not contagious.  Pus of  all kinds has been
inoculated, and by all possible methods,  infection does  not take
place.   This pus, then, is not a condition  of the contagious proper-
ty 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 ve-
nereal mode  cannot? be inoculated before it has manifested its ac-
tion, by immediate contact in the act of coition, (which does not
take place till some time has elapsed,) wre 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 exposed to the air nor disseminated in the puru-
lent 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 its action, one cannot suppose
but that the venereal mode is electric fluid, or some other modifica-
tion of dementary fire altered  and changed  under a form of ex-
pansion." 
INOCULATION OF THE  SYPHILITIC  VIRUS.
11
  After Bru, I think I ought to quote what Caron* says of the ve-
nereal virus, and its manner of infecting.
  " If it can be said correctly that the impregnation of females is
in fact a contagion, 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 intersuscep-
tion, or absorption of a virulent  fluid.  The communication of the
contagious principle  during  the purulent secretion which it has
caused, has led into error, and caused  the venereal pus to be con-
founded with the virus, although it was only the consequence of it.
Deceived, moreover, by the manner in which variolous matter inocu-
lates, and by its supposed 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 absorp-
tion, and travelling through  the  system by means of the general
circulation.  This manner of regarding the process appears  so
natural,  and  is so sanctioned by time  and custom, 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 astonished, without
being  convinced, on  finding, by  numerous simple  and easy ex-
periments, 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
reflect that it is impossible to conceive of any morbid action without
a previous derangement in the vital powers, we shall soon be con-
vinced 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 ani-
mal  process,  depending  upon a disturbance or modification of the
peculiar functions of the system.  In fact, it is the natural suscep-
tibility  of the vital principle, the sympathy of the capillary and
nervous systems which develop it, and hence its  primary cause is
w little known as that of the other vital  actions.   All that we can
comprehend of contagion is, that the virulent principles must have
properties in common with the bodies which contract them.  Now,
without being able to explain the nature of the venereal virus, or
rather the principle of its conception in the system, we shall  as-
              * Nouvelle doctrine les  maladies veneriennes. 
12       CRITICAL RESEARCHES  AND GENERAL  REMARKS-
sume, as an incontestable truth, that it takes place only by a speci-
fic 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  has in itself nothing
contagious or irritating, it is not capable of developing the virus.
  " 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 from  them; they
must  either be refuted  or  more justly drawn; for singular and
paradoxical as they may seem, they ought to be admitted, if ap-
proved by  reason and confirmed by experience.
  " But it  is asserted, that it is only during the voluptuous excite-
ment of the venereal act that the virus can be materially inoculated
with the pus.   Now 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,  in 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 properties,  and that
if the venereal  infection  can be conceived during coition, it is by a
new act  of the organism which reproduces it.  In fact, the syphi-
litic matter being destitute of life or sensibility, how  should it ac-
quire 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  when favored by a  far more
powerful cause.
  " Thus it is not a virus which is transmitted by inoculation  in
the venereal contagion, but an occult vice, which is developed  in
us : it is nature or life which establishes the syphilitic constitution,
and not the pus, which is only the sequence  of it.  In short, the
material principles of contagious diseases, 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 
INOCULATION OF THE SYPHILITIC VIRUS.
13
reality, in as far as they are united to that of effects, of which they
are regarded as the causes.
      *        *       *       *        *       *       *
  " The  venereal infection has at first only a local action, which
extends itself in succession to certain  parts;  but it is always sub-
ordinate  to the powers of nature,  or  subjugated by the essential
organs of life, because the heart, stomach, brain, lungs, &c, never
feel the  effects  of it.   If the  generating organs of the venereal
virus, if  the skin and  the exterior  lymphatic ganglions, and more
especially the organs of sense, receive it first, it is because a pe*
culiar sympathy exists between  all 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 irri-
tations.  Now the venereal mode being once received into the sys-
tem, it must, if  its action be developed,  establish itself on the skin,
nose, mouth, eyes, ears, or pharynx, &c, since independent of the
natural disposition of  these organs to contract it, the contact of the
garments, air, light, and  all exterior irritations must favor its de-
velopment.
      *******
   " A powerful and  repeated irritation may disorder the natural
sensibility of the skin, and produce some  disease in the irritated
parts, but it never causes the voluptuous sensation procured by the
parts of generation, and these which  are analogous to them. Thus
the delightful sensations in coition, suckling, chafing the lips and
eyelids,  which  agitate and  excite  the sensitive principle, with  so
many charms and so much energy, are also the only means of con
tagion.  However great the voluptuousness  of kisses, and the suck-
ing of the nipples, it  may yet be thought that these organs, which
so  easily contract  the venereal disposition, wThen 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, degenerate, and dangerous, according as the
 act which gave rise to it is removed from coition, its true origin."
    " After these statements, it appears easy to reconcile the appa-
 rently contradictory facts which the syphilitic infection of newborn
 infants,  nurses,  and nurslings,  presents.   We see that it has been 
14        CRITICAL RESEARCHES  AND GENERAL REMARKS--

justly asserted, from very exact  observations,  that  the  venereal
virus was not materially contained in the semen, milk, or  saliva;
but on  the  other hand it is wrong to conclude from this that the
aura vitalis of the first two fluids, and particularly of the sperma,
acted upon by that which constitutes the syphilitic principle, might
not affect the foetus or  nursling : although the venereal disposition,
weakened or repressed in its  action by the vital  powers  of the
lather  or nurse, did not present any indication of its existence.
Certainly we must not  conclude, from the experimental inoculations
which have been instituted, that the matter of recent gonorrhoeas
and primitive chancres, inoculated under  peculiar circumstances,
and with certain vital  conditions, is always innocent; but we may
be  sure it will  not impregnate with the syphilitic mode which it
does not contain.  In fact, 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 morbid  action 1
But what will be its nature 1—a purely local affection proportional
to the nature and energy of the inoculated fluid, and of the  irri-
tation."
   From these extracts it is evident that Bru has only brought for-
ward his experiments, to support a theory which was opposed 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 re-
futation;  and the manner in which he expresses himself as to 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 for the school  to which this  able
writer belongs.
   " It is pretended," says he, " that the venereal virus belongs ex-
clusively to the human race.   This assertion rests principally upon
some experiments from which Hunter and Turnbull  have concluded
that dogs, rabbits, and asses, cannot receive the syphilitic infection
by inoculation. But if the syphilitic virus cannot be communicated 
INOCJLATION OF THE  SYPHILITIC VIRUS.            10
bf uo culation to animals, neither can it always even to men. Farther,
true venereal affections are very frequently observed amongst brutes.
Dogs and bitches often present very  unequivocal traces of inflam-
mation of the mucous membrane of the genital and urinary organs,
followed by gonorrhoea, chancres, phymosis, paraphymosis, 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 gon-
orrhoea  upon himself, without success, and the inutility of these
attempts,  which have also failed  in the  hands of other experi-
menters, is very remarkable, as  it shows that  the  efficacy of the
venereal pus  is in this respect very inferior to that of hydrochlorate
of ammonia.
   " Yet," says M. Jourdan, " positive as these assertions are, other
experiments  prove  that the  insertion of  the pus of  chancres or
gonorrhoea, can produce ulcerations followed by swelling of the ad-
jacent lymphatic 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 venereal inflammation.  On the other
hand, it is very common and almost constant, according to M. Cul-
lerier, jun., who, having made several  experiments and repeated
them several times on the same  patient, has  always seen ulcers,
similar to those which furnished  the pus, develop 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 Hopital des
Veneriens have had, in consequence of similar experiments, an ulcer
of long duration, and which was attended with swelling of the  ax-
illary glands ; in them, the symptoms yielded to antiphlogistic treat-
ment.  Another, who made the same experiment some time after,
experienced no  local irritation."
   But  it  is of little  importance  whether the symptoms, in con-
sequence of these kinds of  inoculation, be rare or common.  They
are not sufficient to prove the existence of a peculiar virus, because
we freauently  see  similar and  even more  severe  results from a

     •Traite complet des maladies veneriennes, 2 vols. 8 vo. Paris, 1826. 
16        CRITICAL RESEARCHES AND GENERAL REMARKS--

simple puncture.   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 those even
who  believe in the existence  of the  virus.  M. Lagneau doubts
whether  the disease can be inoculated by introducing a bougie
covered with the gonorrhoeal 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. Culle-
rier, sen., who expresses  himself thus  upon inoculation in  general
" We think  we may assert, that the fluid which serves as a vehicle
for  the virus must possess a certain degree of warmth, a kind of
life, which preserves to the virus the  power of attaching itself to
;he new body, to  which it has been transmitted."*
  It would have been more correct to have said that the parts ex-
nosed to the contagion must be  in a certain condition, in  order to
receive 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 experience.   Indeed, experiment proves, as Hunter and Turn-
bull have stated, that the animals they have mentioned cannot con-
tract syphilis as met with in the human subject, by means of inocu-
lation ; this, however, by no means prevents their having inflam-
mations of the mucous membranes, and ulcerations of the genitaj.
organs; all inflammations and ulcerations of these organs, however,
are  not necessarily syphilitic in brutes  any more than in men, even
though they  follow on what this depended, coition; of this 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 produced the conse-
quences which followed, without detracting from the value of inocu-
lation 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 Cullerier,
and also the  remarks which follow, (and to which M. Jourdan should
have  added  the note to the treatise on the different kinds of gon-

             * Dictionnaire des Sc. med. tome i.  Paris* 1821. 
INOCULATION OF  THE SYPHILITIC VIRUS.
17
orrhoea by Hecker,*) their value  will be better  estimated, after
having seen the result of our researches.
   But to  pursue the course we have adopted, and  that we may
know  all that has been said on each side, let us see if M. Richond
des Brusf has been more fortunate  in his refutation of the facts re-
lative  to inoculation.
   " We must  conclude," says he,  " that the contagion of the  ve-
nereal diseases does not prove that  they depend upon a specific
virus."
   " Let  us now examine whether the development of ulcers  and
swelling of the lymphatic glands, after the inoculation of the  ve-
nereal pus, can prove the existence of this essence."
   " The  results of these inoculations are far from being so confir-
matory of the  syphilitic  theory, as its defenders think*  In  many
cases  the insertion of the venereal pus under the skin causes no
effect: and in those cases where some inflammatory symptoms are
developed locally or in the remote ganglions, this phenomenon  can
easily  be explained, without admitting a chimerical essence."
   " Hunter (in our opinion, the most rational writer on syphilis,
<md in whose  works truth is often seen to shine out of a  number
of errors,  which  were common to his age) made divers experi-
ments  as to inoculation of the syphilitic  virus, with  the following
results—
   " I.  He took  pus  from  the  ulcers  of a syphilitic  patient at St.
George's Hospital.   He made three small incisions (deep enough
to bring  blood,)  in  the  soft  and  sound  skin of  the  back, into
which he introduced  purulent matter.  He then made a fourth in-
cision  with a clean lancet.   All the  wounds  healed  and none re-
appeared.  He repeated this experiment several times, and always
with the same  result.

  * One might doubt the experiments of Harrison, cited by Swediaur, or those by
Bell, upon reading  those lately made in the Hopital des Veneriens, at Paris, by
Bertin,  Cullerier, and Gilbert, who have repeatedly endeavored to  inoculate the
virus of gonorrhoea and  chancre, and who have all assured me  they were never
able to produce a single symptom; whence follows the conclusion, that these dis-
eases are only to be communicated by coition.  Traite des difTerentes especes de
gonorrhees, par A. F. Hecker, trad, de PAllemand, par A. J. L. Jourdan, avec des
notes de P. P. Alyon, p. 255.  Paris, 1812.
  The same men afterwards obtained contrary results, which proves that the first
experiments were badly performed.
  ♦ De la non-existence du virus venerien, tome i. p. 76.   Paris, 1826.
3 
18        CRITICAL RESEARCHES AND  GENERAL REMARKS--

  " II. A man who had venereal  pustules in different parts oi his
body was inoculated, and in sound parts of the skin, with pus from
a chancre of another  person, as also with that which flowed from
his  own  ulcers.   The wounds impregnated with the pus of the
chancre became well marked chancres, whilst the others healed.
Hunter states, that having often repeated the above experiment, he
always found the same results."
  " These facts, I think, might lead  to the conclusion, that the
general infection of the humors, which it is pretended exists when
any of the signs of what is termed confirmed syphilis show them-
selves, is chimerical;  since the pus taken from venereal pustules,
and  constitutional ulcers, was not charged with virus, and did not
produce  the effect which  ought  to have been observed, if  it had
been  virulent;  and since,  if it had existed, a new infection could
not have been made with the pus  of a stranger, the whole economy
being in  a manner saturated."
  " III. From the last fact, in my  opinion, it might be concluded,
that the  contagious property does  not  depend on the specific es-
sence of  the pus, but most often upon the greater or less acuteness
of the inflammation which forms it.  Thus gonorrhoeas, which are
contagious in their acute form, cease to be so when they become
chronic;  and in  the  same manner  the nasal secretion, which, du-
ring the first days of a violent coryza, excoriates the lips, loses this
property  towards  the end, and leucorrhceas in an acute stage  often
produce  urethritis in  men, who expose  themselves to the excreted
mucus, whilst in their chronic state  they are generally innocuous."
  " If it were not so, it would be difficult to understand the result
obtained  by Hunter;  for it is clear, that the pus from the venereal
pustules  ought  to be more virulent than that which flows from a
chancre,  as  these  are  the result of a general infection, whilst the
chancre is only the germ of it, as yet barren."
  " Perhaps it may be objected, that the virus taken from  an in-
dividual cannot have any action  on himself, the parts being, as I
say myself, supersaturated ; whilst a new virus being deposited in
a system,  which is not accustomed to it,  may cause morbid action.
But, in the first place, it is not true that  the pus furnished by a per-
son, other than the one inoculated, contains for him a new and un-
accustomed  virus, for the virus is ever the same, and according to 
INOCULATION OF THE  SYPHILITIC  VIRUS.
19
the theory which I am attacking, it should be considered identical
in different individuals, otherwise its effects should be very different,
and it is said they are the same.   In the second place, the statement
that the system becomes habituated to the virus is a dream, which
is refuted by daily observation.   Indeed, what practitioner  has not
had occasion  to  observe in patients suffering under severe attacks
of syphilis, new symptoms occasioned by inoculation of their  own
pus.
   " I observed this fact very often in a man named Perrez, whom
I treated with mercury for ulcers and buboes. An ulcer on the glans
increased much in extent during  a  profuse salivation.   The thigh
was touched by the pus which flowed from it on a spot where there
was a bubo open at its extremity.  This caused an ulcer, which in-
creased to the size of a five-franc piece, with  hard, uneven edges,
a grayish surface, and rounded form.   In another soldier, I  saw
precisely similar ulcers, produced upon the thigh by the matter of
a gonorrhoea.   In my wards at Strasburg, I daily saw  gonorrhoeas
produce ulcers, buboes, vegetations, &c, although  they might be
considered as the results of  a general infection."
   " Moreover, if the opinion that  the virus differs in  different in-
dividuals be still maintained, I might oppose the opinion of Hunter,
who contends that two  actions cannot take place in the same  con-
stitution, nor on  the  same  part at the same time, and that this is
the reason why some persons resist certain miasmatic, or contagious
affections.
   " But to return to the experiments.   A person was inoculated
with matter from a decidedly venereal ulcer, upon one of  the  ton-
sils, as well as from a gonorrhoea.  This latter produced a chancre;
the  other  was without effect.   It is very remarkable, that pus
coming from a consecutive ulcer, and consequently highly venereal,
produced  nothing, whilst the mucus from  a  urethritis, a  disease
whose syphilitic  nature is generally denied by writers, produced a
chancre.
   " Either Hunter was deceived in thinking the ulcer of the tonsil
very venereal,  and  then the diagnosis was difficult, or it  was so,
and then the pus which flowed from it was not virulent. One ought
to place little reliance upon the examples which authors relate of 
20
CRITICAL  RESEARCHES AND  GENERAL  REMARKS--
inoculation of syphilis, by means of pens impregnated with saliva,
glasses, bandages, &c."
   " Ought it to be concluded that a gonorrhoea is venereal, because
it  has produced a chancre 1  This would not be reasonable, as it is
fully proved that similar phenomena are produced by gonorrhoea,
occasioned by causes other than coition.
   "Bru, who  from the  result  of his  numerous experiments has
been led, like Hunter, to consider the general infection of the sys-
tem as an irrational and untenable hypothesis, furnishes the follow-
ing case:—
   " Two sailors, in order to  avoid the laborious work they  were
obliged to perform, and to escape a voyage which was about  to be
made, put some cantharides upon the glans, which caused symptoms
seemingly venereal.   When the affection which resulted  had par-
tially disappeared, and only a slight ulceration remained, they en-
deavored to inoculate  themselves with the complaint of their  com-
rades.  They took pus from several of them, applied it to their ulcers,
and waited in vain for the expected result;  they were cured not-
withstanding their repeated attempts."
   " In many other  cases the surgeon  attempted to inoculate with
the pus of ulcers on the penis, or of suppurating buboes, but could
never obtain venereal effects.   He  also made some trials on  dogs.
On many of them he  produced excoriations  with cantharides, and
then applied venereal pus to them and obtained no  result.   It  is
easy to understand the reason; it  was not because  the  syphilitic
virus is peculiar to  man,  as has been said, but because the cantha-
rides had caused a sufficiently lively action to prevent  the  action of
a new irritant."*
   M. Dubled, interne  at the Hopital des Veneriens, related, March
11, 1824, in the surgical section of the Academie Roy ale  de Mede-
cine, an experiment that  he had made upon himself, February 27.f

  * The want of a successful result in this case only proves, that certain con-
ditions cf tissue are necessary in order that the venereal virus may act, and ex-
perience has shown me, that vesicated surfaces are particularly difficult to inocu-
late. Indeed, I daily use blisters on virulent buboes, even after they aib 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 exceptions to this general rule.
  f Experience de M. Dubled.  Extrait des annales de la med icine physiolo^imie
No. d'Avril,  1824.                                             ° H   * 
INOCULATION  OF THE SYPHILITIC VIRUS.
21
" Having  gone," says he," to the venereal hospital, I requested
MM. Hutin and Cazoviel, internes at this hospital, to inoculate me ,
with syphilitic virus.  We went into the first ward, and M. Hutin,
having collected on the point of a lancet some pus from a chancre
of Ihe glans, and some purulent  matter from the canal of the ure-
thra, inoculated with it  the  middle of the dorsal  surface of my
fore-arm.   Upon withdrawing the lancet, he applied his thumb to
the puncture and kept it there some minutes;  we then applied  a
compress to it, dipped in  fresh water,  and fastened it with a ban-
dage.  The pain, which  was pretty acute at the moment of the
puncture, soon began to diminish, and on the second day the wound
was perfectly cicatrized.
   " I have frequently pricked the thighs and abdomen of patients
under my treatment with  lancets charged with pus, from the most
severe chancres, and without any result, except in one case, where
there was a slight inflammation."
   " M. Bertin has never been able to produce syphilis by inocula-
tion, although he has tried on several individuals."
   " Probably, (as M. Dupau  observes, in reply  to the observation
of M. Dubled,) if the inoculations were made upon the  prepuce
or glans of an individual, during erection, the infection would be
more easy;  for in this  case, the engorgement of the capillary
vessels, which enter into the composition of the corpora  cavernosa,
causes an increase of heat and sensibility,  which renders  the ab-
sorption more easy, and the excitability of  the part more  intense.
But the symptoms which might result  from an  inoculation, made
under these circumstances, would nevertheless not be venereal."
   " I think, with M. Dubled, that venereal pus may cause an ulce-
rative inflammation; but  even in this case, it would only constitute
a purely local phenomenon, which, like other inflammations, might
affect, either by sympathy, or continuity of tissue, the  adjacent or
remote organs.
   " In opposition to these experiments, the result obtained by three
young  men from inoculation upon themselves,  will doubtless be
cited, and  which have been extensively published in the journals
All three  are said to have made a puncture on  their arms with  a
lancet charged with syphilitic pus.   In one the axillary glands
oecame engorged, and this engorgement, being  treated  simply by 
22       CRITICAL  RESEARCHES AND GENERAL  REMARKS--

antiphlogistic means, suppurated  and produced a considerable de-
struction in the axilla.  In the second, the puncture becam, inflam-
ed, ulcerated, a chancre with all  the venereal characters presented
itself, and extended its ravages.  But  see to what an extent the
desire of the marvellous may be carried!   It is pretended that this
young man, after  having consulted a  professor of the Ecole de
Medecine, who told him that the ulcer was  venereal, and that he
must take mercury, returned to the hospital and opened the crural
artery."*
   With due respect for  the services  rendered by M. Richond to
science,  can we  admit one of his arguments against the positive
facts of inoculation, and the proofs of which, he himself furnishes 1
I think not; for if I rightly understand him,  his objections amount
to the following propositions.
   1. The results of inoculation are negative  or uncertain.  2. The
secondary symptoms of syphilis,  more virulent than the primary,
ought alone to inoculate themselves, and the contrary takes place.
3. If constitutional syphilis  and general infections exist, individuals
saturated with the  venereal principle  ought not to  be suscep-
tible of a new infection,  and  yet Hunter by experiments found it
otherwise.   4. The contagious property of the venereal secretions
does not depend upon the essence of the pus, but upon  the degree
of inflammation in the part which furnishes it.   5.  The pus of
gonorrhoea, which many authors regard as a simple affection, ought
not to inoculate, and yet Hunter has found the contrary.
   But how can M. Richond  support such propositions 1  May it
not be answered, 1. That the uncertainty of the results of inocu-
lation depends upon the want of  precision in the experiments.   2.
That for the secondary symptoms  to arise from a special cause it
is  not  necessary that they should inoculate like the primary, or be
more virulent than  the latter.  3. That the possibility of inoculat-
ing new primary symptoms, as  he has observed, does not  pre-
clude the previous and present existence of a general affection, as
one  infection  does  not  prevent a second.  4. That chancres can
never be produced by the  pus of a gonorrhoea, leucorrhoea, or of a
simple coryza,  although it may  cause an irritation, or even exco
* This is a fact, he was one of my friends. Note of the Author. 
INOCULATION OF THE  SYPHILITIC  VIRUS.
23
nations.  5. That w7hen the pus of a gonorrhoea produces a chancre
by inoculation, there is something besides a gonorrhoea. 6. 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.
  As  M. Devergie,* to whom  physiology is much indebted, has
not adduced any arguments except those refuted above, he will not
detain us.  He asks, whether experiments are in favor of inocula-
tion ; and says, it has been often  attempted, but has  never  pro-
duced  any decided result.  In many cases, according to him, it has
been followed by no effect, either when made with the pus of pri-
mary sores, or of secondary affections.   Sometimes local symptoms
have appeared in the neighboring or remote glands.   The follow-
ing  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
buboes, whilst he thought he had succeeded with the matter  from
chancres and blenorrhoea.  " I myself made some experiments," he
adds, " but they led to nothing satisfactory."
  "Occupied during the campaign of Germany (1807-8)  wTith
the treatment of syphilis, I repeated these experiments successively
with matter from urethral discharges, ulcers of the glans, buboes,
chronic ulcers, and generally failed: in two individuals pus  from
the  chancres  of the penis caused ulcerations of a mild character,
which for their cure required only attention to cleanliness."
  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
  " As authors," says he, " are not  able to determine, a priori, the
particular and distinguishing  characters of ulcers, they have re-
course to means which are uncertain and cannot guide them in the
diagnosis;  thus they affirm, that a  lesion of the genital organs or
other parts is syphilitic when it is attended  by another lesion ; when
it is caused  by coition, or when there is  any circumstance which
would lead them to suspect the origin of these  complaints ; if these

  * Clinique de la maladie syphilitique par M. N. Devergie.  Paris, 1826.
  fTraite pratique des maladies veneriennes par H. M. J. Desruelles, p. 167,
Paris, 1836. 
24      CRITICAL RESEARCHES AND GENERAL  REMARKS--

investigations do not satisfy them, they inoculate the pus from the
ulcers.  Cullerier and Ratier state that:—
   " A more defective 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 re-
sult 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 partisans  of this ex-
perimental  operation think that there is no more difficulty in curing
a double than a simple syphilis, by means of mercury.  Farther, the
ulcer  which results from inoculation presents  no  new characteristic
marks to those who were unable to recognise them on the ulcer which
was first developed ; and if by any chance, through  the inadvert-
ence or negligence of the operator, the inoculation should  not suc-
ceed,  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 disease to persons with
whom he might have  connexion.  To such  an extremity may a
false opinion, whose consequences have not been foreseen, lead."
   " During the eleven  years  that we  studied  experimentally ve-
nereal diseases, at the Val de Grace, we could never resolve to in-
oculate any from syphilitic lesions."
   " Our position, we thought, did not permit  us to subject the sol-
diers intrusted to our charge to the hazard of disease, and on this point
our opinions are those of Cullerier and Ratier.  On the other hand,
M. Ricord, surgeon to the Hopital de  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 ar-
rived  ;  we give them as we have them from  M. Ricord  himself.
   " A chancre can always inoculate during its period of ulceration.
The suppurated bubo, of absorption, can always inoculate.
   " The inoculated pustule can be reproduced by its pus, ad injmi- 
INOCULATION OF THE  SYPHILITIC  VIRUS.
25
turn.  The pus of an urethritis, where there is  no ulceration, can
never inoculate."
  " From the above it seems that only the ulcerative form, and in
the acute stage, is capable of inoculating.   Before judging of the
value of M. Ricord's experiments, we shall wait till he has com-
pleted all those he proposes to make, and has published an account
of them.
  " From what has just been stated, we may draw the following
conclusions : — There is, properly speaking, only one kind  of pri-
mary venereal disease, viz., the irritation of4 a sensitive surface,
which has  been touched  by the contagious cause.  The other dis-
eases, such as ulcers, buboes, swelled testicle, and excrescences, &c
are only affections, whose development is  secondary to the  erythe-
matous  form, which is primary, and which always appears before
all other  forms.   The  consecutive affections  also depend upon
the erythematous form.   Whatever the kind of venereal  disease
may be, it is impossible to assign to it  a character so  defined and
positive, that no uncertainty shall  remain in the mind of the  ob-
server 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 should express his doubts upon the uncertain chances to which
it would subject the patients confided to his care.   As to the opinion
of the evils of experiments which M. Desruelles also holds, I cannot
let it pass unrefuted.
   It is possible that men, like M. Desruelles, notwithstanding their
opinions on venereal diseases, object  to making experiments, and
even if  they blame others for doing so, their opinions should be  re-
spected.  But it is  difficult  to understand  why those  who have
made them, and who do  not fear  to do so from  a diseased to a
healthy person, should have  expressed themselves as we have seen,
especially when the same persons, since the article quoted appear-
ed, have again made inoculations.
   Let me here be permitted, while I acknowledge the merit of the
                              4 
26       CRITICAL  RESEARCHES AND GENERAL REMARKS--

works of my learned  colleague  M.  Cullerier, to cite  the  article
Diagnosis, from a thesis by one of my pupils *
  Diagnosis.—" In our first part we have stated the insufficiency
of the ordinary means of diagnosis.   The position  of  the  disease
can prove nothing, as the organs of generation are subject to ulcer-
ations or mechanical lesions, which  cannot possibly be  traced to
chancre; and chancre is found with  its  unquestionable characters
in every part of the cutaneous or mucous tissue.   The form affords
nothing more definite;  we have  seen that it may vary according
to the part affected, or  some complication  disconnected  with the
disease.  Some authors have recommended the progress of the dis-
ease as the best means of diagnosis.   This appears  to  us very in-
sufficient ; for it is frequently impossible to see the entire course of
the malady, and out of a  hundred cases, taken promiscuously, it
will scarce be found regular in two of them, influenced  as it will
be by idiosyncrasies and accidents, which may obscure it.  The degree
of pain and inflammation sometimes varies extremely, and sometimes
unaccountably.  The treatment cannot be appealed to  ; for, as we
have said, ulcers and sores which have become atonic, or which pre-
sent such appearance in consequence of bad treatment, demand, in
all its details, that treatment which some have regarded as proving
the existence of syphilis.  Lastly, we cite the authors of the article
Syphilis, in the Dictionary in 15 vols., who, after opposing  every
means of diagnosis for chancre, even in part that which they consider
the best, remark:  ' We are much mistaken, if the diagnosis of chan-
cre, according to our views, is not more  certain  and useful.   It is
doubtless sad to see science not  only little  advanced, but still  en-
cumbered with errors;  but is it  not better to stop and  return, than
to follow an apparently beaten and easy path which leads to nothing
positive, or to open a new one at a venture without knowing whither
it will lead V
  " M. Blandin, in his excellent article upon ulcers  in general, in
the Dictionary in 15 vols., remarks:  ' The common characters of
syphilitic ulcers are not so well defined as some  persons think.
Ulcers which depend on a different cause, are often  very analogous
to them.  However, generally speaking, syphilitic ulcers are round,

  * Consideration sur le chancre, par M. le docteur Doussaint de Grand  14 Mar*
1837. Paris, these, No. 68.                                  ' 
INOCULATION OF THE SYPHILITIC VIRUS.
27
with violet, hardened, raised, and abrupt edges;  their surface is
hollowed  and grayish;  the  suppuration is  bloody, and  in  small
quantity.   The collateral circumstances, the  position of the ulcers
in the places where they generally show themselves, aid us greatly
in the diagnosis; but we must  confess, that 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.'
   " These quotations show the true value  of the  proposed means
of diagnosis; we shall now add the propositions laid down by M.
Ricord.   ' The unequivocal, incontestable pathognomonic signs of
chancres, are the production of certain  symptoms of general infec-
tion, which never occur without this antecedent, and especially the
constant and regular results of inoculation,  during  the  period of
progress.' "
   " Having long attended the clinic of M. Ricord, and seen all his
experiments repeated, we embraced his opinion ; for it seemed to
us rational to consider, as  chancre, the primary symptom existing
alone in a patient, and which, in case it was  followed by secondary
symptoms, presented what all  enlightened practitioners  recognisr,
as belonging to syphilis; and which also, at a certain period of its
existence, presented the regular character of inoculation.   What
are the arguments that are opposed to this  latter criterion, which
we think  of the utmost importance, as M. Ricord's first mode will
only do in certain cases 1   MM. Ratier and Cullerier seemed 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 arti
cle Inoculation in the same work, this  accusation, which  we must
say would attach  infamy to all who deserved it.
   In reply to the first part, in  which it is  said that inoculation  is
the most defective mode of diagnosis, let us  quote a few lines from
the above article, by the same authors. " The pus of the primary
ulcers taken at any period whatever of their existence, (but partic-
ularly when they are not of long  standing, and  when 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 epithelium with a lancet, or only applied to
          * See p. 23, the article of M. Desruelles already quoted. 
 28       CRITICAL RESEARCHES  AND GENERAL  REMARKS--

 a cutaneous or mucous surface, deprived of the protecting membrane,
 causes, at the point of insertion, an inflammation of peculiar form,
 and which appears to us characteristic."
   The reproach, as to  the faultiness of the  diagnosis by inocula-
 tion, cannot  be maintained  against  the  answer they  themselves
 give, when they say, that a chancre must in all its stages produce,
 by inoculation, an inflammation of a characteristic form and  na-
 ture.  (Cullerier and Ratier.)
   " The patient has  one or two ulcers more;  the chances of gen-
 eral infection increase in proportion, so that they have given con-
 stitutional syphilis to a man who would perhaps never have had  it."
   The accusation  is  serious;  but Messrs.  Cullerier and Ratier re-
 ply, a few 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 treat-
 ment, and imbued  with  the  opinions of the schools, neglected  the
 local affection  before him, to treat remote prospective evils, 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 guar-
 anty them from ulterior symptoms."
   As to  the double syphilis  that has  been mentioned, we confess
we were at a loss to understand it; it is a species  described by no
author, not even in the classifications of Messrs. Cullerier and Ra-
tier.  In all cases, as these gentlemen  assert  that the primitive af-
fections are in the  power of the practitioner, one might prevent it
 at pleasure.  Finally, all difficulties would be removed, if, as they
think, inoculation produced in animals the same results as in man,
for then no blame could be attached to such experiments; but, un-
fortunately, experience has proved their assertion to  be entirely
false.
   " Besides, the ulcer which results from inoculation will not pre-
sent more characteristic marks for  those who were unable to  recog-
nise them on  the ulcer which developed itself at first."
   The answer is to be found in  the article Inoculation, where  we
read, as we have quoted, that the pus of a chancre being inoculat-
ed, causes, upon the  point of insertion, an inflammation of peculiar 
             INOCULATION OF  THE SYPHILITIC VIRUS.           29

nature and form, which appears characteristic.   Then, a page fur-
ther, after having said that the different kinds of venereal pus, except
the chancre or primitive ulcer, yield nothing by inoculation which
can be characteristic, Messrs. Cullerier and Ratier add :  " When we
say that the pus produced by divers morbid surfaces may be inocu-
lated 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 ir-
ritating substances, while we understand by inoculation the produc-
tion, after an inoculation, of a morbid affection, constant in its form,
and regular in its progress  and duration, and in its turn furnish-
ing a pus susceptible of being inoculated."
   Inoculation then will distinguish chancre from every syphilitic
ulcer, either secondary or other.
   As to the latter objection, founded on the cases  where the inoc-
ulation has not succeeded through the inadvertence of the  opera-
tor, to say nothing of  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 the  circumstances  be but  slightly
favorable, have appeared to us so very numerous,  that we did  not
think it necessary to report  them.
   Lastly, relative to the patient who, receiving a clean bill of health,
will go his way and communicate a grievous disease to  those with
whom he has  connexion, what  surgeon v^puld dare  to permit or
advise coition to a patient with ulcers  on the genital organs, even
if he were certain that the disease was not syphilitic ?   Would he
not be exposed in the most favorable condition for infection, or at
least, by the irritation produced, would he not 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 the most triumphant argument  against the princi-
ples they have promulgated, let  us  sum  up all these  arguments,
adding some remarks drawn from 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 ulcera-
tion  reputed syphilitic, even that secreted by the papula mucosa, 
30        CRITICAL RESEARCHES  AND GENERAL REMARKS--

(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 1  According
to the passage  above quoted, Messrs. Cullerier  and Ratier declare
that inoculation is  necessarily  the true  means of  diagnosis, and
that we may distinguish, by the trial of its pus, between an  ulcer
resulting from the inoculation of the chancre, and any lesion which
may in certain  cases be  produced  by other pus, tried in the  same
manner; now is not that which they consider as a means of diagnosis,
and to  which they appeal in case of chancre, inoculated with a
lancet  from the pus of a primary and therefore inoculable ulcer,
consequently  also probatory for the latter 1
  Hence, according to the opponents of  inoculation, must we not
admit that when the pus  of an ulcer produces certain symptoms
constant in their form and development, and which  present certain
characteristic conditions, the ulcer, whose pus has been inoculated,
was "a chancre,  and consequently that the  necessary character, with-
out which an ulcer cannot 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
the consequences to be drawn from them, I reply, that no conclu-
sions can be drawn from experiments badly performed or observed;
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 labors, 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 connexions
between cause  and effect, that the  syphilitic diseases are ascribable
to a specific agent or deleterious principle, which is  only to be con-
sidered 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.   It will then be evident  that  those  who will
search for this cause, ascertain its  effects, and endeavor to neutral-
ize its principle, oi its  consequences,  will, I think, deserve  some
encouragement, and they will be able to  retort  upon their antago- 
INOCULATION OF THE  SYPHILITIC VIRUS.
31
nists the accusations of indolence, ignorance, and quackeiy, which
appear to me more applicable to those who foster a doctrine which
has been  summedjip as follows:*  "Physiological medicine ought
to confine itself in syphilitic affections to the study of the forms and
degrees of irritation in the different parts of the body, and note the
modifications it can oppose to them."f
   Well convinced  that the subject was not exhausted, and encour-
aged by the most  celebrated names and the highest authorities, I
commenced the researches, the results of which will now be stated.
   It has been asserted, that  the venereal virus is a chimerical and
intangible essence; that the effects imputed to this imaginary cause
depend only on the nature of the part affected, the peculiar vitality
of the diseased parts, the different degrees of inflammation, and the
sympathetic reactions which may result from it.
   I  had, therefore, to endeavor to materialize  this cause, to coerce
this  pretended imaginary essence, to assign to it definite  and spe-
cific characters, which should  not  allow it to be mistaken, except
by ignorance and obstinacy; and to prove that the position, vitali-
ty, and functions of the diseased organ have only a secondary in-
fluence upon it,  and that it was not the fortuitous consequence of
a  greater or less degree of inflammation.
   And first, when we  propose to study a body, and to  distinguish
A from those with which it may be confounded, must it  necessarily
differ from them  in every point 1  Are all the characters of each
order, genus, and species different in physics, chemistry, or natural
history 1  Is not  one often sufficient to establish the difference ?   In
our  medicinal  substances, for  instance, is it always easy to point
out the essential  condition which gives to  a  certain substance a
property not possessed  by another, to which it is nevertheless very
analogous ?  And  does this property, although invisible, immateri-
al, and not separated from the substance which possesses it,  consti-
tute  an entity 1   Undoubtedly  not.   Now, the  incontestable exist-
ence of the venereal virus  is  proved by a peculiar property of a
distinct morbid secretion, and therefore the pus furnished by certain
syphilitic  affections has the  constant  and regular property of re-
producing a pus similar to itself, in consequence of an alteration
     * Desruelles, Traite pratique des maladies veneriennes.  Paris, 1836.
     t Broussais. 
32       CRITICAL RESEARCHES AND  GENERAL REMARKS--

identical with that which first secreted it.   We may, by this essential
character, distinguish  between  different  physiological and morbid
animal secretions, with the same precision as we do chemical sub-
stances.  In fact, if we inoculate the venom of the  viper, the saliva
of a mad dog, the pus of variola, vaccine, or syphilis, we shall have
specific effects, which will leave no doubt  of the difference and
specialness of the causes which produced them.
  Syphilitic pus, studied in all  its  relations, may present globules
more or less resembling those of other kinds of pus.   It  may, ac-
cording to the localities, be combined with  other fluids of morbid
or normal secretions, particularly with mucus in the form  of muco-
pus.  According to the localities or  its combinations, it may remain
alkaline or become acid, it may contain accidental animalculse or
be devoid of them ;  but its most distinguishing and specific char-
acter is, that it can inoculate itself and produce characteristic results.
  Before passing to the study of these  results, we think  it  proper
to give here a complete analysis of a work recently published.
  M. Donne, to whose  researches we  are  disposed to do full jus
tice, in attempting to find  a means of distinguishing  between  the
different syphilitic secretions, has studied the  mucus  found in the
genital organs of the male and  female,  both in the healthy and
diseased state, and also the mucus mixed in different proportions Avith
pus formed either by simple changes or those from specific causes, and
finally the pus thrown out  by syphilitic ulcers;  in each one of these
products he  has found organic formations,  chemical properties,
and a  creative power of animalcules, results which always present
constant differences, and  offer by these differences a sure mode of
diagnosis.  Let  us now examine the facts advanced by M. Donne.
  Sect. 1. Examination of the  pus of urethral blenorrhcea, or  of
the pus formed by inflammation of the urethra in males and fe-
males.
  In  blenorrhcea the pus  from the  urethra  of the  male  does
not differ from that of the female ;  its globules do not  differ from
those of pus in general; it is alkaline, and M. Donne has never yet
been  able to detect  animalcules in this morbid secretion.  These
characters are  doubtless  interesting, but we  must question their
utility in settling the question which M. Donne pretends to resolve;
for, if we consider the defects  of an imperfect analysis, since ho 
INOCULATION OF THE SYPHILITIC VIRUS.
33
 alludes simply to pus which may be found in the urethra, and says
 nothing of accidental secretions or of locality, and finally that the
 pus may vary in its appearance and constituent parts, according to
 the degree of sickness  and its principal seat, I ask, what informa-
 tion have we  gained as to the  cause of disease ?   Is blenorrhcea
 syphilitic, or produced  by a chemical or physical 2ause ?  Does it
 depend on a  special or  sympathetic reaction ?   On these  points,
 Donne's  microscope  has thrown no  light.   We were much sur-
 prised also to find that the first section of M. Donne, comprising a
 page  and a  half, does not state that he treats simply of one case
 where pus was mixed with the excessive mucous secretion  of the
 urethra ; for in fact it would be difficult to find there any thing but
 a superficial examination of the smallest part  of the question, as
 will be admitted by any one acquainted with  the different degrees
 of the urethral affections  from excessive secretions to deep disease,
 which may exist in this canal;  and particularly as we have stated
 the variable influence  of a general  or local specific cause, and
 finally the accidental  and morbid secretions which more or less re-
 semble blenorrhcea.  So far as  novelty  is concerned, if M. Donne
 had paid more attention to the labors of the ancients, he would
 have found that  blenorrhcea had  long been regarded  as  acid,
 saline, and alkaline.
   Sect.  2. Examination of the pus of chancres and  buboes.—
 So far  as relates to  chancre,  chemistry has only shown that the
 state of the pus is alkaline; but the microscope has  demonstrated
 to M. Donne that the form of the globules is changed, (some seem-
 ing dissolved in the fluid in which the remnants of them floated,)
 and cause the constant existence in the pus of chancres of a great
 many animalculae, having the form of the vibrio lineola described
 by Muller.  M. Donne  says that he had not at first attached much
 importance to these vibrios, which are so common, and which mul-
tiply so rapidly in putrefying animal matters, and in many infusions
   M. Donne states that ne  had  looked for the vibrio in pus othei
than that of chancres of the glans and vulva, but in vain; hence,
to give importance to his discovery, he asks:   " Are these animal-
culse characteristic  of the syphilitic virus, or do they contribute to
transmit venereal affections ?"    But being  struck by the reflection
that it  would be too absolute to  say that chancres of the glans anr:
                               5 
34        CRITICAL RESEARCHES  AND GENERAL  REMARKS--

vulva were the only ones which were privileged to be syphilitic,
he intercedes in favor of the vibrios, and states that if they are not
the agents of the syphilitic affections, they  require, however, for
their existence, the syphilitic element.  Here, likewise, M. Donne
was struck with the idea that his proposition  would fail if the ve-
nereal element did not furnish the vibrio,  in a manner independent
of the locality, and  he decides to claim at least for the animal-
cule  the interest which its natural history might inspire—referring
doubtless to the labors of Muller.
  M. Donne  has never found  animalcules in the pus of syphilitic
ulcers, unless situated in  the glans and vulva;  he however found
a great many in the pus  coming from an ulcer of the leg in a fe-
male affected with syphilis; this ulcer had a livid base, and all the
characters of hospital gangrene, and the  matter discharged from it
was extremely fetid.   This fact seems important, for if the syphi-
litic pus is necessary for  the vibrio, how could  this  animalcule be
developed except in a primitive chancre 1   And if the  syphilitic
principle be intense enough  to produce the animalcule in a wound
of the leg, how can ulcers depending on the same principles, and
situated in different parts of the body, be deprived of the privilege
of this animal creation, which cannot be ascribed to  the fetidity of
the pus, and  to hospital  gangrene, without  depriving of its value
this new rule of diagnosis 1
  We would remark in  passing that  in this passage-, as in many
others of this memoir, there is a want of precision which may lead
to error, at least  on the part of commentators, for  in syphilogra-
phy, the term syphilitic cannot be  confounded with that of venere-
al, and yet they are used  by Donne in the same sense.
  The vibno has never been found in the inguinal buboes of those
affected with chancres, at any period of their suppuration :  this pus
is composed of globules similar to those of common pus.
  In fact, if the labor of M. Donne in regard to the pus of bubo be
not purely the result of theoretical  induction,  we do not understand
how he could obtain this  result from the microscope.   Omitting,
with M, Donne, to speak of the direct action  of the chancre on bu-
boes, we wrould ask, how it happens that  bubo, which, according to
the most experienced syphilographists, and to the results of inocu-
lation,  is only  a  chancrous ulcer frequently presenting all  the 
INOCULATION OF THE SYPHILITIC VIRUS.
35
Hunterian characters, we would  ask,  I say, how  it happens that
the pus of chancre, without reference to its position, generally dif-
fers from common pus by the rougher form of its globules, and by
the kind of interstitial dust which M. Donne has described so care-
fully, while, on  the contrary, he asserts that  the  bubo is never
chancrous 1
   Vibrios are found then only in the chancres of  the  glans and
vulva;  but  they  appear frequently in  cases of  balanitis.   M.
Donne admits how dangerous this fact  is  to the doctrine, and in
stating the question contradicts M. Cullerier.
   In fact, M. Cullerier declares that in his opinion  balanitis is not
syphilitic:  and also, that the diagnosis of this disease is easy.   M.
Donne asserts the contrary, in opposition to the experience of many
authors.
   M. Donne asserts that vibrios are found constantly in the chancres
of the glans and penis, at least, unless removed  by cauterization or
injections; this seems to us difficult to comprehend,  if they depend
on the syphilitic principle.  Could one cauterization or one injection
destroy the virus,  and  thus deprive  it of its creative or accidental
faculty, since in these  cases  it may still retain  its power of inocu-
lation 1
   M. Donne asks, if the existence of the virus does not depend on
the place where the suppuration exists, rather than on the nature
of the pus.   After examining the sebaceous matter  secreted by the
follicles at the base of the glans, and the pus arising from  an arti-
ficial balanitis,  he found no vibrios;  they  depend  then on the
syphilitic element, but then, as we have already remarked, (as M.
Donne states that the chancres of the glans and vulva alone  are
virulent,) why cannot the syphilitic element produce  animalculae
in other parts ?
   We have hitherto  admitted, following M.  Donne step by step,
that the vibrio arose solely from  chancres of the glans  and vulva;
but a3 inoculation has-been established, M. Donne,  who finds fault
with this practice so far as it contradicts his discoveries, does not
hesitate to avail himself of it in  supporting his theory, and he in-
troduces the vibrio with the chancre by inoculation.  Here is a new
embarrassment;  are those syphilitic chancres which can be trans-
mitted by inoculation and without vibrios, or  can those only which 
36        CRITICAL RESEARCHES  AND GENERAL REMARKS--

present vibrios be transmitted by  inoculation ?  On this point M.
Donne is silent:  if the latter supposition be true, why is it that the
microscope fails  to detect animalculae in the primitive chancres,
situated in other parts than on the  glans and vulva ?  Such ulcers
are not rare, and if M. Donne is so  conscientious as to blame inocu-
lation, in examining them, he might avoid reproach, since  they are
the results of natural inoculation, if we may be allowed the ex-
pression.
  M. Donne, however, gives us  a  table  of inoculations:  (see the
article in which he states that he has inoculated the pus of a chan-
cre with vibrios, in combination with vinegar and water, and the
vibrios have died by the action  of  the diluted acid; sometimes the
inoculation has succeeded, and sometimes it has failed.)
  What does M. Donne conclude 1  1.  That the vibrios are found
in the pus of certain chancres.  2.  That they may follow the inocu-
lation of this pus.   3. That  neutralizing the  action  of the virus
will not destroy the vibrios.   4. That we have no proof that the
neutralization  of the  virus  must  be  necessarily attributed to the
action of the acid on the vibrios.   5. That the acid alone may de-
stroy  the contagious properties of  the pus.  6. That there are not
enough  experiments to go further   7. Finally, that there are pro-
bably chemical  agents and  substances capable of producing more
active effects than vinegar, and  with which  useful experiments
might be made.                                ■
  We have here cited the conclusions of M. Donne without remark
allowing every one to form  his own opinion of a rule of differ-
ential diagnosis.   We will  draw  only one  conclusion  from  the
whole of  the 2d section, viz.: that the  animalcule described by
Muller as  the vibrio lineola,  exists  in the  pus formed in certain in-
flammations and by ulcerations  of the glans and  prepuce  in the
male, and the vulva in the female, under certain special conditions.
  Our researches upon venereal and syphilitic secretions,  so far as
the vibrio is concerned, have shown that  these animalcules are de-
veloped in the pus, which is  often confined and in contact  in the
glans and  vulva, with peculiar secretions which are readily changed.
Thus  we think that the animalcule  arises from decomposition, with-
out regard to the venereal element, and M. Donne  almost  admits
this, when he says that the vibrios disappear  from  an ulcer when 
INOCULATION OF THE  SYPHILITIC VIRUS.
37
 it has been washed or cauterized:  what is this but removing the
 altered pus from the surface of a wound, from which the syphilitic
 element is not so easily  expelled 1  Finally,  as regards the  action
 of chemical agents on the virus, I ascertained several years  ago
 that this ceases to be transmissible when it has been  mixed with
 acids or alkalis, pure, or even somewhat diluted.
   Sect. 3. Examination of the vaginal mucus in the normal state,
 and of the different kinds of vaginal discharges.—As  regards the
 mucus  of the vagina,  M  Donne lays down  certain  properties.
 1st, It is acid in the normal state, and this acidity may be increased
 by the  inflammation of the secretory organ, provided however that
 pus is  not formed, the  mixture with which, from its alkaline pro-
 perties, might neutralize the acid ; it is white, dense, creamy, but
 not stringy ; when examined by the microscope, it presents special
 mucous globules, which, however, might be  only the remains  of the
 normal and daily disorganization of the epithelium mentioned by M
 Raspail.
   M. Donne thinks, from his chemical researches on the nature of
 the acid of the vaginal mucus, that it contains hydrochloric  acids,
 but  his experiments have  not always presented the same re-
 sults ; and, consequently, the mucus of the  vagina probably con-
 tains acetic acid, but it is difficult to detect this acid when the fluid
 is in small quantity.  This last remark on the deficiency of ma-
 terial will doubtless surprise those who are familiar with Paris.
   The microscope, by showing the globules of pus in the mucus of
 the vagina, will indicate the degrees of the  pathological affection;
 and i-n case of chancre of the vulva or  vagina, we shall  find vibrios
 in it.  We think it unnecessary to recur to  our remarks, for  M.
 Donne having stated that vibrios cannot be  expected where injec-
 tions or cauterization has been employed, our opinion of the
 simple alteration of  the pus as causing the vibrios is unchanged.
   Vaginal tricomonas.—According to M. Donne, if the glans has
 its vibrio, the vagina has its tricomonas, a new species, which  is
 never found in the vaginal mucus in its normal state, but purulent
 matter is necessary  for its development.  This would all be very
veil if M.  Donne confined himself to the question of natural his-
tory, but, unfortunately, led away by a fertile imagination, as in the
preceding section, he begs the question and establishes dogmas • 
0(8        CRITICAL RESEARCHES AND GENERAL REMARKS-—

thus, a discharge of non-purulent vaginal mucus,  however abun-
dant it may be, has  no suspicious origin.  Females  will thank
M. Donne for this remark, but practitioners will ask what is meant
by suspicious ? for coition may act mechanically, irritate the vagi-
na, and produce  different discharges, from excessive secretion to the
formation of pus ; and the blenorrhoeal  material may act simply as
an irritating fluid; and farther, the pus  of chancre, as a specific or
chemical agent, may, in certain cases, produce different effects, from
a simple  excitement to blenorrhcea only, or it may inoculate and
then be complicated with different symptoms of blenorrhcea;  and
finally, the mucous membrane of the vagina is  often affected with
profuse secretion, which is sometimes even puriform, in consequence
of sympathetic action in certain cases of cutaneous syphilitic erup-
tion.  From these remarks, admitted by all practitioners, we ask
the meaning of the term suspected in M. Donne's remark, on which
he rests and says: " It is now easy, except so far as relates to pu-
rulent discharges, to know  when  they  depend on a specific cause,
or when they arise from common inflammation of the mucous mem-
brane of the vagina."
  To settle this  question, the following facts are cited in regard to
24 females affected with real vaginitic  blenorrhcea, nearly half of
whom likewise -presented other syphilitic symptoms, as chancres,
buboes, mucous  pustules, and vegetations: in  19, a considerable
number of the tricomenas were found in the purulent  discharge:
in 5 others, in which this animalcule  was not found, it might have
been destroyed by injections.  This is M. Donne's remark : — How
did he know that the blenorrhcea was  syphilitic 1   By the admis-
sion  of the  patients themselves; but  how  did  they acquire  this
knowledge ?  But let us proceed.  According to M. Donne, the case
was  characterized by redness of the vagina, with alterations of
the neck in different degrees, as tumefaction, redness, erosion, and
even granular ulcerations.  In fact, we would ask  which of these
signs characterizes syphilis,  or even a venereal affection 1  Do they
not all belong  to  simple catarrh 1   Is not fluor albus sometimes
attended with ulcerations, or more serious alterations of tissue 1 On
the other hand, when vegetations  and granular ulcerations are ar-
ranged by M.  Donne among  the positive symptoms of syphilis,
(since he sustains himself by saying, even to granular ulcerations,) 
INSULATION OF THE  SYPHILITIC VIRUS.
39
does it not prove the  danger of treading on  uncertain  ground ?
Who in fact would dare to say that a vegetating  surface is neces-
sarily under the influence  of the syphilitic  virus, or rather that
granulation is not a process for the restoration  of wounds, a state
^'hich excludes the presence of the  destructive  virus, under  the
action of which the  granulations  frequently  could not be pro-
duced 1
   We shall not follow M.  Donne in his attempt to establish the
probability of the syphilitic origin of the tricomenas, but shall  cite
his conclusions, viz.:   1. That purulent vaginitis frequently comes
from blenorrhcea, and then  the  tricomenas  is ordinarily found in
it.  2. That when it does not arise from venereal affections, I think
that these animalcules are  not developed, but I do  not  assert this,
in consequence of want of  sufficient  observations on this point.
   This is the rule of M. Donne: we wTould now ask if he has thrown
much light on the diagnosis, and then, as he states that  in those fe-
males who have used alkaline injections, the tricomenas has disap-
peared, although the disease was not modified, might not we be led
to admit, as in the case of  the vibrio, that these infections depend
on the decomposition  of the secretions.
   Hitherto M. Donne had  claimed  some pathological  importance
for the vibrio and tricomenas; but here, stating what is doubtful as
a fact, the vibrio is no longer found in chancres  of certain localities,
but in the chancre, unqualifiedly, and to give weight to his theory,
M. Donne invokes our authority.   Since we have admitted that the
virulent pus exists only in  this kind  of ulceration  in the primitive
state, M. Donne sustains his opinion by the  results of  inoculation
which he considers as proof; but being consistent with his  mode
of reasoning, as our labors on the inoculation of the pus of buboes
do not appear to agree with his theory, our researches  and inocu-
lation are doubted, and M. Cullerier is cited  to support the opinion
that the pus of buboes does not inoculate.  M. Donne  is unfortu-
nate in his quotations, for M.  Cullerier has publicly stated that he
never made these experiments, that  these facts  would never have
been published except after a book of his  uncle, and that for his
part, he professed the contrary opinion, in which he was confirmed,
by our experiments afterwards repeated by  himself.  Farther, M.
Donne has attended our clinique,  and he must have closed his eyes, 
40        CRITICAL RESEARCHES AND GENERAL REMARKS--

if he has not seen facts which are repeated almost daily, either by
inoculation or accidentally, facts  which I should be happy to show
to any one who may feel interested.
  Sect. IV. Of the mucus of the uterus.   The chemical examina-
tion of uterine mucus only proves its alkaline quality, and that vis-
cidity or tenacity which causes it to resemble the white of an egg
I pointed out this latter character long since, and this will present
an easy mode of diagnosis.
  Uterine  mucus never  contains animalcules;  hence  M. Donn-'
depends principally on the distinctive  character  of  alkali in  th
uterus and acidity in the vagina,  as certain mucus of diagnosis, ur.
less neutralized.
  This last remark  leads to the inquiry, how a man  with an  alka
line blenorrhcea  can communicate disease, by introducing a fe\i
drops of this into  a  mass  of acid secretion increased  by the actioi
of coition.  Ought not its principle to be neutralized 1   Again, car;
chancres form in the vagina, when  the vibrio dies in even a very
weak acid 1
  We shall terminate this analysis by citing a passage of the abstract,
in which M. Donne says : " The pus  of chancres of the glans and
vulva is alkaline ;  its globules are less smooth than those of other
pus, and it is the only one in. which the vibrio is found ; it  is the
only one too which  can produce by inoculation the  characteristic
pustule and chancre."   Hence the rule of differential diagnosis, a
necessary consequence of the labor of  M. Donne, cannot be  laid
down more clearly.
  Thus no ulcer except one situated on the glans and vulva can be
propagated by inoculation;  and as the  pustule of inoculation  is
characterized by furnishing a pus which is inoculable, this pustule
can only appear on the glans or vulva: consequently there are no
chancres except in  these limits.
   In medical researches  particularly, we must distrust the illusions
produced by a too brilliant imagination;  I have  read at the Aca-
demy of Medicine,  a memoir on the  inoculation of syphilis, and
proposed to inoculate myself with the different kinds of pus  taken
 from ulcerations termed venereal, except the symptomatic bubo and
 chancre.   Would M. Donne do  the same with ulcers not belonging
 to the class indicated above, we should prefer to  think that we had 
LMOCULATION OF  THE SYPHILITIC  VIRUS.             41
misunderstood M. Donne's remark cited  above, or rather that M.

Donne has not expressed himself clearly    •

   At the end of the memoir we find a new mode of treating blenor-

rhcea ; we thought at first that it was  a  mode  for destroying the

vibrio, but found  it was simply suppositories of copaiva, cubebs, and

butter of cocoa.  We have not tried this remedy, and therefore shall

say  nothing  about it.*

  * After this analysis of M. Donne's work, we will quote Deidier's opinion on
the nature of the virus (Dissert, vied, sur les malades ven. p. 13, Paris, 1770). He
says, " I believe the venereal virus to be small living worms which produce eggs
by copulation, and which, like other insects, can readily multiply : this supposition
of venereal worms explains venereal diseases much more easily than any other
hypothesis, and we know too that all species of worms and ova are extirpated by
mercury, the only remedy by which the venereal virus can be radically destroyed,
supposing that it is employed by reducing it into small particles which can penetrate
the tissue  of these worms and ova, and may by its gravity divide their vessels, as
:t  divides parts of gold with which it mingles readily.
   Every animal comes from an ovum, and consequently worms are formed in the
same way, but the verminous ova require a certain degree of heat for their perfec-
tion  ; thus, while a  healthy female has connexion with a healthy man, the ve-
nereal ova do not find in the uterus the degree of heat suitable for them, while in
a female who receives different kinds of seminal fluid, these  ova find a requisite
degree of warmth from the corruption of this seminal fluid.
   These venereal  worms engender others, and thus we may suppose that the syphi-
litic  virus  is propagated.  How can it be supposed that syphilis has been brought
from the West Indies to Europe, and has  then passed  by intercourse with one
diseased woman into the French army, and thence into  France, unless by means
of these venereal  worms, which constantly lay a great number of ova, which find
in the corrupted semen the degrees of putrefaction necessary to hatch  them?
   We have already stated that the venereal virus  can only arise from an impure
connexion, where unnatural coitions contribute to form venereal worms and ova.
   Those who  pretend that syphilis arises from  the lepra  of the ancients are
obliged to admit our opinion as to venereal worms, the lepra of the ancients having
been produced by small living worms, as is demonstrated by Calmet, in his Disser-
tation on lepra, at the beginning of his literal commentary on Leviticus;  now the
syphilitic disease could not be changed into lepra, which is a  verminous disease, it
it  had not been caused by worms.
   By the supposition of venereal worms it  is easy to explain why the venereal
virus has become  tractable, and made less progress in Europe than  it did at Na-
ples, this verminous disposition being in some degree changed ; it has  become less
energetic,  either by the change of climate, or by the production of  new  kinds of
Worms, or by the  aid of remedies.
   Have not the worms of the ancient lepra, which were at first furnished with large
teeth to gnaw flesh and stones, in the course of time changed their form, and assum-
ed a  more  simple and delicate tissue, swimming like fishes in the  torrent of the
fluids ?  If we attend to  the different changes of insects, we can easily understand
the formation of worms of lepra,  and those which now form the venereal virus.
   The silk-worm, for instance, and the  moth, seem very different from the  butterfly
which comes from them.  They are however the same animals which, enveloped
in their chrysalis, assume  the forms  of butterfly, by  the development  of their
wings : perhaps also the worms of lepra, which were  gnawing insects, became
aquatic from the development of their  swimming  membrane.  Astruc very pro-
perly remarks  that this  system, singular  as it may seem, is not entirely new.
Abercomb, Hartsoecker, Calmet, have  all  adopted it.   It is surprising that so
learned a physician should  be ignorant  that similar theories have been advanced
in England. 
42       CRITICAL RESEARCHES AND GENERAL REMARKS^
  Convinced, nevertheless, as I  have before said, that syphilis is
one of the most serious diseases  which can  afflict mankind, I was
obliged to exercise  the greatest prudence and reserve in my re-
searches, 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 dis-
ease, the consequences  of which  cannot be foreseen; and if in con-
sideration of the interest of science, which undoubtedly influenced
them, we might find some excuse for those who have thus experi-
mented, their example  cannot now be followed  without culpability.
  Although the experiments upon animals were  negative  in  their
results, even in the hands of the most experienced  men, I felt it
necessary to repeat  them.  Public experiments have been made in
my clinic, at the Hopital des Veneriens, upon dogs, rabbits, guinea-
pigs, cats, and pigeons,* and m  all cases  with negative results.
  All  the experiments, repeated in every possible mode of infection
and inoculation, and with every necessary precaution, wTere  each
time made with pus, which had produced  positive results  in  man;
so that after these experiments, joined to those  we already possess-
ed, we may conclude that the inoculable principle of syphilis is
peculiar to man, and cannot be transmitted to brutes.  This, how-
ever, as we have seen, does  not prevent  them from being subject,
under the influence  of irritating causes, to  inflammations of the sex-
ual organs, which, as in all other tissues,  may be followed by sup-
purations, ulcerations, &c, without these lesions having any relation
to the  syphilis of man.
  Let  it, however, be  remembered, that even if one should be able
to transmit true syphilis to an animal, that  would not detract from
the specific nature of the syphilitic principle, any more than the pos-
sibility of transmitting the vaccine of the cow to man, disproves the
peculiar nature of this virus.
   Hitherto, then, syphilis can only be  communicated by inocula-
tion to man ; but, as we said above, not being allowed  to pursue
the researches frcm a diseased to a healthy  individual, my observa-
tions were necessarily  confined to the patient, and were founded
upon the following propositions.
  * An  Italian physician, whose name I forget, has asserted that pigeons die quickly
if inoculated with venereal virus.  Those who have assisted at my experiments
can testify tl ^.t this is not the case, and that these birds were never betf 
             INOCULATION  OF THE SYPHILITIC VIRUS.           43

  I.  A venereal affection already cured, or still existing at any pe-
riod of its duration, does not prevent  others being contracted, and
the number of successive infections cannot be limited.
  II.  An individual actually infected, and under the influence only
of primary symptoms in one region, never sees symptoms similar to
the first developed in other parts of his system, except  by a new
contagion from contact with the pus of the first, or communicated
by another individual.
  III. Secondary symptoms, or general infection, never prevent the
patient from contracting other primary  affections.
  IV. The frequency of constitutional syphilis bears no direct ratio
to the number of primary  symptoms developed at one time.
   Do not the  observations of former times combine with daily ex-
perience to corroborate the experiments  of Hunter,  which  prove
that one infection does not prevent a second ;  not only in the de-
velopment of symptoms different in form and principle, but also of
those which are owing to  a cause of the same nature ?  Do we not
often see patients who  have a blenorrhcea contract  a chancre by
other sexual intercourse;  or  who  have at first a chancre, and are
attacked with gonorrhoea, after a new coition ? I should think no
candid person would attempt to deny so well known a fact.  But
the manner in which the symptoms following the first are produced,
might be contested.  Those who think there cannot  be a primary
infection without general symptoms, look upon all those which fol-
low as in consequence  of a first symptom, without  the necessity
of a new contagion.  Thus they attribute distinct diseases, contract-
ed 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  contagious 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 beyond 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
with which they were made.
   It is thus that in  all individuals  affected with  primary reputed
venereal symptoms  of all kinds, artificial wounds,  or  operations 
44       CRITICAL RESEARCHES AND GENERAL REMARKS--

performed at a distance from the venereal lesions, have nevei as-
sumed the syphilitical appearance, nor any of the characters of
venereal affections, when proper precautions hare  been taken to
prevent their being soiled by the contagious pus.  Many examples
have been cited, of wound's having assumed the character of pri-
mary ulcers, envenomed by the general infection, and this is said to
be very common in leech-bites.   Yet in all these cases the real ex-
planation has been overlooked, and the true cause might have been
found.  Thus, where a number of leeches have been applied on and
around the penis, some of the wounds often assume the appearance
of chancre, while others heal at once.  If wTe search  for the  cause
of this difference in wounds of similar nature and in the same region,
we shall find that those wounds are attacked with which the  penis
could come in contact, while those which are out of reach remain
uninjured.  The following case  is interesting;  a  woman in one
of my wards, at the Hopital des Veneriens, had a number of  chan-
cres on the vulva; these chancres were primary, and  at the period
of development they suppurated freely, when she was seized with
a rheumatic pain in the right malleolus externus, 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 were found  to be
inflamed, resembling pustules of ecthyma, which were soon followed
by ulcers, having all  the  characters  admitted  to belong to a true
chancre.   The part where the leeches  had been applied, and the
distance  of the situation of the primary ulcers of the vulva, induced
most of the gentlemen who attended my clinic,  to regard this acci-
dent as a consequence of a general infection, or a bad disposition in
the subject.   I ordered some more leeches to be applied to the other
leg, and  also some fresh ones to the same leg, taking care to pro-
tect these new wounds by isolating them from all contagious con-
tact ;  and then while 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 furnish-
ed the pus, the wounds which had been protected, healed without
any accident.
   Sometimes  leeches,  applied to buboes, cause ulcerations of a
malignant nature, and we cannot  trace their origin  to the applica- 
INOCULATION  OF THE SYPHILITIC VIRUS
45
tion of contagious pus.   In these  cases, either the leech-bites are
simply irritated or inflamed, and  have been followed, as it often
happens, by a kind of furuncle which suppurates, and then the pus
which they furnish does not inoculate; or having become true in-
oculable chancres, the  infection  was  communicated  from  within
outwards—i. e., that being situated on  a  virulent suppurated bubo,
the  pus of the ganglionary chancre has  inoculated the leech-bites
in passing them, to make its escape.  The same is true 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 had sweated.  But
he  has omitted to state in what  condition  these latter were, and
whether they had  any ulcers.   It is more than probable that some
such affections existed, 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 cessa-
tion or continuance of a  primary symptom, in whatever period of
its  existence it may be,  does  not prevent the patient from being
susceptible of contracting others, and that we could never, in con-
sequence of a  primary affection, become hardened  to the  causes
which might produce a second.   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 Montpel-
lier, Ruef of Strasburg,  and Blandin, surgeon of the  Hotel Dieu,
of Paris, &c, is, that the number of secondary symptoms stand in
no relation to that of the primary symptoms developed at the same
time.  The proposition that there are not more symptoms of gene-
ral infection after two, three, four, or five chancres, contracted at
the same time, than after a single one, is based on facts collected
six years since, and cannot now be doubted.
  These  facts being  once established, I reviewed all  the reputed
venereal affections, whether primary or secondary. All the normal
or morbid secretions, of persons reputedly syphilitic, have been ex-
amined  by means of inoculation,  and only one form has given
uniform and constant  results, and this form is the primary ulcer or
chancre.   This chancre is to constitutional syphilis, what the bite 
46        CRITICAL RESEARCHES AND GENERAL  REMARKS--

of the mad dog is to hydrophobia, and does not produce a specific
pus, except at a certain period of its existence.   It is evident that
the results of inoculation have been contested, or appear uncertain,
from not attending to this simple fact.
  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.
Similar characters and results cannot be required from these differ-
ent phases ; it is  in the period of development or statu  quo of the
ulceration, while  there is no effort of cicatrization, that the chancre
secretes the venereal virus.
  The specific nature of the secretion of chancre, as we have be-
fore said, does not depend upon the organ affected, nor the vitality,
functions, or sympathetic reactions of this organ, nor upon the de-
gree of inflammation which may attend the ulceration.
  The locality has so little influence upon the peculiar nature  of
chancre, that it cannot be regarded, without error, as peculiar to the
sexual organs.   In  fact,  it may appear in any part of the skin;
no  part of the skin, if in the necessary condition and accessible,
is secure from it.  If it be  developed on other regions  than the
sexual organs, it yet maintains, without  exception, all its charac-
teristic marks.
  Thus a chancre 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
capable of producing a similar chancre by inoculation,  without the
participation of  the sexual  organs; whilst no other affection of
these  organs, whatever its form or extent, or the degree of inflam-
mation which may  accompany it, can reproduce a chancre.
   One circumstance, however, is undoubtedly true, and may have
induced  the  error, viz., that the sexual organs are most frequently
affected; 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 openings of their follicles, the intimate  and pro-
longed relations  they establish 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 
INOCULATION OF THE  SYPHILITIC  VIRUS.
47
no artificial lesion, whatever the agent employed may be, can pro-
duce 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.
   This fact, then, is established by experiment, that chancre, what-
ever its seat, is the consequence of  a specific pus, which it alone
secretes, and which, justly termed true leven, (veritable levain, fer-
ment special,) reproduces an identic disease wherever it is suitably
deposited.
   But this peculiar leven, which has a special action only when it
produces an ulceration, is generated only during a certain period of a
chancre, which then becomes, if we m,ay he allowed the expression,
an accidental virulent organ.  In fact, the  chancre, 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;  the  second, which
is the state of reparation, can  only  occur by passing to the state
of 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 contagious pus a few days later, one would conclude the
experiments to be uncertain, where, in fact, they are of the great-
est 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 under the epidermis, we shall find the following result.
   During the first twenty-four hours  the punctured point becomes
red, as in vaccination;  from  the second  to the third day, there is a
slight swelling, and  it  has the  appearance of a small papula sur-
rounded by a red areola ;  from the third  to the fourth  day, the epi-
dermis, elevated by a more or  less  turbid fluid, often assumes a
vesicular form, with  a black  point on the summit, caused by the
drying of the blood  of the small puncture; from  the fourth to the
fifth day, the morbid secretion increases, becomes purulent, the pus-
tular form is more defined, and its summit becoming more depressed,
gives it an umbilicated  appearance,  which makes it resemble the 
48       CRITICAL RESEARCHES AND GENERAL REMARKS

pustule of the small-pox.   At this period the areola, which had
increased in extent and intensity, begins to vanish or dimmish, par-
ticularly if the disease has  not increased much; but from the fifth
day, the subjacent tissues,  which have often hitherto  remained un-
affected, or were but  slightly cedematous, become infiltrated and
hardened  by the  effusion  of plastic 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 grayish surface is
formed of a lardaceous and sometimes ^wltaceous  substance, 01
sometimes a pseudo-membrane,  which  cannot easily be  detached.
The edges of  the ulcer at  this period seem cleanly cut, as if by a
perfectly circular punch, but  yet  are undermined  to a greater or
less extent, and when viewed with a lens, present slight indentations,
and a surface similar to that of the ground ;  their margin, which,
engorged  and  indurated like the base, presents a kind  of a red
brown, or more  or less violet circle, which projects more than the
neighboring parts, raises the edges and reverses them a little, which
in the first period gives a funnel-like appearance to  these ulcera-
tions.
   These  signs  are so regular and constant as  to form  a general
rule,  the rare exceptions to which are easily explained;  they lead
to the following propositions :—
   1.  A chancre is not to be determined 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
system to  which it may give  rise, as all the above mentioned con-
ditions may vary; the secretion, and its general consecutive effects,
remaining alone the same.   2. The pus of a chancre alone pro-
duces a chancre.  3. The  best method of  producing a chancre is
by inoculation with the lancet.  4. To  produce a chancre, neither 
             INOCULATION OF  THE SYPHILITIC VIRUS.            49

the orgasm of the venereal act, nor previous excitation of the part
about to be inoculated,  is necessary.   5.  Inoculation never fails
if the pus be taken  in the proper state  and  well applied.   6. The
pus taken from  a pustule, produced by inoculation,  reproduces a
chancre in the same manner, and so on from one to another, with-
out any limit,  but that of failure in the experiment.   7. If several
punctures be carefully made with pus from  the same ulcer, each is
certain  to produce a pustule, and then a chancre ; and the number
is equal to the number of inoculations.  8. The pustule  and the
chancre which succeed it are  developed upon the precise point  of
inoculation, and  never elsewhere.  9. Whatever may be the varie-
ties and complications of the chancre from inoculation at a later
period,  its progress in  the  commencement is always as  we have
described; the pustulous period is wanting only when the infected
parts have no  epidermis, and it is only preceded by phlegmonous
inflammation and abscess, when the virulent matter has been intro-
duced into the subcutaneous cellular tissue or the lymphatics.  10.
There is no incubation in the sense in which this word is generally
used ; for the evolution of the chancre commences at the  moment
of contact with the  infecting pus, and continues till the formation
of the ulcer.   11. Chancre  is at  first a local disease.   12. The
symptoms of general infection, which can only occur  when prece-
ded by  chancre, are not  seen in all  cases, and never appear when
they do  occur, except it has lasted a certain period.  13. To arrive
at this important result, we must distinguish the real from the ap-
parent commencement of the chancre, and not reckon  from the day
on which the patient first perceived it, but  from the time of infec-
tion.   14. 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.  15.
The induration of chancres does  not begin  till about the fifth day.
The chancres which are followed by secondary symptoms are gen-
erally indurated, and this induration would seem  to  indicate that
the venereal 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 spe-
cific matter produced by chancre, preserved  its  contagious proper-
                               7 
50        CRITICAL  RESEARCHES AND GENERAL  REMARKS--

ties for a  certain time, like vaccine.   Numerous observations, and
amongst others those of Hunter* one would think left no doubt
upon this subject; but this, however, is  not the case, as we see by
what the late Cullerier says upon it, in the great Dictionnaire  des
Sciences Medicates.

                 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,
coming in contact with the syphilitic, or  even  their clothes;  that the
meetings of  Christians for worship, &c, were frequent means of
contagion.   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;
because the virus generally has its seat in these organs, and because
they are always moist, and the  epidermis which  covers  them is
delicate and thin, the organs remain in contact, and friction renders
absorption more easy.  The  organs  of the  mouth are often the
propagators 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 breasts,  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 mode of determining whether the disease
has passed from the nurse to  the child,  or  from the child to the
nurse %
  If the  disease exist in both individuals at the same time,  and has
arrived  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

  * Petit Radel says: This same deleterious matter, taken from the syphilitic pus
furnished 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, pro-
duces venereal ulcers, 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.
OJ
the disease showed itself in one or other of them, which is some-
times very difficult to ascertain.   But one  may be certain that the
child has communicated the disease to the nurse, if it has ulcers in
the nasal fossae, tubercular pustules, a  scaly or ulcerated state in
any part of the body, with marks of a disease already of long stand-
ing.   On the other  hand, we may be certain  that the  nurse  has
infected the child, if she  has  ulcers in  the fauces, 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 after-
wards 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 without being wiped.   We  have seen several
well-established cases of these different  methods of communication.
   The eyes may also be directly  infected  by a moist kiss upon the
eyelids, or by a material projected  from a certain distance.   The
pus  which spirts from a suppurated bubo when it is opened, if it
touches the  conjunctiva, may produce syphilis and disorganize the
eye.
   The touching the hands or cheek of  a healthy person by an in-
fected 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, dressers in the public hospi-
tals, examining  pregnant women  by touching, or acting as  ac
coucheurs, have  caught the disease with which the women were af-
fected, by having slight excoriations from the little prolongations of
the epidermis at the base of the finger nails.
   We think  we  may assert that the fluid which serves as a vehicle
for  the virus, ought to possess  a  certain  degree of warmth, or
kind of life, which preserves for the virus the power of attaching
itself to the new body to which it has been transmitted.  We con-
fess our incredulity as to contagion 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 
52        CRITICAL RESEARCHES AND GENERAL  REMARKS--

been laid off  a whole night by the  wearer.   Nevertheless we
will  not  absolutely deny the possibility of this  contagion, if by
this admission  we explain things  which otherwise are inexplicable.
I have taken pus from some chancres and inoculated pustules, which
had been eight days in tubes similar to those used to preserve vac-
cine, and have found that it produced the same result as recent  pus,
In the same manner I found that muco-pus of a blenorrhcea, a phleg-
mon, simple ulcers, and non-virulent buboes, kept in the like man-
ner, produced  negative results.   It deserves to be noted, although
not a constant sign, that the pus which can be inoculated was al-
ways more fluid than that which was not virulent.
  It  must be admitted that women who have had connexion 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  connexion with a woman
affected with chancres, and  also the same day with his mistress,
wKo  became infected with the disease: the young  man  remained
unaffected, but he had not washed himself after the first connexion,
and his prepuce was very long. 
CHAPTER II.
    INOCULATION SE3VES TO DISTINGUISH FROM  EACH OTHER THE
            REPUTED PRIMARY SYMPTOMS OF SYPHILIS.

 . Whoever has taken pains to study syphilitic diseases, has no
doubt found that no affection is so ill defined, and no diagnosis so
uncertain.  What is syphilis 1  What are the symptoms 1   What
are symptoms  which are quite unconnected with  it 1  These ques-
tions 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  enu-
merated by Astruc and adopted by Capuron 1  But then it would
be impossible to admit a unity of principle, cause, and results, and
from confusing everything together, do we not remain  in  error  1
What  conclusions can  we draw from the observations of older
authors and from recent  statistics of venereal diseases, as to the
cause, effect, and treatment, when we see thrown together, under
the name of syphilitical diseases, blenorrhoeas, balanitis, (external
gonorrhoea of the glans penis,) orchitis, phimosis, paraphimosis, and
many others, which  have  no connexion with  syphilis 1   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 any thing has hitherto done.   In the first place, we will adopt
the very natural distinctions  made  by Fernel between primary and
secondary symptoms, or those with which the disease breaks out,
and the consequences  wdiich it  may afterwards produce.   Let us
first examine the symptoms which are called primary.  They  are:—
   1. Blenorrhcea in  its different situations.  2. Chancre or  prima-
ry ulcer.   3. Bubo, considered as a primary symptom.  4. Mucous
tubercle, or flat, humid, mucous pustule, said to be primary, &c.
  These affections  have been admitted as primary symptoms, be-
cause it is thought that they all have been observed  as the  first 
54
INOCULATION OF THE REPUTED
 symptoms which have shown themselves after an impure connexion,
 and a consequent  conviction that they indifferently produced the
 various symptoms  of  general syphilis.   Identity of cause, identity
 of effect, is a doctrine professed by most  practitioners of both the
 virulent and physiological school.
    From the connexion 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
 everything depended  upon the degree of irritation.
    Here again we  find doctrines  founded on  bad  observations or
 lalse explanations.
    § 1. I asserted and proved, in  the foregoing chapter, that chan-
 cre alone produces chancre; and  yet  most authors  have admitted
 the  existence of  blenorrhoeas which were virulent and identical
 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.
    All  authors have justly attached much  importance to the ques-
 tion, whether blenorrhcea is identical  with  chancre,  and whether
^jt constitutes a primary affection, by which syphilis may begin, and
 it is well known that the most  distinguished authorities have dif-
 fered in opinion.
    This difference of opinion induced the Medical Society of Besan-
 gon to offer this as a prize  question ;  and Hernandez, who justly
 concludes as to the non-identity of blenorrhcea 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 tran-
 scribe  part of his work*
    " Inoculation of the  virus of gonorrhoea  does not  produce
 chancres.   Andree tells us, that a surgeon inoculated himself with
 gonorrhoeal matter and had a chancre.   This isolated fact is of lit-
 tle  importance.    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 its syphili-
 tic nature was presumed merely from  its appearance.  We shall

    * Essai analytique sur la non-identite des virus gonorrhoique et syphilitique;
  par J. F. Hernandez.  Toulon, 1812, art. 4, p. 57. 
PRIMARY SYMPTOMS—GONORRHOEA.
55
■.  y\  >*dy show how little external signs are to be depended upon
tu such cases.   Even admitting the fact, a single  case like this
will  not overturn, nor even raise a doubt upon a mass of observa-
tions.
  "  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  ap-
peared at the points  of insertion.  Thus far it appears that the go-
norrhoeal virus produced chancres; but these chancres healed of
themselves, which is by no means the nature of chancres and syphi-
litic  ulcers.
  "  In this case, it is true, recent chancres appeared and vanished
of their  own accord: symptoms apparently syphilitic supervened:
a bubo, and, after its resolution, ulcers of the throat, which healing,
were  succeeded by  pustules; but the ulcers, the undoubted pro-
duct 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 pustules might also depend upon other causes.
Moreover, this train  of symptoms occupied three  years in its deve-
lopment ;  how can we be sure but that a  new infection during this
interval  occurred, and that the local affection, which  produced
these  symptoms,  was  not  observed?   Might  not this  patient
have  previously been affected with syphilis 1  The disease may
have lain dormant in the  system 5  an unclean connexion may have
communicated 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 a case 1  Can we then depend much upon the
syphilitic nature of  all the affections brought forward as syphilitic
by great surgeons 1   It is plain that this point is important, in or-
der  to estimate the value of the inoculation of which we are speak-
 ing, 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 some time after, a cutaneous eruption following,
 he considered it a syphilitic affection.   The celebrated Lettsom, to
 whom he communicated the fact, was of the same opinion.  The
 tooth was extracted, and all  the symptoms disappeared   We see 
56
INOCULATION OF THE REPUTED
from this circumstance how readily the venereal nature of an affec
tion was admitted at the time these authors wrote, and therefore how
slightly conclusive is the observation of Hunter, and how  little it
decides the question.
  " Bell relates, that  two young men tried some experiments with
inoculation upon themselves.   The glans and prepuce  were scari-
fied with a lancet and then  rubbed with gonorrhceal matter; they
became covered with  small  ulcers, which  had no resemblance to
chancres, and healed without 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 changed
the nature of the ulcers, and transformed them into something other
than would have been the natural product of the inoculation.   In
those of Bell, the matter is more clear and less involved in doubt.
If the inoculated virus be syphilitic, 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 syphilitic infection, or  pre-
vent it assuming its   essence and character.   It is therefore evi-
dent, that if inoculation  produce  ulcers which are not  syphilitic,
neither could the infecting matter be so ; and we necessarily con-
clude,  from the experiment of which Bell speaks, that the gonor-
rhceal virus producing ulcers, which are not syphilitic, has a different
and peculiar nature.
  " Thus far the observations  in favor of the production of chancre
by inoculation of  the  gonorrhceal matter, are few  and undecisive.
As there are so many  circumstances which may attend the ulcers
produced by inoculation of gonorrhoea, and even render them truly
venereal, two single  observations, in which  the ulcer obtained
might  be truly venereal, can  hardly be  depended  on to solve a
doubtful question 1  But the venereal nature of the ulcers produced
by the inoculation in Andree's case is,not proved, and that of Hun-
ter 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
produced by inoculation  of gonorrhceal virus  are not  syphilitic
We are therefore  obliged to conclude, that the  gonorrhceal  vinia
has a peculiar nature, strikingly different from the syphilitic virus 
PRIMARY SYMPTOMS—GONORRHOEA.
57
  " After all these experiments, I shall relate some which I was
enabled to make under  very favorable circumstances.  The work
of Bell, 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 dreaded the labor at the Arsenal, to submit to some  experi-
ments, in which there  could be no danger.
  " Many of the convicts had gonorrhoeas ; I selected three to fur-
nish  the necessary virus, and  kept them several  months, during
which  time  I  made my  experiments.  Three  healthy men in the
prime of life were repeatedly inoculated on the glans and prepuce.
Several threads dipped in gonorrhceal matter were laid  upon inci-
sions  made  with a lancet.   Slight ulcerations always followed
without having the appearance of chancres, and they healed with
the most simple dressings.
  " In two others, who had  great  tendency to scurvy, although it
had never broken  out, some obstinate ulcers  appeared, which re-
sisted all local applications, and only yielded to excitants combined
with acids.  One of them had  pains all over his body;  the pus of
the ulcer was bloody,  and the flesh of a fungous nature.
  " Four young men were formerly afflicted with scrofula, and still
had a scrofulous habit: in three of them, the ulcers were very ob-
stinate ; in two they possessed nearly all  the syphilitic characters,
and an herpetic 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
imprisoned three years, the other two, and neither had been allow-
ed to quit the  Arsenal.
  " A  young man, whose parents were afflicted with the gout, and
who seemed predisposed to it, was inoculated  in  the  spring.   An
ulcer was produced; the damp weather made it worse;  it was ac-
companied by wandering pains, and all the derangement caused by
weakness of the digestive organs.  It resisted all remedies, but the
warm weather setting in, it healed quickly.
  " A man about fifty years of age was subject to  hemorrhoids,
which  gradually disappeared.  Just at this time he was inoculated
                              8 
58
INOCULATION  OF THE REPUTED
The ulcer assumed a syphilitic appearance, and did not heal till the
hemorrhoidal flux returned.
  " Out  of six individuals of a sickly, irritable constitution, four
had obstinate ulcers, and two had even pains and cutaneous  erup-
tions.  These obstinate ulcers, whether accompanied by pains and
the eruption or not, only yielded after a long course of internal to-
nics ; the other two recovered easily with only simple dressings.
  " These experiments were made upon seventeen persons; thev
are the most  numerous, and perhaps  the most  careful, that have
been  made, and furnish important results.   Five of  these cases
were cured quickly, and without internal remedies, and the  ulcers
had no syphilitic appearance.  In the others, there  were obstinate
ulcers, some o'f which presented a syphilitic appearance, accom-
panied 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 dis-
orders ;  all the ulcers yielded to remedies  calculated to destroy
these disorders, but which are inert  where  syphilis is concerned
I might have been deceived had I not chosen my patients in ad-
vance, and carefully examined the state of their  health.  The scro
fulous subjects with abdominal obstructions might have led to error.
Here we had the symptoms of ulcer, cutaneous eruption, and the
efficacious effect of mercury alone!   What reasons for admitting
the existence of the syphilitic virus, had the disease not been pre-
viously  recognised, but  made  its appearance at the same time, or
shortly after, and had not other patients, with similar affections, and
without ulcers or venereal symptoms, experienced the  good effects
of this treatment!
   " My experiments prove that the ulcers, which are produced by
inoculating  the  gonorrhceal  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 o».
disguise them, and to such a degree that it may easily impose upon
inattentive observers who do not foresee these cases of complica-
tion."
   I will here relate some experiments which were made in Phila-
delphia. " Dr. Barton," says Dr. Togno, " to whom we are indebted 
PRIMARY SYMPTOMS—GONORRHOEA.
59
for them, inoculated me on the arm with matter from a very viru-
lent gonorrhoea, and no inflammation even ensued.
  " My fellow-student, Mr. Rowan, was also inoculated  with the
same matter upon the right arm, and there was no inflammation.
The same was the case with Mr. Thompson and a servant.
  " Three wreeks afterward, the operation being repeated with some
fresh gonorrhceal matter upon Mr. Togno's fore-arm, and a fortnight
later, in the same place, upon Mr. Rowan, neither chancre nor in-
flammation was produced.
  " Two pieces of lint, well soaked in fresh gonorrhceal matter, of
the virulence 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.   The same experiment
was performed upon the glans 'and prepuce of a healthy  man, and
with no effect."
   These  experiments  of Dr.  Togno 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
manner of the transmission of  syphilis, and  on this account its
transmission and its effects fail.
   We know that an excoriation or incision particularly favors the
action of  the  venereal  virus, of which we shall  give  numerous
proofs in this work.   But we have upon this  subject, and by the
same means, some very decisive  experiments by Dr. Togno.
   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; 
60
INOCULATION  OF  THE REPUTED
 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 similar 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 syphi-
 litic matter and a solution of sulphate of copper, in the proportion
 of a scruple to the ounce of water; the chancre appeared.
   At the same time he inoculated the same person on the  left arm
 with syphilitic matter,  and an equal quantity of a solution of sul-
 phate 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 pro-
 duces chancres.  In the latter, even when added to medicaments or
 energetic substances, it was always followed by syphilis.
   Dr. Harrison,  also, made some  inoculations with chancres;  the
 pus of which was followed by an ulcer and syphilitic symptoms.
   Upon considering carefully all the experiments relative to inocu-
 lation, we find some amongst those we have quoted which might
 undoubtedly be questioned, or whose consequences have been bad-
 ly deduced, without, however, detracting from  the regularity and
 precision of inoculation.
   The researches I have made publicly 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 blenorrhcea 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 cause 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 powerful irritant  in pro-
ducing the inflammation of the mucous membranes.  Yet the viru-
lent  pus, secreted by a  chancre, frequently produces a  blenorrhoeal
 discharge;  but then it  is easily seen  that the mode in which this 
PRIMARY SYMPTOMS—GONORRHOEA.
61
cause acts, differs  according to certain circumstances, and has not
always been properly explained, as we shall see hereafter.
   Nevertheless, the most distinguished authors have asserted and
been convinced, that one woman  having connexion with several
men, could give chancres to some of them, and to others gonorrhoeas
and buboes ;*  whence they have concluded that the nature of these
different affections is identical, 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 been admitted for some time without refu-
tation, it cannot be now.  Since I  have applied the speculum uteri
to the study of venereal diseases, the hitherto inexplicable enigmas
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 blenorrhcea,  and deep chancres in the vagina
or uterus, and the blenorrhcea alone show itself externally; so that,
apparently affected with gonorrhoea, she could easily give chancres
and gonorrhoea together, or only one of them, according to the pre-
disposition of the persons who exposed themselves to the infection.
But we can affirm, and from numerous observations, that whenever
we have  examined women who h^ve communicated disease, we
never found that a chancre had been produced by a discharge with-
out ulceration  in the sexual organs  of  the person who had commu-
nicated it.   Inoculation has confirmed what  had  been established
by observing ordmary contagion, better made with  the aid of the
speculum.
   In women, blenorrhcea in the whole extent of the organs of gen-
eration, in its different stages cf acuteness and duration, and inocu-
lated in the same  manner as employed for chancre, produced no
result, whenever the mucous membrane, affected with blenorrhcea,
was not actually the seat of a chancre.
   It is now well known, and is  proved by pathological  anatomy,
as also by the speculum, that blenorrhcea  is often accompanied or
followed by erosions, or more or less  extensive destruction of the
mucous membranes; but the ulcerated form of blenorrhcea, if I may
thus express myself, does not render it more capable of  being in-

  * This opinion has  been maintained by Fabre, Pressavain, and Cullerier, and
more latterly by Capuron, Lagneau, Gibert, &c. 
62
INOCULATION OF THE  REPUTED
oculated than that which is not; the blenorrhoeal ulcers being es-
sentially distinct from chancre.  The observation which my learned
colleague, M. Gibert,* has related,-as opposed to my doctrine, in
fact proves its validity   He says:—
  " I do not think that the inoculation proposed by M. Ricord, as
a means of diagnosis, can  really be used with advantage ; for this
inoculation has never succeeded in producing characteristic  syphi-
litic  symptoms, either  in  my hands, or in cases where there was
seemingly no doubt  as to the  contagious nature of the disease.
Lately a young girl, with an acute urethral and vaginal discharge,
with a granulated ulceration of the neck of the uterus, was  inocu-
lated with the matter of the discharge in my wards, without suc-
cess.   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 oc-
curred ; 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, when the
speculum had shown that no ulcerations of this kind existed any-
where, we might conclude, as I»have done, from the strictest  analo-
gy and the soundest  logic, that whenever the urethral blenorrhcea
of a man communicated a  chancre to a woman, there must have
been something else  than a blenorrhcea, 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
reason, viz.: because they had  never seen them, as if each indi-
vidual  could have seen everything ; but what is still  more strange
is, that the existence of every kind of ulceration has been  doubted,
and the power of ulcerating, under the influence of  causes  which
produce ulcers in all other  mucous  membranes, is  denied  to this
canal/because Morgagni never found any ulcerations in blenorrhcea.
Morgagni, who observed chancres in the meatus urinarius and cica-
trices in the urethra, which must have resulted from some  previous
destruction; and because Hunter  found no ulcerations in the ure-
thra of two men who were hanged, when affected with gonorrhoea;
         * Gibert, Manuel des maladies veneriennes.   Paris, 1836. 
PRIMARY  SYMPTOMS—GONORRHOEA.
63
and lastly, because M. Cullerier and M. Philip Boyer each made a

dissection and found  an unulcerated mucous membrane.   It is but

just to remark, that M. 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,

however, by a series of observations, and the aid of pathological

anatomy, that this  canal,  which was so often seen ulcerated at the

meatus urinarius,*  and in  the anterior  portion, might be so in any

part of  its extent, and apparently  afford  only symptoms of blen-

orrhoea.f
   In those cases related by some  authors,  and which appear to me

incontestable, where the pus of chancre introduced into the urethra

produced  a blenorrhcea, one of two things must occur;  either the

matter of the chancre acted only as  a  simple  irritant,  causing a

 discharge, or operating in a specific manner, it caused an urethral


   •Astruc, Frank, Bell, Wiseman,  Howard, Capuron, Spangenberg, Swediaur,
 Traite sur les maladies veneriennes, p. 137, Thomas Bartolin, Lisfranc, Fourcroy,
 Teytan, &c.
   t Astruc says: " I have seen several cases where a chancre existed at the com-
 mencement of the urethra."  Frank remarks—" Et sub aspectu medorrhea luem
 viro incauto conferre  queunt,  Met interdum  ulcusculum quin symptomata id do-
 ceant in uretro."  Bell mentions three cases of it occurring, one in his own prac-
 tice one in Wiseman's, the other in Howard's;  Capuron relates two cases of it.
 Spangenberg mentions the following case:  " A young man had a virulent gon-
 orrhoea which was treated by injections; a  gleet remained—there was a fixed
 and painful point in urinating, and on pressing  the urethra, near  the glands cS
 Morgagni, a drop of bloody pus appeared  at  the orifice of the urethra.  Tonics
 and stimulating ointments were used, and the  running disappeared, but the  pain
 continued.  Some time after, the patient perceived that the urine escaped through
 several openings in  the canal, which presented numerous small but true chancres
 which  had a fistulous opening.  It was then admitted that the pain depended
 on a chancre, which was previously unobserved.   Swediaur {Traite sur les mala-
 dies veneriennes, p. 137)  believed in the identity of blenorrhcea and chancre in
 respect to the essence or virus producing them, in consequence of false conclusions
 drawn from facts ;  but he admits the existence of ulcerations, and says :—
    " The reason why infection occurs so  seldom from blenorrhcea is, that the virus
 produces a superficial inflammation, and seldom causes ulcers which give rise to
 absorption in the mass  of the  blood; the mucous membrane is defended by the
 secretion of mucus, which is  increased  by the infection.  The virus is then ex-
 tremely diluted, the  parietes of  the urethra axe protected, and  consequently the
 formation of an ulcer is impeded.   If it be diminished, it is certain that in nine
 out of ten cases  the urethra would be ulcerated or excoriated, and the disease
 would appear as certainly as  syphilitic ulcers can produce it."
    T Bartolin has cited many cases of it.  M. Lisfranc has reported cases, in his
 inaugural  thesis, which cannot  be contested ; but the most interesting are those
 reported  by Teyiau.  (Traitt sur la gonorrhee, p. 83-107.) By these extracts,
 it will be seen how important it was for me to establish the fact, that blenorrhcea
 could be attended with ulcerations, although the differences between certain sim-
 ple ulcerations and chancre have not been a? well designated as they can be now,
 by inoculation. 
64               INOCULATION OF  THE REPUTED

chancre, which, from  its situation, could only occasion symptoms
of blenorrhcea, constituting what I have  termed  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 secretion of gonorrhoea, from a mucous surface not affected
with  chancre.
   Bell (vol. i. p. 492)  relates the following cases:—
   " Two young students of medicine, 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 syphilis.   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
gonorrhceal  matter, and allowed  it to remain in  the  same place
during twenty-four hours.   They expected to  see chancres spring
up, but in one, a great  degree of inflammation followed, with all
the appearance of what is called bastard gonorrhoea.   A considera-
ble quantity 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 in-
flammation 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  attacked  the second day with a considerable degree of gon-
orrhoea, 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
experiments,  and determined  not  to  prosecute them, although
they  were ardently continued  by his friend, who, shortly after  the
inflammation from  the  first experiment  had subsided, introduced
some  gonorrhceal 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 with-
out any application  to it.   His last  experiment was  attended with
more serious consequences.  He  introduced the suppuration of a 
PRIMARY SYMPTOMS—GONORRHOEA.
65
chancre on the end of a probe, to the depth of three or four lines
into the urethra: no symptom of gonorrhoea appeared ; but in the
space  of  five or six days, he  perceived a painful inflammatory
chancre on the  spot where he had applied the matter.   To this
affection succeeded a bubo, which suppurated, notwithstanding 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 considerable
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 could be desired,  of the  difference between the
matter of  gonorrhoea  and syphilis, and  to  show  neither chancres
nor other general symptoms can be produced by the matter of gon-
orrhoea, 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 Valentin, quo-
ted by Freteau,  tried several  times  without  success to inoculate
himself with blenorrhcea, without producing either chancres or even
a discharge.
   It has  been thought that the only difference between chancre
and gonorrhoea, was ascribable to the greater or less concentrated
degree of the virus; forgetting this fundamental law of syphilitic
diseases, that the  intensity of  the symptoms never depends on the
 acuteness  of  the  disease  in the person who infects, but of that in
the person who  is infected.   Supposing variations in the strength
 of the virus, and the existence of a superficial* and a more deeply
seated syphilis, it will easily  be seen that the virus of chancre in
 losing its strength could only produce gonorrhoea, which would be
 contrary to .the opinion of Swediaur, who  considers ulceration as
 the consequence of a less degree of irritation; but in this  case, now
 can the virus, weakened in these, in  its turn reproduce a chancre 1
 According to an opinion more absurd, it has been thought that the
 mucous membranes, affected with blenorrhcea, did not ulcerate, be-
 cause the virus was enveloped in mucus.   (Hufeland.)   It is very
 possible that virus, thus incarcerated, might have no  action  upon
 * Some authors, and amongst others M. Lagneau, give this synonyme to gonorrhoea.
                                9 
66
INOCULATION OF  THE REPUTED
a healthy mucous membrane, but that it should produce ulcerations

precisely in this part, and not affect those which had secreted it, or

at least  the neighboring or  contiguous parts, is far too irrational.

M. Lagneau's theory, according to which a blenorrhcea only pro-

duces constitutional syphilis, when  a part  of the  mucous membrane

remains sound, to absorb the  virus which  is secreted by the infected

part, is also  inadmissible, particularly as experience teaches that

the syphilitic virus cannot flow over the  skin  or a healthy mucous

membrane,  without infecting  it directly.  As regards Swediaur's

opinion, that blenorrhcea ulcerates the tissues to produce general in-

fection, it may be reduced  to  this  proposition:  that chancre alone

can produce secondary symptoms.

   It has been thought also that  the cause of  chancre and gonor-

rhoea being the same, the difference in the form  depended upon  the

tissues  affected, 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 blenorrhcea.*   We know that


   * The pus furnished by a well-established chancre, is sometimes  sufficiently
abuadant to spread to the neighboring parts; when it  is situated at the glans or
interior of the prepuce, it inflames  and sometimes excoriates these parts, causes
even new ulcerations, which soon produce fresh symptoms, and particularly  phi-
mosis.  In the plates of Mertens we find the history of a similar case marked by
a number of chancres which surrounded the base of the glans.'  The prepuce was
of a deep bluish red, and the pubic vein and its branches were gorged with a thick
and bluish blood.  Matter from a suppurating chancre, if inoculated immediately,
may give rise to  symptoms as  formidable, and  sometimes more so than those
arising from most impure coition.  Duncan cites an experiment made to ascertain
the power of pus from a chancre on the canal of the urethra. " I took,"  says
this author, "on the end of a sound some matter from a chancre on the glans, be-
fore any remedy had been applied to it, and introduced it completely into the ure-
thra, expecting  to produce blenorrhcea.   During the first eight days, I felt no
inconvenience, but, about this time, suddenly perceived pain in urinating.  Sepa-
rating the lips of the orifice of the urethra as far as possible, I found a chancre,
extending through nearly the whole of the  canal, and a  few  days after, a bubo
appeared in each groin.  There was  no discharge from the urethra during the
whole disease, but another  chancre soon appeared on the other side of the ure-
thra, which, with the other, was touched with red precipitate.   At the same  time
I used mercurial frictions on each groin, and was somewhat salivated ; the buboes
were arrested, and finally disappeared entirely.  The chancres yielded, and I was
cured."
   " The thicker the skin, the more difficult is  it  for the chancre to form; but if
the cuticle has been abraded, the ulcer is soon produced."
   " A peculiarity of the chancre is to burrow in the  part where it is situated.
The chancre presents a focus, where is constantly elaborated a material which
can communicate infection to a healthy individual and,  a fortiori, this  matter
causes it in the individual, where it is constantly in contact with the orifices of the
absorbent vessels, whose power is  rendered by it more active."—Cours des mol
syph., by M. Petit Radel:  vol. i. p. 317. 
                 PRIMARY  SYMPTOMS--GONORRHOEA.              67

blenorrhoeal  matter never produces chancre on  the skin, and that
applied to mucous surfaces,  when it  acts, it only produces a dis-
charge.
   The blenorrhoeal 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 blenorrhoeal  ophthalmia
(ophthalmie  blennorrhagique) ever produced chancres by inocula-
tion or otherwise, although the eyelids are susceptible of being in-
fected by chancre.  We may add, that the muco-pus of a balanitis,
&c, whether arising from an impure coition, or produced artifici-
ally by an irritant, has never furnished a result by inoculation, and
that these affections  therefore  cannot 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 blenorrhcea, there
are two  which  are  pretty  frequent and  regular, as  consecutive
symptoms; these are buboes, (yet far less frequent than after chan-
cre,)  and swelled 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 sup-
puration,  which is rarely the  case ; they otherwise partake only of
the nature of an engorgement or simple abscess, whose characters
frequently correspond to strumous, and not syphilitic affections.
   As to swelled testicle,  which  still more rarely suppurates, the
pus never produced anything by  inoculation.
   The observations made upon  blenorrhcea, during my researches
upon  inoculation, lead to  the following propositions:—
   1.  The matter of a  blenorrhcea,  applied  to  a healthy mucous
membrane, causes blenorrhoeal inflammation  the more easily, the
nearer it  approaches the purulent form, and  therefore,  contrary to
the opinion of Wathely, in proportion as its nature is less mucous.
  •"As we have already remarked, simple balanitis cannot be a severe affection,
and it is simple  in most cases : no one asserts that it can give rise to constitutional
or secondary syphilitic symptoms, nor have any facts ever been adduced to prove
it.  We  think  it cannot be venereal, and regard it as an affection which is not
virulent, and can produce no bad consequences.  Hence we think  that any anti-
venereal treatment is entirely unnecessary.  But we speak here only of simple
balanitis, in which  real ulcerations are never seen, and which are unaccompanied
by excoriations, that is, a chafing of the epithelium, without  rupture of the mu-
cous membrane of the glans or prepuce."—Cullerier and Radel. 
68
INOCULATION OF THE  REPUTED
  2. Under no circumstances can it produce chancre;  but as  an
irritating matter, like that of coryza for instance, it may excoriate
the skin, with which it sometimes remains long in contact, but it
never produces a specific ulcer.   Convinced of these truths, which
were so often verified, one of my pupils, M. Leon Ratier, often in-
oculated himself with the muco-pus  of blenorrhcea upon the skin
of the fore-arm, without any results.
  3. The consecutive, undoubted, and regular symptoms of blenor-
rhcea, do not furnish an inoculable pus.
  4. The  symptoms of  constitutional  syphilis  are not the conse-
quence of blenorrhcea.   In  all  the cases in which authors mention
that it was an antecedent, the frequency of which precisely corres-
ponds with  that of  masked chancres, (chancres larves,) the diag-
nosis was not correct;  the diseased surfaces not having been ex-
amined.
  5. Lastly, the  only correct means of diagnosis, in  the present
state of science, is inoculation.   Every  blenorrhcea which is tested
by inoculation in its various periods, without producing any result,
is only a simple affection, and cannot communicate syphilis, whether
primary in another subject, or constitutional in the one first affected.
  Having proved that  blenorrhcea and chancre  are  two  entirely
distinct  diseases, as  regards their cause, form, and  consequences,
we shall examine the other  reputed primary syphilitic symptoms.
  § 2. Chancre, the inevitable consequence  of  the application of
the syphilitic virus, either to the skin  or mucous membranes in the
proper state for inoculation, often presents such varieties in its ma-
terial aspect, that it seems to constitute different diseases.
  Some have  considered these  differences  in chancre, which are
not well known, or not duly appreciated,  as  an  argument against
the identity of the venereal virus and  its unity of action, and others,
as proving the existence of a  plurality 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  uncompli-
cated cases, the apparent differences are easily explained, and  all
contradictions are reconciled;  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 char-
acteristic pustule is obtained, when the virulent  pus is inserted un 
PRIMARY  SYMPTOMS--CHANCRE—BUBO
69
der the  epidermis or  epithelium, an  immediate (d'emblee) ulcer
when it is applied to denuded tissues,  or  an abscess when it is in-
troduced 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 and characteristic features  in the ulcer at its commence-
ment ; and  that, too, whether it be the consequence of the rupture
of the pustule, the opening of a virulent abscess of the cellular tis-
sue or lymphatic ducts, or whether it have arisen immediately. The
deviations or  peculiar forms only develop themselves  after, and
under the influence  of circumstances foreign to the specific  cause,
such as:—the constitution of the patient, his former or co-existent
diseases, his health,  and  the general and local  treatment which  he
has employed.   From this cause, we see  patients  affected with
phagedenic  chancres, who have contracted  their disease with per-
sons who had apparently only mild 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
chancre in its different forms beyond all  doubt, and  explained  its
deviations.
   It is, as we have seen, inoculation which has enabled  me to dis-
tinguish these two very distinct periods of chancre, viz.,  the period
of ulceration, which may be still increasing  or arrived at a station-
ary state, in which there is a balance  between the  nutrition and
source of ulceration; and the period of reparation, either by pass-
ing to the state  of a simple ulcer, or to the transformation in situ,
or to the secondary symptoms on the spot.
   The period of the specific ulceration is unlimited in its duration,
preserving the characters of the primary ulcers; thus  I have inocu-
lated with pus furnished  by ulcers which had already existed eigh-
teen months.  The different periods of chancre may always be de-
termined by inoculation.
   But if inoculation  presents curious and important results, the his-
tory of buboes is still more interesting.
   § 3. The bubo, so frequently a symptom of venereal diseases,
and which  was  so  well described  by Guillaume  de Plaisance,*
                * Guillaume de Plaisance wrote in 1343. 
70
INOCULATION  OF THE REPUTED
although Astruc considered it as a recent symptom of syphilis, was
not always well known to the  ancient writers on syphilis, which
explains the singular assertion  ~f Astruc, nor even to the authors
of our own  times, as  may be seen by the writings of modern au-
thors, and the objections which have been made to my researches.*
   Inoculation, applied to the study of this symptom, has established
experimentally the following species :—
   1.  A bubo may be simply inflammatory.
   (a) By propagation of the  inflammation by continuity, without
regard to the particular nature  of the primary affection which pro-
duced it, whether this was a blenorrhcea, a chancre, or other lesion.
(6) By syphilitic reflection.
   2.  Virulent, that is, owing to the direct absorption of the specific
pus of syphilis, and  in this case it is strictly the consequence of
chancre; the pus  of chancre alone  can produce it.
   3.  Superficial or deep-seated, or it may present these two forms
at the same time.
   4.  Seated in the cellular tissue, the lymphatic  vessels, or gang-
lions, separately or differently combined.
   5.  Chronic or acute.
   6.  Preceded by other symptoms termed primary, or show itself
immediately (d'emblee).
   7.  When other  symptoms have  appeared before it, it  may suc-
ceed them immediately, and then be only a successive symptom, or
it may only manifest itself at the period  of general  symptoms of
syphilis, and constitute the secondary bubo.
   When  one is satisfied of the truth of the divisions just established,

  * " The pus formed in the buboes which  accompany primary or secondary ul-
cers, or blenorrhcea, may be introduced under the epidermis, or epithelium, with
impunity."   MM. Cullerier et Ratier, article inoculation, Diet, en 15 vols.
  "Inoculation has been proposed as  a means of diagnosis between sympathetic
and syphilitic buboes; most experimenters, among others M. Cullerier, obtain-
ed 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 the
characteristic pustule whenever the bubo was united with a chancre, or a vaginal
discharge, which arose from ulcerations of the neck of the uterus.  The  few ex-
periments I have made, or seen performed by my friend and colleague, Dr. Manec,
afforded, like those of M. Cullerier, a  negative result.  As most  buboes in wo-
men terminate by resolution, the cases in which inoculation would be practicable,
are very limited." M. Gibert, manuel des maladies veneriennes.   Paris, 1836.
  M. Ruef, of Strasburg, has also said that all buboes were not capable of  being
inoculated, but did not mention the cause of this difference, although he assisted
at my experiments, which he probably did not recollect. 
                    PRIMARY SVMPTOMS—BUBO.                  71

and which are generally admitted, we are astonished to hear learn-
ed and wise 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
inoculate, inoculation is an uncertain  means, either of proving, as
we have said  elsewhere, the existence of the virus, or of diagnosis ;
not perceiving that tfcis pretended uncertainty of inoculation, was
what  established its absolute value.
   Whenever an inflammation  of  the cellular tissue, or lymphatics
of the inguino-crural  or other regions, has been caused  by any
thing but chancre, if suppuration  has supervened, it has never pro-
duced anything by inoculation, at whatever may have  been  the pe-
riod or the conditions in which the pus was taken.  Thus it is, for
example, that when a bubo had been preceded by a gonorrhoea, it
never, when it came to a state of suppuration, as we  before  said,
furnished an inoculable pus; only when a bubo is preceded by a
chancre, can it furnish  a specific pus capable of inoculation.   But
because a chancre has preceded a bubo, it  does not follow that it
will afford a specific pus; in order to this, the bubo must  not be
the result of a simple inflammation from sympathy or succession,
but there must have been  absorption.   Now, absorption, when it
takes place from a chancre of the sexual organs, only occurs in the
superficial ganglions, and most frequently in one at a time, although
several ganglions, either superficial or deep-seated, may be  inflam-
ed or swollen at the same time*  so that one ganglion presents all
the characters of a virulent bubo, while the neighboring ganglions,
in which the inflammation may come to suppuration, as well  as in
the surrounding cellular tissue, only present a simple and non-viru-
lent character.
   It required some time to  recognise these conditions, and to ex-
plain  to  myself why all  buboes  did not inoculate, as asserted by
those who have repeated my experiments, without being well ac-
  * 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 affec-
tion, the division of buboes into superficial and deep-seated, is correct; but if only
those be considered syphilitic buboes which are the result of the direct absorption,
of pus, there only exist superficial buboes, and the  opinion of my colleague and
friend, M. Philippe Boyer, is correct. (De la syphilis. Paris, 1836.) As in the
study and treatment of buboes, there are other things to be attended to besides the
syphilitic virus, this distinction of deep-seated and superficial buboes, upon  which
M. Desruelles particularly insists, ought to be adhered to and studied with care 
72
INOCULATION  OF THE REPUTED
 quainted 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 more exact experiments, and I first inocu-
 lated from all the buboes when they were first opened, with the first
 pus which escaped, but with no results whicrt explained M. Culle-
 rier's assertion,  who had perhaps only made his experiments under
 these circumstances, or in cases of simple buboes.  I then took pus
 from these same buboes, two, three, four, five days and more  after
 the opening; sometimes the inoculation succeeded, but in other cases
 it failed.   In the first case, the centre, as well as the edges  of the
 opening, soon assumed the character of chancre, while in the se-
 cond, the abscesses progressed like  simple phlegmonous or lympha-
 tic abscesses, and healed.
   An important question however remained, viz., whether in these
 cases where the pus from a bubo did not inoculate when this bubo
 was first 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 rnv
 notice, with a bubo consequent on  a chancre, which had suppu-
 rated copiously.  I opened the abscess;  but after evacuating 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 inoculated with the  pus it contained, and also with
 pus taken from the surrounding parts, viz., the cellular tissue;  while
 the pus taken from the ganglion produced the characteristic pus-
 tule, that from the cellular tissue remained inert.  I was then con-
 vinced that the difference did not  depend upon chance, or upon
 circumstances occurring after the opening of  the buboes, but upon
 the virulent  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.
  I now selected some buboes in which the suppuration was far
 advanced, and which had been preceded by chancres.  I inoculated
with the  first pus which escaped at the moment of  opening;  and
then, having freed them as completely  as possible, I made a large 
PRIMARY SYM'TOMS—BUBO.
73
opening, and took pus from the base of the suppurated ganglions
to inoculate.   The results were like the first:  the superficial pus
Produced nothing; the deep-seated pus, a pustule.
  However, it is easily seen, that where suppuration has existed  a
long time, the virulent ganglionary pus may  have come 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.  From the diffi
culty of separating the layers of simple from those of virulent pus
it is easily understood that  results  apparently contradictory might
appear;  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 taken from the
course of the lymphatic vessels.   The lymphatic vessels are some-
times inflamed and engorged in their whole extent, between a chan-
cre and the ganglions, in which they terminate.  The disease of
the lymphatic vessel may take place without the ganglions being
necessarily affected.  A chancre may even exist on one  side and
occasion a bubo on  the other ; in which case, the absorbent ves-
sels may remain healthy or become engorged, marking their course
from one side  to another, crossing the median line.  WThenever the
inflammation  of the vessels terminates in suppuration, and  is the
consequence of absorption  of chancrous pus, it has in its turn fur-
nished an inoculable pus.
  We have already seen that the phlegmonous bubo, or the simple
suppuration of the cellular  tissue, produced  nothing by inoculation,
if the source did not afterwards become infected by contact with
virulent pus, proceeding from some part, and generally from the
opening of an affected  ganglion or  lymphatic 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 be-
tween the chancre and the  abscess, which cord  might be  taken for
a lymphatic vessel, but is  in fact  only indurated cellular tissue.
These  abscesses inoculate   at  the  very moment  of their  being
opened, and with all the pus they contain, without distinction.
  When the deep seated ganglionary engorgements.   17 
74
INOCULATION OF  THE  REPUTED
 seated buboes, suppurate, which is far more rarely the case than in

 superficial ganglions,  the pus  from  them never  inoculates, unless

 they be subsequently soiled with matter from a neighboring chan-

 cre, or an infected  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 being inoculated, does not pass the first ganglion

 by direct means of absorption from the chancre, to which the  bubo

 succeeds.

   A question of the greatest interest, which  has not  always  been

 tnswered in the same way, is the existence of primitive bubo, as a

 primary symptom  (d'emblee.)

   Do primary syphilitic buboes, in the strictest sense  of the word,

 really exist;  that is, without any other antecedent than an impure

 coition, and without concomitant symptoms, to which they might

 be attributed ?   Men of equal  celebrity have replied  in the nega-

 tive and in the affirmative to this question.*

   If the  patients be closely and minutely questioned, it will  soon

 be found that the  reputed primary buboes are very rare; for  most

 frequently the cause of those supposed to be such is so evident that

 we are surprised that the  patients themselves did  not  perceive it;

   * The buboes termed primary, appear without the previous appearance of any
 syphilitic symptoms: the inguinal glands are those most commonly affected.  Some
 writers  doubt the existence  of this  kind of tumors, but facts have proved its
 existence, which  is now admitted by the physicians of our age.  In fact, it is
 generally admitted that syphilis may affect the system and produce its most serious
 symptoms, although the part whence  the absorption has taken place may present
 no primitive symptoms, as blenorrhcea or chancre : how much more probable is it,
 then, that this virus may affect the lymphatic glands found in its course, and thus,
 by its irritating properties, cause engorgement to a greater or less extent: this
 opinion is sustained by many distinguished authors.
   Fallopius cites the  case of a young man, who perceived  an  inguinal bubo,
 twenty-four hours after an impure coition, unattended by any other symptom.
 Astruc remarks: "Ex impuro concubitu  aborti mediati vel immediati."   Swe-
diaur and Bertrandi cite cases in support of the same opinion.  The Hopital des
Veneriens often presents similar cases.  In 1811,1 attended a young officer, who
had never been affected with syphilis.  One month after connexion with a sus-
picious female, he had two inguinal buboes, which were not  preceded by chan-
cres, gonorrhosa, or the least irritation of the genital organs.  A stranger applied
to  me  three years since with two  buboes in the same position,  which ap-
peared  three weeks after coition.   In a young  man who applied to me  about
the same time, the venereal tumor appeared in the left groin ten days after  expo-
sure.  Mordret, physician of the hospital at Mans, has mentioned two cases, and
in  a third case, three months elapsed between the exposure and the development
of  the bubo.  (Mem. sur Vexistence du virus syphililique. Paris, 1827.) La«neau
does not say that these buboes have been followed by secondary svmritoms.
(Traite des mal. syph.  1828. vol. 1, p. 204.) 
PRIMARY SYMPTOMS--BUBO.
75
thus patients, who have been informed of their disease by the de-
velopment of a more or less painful tumor in the groin, will  only
allude to this tumor, which  they  perceived  the day previous, or
even that day.   If you interrogate them, they refer to an exposure
a fortnight or month previous; if  they be then examined, a chan-
cre will be found, often pretty extensive, upon the penis, prepuce,
or some neighboring part.   However, it is true that after an unclean
connexion, the engorgement of the ganglions, situated near the
sexual organs, become, though rarely,  primarily diseased.   Yet
there are some circumstances where no suspicious antecedent or
concomitant can be found, and we are then  obliged  to admit the
existence of the primary non-consecutive bubo.
   On examining these engorgements attentively, guarding  against
being led into error by tffose which may resemble them, we  find
that they generally appear in the deeper ganglions, and not unfre-
quently even in those  of  the fossa iliaca, or  at  least the suba-
poneurotic ganglions of the thigh; that  their progress is often
chronic; that they are  a long time indolent, and  have little  ten-
dency to suppuration;  and when they suppurate, the pus from them
does not inoculate: hitherto I have never found a bubo with all the
rational signs of a primitive bubo, which furnished  an inoculable
pus.  If to  this important observation  be added, that  after very
careful researches, I have never found that a strictly primitive bubo
has been  followed by  symptoms  of general syphilis, the impor-
tance of inoculation in this case will be apparent.  Moreover, as
regards absorption in general, in order that the primitive virulent
bubo may occur, the lymphatic vessels must have orifices, opening
on the mucous or cutaneous surfaces;  for, according  to the hypo-
thesis that all absorption must be preceded by a kind of imbibition,
the tissues which are impregnated with the pus of a chancre would
be first infected, as this  pus necessarily produces ulcerative inflam-
mation wherever it penetrates, except  in the lymphatics, when
their internal membrane is entire ;  for if this be not  the case, we
see them attacked, 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:—
   1. That the virulent bubo, or that from the  absorption of the pus 
76
INOCULATION OF THE  REPUTED
of chancre, is analogous to chancre, as regards its nature, and only
differs  in  its seat.   2. That the virulent bubo is  the  only one
which inoculates.  3. That the signs which have been mentioned
by all  authors to distinguish virulent buboes from the engorge-
ments with which they might  be  confounded, only serve in most
cases to establish a rational or probable diagnosis;  and that inocu-
lation alone can  be considered as an unexceptionable and  pathog-
nomonic sign. 4. That if, in a great many cases of supposed primi-
tive 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 pro-
perly 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  necessarily syphilitic, because it ap-
peared soon after a coition.
   § 4.  One reputed primary symptom remains to be examined: the
mucous pustule, {pustule muqueuse, pustule plate, humide, tubercule
muqueux, papule muqueuse.)
   Whatever may have been the antecedents of the mucous pustule,
or at whatever period  it is  examined,  it never produced anything
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 without  any result; and yet the conta-
gion of the mucous pustule seems to be  proved, and  in some indi-
viduals it seems to be the first symptom of syphilis.  But, contagious
by an intangible  vital process, which cannot be explained, the mu-
cous tubercle cannot  be transmitted by  inoculation.
  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 genera. infection.  Similar in ap-
pearance to chancre, thought like it to be contagious, and  perhaps 
             PRIMARY SYMPTOMS--MUCOUS  TUBERCLE.           77
                                         t
the beginning of syphilis, it differs from it in the results of inocula-
tion.  It resembles the secondary symptoms, inasmuch as like them
it succeeds to chancre, it may be inherited, but cannot be transmit-
ted by inoculation.
   The mucous tubercle, however, which some authors have wished
to divide  into  two  species, the primary and the secondary, and
which is evidently the same in its  nature and source in all cases,
differing only 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, con-
comitant symptoms,  and consequences,  it is sufficiently interesting
to detain us a moment.
   It may be confidently asserted, that the regular and constant an-
tecedent 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 contracted them from  an individual who  has had chancres;
in short, we find, on a rigorous 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 incontestable  fact in the history of the causes which regulate
the development of mucous tubercles is, that all  individuals are not
susceptible of them;  if they can be situated  in the mucous mem-
branes, 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 to become affected by it.  Thus persons of a
lymphatic habit, women, and children, are  most subject to it; the
mucous membranes of the genitals, anus, and mouth, are most fre-
quently attacked; and  the skin  is seldom affected by it, except
around the sexual organs, anus, or umbilicus, in the meatus audi-
torius externus, behind the  ears, &c.
  In its material form, or in the lesion  of the tissue which consti-
tutes it, the mucous tubercle, especially when  isolated, is very often
difficult to distinguish from chancre during the period of unhealthy
granulation; in most cases the remains of the ragged edges of
chancres distinguish them from the  less defined  base and  circum-
ference of the mucous tubercle ;  but in chancres which have re- 
78
INOCULATION  OF THE REPUTED
mained superficial, and which quickly pass to the state of granula-
tion, or  into one of the varieties of ulcus elevatum, the distinction
is often impracticable.
  It is very evident, that the mucous tubercle is far more common
as a secondary than as a primitive symptom.   If, on the other hand,
we  consider that in the latter case it is far more frequent in women
and children, where the  chancres  to which they owe their origin
may have remained unperceived or concealed; that  the time when
the patient complains  of it, 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 them-
selves, it will be easy to admit that a chancre  may have preceded
it;  the more so, if a patient only presents one or two mucous tuber-
cles upon the parts generally subjected  to contagion, with no other
antecedents than connexion with an infected individual.   The accu-
rate observer will thus conclude these are only chancres in an  un-
healthy state of granulation or transformation in situ.  Farther, we
often find, in the midst of a knot of mucous tubercles, an untrans-
formed chancre, which affords  an  inoculable pus.   In other cases,
the tubercles are very numerous, and appear often upon different
parts of the body at once,, or accompanied  with other symptoms,
which leave no  doubt as to their characteristic and specific form,
and their nature as symptomatic of constitutional syphilis.
  We must not, in this place, forget, that  of all  the  secondary
symptoms  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 suc-
ceed to  a blenorrhcea.  The following are the results I obtained:—
  A blenorrhcea, properly so called, i. e., a muco-purulent discharge
uncomplicated with chancre, and therefore not inoculable, was never
followed by mucous tubercles, any more than  by other symptoms
of constitutional syphilis.  In cases where  blenorrhoeal discharges
have seemed alone to precede the development of mucous tubercles,
either there existed at the same time a concealed chancre, (chancre
larve,) or it was only  one of those  discharges which are  concomi- 
             PRIMARY SYMPTOMS—MUCOUS  TUBERCLE           79

tant or consecutive to mucous tubercles, and which superficial ob-
servers might then regard as the primary cause of them.   I confess
it was long before I discovered  this fact, that, where the mucous
tubercles develop  themselves,  they not only generally furnish a
peculiar  morbid secretion, but also cause a catarrhal flux of the
mucous tissues on or near which they are seated.   From the fore-
going, I have drawn the following conclusions :—
   1.  That the mucous tubercle never inoculates.   2. That it ought
to be referred to the secondary symptoms, and is a proof of con-
stitutional syphilis.  3. That its secretion, acting like irritating
matter, may inflame the tissues with which it comes in contact.   4.
That when syphilis has been transmitted to an individual from mu-
cous pustules or tubercles, there must have been other specifically
contagious symptoms at the time of the infection   5. That, like the
other secondary symptoms, the <me  mucous  pustule  can only be
transmitted by inheritance. 
CHAPTER III.
  INOCULATION DISTINGUISHES PRIMARY FROM SECONDARY  SYMPTOMS.*


    The celebrated Hunter had already established, by  accurate and

 learned experiments, erne fact, since confirmed by many other ex-

 periments, that the symptoms of constitutional  syphilis  cannot be

 inoculated.

   * My clinical observations have led me to the following classification of the symp-
 toms of syphilis.
   1. Primary symptom, (accident primitif) chancre from the direct action of the
 virus which it produces, and by means of which it propagates itself by contagion
 from a diseased to a healthy individual, either by inoculation in the same manner,
 or in the individual himself from one point to another, without being transmitted
 by inheritance  with its principal character—the  possibility  of inoculating; but
 capable of producing the primary infection of the infant at the moment of its birth
 or afterwards.
   2. Successive symptoms, (accidents successifs,)  or those which arise from conti-
 guity of tissue, or by simple extension of the first local symptom, as new chancres;
 simple inflammatory, or virulent abscesses, or simple or virulent adenitis, &c.
   3. Secondary symptoms, or symptoms of general infection, in which  the virus
 has undergone a modification and produced the syphilitic temperament; symptoms
 appearing on the  skin, the mucous membranes, the eyes, testicles, &c, and seldom
 happening before the first two weeks of the duration of the primary affection, chan-
 cre; but generally after the fourth, sixth,  eighth,  or even much later;  not capa-
 ble of inoculating, if we can recognise them, and are not  deceived by the pa-
 tients.   These secondary phenomena can be transmitted by way of inheritance,
 and that in a most incontestable manner, from mother to child, which then pre-
 sents after its birth general symptoms corresponding to those of the mother, with-
 out previous primary affection, and without their  being attributable to the previ-
ous or subsequent action of the sympathies upon them, by the sexual organs  of the
father or mother, ivjo or three months after birth.
  4. Tertiary symptoms, (accidents tertiaircs,) occurring at indefinite periods, but
gcaeiaily iopg after the cessation of the primary affection; not appearing in most
subjects until after secondary symptoms have occurred, whether they still exist or
have disappeared, which  ought not to be neglected in the diagnosis; symptoms,
which net only no longer inoculate, but which can no longer be transmitted by in-
heritance, with the specific characters of syphilis, like the secondary, and  which
are perhaps a frequent caurr-, by generation, of 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, exos-
toses, caries, necrosis, syphilitic tubercles of the brain, which I have described and
shown to the Academic de Mcdecine; internal affections which have been hitherto
ill defined, (Sanchez,) &c.
  5. Lastly, foreign diseases, unconnected with syphilis, which however may have
favored their development, such as cancer, phthisis, scrofula in the individual pri-
marily affected,  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. 
INOCULATION DISTINGUISHES  SYMPTOMS.
81
  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 symp-
toms of syphilis reputed  secondary, and the results have been in
conformity with the facts established by Hunter.
  But from this great  and acknowledged difference between the
primary affection,  chancre, and its secondary symptoms, can wre
conclude, as M.  Richond and  his  supporters 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 in inoculation having made me better acquainted
with the primary symptom of syphilis, its true commencement, I
arrived at the conclusion, which has  been established by most good
observers, that  all the reputed secondary symptoms  are far  from
being specific;  that the 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
also have  caused ;_but that independent of these symptoms, per-
haps the most common, and which afford a fallacious support to
the doctrine of the  non-specific nature of syphilis,  or the  non-
existence of the virus, there are some, regular and characteristic,
occurring as the necessary and invariable  consequence of the pri-
mary  infection,  and which are the result of chancre, under one of
the forms we have above  assigned to it, or the product of inheri-
tance, which only military surgeons can deny, for  want of a proper
field for observation.
  When we have followed the pus of the chancre into the system,
wTe have seen that as long as it was only imbibed by the cellular
tissue, at whatever depth it might arrive, it  preserved  its charac-
teristic property, the possibility of inoculating.   The same was the
case with the vasae lymphaticse afferentes, which run from a chan-
cre 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 experienced a
change, which without depriving it of its specific nature, with re-
gard to the symptoms it produces in the system, destroyed its power
                              11 
82             INOCULATION DISTINGUISHES PRIMARY

of 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
requisite to develop the symptoms of constitutional syphilis  that
the virus should pass through the lymphatics, or that the produc-
tion of buboes should precede it in all cases.
  But if absorption of the venereal  virus does  undoubtedly take
place in two ways, first, by the lymphatics and without any altera-
tion in these primitive  qualities till it arrives at the first ganglion;
secondly, by the veins which can infect the system and so easily pro-
duce  cutaneous affections, as is seen in all cases where 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 viru-
lent pus no longer inoculates.
  We must be careful  not to be imposed upon by what frequently
occurs 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 frequently observed this symptom, and proved that  it was
owing to an inflammation of the lymphatics and not  of  the veins;
for if we observe that this kind of cord, which is frequently knotty,
runs from the chancre  to the  ganglionary regions, and  never ex-
tends beyond them, and that it does not present the uncertain  course
as regards its limit,  extending itself towards the centres of the cir-
culation, which the  venous inflammations so  unfortunately do, we
are led to acknowledge that the lymphatics alone can present these

  * M. Jourdan says, in his  treatise on venereal diseases, (Traite des mal. ven. vol.
1, p. 409,) " The blood of  an individual affected with syphilis  is not more in-
fected  than it is in variola,  according  to Darwin ;  or in  hydrophobia  according
to MM. Trollier et Berthold.                                 '
  " The blood of a syphilitic patient,  says Hunter, is not contagious. It may be
inoculated without fear of the disease; for if it were capable of  irritating a sim-
ple wound and producing in it a venereal inflammation, every individual in whom
this matter circulates, or who is attacked with syphilis, must necessarily have a
renereal ulcer wherever he might wound himself, or even scratch himself with a
pin ; the part thus ulcerated would  become a chancre."'  Bell thinks that this
happens sometimes, but he  particularly insists that it is in the very advanced pe-
riod of the disease.  I think Bell did not well observe the circumstances in which
this happened. 
FROM  SECONDARY SYMPTOMS.
83
conditions ; but if, as I have done, the diseased parts be dissected,
pathological anatomy leaves no doubt on the subject.   When they
suppurate, which is not very rare, and the abscesses open or are
opened, we find pus  not mixed with  the  blood, either in clots or
otherwise, as is the case in phlebitis.
   If, however, all good observers are agreed, as  to the impossi-
bility of inoculating with  the lancet the pus or morbid matter pro-
duced by the secondary symptoms, as well as the different normal
or abnormal secretions of individuals reputedly affected with con-
stitutional syphilis, some men may have been  misled by symptoms
which, on account of their seat and the time  at which they were
developed, might, upon a  superficial examination, be attributed to
a general infection ; thus I have found primary ulcers of the lips,
tongue, and even of the pharynx, which had  been contracted  di-
rectly and by illicit means, and which necessarily furnished an in-
oculable pus ; symptoms,  whose true cause, or the manner in which
they were produced,  the patients sought to conceal: this is perhaps
still more the case with primitive diseases of the  anus.   In indivi-
duals 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
eruption, the production of the primary pustule of chancre, one might
believe 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 symptoms.
   From the facts relative  to inoculation of the secondary symptoms,
we must conclude,
   I. That it does not  follow that because a symptom does not in-
oculate,  it is not syphilitic, since  the  virus,  modified by venous
absorption and susceptible of poisoning the system, loses this quali-
ty, and retains that of propagation by inheritance alone.
   II. That  whenever a  symptom,  whatever  may be its seat and
apparent form, still  inoculates, it is necessarily produced by direct
contagion, and is not the  result of a general infection, arising from
the absorption in another point, and does not actually indicate the
venereal temperament, or, in received terms, constitutional syphilis. 
CHAPTER IV.
           INOCULATION SERVICEABLE IN THE THERAPIA.

                           Section I.

   Dishonesty  and the speculations of quacks, which continually
make the most sacred science subservient to their purposes, have
availed themselves of the inoculation  of syphilis, like every other
road to success and celebrity; but if there be men who are deprav-
ed and reckless, there are some  too whose  actions are  guided by
the interest of science alone, and whom no  imputation can affect.
   Thus inoculation has been employed in the study of the preven-
tion of syphilis, which cannot  be too much encouraged, and  which
we think will  one day cause the  discovery of a substance,  which
will neutralize 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 disease, and it has been only used
to  prove the efficacy of any preservative.
  With  this intention, Luna Calderon* made  his  experiments,
which, although satisfactory,  were so  badly received at a time
when the search for a preservative 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 inocula-
tion, and the demonstration  of the results of prophylaxv, ought to
be  mentioned in  this place.   A  commission,  appointed by  the
Societ6 du cercle medical, and composed of  Capuron, de Mangeon,
Gardien, and d'Olivera, assembled in the  venereal  hospital of the
capital for this purpose.

  • Demonstration pratique de la prophylaxie syphilitique, par le  docteur Luna
Calderon, publiee a Paris, en 1815. 
INOCULATION SERVICEABLE IN  THE  THERAPIA,          85
  "First Experiment, with previous resolution to permit the infection.
November the 7th, 1812.  The assistant surgeon selected, in the public
receiving rooms,  a well  characterized venereal chancre,  and  dipped a
lancet in it.  I scratched myself with this instrument on the external part
of the right side  of the prepuce,  but did not make it bleed.   Five days
after, I went to the hospital, accompanied by the members of the commis-
sion, 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-chief de-
clared he wished  to 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 had become a
well-defined chancre.   There were also three other little chancres around
it.  All present declared the 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 certified by the
commissioners, and entered in the register of the hospital.
   " Second Experiment, with the previous determination of protecting my'
self.  December 18th.  The  prepuce  was again  scratched with a lancet,
dipped in a venereal  chancre, chosen with the same precision and the
same circumstances as in the first experiment.  Immediately after, I ap-
plied the preservative to it.  At the  end of five days, I went  to  the  hos-
pital 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 at-
tained.   The experiment was certified, &c.
  " Third Experiment, with previous determination  to protect  myself
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 myself
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 presented myself
without having perceived the least sign of ulceration on the prepuce.
  " Fifth Experiment, with a bloody incision.   Having gone before the
commissioners, on the 17th of January, I prepared to make an incision in-
stead 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 determined to vary this trial in the following
manner,  so as to obtain a decided result.
  " Sixth Experiment, with a double incision: the one simple, without con-
tagion, the other contagious.   My purpose in this experiment was to show
the contagious incision, cicatrized in  the same time  as the non-contagious
incision, by preventing the development of the infection in the inoculated
point, by means  of my preservative.  The  10th of February  following, i
made two incisions: one contagious, on the left  side of the prepuce, with 
86
INOCULATION SERVICEABLE
a lancet dipped 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 dipped in the virus; I applied my preservative to
the two inoculated points.
   " I attended  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.
   " This double and threefold experiment has proved, that by means of
the preservative  the contagion did not develop itself in the inoculated
points; for the contagious incision, and the  part which was scraped till it
bled, would not have cicatrized in the same time as the simple incision, if
the infection had developed itself; thus the  object was attained.
   " Seventh Experiment, of a double  contagious inoculation, in two differ-
ent points, icith the design of protecting  the one by means of  the preserv-
ative  application, and permitting  the development 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 dipped  in  the  virus,  and I
made in the same manner, a contagious incision on  the right side; I ap-
plied  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 venereal ulcer.   The end  was attained and the result
recorded.
   " Eighth Experiment,  with  the determination of  preserving  myself.
March the 24th, I took a lancet  that had been dipped  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.   The end was attained, and the experiment recorded.
   " 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 before.  I then  applied my pre-
servative 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.
   " Tenth Experiment, contagious incision, with determination to preserve
myself  May the 19th, I 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.  The experiment succeeded, and was
recorded.
   " Eleventh Experiment, double incision, both contagious, on each side oj
tne prepuce, with a previous determination of protecting one side and per-
mitting the infection on the other.   June the 3d, I made  three slight and
contagious incisions, very near  each  other,  on the right  side of the pre- 
iN THE  THERAPIA--PROPHYLAXY.
87
puce, and three, also contagious, on the left. I applied the preservative on
the right and not on 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 ap-
plied the preservative, were  cicatrized ; but  the wounds on the left pre-
sented a well-marked chancre; a bubo also appeared :n 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, I presented myself 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 is 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, of balanitis, and of vaginitis, saliva, fecal mat-
ter, perspiration, semen.
   In  all these mixtures, the virulent  pus of chancre experienced
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 can-
not communicate 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 alkali, or a weak acid, the results of the
inoculation have  been negative, the chemical substances decom-
posing it, not because they have  peculiar specific virtues, as  some
have thought, but on account of  their property of destroying mat-
ter or organic products without distinction;  thus sulphuric, nitric,
hydrochloric, and acetic acid, and  the pure  chlorides, mixed with
virulent pus, have  constantly prevented it from acting by inocu-
lation    and whilst  the  oure  pus inoculated in the same subject 
88                  INOCULATION SERVICEABLE

produced  a pustule, the  pus altered  by one of  the  above-named
substances always  remained without  effect,  when  placed side by
side with  the former  and  in the same condition, except  the neu-
tralizing agent;  the same was the case with the  caustic alkalis,
potass, soda, volatile alkali, wine, and alcohol;  a concentrated de-
coction of oak bark produced the  same results.
  But if  these substances, from the  consequences they  produced
after inoculation, have been  considered  as prophylactics, it must
be remembered that  the results only followed when the mixture
was made before or at the time of the inoculation; for as soon as
the virulent virus has  been implanted in the tissues,  if we may be
allowed the  expression, and  these are infected,  even on the  first
clay, unless the  parts  are  destroyed by cauterization to  a greater
depth than those which have  been contaminated, the .neutraliza-
tion does  not take place, and the chancre is developed.   From
very exact experiments with inoculation, we find that the efficacy
of any of  the above-mentioned prophylactics cannot be  depended
upon except to destroy the virulent pus, soon  after it has been
placed on an entire surface, or momentarily to destroy a virulent
secretion   in  an individual who  might  otherwise  communicate
disease.
   Some persons have thought to prove the specific action of mer-
curials, by advancing, that, mixed with virulent  pus, they destroy
its contagious property ;*  now they only act  in two ways, either as
caustics or coagulants, as  corrosive sublimate does, either in pow-
der or in  solution,  and this is here only a chemical  action; or as
when mixed with fatty substances, which  then only  oppose them-
selves mechanically to the application of the virus,  and even this
does not  always take  place.
   A fact, perhaps  not without interest, will now be noticed.   M.
Malapert, in his Theorie du traitement du bubon par le VBsicatoire

  * Petit Radel, in his Traite des maladies syphilitiques, says, p. 17 : " The nature
of the syphilitic deleterious principle, so well known by its  effects on our system,
is far from being well understood.  Always united with a mucous or purulent
matter, which serves it as matter, all experiments which may be made  upon  it
are ineffectual. Experiments, however, have nevertheless served to establish
this; viz., that the deleterious principle, if triturated with an oxyde of mercury,
or any mercurial salt, loses its infecting property, although this is preserved, after
a long contact with the most powerful caustics."  This assertion  is abso?\itely
false. 
IN THE THERAPIA  OF SYPHILIS.
89
 et la solution de  sublime corrosif says, " that the mercurial pre-
 paration  used as a caustic had also another beneficial action, in
 neutralizing  the virus on the spot, and  thus transforming a viru-
 lent into  a simple or benignant bubo."   Experience shows, how-
 ever, that buboes which were treated in this manner, and accord-
 ing to the indications the author has himself given, and many of
 which had suppurated, have furnished an inoculable virulent pus,
 like that  of  the chancre which preceded them, and similar to the
 pus of virulent buboes, which wTere not treated in this manner.
 Mixed with fatty substances, the virulent pus undergoes no change
 and remains inoculable.
   Inoculation cannot be very useful in ascertaining the curative or
 anti-syphilitic effects of therapeutical agents.  We might certainly,
 if we wished, determine, during a general  or local treatment, 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,
 prove the neutralization of the virus by the effect of the medica-
 ment actually employed,  as  this  result may, in some  cases, be
 spontaneous.
   § 2. Inoculation has, however, been seriously employed as a
 therapeutical  agent, with the  view of modifying an obstinate or
 reputed incurable affection of old standing.
   I will here quote the observations of Percy, who seems to have
 been  the first who  attempted  syphilitic inoculation as a therapeu-
 tical 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:
   " A drummer of the regiment de Rouergue had in vain tried all
 remedies  at  Landau  and  Besangon for a syphilitic  complaint,
 whose symptoms were a bubo in the right groin, a deep  chancre at
the base of the glans, near the frenum, pains  in his limbs, and a sort
of universal icterus.   The desire of being cured rendered this man
 very docile and strict, during two courses of medicine, one of which
was unsuccessful, while the other  cicatrized the  chancre, without
affecting the jaundice or bubo, for which the patient used mercu-
    * Deguerre, Essais sur l'inoculation du virus syphilitique. Paris, 1804.
                              12 
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INOCULATION SERVICEABLE
rial pills and emollient plasters, till his  patience exhausted.  He
contracted a second syphilitic affection, which a fortnight after
exposure  declared itself by a  multitude  of warts on the penis, a
chancre on the prepuce,  and the renewal  of the*  old one;  this
bubo  swelled, and the pains were increased  in all his limbs; the
jaundice alone appeared not to feel the effects of it.  In this state he
returned to the hospital  of  St.  Louis, at Besangon, where he
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 preliminary treat-
ment, he received eighteen  frictions of two drachms each;  he  was
salivated at the fifth; but the salivation having suspended the fric-
tions  but  for  a short  time, the  above number wTas completed in
about six  weeks.   He  discontinued  the  treatment, deriving from
them no benefit, except the cicatrization  of  the two chancres of
the penis; that  of the throat still existed, and the  excrescences,
which had been cut and cauterized, soon reappeared; besides this,
he had a kind of aphonia, attended with  a constant buzzing in the
ears.  One of his  relations placed him under the hands of an old
surgeon-major of artillery, who subjected him to a new treatment,
which was as  ineffectual as the first.  This  surgeon  cut away the
excrescences, which soon returned again ; the throat remained the
same; the buzzing in  the ears and loss of voice persisted.  This
patient was not cured, 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  chancres, produced
a third,  as well as  a  bubo  in  the  right  groin, and ulcerated  the
fauces very  extensively.   The cure  of this recent  disease was
confided to M. Percy, sen.; the patient,  after being  properly pre-
pared, received sixteen frictions;  there was  no appearance of
salivation ;  the bubo dispersed itself; the excrescences fell off of
themselves;  the patient regained his health, which has hitherto
remained good. 
IN THE THERAPIA OF SYPHILIS,               91
  " 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, had come there with the consent of M.
Percy, sen., to be cured of a disease 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  affection of the perinseum, 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 medi-
cine  and taken an immense number  of drugs for this complaint.
After some preliminary preparation, and  having in vain tried the
tisane de Felz, M. Percy inoculated the  venereal virus upon this
patient, in  the presence of many medical men; after diluting the
chancrous 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 in-
strument, 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  a  sudorific tisane.
Five days passed, and nothing appeared; on the sixth, about  noon,
the patient felt 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 horripilations; during the night, he had  head-
ache, 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 ax-
illary glands  swelled;  the throat was burning, the patient feverish
all the day, and in  the evening about nine o'clock he complained
tha': 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 suppurating wound;
the cutaneous affection and the chancres had increased but little.
The ninth and tenth, things  seemed to be  in the same state; the 
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INOCULATION SERVICEABLE
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 better;  the pains caused by
the cutaneous affection and chancre had subsided.  On the  eigh-
teenth, nearly all the symptoms had disappeared ; 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, left the care of the treatment to his
father, who began  the preparations a  month and a half after  the
inoculation;  he gave  him sixteen frictions.  This treatment was
perfectly successful."
   Admitting that M. Percy had reason to be satisfied with his ex-
periments,  and  that patients,  under treatment  for  some recent
affection, sometimes  recover  from obstinate symptoms of longer
standing, these  results  are not  sufficiently regular 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 results cannot be
exactly foreseen, at least in the present  state of science, cannot be
regarded as a rational method.
   Inoculation of a new blenorrhcea  has been  advised, and is still
perpetrated by many practitioners, either to cure a  chronic dis-
charge, or  to  combat  by revulsion, symptoms which blenorrhcea
may produce, such as epididymitis, ophthalmia, arthritis, &c.
   Some  in this case  advise  another  impure  coition; others, as
Hirscheld, Berton, Swediaur, Tarbes, Toulouse, Perrolle, and Lar-
rey, make a kind of inoculation with the muco-pus of blenorrhcea,
carried on a probe into the urethra, or applied to the mucous mem-
brane it is  wished to infect, by means of a bit of lint, which is  im-
pregnated with it.    The matter of blenorrhcea can never be inocu-
lated 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 cer-
tain that the muco-pus of blenorrhcea  is contagious, and may be
considered as the most effectual agent of a disease similar to that
which produces it, most  frequently the  result obtained is owing to 
IN THE THERAPIA  OF SYPHILIS.
93
the mechanical action alone of the instruments employed, as Brom-
field and the late Cullerier insisted.
   However, were I not convinced that the cases in which it is use-
ful to recall an old discharge, or develop 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 it a  new
complication, I would not apply the muco-pus of a blenorrhcea of
one individual to another, before  having ascertained upon  the one
from whom it is to be taken, that it  produces nothing when inocu-
lated with  the lancet;  otherwise, without  this precaution, a patient,
with blenorrhoeal symptoms, might,  being affected with concealed
chancres,  (chancres larves,)  communicate to  an  individual, who
till then had only a simple  catarrhal affection,  all the formidable
consequences of syphilis.
   § 3.  Inoculation has  not only been  tried to cure venereal and
syphilitic diseases, either as a prophylactic, or in the curative treat-
ment of primary or secondary  symptoms, but  has been by some
applied  to the treatment of  other diseases, which, although often
incurable when uncomplicated, seemed, when combined with syphi-
lis, 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 which have resisted the ordinary thera-
peutical agents, has not diligently sought in these cases to find some
syphilitic element, and thus obtain a pretext for a specific  medica-
tion, wjaich is so  frequently crowned with success 1  But if these
cases are so frequent and of daily occurrence, are there not some
circumstances in which diseases,  quite independent of syphilis, and
which had yielded to no treatment,  have  yet, after a syphilitic in-
fection, undergone a modification, by which  they  became  accessi-
ble to the  anti-syphilitics, and  have  been cured  and  disappeared
with the venereal symptoms which  had supervened 1  I have fre-
quently shown at my clinic, severe  cutaneous affections  of an old
standing, and  till then incurable, which have had, under these cir-
cumstances, these happy results.
   After similar observations, Dr. Martini, of Vienna, had commenced
some very  interesting researches on this head, when a serious ill-
ness interrupted his labors.
   If the medical use of the venereal virus might, like so many other 
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INOCULATION SERVICEABLE
poisons from which benefit is derived, be allowed in therapeutics,
it could only be with extreme caution, and after accurate observa-
tions ;  for  it  must not  be forgotten, that  the consequences of a
syphilitic affection cannot be  foreseen, and that generally syphilis
is serious, in proportion to the antecedent or concomitant  disease
with which the patient, who contracts it, may have been affected.
  § 4.  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
chancre, or truly primary syphilis, could be cured only by mercury,
and that it was hurtful in contrary cases, as Hunter and his follow-
ers 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 service.  But, as  daily observation shows, the primary
symptoms often heal of themselves, with proper attention to clean-
liness, or with different kinds of local  applications, without all being
supposed to possess specific virtues.
  It is however  proved, that all primary symptoms, (chancres,)
capable of being inoculated, do not produce general infection; and
that in cases where secondary symptoms would appear, the mercu-
rial treatment, for instance, employed during the existence  of pri-
mary symptoms, is  so far from  preventing them in all cases, and
invariably, that some superficial  observers of the  physiological
school assert, that the pretended secondary symptoms of syphilis
resulted entirely from the use  of mercurials; although these, if con-
tinued or employed after their use has been suspended, are the best
remedy for the symptoms, which were  ascribed to their use; that
in these cases where their development was not prevented,  it was
because these remedies were not  properly employed;  and that most
of the  characteristic secondary symptoms of syphilis appeared un-
der favorable circumstances, far  more frequently in patients whose
primary symptoms have not been treated with mercury.
   To sum up, for those physicians who  are convinced that syphilis
cannot be radically cured, unless the primary symptoms have been
treated with mercury; and those who, on the other hand, without
entering into all the exaggerations of the antagonists of mercury,
yet are convinced that this medicament ought not to be uselessly 
IN THE THERAPIA  OF SYPHILIS.
95
employed, inoculation is  incontestably the only  unexceptionable
touchstone, whenever it may not be too late to employ it.  If one
day the definite value of mercury should be  better understood, or
if an absolute specific for syphilis should be discovered, its  value
must be proved, or its employment indicated, by inoculation.
  If, at the present time, inoculation does not settle the indications
of treatment, with those persons who are wavering in their treat-
ment, it is of great value as regards  the prognosis  of the future
chances of the patient, for every individual who has had inoculu'ole
symptoms remains positively susceptible of general infection, and
liable afterwards 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 apologizes for the indecency of his
subject, as if a medical man could be reproached for soothing suf-
fering humanity !  As well  might it have been said to Mascagni,
that there were indecent things in anatomy.   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.
   Whoever sees men as they are, in the office of the practitioner,
and without that disguise of morality which society requires, must
admit that there are  circumstances in which sexual intercourse be-
comes 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 cir-
cumstances 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 pa-
tients, upon ill-founded convictions, we should take care not to
affirm that such and  such symptom, which has been  found conta-
gious, 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 the pus of which cannot be in-
oculated, and who is not actually under the influence of an abun-
dant  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 legal medicine, which refer 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 consequences of syphilitic 
       INOCULATION  SERVICEABLE IN  FORENSIC MEDICINE, ETC    97

infection are often  brought forward as a proof.  Almost every
practitioner in the present state of science, on seeing a man affect-
ed with gonorrhoea, accused of having violated a woman  actually
infected with chancre, would have regarded this pretended coinci-
dence as a proof of great  value ?   But when it is incontestably
shown, that chancre alone  can produce chancre, if the blenorrhoeal
muco-pus of the individual, who is supposed 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 con-
victed 1  And again, would it not  be  proved, by the same  way,
viz., by experiment, that individuals accused of having communi-
cated syphilis, which must  aggravate the position  of all persons
thus accused, have only caused by mechanical  violence, or by the
action of some morbid or normal secretion, simple inflammations 1
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 conscien-
tious physician would have remained in doubt, which, although pru-
dent, is not expected in a man of science 1
  Such results, whose whole force cannot yet be seen, would alone
suffice to justify my numerous researches,  had they not already
served greatly to elucidate  questions which had hitherto remained
insoluble, and to overthrow a host of prejudices, sanctioned by time
and powerful  authorities.
                               13 
 
PART   THE  SECOND.
CLINICAL AND EXPERIMENTAL RESEARCHES.
                          CHAPTER I.

                 PRACTICAL OBSERVATIONS

                            Section I.

INOCULATION OF THE PUS  OF CHANCRE, SIMPLE AND COMPLICATED
               IN ITS VARIOUS FORMS  AND  PERIODS.

  Case I. Regular chancre, with symptomatic bubo, and suppurated lym-
phatic, 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 deter-
mined ; but twenty days previous, a bubo had appeared on the right side,
and at the same time the course of a lymphatic vessel on the dorsum penis,
running towards the tumor of the groin, was  marked by redness and a
hardened point about the middle of the dorsal surface  of the organ.  Ten
days since, having uncovered the glans, the patient not being able to re-
place the prepuce, a paraphimosis 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, inocu-
lating the division of the skin, caused by pressure of the band of the para-
phimosis : the reversed mucous membrane of the  prepuce formed a hard
sac, upon which were some ulcerated points.  The little lymphatic tumor
had suppurated and opened spontaneously the previous day;  the bubo had
suppurated at the summit.  Aug. 3d. The pus taken from the band of the
paraphimosis, was inoculated with a single  puncture on the right thigh.
The ulceration having destroyed the band of the paraphimosis,  some lint
merely was applied, dipped 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 3d  had  produced the characteristic pustule.
The 8th. The pustule was cauterized; and the  pus of the ulcer resulting
from the spontaneous opening of the lymphitis  on the dorsum penis was
• See Formulary. 
 100         CLINICAL AND  EXPERIMENTAL RESEARCHES---
                                                                   »
 inoculated;  the bubo was opened and furnished much pus.  The 9th. The
 pus of the bubo was inoculated on the left thigh.  The 12th. The inocu-
 lations made on the 8th and 9th had succeeded 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. mercur. 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 granu-
 lations; the engorgement of the  base had decreased.  On the left thigh,
 the pustules resisted  the cauterization: they were dressed with the aro-
 matic wine.  Sept. 10th. The chancre on the prepuce was almost  healed.
 The same dressing of aromatic wine was used, with an addition of tannin.
 20th. The chancre of the frenum was  cicatrized; the inoculations on the
 thigh were in a fair way to heal.
   30th. The thigh was healed, and the bubo covered  with fleshy granula-
 tions ;  it was slightly cauterized to make it cicatrize.  Oct. 3d. All being
 well, the patient was dismissed.

   Case II.  Primary chancre and  blenorrhoza ; inoculation  successful  in
 the first case, unsuccessful in  the second.  Jean Bart----,  aged 17, re-
 ceived May  23, 1836.   Five weeks previous, the patient having torn the
 frenum during coition, the wound  became  chancrous; two days later, a
 blenorrhoea appeared ; it seemed, however, that here were two  infections,
 for the patient had connexion with a woman eight days previous to the
 appearance  of the blenorrhoea.  He had been treated for these two affec-
 tions by an apothecary.
   May 29th. The pus of the blenorrhoea 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 blenorrhosa; the
chancre was dressed with aromatic wine, and cauterized with nitrate of sil-
ver. June 1st. The puncture made with the pus of the chancre had pro-
duced the characteristic pustule; the pus of the blenorrhoea 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 blenorrhoza ;  the inoculation of the  chancre suc-
cessful, that  of blenorrhoea unsuccessful.   Cour----Claude, aged  26,  en-
tered June 19, 1835.  In this patient the blenorrhoea appeared three days
after a suspicious connexion; two days later, chancres were seen at the
 base of the glans.  The blenorrhoea was very painful, and the discharge
 very copious at the commencement. Now, the matter flowing from the
 urethra was still bloody; but  the  patient did not  suffer  in urinating; the
 chancres were  still at the period  of ulceration;  the  chancrous pus was
inoculated on the right thigh, and  that of the gonorrhoea on the left. 
       PRACTICAL OBSERVATIONS—INOCULATION OF  CHANCRE.     101

  June 2d.  The puncture on the right thigh had produced the character-
istic 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 blenorrhoea was  treated with injec-
tions of acetate of lead and copaiva; the chancres by cauterization 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 successful.  Gou----, aged
34,  entered August 12, 1836.  This patient had contracted chancres on the
glans about four weeks ago.  About a fortnight since, the forefinger of the
right hand was torn in three or four places by accidentally being under a
cask of wine.   During the first days, the wound presented a good appear-
ance; 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 be-
come dark  and grayish, and lymphatic engorgements develop themselves
in the axilla and plica brachii.
  We found the chancres of the penis almost healed; the lymphatic en-
gorgements hard and of considerable volume, but not painful when touch-
ed; the pus from the surface  of the wound of the finger was inoculated;
the  chancres  were dressed with aromatic  wine, and cauterized with ni-
trate of silver.
  August 21st.  The puncture with the pus of the ringer had  produced the
characteristic pustule; the bubo did not seem to progress  towards  sup-
puration ;  they were dressed with  ung. hydrarg. and cataplasms.   Sept.
6th. All was  healed except the ulceration on the thigh, which had been
allowed to take its course, but  it was in a fair way towards reparation.
Sept. 10th. The patient was dismissed cured.

  Case V.  Encysted chancre, commencing with an abscess of the scrotum,
inoculation successful.   Boucl----, aged 60,  received April  25, 1835.  A
few days after an impure connexion, the  patient perceived  two chancrei
on the skin of the penis.  Now the surface of the chancres presents some
points  of  healing, each of them being about the size of a shilling;  neat
the  middle of the scrotum, about an inch from the penis, there were two
hard kernels in the substance of the skin, with induration of the surround-
ing  parts;  the larger appeared suppurated in  its centre; it was opened,
and the thin,  bloody pus inoculated on the right thigh; the ulcers were
dressed  with  cerate  of calomel  and opium.   The 27th.  The puncture
made with the pus of the encysted chancre of the scrotum had produced
the  characteristic pustule; it was allowed to  develop itself.   The second
chancre was  opened; the ulcers were cauterized, and  dressed with the
cerate of calomel and  opium.
  June 2d.  The chancre on the thigh was dressed with aromatic wine;
those on the penis were healed, and those on  the scrotum were granulat- 
102         CLINICAL AND EXPERIMENTAL RESEARCHES---
                                                                  m
ing; and the patient was dismissed cured on the 20th.  These chancres,
which commence by an abscess, whose parietes become indurated, so as
to form  an actual cone before they are opened, in all respects deserve the
expressive name of encysted chancres.

   Case  VI. Chancres and acute blenorrhoea, contracted in a single coition
inoculation successful with the pus  of the chancre,  and unsuccessful with
that of the blenorrhoea.   Cor----Edward, aged 21,  entered June 20, 1835.
His disease commenced six weeks previous.  The day after the connexion,
chancres appeared on the frenum and prepuce; two days later, an acute
blenorrhoea showed 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  taken 60 mercurial pills, from
another hospital.   The chancres were still on the period of increase, the
blenorrhoea afforded a greenish and bloody matter; the chancre was inocu-
lated with two punctures on the right thigh, and the  blenorrhoeal 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 made with the pus of the chancre had produced the char-
acteristic pustule; the upper was cauterized, and  the other  allowed to
develop itself; the punctures made  with the pus of the blenorrhoea had
produced nothing; the same treatment  was continued; the blenorrhoeal
pus was again inoculated.  28th. The inoculation of the blenorrhoeal pus,
made on the 24th,  had produced nothing; the chancres were in the stage
of reparation; the gonorrhoea discharged a little whitish matter; the inocu-
lated 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 blenorrhoea  had disappeared under the treatment with injec-
tions and copaiva with magnesia in  the form of  bolus ; the chancres were
cicatrized ;  and on the 18th, the patient Avas  dismissed cured.

   Case  VII.  Superficial and follicular chancres, producing the character-
istic pustule by inoculation.   Bour----, aged  20, entered August 25, 1836.
The commencement of the disease dated from about twenty-four days since:
ifter a difficult sexual connexion, 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 ulcer-
ations, which are  called  superficial chancres.   He has hitherto had no
treatment.
   In consequence of the irritation,  there was a  phimosisj which allowed
the diseased organ to be 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.
Inoculation was  practised with the pus  from a superficial  ulcer, which
had scarce destroyed the thickness of the mucous membrane of the glans 
        PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE.    103

  n the left thigh, the pus from a follicular chancre, whose orifice was
scarcely as large  as  a pin's head, was inoculated.   There was  no lym-
phitis ; but there was an engorged ganglion on the left  side, which was
moveable and indolent.
  This patient had  never  received any medical advice; he was treated
after  M.  Serres'  plan, with  iodide of silver, a twelfth of a grain daily;
an emulsion of gum arabic as diet  drink.  The chancres were washed
and dressed with a decoction of mallows.
  Sept. 1st. The inoculations having produced the characteristic pustule
on both  thighs, they were cauterized 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 aromatic wine, and the fleshy
granulations were  cauterized; six doses of a twelfth of a grain  of iodide
of silver were given, but without any therapeutical action.   Till the 1st
of October, the dose of the iodide was gradually increased, but the patient
felt no effect; the disease was neither better nor worse than if left entirely
to itself.   The dose was now four grains of the iodide  of silver per diem.
  It was determined to suspend a medicine which produced no result, the
ulcerated surface was cauterized, and then lint dipped in aromatic wine was
applied.  The 4th. The superficial ulcers of the glans were almost dry,
the base of the ulcerated follicles was raised and projected like granu-
lations at their commencement;  they were cauterized and  dressed with
the wine.  The 6th.  All was nearly well, only one or two points remain-
ing uncicatrized on the margin of the  prepuce; and the patient  was dis-
missed cured on the 10th.

  Case VIII. Regular chancre ; inoculation successful.  Jos----Emilie,
aged 24,  entered  May 27th, 1834.   The disease apparently commenced
about eight days previous.  On the internal surface of the external labia
and the  entrance of the vulva, some little pimples appeared four days
after a suspicious connexion, and soon,  as by regular inoculation,  chancres
formed ;  there was neither pain in urinating nor vaginal discharge.   The
ulcerations were in the period of increase.
  On the 28th, pus taken from the  surface of a chancre of the external labia,
was inoculated on the right thigh, and that taken from  the  vulva on  the
left.   It was observed that the induration on the external  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 inocu-
lated  points were cauterized with nitrate of silver.  The ulcerations of the
vulva remained in the stage of increase and were very painful; they were
touched with a brush dipped  in creosote.  Half an hour after the appli
cation, the patient had acute darting pains; but by the following day they
""'  npariv subsided.  The 18th.  The ulcerations were touched  p^u  •'—
I 
104         CLINICAL AND  EXPERIMENTAL  RESEARCHES---

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 22d. Pills  of hydrarg. iodid. were  ordered  as a resolutive.  There
only remained brownish spots instead  of  the chancre from  inoculation.
At  the anus  there was some degree of irritation, and a rhagas; it was
dressed with  lint dipped in liq. sodae chlorid., and sprinkled with calomel.
July 10th. All the ulcerations had disappeared, the  still existing indura-
tion was  much  diminished, and  on the  22d, the  patient  was  dismissed
quite cured.

  Case IX.   Chancre of the cervix uteri, vaginal blenorrhcea; inoculation
successful.
  Haul---- Catherine, aged  23, entered April 8, 1834.  This patient had
Deen cured of one infection seven months since, and  having again exposed
herself, contracted  chancre and a blenorrhoea, of a person affected  with
only a chancre.   She had received no treatment.  It ought to be remarked,
that this  patient had long  been,affected with a chronic  discharge, which
gave a blenorrhoea to each of her new  lovers; then, if after being cured
they continued  their relations with her, by a sort of acclimation, they re-
sisted the contagion.
  On  entering  the  hospital, she had a  chancre  on the left labium, and
another on the corresponding nympha.   When examined with the specu-
lum vaginae, we found puriform vaginal secretion, uterine  catarrh, ulcera-
tion of the anterior lip of  the cervix, with a grayish base, irregular and
raised edges.
  Till  the 10th, emollient injections were  made, and the chancre  was
dressed with  opium cerate.  The 18th.   The acute stage had disappeared,
the matter of the discharge was whitish and less abundant; the appearance
of the ulceration of the cervix was  the same; some pus  taken from its
surface was inoculated on the right  thigh, and then some muco-pus was
collected at the base of the  cervix, in the peri-uterine cul-de-sac, and by
means of a puncture inoculated 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,
ooth on  the  right  and left thigh, and the pustule on the  22d was  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 grayish
base.   They  were  cauterized and dressed with ung. calom. c. opii.   The
chancre on the  nympha had disappeared, under the influence of the cau-
terization ; that of the labium  was healing. 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
* See Note to Formulary, at the end of the work. 
       PRACTICAL OBSERVATIONS—INOCULATION OF  CHANCRE     105

which remained, presented  a granulated surface, which was inclined  to
cicatri je.  The 10th. The chancre of the anterior  labium had  healed.
The spots inoculated presented granulations; the base of the ulcers had
become indurated.  The 20th. The induration around the different chancres
had increased.  The wound of the cervix was healed; the blenorrhoea had
disappeared.  Pills of hydrarg.  iodid.  were ordered, and sudorific  sirup
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 remained.
The patient, who had been affected with symptoms of pulmonary catarrh,
is now very well.

  Case X.   Chancre and symptomatic bubo inoculated successfully.
  Bou----, aged 21,  entered March 7, 1833.   The complaint was of five
months standing; at  that time a chancre had appeared upon the  skin  ot.
the prepuce; a few days afterward a bubo was seen on the right side; the
progress of the ulcer, which had at first been regular, assumed the phage-
denic character; a large portion of the prepuce was destroyed, and a third
of the thickness of the  glans itself eaten away;  the  bubo quickly sup-
purated, and  opened  spontaneously.  A course  of bichloride of mercur;
was administered, in  the form of pills; the patient was salivated, and the 3
gargles were employed.   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 presented a loss
of substance down to the urethra; there  was also much general irritation.
The characteristic signs of the period of  increase were everywhere visible.
Dressings with  a concentrated  decoction of opium  were  applied, and
general anti-phlogistics prescribed.  By  the 18th, the  inflammatory state
seemed to have yielded to the treatment; dressings of calomel cerate were
then applied.  On the 21st, the chancre of the groin was better; its ground
was becominjr clean ; some healthy granulations appeared on the penis.
  April 1st.  The chancre of the glans was cauterized with nitrate of silver,
and the dressings with calomel cerate were continued.  10th. The circum-
ference of the ulcer  of the groin was diminished; yet in the centre, the
characters of the ulcerative period were  perceived.  21st. Some pus 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  commencemenr of an  irruption being perceived upon the skin,
the pills of hydrarg. iodid. were  prescribed, with  sudorific sirup 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
                                      14 
106        CLINICAL AND EXPERIMENTAL RESEARCHES---

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 inel.
lodat., cerat. plumb.,  wine, cerat. belladon., decoct, opii  concentr., solution
of sublimate, cauterization with arg. nitr.  and hydrarg. nitr., applied  alter-
nately, 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 appeared as if dissected cir-
cularly.
  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 toward the frenum, the remaining portion of the prepuce
was covered with granulations; but on the superior, the chancre continued
to destroy the corpora cavernosa.  Aug. 20th. The cicatrization had  retro-
graded.  The 30th. Pus was taken from  the surface of the corpora caver-
nosa, and inoculated an inch 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 reparation showed themselves in several point3
of the surface  of  the chancre.  The chancre of the thigh, resulting from
the inoculation on the 30th of August, was dressed 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 frenum.  It resembled an interstitial
gangrene.  Nov. 1st.  The ulcer, which had for some days seemed stationary,
appeared better.   27th. All is nearly well;  on the corpora cavernosa,
there was a cicatrix 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
  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  arabic
sweetened  with sirup, symp.   The patient was  of a sanguine  and
irritable temperament; during  all the time of his being in the hospital,
he  appeared very melancholy; being continually hungry, he often procured
food for himself besides his regular rations.

   Case XL  Phagedenic chancre, partly  gangrenous; inoculation  suc-
 cessful from the ulcer in a progressive  stage, but unsuccessful from the pus
 af the gangrenous part. 
        PRACTICAL OBSERVATIONS'---INOCULATION OF  CHANCRE.    107

  Pers----, aged 40, entered April 13, 1834.   The disease commenced
two months and a half previous;  in consequence of an  erosion of the pre-
puce during coition, a chancre appeared : its course was at first regular,
but, after repeated excesses, and an attempt at cauterization with a lighted
cigar, the ulcer assumed an acute inflammatory and phagedaenic form.
  Now nearly the whole surface of the prepuce was affected, but two
portions appeared distinctly separated; all the parts touching the sack at
the base of the glans presented a gangrenous ring; the remainder presented
the characters of a phagedaenic chancre, properly so called; all was in the
progressive stage.
  The 14th. Some pus, taken from the ring at the base  of the prepuce,
was inoculated on the right thigh; an application of a concentrated decoc-
tion of opium was ordered.  The  18th. The  inoculated puncture had pro-
duced nothing; the gangrene seemed checked.   Some pus was taken from
the surface of the prepuce, toward the margin, beyond the limits of the
gangrene, and inoculated on the left thigh.  Dressings  of calomel  cerate
were ordered,  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 punc-
ture had produced the characteristic pustule.   The 26th. The progress of
the  inoculation, hitherto regular, appeared  to  assume the  phagedaenic
form; it was deep-seated, and rapidly destroyed the tissues. Dressings oi
calomel and opium ointment were used, and cauterization with arg. nitr
The 30th. There was an improvement, the liquid  chloride of  soda was
used as a wash, and calomel was sprinkled upon the part.   May 9th. The
penis was nearly well; the inoculated chancre was in a fair way of re-
paration.

  Case XII.   Chancre and blenorrhoea ; inoculation successful in the first
case, and unsuccessful in the second.
  Cha----,  aged 20, entered August 9, 1836.   This patient, affected with
blenorrhoea,  which at the commencement was very painful,  and  with
chancres at the lower part of the base of the glans, entered 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  blenorrhoeal discharge, and  a  balanitis; the
chancres of the corona glandis presented several points in a state of repara-
tion.
  The pus of the blenorrhcea was inoculated on the right thigh, and the
pus taken from a point on  the base of the glans, still presenting the cha-
racters 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 blenorrhcea had  produced  nothing. Emulsion of co-
paiva, and injections of nitrate of silver, were prescribed, and the chancres 
108         CLINICAL AND  EXPERIMENTAL  RESEARCHES—
ordered to be dressed with vin. arom.   The patient was dismissed cured,
Sept. 7th.

  Case XIII.  Chancre and blenorrhoza ; the pus of the inoculated chancre
successful; the pus of the blenorrhoea unsuccessful.
  Depl----, aged 22, entered April 29, 1836.   After a balanitis, for which
the patient received no treatment, some vegetations developed themselves
on the glans; they were  cut, and three days afterwards, after a coition,
chancres appeared on the spots where  the vegetations had  been.   At the
same time a blenorrhcea, which occasioned 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 blenorrhcea on the left.
  The 4th. The puncture on the right thigh was  red and slightly vesi-
cular ;  that on the left was  entirely cicatrized.  Dressings  with aromatic
wine were used, and the chancres were cauterized.   For the blenorrhcea,
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 on the 6th,
and the patient was dismissed cured on the 16th of May.

  Case XTV.   Chancre of the prepuce, with concealed chancre, (larve,) and
abscess of the canal;  inoculation successful in  all cases.
  Bel----, aged  19,  entered July 18, 1836.  This patient, who had been
affected for four years with a blenorrhcea, which he several times renewed,
and brought back to the acute stage, by impure connexion, had contracted
several chancres  on  the  prepuce, three weeks  since.   The blenorrhcea,
which  only furnished a serous pus, had  increased and occasioned acute
pains.  At the time of his entering, the canal presented several indurated
points  in its extent, principally toward the fossa navicularis.  The chancres
of the prepuce were in the stage of increase.
  July 20th.  The pus of the blenorrhoea was  inoculated  on  the right
thigh.  22d.  The puncture was red, but its progress was slow.  23d.  The
pus of  the blenorrhoea 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 the  blenorrhoea,
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 fluctuation was perceived.
  The  27th.  The  punctures  made with the  pus of the chancres  of the
prepuce,  and the second time Avith the pus of the blenorrhcea, had  pro-
duced-the characteristic  pustules, which were then cauterized with the
nitrate of silver.   The tumor on th* «;de of the canal was  about the size
i 
        PRACTICAL OBSERVATIONS---INOCULATION OF CHANCRE.    109

 of a nut; the skin had become thin; being opened,  a pus flowed from it
 similar to that of the blenorrhoea. The cavity presented 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  progressed outward 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 nitrate  of  silver; the chancre on the penis
 was almost healed; but the canal was  indurated to the posterior part of
 the penis.  The injections 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. 3d.  The pustules resulting from the inoculation of the  pus of the
 abscess of the canal were cauterized ; the induration was much diminish-
 ed.  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 dis-
 missed cured.

   Case XV  Concealed chancre,  (larve,) with  symptomatic bubo; inocu-
 lation successful in each case.
   Dum----,  aged 26, entered Nov. 11, 1835.   Could not fix  accurately
 the time of the commencement of his complaint.  He stated that he had
 six weeks previous felt a slight  pain  at the meatus urinarius. 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  navicularis.  Upon separating the edo-es
 of the  aperture, no ulceration was perceived;  upon pressure,  a little pus
 came;  the canal of the urethra appeared  sound  beyond the above men-
 tioned point.  The patient never, at any time,  perceived a blenorrhoeal
 discharge.  The only pains he  felt were at  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. 23d.  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 applied to  the groin.
28th.  The inoculated  punctures have taken and produced the pustules;
they were allowed to take their course.  Near the frenum, a small hard-
ened tumor was perceived.  The same dressings were continued. 
110         CLINICAL AND EXPERIMENTAL RESEARCHEI
  Dec. 1st. The chancres of the thighs, from the  inoculation of the pus
from the urethra and from the bubo, were cauterized with nitrate of sil-
ver, 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 inoculated, by a puncture, on the  right
thigh.   17th. The inoculated  puncture, made with the pus  of the chan-
crous 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.  Alto-
gether 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,  ivith an ulcer  of the canal; inocv-
lation producing the characteristic pustule.
  Fouc----, aged  19, entered July  19, 1836.  The disease apparently
commenced eight days before  he entered  the hospital;  the  chancre was
situated at the root 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 tumor, though small, was painful, and the skin very red.
The blenorrhcea,  which had only appeared eight days previous,  afforded
but little pus;  the patient refers the pain, which he felt during the emis-
sion of his urine, to the end of the penis.
  20th. 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 blen-
orrhoeal pus was  inoculated,  by a puncture, on the right thigh.   The de-
velopment of  the  bubo  appeared  arrested;  emollient cataplasms  were
ordered.  The chancre was cauterized, and dressed with  the vin. aromat.
The nitrate of silver  was introduced into the urethra, to cauterize the ul-
cerations of the meatus.  27th. The pustule of the inoculation was pointed
and seemed to succeed.  28th. The pustule, from  the inoculation,  being
formed, was destroyed  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
granulations appeared on several points.   Aug. 6th. The chancre on the
glans was healed; scarce any thing flowed  from the urethra; cauteriza-
tion with nitrate of silver was prescribed.   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. 
        PRACTICAL  OBSERVATIONS---INOCULATION  OF CHANCRE.    Ill

  Case XVII.  Blenorrhoza, urethral chancre, and inoculation with positive
results.
  Pri----,  aged 20, entered Oct. 28,  1836.   This patient was affected
with blenorrhoea  for six weeks, which, after being acute for some days,
soon became chronic;  since  that time, having again had  sexual inter-
course, he  perceived a  chancre about a fortnight  previous to his entry,
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, except at
the meatus, where  it was  easy to detect the characters of the chancre
with an indurated base.   Upon separating the lips of the orifice, a small
ulcer was perceived, presenting the characters of the period of increase.
   29th. The pus collected  at the meatus, mixed with the secretion of the
chancre and gonorrhceal 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
dipped in vin. arom. was inserted.   31st. The inoculation had succeeded
and produced the characteristic pustule, which was large, and  distended
with pus; it was  opened  and cauterized with nitrate of  silver.   The
whole surface of the  urethra was cauterized with  Lallemand's caustic
holder; for the chancre the  same dressings were continued.  Nov. 6th.  The
chancre was almost cured; the  induration of its base  was diminished;
there was but little discharge from the blenorrhoea;  the parts were again
cauterized.  11th. 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 ; mocu
lation producing the characteristic pustule.
   And----, aged 29, entered  April 26, 1836.  The patient could not ex-
actly tell when his disease commenced; for  a  long  time, at short inter-
vals, 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 re-
lations  till within the last fortnight; about that time, he felt  a tickling
sensation at the meatus urinarius, 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.
   On examination,  the chancre on the.  frenum was  found partly at the
period of reparation; the  bubo had  suppurated;  its  seat  was in the
superficial ganglions; the  tumor was conical and fluctuating to its base.
On opening the lips of  the meatus urinarius, the mucous membrane ap-
peared  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  a good deal of  thin and  bloody pus 
112         CLINICAL AND  EXPERIMENTAL  RESEARCHES*--
was discharged.   The pus  from the urethra was inoculated  on the .efi
thigh, and that taken from a point of the surface of the chancre, which
still appeared stationary, on the right thigh.
  29th.  The inoculated punctures had produced the characteristic pustule
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 th^ meatus,  was allowed to take its course.
  The chancre and bubo, whose ulcerated opening showed its chancrous
nature, were dressed after cauterization, with aromatic wine ;  the indura-
tion of the canal had increased, as well as that at the base of the chancre;
the sirup, acid, hydrocyan. with sirup, gentian, in an infusion of hops, were
ordered, on account of the lymphatic temperament of the patient.
  June 3d. Upon separating the lips of the meatus urinarius,  the mucous
membrane was found  ulcerated ; the nitrate of silver was introduced into
the urethra, and then injections  of  aromatic wine were prescribed.  The
pustule from  inoculation on the left  thigh had produced a chancre, 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 sur-
face of  the bubo  became covered with granulations.  The cauterization
and the dressings with aromatic wine were continued.  The patient was
dismissed quite cured on the 25th.

  Case XIX. Chancre, concealed chancre,  and inoculation producing tht
characteristic pustule.
  Bal——, aged 20, entered January 3, 1837. This  patient contracted a
chancre of the frenum, in consequence of a rupture of it during coition, a
month previous to his entry; eight  days later, a blenorrhoea 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.  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.  6th. The inoculation had succeeded and the pustule was formed
an inch and a half in the interior of  the canal an indurated point was per'
ceived.   The interior of the canal was cauterized, and injections of the
wine with tannin ordered.   12th.  The chancre of the frenum was healing;
its course had been regular  since the cauterization of the urethra; the in-
duration 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  urethra, had progressed, notwithstanding a cauteriza-
tion on the 10th; but on the 13th, the#haracter of the ulcer was no longer
chancrous; there  remained a deep wound from the cauterization, whic^
was dressed with vin. arom.  24th. The chancre of the frenum had healeo 
       PRACTICAL OBSERVATIONS—INOCULATION  OF CHANCRE.    113

without leaving any induration,  with the application of the  nitrate  of
silver and dressings with the wine ;  the urethral discharge had nearly dis-
appeared.  30th.  Nothing remained, not a single  drop of the  discharge,
and on the 6th of February the patient was dismissed cured.

  Case XX. Blenorrhoza, concealed chancre ;  inoculation successful during
the period of ulceration, and unsuccessful during that of reparation.
  Br____, aged 19, entered March 9, 1833.   Three days after a suspicious
connexion, this patient perceived a discharge of some drops of pus from the
urethra; the secretion gradually  increased;  he had acute pain on urinat-
ing,  irritation of the  glans and phimosis, which however permitted two
thirds of the organ to be exposed, when a slight redness was perceived on
it, but no excoriations.  March 11th. The pus of  the gonorrhoea was  in-
oculated upon the right thigh by  three punctures.   The pil. opii. c. camph.
were ordered, and emollient lotions.  15th. The inoculations had produced
the pustule; but it was not much developed.  The blenorrhoeal pus was
again inoculated on  the left thigh.  17th. The pustules, both right and
left, had assumed the pathognomonic 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 navicularis, an induration was perceived, indicating the seat of a
 chancre; the  treatment  was continued.   22d.  The appearance of two
 buboes was perceived, and leeches were applied to each tumor.  Tw
 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 cedematous, and  a phimosis ensued.   The chancres on the
 thighs were dressed with cerat.  opii.  27th. Pills of hydrarg. iodid. were
 ordered, to  combat  the induration, and injections of acet. plumb, for the
 blenorrhoea.
   April 6th. The chancre inoculated on the chafed part had nearly destroy
 ed the frenum.  The discharge was much diminished, and the matter ha<i
 lost its greenish  color.   10th. The patient  complained of soreness  of the
 gums; the mouth was irritated, but there  was no  salivation; the gums
 were touched  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.   18th.  The puncture had pro-
 duced nothing;  there was less induration 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 dis-
 charge remained.  3d. There was no more induration; the chancre of the
 frenum was healed ; the pills were omitted, and the patient left the hos-
 pital on the 14th.

   Case XXI.  Chancre and symptomatic bubo ; inoculation successful.
   Leg----Leonard, aged 18, entered October 12, 1835.   For fifteen days
                                  15 
 1.14        CLINICAL AND EXPERIMENTAL  RESEARCHES—■

some chancres were seen on the glans; four days after they appeared, a
bubo developed itself on the right side; its course was  acute, and it  was
opened October 14th.  16th.  The  pus of the bubo was inoculated on ine
left thigh, and that of the chancres on the right.   21st. The two punctures
had succeeded and the pustules were formed ; some of the pus taken lrom
the pustules on  the left thigh was inoculated on the right;  the first  inocu-
lation had been destroyed with caustic; the chancre of the penis and the
bubo were dressed with aromatic wine.  24th.   The puncture made with
the pus of the pustule on the left thigh had produced its characteristic re-
sult ; it was allowed to take its course.
  29th. The chancres of the penis were healed, and the  bubo in a fan way
of reparation; the chancres of the right thigh, or the last inoculation, were
dressed with aromatic wine, and cauterized with arg. 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 from the bubo, had _
made rapid progress.  The patient was dismissed cured.  M. Cullerier has
seen these inoculations, and observed their development, and also publicly
acknowledged that the pus of a bubo is capable of being inoculated.

   Case XXII.  Primary chancre of the anus, inoculated successfully.
   Tomb----Barbe, aged 23, entered  April 2, 1833.  A month  previous,
this patient had had intercourse, a prcepostera venere, with her  husband,
who Avas affected with chancres; the raphe was torn, and the chancrous 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  six  leeches to be  applied;  the leech-bites being
 soiled  by the pus from the anus, became inoculated.
   April 4th. The different chancres  were dressed with cerate  of opium
 and calomel.  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 char-
 acters of the period  of increase;  its pus was inoculated on the left thigh-
 28th.  The  inoculation  had  succeeded; the pustule was destroyed by
 cauterization with arg. nitr.  The  anus was  dressed with  a bit of lint,
 the lower  end having been dipped in sod. chloride;  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 near-
 ly healed,  and it was only  superficially cauterized.   The patient being
 cured, was dismissed  on  the 10th.

   Case XXIII. Chancre, rhagades, mucous pustules ; inoculation success-
 ful in the two former cases, and unsuccessful in the latter.
   Pier---- Clotilde, aged 16, entered April 2,  1833.   This patient  had 
       PRACTICAL OBSERVATIONS—INOCULATION  OF CHANCRE.    115

been affected with chancre of the vulva and a blenorrhoea  for 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 fourchetle, was inocula-
ted on the right thigh, and the pus of the mucous papulae on the lefi thigh.
Cauterization and dressings with calomel and opium cerate were prescribed.
12th. The inoculation made with  the pus from the  chancre of  the four-
chelte, 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 ulcerative period, was in-
oculated.  16th. The inoculation of the 12th had succeeded, and produced
the pustule; the anus was dressed with the chloride of soda and calomel;
the chancres were cauterized  with nitrate of silver.  19th. Better defined ;
almost all the ulcers had assumed the characters of the period of repara-
tion.   21st.  Better; almost cicatrized; the mucous pustules had disap-
peared.  The same dressing was continued; and the patient was dismissed
cured on the 28th.

  Case XXIV. Chancre; inoculation by the nails;  successful inoculation
with pus preserved in a tube.
  Tang----, aged 32, entered Sept. 20, 1S36.   Seven weeks previous, this
patient had  contracted chancres on the margin of the prepuce,  which were
neglected ; the ulcers soon became confluent, 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, resem-
bling an ulcerated mucous tubercle, upon the left commissure of the lips.
It was thought that the disease of the lip was caused by the irritation  pro-
duced by using a pipe, to which the patient was excessively 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.
i!6th. The dose of the cyanuret of silver was increased one tenth.  28th.
The dose  was increased two tenths of a grain;  the state of the chancre
was unchanged; the patient felt no effect from the medicine.   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 inocu-
lation, was perceived at the lower part of the upper and inner third of the
left thigh.   The  patient said, that  it came from  a scratch with the nail.
The state of the chancre of the prepuce remained the same;  on the other
hand, the patient felt no effects of the cyanuret of  silver; the dose was in-
creased to three grains.   Some pus was taken from the pustule of the left
thigh, and inoculated, by a puncture, on the right thigh.   8th. The inocu-
lated puncture had produced a well filled pustule, from which a glass tube,
open at both ends, was filled.  The nature of the  inoculation by the nails 
 116         CLINICAL AND EXPERIMENTAL  RESEARCHES-

 of the patient being known, it was cauterized with nitrate of silver.  10th.
 The pus preserved in the tube was inoculated, by a puncture, below the
 first inoculation on the left thigh.   11th. The inoculation of the preserved
 pus had produced the characteristic pustule.  The patient was taking four
 grains of cyanuret of silver; the chancres were better, and produced fleshy
 granulations.  12th. The pustule, from inoculation of the pus in the tube,
 was very large.   Six grains of the cyanuret were given, without any per-
 ceptible effect.   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 second
 pustule,  inoculated on the right  thigh, had progressed and produced a
 chancre, which was dressed with cerate.  27th. The first and third inocu-
 lations were  healing; the first especially Avas nearly cicatrized.  At  the
 base of the inoculation on the right thigh, which  had not been cauterized,
 an indurated  knot Avas perceived.  Thus, although the  cauterization Avith
 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 tOAvards cicatrization,
 Avhilst the  inoculation, which had not been cauterized, had gone on in-
 creasing.  In order to promote  the cicatrization,  dressings of vin. arom.
 were used.   Nov. 4th. The patient was dismissed cured.

  Case XXV. Chancre, blenorrhcea ; inoculation successful with the pus of
 the chancre, and unsuccessful with that of the blenorrhoza ;  inoculation of
 the chancrous pus with hydrochloric acid, unsuccessful.
  Vill----, aged 28, entered  September 19, 1836.   This patient, Avho had
 a natural  phimosis, could  not precisely state  the  period at  Avhich he had
contracted chancres; only that six weeks since, he had  perceived  a bala-
nitis Avith swelling of the prepuce.  The gonorrhoea, Avhich appeared nine
days after a suspicious connexion, had lasted three weeks; it still remained
acute; the patient had received no treatment.  Upon examining him, Ave
found  an abundant greenish yellow discharge from the  blenorrhcea;  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  granulation.
  21st. The blenorrhoeal pus Avas inoculated on the left thigh ; there was
no induration in the canal.  Some pus Avas taken from the surface of  the
chancre, and  divided into two portions; the first  Avas  inoculated on  the
 right thigh, and the second mixed Avith acid,  hydrochlor. was also inocu-
lated on the right thigh, below the puncture made with the  unmixed pus.
 The chancre  and balanitis were cauterized, and then dressed with aromatic
 wine; injections of nitrate of silver were ordered.   24th.  The puncture
 made Avith the blenorrhoeal pus had produced 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 
        PRACTICAL OBSERVATIONS---INOCULATION OF  CHANCRE.    117

 *ie characteristic pustule; but that  made with  the  chancrous pus, mixed
Avith hydrochloric acid, had produced nothing, and Avas healed the follow-
ing day.   The same treatment with  cauterization and injections of nitrate
of silver.  26th.  The pustule from inoculation, whose base Avas somewhat
indurated, was cauterized ; to the above-mentioned treatment, six drachms
of cubebs per diem were added for the blenorrhoea.
  Oct. 7th. The chancres were healed; the balanitis had disappeared three
days previous; the discharge from the blenorrhcea was slight and Avithout
pain.   10th. The pustule from inoculation, Avhich had  not been destroyed
by the cauterization, Avas dressed with vin. arom. and cauterized.   18th..
The chancre on the thigh Avas almost healed; there was no more discharge
from the blenorrhoea, and no induration remained Avhere the chancres had
been on the penis.   On the 21st of October, he was dismissed cured.

  Case XXVI.   Chancre and  symptomatic bubo,  inoculated icith positive
result ; chancrous pus, dried by the heat of boiling water, then being diluted
with water, loas inoculated, without success.
  Dern----, aged 29, entered Sept.  20, 1836, had contracted chancres six
weeks previous; they were situated on the upper and inner part  of  the
prepuce.   About a fortnight since, a bubo appeared on the left side.  The
chancres are now partly at the period of reparation.  The  bubo was seated
in the superficial ganglions;  it was very large, and  the ifuctuation at its
summit doubtful.  The chancres Avere cauterized Avith nitrate of silver, and
dressed with vin. arom.   A blister was placed on the bubo, which Avas or-
dered to be dressed the folloAving day Avith a solution of sublimate, twenty
grains to the ounce of AArater.                                            -•
  26th. The fluctuation was evident; the bubo was opened, and discharg»
ed a  bloody and thin pus;  it was  immediately inoculated  on the right
thigh.  The chancres were quite  modified, and tending toAvards cicatriza-
tion.   A cataplasm was placed upon the opened bubo, and the same dress-
ings were continued  for the chancre.   28th. The inoculation  of the pus of
the bubo Avas Avithout result; yet the wound of the opening had become
rounded, and its edges assumed  a chancrous appearance.  A  new inocula-
tion Avas made on the right thigh, with the pus  of  the bubo.  30th.  The
pustule from inoculation Avas developed ;  it was cauterized with argent.
nitr.  Some chancrous pus was collected and dried in a capsule exposed to
the heat of boiling water, some drops of Avater Avere then mixed with it,
and an inoculation made  on the thigh.
  Oct. 3d.  The  inoculation  of  the dried pus had produced nothing.  The
chancres of the prepuce were healed; the bubo Avas much diminished;
dressings of ung. mercur. had been used the last two days, in order  to pro-
mote  the resolution  of the base.  10th. Dressings of aromatic wine were
applied to the bubo,  and its surface Avas cauterized with argent, nitr.   No
engorgement was felt at  the base; and fleshy granulations Avere produced.
On  the 25th, the patient Avas dismissed cured. 
   218         CLINICAL AN!  EXPERIMENTAL RESEARCHES—

     Case XXVII.  Chancre  at  the period of reparation ;  inoculation unsuc-
   cessful.
     Bign----Alexandre, aged 24, entered June 13, 1S35.   Early in May,
   this patient had chancres around the glans  near the corona, on the frenum
   and prepuce; those on the glans had healed Avith  applications of calomel
   and opium cerate, and cauterization Avith nitrate of silver.   There only re-
   mained a chancre with a rose-colored ground  on the prepuce, and another
   Avith a granulated ground, in the region of the frenum;  they  Avere dressed
   Avith opium cerate.  18th.  The ulcerations, which appeared to remain un-
   changed, Avere cauterized Avith nitrate of silver, and dressed Avilh calomel
   and opium cerate.  24th. There was little alteration;  the  pus from the
   ulcer, with a rose-colored  ground, was inoculated on the right thigh, and
   that collected on the one Avith a granulated ground, upon  the left; dress-
   ings  with via.  arom.  were  ordered.  29th. The  chancres were healing;
   the inoculated puncture had produced nothing; the chancres were cauter-
   ized  and  dressed Avith vin.  arom.   The  patient was dismissed  cured,
   July  3d.

     Case XXVIII.  Phagedenic  diphteritic  chancre, inoculated by the nails
   in the subclavicular region; inoculation with the pus  of this latter ulcer,
   which had arrived at the  stage of reparation, unsuccessful; sympathetic
   bubo.
     Tug----, aged 23,  entered  May  10, 1836.  Three  weeks previous, a
   chancre appeared on the frenum, which at  first made little  progress; but
   after an excess in drinking and several nights spent without rest,  the ulcer
m  became inflamed, and  passing to the phagedaenic  state,  destroyed  the fre-
   num and a portion of the substance of the  glans; at the same time as the
   chancre became phagedaenic, a bubo developed itself in the right groin;
   its progress Avas very indolent.  We found the chancre presenting all the
   apparent characters of phagedaenic chancre; the Avound it had caused Avas
   deep, and its ground covered with a grayish, pulpy, pseudo-membrane,  re-
   sembling the pus of hospital gangrene; upon the large and indurated bubo,
   Dlisters Avere placed, which Avere dressed with the  opiated solution of subli-
   mate.   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 sirup,  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;  com-
   pression Avas applied by means of a spica bandage ; the  patient 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 Avound Avas about the size of a  sixpence, and resembled a chancre at
   the period of reparation; the pus it  furnished Avas inoculated on the right
   thigh;  it Avas then cauterized and dressed with aromatic wine.   10th. Tht 
        PRACTICAL OBSERVATIONS'---INOCULATION OF CHANCRE.    119

inoculation of the pus  from the ulceration of the clavicle had produced
nothing.   The bubo Avas almost levelled,  and but little indurated; the
chancre Avas cicatrizing.  June 30th.  The chancre Avas healed; very little
induration remained in  its place; the bubo had nearly disappeared.  The
patient left the hospital  cured, July 18th.

  Case XXIX. Blenorrhoza, chancre in a state of reparation; inoculation
unsuccessful.
  Marti----, aged 28,  entered June 27,  1836,  had been affected Avith a
blenorrhoea of an  intermittent nature for more than a year, for Avhich he
had  received no regular treatment.   A month since, a chancre appeared
on the frenum ; we found the urethral discharge Avhitish ;  he had no pain
in urinating.  The chancre was  everywhere at the period of reparation,
and  there was no  induration at its base.   From  the  commencement of
the  disease, no symptom had been  noticed Avhich could be referred to
a secondary syphilitic affection, and the general health had always been
excellent.
  29th. The pus  of the gonorrhoea was inoculated by tAvo punctures on
die 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 Avere ordered
for the gonorrhoea.   The  chancre Avas cauterized  and dressed Avith vin.
arom.   July 3d. The  inoculation had  produced nothing, either on the right
or left side; there  was  no  pustule; the blenorrhoeal discharge was  much
diminished, and the chancre was  almost dried.  The same treatment was
continued.  6th. The discharge  had  ceased;  the  chancre was  perfectly
cicatrized, and had left no induration.  The  patient Avas therefore dis-
missed cured.

  Case XXX. Phagedenic indurated chancre in the stage of reparation ;
inoculation unsuccessful.
   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 consequence of some  errors
of diet, and extended  to nearly the Avhole of the margin;  a remarkable in-
duration was formed at the base of the ulcer, and its surface assumed the
appearance of a phagedaenic chancre, from excessive induration, destroying
the tissues by a kind of interstitial gangrene.
  Five or six days after passing from the  regular  to this  latter form, the
body aud limbs became the seat of a lenticular  syphilitic  eruption, and
some patches of mucous tubercles developed themselves on the anus.  In
the  right inguinal region, the tension of  the  ganglions  produced  some
hardness; he had  received no treatment whatever.  We found his general.
health  good; the digestive functions regular; the temperament Avas in-
clined  to  be lymphatic.  The whole surface of the chancre appeared  in the
stage of  reparation;  the syphilitic eruption was still in the acute stage; 
120         CLINICAL  AND EXPERIMENTAL RESEARCHES---

the papulae Avere  raised.   20th. Some pus Avas taken from the chancre,
and was inoculated on the right thigh.  Pills of the iodide of silver were
ordered, according to the  formulary  of M.  Serres de Montpellier, begin-
ning Avith a tAvelfth  of a  grain as a dose daily; the patient drank gum-
water, and the  chancre was  dressed with  cerate.   27th. There was no
change in the general health, the inoculated point had produced nothing.
The dose of the iodide of  silver was gradually increased  to three twelfths
of a grain.  Sept. 1st.  There Avas no perceptible effect from  the medi.
cine; five twelfths Avere  given.   7th. No improvement, and  the disease
folloAved the usual course, as if it  had remained Avithout  treatment.   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.  9th.  Seven twelfths were given; on  the 12th, a
grain; the 20th,  fifteen twelfths; the26th, seventeen twelfths; and  at
length,  Oct.  2d, still Avithout any modification, the  dose had been in-
creased to fifty-four twelfths.  Six grains of the iodide were ordered to be
taken in the morning, fasting.
  7th. Eight grains Avere  given in the same  manner; on  the 10th, the pa-
tient took twelve grains of the iodide of silver, without  experiencing the
least action.  The syphilitic eruption progressed ;  the mucous papulae at
the anus had  extended themselves ; the induration at the base of the chan-
cre, which was not quite cicatrized, remained.  It was then thought proper
to abandon M. Serres' treatment, which had so long been folloAved Avith
such exactitude and without any success.  The pills of iodide of mercury
were prescribed, the tisane of hops, the  anti-scorbutic  sirup,  and  fumi-
gations with cinnabar, every second day.  The  mucous papulae of the anus
were dressed Avith calomel and chloride of soda.  14th.  An improvement
was already perceived ; the papulae Avere less raised;  the secretion which
took place upon the surface of the  mucous papulae had nearly ceased. Tavo
pills were ordered to hasten the cure;  the functions continued quite regular.
19th. But few squamae remained.   On the legs, scarce anything 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 disappear-
ed; the  dose  of iodide of mercury Avas increased  to three pills.  27th.
Only a {ew broAvn spots remained upon  the body  and limbs, which be-
came 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 patient was dismissed cured.

   Case XXXI.  Chancre at the period of reparation; inoculation unsuc
cessful.
   Quan----, aged 24, entered July 1, 1835,  had been affected five weeks
Avith a  blenorrhoea, which was very  painful at the commencement, an"
Avhich appeared three days after a coition.  On the skin of the prepuce, 
           PRACTICAL OBSERVATIONS---INOCULATION  OF CHANCRE.    121

   toAvards the base of the glans, were two ulcerations.  He had received no
   treatment;  but a phimosis having supervened, in consequence of the in-
   crease of the chancre  on  the  prepuce, the patient entered the hospital.
   At this time there was no  pain on urinating, but he suffered much at the
   end of the  penis, which Avas greatly swollen.  The skin of the  prepuce
   was of a violet  red  color; on the under side,  two indurated  points were
   perceived, corresponding to the seat of  the chancres of the mucous mem-
   brane, as pointed out by the patient;  leeches were  applied to the  penis;
   some  pus Avas taken from the aperture  of the  prepuce and inoculated on
   the right thigh.  July 4th. The inoculated puncture had produced nothing;
   the patient took bolus of copaiva;  the  glans and prepuce were cauterized
   with nitrate of  silver; the phimosis Avas no longer  in the inflammatory
   stage.   11th. A fresh inoculation was made; pills of hydrarg. iodid. Avere
   ordered, on  account  of the induration which remained at the base  of the
   prepuce; the chancres were cauterized and dressed Avith vin. arom.  12th.
   The  inoculated punctures  had produced  nothing; the chancres were
   almost healed;  the blenorrhcea had  disappeared, under the  influence
   of the copaiva  and the injections of  acetate of lead.   Aug. 13th.  All
   was healed, and circumcision was- performed.  The patient left cured
   Sept.  15th.

     Case XXXII.  Chancres at the period of reparation, blenorrhoza  in  the
   acute stage ; inoculation unsuccessful in both cases.
     Lev----Pierre,  aged 26, entered June 3,1835, had been affected three
   weeks Avith chancres on the frenum and corona glandis, for Avhich he  had
—  had no treatment.  The ulcers, which were in  the stage of reparation, ap-
   peared much irritated and caused gieat pain; the patient attributed  this
   state to a coition two days previous to entering the hospital: fomentations,
   with  a  concentrated decoction  of  opium, were ordered.   5th. An acute
   blenorrhoea  had  developed  itself; the patient  suffered much; the blen-
   orrhoeal pus Avas inoculated on both thighs; and twenty leeches were ap
   plied  to the perinaeum. 8th. The  inoculation  of the blenorrhoeal 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  opium cerate.  10th. The punctures made on
   the 8th with the chancrous pus had  produced nothing; the blenorrhoeal
   pus was again inoculated on the left thigh, and the pus of the chancre on
   the right; injections  of acetate of lead  were ordered; the chancre,  Avhich
   still remained, was cauterized;  those on the corona glandis were  healed.
   12th.  The chancre was fully cicatrized ;  the blenorrhoeal  pus was again
   inoculated on  the  right thigh; the inoculations of the 10th  having pro-
   duced nothing.  13th.  The puncture from the last  inoculation was red
   and inflamed; there  was little discharge ; the patient experienced no pain
   on urinating; the injections Avere continued, with copaiva in form of bolus.
   18th.  The false pustule, caused by the inoculation on the 12th, had dried
                                    16 
122        CLINICAL AND  EXPERIMENTAL  RESEARCHES--

up and disappeared; the blenorrhcea Avas nearly cured.  24th.  Thepatier.it
left quite Avell.

  Case XXXIII.  Chancre of the  prepuce  at the period of reparation,
blenorrhcea, sympathetic bubo ; inoculation unsuccessful in each case.
  Fourn----,  aged 20, entered Nov. 21, 1835, had contracted  a blen-
orrhoea and chancre of the prepuce, about three months previous; he had
received no treatment.  A fortnight since, a bubo had developed itself in the
right groin; its course had been acute; the blenorrhoea  had caused some
pain  on urinating.  Upon separating  the lips of the meatus urinarius,
some points of the mucous membrane were found eroded, similar to those
which are seen in balanitis;  the chancre of  the prepuce  presented all the
characters of the period of reparation; its surface was covered with fleshy
granulations; the bubo had suppurated;  there was no engorgement at us
base, and none in the chancre ; it was opened, and much creamy Avhitish
pus Avas discharged.  23d. The pus of the blenorrhoea Avas inoculated on
the left thigh, that of the bubo on the  right, and  that  of the chancre hi
the period of reparation by punctures made on the right thigh below That
from the bubo.  For the blenorrhoea, injections of sulph.  zinc. Avere order-
ed; the chancre Avas  cauterized and dressed  with calomel and opium
cerate, and cataplasms were  placed on the bubo.   28th.  The inoculations
were unsuccessful; the pus  of the blenorrhoea 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 thetuenorrhoea was less; the chancre was almost cured;
the bubo, the aperture of Avhich was not at all ulcerated, Avas healing;  „
some  resolutive  frictions  had been  made  Avith ung. mer.   18th. The
chancre Avas healed;  there Avas no  discharge of pus from the bubo; some
granulations at its aperture Avere  cauterized Avith nitrate of silver; the
blenorrhoea only furnished a white  mucous fluid.   The  injections and
copaiva Avere continued.   Being completely cured, he left the hospital on
the 30 th.

  Case XXXIV.  Chancres at the period  of reparation,  inoculation with-
tut result.
  Franc----, aged 20, entered August 1, 1836.  In this  patient chancres
appeared at the base of the glans, seven weeks previous, which inocu-
lated  themselves by contiguity of tissue on all  its circumference, and on
the corresponding part of the prepuce;  some points had passed  to the
period of reparation, and vegetations had developed themselves.  On the
scrotum an ulceration  formed, Avhich gradually increased; no  particular
treatment had been used.  There remained, at the time of his entrance,
upon  the corona glandis only some vegetations, with ulcerated points in
their interstices; in the meatus urinarius a chancre Avas perceived, with
all the characters  of the period of reparation.  On  the anterior and upper 
        PRACTICAL OBSERVATIONS---INOCULATION OF CHANCRE.    123

parts  of the scrotum, an inch below the penis, an ulcer was seated with
irregular reverted and jagged  edges, and vermilion ground; the  whole
thickness of the skin was  perforated; the general form of the ulcer was
irregular funnel-shaped ; all parts seemed at the period of reparation.
  3d. The pus collected from the surface of the ulcer of the scrotum Avas
inoculated by two punctures on the right thigh.   Dressings of aromatic
wine Avere  applied to the interstitial ulcerations of the  vegetations, as
well as to the chancre of the meatus urinarius, which was also cauterized
with  nitrate of  silver.   7th.  The inoculated punctures  had produced
nothing; the interstitial ulcers were healed, and the chancre of the mea-
tus was almost dry;  it was cauterized and dressed with vin. arom.   10th.
The  vegetations Avere cut; the chancre of the  meatus was cicatrized;
the ulcer of the scrotum was covered Avith the  granulations of the period
of reparation; the skin  seemed  corrugated  all round; the circumference
had diminished, and  the base Avas more raised.   On the 15th, all being
healed, and no induration remaining, the patient left the hospital.

  Case XXXV.   Chancres, balanitis, symptomatic  bubo, inoculated with
success.
  Alex----, aged 22, entered Nov. 14,1835.  The disease had commenced
five weeks previous, with chancres on  the glans and inner part of the pre-
puce.  A balanitis soon developed itself in  consequence of an incomplete
phimosis.  He had, till then, received  no treatment.  Three weeks previ-
ous, a bubo formed on the left side, which is now  suppurating; there was
also a considerable blenorrhoeal discharge.
  17th. The day after the opening of the bubo, its pus was inoculated on
the left thigh, and the pus of the balanitis, mixed with the pus of the chan-
cres of the glans, Avas inoculated on the right.   For the  balanitis,  a cau-
terization was made  all around with nitrate of silver, and it was dressed
with  vin. arom.; cataplasms were applied to the bubo.   19th. The inocu-
lated punctures had produced the pustule on the right and left thigh; that
on the left had developed itself more rapidly than  that on the right.  21st.
Inoculated pustules  Avere Avell 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
Avere healed ; the  pustules from inoculation had disappeared, under the in-
fluence of the cauterization with nitrate of silver; the centre of the bubo
was in the stage of  reparation;  the dressings with aromatic wine and the
cauterizations were  continued.  The patient was dismissed cured on the
15th.

   Case XXXVI.  Balanitis, with superficial  chancres ;  inoculation with
vositive result.
  kBonj----, aged  40. entered Aug. 23,  1836.   This patient, who had a 
 124        CLINICAL  AND  EXPERIMENTAL RESEARCHES-

uatural phimosis, perceived a swelling of the prepuce twelve days  after 3
suspicious connexion; for three or four days he felt some itching at the end
 f lb-? penis ; but at the period mentioned, after a long Avalk, he  suddenly
experienced, at the same time with the sAvelling, very sharp pains, and a
copious discharge flowed over the margin  of the prepuce.   We found a
slight oedema of the parts, but no induration.  On separating the edges  of
the contracted aperture of the prepuce, some ulcerations were found on the
glans, Avhich had eaten through  the thickness of the mucous membrane
the matter of the discharge Avas greenish and bloody; the urethra  did noi
furnish pus upon pressure; the patient had not suffered in any  other way,
and the pains he felt on urinating, were stated  by him to affect  the glans
and prepuce only at the moment when  the urine passed over these  excori-
ated parts.  24th. The pus which appeared at the aperture of the prepuce,
was inoculated by a single puncture.  The diseased surfaces were  cauter-
ized 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 tAVO mucous surfaces from coming in con-
 tact.   26th. The inoculated  point had  produced the  pustule; the same
 treatment was continued;  there was already a decided improvement. 27th.
 The inoculated  pustule was  cauterized with arg. nitr.  The aperture  of
 the prepuce permitting the introduction  of a bit of dry linen, a fresh cau-
 terization Avas made, and the parts again separated.
   Sept. 10th.  The balanitis  had  completely disappeared ; the ulcerations
 of the glans and prepuce Avere cicatrized ;  no induration remained  on the
 seat of the disease;  circumcision was  performed.   20th. The wound from
 the operation  was almost entirely united: some fleshy granulations were
 cauterized, and the patient dismissed cured.

   Case XXXVII.  Superficial chancres, balanitis, phimosis;  inoculation
 successful.
   Bor----, aged 19,  entered May 3, 1836.   A few days after a suspicious
 connexion, this patient, who had a natural phimosis, perceived a slight
 SAvelling and felt a smarting on the glans during the emission of his urine;
 at length, an abundant discharge  took place upon the  opening of the pre-
 puce.  We found the mucous membrane red, and presenting here  and there
 ulcerated patches, resembling superficial  chancres; no pus was* produced
 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  an-
 other hospital.  The pills of hydrarg. iodid. were prescribed.
   May 4th. The pus collected at the orifice of the prepuce was inoculated,
 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  Avere  made with vin. arom. to wash the surfaces, and a few
 threads  of lint introduced upon  a probe, to prevent the contact of the in-
 flamed mucous membranes.  7th. The inoculated puncture had produced 
       PRACTICAL  OBSERVATIONS—INOCULATION  OF CHANCRE.    125

the characteristic pustule of the chancre;  it Avas destroyed Avith nitrate of
silver.  For the balanitis, the cauterization and injections Avere continued.
Nearly all the glans could be uncovered.  10th.  The cauterized inoculated
pustule had disappeared; only one or iavo ulcers remained upon the glans,
and they presented  the characters of the  period  of reparation ; they Avere
cauterized and dressed with aromatic wine. 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 Avas therefore cut, and the small wound
dressed  Avith  opiated cerate.   No induration remained on the site of the
superficial chancre.   The patient Avas dismissed, May 24th.

  Case  XXXVIII.   Transformed chancres, blenorrhoza: inoculation suc-
cessful.
  Cha----Louise,  aged 19, entered April 1, 1S34,  had been  affected with
the above symptoms for five Aveeks;  the person  from Avhom she had con-
tracted them had a  chancre only.   On  the internal surface and margin of
the external labia, some pimples  appeared, which, following the regular
course of the inoculated pustules, became filled Avith pus, opened, and pre-
sented as many chancres as there had been pustules; a vaginal blenorrhoea
shoAved  itself at the same time; during ten days it was very acute and
painful, and then became chronic.  Although she had used no treatment,
the ulcers appeared at the period of reparation, their ground Avas raised,
and their surface covered Avith  a  grayish albuminous secretion, not easily
detached, and secreting a serous pus.   The matter of the blenorrhoea was
whitish ; there was no pain on passing her urine.
  2d. A bath was ordered, and emollient lotions.  5th. The pus taken from
an  ulcer on one of the external  labia was inoculated  on  the left thigh;
cerate dressings  were used.   7th. The  inoculation  had produced nothing;
the pus of one of the transformed chancres, which furnished the most puru-
lent matter, was inoculated on the left  thigh below the former puncture.
Injections of decoct, alb. were used.  8th. The  inoculated punctures were
red ; but slightly elevated.  9th.  The redness of the inoculated points had
disappeared and Avithout any  effect.   The chancres were  dressed with
calomel  and opium cerate.  18th.  An examination  Avas made  with  the
speculum.;  the  cervix  Avas  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 external
labia Avere nearly  all healed.   Injections were made, and  tampoonings
with decoct, alb.  28th. All Avas  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.*

      * De la non-identite de la blenorrhagie et du chancre, p. 24, 1837. 
126        CLINICAL  AND EXPERIMENTAL  RESEARCHES---

  " Has not M. Ricord proved, by the two pathological anatomical speci-
mens Avhich he presented to the academy, that urethral chancres exist ?—
chancres Avhich have  been indicated by inoculation, and which I have
found before and after death, and upon  Avhich I have been able to make
the following observations:—
  Obs. I. "Boisseau, aged  20, entered the Hopital du Midi, April 2, 1S36.
He had been  affected at four different times with gonorrhoea, at periods
Avhich he could not fix precisely;  they had all been quite cured.   The last,
which had  caused him much pain, was followed, after having lasted  two
months without treatment, by an  orchitis, for Avhich the  patient Avas re-
ceived into the hospital; the  orchitis had existed eight days when he was
admitted.  After several applications of leeches, the swelling of the testi-
cle had decreased a little.  M. Ricord pointed out a complication  with a
hydrocele in an acute stage, which he punctured successfully.  The pains,
Avhich  had much decreased  in consequence of this  puncture, returned on
the third day, at the same time with a new effusion of fluid into the tunica
vaginalis.  A fresh puncture  had  the same result; M. Ricord made a third
puncture and used  a vinous  injection.  Although in the  acute  stage, all
went on as if it had been in the simple stage.
   "May 30th.  The patient was cured  of his orchitis and hydrocele;  but
the blenorrhoeal 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 Avith an orchitis complicated
with hydrocele, as in the affection of the first  testicle. The hydrocele  was
then punctured Avith a bistoury; but the blenorrhoeal discharge had  pro-
gressively increased;  the bowels  became confined;  manna in  Avhey  Avas
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 fore-
part, a flap of the mucous membrane of the urethra, detached from the
subjacent parts, and  only  adhering by the anterior portion,  Avas slightly
hypertrophied ;  posterior to this, there Avas another flap which was hyper-
trophied and indurated ;  several rounded  ulcerations, with the characteris-
tic form of syphilitic ulcers, perforating the whole thickness  of its mucous
membrane, appeared on the  surface of the bladder.  The seminal vesicle
of the left side presented an  extensive abscess and  some ulcerations;  that
of the right side was uninjured;  but the  ejaculatory canal  and vas deferens
of the left side established a continuity  of disease from the urethra to the
suppurated  epididymis, Avhich  presented in  its interior an abscess which
nad already penetrated a part of the testicle; in the same organ, the palli-
ative puncture, Avhich had been  made, had produced pseudo-membranes, 
        PRACTICAL OBSERVATIONS—INOCULATION OF CHANCRE     127

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
adhesion 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.
   Obs. II.  " Jean Bourdon, aged 17, entered the Hopital du Midi toAvards
the end of September, 1836.  He had contracted a chancre of the glans
six months previous, for which he at first had no treatment; he soon per-
ceived a slight discharge from the meatus urinarius, Avhich increased, al-
though slowly.  After some  very fatiguing work, he was attacked Avith a
very inflammatory phimosis,  for Avhich a surgeon Avished to make  the in-
ferior  section, but the parts were drawn to one side, and the edges of the
wound became inoculated.  Notwithstanding all the treatment employed,
the disease could not be cured ; in this state he entered the hospital.
   " He was much  emaciated, although the functions Avere regular; the
glans and the flaps of the ulcerated prepuce were so blended as to offer the
appearance of a triple-headed penis.  The chancre possessed all the char-
acters of the period of increase; and  notwithstanding the various local ap-
plications and attention to diet calculated to favor the internal treatment,
very little amelioration could be obtained.  The blenorrhoeal discharge was
frequently  bloody, and accompanied  with pain; upon  inoculation  it pro-
duced  the  characteristic pustule, which was then  destroyed.   Thus, after
many months of suffering, without any instrument  ever having been intro-
duced into the depth of the urethra, incontinence of urine supervened,
Avhich led M. Ricord to refer it  to  ulcerations in  the neck of the bladder
and canal of the urethra; the incontinence of urine  continued till the death
of the patient, Avhich took place  December 20, 1836, and AA'hich was ac-
celerated by a diarrhoea which resisted all  treatment.  Although, upon a
post-mortem examination, the intestinal canal presented no other alteration
than the other abdominal organs, which Avere in their normal state, except
the  bladder, in the chest there were some  chronic adhesions; on  the
right side  there  Avere 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;
they were  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 spongy part of the urethra
an inch deep and  eight lines long, perforating the entire thickness  of the
mucous membrane; but behind  the region of the bulb in the pars  mem-
branosa and prostatica, the neck and cavity of the bladder, traces of a large
phagedaenic chancre were perceived.  And especially on the lateral parts
of the prostate, two large excavations in its suostance were found, separated
r-"■"? each other bv a hvpertroonied ana indurated tongue.  At tne inferior 
 128         CLINICAL AND EXPERIMENTAL RESEARCHES---

part, the reversed prepuce shoAved traces of the operation, and the inocula-
ted edges.  On the corona glandis, a large chancre was seen;  on the lateral
parts Avere tAvo Avounds from the operation, which had become chancrous;
and lastly, there Avas a chancre of the meatus urinarius and corpus spongi-
osum.
  Obs. III. "----Florence, aged 19, entered the Hopital du  Midi January
17, 1836.  She had  previously tAvice had a  blenorrhoea, which yielded to
injections of decoct alb.  Upon her  entry, she had a vaginitis of a fort-
night's standing; she felt acute pains on passing her Avater at the eighth
day of her vaginitis, and this determined her to enter the hospital.  Inocu-
lation with the pus from  the  vagina, in Avhich the speculum showed no-
thing, was unsuccessful; that from  the urethra produced the characteris-
tic pustule of the chancre.  M. Ricord then  declared the existence  of an
urethral chancre, Avhose  existence Avas soon demonstrated  by its appear-
ance at the meatus urinarius.  In a month's treatment it was cured com-
pletely."
                             Section II.

   INOCULATION OF  THE MUCO-PUS OF BLENORRHCEA, SIMPLE AND
             COMPLICATED,  AND  IN ITS  VARIOUS SEATS.

  CaseT\  Acute urethral blenorrhcea, inoculation unsuccessful.
  Caf----, aged 40, entered June 27, 1835.   The  disease appeared three
days after coition, and had existed  five, accompanied  with  very acute
symptoms; the matter of the discharge Avas greenish,streaked with blood.
Twenty leeches Avere  applied to the perinaeum; a purgative  enema was
ordered, as the  boAvels had not been relieved for four days, and tAvo cam-
phor pills per diem.  The 29th. There Avas a little less pain ; no  indura-
tion Avas perceived in the course of the canal; the blenorrhoeal  pus was in-
oculated  Avith two punctures on the left thigh.
  July 3d.  There Avas some little  irritation in the inoculated  punctures;
the skin was  red and raised, but there was no pustule.  4th. The red spot
produced by the inoculations faded without developing the pustule; the
blenorrhoea no longer caused  pain during the emission of the  urine.  Cu-
bebs and injections  of sulphate of zinc Avere prescribed.   6th. The blen-
orrhoeal pus Avas inoculated on  the right thigh, with tAvo punctures; the
matter of the discharge was whitish.   10th. The same elevated  spot was
observed, as was produced by  the inoculation  on  the 26th, and it disap-
peared in the same manner, Avithout producing a pustule.  11th. Afresh 
      PRACTICAL OBSERVATIONS—INOCULATION OF BLENORRHOZA.   129

noculation was made by  two punctures on the left thigh; the discharge
was less  in  quantity, and contained less pus. ' The cubebs and injection?
were continued.
  The I4tn. The inoculations made on the 11th had produced nothing,
not even the inflamed spot; the discharge from the blenorrhoea Avas mucous.
The patient left cured on the 22d ; the discharge having ceased since the
17th.

  Case II.  Urethral blenorrhcea ; inoculation unsuccessful.
  Mar----, aged 22, entered April 13, 1836.  The  disease had  lasted a
month ; at first it was very acute; it soon became chronic from using baths
without any other treatment.  On his entry, Ave found the matter of the blen-
orrhoea whitish; no induration was perceptible in the course of the urethra ;
there was neither pain in the emission of urine nor during erection ; the
inoculation Avas made by two punctures on the  right thigh.  The cubebs
and iron were given.
   18th. The inoculations had produced nothing.  The treatment was con-
tinued.  21st. The purulent matter of the discharge had much diminished.
May 1st.  Little more than a mucous secretion remained.  10th. No more
discharge remained; only in the morning, a single drop of transparent fluid
was perceived at the meatus  urinarius.  16th. The patient was dismissed
cured.                             »

   Case TIL  Urethral blenorrhoza ; inoculation unsuccessful.
   Bous----, aged 28, entered April 15, 1836.  The affection, which Avas
of  eight  days standing, appeared four days after a connexion.   Upon
separating the lips of the meatus urinarius, much  pain in urinating, with
tension of the canal, but no indurated point in its course.  The mucous
membrane appeared  red, and the  discharge was thin  and bloody; the
blenorrhoeal  pus was inoculated by two  punctures  on  the right  thigh.
Five-and-twenty  leeches Avere applied to the perinaeum, and  pil. opii  c.
camph. were ordered, with cubebs and iron.
   18th.  The inoculations had produced nothing; the discharge appeared
modified; the same treatment was continued.   The blenorrhoeal  pus Avas
inoculated by two punctures on the left thigh.  28th.  The inoculation
had produced no result; the discharge Avas losing gradually, although
slowly, its reddish tint; the dose of cubebs Avas increased, and injections
of  sulphate of zinc Avere used instead of those of acetate of lead.   30th
The discharge was whitish and  without pain.  The same treatment being
continued, only a slightly increased mucous secretion remained on the 6th
of May, and on the 16th  the patient was dismissed cured.

   Case IV. Acute urethral blenorrhoza ; inoculation without result.
  R----, aged 18, entered  May  13, 1836.  The disease was of fifteen day*
standing; it appeared eight days after an  impure  connexion ; the pain  in
                                  17 
130      CLINICAL  AND  EXPERIMENTAL  RESEARCHES---

the emission of the urine was very acute; the matter of the discharge
was greenish, Avith many streaks of blood; the urethral canal was not in-
durated, but very tense.
  May 14th. The blenorrhoeal pus Avas inoculated  on the right thigh, by
two punctures.  Twenty-five leeches were applied to the perinoeum ; the
bowels not  having been moved  for four days, the  patient was  ordered a
bottle of Seidlitz Avater.  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.   21st. The
matter of the discharge was no longer  streaked with blood; its color Avas
whitish; and there Avas a tendency towards  the mucous state.  Cubebs,
four drachms per diem, were ordered, and the injections of arg. nitr. con-
tinued.   23d.  Only a  super-secretion of mucus remained;  the  same
treatment Avas pursued, and on the 7th  of June the patient left cured.

  Case V. Urethral  blenorrhoza ; inoculation  unsuccessful.
  Mau----, aged 28, entered April  23,  1836.  The disease, which had
existed  for eleven days, appeared eight days  after a connexion.  At first
there was no pain, and the discharge  almost immediately became whitish,
with the characters of a blenorrhoea.  An induration Avas perceived on the
prepuce, marking the seat  of a chancre, cured a month previous.   27th.
The blenorrhoeal pus was  inoculated on  the  right thigh.   Injections of
nitrate of silver, and copaiva in  emulsion,  were ordered.   30th. The
inoculation had produced nothing;  the  discharge Avas diminished.
  May 1st. The canal was cauterized with the  caustic holder.   2d. The
discharge was increased; it was  purulent and strfeaked Avith blood.  4th.
The blenorrhoea had almost  disappeared, and only  a little mucous dis-
charge remained.   The patient Avas dismissed cured on the 11th.

  Case VI. Acute urethral blenorrhoza ; inoculation unsuccessful.
  V----, aged 28,  entered May 30th, 1835.  The disease, which appeared
eight days after exposure,  had lasted  ten days, and  presented all the
symptoms of the  greatest  acuteness.  He had  taken,  by the advice of a
gardener,  a  tisane  of straAvberry roots.  Thirty leeches were  applied to
the perinaeum.  June 8th.  The blenorrhoeal pus Avas inoculated on the left
thigh, with  two punctures.  10th.  Injections of sulphate  of  zinc  were
ordered, as the  blenorrhoea Avas far less painful, yet some streaks of  blood
were still remarked in the  discharge.  11th. The inoculated punctures had
produced nothing; the matter of the discharge was whitish yellow; but
its quantity was somewhat less.  21st.  The inoculation of the 15th being»
unsuccessful, it was repeated.  Cubebs Avere ordered, the dose two drachms.
30th. The last  punctures  were  unsuccessful; the  discharge was  much
less.  July 6th. There remained only  an increased secretion of mucus.
nth. The patient left cured. 
      PRACTICAL  OBSERVATIONS---INOCULATION OF  BLENORRHCEA   131

  Case VII. Urethral blenorrhoza ; inoculation without result.
  Lez----, aged 26, entered May 31, 1836.  A month previous, a blen-
orrhoea had appeared, eight days after exposure.   At first  it Avas very
painful, but the acute stage lasted only eight days,  although the patient
underwent no treatment.  Upon his entry,  the discharge was copious, of
a yellowish white  color; there was neither pain nor induration in the
canal of  the uiethra.   The blenorrhoeal  pus was inoculated on the left
thigh, by two punctures.  Injections of argent, nitr. Avere ordered, with an
emulsion of copaiva.  June 3d. The inoculation had  not succeeded; the
same treatment was continued.  6th.  The discharge  had much decreas-
ed ; the mucous matter prevailed.  10th. The injections of nitrate of silver
Avere suspended.  On the 12th, scarce  any discharge  remained; and the
20th, the patient left cured.

  Case VIII. Acute urethral blenorrhcea; inoculation unsuccessful.
  M----, aged 18, entered April 26,  1836.  The  affection commenced
five days previous;  the  patient was suffering much ; the discharge, which
was very copious,  Avas of a  yelloAvish  green  color  and streaked  Avith
blood; the canal of the urethra Avas  painful when  touched, and very
tense; but no induration Avas  perceived in any part of its extent.  27th.
The gonorrhceal pus was inoculated by two punctures on  the right thigh,
thirty leeches Avere placed  upon  the perinaeum; a camphorated enema
was ordered for the evening, and bleeding,  if the fever should require it;
diet strict.   29th. The fever still continued, and the patient was therefore
bled,  as had been directed on the 27th.   31st.  There was less pain ; the
inflammatory stage  seemed to be calmed; the inoculated punctures had
produced nothing.   Injections  of nitrate of silver were prescribed.
  May 6th.  The discharge had diminished, its yellow color had disap-
peared ; the secretion was Avhite, and rather mucous than purulent.  Four
table spoonfuls  of the emulsion of copaiva  per diem were ordered.   11th.
A little mucous discharge in the morning remained;  the dose of the
emulsion  was  increased  to  six  spoonfuls; the injections  were discon-
tinued ; and on the 24th, the patient left cured.

  Case IX. Acute urethral blenorrhoea'; inoculation unsuccessful.
  Far----, aged 24, entered Dec. 27, 1836.  The  affection had  existed a
fortnight, and appeared three days after exposure.  At first the patient had
suffered much; there was a chordee.   There was tension, but no indura-
tion of the canal; the acute stage still existed; the matter of the discharge
Avas of a yellowish  green color ; the mucous membrane of the urethra ap-
peared red  and: tumefied.   The blenorrhoeal pus was inoculated on the
left thigh Avith two  punctures.   Thirty  leeches  were applied  to the
perinaeum.
  30th.  The acute stage had nearly disappeared;  four spoonfuls  daily
of the emulsion of copaiva were ordered. 
132        CLINICAL AND EXPERIMENTAL RESEARCHES---

  Jan. 10th. The discharge Avas diminished ; the matter was whitish and
mucous.   13th. The discharge was still copious; injections of the iodide
of iron were  ordered ; by the 16th, all had disappeared, and the patient
left cured  the following day.

  Case X. Acute urethral blenorrhoza; inoculation unsuccessful.
  Che----, aged 22,  entered Sept.  13,  1836.   The disease  had  com-
menced four days previously,  eight days after coition.  The matter of the
discharge  was greenish and purulent; the patient suffered  much in uri-
nating ; the blenorrhoeal pus was inoculated on the right thigh Avith two
punctures.
  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.   17th.  There had been much discharge from the
blenorrhoea since the previous day; there Avere some streaks of blood, but
no pain.   18th. The discharge  had  much decreased  ; it Avas Avhite, and
almost Avholly mucous.  The emulsion of copaiva was given in doses of four
table spoonfuls daily.  19th. The discharge was almost cured ; the urethra
was cauterized.  20th. The same phenomena appeared as aftei  the former
cauterization.  28th. Only a drop of  muco-pus in the morning  remained.
29th.  The discharge had ceased, and  the  patient left Oct. 4th.

   Case XL Acute urethral blenorrhoza ; inoculation unsuccessful.
  Ois----, aged 20, entered Oct.  4, 1836.  The disease commenced six days
previous, and had appeared four  days after a suspicious intercourse.  The
pains in urinating were very acute; the acute stage  still continued: the
mucous membrane of the urethra, Avhich was red and  tumefied at the mea-
tus, did not appear ulcerated.   The matter of the  discharge Avas very
copious, and of a yellowish green color;  it was inoculated by two punc-
tures made on the right thigh;  twenty leeches were  applied to the  peri-
naeum, and pil. opii c. camph. prescribed.
  8th. The inoculated punctures had  produced  nothing; the emulsion of
copaiva and injections of nitrate  of silver Avere  ordered.   10th. The pain
on  passing the Avater had ceased;  the discharge was Avhitish.   12th.
Patient better; an enema of sulphate of magnesia was prescribed for the
constipation.   18th. The gonorrhoea  was almost cured; an emulsion of
copaiva was ordered, and in a few days the patient left cured.

  Case XII.  Acute urethral gonorrhoea; inoculation unsuccessful.
  Vas----, aged 19, entered July 5, 1836.  The  disease appeared four
days before, after  a suspicious  intercourse;  at  first the patient  had felt
acute pains in urinating, and the discharge became very copious.   On
entering, the blenorrhoea was still in  the acute stage; the patient suffered
much; the muco-pus was bloody and  greenish, and  the mucous membrane 
      PRACTICAL OBSERVATIONS—INOCULATION  OF BLENORRHCEA.  133

of the urethra appeared  superficially excoriated ;  the canal was tense, but
not indurated ; pressure caused some pain.
  July 6th. The blenorrhoeal pus Avas inoculated by two punctures on the
left thigh; the pil. opii. camph. were ordered, with thirty leeches to be
applied to the perinaeum, and an enema with tAvo ounces of mel. mercur.
10th.  The inoculated punctures had produced nothing; the  blenorrhoea
was less painful, and the discharge less decidedly marked Avith streaks of
blood.  The pills Avere continued, and injections of nitrate of silver ordered
for the following day. 15th.  The gonorrhceal pus was again inoculated, in
the same manner as before, on the left thigh.  The matter of the discharge
appeared modified in a remarkable manner;  its color was whitish,slightly
tinged Avith yelloAV.  The pain having entirely disappeared, the pil. camph.
were discontinued ; the  injections  were  continued, and  copaiva in bolus
form  Avith magnesia was added.  17th. The discharge had  decreased;
the inoculated  punctures had produced nothing.   21st.  Only a  little
mucous secretion remained ;  and by the 27th, the patient was cured and
left the hospital.

  Case XIII. Acute urethral blenorrhoza ; inoculation without result.
  Bic----, aged 17, entered  April 12, 1836.  The blenorrhoea, witliAvhich
this patient Avas  affected, appeared two days after exposure;  the course
of the disease  had been very acute  and painful; by rest and the use of
baths, the acute stage had disappeared;  copaiva had been given, and the
discharge  had stopped;  but  in consequence  of the fatigue of a journey,
undertaken just as the disease  had ceased, the discharge reappeared very
copiously, of a whitish color, and occasioning very little pain.   The above
named day was the third from the return of  the  blenorrhoea;  the mucous
membrane, on  separating the lips of the meatus, appeared excoriated; the
passing of the urine occasioned at this point severe  smarting;  the  patient
had chafed himself in using the syringe;  the gonorrhceal pus was inocu-
lated by two punctures on the right thigh.  Injections  of sulphate of alum
were ordered.
  22d. No result from the inoculated punctures; the discharge had much
diminished ; the redness of  the meatus  had  disappeared.  The potion de
Chopart was  prescribed. 27th. The discharge  had nearly disappeared
the potion was continued.  The patient left cured on the 29th.

  Case XIV.  Urethral blenorrhoza ; inoculation unsuccessful.
  Lau----, aged 26, entered Dec. 16, 1836.   This disease Avas  of three
weeks' standing; in the beginning  of it, there had  been  much pain and a
chordee.   No induration was perceptible in the canal  of the urethra, nor
pain upon pressure;  but there was a slight  itching during the emission
of the urine;  the matter of the  discharge  was whitish.  An  indolent
turnor was perceived in the  left groin.
  17th. The gonorrhoeal pus Avas inoculated  on  the left  thigh ; injections 
 34        CLINICAL  AND EXPERIMENTAL  RESEARCHES—

of nitrate of silver, a fourth of a grain to the ounce of water, Avere ordered,
19th.  The inoculated puncture had  produced nothing; the discharge Avas
less;  cubebs were ordered, four drachms daily; the injections were con-
tinued;  a fresh inoculation of the muco-pus Avas made on the right thigh.
20th.  The  inoculated  puncture was unsuccessful;  the  blenorrhoea only
furnished a very mucous matter mixed wita streaks of pus. The left thigh
was inoculated. 24th. The last inoculated puncture had produced nothing;
there  was no more discharge from  the blenorrhoea; the ganglionary en-
gorgement had  not progressed.  The patient left cured on the 29th.

  Case XV. Urethral blenorrhoza ; inoculation without result.
  Blan----, aged  17, entered June 20, 1835,  had been three weeks affected
with blenorrhoea; eight days  previous, without any appreciable cause, a
bubo appeared 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.  Nothing had been done for the patient; leeches Avere  placed
upon  the bubo, Avhich presented no  point of  suppuration, and the progress
of which had been sub-acute.
  24th.  The blenorrhoeal  pus was  inoculated  on the right thigh; injec-
tions  of sulphate of zinc were ordered, and mercurial frictions  made upon
the bubo, which was very hard.   28th.  The inoculated punctures had pro-
duced nothing; there remained but little discharge from the blenorrhoea;
the bubo Avas  somewhat  resolved.   July 10th.  The bubo, to which com-
pression had been applied, had quite disappeared, and there had been no
discharge for six days : the patient was discharged cured.

  Case  XVI. Acute urethral blenorrhoza ; inoculation without result.
  Andr----, aged 26,  entered Aug.  16, 1836. This patient could not ex
actly  fix the time at which the blenorrhoea had commenced ;  only he re-
marked that eight days after the last sexual connexion he had suffered
much, and  that the discharge had greatly increased.  At the time of en-
trance the  blenorrhoea Avas in the acute stage; and the discharge was
bloody and thick.   Twenty leeches  were applied to the perinaeum, and an
enema Avith mel. mercur. was administered.  The  blenorrhoeal  matter Avas
inoculated  by two punctures  on the right thigh.   19th. The inoculated
punctures had healed; camphorated pills were ordered ; but little pain re-
mained  ; a cauterization was made with Lallemand's caustic holder. 21st.
Little discharge remained; injections of nitrate of silver were ordered; and
the patient left cured on the 30th.

  Case  XVII.  Acute urethral blenorrhoza ; inoculation without result.
  Dan----, aged 25,   entered Nov. 11,  1836,  had been  affected with
blenorrhoea eight days after  exposure;  at first it Avas very painful;  the
canal of the urethra  tense, and very painful on being touched, presented
all the  symptoms of  a chordee; the acute stage was in its  greatest in- 
     PRACTICAL  OBSERVATIONS—INOCULATION OF BLENORRHCEA.   135

tensity;  the matter of the discharge Avas greenish and bloody ; hoAvever,
upon separating the lips  of the swollen meatus urinarius, no ulceration
was perceived ; neither was there any induration in the Avhole course of
the  urethra, but  a general tension; there was a large indolent  engorge-
ment in the  left groin; but the patient said it existed before  the blen-
orrhoea.
  12th. The blenorrhoeal  pus was inoculated on the right thigh ; twenty
leeches were applied to the perinaeum ; two pil. opii camph. were ordered,
with fomentations of decoct, malvae.  15th.  The patient suffered  less; the
discharge Avas less bloody, and  the erections less frequent; the  engorge-
ment in the groin remained stationary; the inoculations had healed.  The
blenorrhoeal pus Avas 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 Avater,
were ordered.
  18th. The inoculated punctures of the 15th had produced nothing ; the
blenorrhoea discharge was less copious and without pain; the matter of the
discharge was whitish.  The injections were continued, and four drachms
of cubebs were ordered.   Dec.14th. The patient left cured.

  Case XVIII. Urethral  blenorrhoza ; inoculation unsuccessful.
  Ceint----,  aged 24, entered  July 18, 1836.  This  patient had  been
affected Avith  a blenorrhoea eight days; it appeared six days  after ex-
posure ; the discharge began without pain, and  on the above named day
the disease appeared like blenorrhoea.  On separating the lips of  the mea-
tus urinarius, which was a little red and SAVollen, the mucous membrane
was found to be slightly eroded; the discharge Avas slightly streaked  Avith
blood;  there Avas no induration in  the  canal;  only at the depth of two
inches there was a point painful to the touch.  19th.  The urethral secre-
tion was inoculated on the left  thigh; copaiva was prescribed, and injec-
tions of arg. nitr.  20th.  The inoculated punctures had healed  ; the dis-
charge was much diminished;  a cauterization with nitrate of silver was
ordered.   21st. The injections and copaiva were resumed ; and the patient
left on the 24th cured.

  Case XIX. ■  Acute urethral blenorrhoza ;  inoculation unsuccessful.
  Guil----, aged 24,  entered May 13, 1836.   The affection had existed
eight days, and had been very painful in the beginning; now, the discharge
was very copious and bloody.  14th.  The blenorrhoeal pus tinged with blood
was inoculated on the right thigh; twenty leeches were  applied to the
perinaeum. 17th.  The inoculated puncture had healed ;  the acuteness of
the blenorrhcea Avas much diminished ;  the patient had no more pain on
passing his water. Injections of nitrate of silver were ordered.  19th. Cu-
bebs Avere ordered, two drachms three times a day.  20th. There had  been
a little  diarrhoea;  cubebs  Avere ordered with sirup, diacod., and  the injec- 
 136        CLINICAL AND  EXPERIMENTAL RESEARCHES---

tions of nitrate of silver were continued.  The cure being complete, June
3d, the patient left.

   Case XX.  Acute urethral blenorrhoza ; inoculated unsuccessfully.
  Kel----, aged  22,  entered May 31,  1836.  The affection had  lasted
tAvelvedays; it appeared three days  after exposure, and from the com-
mencement it had occasioned very violent pains, both  on urinating  and
during the  erections.   The  matter of the  discharge Avas greenish  and
bloody;  on separating the lips of the  meatus urinarius, some superficial
erosions Avere perceived in the canal; leeches were applied to the perinae-
um; camphor pills were ordered, and the blenorrhoeal pus was inoculated
on the left thigh.
  June 4th.  The inoculated  punctures had produced nothing; injections
of nitrate of silver were prescribed.
  8th. The  gonorrhoea was  much decreased; the bolus of copaiva was
prescribed.   The patient left  cured on the 22d.

   Case  XXI.   Acute urethral blenorrhoza ; inoculation unsuccessful.
   Leg----, aged 18, entered  May 31,1836.  Three days after a suspicious
intercourse, this patient felt very acute pain in urinating, and a very severe
blenorrhoea showed itself.   Eight days later, he came to the hospital; the
discharge Avas puriform and greenish; he suffered much, both  during the
emission of his urine and in the erections.
   June 1st. The blenorrhoeal pus was inoculated  on the right thigh ; five-
and-tAventy leeches were applied to the perinaeum, and two pil. opii camph.
were ordered.   4th. The inoculation had produced nothing; the pain Avas
someAvhat  less;  injections of nitrate of silver, a quarter of a grain to the
ounce of water, were  ordered, and the pills to be continued.  10th. The
discharge Avas Avhitish and free from pain;  a cauterization Avas made with
nitrate of silver, by means of the caustic  holder.  12th. Scarce any dis-
charge remained, and the  patient left on  the 20th.

   Case XXII.  Urethral blenorrhoza with  erosion ;  inoculation unsuccessful.
   R----, aged 22, entered Oct. 7,  1836.  The affection  had existed seven-
 teen days;  at first, the pain was very acute.  The patient had had all the
 symptoms  of  the  most intense blenorrhcea with  chordee.  The pain was
 still very acute; the matter of the discharge was purulent and bloody; the
 lips of the meatus were eroded, as well  as the urethra, as far as could be
 seen; the canal appeared to the touch as if stretched on  a probe; but there
 was no particular point indurated.  Twenty-five leeches were applied to
 the perinaeum, and two pil. opii camph. were prescribed.
   8th. The pus taken from  the meatus urinarius was  inoculated ; injec-
 tions of argent, nitr. were ordered.  9th.  The  discharge appeared a littJ"
 modified; the pain Avas much diminished.  10th.  The inoculation had pro 
      PRACTICAL  OBSERVATIONS—INOCULATION OF  BLENORRHCEA.   137

duced nothing; the injections were continued,  and four drachms of cubebs
were ordered.   18th. The blenorrhoea, which was much better, and the
discharge, Avhich was whitish, and flowed without pain, had returned to the
acute stage, in consequence of the imprudence of the patient, who had drunk
tAvo glasses of wine. The injections were suspended and the pills continued.
19th.  The acute symptoms had yielded; the whole surface of the urethra
was cauterized Avith argent, nitr. Avith Lallemand's porte-caujstique.  21st.
The discharge was modified and much diminished; the pills Avere con-
tinued.  24th. The discharge had nearly ceased, and a fresh cauterization
was made, and, Nov. 11th, the  patient left quite cured,

  Case XXIII.  Urethral  blenorrhoza ;  inoculation  without success.
  Fin----, aged 19, entered April 19, 1836.  Eight days after a suspicious
intercourse, this patient became affected with a blenorrhoea, Avhich at first
was very  painful.   The acute stage still  existed;  the erections were very
frequent and  painful.   TAventy-five leeches were applied to the perinaeum;
the boAvels being confined, a bottle of Seidlitz water was ordered.
  27th. The pains had disappeared; the erections had yielded to the pil.
camph.;  the discharge Avas not  very  abundant;  but it contained  much
greenish pus, some of which Avas inoculated on the right thigh ; injections
of nitrate  of silver were ordered.
  29th. The inoculated puncture had produced no  result; the discharge
had become whiter.
  May 10th. There was n<j more discharge from the blenorrhoea, and the
patient left on-the 24th.

  Case XXIV.  Acute urethral blenorrhoza ; inoculation unsuccessful.
  Pay----, aged 21, entered July 5, 1836.  Six days after a suspicious in-
tercourse, this patient was attacked with a blenorrhoea which had caused
him much pain.  When he entered the hospital,  eight days  after the dis-
charge appeared, the matter was greenish, and the emission of his urine
was painful.   Twenty  leeches Avere applied to the perinaeum, and an enema
of the magn. sulph. was ordered.
  July 8th. The pus of the blenorrhoea Avas inoculated on the right  thigh.
11th. The puncture had produced nothing; the discharge was less copious,
and the pain of urinating was less; injections of arg. nitr. were prescribed,
in the dose of a quarter of a grain to the ounce of water.   14th. The mat-
ter of the discharge Avas whitish  and almost  serous; the injections were
 continued, and two drachms of cubebs twice a  day ordered. This treatment
 vas continued till the  27th, when the patient left quite cured.

   Case XXV.  Acute urethral blenorrhoea ;  inoculation unsuccessful.
  Dub----, aged 18, entered Oct. 24, 1835.  Five  days after  a suspicious
intercourse, this patient was attacked with blenorrhoea, the discharge from
which had gradually increased, and at the time of  his entry had become
                                   18 
138        CLINICAL AND EXPERIMENTAL RESEARCHES-

very copious.  The patient felt acute pain  on urinating, and had taken no
medicine; the discharge was greenish and bloody; no induration was to
be perceived in the canal of the urethra.
  Oct. 26th. The blenorrhoeal 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 Avith decoct, malvae.  27th.  The inoculated  points were
slightly reddened.  The treatment was continued.   28th. The  two punc-
tures Avere cicatrized ; the inoculation had  produced no result.
  Nov. 1st.  The inflammation was  decreased.  2d. A  fresh inoculation
was made by two punctures on the  right thigh; the discharge Avas still a
little bloody.   6th. The inoculation of the  2d having produced no result, it
was repeated  on the left thigh.  8th. The punctures  were  cicatrized-
Emulsion of copaiva was prescribed, AAUth injections of nitrate of silver. On
the 25th, the patient left cured.

  Case XXVI.  Urethral blenorrhoza become acute ;  inoculation  unsuccess-
ful.
  Lien----, aged 22, entered June 28, 1835.  For six weeks  this patient
had been affected with a blenorrhoea, which he appeared  to have renewed
several times.   He had never taken medicine; a few days  rest, and a warm
bath or two, had removed  the acute and brought back the chronic stage. On
entering, the discharge was very copious, inconsequence of some excesses;
he had pain  in urinating,  and  the bowels were constipated.  The  blenor-
rhoeal pus was inoculated on the left thigh; a bottle of Seidlitz water, cau-
terization Avith arg. nitr. and pil. camph. were prescribed.
  July 18th. The discharge had much decreased; the  inoculated puncture
had produced nothing; four drachms of cubebs were ordered.  The patient
was dismissed in a feAv days;  eight days afterwards he came to  the hospi-
tal, and the discharge had  not returned.

  Case XXVII.   Balanitis, acute urethral blenorrhoza ; inoculation unsuc-
cessful.
  Gui----, aged 27, entered Nov. 1, 1836,  had contracted an acute blenor-
rhoea six  Aveeks previous, for Avhich he was not treated. Three weeks
later, after fatigue, a balanitis, favored by a natural  phimosis,  developed
itself.  Now the blenorrhoea Avas in the acute stage, in consequence of an
inflammation  which had  lasted eight days;  the purulent secretion was
much  increased; the pains were very intense during the emission of his
urine; there Avas no induration in the canal of the urethra; the discharge
was a little tinged with  blood.  The balanitis appeared super-excited;
some very red  spots Avere perceived on the glans, marking  the points which
were deprived of the epithelium.
  4th. The pus from the  blenorrhcea was  inoculated on the left thigh by
 wo punctures; injections of aq goulard. were ordered for the blenorrhrpa. 
      PRACTICAL OBSERVATIONS—INOCULATION  OF BLENORRHCEA.  139

12th. The inoculated punctures had produced  nothing.  A fresh inocula-
tion of the blenorrhoeal pus was made on the right thigh ; thebalanitis was
cauterized with argent, nitr. by carrying the  caustic around betAveen the
glans and the prepuce;  some fine lint was then introduced to  prevent the
contact of the mucous surfaces.  The urethral surface was cauterized with
nitrate of silver, by means of the caustic holder.  18th. The balanitis had
disappeared,  and but little discharge remained.  The punctures inoculated
on the 12th had produced nothing ;  the urethral cauterization was con-
tinued; four  drachms of  cubebs per diem were prescribed.  24th. The
urethral discharge no longer presented  the characters of a mucous super-
secretion;  on the 30th, the patient left quite cured.

  Case XXVIII.   Utero-vaginal blenorrhoza, ulceration of the cervix uteri;
inoculation unsuccessful.
  Sal----Caroline, aged 28, entered June 16, 1835.  For seven years this
patient  had been affected with a discharge which  had several times re-
lapsed into the acute stage;  she had  often  communicated blenorrhcea, but
never chancres;  moreover, she stated she  had  never perceived any such
ulcers on herself.  She had never had any symptoms which could be attri-
buted to a secondary syphilitic affection.   Now, the blenorrhoeal discharge
was very abundant and of a greenish color; on examining the sexual or-
gans Avith the speculum, a purulent secretion Avas 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 tumefac-
tion of the follicles.   Some pus was taken from  the ulceration of the com-
missure 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.
  19th. The inoculations had produced nothing;  the discharge was whitish,
and indicated a tendency to return to the chronic stage.  24th.  On examin-
ing with the  speculum, the  vagina was  pale; the granulations had disap-
peared ; 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.   27th. Little discharge re-
mained ; the  superficial ulcer of the posterior lip of the cervix  had disap-
peared,  and the epithelium had become smooth.   29th. All was cured: the
patient left the  hospital.

  Case XXIX.  Utero-vagmal blenorrhoza, ulceration of the cervix, inocu-
lated without result.
  Plais----Anne, aged 39, entered July  21, 1835.   The disease commenc-
ed two years previous, at which  time a chancre at the anterior  part of the
vulva and a blenorrhcea appeared ; the chancre was dressed with ung. mer 
140        CLINICAL AND EXPERIMENTAL RESEARCHES'---
and cerat. saturn., and cured after two months treatment; three  months
 ater, a lenticular syphilide showed itself, but disappeared after a month's
treatment with  pills  of iodid. mercur., sudorific sirup, and tisane.  On en-
tering, she had a  blenorrhoea, which, without completely stopping, had
frequently become again acute.  In examining with the  speculum, a copi-
ous utero-vaginal discharge was found; the cervix presented several points
Avhich were deeply eroded, and  whose surface was grayish and  covered
with an albuminous  adhering secretion.   Injections  and  tampooning Avith
decoct, alb. were ordered.
  Aug. 5th. The discharge had decreased, but the ulcerations of the cervix
were nearly in the same state.  Some pus was taken from their surface
and inoculated on the right thigh; a general cauterization  Avas then made
Avith argent, nitr.  The injections and tampooning were  continued.  12th.
The inoculation made on  the 5th had produced  nothing;  a fresh cauteri-
zation was made with arg. nitr.
  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.  25th. But little discharge remained;  the injections and  tampooning
were continued.  31st.  The mucous membrane of the vagina was pale and
healthy; all the surface of the cervix presented a smooth and well-organ-
ized epithelium. The patient left the hospital cured.

  Case  XXX.   Urethral  blenorrhoza, epididymitis; inoculation  without
result.
  Eno----, aged 21, entered June 6, 1835.  The blenorrhoea had in this
case lasted a month; it appeared eight days after a suspicious connexion;
during the first  part of the time, the complaint proceeded Avith great acute-
ness and occasioned violent pain, which soon disappeared, the patient hav-
ing submitted to a strict diet and perfect rest; a fortnight after the appear-
ance of a  blenorrhoea, he had recourse  to the treatment  with Armenian
bolus and  sarsaparilla;  at first the  discharge decreased  a little, but an
obstinate constipation soon followed; the urine became red; at length, to
use the expression of the patient, he was seized Avith a great heat, follow-
ed by an epididymitis, which  induced him to come to the hospital.   We
then found but little discharge, which  was  slightly tinged with green;
there Avas no induration in the canal, nor  pain in passing his urine, nor on
pressure; on the right side there Avas an acute epididymitis ; the affection
was only sympathetic; the spermatic cord and testicle were healthy, but
the epididymis was four times its usual  size;  thirty leeches were placed
upon the course of the cord and an opiated cataplasm applied to the scro-
tum.  A bottle  of Seidlitz Avater was prescribed to evacuate the rectum.
  8th. The acute symptoms of the  epididymitis had somewhat abated;
nowever, twenty-five leeches Avere applied to  the course  of the cord ;  fric-
tions of half a drachm of  ung. mer. were  made upon the  scrotum.   The 
      PRACTICAL  OBSERVATIONS---INOCULATION  OF BLENORRHCEA.  141

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.   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.  21st. Only an
indurated knot remained on the epididymis; the treatment was continued.
Little discharge remained; four drachms of cubebs were ordered.  27th.
Compresses imbibed with decoct, alb. were applied to the scrotum.  The
injections Avere  suspended  and the cubebs continued.   July 11th, he left
cured.

  Case XXXI.   Urethral  blenorrhoza, epididymitis;  inoculation without
result.                    ,
  Mor----Edouard, aged  18, entered Oct. 10, 1835.   This patient, who
Avas affected Avith a blenorrhoea, the commencement of Avhich could not be
accurately determined on account of the numerous relapses Avhich had
occurred, entered the hospital to be cured of a sympathetic epididymitis,
Avhich had followed an excess at table.  At the time of his entry, the blen-
orrhoeal discharge Avas nearly suppressed from the irritation of the epididy-
mitis, and only in the morning a few drops of a whitish matter Avere per-
ceived at the extremity of the penis;  leeches Avere applied along the course
of the cord, and  cataplasms to the scrotum.
  17th. The inflammation of the epididymis was much diminished, but
the blenorrhcea  had reappeared in a large quantity; injections of acetate
of lead were ordered, and  mercurial frictions made on the testicle.  28th.
The blenorrhoeal pus was inoculated  on the left thigh.  30th. The punc-
ture had produced nothing; the injections were continued, and copaiva in
bolus Avas ordered.   By Nov.  the  20th, the patient was cured and left the
hospital.

  Case XXXII.   Urethral blenorrhoza, sympathetic epididymitis; the pus
of the blenorrhoza inoculated unsuccessfully.
  Resk----Nicolas, aged 21, entered May 24th, 1835.   This patient had
been  affected with a blenorrhcea  for two months; it "had appeared tAvo
days after a connexion, and at the commencement Avas very painful; the
patient had been under no treatment; an epididymitis  had appeared four
days  before  his  entry.  We  found the discharge whitish and  small  in
quantity; it had nearly disappeared  on  the  second day after the develop-
ment of the epididymitis;  the cord was healthy, thirty leeches Avere ap-
plied on its course;  frictions with ung. mercur. and applications of cata-
plasms Avere made to the testicle.
  June 8th.  The epididymitis was far less intense; the blenorrhoeal dis-
charge had again become copious;  some of the pus was inoculated  on the
right  thigh, and injections of acet. plumb, with bol. copaiv. Avere prescribed. 
142        CLINICAL  AND  EXPERIMENTAL  RESEARCHES---
 32th. The inoculation of the blenorrhoeal pus  Avas unsuccessful, and  the
 patient left cured on the 27th.

   Case XXXIII.  Urethral blenorrhoza and sympathetic epididymitis; the
 blenorrheal pus inoculated unsuccessfully.
   Pap----Julien, aged 18, entered May 30, 1835.  The blenorrhoea had
 lasted six weeks; it first appeared eight days after a suspicious connexion;
 about a Aveek previous to his entry, an  epididymitis appeared on  the left
 side, in consequence of over exertion;  the  patient suffered much at  the
 commencement; he had colic, nausea, and headache.   Upon his entry Ave
 found  the testicle little developed,  the epididymis large, but with  little
 tension; the  cord was healthy.  TAventy leeches were ordered to  be  ap-
 plied along the course of the cord, and cataplasms; for the blenorrhoea,
 injections of sulphate of zinc; but previous to  any treatment,  the Avhitish
 pus proceeding from the urethra Avas inoculated on  the right thigh.
   June  8th. The puncture had produced nothing;  a fresh inoculation was
 made on the  left thigh. Haifa drachm of ung. mercur. was rubbed  in on
 the testicle.  9th. There was a great improvement; the copaiva bolus was
 prescribed.   10th.  The inoculated  punctures had produced nothing- and
 the patient being cured, left on the 20th.

   Case XXXIV.   Utero-vaginal  blenorrhoza,  bleeding ulceration of the
 cervix ; inoculation unsuccessful.
   Bu----Sophie, aged 19, entered July 28, 1835.   A  fortnight previous,
 this patient perceived a copious discharge and smarting of the vulva.  Now,
 examination with the speculum showed the existence of a purulent uterine
 catarrh; the  vagina presented here and there some red and seemingly  exco-
 riated spots;  on the anterior and internal surface of the posterior lip of the
 cervix,  a  bleeding ulceration  was discovered.   The  pus  collected on its
 surface was inoculated on the right thigh.  30th. The inoculation had not
 taken; the ulceration of the cervix was cauterized with arg. nitr. and in-
 jections and tampooning with decoct, alb. were ordered.
   Aug.  6th.  The discharge was much diminished.  A fresh cauterization
 and the same treatment as before were ordered. On the 26th, the patient
 left cured.

   Case  XXXV.  Urethral blenorrhoza, indurated bubo ;  inoculation unsuc-
cessful.                                                             »
  Jac----, aged 18, entered May 10, 1836.   This patient had been affect-
ed with blenorrhoea for two months, generally of an indolent character.
A fortnight previous to her entry, a bubo appeared 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 blenorrhoeal pus was inoculated with  tAvo punctures on 
      PRACTICAL  OBSERVATIONS—INOCULATION  OF BLENORRHCEA.  143

the right thigh ; compression and compresses dipped in decoct, alb. were ap-
plied to the bubo ; for the blenorrhoea, the cubebs and iron in doses of four
drachms per diem were given.  16th. The inoculated punctures had pro-
duced nothing.  The bubo seemed  to vanish;  the blenorrhoeal discharge
had decreased.  18th. The bubo and  discharge had  nearly disappeared
On the 24ih, the patient left quite cured.

  Case XXXVI.   Urethral blenorrhoza, sympathetic bubo ; inoculation un-
successful.
  Br----, aged 32,  entered July 11, 1835.  This  patient had for  three
months been afflicted with a blenorrhoea, which  was very painful in the
commencement, and  for which he had received no treatment.  Six weeks
previous, a bubo had developed itself in the left groin; its progress had
been sub-acute, but it was suppurating.  The blenorrhoea had caused a co-
pious Avhitish  discharge;  there Avas 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 appeared to be an  indurated  engorgement,
embracing some of the deep-seated ganglions.
   12th. The bubo was opened, and cataplasms applied to it.
   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.   19th. None of the
inoculated punctures  had taken; the blenorrhoea remained little decreased.
21st.  There was much pus from  the bubo;  but  its base was a little di-
minished ; the treatment was continued.  For the blenorrhoea, tAvo drachms
of the copaiva bolus per diem Avere added  to the  injections.  30th. There
remained but little induration around the bubo, Avhich had nearly disap-
peared, as well as the blenorrhoeal discharge.   The treatment was con-
tinued.          '
  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 blenorrhoza, lymphitis and sympathetic bubo,
inoculation without result.
  Nob----, aged 20,  entered Jan. 3,1836.  This patient had a  blenorrhoea
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 toAvards the groin ; at the
same  time a bubo developed itself.  Till the above day, no treatment had
been  used;  the blenorrhoeal discharge  was copious, and the matter of a
greenish Avhite color.  The red line from the lymphatic had nearly disap-
peared, but the vessel appeared indurated to the touch.   The ganglionary
'  --"msnt was verv indolent and made no progress. 
144         CLINICAL  AND EXPERIMENTAL RESEARCHES-
  4th.  The blenorrhoeal pus was inoculated on the right thigh.
  8th.  The inoculation was ineffectual, and it Avas repeated.   18th. Th«
inoculation made on the 8th had produced nothing.   Cataplasms were
applied to the bubo,  as the patient had  felt some  pain.  23d. Injections
of iodide of iron Avere ordered; half a drachm to eight ounces of wajer.
  Feb. 10th.  The discharge was somewhat less;  the dose of the iodide
of iron Avas increased to a drachm to the same quantity of Avater.  13th.
The discharge still remained; the matter was still muco-purulent.  The
iodide  Avas increased to tAvo drachms.   17th. Only a mucous discharge
remained; the patient felt no  pain in the canal.   The  iodide  was in-
creased to three  drachms to the eight ounces of water.
  March 3d.  The patient was dismissed cured.

  Case XXXVIII. Urethral blenorrhoza*, sympathetic bubo ; inoculation of
the blenorrhoza unsuccessful.
  Mel----, aged 20, entered Aug. 30,  1836.   The blenorrhoeal  affection
had lasted eighteen  months; the patient had undergone no treatment;
three weeks previous to his entry, eight  days after a connexion and ex-
cesses  at table, an indolent bubo appeared on the right side. Blisters Avere
ordered to be applied to the bubo,  and dressings of sublimate, twenty
grains to the  ounce of water.
  Sept. 10th. The pus of the blenorrhoea was inoculated on the left thigh.
16th. The puncture made on the 10th had produced nothing;  the bubo had
much decreased  under the influence of the blisters and dressings of sub-
limate.  Injections of iodide of iron Avere ordered for the  blenorrhoea.
22d. The discharge  had ceased; the bubo had nearly disappeared,  and
on the 27th the patient was dismissed cured.

  Case XXXIX. Urethral blenorrhoza, sympathetic bubo ; inoculation un-
successful.                                         •
  Des----, aged 32,  entered Nov. 1, 1836.  This patient had been affected
with a blenorrhcea two  months previous, Avhich had soon yielded to an-
tiphlogistic treatment.   Six  Aveeks  before his entry, after some  very
fatiguing Avork, a bubo appeared in the  left groin; its progress was sub-
acute,  and it opened  spontaneously some  time previous to his entry into
the hospital, at which time the blenorrhcea Avas 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.
  2d.  The pus collected at a point, which seemed in the ulcerated stage,
was inoculated  on the right thigh;  the canals were divided, and some
flaps of skin taken  away.  4tn. The inoculated puncture had produced
nothing;  the bubo was cauterized and dressed Avith aromatic wine.   8th
Cataplasms and ung. mercur. Avere applied to the bubo.  By the 18th the
patient Avas cured and left the hospital 
      PRACTICAL OBSERVATIONS---INOCULATION  OF BLENORRHCEA.  145

  Case XL.  Urethral blenorrhoza, sympathetic bubo ; inoculation unsuc-
cessful.
  Chauv----, aged 28, entered April 19,  1836.   The blenorrhoea had
lasted nearly tAvo months, and the bubo a fortnight.  We found a copious
whitish discharge; the patient felt no pain on passing his Avater; the pu3
from the urethra was  inoculated.   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 blenorrhoea Avas continued.   7th.  The puncture  made
with the pus from the urethra had produced nothing; the blenorrhcea had
disappeared.   The patient left cured on the 17th.

  Case XLI. Urethral blenorrhoza, followed by a ganglionary engorge-
ment ; unsuccessful inoculation of the blenorrhoeal pus.
  Col----,  aged 22,  entered May 31, 1836.  Eight days after a con-
nexion,  this patient was affected Avith an  acute  blenorrhoea,  for which
he was not treated.   On entering,  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 Avas a slight ganglionary engorgement
on the left side, Avhich had not increased in the last month.
  June 3d.  The blenorrhoeal  pus was inoculated on the right thigh ;
injections of arg. nitr.  and two drachms of cubebs night and morning were
ordered.   10th. The blenorrhoea  had nearly disappeared ;  the inoculation
was unsuccessful; the  injections  and cubebs Avere continued.   July 1st,
the patient left cured.

  Case XLII. Urethral blenorrhoea, indolent buboes; inoculation  of  the
blenorrhoeal pus without result.
  Ferr----,  aged 22, entered Sept.  19, 1836.  The blenorrhoea had been
contracted a month previous;  it developed itself eight days*after  a con-
nexion.   At  first very painful, it  soon  became chronic; two sub-inflam-
matory buboes developed themselves on the right and left, and were noAV
very large.   The patient had never had chancres; no traces of any cica-
trized ulcerations Avere to  be seen upon the  penis; the blenorrhoeal dis-
charge was  very copious.   Prescription:  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. 21st. The blenorrhoeal pus was inoculated on the right  thigh, be-
fore commencing the  treatment.  24th. The punctures were cicatrized.
29th. The buboes were much  decreased; a fourth blister was applied;
four drachms of cubebs per diem Avere given, and by the 12th  of Oct. all
was well.
                               19 
146        CLINICAL  AND  EXPERIMENTAL  RESEARCHES---

  Case XLIII.  Urethral blenorrhoza ; inoculation unsuccessful.
  Del----Leon, aged 17, entered May  3, 1836.  This patient Avas for the
first time affected Avith a  blenorrhoea,  two months and a half before 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, Avithout sexual intercourse or having committed any excess,
the blenorrhoea reappeared, but  without pain.   Prescription : injections
of arg. nitr. one grain to four ounces of water.  The blenorrhoeal pus Avas
inoculated on the right thigh.
  6th. The punctures had produced nothing.  Prescription: injections of
nitrate of silver; cubebs in tAvo drachm doses night and  morning.  The
patient was dismissed cured May 9th.   A week later, he  presented  him-
self again at the hospital, Avhen the blenorrhoea had not returned.

   Case  XLIV.  Blenorrhoza;  chancre from  a  new  infection;  urethra
genital blenorrhcea ; 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  blenorrhoea in  the beginning  of February.  After  tAventy days in the
acute stage,  the affection became chronic without any treatment;  from
that time the patient,  Avho  thought she had only an  increased secretion
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 blenorrhcea, she determined to come to the hospital
to be treated  for some  chancres which she had contracted about  a Aveek
previous.  We found confluent chancres at the entrance of the vulva, and
a very copious discharge.   By examining Avith the speculum  it was found,
that the acute blenorrhoea 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,  but not  eroded;  the mucous
membrane of the vagina was red and granulated ; the cervix, over which
the pus of the  uterine  blenorrhoea passed, presented at the os tunica, the
anterior and posterior labia, deep ulcerations, having the appearance of
chancres; their base was covered with a pultaceous  grayish membrane;
at  the commissure of  the labia  on the left,  there was a superficial granu-
lated ulceration, penetrating into the cavity  of the cervix.
   17th.  A bath and emollient injections Avere ordered.  20th. The  chan-
cres of the vulva were dressed with calomel and opium cerate.  23d. The
speculum was applied, and the cavities of the uterus and cervix Avere cau-
terized; the  nitrate of .silver  Avas applied to the ulcerations, then carried
gently over the surface of the cervix and vagina; the patient felt no pain
upon the application of the caustic; the vagina was lampooned with dry
 lint. 24th. The discharge had become much less since the cauterization. 
      PRACTICAL  OBSERVATIONS---INOCULATION  OF BLENORRHCEA.  147

25th.  The matter of the discharge was less charged with pus; the u.cer-
ations of the cervix had nearly freed themselves of the pulpy crust Avhich
covered their surfaces.   Injections of decoct, alb. had been ordered on the
preceding day.  30th. The chancres of the vulva appeared to tend towards
the period of reparation; the erosions of the cervix presented a rose-coloreo
base,  covered with granulations; the suppuration Avas very active on their
surface; the  edges were no longer raised ; pus taken from the posterior
labium Avas inoculated by two punctures on the right thigh; a  general
cauterization Avas then made Avith the nitrate of silver, and tampooning
with  dry lint was performed.
  July 7th.  The discharge  had  much  decreased ;  the  surface of iiri
vagina  appeared  healthy, and  no  longer red or granulated;  the mucus
which passed over the. cervix was transparent; the ulcerations of the
posterior lip were almost level with the  surrounding parts;  their surface
Avas  in full progress towards  reparation, they still furnished much pus ;
the anterior  lip Avas cauterized ; only an ulceration  covered Avith granu-
lations  remained; that of the commissure had disappeared  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 mucus.  Some
pus was taken from the ulceration of the posterior lip of the cervix, and
inoculated in two places on the inner part of the left arm of a healthy in-
dividual ; then some  of the pus was  inoculated on the left thigh of the
patient.  The inoculation made June 30th had produced nothing.  By the
aid of the speculum, a general cauterization was made, particularly upon
the ulcerated points.
  July 10th.  The inoculations made upon the healthy individual had pro-
duced nothing, nor had that  made upon the thigh of the patient.  The
discharge had  nearly  ceased;  injections  of decoct, alb. were ordered.
17th. An examination was made with the speculum; the  ulcerations 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 blenorrhcea with superficial erosion
of the cervix ; inoculation unsuccessful.
  Gentil----Marguerite, aged 19, entered May 19, 1835.  The affection
had lasted four months; chancres appeared at the orifice of the vulva, and
also  a copious blenorrhoeal discharge; a fortnight later, buboes appeared
on  each side; their progress Avas acute;  they were opened, and then as-
sumed  the appearance of  symptomatic  buboes.  We found the chancres
and buboes in the period of reparation ;  the matter of the discharge was
greenish and charged Avith pus.  The speculum being applied, the cervix
was seen to be eroded  at several points, as in some cases of balanitis;  the
varina was red,  and  covered  with a thin purulent secretion ; the mucus,
proceeding from  the uterus, appeared transparent.   The granulated sur-
face  of  the chancres was cauterized, as  well as  the  buboes, which were 
148         CLINICAL AND EXPERIMENTAL RESEARCHES'—
also in the period of reparation; dressings of calomel and  opium cerate
were ordered.
  21st.  The pus collected from the surface of the vagina Avas  inoculated
by tw"o punctures made on the left thigh.   26th. The inoculated punctures
had produced nothing; the same dressings  were  continued, Avith injec-
tions of decoct, alb.   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. Avere ordered.
  June 7th.  The surface  of  the cervix and  vagina was cauterized with
arg. nitr.  10th. The  discharge had nearly disappeared, and on the  14th,
the patient Avas examined with the speculum;  the cervix and  the vagina
were perfectly healthy.  The patient was therefore dismissed.

  Case XLVI.  Chancre, blenorrhoza, abscess of the epididymis ; inoculation
unsuccessful.
  Dae----Victor, aged 20, entered June 30th, 1835.   This patient, Avho
had  been affected for two  months with a blenorrhoea, which appeared six
days after  exposure, and a chancre of the frenum, contracted in conse-
quence of a rupture of this part, had hitherto made some irregular attempts
at treatment, but had received no benefit.  Four days before his entry into
the hospital, an epididymitis  supervened.  We found  that the  urethral
discharge  was without  pain; the matter was Avhitish; 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 blenorrhcea, in-
jections of sulphate of zinc and copaiva in bolus form were ordered;  cata-
plasms were applied to the scrotum, and frictions made Avith ung. mercur.
The chancre was dressed with calomel  and  opium cerate.  The boAvels
not having been relieved  for three days, an enema of magnes.  sulph. was
administered, and to combat the inflammation of the  epididymis, twenty
leeches Avere applied to the spermatic cord.
  27th.  The blenorrhoeal discharge  had  decreased; the chancre of the
frenum  had  been  cauterized  Avith arg. nitr.;  the inflammation of the
epididymis Avas less, and a raised hardened point Avas perceived  upon it.
July 1st.   The blenorrhoea had nearly ceased; the chancre still remained,
and one half of the surface Avas still in the period of progress; the raised
point on the epididymis appeared inclined to suppurate.
  13th.  The patient had only a few drops of blenorrhoeal pus m the morn-
ing ; the chancre  was cicatrizing;  the  abscess on the  epididymis wae
open, and its pus was  inoculated on the right  thigh.
  17th.  The puncture made Avith the pus from  the epididymis had pro-
duced nothing; the blenorrhoea was cured;  the  chancre almost  cica-
trized ; the abscess furnished little pus; compresses with decoct, alb. were
placed on toe scrotum, and, Aug. 8th, the patient left cured. 
     PRACTICAL OBSERVATIONS---INOCULATION OF BLENORRHCEA.  149

  Case XLVII. Phimosis, balanitis with erosion ; inoculation unsuccessful.
  Reed----, aged 21, entered  May  9, 1836.  Unable to define  the  com-
mencement 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.  Since that time  the prepuce
had become oedematous, and the pains had greatly increased; he felt no
pain on urinating, which he could in any Avay attribute to the  canal of the
urethra; he only suffered from the contact of the urine Avith 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
uncovered, Avas inoculated on the right thigh; twenty-five  leeches on the
penis, and emollient and opiated applications were ordered.
  May 11th.   The puncture was red, but not vesicular;  the oedema of the
prepuce had much decreased;  the existence of a balanitis was ascertained,
with erosions of the glans in patches and stretching to its base; the  inter-
nal part of the prepuce was also eroded in  large spots;  the whole surface
was cauterized Avith arg. nitr., and a bit of dry linen placed  between the
glans and prepuce.  The pain, Avhich at first Avas very sharp, entirely ceas-
ed in half an hour.  12th.  The prepuce was no longer oedematous; the
diseased surfaces Avere almost dried up and  free from pain;  the inoculated
puncture was rather vesicular and pointed.  16th.  All was healed, and the
patient left.

  Case XLVITI.   Balanitis with erosion; sympathetic bubo ;  unsuccessful
inoculation of the pus of the balanitis and that of the bubo.
  Laut----Antoine, aged 22, entered Nov. 21, 1836.   This  patient also
having a natural phimosis, Avas unable  to state the time when  the balanitis
had commenced; he only  said that for a month, the pains had been very
violent, and the prepuce had become oedematous.  A fortnight previous, a
bubo had appeared on the left side; its progress had  been subacute an<
little painful.  At the time of his  entry, he could not uncover the glans
which Avas eroded in several places; some of the erosions were deeper, and
seated on the left side of the frenum.
   23d. The pus of the balanitis was  inoculated  on the right  thigh; all
the diseased surface was cauterized with arg. nitr., and a piece of dry linen
placed between the glans and the prepuce.  26th. Only a few of the eroded
points near the frenum remained;  the inoculated puncture, which at first
appeared to folloAV a regular course in  its development,  dried up  without
any result;  the bubo had been treated with cataplasms.
   Dec.  12th. The bubo was opened; the glans was healed.   On the 14th,
the pus of the bubo Avas inoculated on the left thigh.  17th.  The inocula-
tion had not  succeeded; the cavity of the bubo was  cauterized, and the
patient left cured on the 30th. 
150        CLINICAL AND EXPERIMENTAL RESEARCHES—

  Case XLIX.  Balanitis with erosion, blenorrhcea, bubo ; inoculation un-
successful.
  Lem----, aged 34, entered Nov. 14, 1S35.  This patient had perceived,
twenty days  previous, an erosion at  the base of the glans; soon after a
blenorrhoea folloAved,  and then a bubo appeared in the right groin.  "We
found part of the  surface of the eroded  glans healing; the blenorrhoea,
whose progress had been very acute, afforded a copious and bloody dis-
charge; the bubo had suppurated.
  18th.  The bubo was  opened, and the pus inoculated on the left thigh;
the pus of the vesicular  ulceration, seated on the  glans, Avas 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 dipped in decoct, alb. applied to it; cataplasms were placed
on the bubo; for  the  blenorrhcea, the interior of the canal was cauterized
with  Lallemand's caustic holder.  21st. The  inoculation had  produced
nothing, and  the patient left cured.

  Case L.  Balanitis with erosion, unsuccessful inoculation.
  Lesp----, aged 26 years, entered June 20, 1835.   Fifteen days after a
suspicious connexion, this patient was affected with balanitis.  Some ex-
coriations appeared near  the base of the glans;  10 days  after the disease
began, a bubo appeared, the progress of which  was subacute, and which
had now suppurated.   He had received no treatment.
  June 21st.  The pus of the bubo Avas inoculated on both thighs, the bala-
nitis was treated by cauterization Avith  the nitrate  of silver, and by inter-
posing a piece of dry linen  between the glans and prepuce.  26th. The
inoculations Avere unsuccessful.  27th. Both thighs  were again inoculated,
the bubo is cicatrizing; the lips of the opening remain apart and are ulce-
rated.  25th.  The points of inoculation are red and pointed.
  July 1st. No result from the inoculation,  which  is again performed on
the right thigh with pus from  the ulceration. 3d. The punctures are heal-
ed ; the centre of the bubo is cauterized and  dressed Avith wine.  4th. In-
oculation  again performed, but unsuccessfully;  the wound has a fungous
appearance, is cauterized Avith the nitrate of  silver, and  dressed Avith aro-
matic wine.   20th.  The bubo has healed under the influence of the cau-
terization and wine.   Some compresses dipped in the aqua alb. were ap-
plied, and the patient was discharged cured July 24th.

   Case LI.   Balanitis with erosion, unsuccessful inoculation.
  Ban----, aged 25 years, entered May 24th, 1836. He had been affected
Avith an imperfect  phimosis, and the glans  was abraded during a suspi-
cious coition 18 days before.  The whole prepuce had became oedematous,
the glans had swelled, and a very painful balano-posthitis existed.  On the
glans and prepuce were seen slight ulcers, which seemed to come from the
destruction of the mucous membrane; the suppuration  was profuse an<? 
      PRACTICAL  OBSERVATIONS—INOCULATION  OF BLENORRHCEA.  151

sanious;  the edge of the prepuce was cleft; there Avas no discharge of
pus from the urethra.
  24th.  The pus from the orifice of the prepuce was introduced by two
incisions in the right thigh;  the mucous membrane of the  glans and pre-
puce was cauterized with the nitrate of silver; injections of aromatic wine
were prescribed. 27th.  The disease had almost disappeared; only a slight
ulceration remained of the frenum; it was cauterized, and a dry linen was
placed between the glans  and the  prepuce.   28th. The incisions for the
inoculation made  the 25th have healed.  The ulceration of the frenum is
healing; the gentle cauterization and the  aromatic  wine are continued,
and the patient is discharged cured,  May 31st.

  Case LII.  Chancre at the period of reparation, balanitis; inoculation
unsuccessful.
  Lerg----, aged 26, entered May  24, 1836.   This patient had a natural
phimosis; but could not exactly fix the time at which the chancres at the base
of the glans and of the upper and inner part of the prepuce appeared. He  saw
them about a month previously, after having with much difficulty uncover-
ed the glans, since Avhich time the prepuce became oedematous, and a bala-
nitis succeeded.   Ten days before his entry, some spots  of a lenticular sy-
philide showed themselves on the body and extremities; at the seat of the
chancre some induration was perceived; there Avas no  blenorrhoea nor in-
duration in the canal of the urethra, nor engorgement in the groin.
  May 27th. The pus of the balanitis was inoculated on the left thigh, to
ascertain if the chancres of the glans and prepuce Avere still in the period
of ulceration.  The usual treatment Avas ordered for the balanitis.
  June 3d. The inoculation  had healed ; the lenticular syphilide had made
httle  progress.  The pil. hydrarg. iodid. and the sudorific sirup and tisane
were ordered.  25th. The eruption  began to fade.  By July 12th, the pa-
tient  was cured and dismissed.

  Case LIII.  Balanitis with superficial erosion ; inoculation unsuccessful.
  p____} aged 26 years, entered May 4th, 1836.  This patient, who had a
natural phimosis, observed  some vegetations near the frenum after ble-
norrhoea of eight months duration; they were removed, and a moderate
oalanitis followed.   Eight  days since, the  balanitis  passed, without any
knoAvn cause, to the acute stage; there was profuse suppuration ; the pre-
puce  is swelled, red, and painful; on the inner part  there are slight ero-
sions of the mucous membrane.
  The pus from the edge of the prepuce was introduced into tAvo places in
the no-ht thigh. The sores were cauterized with the nitrate of silver.  The
aq. alb. was injected between the glans and  the prepuce, and dry lint was
introduced.  27th.  The inoculations  were unsuccessful.   June  3d  Tha
patien  "eft cured. 
152        CLINICAL  AND  EXPERIMENTAL  RESEARCHES--

  Case LI V  Balanitis, with erosion and ulceration of the edge of the pre-
puce ; inoculation unsuccessful.
  Jaquen----, aged 30 years, entered July 4th, 1835.  Tavo months since
this patient was affected Avith blenorrhoea, Avhich appeared eight days after
suspicious intercourse; at first it Avas very painful, but by baths and anti-
phlogistic diet the disease became chronic; sometimes it Avas aggravated;
flaxseed  and  mallows  tisanes were  the only remedies employed.  For
twelve days there was balanitis  with oedema of the prepuce, the edge of
which seemed ulcerated in several parts, and particularly at tne lower por-
tion, where there Avere deep fissures.
   The prepuce is now much infiltrated, and forms an intense phimosis, and
greenish pus comes from the balanitis; 30 leeches were applied to the pe-
nis, which Avas Avashed with a strong solution of opium.   The pus from
the prepuce was inoculated in two places on the right thigh.   8th. The
mcisions  of the inoculation had healed; the prepuce is  less  infiltrated.
The  glans is not indurated;  its  surface,  and also that  of the mucous
membrane of the prepuce, is cauterized Avith the nitrate of silver, and Gou-
lard's extract is then applied.   9th. The glans is exposed, and no chancre
can be seen ;  there is no pus from the urethra; the prepuce is cauterized,
and the  patient is discharged on the 11th, cured.
                             Section III.

           INOCULATION  OF  THE  PUS TAKEN  FROM BUBOES. '""'

   Case I. Chancre and symptomatic bubo ; inoculation successful.
   Mich----, aged 18, entered Oct. 3, 1835.  The patient  could not tell
the precise date at Avhich the infection had occurred, but thought it was two
months since.   TAventy days previous to his entry, a bubo  appeared on
the right  side; a chancre Avas situated on the  right side  also, near the
frenum, nearly all its  surface presenting marks of the period of repara-
tion;  there Avas no induration at its base.  Tne progress of the bubo Avas
sIoav ; a little fluctuation was felt near its summit; the tumor was super-
ficial; the fluctuating point seemed to be seated in one ganglion alone;
the surrounding  cellular tissue and the inguinal giands Avere engorged.
The chancre Avas cauterized  and dressed with vin. arom.  A blister Avas
applied  to the  bubo and dressed with ung. mercur.   This dressing was
continued  till the 21st.
  22d. The bubo was opened, and afforded a pretty large quantity of red-
dish pus.  The cavity was deep and round; the pus was inoculated by a 
PRACTICAL OBSERVATIONS'--INOCULATION OF BUBOES.
puncture made on the right thigh.  The chancre of the frenum had healed.
24th.  The inoculation made  on the 22d had succeeded, and the pustule
was large  and well developed; it Avas opened, and  the pus from  it in-
oculated on the left thigh.  27th.  The inoculation on the 24th had suc-
ceeded; the pustule Avas formed; it was ruptured, and beneath it a  chan-
crous  ulcer was seen piercing the  entire thickness  of the skin.  Both
inoculations Avere dressed Avith vin.  arom. and  cauterized Avith arg. nitr.
The suppuration  appeared to extend in the indurated mass which en-
veloped  the suppurated ganglion;  the SAvelling  had decreased,  but the
skin was left undermined.
  Dec. 1st. The inoculated points were healing; the skin which covered
the bubo was destroyed by a  rapid ulceration, and the cavity laid  open.
Aromatic wine Avas applied.
  May 10th. The  period of reparation had  commenced.  The dressings
were continued, and the patient left cured on the 30th.

  Case  II. Chancre,  symptomatic bubo ;  inoculation at first unsuccessful,
then producing the characteristic pustule of chancre.
  March----, aged 27, entered June 18, 1835.  The chancre situated near
the frenum appeared five weeks previous;  he Avas first  treated Avith sar-
saparilla.  Twelve days before his entry, a bubo appeared on the left side.
We found the chancre healing; the  bubo had suppurated; it Avas  opened,
and the  pus inoculated immediately by two punctures made  on the left
thigh.   The pus of the chancre was  inoculated on the right  thigh by a
single puncture.  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.  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 Avith vin.  arom.
26th.  The lower pustule was cauterized with arg. nitr.; the bubo  was a
little better.
  July 3d.  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 dressed Avith
calomel  cerate.  12th.  The chancre on  the thigh was modified by the
cauterization;  its base was rose-colored, and there was  no induration at
its  base; it Avas dressed with  the aromatic wine.  20th. The bubo was
better;  the base was becoming cleaner, and the induration decreasing; the
treatment was continued till Aug. 4, when the induration  had disappear-
ed ; the  chancre of the thigh was healed, and the bubo was rapidly cicatriz-
ing ; some fleshy granulations were cauterized.  On the 8th, the patient
left quite cured.
                                20 
 154         CLINICAL AND EXPERIMENTAL RESEARCHES--

   Case III. Chancre, symptomatic bubo ; inoculation successful.
   Rich----, aged 36, entered Oct. 24, 1835.  This patient had at the root
 of the glans some but slightly developed chancres, most of which Avere in
 the period of reparation.  He could not determine exactly Avhen the dis-
 ease  had commenced ' but he said  the suppurated bubo on the left side
 first appeared a fortnight  previous  to  his entry; its progress had been
 acute and painful;  the skin was red and adherent;  there was no indura-
 tion at the base of the tumor, which had  its seat in the superficial gang-
 lions.  On the dorsum penis  a lymphatic  Avas seen, forming a hardened
 line running from a considerable  chancre on the left side of the glans to-
 wards the bubo on the same side.
   Oct. 27th.  The  bubo,  Avhich contained  much pus, was opened.   The
 chancres of the glans were cauterized and dressed Avith calomel and opium
 cerate.  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 the treatment with the  ointment and cau-
 terization with arg. nitr.
   Nov. 1st. The two inoculated punctures, made on Oct. 27th, had fur-
 nished the characteristic pustules.  The inferior pustules were  cauter-
 ized with argent, nitr.  The chancre of the penis was healing. The cavity
 of the bubo, whose ground was becoming gradually raised, was cauterized.
 8th. The second inoculated pustule, which was  already covered  with a
 thick crust, concealing the chancrous ulceration, was  cauterized.  Aro-
 matic Avine was applied to  the bubo, Avhich was also cauterized with arg.
 nitr.   12th. No  trace of the inoculation, cauterized  Nov.  the 1st, re-
 mained;  that which had been allowed  to take its course till  the 8th, had
 resisted  the cautery; it was dressed with vin. arom.  The bubo was bet-
 ter; 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, 1S36. This patient had contracted
a blenorrhoea two  months  previous  to his entry.  A fortnight later, he
perceived a chancre on the inferior and left  side of the frenum.  Lastly, a
fortnight after the appearance  of the chancre, a bubo appeared in the left
groin; its progress  had been  subacute.  We found  the blenorrhoea but
slight; yet the discharge was  greenish,  and there Avas  pain on urinating
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 considerable volume,  appeared  to be  seated in the
superficial  ganglions, and on its summit  there was evident fluctuation, al-
though there  appeared to be but little pus.   The  bubo Avas  opened, and 
        PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES.     155

the pus inoculated on the left thigh;  the blenorrhoeal pus Avas inoculated
on the right thigh.   The chancre  of the frenum was cauterized and
aressed with vin. arom.  For the blenorrhcea, injections of arg. nitr. were
ordered, and cubebs.
  Oct. 3d. The inoculated punctures made on the 30th of Sept. had pro-
duced  nothing, not even  redness; yet the edges  of  the  incision of the
bubo were ulcerated, and presented a chancrous appearance.  The pus of
the bubo Avas again inoculated on  the left thigh.  The same treatment
was continued.  7th. The inoculated puncture made on the 3d, with the
pus of the bubo, had produced the characteristic pustule, which was then
destroyed by cauterization  with arg.  nitr.  The blenorrhoeal discharge had
much decreased; the chancre was healing;  the bubo was  better;  the en-
gorgement at the  base had disappeared;  the purulent secretion was less;
the cavity was cauterized.  12th. The chancre was  nearly healed; the
blenorrhoea yielded a whitish matter, and he urinated  without pain.  The
ground of the Avound being raised, the bubo presented the appearance of
an even wound;  it was cauterized and  dressed with vin. arom.   20th.
The blenorrhcea had disappeared, and  the chancre had been healed three
days.   The bubo was granulating;  the treatment was continued.   27th.
The bubo was nearly healed; it  was superficially cauterized, 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 bubo  ; inoculation successful.
   Bast----, aged 18, entered Oct. 24, 1835.  Six weeks  previous to  his
entry, eight days after a connexion, a chancre Avas 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 was seen on the  right side,
 and was treated with leeches and blisters; it disappeared, and left only a
 little slightly indurated engorgement.   The chancres  were healed by cau-
 terization; but twelve days later, the bubo became inflamed, and suppu-
 rated on the fourteenth day.  On entering, no induration remained on the
 situation  of the  cutaneous chancre.   The bubo was extensively sup-
 purated ; 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.
   28th. The pus  of the  bubo was inoculated by a single  puncture, made
 on the right thigh ; the  edges of  the  incision made in the bubo appeared
 ulcerated.   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.   10th.  Powdered  cantharides  were put into the cavity of the bubo, 
156        CLINICAL  AND EXPERIMENTAL  RESEARCHES---

to obtain the reunion of the undermined skin.  15th.  There was a decided
improvement; the  fleshy granulations  were developed.   A  superficial
cauterization was made.  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.  Chancre, symptomatic bubo ; successful inoculation.
  Bali----, aged 23, entered July 11, 1835.   The patient could not deter-
mine exactly the  commencement  of his disease.  On entering, the chan-
sres of the corona glandis Avere partly at the period of reparation; on the
left side was a bubo of eight days standing, in the acute stage.
  22d. Twenty leeches were applied to the bubo ; the chancres were cau-
terized and dressed with aromatic wine.  28th. The chancres were nearly
cured,  but the bubo  has suppurated.
  Aug. 9th. The bubo was opened, and its pus was introduced into the
left thigh.  The chancres of the glans are cured.  15th. The inoculation
seems  to have succeeded, but advances slowly.  The edges of the incision
on the bubo have an ulcerated  form. They are cauterized with the nitrate
of silver.  18th. The inoculation has progressed, and is now character-
istic ; it is destroyed by cauterization.  The bubo is healing, but the skin
over the abscess has ulcerated.  29th.  Granulations appear in the abscess.
The pus from a point of the surface,  which still seems in an ulcerated
state, is introduced into the right thigh.
  Sept. 2d,  The inoculation is unsuccessful; the whole surface is heal-
ing. The cicatrix is assisted by cauterization.  6th.  The cicatrix is nearly
complete.   Compresses  Avith  Goulard's extract are  applied, and  the
patient is discharged cured on the 7th.

  Case VII. Chancres, symptomatic buboes; inoculation unsuccessful the
iay of the opening,  but furnishing the pustule by inoculation made the fol-
lowing 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 pre-
sence on the skin of the prepuce, eight days after connexion; 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 suppu-
rated 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 to the statement  of the patient,
was red and swollen at the time of the commencement  of the buboes, and
extended to  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.
   10th. The bubo on the right side was  opened, and its pus inoculated or 
         PRACTICAL OBSERVATIONS---INOCULATION OF BUBOES.     157

the right thigh ;  the pus of the left bubo on the left 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 Avhich Avere much
undermined.   12th. The inoculation made on the left side, Avith the pus
of the bubo, Avhich had opened spontaneously, had  produced the  char-
acteristic pustule.  On the right thigh, the inoculation made with the pus
of the bubo on the right side  the day it was opened, had produced nothing.
Afresh inoculation was made on the right thigh, with the pus of the bubo
on the right side.  13th. The pustule from the first inoculation was cau
terized; the second, made on the 12th, had succeeded.  The same dressing
was continued for the chancre.  16th. Pulverized cantharides were placed
in the  cavity of the buboes, to promote the formation  of granulations, an.J
thus obtain the adhesion of  the undermined  edges; by Nov. 4th, the pa-
tient was quite cured and left the hospital.

  Case VIII. Chancre, symptomatic bubo ; inoculation successful.
  Bip----, aged 30, entered Sept. 16, 1836.  This patient  could  not de-
fine  the time when he contracted the chancres of the  frenum;  he had re-
ceived no  treatment; twenty days previous  to  his entry, a bubo had de-
veloped  itself on the right side; its course had been very  acute; it had
suppurated, and  opened spontaneously.  17th. The pus of the bubo was in-
oculated on the right thigh ;  the chancres of  the frenum were cauterized,
and dressed Avith vin. arom.  The bubo was treated in the  same manner.
21st. The inoculated pustule was cauterized ; the chancre  of the frenum
had healed, and on the 23d of Nov. the patient left cured.

  Case IX. Chancres, symptomatic bubo ; inoculation successful.
  Boul----, aged 26, entered July 2d, 1835.   Three Aveeks after a sus-
picious connexion, this  patient perceived two  little chancres near the
frenum;  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 examined his penis only when he felt the pain in the groin, Avhen
he found  small  ulcers, Avhich at the time of  his entry  Avere healing.
Without  having undergone any treatment, 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 *»he
right side.
  4th.  The bubo on the right  side  was opened; the chancres Avere cau-
terized, and dressed with vin. arom.   8th.  The  bubo  on the left side Avas
opened;  an inch and a half above Poupart's ligament, on the abdomen, a
tumor, painful to the touch, Avas found.
  14th. The bubo which had formed on the abdomen was opened; and
a slightly brownish thin pus flowed  from it,  similar  to that of  the two
other buboes, whose apertures had  become rounded and  ulcerated; they
were dressed with cataplasms. 
 158         CLINICAL AND EXPERIMENTAL RESEARCHES---

   18th.  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.
   22d. The inoculated punctures  had produced the characteristic pustule;
 the pustule on the right thigh, resulting from  the inoculation of the pus
 of the bubo of the right side, was destroyed  by cauterization with argent.
 nitr.; the pustule on the left side was  allowed to  take its course; the
 buboes were dressed with calomel and opium  cerate.  26th. The pustule
 on the left thigh was destroyed by the nitrate of silver ; there Avas 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  sirup and
 tisane Avere given.
   Aug. 3d.  The indurated points  were somewhat diminished; some part
 of the chancrous surfaces was healing.    8th. The buboes were dressed
 with  Avine and tannin.  There Avas a decided improvement.   18th. The
 induration had nearly disappeared; the abdominal  bubo was cicatrized;
 the bubo on the  left side  presented  some  fistulous canals; that on the
 right Avas cicatrizing.  20th.  The Vienna paste was applied to the left
 bubo, in  order to destroy the portions of undermined skin, Avhich prevented
 the free discharge of the pus;  dressings of wine and tannin were applied.
 29th. The bubo on  the right side was healed, and the left Avas  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.

   CaseX. Chancres, symptomatic  buboes ; inoculation producing the char-
 acteristic pustule.
   Ducel----, aged 20, entered  Feb. 16, 1835.  The patient 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  appeared  on the right and
 left sides, with no other apparent cause than the ceasing of the ulceration
and healing of the chancres* their course had been acute; the bubo on the
 right side presented a little more engorgement than that on the left.  The
chancres  Avere healed, and  the two buboes suppurated; the cavity ap-
peared large, and the surrounding skin much undermined; upon both be-
 ing opened, a thin brown pus flowed from them.   Cataplasms were then
applied.
   18lh. The pus from the buboes was inoculated, that on the right side,
 by tAvo punctures  made on  the right thigh; that on the left, by a single
puncture  on the left thigh : the margin of the incisions appeared ulcerated,
 and the secretion  of pus copious.   The inoculation Avas  made in the pre-
 sence of M. Desruelles.  20th.  The punctures had produced the character-
 istic pustules on both  thighs.  22d. The result of the inoculations was 
         PRACTICAL  OBSERVATIONS   INOCULATION OF BUBOES.      159

ehown to M. Desruelles.   One of the pustules on the right thigh and that
on the left, were allowed to take their course.   The loAver pustule on the
right thigh, and the cavity of the buboes, were  cauterized Avitn argent.
nitr.; dressings of vin. arom. Avere ordered.
  March 4th.  The inoculated  pustules, which had been alloAved to  take
their course, had produced chancres;  they Avere cauterized with arg. nitr.
The pustule which had  been first cauterized  had disappeared.  The bu-
boes were better.  11th. The  chancre on  the  left thigh progressed, not-
withstanding the cauterization, but it appeared  modified.   It was dressed
with vin. arom. and cauterized.  19th. The chancre on the left thigh had
healed without leaving any induration; the buboes Avere almost cicatrized,
especially the left.  The dressings were continued, and the patient left cured
on the 30th.

  Case XL Blenorrhcea,  superficial  chancre, symptomatic  bubo;  inocu-
lation producing a positive result.
  Moig----, aged  24, entered Oct. 10, 1835.   The patient  had for three
months been affected with a blenorrhoea, and superficial ulcerations 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 pro-
gress had been acute, and it  had suppurated.  The little discharge that
remained was Avhite and  mucous; the  patient  suffered no  pain on uri-
nating; on the prepuce and glans were some ulcerated spots  covered with
healthy granulations; the  bubo Avas  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. nitr., and
cataplasms were applied to the bubo.
  17th. The margin of the incision made in the bubo was ulcerated ; the
reddish pus taken from the depth of the cavity Avas inoculated on the left
thigh; the injections and the  cubebs  were continued for the blenorrhoea;
the ulcers of the glans were nearly healed; a cauterization  and dressings
of vin. arom. were ordered.  20th. The inoculation made with the pus of
the bubo had  furnished the characteristic pustule; the blenorrhoeal dis-
charge still continued;  the muco-pus was inoculated on  the left  thigh;
only a single uncicatrized  point remained  on the prepuce;  cauterization
and dressings of vin. arom. Avere ordered, and the same treatment  for the
cavity of the bubo, which had a grayish color.  22d.  The inoculation
made Avith the blenorrhoeal pus had  produced nothing; the pustule from
the inoculation of the bubo was well cauterized.
  28th. The blenorrhoea had ceased;  the chancres had disappeared ; the
inoculated pustule  had been  destroyed by the  cautery; the bubo Avas
healing; it was cauterized, and dressed  with vin. arom.; there Avas no en-
gorgement at its base. 
160        CLINICAL AND EXPERIMENTAL RESEARCHES---

  Case XII. Chancre  of the urethra, symptomatic bubo ; inoculation pro-
ducing the characteristic pustule.
  Vac----,  aged 41, entered Sept. 13, 1836.   Three weeks had elapsed
*ince this patient, without having any blenorrhoea or wound on the penis,
observed a  bubo develop itself in the right  groin.   The progress  of the
affection had  been sub-acutely inflammatory,  and   suppuration ensued,
notAvithstanding an application of leeches. Now the bubo had suppurated
and undermined  the  surrounding skin;  no trace of ulceration was to be
perceived on the penis; there was no blenorrhoea ;  at, the depth of two
lines  in  the urethra, by separating the lips  of the  meatus urinarius, a
spot of the size of a lentil Avas perceived, whose granulated surface indi-
cated the seat of an ulcer in the stage of reparation.
  16th. The bubo was  opened, and the pus taken from the depth  of the
cavity was  inoculated on the  right thigh.    Cataplasms  were applied.
19th. The inoculated puncture was red  and vesicular;  the  caArity  of the
bubo was cauterized, and dressings  of vin. arom. applied.  21st. The in-
oculation had succeeded; the  pustule was then destroyed  with arg. nitr.
Oct. 15th. All was well,—the patient Avas dismissed.

  Case XIII. Chancre and blenorrhoza,  symptomatic bubo ; successful in-
oculation of the bubo.
  Fir----, aged 20, entered April 22, 1836.   This patient had long been
affected with a blenorrhoea, which had been reneAved by frequent exposure,
and had been affected with chancres of  the glans, near the frenum, about
a month  before.  Ten  days since  a bubo appeared on each side, which
progressed very  rapidly, and had now suppurated; there  was much in-
flammation and  severe pain.
   Noav  the chancres  have disappeared;   the cicatrix presents  some
cartilaginous  hardness;  there is no blenorrhoea;  the  two buboes were
opened;  the pus is thin and sanious; cataplasms are prescribed.   April
25th. Inoculation was performed with pus from the right bubo in the left
groin, Avhich produced  a vesicle  on the 28th.  29th.  This vesicle was
destroyed by the nitrate of silver; the base of the buboes was cauterized,
the cataplasms were continued, and the patient Avas cured May 13th.

  Case XIV.  Concealed chancre, symptomatic bubo, inoculated with posi-
tive result.
  Marc----Jean, aged  17, entered May 23, 1835.   Five or six days after
exposure, and a fortnight before his entry, this patient perceived a slight
discharge;  he felt no pain except at  the extremity of the penis,  where
there was an indurated spot.  Having been obliged  to  do  some fatiguing
work, the pains increased, and a bubo appeared on the left side; its course
was acute.  On  his entry into the hospital, there was no  discharge, but
the induration still remained.  The bubo was opened, and its pus inocula-
ted by two punctures, made on the right thigh.  23d.   The punctures had 
         PRACTICAL  OBSERVATIONS---INOCULATION OF  BUBOES.     161

cicatrized ; a fresh inoculation was made on the right thigh;  the margin
of the incision in the bubo had assumed a chancrous appearance.
  June 8th. The inoculation had taken;  the pustule Avas opened, and the
pus inoculated on the left thigh, and the chancre from the inoculation was
cauterized.  19th.  The  inoculation of the  pus from the pustule on the
right  thighs had  produced a pustule on the left thigh;  it was well cau-
terized.   The first inoculation, which had not beqn entirely destroyed by
the cautery, had been dressed with vin. arom.;  it was nearly healed; but
the bubo, Avhich Avas extensively open, did not unite its undermined edges
with the subjacent parts, and had  all the appearance  of malignant chan-
cre; its  surface Avas gray and pulpy, and the cavity appeared inclined  to
increase.   It  Avas well cauterized,  and then dressed with vin. arom.
June 26th. There was  a decided improvement, and by July 24th, all Avas
well.

   Case  XV.  Chancre, symptomatic bubo, the pus from which was inocula-
ted after having been preserved and dried in the air ; the result was unsuc-
cessful.   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 after sexu-
al intercourse, this patient was affected Avith 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.  On
entering the hospital, the tumor Avas large, but there Avas no fluctuation.
Seventeen  days had elapsed since the affection appeared ;  the chancres had
healed.   A blister for the bubo, and dressings of sublimate, twenty grains
to the ounce of Avater,  were ordered.   15th. A little fluctuation was per-
ceived at the summit of the tumor.  The same treatment Avas ordered,  as
on the 13th.  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.  3d. Some of the pus Avas put in a capsule, and
allowed to dry, exposed to the atmosphere.   4th. This pus, having been
moistened Avith a small quantity of water, Avas inoculated on the left thigh ;
two days later, it had produced no effect.  10th. Some pus Avas taken from
the bubo, and preserved in an open tube; iavo days later, having remained
fluid, it Avas inoculated  on the left  thigh.   J 6th. The puncture made  on
the 1.2th was red,  raised and pustular; it Avas allowed to take its course,
that the Tesult  might be undoubted.  20th. The pustule had burst, and
the chancre was  perfectly characterized;  it Avas  cauterized, and dressed
with vin. arom.   Cataplasms and ung. mercur. Avere ordered to be applied
to the bubo.
   Nov.  21st. The chancre from the matter in  the tube was quite healed;
the bubo was dressed with aromatic Avine, and on the  9th  of Jan., 1837,
the patient left cured.
                                 21 
 162        CLINICAL AND EXPERIMENTAL RESEARCHES---

   Case XVI.  Blenorrhoza, chancre ; symptomatic bubo incculated success-
 fully.
   Man——, 28 years old, entered Nov. 7, 1835.   For three months this
 patient had been  affected with blenorrhoea, which was very acute at first,
 and painful, but Avhich soon passed to the chronic state, although no medi-
 cal treatment was employed.   Twenty-three days  since, after a new ex-
 posure, chancres  appeared on the left, near  the  frenum, and fifteen days
 afterwards a bubo on tnc left groin.
   The  blenorrhoea, the  discharge from which had gradually increased, at
 the period Avhen  the chancres were contracted, was  now chronic; there
 was no pain in urinating, and no induration in the  course  of the urethra ;
 the discharge was whitish, and muco-purulent.   The bubo, the progress
 of which Avas subacute,  had not suppurated; it is hard, and situated  in the
 superficial ganglions; its base is moderately engorged, and it begins to ad-
 here to the skin.   Injections of the acetate of lead and boluses of copaiva
 solidified with magnesia Avere ordered.   The chancre Avas cauterized and
 dressed Avith the pommade of calomel and opium.   A blister was applied
 to the bubo, and dressed with a solution  of corrosive sublimate, 20 grains
 to the ounce of Avater.
  Nov.  15th.  The bubo  discharged, and its pus was inoculated on the left
 thigh.   The  blenorrhcea  continued  slightly, the  injections and copaiva
 Avere still used.  The chancre is in the state of reparation; it was cauter-
 ized with the nitrate of silver, and  dressed with fine lint  soaked in vin.
 aromat.  The bubo was opened freely, and its centre was cauterized Avith
 the nitrate  of silver, and  covered with a cataplasm.  17th. The inocula-
 tion Avas successful, and  it Avas cauterized; the copaiva  was continued for
 the blenorrhoea, which  was now slight, the  injections were omitted, the
 chancre was cured.  The bubo was cauterized, and dressed with vin.
 aromat.  20th. Its base Avas rosy, and it seemed disposed to heal, and the
 patient  was discharged cured, Dec.  9th.

  Case XVII.  Chancre,  blenorrhoza; symptomatic bubo inoculated suc-
 cessfully.
  Montr----, aged 19 years, entered July 12,  1836.   The blenorrhcea had
continued six months; a month since, from a new exposure, chancres were
contracted,  which appeared around the  corona glandis.  Fourteen days be-
fore the patient entered, a bubo appeared on the right side, of an  acute
character;  it  was superficial and  slight; no medical treatment was em-
ployed.   Now the blenorrhoea was slight; the bubo has suppurated at its
 base, Avhich does  not appear indurated.  It was opened Avhen the patient
 entered  ; the pus was reddish and not stringy; there Avas some sloughing,
 and poultices were applied. The blenorrhoea is treated with injections of
 the nitrate of silver.  15th. The pus of the bubo is inoculated in the right
 thigh.   The edges of the bubo are ulcerated.  18th. The inoculation  has
 produced the characteristic  pustule, which is cauterized Avith the nitrate 
          PRACTICAL  OBSERVATIONS---INOCULATION  OF BUBOES.     163

of silver.   The bubo  is filled with powdered cantharides, to obtain granu-
lations.
  Aug. 6th. The inoculated pustule is entirely destroyed by the cauteriza
tion of July 18th. The blenorrhoea runs less; cubebs are given in doses of
four drachms, and the  injections  are  continued.  30th. The bubo is cau-
terized Avith the nitrate of silver, and some parts of it seem disposed to
heal.
  Sept. 2d. The blenorrhoea is cured; the cubebs are continued ;  the injec-
tions stopped.  The centre of the bubo, which is now healing, is again
cauterized, and on the 9th the patient is discharged cured.

  Case XVIII. Chancre, bubo on the right and left sides ; that on the right,
sympathetic, and unsuccessful after inoculation ; that on the left, symptom-
atic, and yielding the  characteristic pustule on inoculation.
  No----, aged 18, entered Jan. 17,1S37.  This patient could not precise-
ly determine when he contracted a chancre on the inner and upper part of
the prepuce, but thought it Avas about six Aveeks before entering.  Twenty
days since, two buboes appeared, one on the right side, which appeared to
be  situated in the deeper ganglions, and had only suppurated at the sum-
mit ;  the other on the left, suppurated in its Avhole extent, and only affect-
ing the superficial ganglions.   Now the chancre had cicatrized; both bu-
boes 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, the left bubo  nearly disappeared ;  on the right, the tumor still re-
mained large; to promote its  resolution, the ung. mercur. was prescribed
for the next day.   Cataplasms were applied  to the left side.  20th. None
of the inoculations had taken;  but  in the right bubo, to which the ung.
mercur. had not been applied, the edges of the incision were not ulcerated;
whilst that made in the left bubo had become round and appeared chan-
crous.  Inoculation was again  performed;  the right bubo was dressed with
ung. mercur.; the left was  cauterized  and dressed with vin. arom.   23d.
The inoculation Avith  the pus of the right bubo had  produced nothing;
that of the left had afforded the characteristic pustule.   24th. The pustule
from the inoculation was destroyed, by an application of Pate de  Vienne.
The tumor on the right side Avas much smaller.   27th.  The wound result-
ing from the application of the  caustic paste was cauterized; the left bubo
Avas dressed Avith wine, and seemed disposed to heal.  31st. The cauteri-
zation had cicatrized.
  Feb. 6th. The left  bubo  was  cicatrizing;  the right  tumor had nearly
disappeared.   14th. The surface of the nearly healed  bubo was slightly
cauterized.  24th.  The patient left; there still remained a little induration
on the seat of the chancre on the prepuce. 
164        CLINICAL  AND  EXPERIMENTAL  RESEARCHES---

  Case XIX.  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 inoculited by the chancrous pus.
  Gued----, aged 28, entered May 6, 1836.  The chancre  of the frenum
had existed a month ; its form Avas regular; no treatment had been used.
The bubo  appeared in  the  right groin, eight days previous to his entry;
its progress had been acute;  'it had suppurated, and seemed seated in the
superficial ganglions;  there  was also some fluctuation  in the surrounding
cellular tissue.  We opened the bubo, and inoculated, in two punctures on
the left thigh,  the pus which floAved from it in large  quantities.   There
were  some granulations on the chancre, Avhich was cauterized with arg.
nitr. and dressed  Avith  vin. arom.   10th. The  inoculation  had produced
nothing; the lips  of the incision had assumed a chancrous appearance; the
negative result Avas  attributed  to a large quantity of phlegmonous pus, be-
ing mixed with the  pus of the  ganglionary chancre the  day 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.   12th. The inoculation  made on  the 10th had pro-
duced  the  characteristic pustule;  it was destroyed by means of the arg.
nitr.  20th. The chancre on the frenum was cured; the cauterized  pustule
had disappeared.  The blister  applied to the bubo had  not become inocu-
lated, although it had been covered with chancrous pus; the cavity was
inclined to fill up.
  28th. A decided improvement, especially since the preceding day;  pow-
dered  cantharides had been introduced into the cavity.  A cauterization
and dressings  of  vin. arom.  were ordered.   30th. The  bubo was nearly
closed, and  yielded no more pus.  Compresses  imbibed with decoct, alb.
were applied.
  June 3d.  All was  well;  the chancre had left no induration.

  Case XX.   Chancre,  suppurated lymphitis, symptomatic bubo; inocula-
tion producing the characteristic pustule.
  Lar----, aged 22, entered  July 26, 1836.   This patient had  perceived,
nine days previous,  a chancre  on  the  frenum;  the ulcer Avas small, and
appeared to have  existed about twenty days, from its being in the stage of
reparation at the time of his entry.   On  the dorsum penis  there was a
suppurated  tumor,  seemingly  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 tOAvards the right groin, in Avhich Avas
an incipient bubo: this bubo Avas seated in the superficial ganglions, and
detached from  the surrounding  parts, but painful  to the touch;  there was
no blenorrhoea.  The patient, of a  bilioso-sanguine temperament, enjoyed
otherwise good health; the digestive  functions were in perfect order.
Twenty-five leeches were applied to the buho; the chancre was  cauter-
ized with arg.  nitr. and dressed with vin. arom.  29th.  The tumor on the 
         PRACTICAL OBSERVATIONS—INOCULATION OF  BUBOES.     165

dorsum penis was  opened, and yielded a  thin yellowish pus, Avhich was
inoculated by a single puncture made on the right thigh.  Notwithstand-
ing the application of leeches,  the bubo progressed rapidly; it had already
become adherent.  A blister was  applied  to it, which was ordered to be
dressed Avith a solution of sublimate, twenty grains to the ounce of water.
  Aug. 1st. The inoculation  from  the lymphatic abscess had  produced the
characteristic pustule ;  the cavity  presented all the appearances  of a chan-
cre ; the edges  Avere reversed and indurated, and the ground  covered with
a grayish pulpy matter: it Avas cauterized with arg. nitr., and dressed with
vin. arom.  A fluctuating point Avas felt  in  the bubo; the pustule on the
right thigh was cauterized.  6th.  The bubo Avas opened, and its  pus in-
oculated on the left thigh ; the chancre on the frenum Avas nearly healed :
that on the penis had a rose-colored base.   8th. The  punctures made
on the 6th had produced nothing, although the  margin of the  incision
made  in the bubo Avas ulcerated;  the right thigh was again inoculated.
12th.  The last  inoculation had produced the pustule; it was cauterized.
The first pustule, Avhich had been cauterized on the 1st, had Avithstood the
action of the cautery; it Avas dressed  with vin. arom.  The  base of the
bubo was indurated; the suppuration was slight;  there appeared but little
tendency tOAvards reparation ;  the applications of vin. arom. Avere suspend-
ed, and dressings of ung. mercur. with cataplasms Avere substituted.  18th.
The chancre on the penis was a little granulated, its surface was healthy
and rose-colored ; the ulcer on the frenum had disappeared, without leav
ing any induration.  There was better pus from  the surface  of the bubo,
and the induration at its base had decreased.   21st. The cauterization  and
dressings of vin. arom. were resumed for the bubo, but little induration re-
mained ; the pustules on the  thighs from inoculation had increased,  and
undermined the skin.  25th. In'order to obtain  the reunion of the skin
with the subjacent parts, from which it had been detached by  the action
of the  chancrous pus, a blister Avas applied to each ulcer on the  thighs,
and the cavity Avas filled with  powdered cantharides:  the lymphatic chan-
cre 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 can-
tharides to the  ulcers on the thigh had produced  the desired effect;  the
skin remained but little undermined.  20th. The bubo was well; no indu-
ration remained ;  the ulcers  of the thighs Avere slightly cauterized, and by
the 27lh all Avas well, and the patient was dismissed.

  Case XXL   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 28th, 1835.   This  patient hav-
ing, twelve days previous to  his  entry, exposed himself to  an infection,
perceived the folloAving day  an excoriation Avhich soon became a chancre; 
166         CLINICAL AND EXPERIMENTAL RESEARCHES--
eight days after the infection, a bubo appeared on  the right side; its pro-
gress Avas rapid, and it occasioned much pain.  Upon his entry, the sup-
puration was  evident,  but  not extensive, and only at the  summit of the
tumor; the chancres in the ulcerative stage were at the base of  the glans
on the frenum, where the affection had commenced;  they Avere dressed
with aromatic wine, after having been cauterized; cataplasms were ap-
plied to the bubo.  30th. The bubo was opened,  and  yielded much thin
and bloody pus; the chancres were dressed with calomel and opium cerate.
  May 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 Avith equal
parts of sod. chlor. Avas used at two punctures.  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.
  18th.  The bubo and the chancre on the thigh, which had been allowed
to develop itself, were dressed  with vin. arom.  30th. The chancre on the
thigh was  healed,  but some induration still remained  at the base of the
bubo; there was also a little induration aiound the cicatrix of the chancre;
applications of liq. Van Swieten. were ordered.
  June 14th. The indurations Avere less ; the bubo had been treated with
cataplasms and ung. mercur.   20th.  The induration on the penis had dis-
appeared; there was a slight salivation, the use of the liquor was  there-
fore  suspended ;  the gums were touched with acid, hydrochlor. and  a gar-
garism Avith quinine ordered.   30th. The induration of the bubo had disap-
peared, and, on the 11th of July, the patient left quite cured.

  Case XXII.  Chancre; symptomatic bubo inoculated unsuccessfully the
first day, then successfully on the third day; the pus mixed with hydro-
chloric acid producing nothing.         ,
  Burb----, aged  20 years, entered  Sept. 20th, 1836.   One month since
this patient contracted a chancre  on the right side  of the frenum  ; ten days
afterwards, a bubo appeared in the right groin; its progress was subacute.
Now the chancre  is small but regular, and seems to be healing in every
part.' The bubo is seated in a superficial ganglion; it is small,  and is at-
tached at its base and to the skin; there is no induration, the tumor has
receded  entirely; it was opened, and much greenish stringy pus Avas dis-
charged ; it  was then inoculated in  the right thigh.   The  chancre was
cauterized and dressed with vin. arom.  24th.  The inoculation produced
nothing; the edges of the opening of the bubo, however, present a chan-
crous aspect.  The left thigh is again inoculated,  and then this  same pus
is taken, mixed  with some drops of hydrochloric acid,  and introduced
into the  right thigh.  27th.  The  incision in the left thigh has  produced
the characteristic pustule, but not so with the  pus  which Avas mixed Avith
the acid.  20th.  The bubo  was dressed with the vin. aromat.; the skin
was  covered; it was nearly destroyed by the  ulceration;  the base of the
ganglionary chancre was cauterized, and the pustule was destroyed by the 
         PRACTICAL OBSERVATIONS—INOCULATION OF BUBOES.      167

nitrate of silver.  The chancre of the frenum is nearly healed.  Nov. 1st.
The bubo presented granulations, and there was no induration at the base ;
the chancre of the frenum had disappeared ; the pustule, which Avas caute
rized Oct. 28th, was modified  in its nature and seemed to make no pro-
gress.  10th. The inoculated pustule is cured ; the bubo is nearly closed .
it is cauterized with the nitrate of silver, and dressed with the vin. aromat.
19th. The patient is cured.

  Case XXIII.  Chancre ; symptomatic bubo ; pus preserved in a tube in-
oculated  unsuccessfully.
  Joig----,  21 years old, entered  Oct. 14th, 1836,  Avith chancres  of the
frenum contracted six weeks previously; fifteen days after a subacute bubo
appeared on the right side;  now the chancres are still in the  acute stage ;
the bubo, Avhich appears superficial, has suppurated;  there is no engorge-
ment at its base.  Nine days  since the bubo opened spontaneously; the
skin covering the abscess is ulcerated, and indicates the nature of the pus,
with Avhich a tube is filled.   The chancres and  bubo are  cauterized and
dressed Avith  vin.  aromat.   22d. Inoculation is  performed with the pus
from the tube; the dressings and cauterization are continued.  24th.  The
inoculation has succeeded;  was  fully developed on the 28th, and is caute-
rized Avith the nitrate of silver on the 31st.
  Nov. 4th. The inoculation has progressed,  the  chancre and bubo seem
inclined  to  heal, but there is  a slight induration at the base.   8th. The
chancre of the frenum is almost cicatrized, the bubo is better, and is granu-
lating; the pustule in the thigh is changed, but not destroyed; its different
points present but little pus. The bubo and chancre are dressed Avith mer.
curial ointment, and pills of the proto-iodide of mercury and the sudorific
sirup and tisanes are prescribed.  The induration had diminished  on the
22d; the chancre of the  thigh is cicatrized;  the  granulations Avhich cover
the bubo are cauterized  superficially, so as to dry the surface of the ulcer.
The patient was  discharged cured, Nov. 30; there is no trace of  indura-
tion where  the ulcers were situated.  The health of the patient is better.

   Case  XXIV.   Chancre, symptomatic bubo ; inoculation of the first pus
flowing from the bubo, when 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 re-
ceived no treatment, was healing.   24th. The bubo was opened, and the
first pus which escaped was inoculated on the right thigh; then that taken
from the depth of the cavity Avas inoculated on the left thigh; the cYn>~'
was cauterized, and d-^-   '    '  -•'« "-™   07-^  -~ 
168      CLINICAL AND  EXPERIMENTAL RESEARCHES---

the puncture, made with the first pus Avhich escaped, had produced noth-
ing, Avhilst the pus from the depth of the bubo  had produced the charac-
teristic pustule on  the left  thigh.
  28th. The pustule from the inoculation was  cauterized, in order to de-
stroy  it; the bubo had assumed a chancrous  appearance,  and  the  skin
which covered it was ulcerated; it Avas cauterized, and  dressed with vm.
arom.
  Jan. 10th. The chancre had healed; the bubo appeared modified.  18th.
The bubo suppurated very little;  the base was indurated;  the use of the
vin. arom.  was suspended, and ung. mercur. substituted.  20th.  The sup-
puration was re-established ; the base of the bubo had lost its induration,
and was reduced to the level of the surrounding parts.  28th. The dress-
ings of vin. arom. were resumed.  30th. The surface of the ulcer was ci-
catrizing ;  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 XXV.  Chancre, symptomatic bubo; inoculation of the superficial
pus, and that taken from  the depth of the bubo  on the day of opening, with
positive  result.
   J----, aged 24, entered Jan. 24, 1837.  The affection had existed two
 months; the chancres Avere 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 bu-
 bo, in Avhich evident fluctuation was perceived, even at its base, had much
 undermined the surrounding skin.  The chancres were partly healing.
    Jan. 25th. The bubo was opened, and a bloody bad smelling pus escap-
 ed ;  the first pus which flowed out  Avas inoculated  by a single  puncture
 made on the left  thigh, and that taken from  the surface  of the base of
 the cavity, also by a single puncture on the right thigh; cataplasms  were
 applied  to the opened bubo; the chancre, having been cauterized Avith the
 nitrate of silver, was dressed with vin. arom.   26th. The inoculated punc-
 tures on both thighs were red  and swollen. 27th. The inoculation on both
 sides had succeeded; the pustule  Avas small but Avell formed.  The same
 treatment  was continued for the chancre  and bubo.  30th.  The pustules
 were filled  Avith pus—presented all  the characteristic signs of  the chan-
 crous pustule.  31st. The pustules were divided, and the skin below was
 found penetrated in its whole substance by the chancre,  Avhose edges Avere
 abrupt;  they were cauterized with arg. nitr.
   Feb. 1st. The nitrate of silver appeared not to have sufficiently destroy-
 ed the chancres from inoculation;  the Vienna paste was therefore applied
 to them; the bubo Avas cauterized with nitrate of silver, and dressed with
 vin. arom.  The  chancres on  the penis Avere nearly healed ; they  were
 slightly touched with the  caustic, to dry up the surface.  6th. The Vienna 
        PRACTICAL OBSERVATIONS—INOCULATION OF  BUBOES.     169

paste had destroyed the chancres from the inoculation, and their surface
appeared disposed to cicatrize regularly; dressings of vin. arom. Avere ap-
plied;  the chancres on the prepuce and glans were completely cicatrized,
and left no induration. 10th. The points cauterized with the Vienna paste
were nearly cicatrized;  the bubo was better, but as the granulations were
tardy in their development, powdered cantharides were introduced into the
cavity.  14th. The inoculated points were entirely cicatrized;  the bubo
had assumed  all the characters of the period of cicatrization, and  the ex-
tent  of its surface  was  diminished one fourth.  18th.  Cantharides were
again applied.  21st. The progress of the cicatrization was rapid ; a super-
ficial cauterization  and  dressings of vin. arom. were ordered.   25th. The
bubo Avas nearly cicatrized, Avithout leaving any induration at the base.
  March 2d.  Compresses with decoct, alb. were applied, and the patient
was  cured on the 7th.

  Case XXVI.  Chancre, symptomatic bubo;  inoculation of deep-seated
and superficial pus on the day of the opening, unsuccessful; successful two
days afterwards.
  Jarf----, 21  years  old, entered Dec. 2, 1836.   One month previous this
patient contracted chancres of the glans and prepuce; at first he used the
opium dressing; two  days  afterwards a bubo appeared in the left  groin;
it has noAV suppurated freely, and there is  but a slight degree of engorge-
ment at the base.   The bubo Avas opened  on the 6th.   The first pus Avas
inoculated in two places in the right thigh, and the pus was taken from
the surface of the base of the abscess; a small chancre near the frenum,
which was healing, was touched with the nitrate  of silver;  the place
where the first  chancres were situated  presented  no  mark of induration
Cataplasms were applied to the bubo.  None  of the inoculations had suc-
ceeded on  the 9th.   The edges of the opening had ulcerated, and the
wound was rounded ; the  left thigh was inoculated in one place.  The
bubo was cauterized  and dressed with aromatic wine.   On the 10th, the
inoculation made on the 9th is red  and elevated ; the same dressing Avas
applied to the bubo.  14th.  The pustule  of the inoculation is formed ; it
is cauterized  Avith the nitrate of silver; the bubo is  dressed with cata-
plasms and mercurial ointment.   20th. The dressings with vin. aromatic.
and  the cauterizations with the nitrate of silver are resumed; the base
of the bubo  has granulated,  and tends  to heal;  and the  patient left
Jan. 5th.

  Case XXVII. Chancres, symptomatic bubo ;  inoculation of the superficial
and deep-sealed pus, the day  of its  being  opened ; negative  result in the
former case, and positive in the latter.
  Quini----f aged 22, entered Dec. 2, 1836.  Ten days after the appear-
ance of chancres on  the glans, a bubo was seen on  the left side; its pro-
gress had been acute, notwithstanding two applications of leeches.  The
                                  22 
170         CLINICAL  AND EXPERIMENTAL RESEARCHES---

cavity was extensive, and the  skin become very thin.  7th.  The bubo was
opened, and the superficial pus was  inoculated on the left thigh, and then
that pressed from the bottom of the wound on  the right thigh.  10th. The
puncture made on the left thigh with the first  pus which  escaped had
produced nothing; but on the right, the inoculation of the pus taken from
the ulcerated surface, Avhich  formed the  ground  of the cavity, had pro-
duced the characteristic pustule.   12th. The pustule from inoculation was
cauterized ; the chancres of the glans which had been cauterized Avith arg
nitr. and dressed Avith vin. arom. were healing; they Avere  dressed Avith
opiated cerate.   17th. The chancres on the  penis  were healed ;  the bubo
was treated with cataplasms  and ung. mercur.  26th. The bubo was or-
dered to be dressed with vin.  arom.  after  being cauterized with arg. nitr.
Jan. 9th, 1837.  The patient left cured.

  Case XXVIII. 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 appeared six days after exposure.
On entering,  the bubo had been developed a fortnight, and up to  that
time he  had undergone  no treatment.  We  found the  bubo suppurated,
and on  the right side, and near the base  of the glans, a chancre, some
points  of whose surface Avere healing. 23d.  The bubo was  opened;  the
discharge was  bloody pus, which  having been  wiped off, some  pus
was taken from  the base  of the cavity, and inoculated on the left thigh;
at the same time, some of the chancrous  pus  Avas inoculated on the right
thigh.   Cataplasms were applied to the bubo, and the chancres were cau
terized and dressed with vin.  arom.  26th.  The puncture  made with the
pus of the bubo, taken from the base of the  cavity, had  produced the pus-
tule, as also that made with  the pus of the chancre.  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.
29th. The pustules from  the inoculation were better; they  were cauter-
ized and dressed with vin. arom.
  Dec. 16th.  The patient left  quite cured.

  Case  XXIX.  Chancre, bubo, and  lymphitis;  inoculation of the pus
the day of the opening without result, but on the following day, an inocu-
lation being made, the result was positive ; and the pustule was subsequent-
ly 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 indurated.  During
the first days, there had been  much irritation,  but the inflammatory symp-
toms  soon yielded to diet and emollient  lotions;  no other treatment had
been used.  About a week previous to his coming to the hospital, a little 
         PRACTICAL OBSERVATIONS'—INOCULATION  OF BUBOES.     171

>"mor formed near the root of the penis on the right side, on a lvmDhatic,
whose course was marked by a red line and indurated cord; nearly at the
same time, a bubo appeared in the right groin.  We found the lymphatic
tumor had suppurated;  but no fluctuation was perceptible in the bubo,
whose progress hoAvever was very acute ; it Avas seated in the superficial
ganglions.   Some points of the chancres were  healing.   6th. The lym-
phatic 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 inocu-
lated, as it was mixed Avith much blood.   The chancres were cauterized,
and vin. arom. applied.   The bubo  was  treated with cataplasms.  7th.
The inoculated puncture was not even red; some pus was taken from the
base of the lymphatic abscess, and inoculated by a single puncture made
on the left thigh.   The  appearance of the open cavity, in the course of
the lymphatic, was  quite  chancrous; it was therefore  cauterized, and
dressed  Avith vin. arom.   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
puncture on the right thigh.  13th. The inoculation made with the pus of
the pustule was successful; this pustule was  then destroyed.  The bubo
had suppurated; it Avas  opened, and  the first  pus which escaped was in-
oculated on the right, and the pus taken from the depth  of the cavity on
the left  thigh, above  the first puncture;  the chancres on  the glans we're
nearly healed, but their base was indurated.
  16th.   The inoculation  of  the superficial pus of the bubo on the right
thigh had produced nothing;  that made with the pus from the base of the
cavity on the left thigh had produced the pustule; the edges of the incision
made in the bubo had  assumed a chancrous appearance. To counteract the
tendency to induration, the pills  of the hydr. iodid. were ordered, with the
sudorific sirup and tisane.  20lh. The chancres on the penis were healed;
the suppurated lymphatic was in an unhealthy state of granulation; there
was little tendency toAvard 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.  30th. The ulcers, under the influence of the iodide, had
assumed a better appearance; their ground was rose-colored, the pus too
was healthy, and  the  induration had decreased.  The inoculations made
on the left thigh had  undermined  the skin; to promote the production of
granulations, and aid  the cicatrization, they were covered with a blister.
The bubo was better; it Avas no  longer covered with  a grayish  mem-
brane;  its ground was rose-colored and granulating;  the ulceration of the
lymphatic  had diminished its extent, and its indurated base was become
softened.
  Jan. 10th. The induration which remained on the seat of the  primary
chancres of the glans had disappeared;  the wound  on the posterior part
of the penis was  closed, and very little induration remained around the 
172        CLINICAL AND EXPERIMENTAL RESEARCHES---
cicatrix; nearly all the surface of the inguinal bubo Avas in a  state of
healthy reparation.   The  chancres  on the thigh Avere cicatrized;  the
base Avas no  longer  indurated.  27th.  All was well, and the patient left
the hospital.  During all the time of the treatment the patient enjoyed ex-
cellent health;  the functions remained perfectly regular.

  Case XXX.  Chancre  in the period  of reparation; sympathetic bubo;
inoculation without result.
  M----, aged 22, entered June 6,  1835.   The  patient  had  contracted
chancres five weeks previously; ten days afterward a bubo appeared in
the left groin ;  its progress had been sub-acute.  Now there Avere ulcera-
tions with the characters of the period  of reparation on the frenum, mar-
gin of the prepuce, and the  posterior part of the penis; the bubo had  sup-
purated ; its base was broad, but yet softened.  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, Avhich
had still some  points in the ulcerative  stage, Avas inoculated on the right
thigh, by a single puncture.  Cataplasms were  applied to the  bubo; the
chancres were cauterized, to check the development of some granulations,
and Avere dressed Avith cerat. opii.  12th. The puncture had  produced no
effect.  13th.  The  pus  of the bubo was inoculated  on the left  thigh.
The chancres were nearly healed ; they were  superficially cauterized, to
obtain a cicatrization; the base of the bubo was softened ; the edges of the
Avound appeared ulcerated; but this seemed  to depend on a want of vital-
ity, in  consequence of the  thinness of the skin.   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 state  of ulceration.   20th.  The inoculation had  pro-
duced nothing; the  incision made in  the  bubo, the cavity of Avhich no
longer secreted  pus, was cauterized.  25th.  The patient left cured.

  Case XXXI. Chancre, sympathetic bubo;  inoculation unsuccessful.
  Bach----, aged 19 years, entered Oct. 11th, 1836.  Ten days after a
chancre appeared  on the  prepuce ;  a  bubo formed on the right side;  now
it has softened and suppurated  ; the tumor is not very large.
  12th.  It is opened, and the pus from its base  is inoculated on the right
thigh in two places;  the pus is taken  in a glass tube.  After being opened
the bubo is completely emptied and covered with cataplasms.  16th.  The
inoculation of  the 12th is unsuccessful;   the  bubo  suppurates less.
24th. The left thigh is inoculated with pus taken on the 12th.  27th. The
inoculation is unsuccessful; the discharge from the bubo has ceased;  the
granulations at the opening are cauterized.   On the 21st the  patient
leaves cured. 
PRACTICAL OBSEBVATIONS--INOCULATION OF  BUBOES.
173
  Case XXXII.  Phagedenic chancre, sympathetic bubo ;  inoculation with-
out result.
  Finarg----, aged 25, entered Oct.  7, 1836.  This affection had lasted
fiveAveeks;  at first, a pimple appeared on the  anterior  and upper parts
of the penis; its progress resembled that of a pustule from inoculation; on
the upper and back part of the glans, a chancre Avas formed in consequence
of an erosion.   The  two  ulcers remained nearly  in  the same state, for
about a  Aveek;  but after  severe exertion  and frequent errors of diet, a
phagedaenic  gangrenous state Avas induced by an excess of inflammation;
the surface of theAvounds became rapidly extended ; then recourse was had
to emollients and opiated cerate.  The progress of  the disease  Avas  soon
arrested;  but there Avas a great loss of substance, especially on the glans;
the ulcer Avas regularly progressing towards cicatrization; Avhen, after some
exertion, it became irritated, and on the folloAving day the patient felt a
pain in the groin, in which  a bubo, whose course Avas very acute, shoAved
itself; it was treated, from  the commencement, Avith mercurial frictions,
and  the chancres had  been dressed with ung. mercur.  On entering the
hospital, ten days after the development of the  bubo, the Avhole mass had
suppurated; there was some engorgement at the base, which appeared to
adhere to a  considerable depth  to the  subjacent parts;  the  chancres pre-
sented all the characters of the period of reparation.   8th. The bubo was
opened, and a greenish bloody pus came from  it;  some of which Avas in-
oculated 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, hydrochlor., and a gargle of alum.
 sulph. Avas  ordered to be used.  Cataplasms were applied to  the bubo, and
 the  chancres  Avere  slightly cauterized, and then dressed  with vin. arom.
 10th. The inoculation on the 8th had  produced nothing;  the  pus  of the
 bubo was  again introduced  on  the left  thigh, and  that  preserved in
 the tube on the right; the same dressings were continued.  12th.  None
 of the inoculations made on the 10th  had produced anything; the chancres
 were rapidly  progressing  towards cicatrization;  the  bubo was  nearly
 closed;  a little deep-seated engorgement  remained at its base.  A fresh
 inoculation Avas made of the pus preserved in the tube since the 8th.   17th.
 Only a small portion of the chancre  of the glans remained ; that on the
 skin of  the penis Avas healed; the  bubo Avas closed;  compresses dipped
 in decoct,  alb. were applied,  and  compression was  ordered  to be made.
  22d. All was cicatrized, no induration remained, and  on the 25th he left
  the hospital.

   Case XXXIII. Blenorrhcea; sympathetic bubo; inoculation  without re<
 suit.
   Ber----, aged 22, entered Sept. 21st, 1836.   This patient could not say
 when the blenorrhoea had commenced, as he had several time's, by frequent
 exposure, brought it back to the acute stage; a bubo had appeared in the 
L74        CLINICAL  AND  EXPERIMENTAL  RESEARCHES---
right groin, about three weeks previous to his coming to the hospital, and
its course had been subacute.  We found the blenorrhoea in the acute stage,
yielding a greenish pus; the bubo was of a considerable size, and but little
suppurated; cataplasms Avere ordered to be applied to it.  22d. The blen-
orrhoeal #pus was  inoculated by two punctures, made on  the  left thigh.
29th.  The inoculated  punctures had produced  nothing.  The bubo  was
opened; its pus was white and creamy ; but little  engorgement remained
at its base; some leeches applied to the perinaeum on the 22d  had much
diminished the inflammatory state.  The blenorrhoeal pus Avas again in-
oculated on the left thigh; some of the pus was preserved in a tube. 30th.
The inoculations made on the 26th had  produced  nothing;  for the gonor-
rhoea cubebs Avere ordered, and  injections of arg. nitr.  The 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 inoculated;
the gonorrhoea had ceased;  the bubo was closed.  7th. The inoculation of
the pus preserved in the  tube had produced no result.  No induration re-
mained around  the closed bubo; the patient left quite cured.

   Case XXXIV.   Chancre, sympathetic bubo ; inoculation unsuccessful.
   Th----, aged 21, entered Aug. 19, 1836.  Fifteen days since a chancre
appeared at the upper part of the prepuce; the next day a bubo was seen
in the right groin ;  its progress was acute and painful;  suppuration soon
progressed in the Avhole of the tumor, which  seemed formed by superficial
ganglions; the  skin covering it was very thin.   The bubo was opened on
the 20th, and there was a profuse discharge of pus from the cellular tissue
around the ganglion;. after emptying the tumor, there remained a number
of hard and engorged ganglions.  The pus from the base of the tumor was
inoculated on the right thigh;  the chancre  was  cauterized, and  dressed
with  vin. aromat.  24th. The inoculation was unsuccessful.   A  blister
was applied to the bubo to hasten its progress, and to resolve the engorged
ganglions.  30th. The chancre is doing well, but the bubo is stationary.
   Sept. 6th. Dressings of mercurial ointment  and cataplasms are applied.
14th.  There is  some improvement; the chancre is healed Avithout indura-
tion.  The surface of the  bubo is cicatrized, but the ganglionary tumor is
slightly diminished.  30th.  Compression is applied.
   Oct. 10th. Resolution proceeds rapidly.  18th. There remains no more
Hardness, and the patient left cured.

   Case XXXV.  Chancre, sympathetic bubo ; inoculated unsuccessfully.
   Be----, aged 27, enteied Nov. 25, 1836.  Six weeks ago this  patient
was affected Avith chancres, and has had no regular treatment.  The chan-
cres have now been healing for fifteen days, and  their surface is  covered
with fleshy granulations.   Twelve days ago,  a bubo appeared on the right
groin; its progress was  acute, and the  suppuration  is now perceptible. 
         PRACTICAL  OBSERVATIONS---INOCULATION OF  BUBOES.     175

27th. It is opened; the pus is greenish and creamy; it is inoculated in
two places in the right thigh.   The chancre is cauterized and dressed with
vin. aromat.; and cataplasms are placed on the bubo.  30th. The inocula-
tion was unsuccessful; the chancre is cicatrized.   The bubo is slightly in
durated at its base, and suppurates freely.  10th. The chancre is healed,
.and to obtain the healing of the bubo, it is filled  Avith cantharides.  20th.
Half of the bubo is cicatrized ; the engorgement of the base has nearly dis-
appeared.  23d. The patient is discharged cured.

   Case XXXVI.  Chancre, balanitis, phimosis; sympathetic bubo inocula-
ted without result.
   Joig----, aged 21, entered July 31, 1835.  Six Aveeks previous, this pa-
tient had contracted chancres, Avhich  he  observed three days after expo-
sure ; a  fortnight later,  after  severe exertion, a  balanitis  and phimosis
supervened, to Avhich, after four days, v/as added a bubo on the right side,
Avhose  progress had  been very sIoav.   Now there was a little fluctuation
in  the  bubo, and pressure occasioned  pain; the phimosis, although  not
much inflamed, did not permit the glans to be uncovered, on which several
indurated points were felt through the skin.
   Aug. 7th. The bubo was opened, and there Avas  a discharge of a little
pus mixed with blood; the right thigh was inoculated by two punctures;
the balanitis was cauterized, and cataplasms applied  to  the bubo.   12th.
The inoculated punctures had healed; dressings  of ung. mercur. were ap-
plied to the engorgement of the ganglion in the right groin, to resolve it.
20th. The resolution progressed slowly ; the edges of the incision were not
ulcerated.  The glans could be uncovered, and showed a chancre near the
frenum, in the period of reparation, which was ordered to be dressed Avith
vin. arom.  30th. A decided improvement; the bubo had nearly disappear-
ed; the chancre was healed.   Compression, with  applications  of decoct.
alb. were prescribed, and, Sept. 11th, the patient was dismissed cured.

   Case XXXVII. Blenorrhoza, sympathetic bubo ; inoculation unsuccessju*
   Pho----,  aged 22 years, entered  Dec. 20, 1836.  A  month after the
commencement of a blenorrhoea, which had  continued for  two months, a
bubo appeared on the left side;  it progressed slowly, and did not suppurate
for three months.   Now,  the whole of it is soft; it was opened, and the
superficial pus was inoculated  at two places in the  left thigh; the pus
from the base of the tumor  is inoculated in the right thigh, and cataplasms
are applied.   23d. The inoculation being unsuccessful, it  is  repeated, and
powdered cantharides are introduced into the abscess, to cause granulations,
25th. The abscess is nearly filled with  granulations, and  the poAvdered
cantharides is,again applied, and the 9th of Jan.  the patient is discharged
cured. 
176         CLINICAL AND  EXPERIMENTAL RESEARCHES---

  Case XXXVIII. Chancre, sympathetic bubo ; inoculated unsuccessfully.
  Fouch----, aged 28  years, entered  April 8, 1836.  In  this patient  the
chancrous infection  had existed for six Aveeks, and the bubo on the right
side, fifteen days. Now, the chancres are healing.   He has had no treat-
ment.  The bubo Avas  suppurated ;  its base is broad and indurated ; it is
opened, and its whitish and creamy  pus is  introduced into the right thigh
by two openings. The chancres are cauterized, and dressed with aromatic
wine.  12th. The inoculation had  produced no effect; the edges of  the
bubo were not ulcerated ; to facilitate the resolution of the base, a blister
was applied to the tumor, and dressings of mercurial ointment Avere or-
dered.   20th. The chancres were nearly healed, A small indolent tumor
was seen in the axilla, which seemed  to advance, although slowly.  29th.
A blister Avas applied to the tumor on the left side.   The bubo on the right
Avas smaller, in consequence of the dressings Avith mercurial ointment.
  May 3d. Fluctuation is evident in the left bubo, and a mesh of lint soak-
ed in  a solution of corrosive  sublimate is applied to the left. bubo.  9th.
The suppuration on the left side is evident; it is opened, and a  thin  red-
dish pus is discharged, which  is inoculated on the left thigh.  10th. The
inoculation failed; the  right bubo is  Avell;  the  left has nearly  disappeared,
after evacuating the  pus.  12th. The chancres have  left no induration;
cataplasms are applied to the left bubo, and the patient is discharged well
on the 13th.

  Case XXXIX. Chancre; symptomatic bubo inoculated unsuccessfully.
  Chaimb----, aged 23, entered May 17, 1836.  This patient had chan-
cres near the frenum, and  a  bubo on  the  right side, which had existed a
fortnight; it had been acute  in its course; the suppuration is  complete,
and no engorgement  remains at its  base.   19th.  The bubo was opened,
and afforded a thick ropy pus, which was inoculated on the  right  thigh ;
the chancre was cauterized.  21st. The inoculation failed: the edges of
the incision  had remained closed, and not ulcerated ; the chancres Avere
dressed Avith vin. arom., and cataplasms Avere applied  to the bubo.   28th.
The chancres were nearly well, and the cavity of the bubo three fourths
united.  The patient left cured, June  19th.

  Case XL.  Blenorrhoza, superficial, sympathetic bubo ; inoculation  un-
successful.
  Ch----, aged 30 years, entered Dec. 19th, 1836.  This patient had been
attacked several times with blenorrhoea,  at short intervals;  the last had
continued nearly a month; fifteen days since, a superficial bubo  appeared
in the right groin;  it  progressed acutely,  had suppurated, and. the  skin
Avas very thin.  20th. The bubo Avas opened, and there was a discharge of
creamy and greenish pus, Avhich Avas  inoculated in the left thigh in two
places; the  superficial pus is  also inoculated  in the right thigh, and  the
urethra is  cauterized Avith Lallemand's pate caustique.   23d. The inocu- 
        PRACTICAL OBSERVATIONS--INOCULATION OF BUBOES.      177

ration failed; the  blenorrhoea was better;  the  cauterization  was  again
practised, and a blister was applied to the bubo.   27th. The cavity of the
bubo was emptied, and it was filled with powdered cantharides ; the ble-
norrhoea was cured.  Jan. 1st.  A few drops of serous pus came from the
bubo.  3d.  It is cicatrized, and the patient is cured.

  Case  XLI.  Chancre, sympathetic bubo ; inoculation unsuccessful.
  Ham----, aged 23 years, entered Aug. 12th, 1836. A  month previous,
this patient had a chancre which had  destroyed nearly all the frenum;
eight  days  after the chancre appeared, a bubo Avas seen on the right side;
two days after, another formed on the left;  the  progress of these tumors
Avas subacute, and  both suppurated at the same time; now fluctuation is
felt on  both sides,  and  on the 13th the buboes Avere lanced,  and a large
quantity of thick and stringy pus was discharged;  the ganglions seemed
dissected by the suppuration of the surrounding cellular tissue; cataplasms
were applied.  The two thighs were inoculated in two places Avith the pus
from the buboes.  The chancres, part of which seemed to be healing, were
cauterized  and dressed with vin. aromat.  17th. The inoculation had fail-
ed.  To resolve the ganglions, dressings of  mercurial ointment and cata-
plasms  were applied, and  to the chancre, cauterization  and vin. aromat.
21st. Resolution of the ganglions progressed rapidly under the dressings of
mercurial ointment. The chancre is nearly cicatrized ; the part seems a
little indurated,  and for this, pills  of the proto-iodide of mercury are
ordered. 27th. The dressings of the mercurial  ointment are  suspended;
the buboes are flat and free from pain; the flaps of skin  are trimmed off
to expedite cicatrization, and the patient is discharged cured, Sept. 7th.

  Case  XLII. Chancre, sympathetic bubo ; inoculation affording a pseudo-
pustule.
  Mor----,aged 22, entered Dec. 6th, 1836.   This patient could not state
when the chancres on the glans had  appeared.  About eighteen days pre-
vious a  bubo appeared in the right groin.  We found the chancres healed ;
the bubo was in full suppuration; the skin had become very thin.   It Avas
opened,  and the first pus which flowed from it  was inoculated on the right
thigh;  then pus taken from the base of the cavity Avas inoculated on the
left thigh,  and cataplasms  applied  to  the  tumor.  9th. The* inoculated
punctures were red and pointed.   10th. A little pus was  seen at the sum-
mit of  the  punctures.   16th. The pustules were formed on both thighs;
around them 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 chancrous pus.   Some of the pus was  inocu-
lated on the right  thigh.   21st. The first two pustules from inoculation,
Avhich were opened on the 16th, had  healed Avithout any  dressing;  the in-
oculation of their pus had  produced no effect.  The induration at the base
of the bubo still remained;  the skin which  covered it had been removed,
                                 23 
178        CLINICAL AND EXPERIMENTAL RESEARCHES---

as not adapted to cicatrization.  Ung. mercur. was applied to promote the
resolution of the engorged ganglions, Avhich Avere perceived at the base of
the Avound, and afterwards cataplasms.  30th.  The bubo was better, but
the induration disappeared but slowly.
  Jan. 10th. The cicatrization had begun, granulation had appeared; the
use of the ung. mercur. was suspended, and cauterization with arg.  nitr.
ordered.   15th. But little induration remained; some granulations Avere
cauterized, and then compresses Avith decoct, alb. applied.   27th. The pa-
tient left cured.

  Case XLIII.  Chancres, sympathetic bubo ;  inoculation unsuccessful.
  Par----, aged 28 years, entered Sept. 9th, 1836.   The  disease had ex-
isted for a month; chancres first appeared on the frenum and loAver part
of the prepuce, and from neglect and want of treatment gradually extend-
ed to the glans and mucous membrane of the prepuce, where they became
confluent.  Hard and painful buboes exist on both groins.  The cyanuret
of silver  is prescribed according to one of the  formulas  of M.  Serres of
Montpellier, and commencing by the slight dose of a tenth of a grain  in
the form  of pill, and  united to the poAvder of orris deprived of its watery
portion.  12th. Two pills were  given; the patient feeling no effect from
one.  16th.  Three pills were  given the buboes progressed regularly, but
as yet there is  no suppuration.  The chancres have granulated,  18th.
Four pills were given, but as yet there is no symptom of the action of the cy-
anuret of silver.  21st. Five pills Avere ordered; fluctuation is felt in the
buboes; the base of the tumors is  hard and broad.  26th. Six pills were
given, and on the 30th  the buboes were opened, and the pus of each bubo
was introduced by two punctures into the thigh of the same side.
  Oct. 4th. The inoculations failed and are repeated; two grains of the
cyanuret of silver are given.  7th.  The inoculations have failed; there is
no perceptible effect from the cyanuret of silver, and  the  granulations  in
the place of the chancres  have become vegetations.   10th.  Five  grains of
the cyanuret of silver are given.   12th. The buboes are  a little better,
but follow the course of a disease left to itself without treatment.  24th.
No improvement; the vegetations are excised ; the cyanuret is suspended;
cataplasms are applied to  the buboes, which are still suppurating and hard
at their base, and the patient is Avell, Nov. 7th.

  Case XLTV.  Chancre, sympathetic bubo ; inoculation unsuccessful.
  Bel-;—, aged 22, entered Aug. 30th, 1S36.   The chancres are situated
at the corona glandis, and are developed near the frenum, Avhere  are  seen
four follicles.   Eight  days after the chancres appeared,  a bubo  Avas seen
on  the left side; its  progress  was acute.  Now  the bubo has  formed
an abscess;  there is no engorgement at the base.  The chancres are heal-
ing and granulating over the Avhole surface.  The bubo is opened, and the
deep-seated pus is inoculated in the left thigh.  The chancres are caute- 
          PRACTICAL  OBSERVATIONS---INOCULATION  OF BUBOES.     179

 rized and dressed Avith vin. aromat.   Cataplasms are applied to the bubo,
 which, after being opened, almost disappeared.
   Sept. 3d. The inoculation failed;  the chancres are  healing, and their
 surface is dried by cauterization.   The bubo is  almost cured,  and dis-
 charges but a little serous pus; the abscess  is nearly healed, and compress-
 es of decoct, alb. are applied.  The patient is discharged cured  on the 9th.
 There is no  induration in the place of the chancres; and on  the bubo is
 only the cicatrix of the incision.

   Case XLV. Blenorrhoea, indolent bubo ; inoculation unsuccessful.
   Bl----, aged 24 years, entered March 7th, 1836.   The disease  is of two
 months standing; at first the blenorrhoea was very acute,  but  became
 chronic by the use of baths and an antiphlogistic regimen. A month since,
 after  some fatigue, an indolent bubo appeared on the right side.   Now the
 discharge is white and muco-purulent,  and there is  no  pain in urinating ;
 the bul^o is large, with a broad base,  embracing some  deep-seated gan-
 glions.   8th.  The pus of the blenorrhoea is introduced into the right thigh.
 Blisters are applied to the bubo, which  are dressed Avith a solution of cor-
 rosive sublimate, twenty grains to the ounce of water, and injections made
 by dissolving two grs. of the  iodide of iron in an ounce of water  are pre-
 scribed for the blenorrhcea.  12th. The  inoculation failed; the injections
 are continued with double the quantity  of the iron.  A mesh of lint soak-
 ed in a solution#of corrosive sublimate  and then cataplasms Avere applied
 to the bubo.  16th. The discharge has  almost ceased; the bubo seems to
 advance  sloAvly to resolution.   A blister  and the solution are again applied,
 and the patient leaves, April 20th.

  Case XLVI.   Chancres, blenorrhoza, sympathetic bubo.
  Laur----, aged 20 years, entered Nov. 7th, 1S35.   Three months since
 the patient contracted chancres, for which  he had  no treatment;  a month
 afterwards he was affected with blenorrhoea, and a bubo appeared on the
 right  side; the chancres were nearly cicatrized. Noav the blenorrhoea runs I
 abundantly ; the matter of the discharge is yellowish white ; there is  no
 pain in urinating, no hardness in the urethra ; the bubo has suppurated;
 its base is hard and very  extensive.
  10th. The bubo is opened, and a thick Avhilish pus is discharged ; at the
 base of the abscess there is a mass of ganglions dissected by the suppuration;
 the skin,  which is  too thin for a cicatrix,  is removed, and the engorged
ganglions are  exposed, to cause immediate  action of the mercurial oint-
ment.  The right thigh is inoculated  in  two places with pus from the bu-
bo, and that of the blenorrhoea is introduced into the left thigh ; four grains
of cubebs are prescribed.  13th. The inoculation failed.  The right thigh
is  again  inoculated with pus from the  bubo, and the left, with that from
the blenonhoea.   The nitrate of silver is introduced  into the  urethra, and
cubebs are continued.  20th. The inoculations failed; the blenorrhcea is di- 
180         CLINICAL  AND EXPERIMENTAL RESEARCHES---
minished by the cauterization with the nitrate of silver; the bubo suppu
rates freely, but the ganglions are smaller.  28th. The left thigh is inocu-
lated from the  bubo;  the  urethra is cauterized with the nitrate of silver;
the ganglions in the groin  are much smaller.  Dec. 1st. The blenorrhoea
has ceased; the bubo has stopped discharging; the dressings with mer-
curial ointment are suspended, and the granulations at  the base of the
abscess are cauterized. 4th. The bubo is almost cicatrized, and compresses
with decoct, alb. are applied.   20th. The patient is discharged cured.

  Case XLVII.  Superficial ulcer; sympathetic bubo inoculated without
result.
  Caub----, aged 22, entered Jan. 30, 1837.  A  month since this patient
perceived, after exposure, a wound on the inner and upper part of the pre-
puce ; at first,  there Avas  much irritation,  and tOAvard the eighth day a
bubo appeared  on  the right side; a few days rest, and dressings with ce-
rate, caused the ulceration to disappear; the bubo remained stationary and
indolent.  The  patient then left Montpellier for Paris; during the journey
he had sexual intercourse, by which the cicatrix of the wound on the pre-
puce was ruptured, and the bubo suddenly increased. Now the wound on
the prepuce was nearly healed; but the  bubo had suppurated extensively
22d. The bubo  was opened, and the first pus which escaped was inocula-
ted by two punctures  in the right thigh, and the pus from the base of the
cavity on the left.  Cataplasms were applied to the bubo.   23d. The in-
oculation failed  ; the cavity was excited by the cautery, and'the cataplasms
continued.  29th. Powdered cantharides were introduced  into the cavity.
  Feb. 1st. There  Avas little suppuration; compresses with decoct, alb.
and a methodic compression Avere applied.  14th. The patient left cured.

  Case  XLVIII.   Chancre and blenorrhoza ; sympathetic  bubo, inoculation
unsuccessful.
  Col----, aged 19 years, entered Dec. 13th, 1836.  The  patient could not
determine when his disease commenced; for several months he had chan-
cres, Avhich disappeared in ten or twelve days by means of a dressing of satur-
nine cerate; but the last affection Avas a blenorrhoea, which had continued
nearly a month ; it  is nearly Avell.  Eighteen days since  a  bubo appeared
on the right side, after excessive drinking; its progress Avas  subacute; noAV
the whole tumor has suppurated; near the base is a kind  of deep engorge-
ment; it is opened, and a great deal of bloody pus is discharged.  The first
pus which Avas discharged, is inoculated on the right thigh, and that from
the base of the tumor in the left, by two incisions.  Cataplasms are ap-
plied to the bubo.   17th. The inoculation failed ; the edges of the  Avound
are not ulcerated, and the  abscess tends to heal.  24th.  The interior of the
bubo is  cauterized, to hasten cicatrization; it is dressed  with compresses
dipped in decoct, alb., and  compression is applied.
   The patient leaves cured, Jan. 13th, 1837. 
        PRACTICAL OBSERVATIONS---INOCULATION  OF BUBOES.      181

  Case XLIX.   Chancre;  deep-seated  multilocular sympathetic bubo in-
oculated without result.
  Gip----, aged 26, entered Oct.  11,  1836.  The affection had existed
eight months;  the chancres first appeared eight days after  exposure ;  no
treatment  had  been used;  the  buboes had been developed two months;
their course had been  indolent; having attained  a  great volume, they be-
came softened at the summit.  The left bubo had  been opened, by means
of caustic  potass; but  some cavities adjacent to the principal cavity had
also to be  opened.  We found the suppuration of the right bubo had ceas-
ed, and it  was nearly closed ; its base Avas indurated, and extended deeply.
The left multilocular bubo  had  two principal cavities;  a superior corres-
ponding Avith the central line, and an inferior in the plica cruris; the right
bubo was  treated with blisters, and cataplasms covered Avith ung. mercur.;
internally, the  iodide  of iron, twelve grains per diem, and a decoction of
hops, with antiscorbutic sirup, were given.
   12th. The pus of the left bubo Avas  inoculated by two punctures made
on the right  thigh; the first puncture was made with the pus from the
central cavity;  the second with that from the inferior.   18th.  The  punc-
tures had  produced nothing; the  right bubo Avas  somewhat  diminished.
Two fistulous passages in the left bubo were destroyed, and several  granu-
lating  points were cauterized.  24th. The right bubo was nearly healed ;
the left suppurated little; but at the base there could be perceived some
deep-seated induration.  Compasses  with decoct, alb. Avere applied, and
compression ordered to be made.
   The patient left cured Nov. 8th.

   Case L.  Abrasion  of the glans;  sympathetic  bubo; inoculated  un-
successfully.
   Men----, aged 19 years,  entered Oct. 3,1835. About fifteen days since,
during exposure, this patient had an abrasion on the left side of the base of
ihe glans.  Partial balanitis  ensued, in consequence of a natural phimosis and
a slight degree  of inflammation in the abrasion; eight days afterwards a
bubo appeared near the upper part of the left thigh, below Poupart^s liga-
ment; engorgement is felt  in  the  iliac fossa.   Now the bubo,  which
is acute in its progress, has suppurated freely; the base is indurated.
   10th. The pus of the bubo was inoculated on the left thigh ; the wound
and balanitis had disappeared.  17th.  The inoculation had failed ;  it Avas
repeated on the left thigh.   21st.  The puncture, which at  first appeared
red and raised, had disappeared;  a fresh inoculation was made on  the left
thigh.
   23d. The last inoculation had  produced nothing; the edges of the in-
cision in the bubo were not ulcerated, and it was healing ; the major part
of the cavity Avas reunited ; dressings of decoct, alb.  were ordered. Nov. 9th.
The patient left cured. 
182        CLINICAL  AND EXPERIMENTAL  RESEARCHES---

  Case LI. Chancre, sympathetic bubo ; inoculation unsuccessful.
  Car----, aged 20 years, entered Nov. 25, 1836.  This patient had chan-
cres near the frenum, on  the  left;  they had existed for a month,  and are
now cicatrized.  Eleven days since, a bubo appeared on the left side; its pro-
gress was sub-acute; it Avas dressed Avith blisters and a solution of corro-
sive  sublimate,  twenty grains ^o the ounce of Avater; the suppuration.
however, progressed,  and it was opened Dec. 7th.   Cataplasms were ap-
plied.  9th. The pus  of  the  bubo  is inoculated; there is no induration ai
the base.   12th. The inoculation failed; the edges of the opening of the
Dubo are not ulcerated; a part of the abscess is cicatrized, but little pug
exudes, and the induration at the  base has completely  disappeared.  The
patient left cured on the 16th.

  Case  LII.  Chancre; sympathetic  bubo, producing a pseudo-pustule on
inoculation.
  Houz----, aged  32, entered Jan. 30, 1S36.   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 shoAved itself on the right side; its  progress
had been very acute.   We found  the chancres healed, and the bubo sup-
purated ; it Avas opened on Jan. 31st, and  a  greenish thick  pus flowed
from it.
  Feb. 1st.  The pus  of the  bubo  was h^culated on the right thigh; the
lips of the wound were red and irritatecL but not ulcerated;  cataplasms
Avere  applied.  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 Avas
made on the right thigh.  10th. The result from  the  second inoculation
Avas the same as  the first; the bubo was cauterized and dressed with
wine; the secretion of pus  was very small.  The patient left cured  on
the 22d.

  Case LIII. Chancre, sympathetic bubo ;  inoculated unsuccessfully.
  Bil----, aged 18 years, entered Aug. 10th, 1835.  For a year this pa-
tient had been affected with chancres, Avhich Avere never treated  regular-
ly.  A month since neAV chancres appeared  on  the  prepuce and  back of
the penis.  Eight days afterwards a bubo appeared on the left side, incon-
sequence of excess in drinking; it had suppurated, was  opened,  and the
pus was greenish, thick, and mucous., It is inoculated with the point of
a bistoury on the left thigh; the chancres of the prepuce and penis are dressed
Avith opiated cerate and cauterized  Avith the nitrate of silver. 14th. The in-
oculation failed.  Cataplasms were applied, and the chancres are better.
20th.  The chancres are nearly cicatrized, the bubo discharges but little
and the patient leaves, Sept. 28th. 
         PRACTICAL  OBSERVATIONS---INOCULATION  OF EUEOES.     183

  Case LIV. Chancres, balanitis,  sympathetic bubo; inoculation unsuc-
cessful.
   Guimb----,  aged 22 years, entered  Dec.  9, 1836.  This patient had
long been affected Avith balanitis, but could not state the precise  time of
the appearance of the chancres, which have left their marks on the  glans
and  frenum.   Now there  is  no  erosion; the balanitis is  nearly cured.
About eleven days since a bubo appeared on the left side; its progress Avas
sub-acute, and it is very soft; the cavity is large.
  10th. The bubo is opened, and the pus from the surface is inoculated on
the left thigh, and the pus from the base of the abscess on the right thigh.
14th. The inoculations failed.  The contiguous edges of the opening had
not ulcerated; the left thigh was again inoculated ; cataplasms Avere ap-
plied.   18th. The inoculation of the 14th failed; the bubo is nearly cica-
trized ; its base is cauterized Avith nitrate of silver;  it is dressed with vin.
aromat.  The patient leaves cured Jan.  14th.

  Case LV. Chancre, sympathetic bubo ; inoculated unsuccessfully.
  Cir----, aged 26,  entered Nov. 15, 1836.  This  patient had  been af-
fected Avith chancres of the prepuce and  frenum for six Aveeks.  Three
weeks since a bubo appeared on the left side ; on  this side is situated the
chancre  of  the frenum.   When the bubo appeared,  the chancres  were
nearly healed.  The patient ascribed the tumor to three days of hard Avork,
being at the same  time intemperate in drinking.  The progress of the
bubo is sub-acute;  it was opened, and the thick  pus discharged from it is
introduced into the left thigh.  19th. The inoculation failed; the base of
the  bubo is slightly engorged; it is dressed with cataplasms and  mer-
curial frictions.   28th. There is no  engorgement;  the bubo is cicatrized,
and the patient is discharged cured.

  Case LVI. Chancre, sympathetic bubo ; inoculated unsuccessfully.
  Br----, aged 21 years, entered Sept.  30th, 1836.   Three weeks since,
chancres appeared at the corona glandis; eight days ago he attempted to
destroy the ulcers by burning them with a cigar;  the day after, a tumor
appeared in the right groin, which rapidly approached  suppuration;  it
was  opened Oct. 1, and the pus Avas inoculated on the right thigh ;  cata-
plasms were applied  to the  tumor; there was  no engorgement at its
base.  Oct. 7th.  The inoculation failed; it Avas  repeated  on  the  right
thigh;  the pus was taken in a vaccine tube.  12th.  The inoculation fail-
ed ;  the pus  of the bubo was again introduced into the right thigh, and
that  in the tube into  the left.  The lips  of the incision are not ulcerated ;
there is no discharge from the bubo.  18th. The inoculation of the 12lh
failed, and the patient left the 26th.

  Case LVII.  Chancre, sympathetic bubo ; inoculation unsuccessful.
  Mic----Louis, aged 26 years,  entered Sept. 20, 1836.  Six weeks ago 
1S4        CLINICAL AND  EXPERIMENTAL  RESEARCHES—

this patient AAras cured of a bubo, Avhich appeared after chancres of the pe-
nis;  since that, there has been  no exposure; at the side of the bubo, of
which only the cicatrix remains, there is a  small tumor, not painful, and
Avhich advances slowly.   In consequence of fatigue, it has progressed and
suppurated,  a  brownish pus  being  discharged  from it;  the  skin  has
sloughed off, the abscess is large; it is introduced into the left thigh, and
cataplasms are applied.
  26th.  The inoculation has failed; the bubo is not ulcerated;  the tumor
has collapsed entirely; the inoculation is repeated on the right thigh;  the
pus is tested, and found to be alkaline.  28th. The inoculation has failed;
the bubo is nearly closed.  30th. The  patient is discharged cured.

  Case LVIII. Blenorrhoza, chancre; sympathetic  bubo, inoculated unsuc-
cessfully.
  Mong----Joseph, aged 19 years, entered May 21, 1835.   This disease
had existed for six weeks, blenorrhoea  appearing eight days after exposure.
Two days before, a chancre  being developed in the skin of the prepuce
was cured after three weeks, by the use of the cerate ; a week later, and a
month after the commencement  of the  disease, a  bubo appeared on  the
right side, which suppurated, although leeches  and  emollients Avere used.
The blenorrhoea has now disappeared; the bubo is large and soft at the
summit; cataplasms are applied.   June 2d.  The bubo is opened.   3d. The
pus from  the  base  of the abscess is  inoculated, which, on  the 10th, had
produced nothing; the bubo is cauterized, and compresses of decoct, alb.
are applied.   The patient is discharged cured, July 22d.

  Case  LIX.   Blenorrhoza, chancres;   multilocular sympathetic bubo,
inoculation unsuccessful.
  Vil----Pierre, aged 25 years, entered July 20,1835.  Five months since,
this patient was affected with blenorrhoea, for which he had no treatment;
a month afterwards, he  had chancres at the root of the glans; he then
used injections of sulphate  of zinc, Avith  saturnine cerate;  now he  has a
bubo of three weeks  standing;   the blenorrhoea and the chancre, marks of
which were still found  on the  left side of the frenum and the base of the
glans, have disappeared, the bubo is indolent, and some soft points are felt
through the  skin above the   ganglionary engorgement;  cataplasms are ap-
plied.  July  24th. A circumscribed abscess is opened, which is seemingly
situated in a ganglion; a thick  pus is discharged, Avhich is inoculated on
the right  thigh.  27th.  The inoculation  has failed.  31st.  It is repeated
unsuccessfully w.th  pus  from  another ganglion,  and the patient leaves
Aug. 10th.

  Case LX.   Chancre of the prepuce, sympathetic buboes inoculated  un-
successfully.
  Pa----, aged 22 years, entered Jan 22,  1836.  Six  days  after exposure, 
         PBACTICAL  OBSERVATIONS—INOCULATION OF  BUBOES.    185

this patient had a chancre at the upper  and inner part  of the prepuce;
two days afterward, a bubo appeared on each side, and advanced rapidly,
although leeches were applied  before he entered the hospital.  There is
no blenorrhcea.
  Feb. 5th. The buboes are opened, and the pus from each is  introduced
into  the corresponding  thigh.  6th.  The inoculation failed, and  it was
necessary to place a piece of lint betAveen the lips of the incision  in the
buboes, to  prevent  their union, and to  facilitate  the discharge of pus.
Here the edges of the wound are not ulcerated, as in the chancrous buboes.
8th.  The inoculation is again performed,  but unsuccessfully; the chancre
is dressed Avith vin. aromatic; it is cauterized Avith the  nitrate of  silver;
cataplasms are applied to the buboes, and the patient leaves, 22d of Feb-
ruary.

  Case LXI. Bubo succeeding blenorrhoza ; cutaneous abscess on the thigh;
inoculation without result; pseudo-pustule.
  Mig----, aged 20, entered Oct. 5, 1836.  This  patient had been dis-
missed from the hospital, August, 1S36, perfectly cured of a blenorrhoea,
which had  lasted eighteen  months; a bubo, Avhich had  been developed
three weeks, was treated Avith blisters and a solution of sublimate.  When
he  left the hospital  it had  nearly disappeared; but in consequence of
fatigue and some irregularities in his diet, it soon increased, and speedily
suppurated.  Ten days previous to his re-entry, a superficial abscess had
formed in the upper 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 Avere applied to both the bubo
and the abscess.  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
little indurated.  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 Avhich had been
only red and  indurated, was beginning  to suppurate; it still remained
pointed.  17th. The  puncture  on the right, after breaking, had dried  up,
and Avas nearly cicatrized; that on the left Avas full of pus.  The abscess
on  the thigh  was  closed,  and the bubo yielded but little suppuration,
20th. The last pustule had disappeared without  treatment like the first;
not having assumed the  appearance of a specific ulcer.
  The bubo was closed, and  no induration remained at its base; in a few
days the patient left quite cured.

  Case LXII.  Chancres, sympathetic buboes ; inoculation unsuccessful.
  Gam----, aged 36 years, entered June 28th, 1835.  Six Aveeks ago this
patient noticed an extensive chancre at  the upper part of the  base of the
                                24 
186        CLINICAL  AND  EXPERIMENTAL  RESEARCHES---

glans;  the exposure had been fifteen days previous.  Three Aveeks after
it appeared, deep-seated indolent buboes appeared on both sides.   Now
the chancre seemed  healing;  the  buboes are enormous,  very  hard and
broad, and the induration extends into the iliac fossa.
  July 3d.  The left thigh is inoculated  in two places with pus from the
chancre.  Blisters are applied to the buboes, and followed by the dressing of
corrosive sublimate.  6th. The inoculation has failed ;  the first day there
was a  little pain in the first puncture, attributed to turning the  lancet
several  times in the wound, but  the  redness and prominence,  Avhich
indicated that the inoculation Avould succeed, disappeared the third.  Fluc-
.uation is evident in the summit  of the left bubo; it is  opened,  and  a
thick whitish pus  comes  from it.   On  the right  is  deep fluctuation.
9th. The  right  bubo is  opened  and  discharges freely;  through the
opening is seen a mass of ganglions, dissected by the pus. The  chan-
cre is cured by cauterization with the nitrate of silver, and dressings Avith
calomel and opium.  11th. Fluctuation is felt under the ganglions, at the
base of the right bubo opened the 9th;  it is opened and pus is discharged
freely.  The left thigh is inoculated with pus from the left bubo, and the
right thigh from the abscess  opened this day.   18th. Both inoculations
failed, and they are repeated.  The buboes are dressed with decoct, alb. ;
they are  smaller; the lips of the wound  are  not ulcerated, and on the left
most of the abscess  has healed.
  Aug. 1st. The inoculation is repeated, the previous one having  failed.
3d. The inoculation failed ; the left bubo has closed; there is  but  slight
discharge from the  right.   8th. The patient is cured.

 ' Case LXIII.  Scrofulous bubo ; inoculated  unsuccessfully.
  Lah----, aged 24, entered May 6, 1836.    The  patient, with a lym-
phatic temperament and tendency to scrofula, had already  had ganglionary
engorgements of the neck; on entering he had two enormous buboes,
which we could not attribute to a venereal affection,  as he had not been
exposed  to it for more than four months ; he had had no  other suspicious
affection than a chancre, which had  been cured a year previous, leaving
no induration on its seat.   The two  tumors  developed  themselves slowly
and suppurated.
  May 7th. The buboes on both  sides were  opened; a thick brown pus
escaped, Avhich was immediatly  inoculated;  emollient cataplasms  Avere
 pplied, and a draught of tisane of hops, with baryt. hydrochlor., and sweeten-
ed Avith sirup of gentian. It may be proper to remark, that  this patient had
 een five-and-thirty days in another hospital, in which  he had been treated
With pills of hydrarg.  deuto-iod.  Avithout  the least  amelioration.  9th.
the punctures had produced nothing; inoculation was again performed, by
*wo punctures on the right thigh.   Blisters were applied to the buboes, to
excite them; the mixture as above AA'as  continued. 15th. The inoculations
made on the 9th had produced nothing;  the affection appeared  not to pro- 
        PRACTICAL OBSERVATIONS---INOCULATION  OF BUBOES.      187

gress, but  there was no  improvement; the suppuration was copious.
30th.  There was an improvement, especially on the left side; compression
was ordered.
  June 10th. The bubo on the left had nearly disappeared under the com-
pression; the general health was decidedly improved.  20th. Compression
was applied on the right side; the left bubo was cicatrized; very little in-
duration remained in the deep-seated ganglions, Avhich formed the base of
the tumor.  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, Avithout the patient feeling
any inconvenience.   July  12th. The two tumors  had disappeared,  and
only a little tension on each side remained from the change the tissues, in
which the affection had  been seated, had undergone.

  Case LXIV. Chancres, periadenic abscess, inoculated without result.
  Fecas----, aged 26, entered Nov. 14, 1835.  This patient could not state
the exact time when he had contracted the chancres on the glans,  on  the
right  side of the frenum, and Avhich Ave found  in the period of reparation.
A fortnight previous to his entry, he felt a pain in the left groin, and  per-
ceived an incipient bubo; the patient observed the strictest repose, applied
cataplasms, and the tumor then appeared arrested in its development;  but
three  days later, the cellular tissue, which was at first only indurated, ap-
peared suppurated.  16th. An abscess in the groin Avas opened and yielded
much creamy pus, which Avas  inoculated by two  punctures on  the  left
thigh. After the  evacuation  of the pus, it could be perceived  that  the
inguinal  ganglions Avere but very little swollen, and that the suppuration
was only periadenic;  the chancres Avere  cauterized and  dressed with
calomel cerate.  18th. The  punctures  had  produced nothing; the  tumor
had nearly disappeared.   24th. The chancres were cured, and the cavity
of the abscess nearly obliterated.  The patient left cured on the 30th.

  Case  LXV. Primary bubo (d'emblee ;) inoculation without result.
  Buis----, aged 18, entered Oct. 7, 1836.  This patient had never  had
either chancre or blenorrhoea; three days after exposure he perceived  a
small indolent tumor in the  inguinal region of the right side, which de-
veloped  itself slowly.  Noav its  volume was considerable;  it Avas situated
in the deep-seated  ganglions, and  through the abdominal integuments an
engorgement was felt extending into the iliac fossa;  the mass Avas every-
where adherent;  at the summit an obscure fluctuation was felt; cata-
plasms were applied. 14th.  The fluctuation was evident; the bubo  Avas
opened, and the pus from the depth of  the cavity inoculated by two punc-
tures  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.  16th
The inoculation  had produced  nothing; the redness  of  the skin  had dis- 
 188         CLINICAL  AND  EXPERIMENTAL  RESEARCHES--

 appeared; the engorgement  of  the ganglion was rapidly disappearing;
 compression was applied.  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.   19th. The inoculation made on the 17th had
 produced  nothing; the wound made in the  bubo was not ulcerated; the
 rapidity of resolution Avas, for indolent buboes, very remarkable.  No en-
 gorgement remained in the iliac fossa.  21st. The compression Avas con-
 tinued with  compresses, dipped  in  decoct, alb.   27th.  The  patient left
 cured; the tumor had nearly disappeared ; exercise and compression Avould
 remove the slight remaining  engorgement.   This patient Avas dismissed
 someAvhat sooner than common,  on account of his lymphatic habit, Avhich
 was ill suited to the diet and residence  in an hospital.  In February he
 presented himself again  at the hospital, Avhen all had disappeared ; scarce-
 ly a trace of the wound made in  the bubo remaining.

  Case LXVI.  Primary bubo ; inoculated without result.
  Pe----, aged 17, entered April 26, 1S36.   This  patient had not  been
 exposed for two months, when the day after a coition he felt a pain in the
 right groin, and a bubo  began to be developed, though slowly.  He Avas
 of a lymphatic sanguine habit;  he had undergone no treatment; the tu-
 mor Avas large and seated in the  deeper ganglions, and its base was large;
 some  engorgement  could  be felt through the abdominal integuments; it
 had existed about three weeks;  hal   the mass had suppurated ; it Avas
 opened, 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 Avere ordered to the bubo.   29th. The inoculations had  failed; the
 engorgement  was  less; suppuration copious; a flap of skin, which ap-
 peared unfit for cicatrization,  was  removed; dressings of ung.  mercur.
were then applied to obtain the resolution of the ganglionary engorgement.
30th.  The suppuration  had increased.   The  left thigh was again in-
oculated.
  May 10th.  The inoculation failed ; the applications of ung. mercur. were
discontinued;  the engorgement had decreased by half, but the surface of
 the wound Avas covered Avith a kind of pulpy membrane. A cauterization
and dressings of cerat. plumb, were ordered.   11th. The appearance of the
Avound Avas very satisfactory; the  fleshy granulations appeared  rose-
colored;  a superficial cauterization and  compression  with   compresses
dipped in decoct,  alb.  were  ordered.   20th.  But  little engorgement
remained ; the surface of the bubo, diminished by three-fourths, was nearly
cicatrized.  It was  cauterized, and on the 25th he left cured.

  Case LXVII. Primary bubo ;  inoculated without result.
  Lef----, aged 18 years, entered July  12th, 1836.  Three weeks after ex-
 posure, a bubo appeared  in the right side; its progress Avas subacute.   On
 the penis are  no marks of ulceration;  the urethra presents no indurated 
        PRACTICAL*  OBSERVATIONS---INOCULATION OF BUBOES.     189

point; there is no pain in urinating ; and the genital organs, although care-
fully examined, present no symptom of disease.  The bubo, whose base is
broad and soft, has suppurated, and the tumor seems to embrace the deep-
seated ganglions.  July 18th. The pus of the bubo is inoculated in  the
right thigh in two places.   To resolve  the bubo, mercurial ointment and
cataplasms are applied.   22d. The inoculation  failed; the dressings  are
continued, and  Avith  benefit.  The right thigh is again inoculated.  24th.
The dressings of mercurial ointment are suspended.   The inoculation of
the 22d failed.   Blisters are applied to the bubo, and its cavity is filled Avith
cantharides.  Aug. 6th.  Granulations appear; a part of the abscess is de-
nuded; compresses soaked in decoct, alb. and methodical compression are
applied, and the patient is cured on the  12th.

  Case LXVIII.  Primary bubo inoculated without result.
  Mart----Francois, aged 19, entered July 4, 1835.  Two months since,
this patient, after repeated excess at table, and a fortnight after exposure,
observed two tumors in  the  groin; the tumor on the left side Avas more
rapid in ts progress,  and was opened at the Hotel Dieu, Avhere the affection
was treatea as venereal buboes, with ung. mercur. and cataplasms, for three
weeks.  We found the left bubo  nearly healed, and the right  in  full sup-
puration.  6th.  The  bubo was opened, and the pus inoculated  by  two
punctures on the right thigh.   8th. The punctures  had produced nothing;
the lips of the  incision, which were  closed and  sound, indicated that  the
pus of the bubo, whose base was free  from induration, had not the pri-
mary syphilitic character; cataplasms Avere applied. 10th.  No more suppu-
ration remained; the cavity Avas closed;  compresses Avith decoct,  alb.
were applied.   The patient was  discharged on the  11th.

  Case  LXIX.  Primary bubo ; inoculated unsuccessfully.
  Conn----, aged 20 years, entered  Oct.  28th,  1836.  This patient had
never been affected with chancre or blenorrhoea ; it was two months since
he was  exposed, when, after violent exercise, a bubo appeared in the right
groin;  its progress Avas  acute  and very painful;  he Avas treated at  the
hospital de l'Ecole de Medecine, Avhere he remained two months; the  bu-
bo Avas opened; he took  sirup of sarsaparilla, sirup of Cuisinier, and pills
of the deuto-chloride of mercury.  Noav the bubo discharges freely; there
is a large slough which requires the removal of  folds of skin, Avhich can-
not serve for cicatrization, and form a valve under which the pus remains;
the base of  the Avound is red  and healing.
  29th. The pus from the base of the bubo is inoculated on the left thigh,
and it is dressed Avith opiated cerate.  31st. The inoculation has failed; it
is dressed with vin. aromat. and cauterized with the nitrate of silver;  the
wound is granuhting, and the patient is cured, Nov. 18th. 
190        CLINICAL  AND  EXPERIMENTAL RESEARCHES---

  Case LXX.  Primary bubo ; inoculated without result.
  Hemont----, aged 24, entered Sept. 7, 1836.   Three days after a night
spent in debauchery, during Avhich the patient had seven coitions, a bubo
appeared on the left side;  its progress Avas subacute.   The  sexual organs
being examined with care, shoAved no trace of ulceration; the canal of the
urethra was healthy;  the bubo had suppurated; little engorgement re-
mained at  the base  of the  tumor.   12th. The bubo was opened, and the
greenish thick pus inoculated by two punctures, made on the right thigh;
the cavity Avas large; cataplasms AArere applied.  16th. The punctures had
produced nothing, although the edges of the incision appeared ulcerated;
but this Avas  explained by the slight degree of vitality of the tissues he-
come thin from the suppuration, and  Avhich at the time of  the  bubo bem"
opened were bluish ; some pus, taken from the base of the cavity, was in-
oculated by two punctures, made on the left thigh; some ol. cantharid.
was introduced into the bubo, to excite the production of granulation. 20th.
The last punctures had produced nothing; the bubo was better; the oil
had produced an excitement, and the cavity was someAvhat diminished in
extent.   28th.  The bubo  was cauterized;  its base was more raised; the
oil was continued, and  by Nov. 4th the patient Avas cured and dismissed.

  Case LXXI.  Primary bubo, inoculated unsuccessfully.
  Kl----Antoine, aged  23  years, entered  June 25,  1835.  This patient
had never been affected Avith blenorrhoea; fifteen months since, a chancre
appeared on the  outer part  of  the  prepuce.  The ulceration progressed
slowly, and yielded promptly to appropriate treatment, leaving a promi-
nent cicatrix, Avhich indicated by its  appearance that  the disease had not
affected the entire thickness  of the skin.   Since  that, the patient has had
no  symptoms which could  be  referred  to  this infection.   Three  weeks
since, tAvo buboes appeared, eight, days  after exposure, which progressed
slowly, and  with  little  redness.  Ten  days since, the left bubo opened
spontaneously, and discharged a large quantity of pus, through a very  nar-
row opening.  Some flaps of thin skin AA'.ere removed,  and the pus was in-
oculated in the right thigh, July 4th.
  8th. There is no effect from the inoculation; the right bubo is opened.
By  rest, cataplasms, and some applications  of decoct, alb. the patient  Avas
cured, and  discharged July 17th, without ganglionary hardness or en-
gorgement.  It is important to remember, that after the chancre had exist-
ed for fifteen months, there Avas no tension nor ganglionary engorgement.

  Case LXXII. Primary bubo, inoculated without effect; some of the pus
being preserved in a tube, did not inoculate after being kept four days.
  Th----,  aged 22, entered Oct. 4, 1836.   This patient assured  us,  that
the only venereal  affection  he ever had Avas blenorrhcea, five years previ-
ous; it had lasted nearly two months, and run through the usual acute and
chronic stages; then, being properly treated Avith injections and copaiva, it 
         PRACTICAL OBSERVATIONS---INOCULATION OF  BUBOES.     191

disappeared, leaving no symptoms Avhich could be referred to a syphilitic
affection; the general  health  having remained in the best stale possible.
Seventeen days had elapsed since a superficial bubo appeared on the right
side;  the patient had not been exposed for seven weeks previous; the base
of the tumor appeared indurated; it was  opened; the cavity was extensive,
and appeared to have invaded the deepinterganglionary cellular tissue; an
inoculation was made by tAvo punctures on the right thigh.
  8th.  The punctures had produced nothing;  the  tumor had lessened, but
the skin appeared loosened.   The right thigh Avas  again inoculated;
some of the pus Avas preserved in a tube, open at both extremities.   11th.
The pus  preserved in the tube Avas inoculated;  the cavity appeared to be
reuniting;  the incision had remained unulcerated.  19th. The puncture
made Avith the pus in the tube had produced nothing.  Thus, in every case,
the inoculation had failed ; the cavity had diminished; the patient, having
a scrofulous habit, was  ordered  a  decoction  of hops, Avith anti-scorbutic
sirup, and  ferri proto-iod. tAvelve grains per  diem.  30th.  Nearly all the
cavity was closed, and  only a few drops of serous pus remained.  Nov. 7th.
The patient left cured.

  Case LXXIII. Chancres, symptomatic bubo ; inoculation with positive re-
sult; pustule carried to the fifth  generation.
  Lob----, aged 18, entered Jan. 5, 1833.   Three days after a  suspicious
connexion, this patient perceived a chancre on  the inner part  of the left
side of the prepuce; the ulcer being neglected, increased, and in  a few days,
a bubo appeared on the left side; its  progress was subacute, and notwith-
standing an application of leeches, ung. mercur. and emplastrum de Vigo,
a complete suppuration followed.  6th. The bubo had opened during the
night; the chancres of the penis appeared  in the period  of progression;
they Avere cauterized, and dressed Avith opiated cerate.   21st. The attenu-
ated skin, which  covered the cavity  of  the bubo, had been destroyed by
the ulceration; the ulcer had thus become denuded, and presented a chan-
crous appearance; the  pus of the bubo  Avas inoculated by tAvo punctures,
made on the right thigh; the ulcerated cavity was cauterized, and dressed
with opiated  cerate; the chancres of the penis' Avere cauterized with argent.
nitr., and dressed with calomel cerate.  24th.  The pustules from inocula-
tion had formed ; they were opened, and their pus  inoculated by a puncture
on the left thigh.  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 inocu-
lation was nearly healed, the second was in the period of progression; the
bubo was  going on Avell; its surface was granulating.  Some pus Avas
taken from the last inoculation, and  inoculated on the right thigh.  Some
induration Avas perceived at the base  of the chancres on the thigh, and on
the body were some spots indicating the commencement of a lenticular 
192        CLINICAL  AND  EXPERIMENTAL RESEARCHES—■

syphilitic  eruption; pills of hydrarg. iodid. and sudorific sirup and tisane
were ordered.   17th. The inoculation made on the  15th had succeeded,
and furnished the third generation; the  bubo had healed.   27th. Pus
taken from the chancre of the third generation Avas  inoculated on the left
thigh.
  March 1st. The fourth generation Avas produced ;  the pus. from it was
inoculated  on the 17th, and in three days time, the fifth Avas evident; the
chancres Avere in  a state  of healing, according to the time of their exist-
ence.    30th. The syphilitic eruption had  not progressed; the treatment
by the proto-iodide of mercury was continued.
  AprilJ.st. Only  two ulcers remained  on the thighs;  their base was
raised;  a cauterization and dressings of calomel and sod. chlorin. were
ordered.
  May 17th. The patient was  dismissed cured, no  induration remaining.
The general health had remained excellent during the whole  of the treat-
ment.

  Case LXXIV.   Chancre of the cervix uteri; symptomatic bubo ; inocu-
lation producing the characteristic pustule.
  Dur----Marie, aged 24, entered April 1st, 1834.   The patient had for
a month been affected with  a blenorrhoea, Avhich had occasioned 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 com-
pletely 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.   2d.  The  edges of the
incision made in the bubo appeared to  be ulcerated; cataplasms Avere ap-
plied, and emollient injections prescribed.   10th.  The wound in the bubo
had assumed a decidedly chancrous 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.
14th. The inoculation on the 10th instant had succeeded and produced a
fine pustule.   Injections of  decoct, alb. Avere ordered; on the cervix Avere
seen tAvo ulcers  Avith grayish bases, and  irregular  abrupt edge?.   19th.
The pus taken from  the centre of the ulcer on the right thigh was  inocu-
lated on the left thigh.  25th. The inoculation made on the 19th had pro-
duced  the characteristic pustule; the ulcers  Avere  dressed with calomel
cerate.  Some  pus from  the cervix, taken from an ulcer with a grayish
base, Avas inoculated on the right thigh.   28th.  The last inoculation had
produced  the pustule;  the bubo  Avas nearly healed ;  the ulcers  of the cer-
vix had become clean,  after being cauterized  Avith  arg. nitr. on the  24th;
that on the upper labium Avas granulated  at  its base, and appeared to be
raised to the level of the neighboring parts.
   May 6th. The first and second inoculations had healed, as well as  the 
             INOCULATION OF SECONDARY SYMPTOMS, ETC        193

bubo; but little discharge  remained.   15th. All was Avell; only a few su-
perficial granulations remained on the posterior labium of the cervix.  23d.
The patient was dismissed perfectly cured.
                            Section IV.


    INOCULATION OF THE PUS OF THE SECONDARY AND  OF OTHER
                   REPUTED  VENEREAL  SYMPTOMS.

  Case I.  Blenorrhoza, chancre in the  period of reparation, mucous tuber-
cles ; inoculation with negative result.
  Che----Elizabeth, aged 20, entered June 23, 1835.  Four months pre-
vious to her entry, she was affected Avith a  very severe blenorrhoea, but
unaccompanied with great pain; one month later, after new exposure, a
chancre appeared in the vulva; no treatment  had been used.  We found
the discharge had become chronic ; the cervix uteri and mucous membrane
of the vagina AA'ere but little  reddened;  but several patches of mucous
tubercles were  observed  in the perinaeum, and inner surface of the right
thigh; amongst these latter, one Avas  particularly remarked  in  the plica
cruris, Avhose surface afforded a thick  and  copious pus; it  appeared to be
owing to a transformation in situ of a primary chancre.  On the  inner sur-
face of the right nympha was an ulcer, with prominent irregular edges and
grayish base,  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  Avas 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. Avere  ordered.  A lotion  of sod. chlorin.
and calomel in poAvder Avere applied to the mucous  pustules, and pills of
hydrarg. iodid. Avith sudorific sirup and tisane were administered internally.
  July 1st. The punctures had remained without effect, and Avere perfectly
cicatrized.  15th. The mucous tubercles  Avere nearly dried up, and level
with the skin.  21st. The ulcer on the nympha was  cicatrized, and  on the
14th of August, the patient left quite cured.

  Case II. Blenorrhoza ;  ophthalmic blenorrhoza, inoculated without result.
  Mas----, aged 26, entered Aug. 16,1834.  This patient had been  fifteen
days affected Avith gonorrhoea; it had been very acute, and the  discharge

    • This case ought to have been inserted under the head of blenorrhoea.
                                25 
194        CLINICAL  AND  EXPERIMENTAL  RESEARCHES---

copious.  During four or five  days, the left eye had been  affected with
blenorrhoeal ophthalmia ; at first, there was only a kind of mucous hyper-
secretion; twelve hours later, pus was produced, and acute pain Avas felt
above the eyebrows; the urethral discharge continued.   On entering, the
eye was much inflamed;  the palpebral mucous membrane presented  here
and  there  granulated  engorgements  of the follicles;  the secretion Avas
greenish  and copious.
  Aug. 17th. A seton was placed 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.
18th. The affection progressed rapidly; there was a hardened oedema on
the eyelids, photophobia, and a sharp  and acrid secretion of tears;  the se-
cretion of purulent mucus was very copious; there was an incipient  che-
mosis.  A  superficial  cauterization was made with  argent, nitr. on the
inner surface of both eyelids.  21st. The cauterization Avas discontinued,
on  account of the increasing  induration  of the palpebrse.  22d.  Thirty
leeches Avere applied;  fifteen on the temple, and fifteen in the mastoid re-
gion ; an enema, with  magn. sulph. was prescribed.   23d. The indurated
oedema continued, but had made less progress ;  there was no febrile reac-
tion; the urethral discharge was  still very copious; the palpebral  surface
of the conjunctiva was ulcerated at several points; belladonna and calotnei
pills Avere ordered; the cornea was becoming opaque.
  24th. The swollen and indurated  eyelids scarcely allowed the cornea
to be seen;  it seemed flattened ; a bloody serous fluid  escaped; we thought
the eye Avas lost.   The patient having in the  previous night laid on his
right side, the  pus from the left eye had floAved into and inoculated the
right, which, till then, had remained unaffected.  Suppuration had already
commenced.  The pus of the discharge from both eyes, and from the ure-
thra, was inoculated on the right thigh;  from the commencement, the
mucous membrane of the right eye had been cauterized with argent,  nitr.
  26th. There Avas a decided improvement; a fresh  cauterization  and an
enema were ordered.   27th. The inflammation was decreasing;  a colly-
rium of zinc, sulph. Avas ordered; the inoculations had produced no effect.
28th. The cauterization with argent, nitr. was repeated.   Small granula-
tions were  perceived on the conjunctiva;  the left  eye  was sensible to the
light.  30th. The patient could discern objects distinctly; the collyrium
Avas continued; and injections of zinc, sulph. ordered  for the blenorrhoea.
  Sept. 1st. The right eye was well;  only a little  redness  remained; the
patient could see Avithout pain ; he could distinguish  objects Avith  the left
eye. The blenorrhoea was treated with injections, and copaiva in bolus.
  30th. The patient left quite cured.

   Cass III. Chancre, symptomatic bubo, mucous tubercles, ecthyma ; inocu-
lation successful with the bubo, and unsuccessful for the ecthyma.
   Leg----Louis, aged 18, entered February 27, 1836.   Two months pre- 
INOCULATION OF  SECONDARY SYMPTOMS, ETC.
195
vious, this patient had entered the Hopital St. Louis, avIiere he was treated
for a chancre, followed by a bubo on the right side.  A fortnight after quit-
ting the hospital, after severe exertion, a new bubo appeared  on the left
side.  We found on his arms and thighs pustules of ecthyma;  at the pos-
terior part of the penis, were some mucous  tubercles;  about  the middle
of the inner surface of the right thigh, an ulcerated point was covered Avith
a thick crust.  To ascertain whether this latter ulcer proceeded from a di-
rect application of chancrous pus, or solely from the ecthyma, its pus was
inoculated on the right thigh.
  Feb. 28th.  The inoculated point was surrounded by a circle formed Avith
nitrate of silver, that it might not be confounded with the neighboring
pustules.
  March 3d.  The  puncture Avas cicatrized ; the bubo Avas opened, and on
the following day  its pus was inoculated on the right thigh.  5th. It was
red and pointed.   7th. The pustule Avas fully formed, and had all the ap-
pearances of an  incipient chancre; it  was cauterized with argent,  nitr.;
ordered pil. hydrarg. iodid.; cataplasms to the open bubo; to the mucous
tubercles, calomel and sod. chlorin.  15th.  There was a remarkable ame-
lioration ; the mucous tubercles  had  disappeared.   21st. The bubo had
begun to cicatrize.      "
  April 6th.  The  crust of the ecthyma was falling off at nearly every point.
20th. Only a few  brown spots remained; the bubo Avas cicatrized; 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. 19th. The patient left quite cured.

   Case IV.  Transformed chancre and mucous tubercles, inoculated without
 result.
   Ler----Josephine, aged 19, entered July 14, 1836. Seven weeks previ-
 ous,  this patient  contracted a chancre at the entrance of the vulva; at
 first  the progress of the  ulcer Avas regular; it extended itself but little ;
 but about three weeks after its commencement its base  became raised,
 and passing  into an unhealthy state  of reparation, it assumed the appear-
 ance 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 Avere healthy ; the abundant
 secretion, covering  the vulva, was produced by the  ulcerated tubercles
 alone.   Some pus was taken from the surface of the transformed chancre,
 and inoculated  by two punctures made on the left thigh.  The pus taken
 from the surface of the tubercles of the vulva, Avas inoculated in the same
 manner on the  right thigh ;  the surface of the chancre Avas cauterized and 
196         CLINICAL AND EXPERIMENTAL RESEARCHES'---
 dressed Avith calomel cerate.  To the tubercles, dressings of calomel ana
 sod. chlorin. Avere applied.  J9th. None  of the inoculations  had  taken
 effect;  the purulent secretion was less by half.  25lh. There Avas no more
 suppuration;  the mucous tubercles Avere dry, and  began  to  disappear.
 30th. The skin on which  the mucous tubercles were situated Avas perfect-
 ly supple; the cicatrix Avas rose-colored and well formed on the part of
 the vulva, which was but slighly ulcerated.
   Aug. 8th. All was well, and the patient left the hospital.

   Case V. Chancre ; ulcerated mucous tubercles ; inoculated unsuccessfully.
^  Bac----Victoire, aged 17 years, entered July 14, 1835.  The disease
 had existed  three months; at first there was a chancre in the ATtlva, and
 a discharge from  the vagina; the chancre was treated Avith dressings of
 mercurial  cerate and the liquor  of Van  Swieten.  A month  after the
 chancre was cured, mucous tubercles appeared at the anus;  at some parts
 they are confluent and  ulcerated ; pus is taken from that part Avhere the
 suppuration was very profuse, and inoculated in two places.  The ulcera-
 tions are dressed with calomel and chloride of soda.
   The vagina was examined with a speculum, and the neck of the uterus
 was found healthy ;  the mucus from the uterus is transparent.  There is a
 little redness in  the mucous membrane of the vagina,  and the urethra
 is  healthy;  injections  were ordered,  and  tampoonment with  solution
 of alum.
   17th.  The inoculations have failed;  the  pus from the ulcerated tuber-
 cles is  again introduced  into the left  thigh.   The  calomel dressings are
 continued.  28th. The ulcerated points alone remain;  the prominences of
 the diseased skin are collapsed; the vaginal discharge has nearly disap-
 peared.  30th. The patient is cured; the tubercles have  nearly disappeared
   Aug. 3d. The patient leaves the hospital.

   Case VI. Ulcerated mucous tubercles ; inoculation unsuccessful.
   Vim----,  aged 37 years, entered Oct. 7, 1836.   This patient could not
 determine the precise time when the chancre of the skin of the penis ap-
 peared.  It was treated, however, by applications of mercurial ointment,
 and decoction of sarsaparilla and guiacum.  Notwithstanding this treat-
 ment, induration appeared, and twenty or twenty-five  days after the disease
 commenced, a lenticular syphilitic  eruption appeared on the body, and
 impetigo on the  hairy scalp.  These symptoms  Avere treated Avith the
 liquor of "Van Swieten.   The  treatment  was considered complete, after
 taking  sixteen grains of  corrosive sublimate, and  the patient was de-
 clared cured.  Tavo months aftenvard he  entered the hospital again.
   Now the cured spots  are seen on the skin, marking the syphilitic  erup-
 tion ; the cicatrix of the primitive chancre is hard, and on the anus large
 patches of ulcerated mucous tubercles, and  also rhagades are seen.  8th.
 The pus from the ulcerated mucous tubercles is introduced into  the 'ef* 
                 INOCULATION OF  SECONDABY  SYMPTOMS, ETC.      '  197

     thigh;  the induration of the  chancre and the impetigo on the head are
     treated by pills of the proto-iodide of mercury ; and on the mucous tuber-
     cles the calomel dressings are applied.  12th. The inoculation has failed ;
     the purulent secretion of the anus is less;  the  left  thigh is again inocu-
     lated in two places with pus from the base of a fold of the anus.  18th.
     The inoculation has produced nothing;  the mucous patches are dry, and
     no suppuration exists except in the rhagades.  24th.  General improve-
     ment ;  there is no induration in the penis; the crusts of the impetigo have
     disappeared;  the  anus  is nearly cured.   The  pills are omitted, to avoid
     producing stomatitis; the gums are red and tender;  they  are  cauterized
     slightly with hydrochloric acid, and a gargle of quinine is prescribed. 30lh.
     The stomatitis has not  advanced;  the pills are again prescribed to re-
     move the  slight  induration in the folds of the anus; and,  Nov. 18th, the
     patient is perfectly restored.

       Case VII. 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 Avhose care the child had been left,
     and indeed, the woman  Avho Avas intrusted with the care of the child, as
     well  as her husband, were actually affected with  chancres.  We found
     the little girl strong and Avell formed; its limbs Avere more developed than
     is usual at this age; the sexual  organs  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 tb.e mons
     veneris, and around  the anus.  At a considerable depth in  the vulva, Ave
     perceived some ulcerations, having the appearance of transformed chan-
     cres,  and ulcerated  mucous tubercles; and lastly, at the commissure of
     the labia Avere mucous tubercles.   24th. The  ulcerations of the vulva
     Avere  inoculated by two punctures made on the left thigh; dressings of
     decoct,  malvae and poppy heads were  applied.   66th. The pus from the
     ulceration  on  the  labia  Avas inoculated by  two punctures on  the right
     thigh  ; the inoculations made on the 24th had produced a pseudo-pustule,
     which was nearly dried up.  The anus Avas dressed Avith calomel, and
    sod. chlorin. and pills of hydrarg. proto-iod. broken into a spoonful of su-
■" '  dorific sirup, Avere given  internally.   28th. The last inoculations had pro-
    duced  nothing; the pus of a mucous tubercle at theanus was inoculated on
    the right thigh.
      May 10th.  The inoculation on the 28th of April had produced nothing,
    the ulcerations of the vulva Avere  better, but much irritation Avas kept up
    by masturbation;  the dressings  Avere  continued.  20th.  The mucous
    tubercles at the  anus had disappeared ; only a single ulcerated point re-
    mained.  The vulva was nearly well;  the ulceration  of the commissure 
198        CLINICAL  AND EXPERIMENTAL RESEARCHES---

of the  labia Avas touched with mel. iod.; they were nearly cicatrized.
30th. All was  well;  the general health of the child had always remained
excellent.   On the 10th of June she left the hospital.

  Case VIII.  Chancres;  acute ecthymatous syphilitic  eruption inoculated
without result  on the patient, and on a healthy individual.
  Huh----, aged 24, entered July 8th, 1835.  The patient  was unable
accurately to state at Avhat period he had contracted chancres on the an-
terior and upper part of the  glans and mucous membrane of the prepuce,
he  stated he had perceived it at the same time as a  blenorrhoea, which,
three months previous to  the time of his entry, had developed itself eight
days after a sexual connexion.  In the commencement the blenorrhoea Avas
very acute; it  Avas not  treated by active means;  the  chancres,  cauterized
with argent, nitr. and dressed Avith cerate, were healed hi a fortnight, leav-
ing induration around the cicatrix.  We found still some discharge from
the blenorrhoea of a  whitish yellow color.  Three weeks previous to his
coming to the hospital,  a pustular syphilitic eruption shoAved 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 eruption first appeared, the blenorrhoea became  again acute.
10th.  Injections of argent, nitr. were ordered for the blenorrhoea.  15th.
The pus taken from one of the pustules on the back, was inoculated by two
punctures made on the left thigh ; the pil. hydrarg. iod, and sudorific sirup
and tisane were ordered;  the injections were continued.   17th. The punc-
tures had produced nothing; the  blenorrhoea was much diminished; cu-
bebs, two drachms per diem, were  given; a fresh inoculation was made
on the  right thigh Avith pus taken from a pustule on the back.  Some of
the same pus Avas  inoculated by two punctures on the left arm  of a
healthy individual.  20th. None of the punctures had produced any effect.
28th. Nearly all the pustules of the syphilitic eruption were drying.  The
blenorrhoea  had disappeared; the injections  were discontinued, 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 IX.  Syphilitic iritis, deformation of the pupil; syphilitic eruption,'
mucous tubercles, SfC. ;  inoculation without result.
  Dura---- Louise,  aged 20, entered Dec. 3d, 1833.  This patient,  who
had been for  a year previous affected Avith chronic blenorrhoea, having
several times exposed herself to contagion, by sexual  intercourse, was un-
able to state at what  time  the last infection had taken place.  In the
month  of July previous, she had felt an itching in the 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 lenti- 
            INOCULATION, OF SECONDARY SYMPTOMS,  ETC.         19lf

cular eruption and  psoriasis  guttata showed themselves.  The eyes be-
came very sensible, and  the vision was affected.   At  the  Hopital  St.
Louis she Avas treated by fumigations of hydrarg. sulph. rub., and a colly-
rium of aq. rosar.   After this treatment had been pursued Avithout obtain-
ing any improvement, the  patient Avas sent to this  hospital.   Upon her
entry we found the syphilitic eruption still in the acute stage;  there was
an iritis;  the  pupil Avas  oval, and drawn directly upwards ;*  about the
anus and vulva were granulating mucous tubercles;  an examination with
the speculum shoAved a  papular vaginitis; the vaginal  secretion Avas
puriform; on the inner and middle part of the right cheek an  ulceration
was observed, resembling an ulcerated tubercle.
  Dec. 4th. Twenty leeches Avere applied to the right temple; a pedilu-
vium, and compresses dipped in decoct,  malvae, to  the right  eye, were
ordered ; the left eye Avas in a very good  state.  8th. A fresh 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 sirup and tisane, and injections with conium.  The ulcer on the
cheek Avas cauterized Avith hydrochloric acid; the menses having  been
suppressed for three months, emmenagogues and an application of leeches
in the fold of the thighs Avere  ordered.  27th. The  vagina was  smooth,
and no papulae remained; the sight Avas  still dull,  but the patient could
read ; the deformities of the pupil appeared to vary during the day.  The
ulcer on the cheek had disappeared, after the third cauterization with hy-
drochloric acid.
  Feb. 10th. Some traces of the syphilitic eruption and psoriasis still remain-
ed ; the pupil Avas becoming round; it Avas moveable, and but  little mor-
bid sensibility  of the eye remained; the  vision  Avas becoming gradually
more clear; the frictions  of belladonna  were  continued;  the  pupil pre-
sented the distorted form in the  morning, but in  the evening  it was
round.  22d. The  pupil presented  an ellipsis, whose greater axis  ivas di-
rected downward and  inward;  the margin of the  superior  half seemed
fringed and condylomatous,  whilst the inferior was even; there Avas no
effusion in the chambers; the iris was slightly changed in its color, Avhich
was  a little deeper.  Fumigations Avith hydrarg. sulph. rub. were ordered,
on account of the syphilitic eruption, Avhich had nearly disappeared; as
had also the tubercles of the  anus.
  27th. All Avas well in the vulva and vagina; the pupil Avas no longer de-
ft med; but a  few brown spots remained, marking the seat of the cuta«
nt -s eruption ;  some vegetations at the  anus  were cut off.
  Iv^arch 12th.  The cure  Avas  complete; the morbid  secretion from the
ulcerated mucous tubercles had been inoculated Avithout result.

  * The deformation of the pupil dDAvnwards and outwards, is far  from being
constant, as has been pretended.   R. 
200        CLINICAL  AND  EXPERIMENTAL RESEARCHES--

  Case X.   Pustular syphilitic cruptmn, ulcerated tubercle, ulceration of
the cervix ofthe uterus, and purulent uterine catarrh; inoculation ivithout
result; excision of a tubercle, before the ramollissement.
  Coup----, aged 26, entered Oct. 10th,  1833.  When twenty years  old,
this patient first contracted an infection, and was treated with  mercury for
a vaginal discharge, and chancres of the external labia.   The treatment
lasted nine months, during Avhich time frequent mercurial frictions and the
liq. Van Swieten. Avere employed; notAvithstanding all this, a  copious dis-
charge still remained. Three months later, some mucous tubercles appear-
ed at the vulva,  and a lenticular syphilitic eruption on the body ; the liq.
Van Swieten. was again given, but nevertheless, the affection  progressed;
the eruption passed 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 corrosive
sublimate; but some months later, the articulation  of the knees became
painful  and swollen.  Soon after, tubercles showed "l^mselves in the
calves, and becoming slowly softened, their cavities were laid open; ihose
on the right leg, June 2d,  1833, and those on the left, Oct. 8th; there had
been a considerable destruction of the  tissues, particularly of the muscles.
On examining with the speculum, a granulating ulcer Avas found  upon the
cervix uteri; and a purulent catarrhal  discharge.
  Till Nov. 1st, the ulcerations of the calves were dressed with a concen-
trated decoction of opium;  injections of decoct, alb. were  ordered for the
purulent vaginal  discharge; the ulceration of the  cervix  was cauterized
with arg. nitr.   Internally, pills  of hydrarg.  iod. Avith pulv. conii, and a
decoction of hops, with anti-scorbutic sirup, on account of the lymphatic
habit of the patient, Avere prescribed.
  Nov. 2d.  The pus of the  ulcer  on the left calf was inoculated on the
right thigh.  6th. There  Avas no pustule on  the  point inoculated; the
ulcers Avere cauterized with  argent, nitr. and  dressed with cerat. opii.
28th. The cicatrization Avas nearly completed on both calves;  but about
one  third down  the anterior surface of  the right leg, a tubercle was felt,
which developed  itself slowly, and whose extent was already 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,
Avas perfectly cicatrized; but the wounds  on the calves, which hitherto had
seemed to be healing, had suddenly returned to nearly their former state;
the cicatrix was entirely absorbed. It Avas found that the patient, thinking
herself cured, had neglected  the  treatment.   The vagina Avas  ordered to
be  tampooned Avith dry lint; the ulcer  on the cervix Avas healed.  10th.
The ulcers on the calves were touched with creosote.   20th. There was
much irritation;  the use of the creosote Avas suspended, and  dressings of
decoct, opii substituted.
   Jan. 6th, 1834.  The application of creosote  was  resumed;  the internal 
            INOCULATION OF SECONDARY  SYMPTOMS, ETC.         201

treatment was  continued.  Near the malleolus externus of the right foot,
the patient pointed out a tubercle, but it could not be removed, as its base
was already adherent.  28th. The tubercle  on the malleolus was suppurat-
ed ; it Avas opened, and dressed with cerat.  opii.
  Feb. 1st. There Avas a general tendency  to cicatrization, and an active
granulation in  the  wounds  of the legs; a cauterization Avas made  with
argent, nitr., and they were  touched with creosote every third day.   10th
The base of the ulcerations was raised, and covered with granulations,
which Avere difficult to repress.   By the 18th of March, the patient being
nearly cured, was able to leave the hospital.

   Case  XL  Chancre ; ecthyma, inoculated unsuccessfully.
   Ma----Louis, aged 22 years, entered Aug. 8th, 1835.   Eleven months
since this patient had chancres of the glans, which Avere cured in 28 days
by using the opiated cerate.   Three Aveeks later, pustules appeared on the
trunk and limbs.  Crusts formed in the hair, and on the anus, mucous tu-
bercles  appeared.  The  patient entered the hospital St. Louis, where he
was treated by fumigations  of cinnabar, pills of corrosive sublimate, sudo-
rific sirups, and tisanes.  He left,, the symptoms  being apparently cured.
   A month after, many pustules of ecthyma appeared on the limbs, and it
was remarked that after the scabs fell off, there Avere livid copper-colored
spots.
   Aug.  12th. Pus from an ecthymatous ulceration of the shoulder was in-
serted near the deltoid region.   14th. The  inoculation failed; pills of the
proto-iodide of mercury, the sudorific sirup, and tisanes were given.   15th.
The left shoulder Avas inoculated Avith pus  from an ulcerated ecthymatous
pustule.  18th. The puncture is red and pointed ;  the treatment with the
pills  is  continued.  19th. The puncture has healed; the patient is better
and leaves Nov. 2d, cured.

   Case  XII.   Ulceration of the throat inoculated without result.
   Nic____, aged 20,  entered  May 3d, 1834.  This young man asserted
that  he had never had  any previous syphilitic affection, and falsely at-
tributed his  disease to an infection from drinking out of a glass with  an-
other person, who had ulcers on the lips and  throat.   It may be Avell to
remark, that in our patient  the affection commenced at the back of the
 throat; at first there was only difficulty in deglutition; the ulcers appeared
sloAvly, and it Avas not till lately that an antiphlogistic treatment had been
 tried; the pains had in a great measure disappeared, but some deep ulcers
still remained in the throat; the tonsils  Avere 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 much irritated ; leeches were applied to
 the neck; an emollient gargarism and  pediluvium were ordered; some pus
 was taken from an ulcer on one of the tonsils, and inoculated by two punc-
                                  26 
202        CLINICAL AND EXPERIMENTAL RESEARCHES—■
tures, made on the left thigh.   7th. Leeches were again applied ; the pain
Avas  much  less.   The inoculation on the 6th  had produced  nothing;  the
punctures were not even irritated.   9th.  There was a sensible amelioration
in the general health;  nevertheless, at several points, the destruction of
the tissues progressed  rapidly; but little of  the left tonsil remained; on
the pharynx were some ulcers,  whose  base  was covered Avith a grayish
pseudo-membrane; their pus was  inoculated by two punctures made on
the right thigh. 12th. The inoculations on the 9th had  produced nothing;
a gargle with conium, and morella was ordered.
  14th. The pain was still better, but the destruction progressed.   Dress-
ings  of mel. iod. were used till the 30th, Avithout decided improvement.
  June 1st. A decoction of hops and anti-scorbutic  sirup, iodine mixture,
and gargle were prescribed.   10th. The disease had rapidly improved  un-
der the influence of the iodine; the progress of the ulceration had nearly
instantly ceased.  20th.  Rose-colored  granulations were  produced every-
where; the base of the ulcers was raised; on  the 23d  they Avere  touched
with nitrate of mercury ; the cicatrization progressed  rapidly; on the  fol-
lowing day, but a single point remained  ulcerated on the seat of the  left
tonsil.  27th. The surfaces  were  become  smooth, and  the patient  left
cured.

  Case XIII.  Secondary ulceration of the throat inoculated without result.
  Bel----Marie, aged 45, entered Jan. 14,1834.   This patient had, a year
previous to the time of her coming to this hospital, contracted  ulcers on
the external labia and a gonorrhoea; she was treated with Hq. Van Swie-
ten, sudorific  sirup,  and  tisane during six weeks.  Being declared cured
she stopped all medication ; but after being two months in a dubious state
during which time she frequently felt a  difficulty in swallowing, she Avas
attacked Avith a very violent  pain in the throat. Leeches were  applied,
and  a mercurial treatment  ordered, Avhich  was continued during  five
months.  Not being cured, she came to the hospital, where she Avas treat-
ed Avith pil. hydrarg. iod. and a gargle of decoction of  conium and morel.,
with sublimate for the ulcers which she then  had in the throat; she stay-
ed three Aveeks, and left when the symptoms had disappeared; she re-
turned Avith ulcers, occupying 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 part  of the throat.  16th.  Some  pus was
taken from one of the points,  affording the most suppuration, and  inocula-
ted by two punctures on  the  right thigh.   The same gargle Avas ordered,
as on the previous occasion.   18th. The punctures had  produced no effect;
the same treatment Avas continued  till Feb. 1st.   The  ulcers Avere a little
cleaner, but the margin was still raised and indurated ; the pills of hydrarg.
iod. Avere prpscribed.
  Feb. 1st. The ulcers were very painful, and still in the progressive stage;
they Avere touched Avith a brush, dipped  in creosote ; ten minutes after the 
INOCULATION OF  SECONDARY SYMPTOMS, ETC.        203
application, the pains were less; it was repeated on the three following
days.   5th. There was a little irritation; an emollient gargle was ordered.
8th. Creosote Avas again applied ;  by the 12th, the extent of the surface
of the ulcers Avas less, and their raised edges had become reduced.  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.
  April 26th. She returned  to the hospital  with an extensive ulceration,
occupying the whole of the velum palatinum;  its form Avas triangular, and
the posterior angles extended towards the arcus, and its base towards the
throat; the uvula was much  ulcerated at its base, and nearly detached;
all around the ulcer was much inflamed; its ground was grayish, and its
edges abrupt; some of the pus was inoculated on the right thigh.  Twelve
leeches were applied to the  ang. maxill. inf., and &. gargle of decoct,  malv.
et capit. papav. ordered.
  May 1st. The inoculations had produced  nothing;  some  inflammation
still remained;  leeches were again applied.   11th. Pil. hydrarg. iod. with
pulv. conii were prescribed; the ulceration was very painful.  17th. The
destruction seemed  arrested; the uvula was detached, and the arcus had
lost much substance.  20th. The ulcers  were touched with  mel.  iod.  A
fresh  inoculation was made on  the  right thigh, with the pus taken from
the right tonsil.  30th. The inoculation was without effect;  there  was a
general improvement.
  June 10th. Nearly all was healed ; the margin was no longer raised, and
the pain had disappeared.  25th. The cicatrization was complete.
  July 2d. The patient left the hospital-; we saw her a year later,  when
she had remained free from any return of the affection.


  Case XIV.   Consecutive ulceration  of the throat, inoculated  without
result.
  Gab----, aged  34, entered May 30, 1835.  This patient had no ulcera
tion 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  jefore, and which had  lasted  about  a
month; the ulcer had been treated with ung. hydrarg. and red precipitate.
Since this time, there hs d been no new infection; the patient had not often
exposed himself to it.  After the chancre was cured, no symptom had ap-
peared which  could be ascribed to syphilis;  when about a year previous
to his coming to the hospital, having been at Avork in  a very damp situa-
tion; and living upon bad food, he felt a pain  in the throat: at first, there
was difficulty in swalloAving; next smarting pains, irritation of the mucous
membrane of the  pharynx and mouth, pain in the epigastrium, acid eructa-
tions, and nausea.   These symptoms soon became less intense; but there 
204         CLINICAL AND EXPERIMENTAL  RESEARCHES---

remained in the throat, on the mucous membrane of the oesophagus and
left tonsil, an ulcer with abrupt edges and grayish ground, covered Avith a
pulpy membrane, thus apparently presenting the characteristic appearance
of a secondary ulcer.   Till this day, the patient had received no treatment;
he had merely, from  time  to time, used  a gargle  of decoct, malvae;  the
breath was very fetid; the ulceration was very extensive, and  occupied
nearly the whole of the posterior part of  the pharynx;  the left tonsil was
half destroyed.  The state of the digestive organs was sufficiently good to
allow of mercurials being given.
  June 8th. The pus of the ulceration of the throat was inoculated by a
puncture on each thigh.  18th.  The punctures had produced nothing; pills
of hydrarg. iod. Avere ordered, Avith sudorific tisane and sirup, and a gargle
of a concentrated decoction of conium, Avith sublimate.   25th.  There Avas
little improvement;  the state of the  digestive organs was still good;  the
treatment was continued;  two pills were given; the ulceration was  cau-
terized Avith nitrate of mercury.  30th. There Avas a little improvement;
the use of the sudorific sirup and tisane Avas suspended, on account of too
great an irritation; the pills were continued;  but only one was given  per
diem.
  July 6th.  Decided  improvement; the surface of the ulcer Avas freed from
the grayish membrane which covered it.  Anti-scorbutic  sirup  Avas pre-
scribed.  20th. The  tonsil was nearly well;  the granulations were  cau-
terized Avith arg. nitr. 30th. The ground of the ulcer  was covered with
healthy granulations; its extent was diminished by half; the digestive or-
gans were in a good  state; the patient left cured, Aug. 8th.

  Case XV.   Ulceration of the breast; inoculated without result.
  God----Eulalie, aged 28, entered  March 22d, 1834. This patient stated
that she had never   had  any primary syphilitic affection; that her hus-
band's health had been ahvays good ;  that she had borne four children, and
that her breasts had  never been sore  whilst suckling.  Four months  pre-
vious to our seeing her, she took a nurse-child; it Avas very thin, but had
neither on the mouth, cor other part of the body, any wound or ulceration;
three Aveeks later, pimples appeared on the forehead, and at the anus;
their surface became purulent, and covered Avith crusts;  it had on the body
some patches covered Avith squamae ; on  the nates and calves of the legs,
deep ulcerations ; the suckling was continued for six weeks, but as the dis-
ease 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 continued for a fortnight to suckle  her own
child, Avho had never ceased to enjoy an uninterrupted good state of health;
the breasts were dressed with opiated cerate, and a decoction of hyoscya-
mus; then ulcerations having succeeded to fissures, and the pains having
become very acute, the patient resolved to come to the hospital.   On each 
            INOCULATION  OF SECONDARY  SYMPTOMS, ETC.        205

side on  the breast and nipples were ulcers, with  grayish base,  abrupt
irregular edges, and resembling, although simple, syphilitic ulcers.  26th.
The pus from the right breast Avas inoculated on the right thigh, and that
taken from the left, on the left thigh; dressings Avith  cerat. opii were or-
dered.   27th. The punctures were red; but on the  folloAving day, no pus-
tule was produced; simple dressings Avere applied to the ulcerations.
  April  6lh. All was becoming clean; there Avas a  decided improvement.
  12th.  The base of the Avounds was nearly level with the surrounding
parts.  The patient was obliged to  leave the hospital on business; and
returning some  time after, we found only one deep fissure remaining,
whose pus Avas inoculated on the left thigh, but Avithout result; a lotion
of sod. chlorin.  was applied, and in a week's time she left quite  cured.

  Case  XVI.   Ulceration of the lip;  sub-maxillary  engorgement; inocula-
tion 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  existed about a month.  The
patient stated that at first there had been only a little pimple, which hav-
ing been scratched off, became ulcerated.   It ought to be remarked, that
the teeth Avere black, and the gums retracted from them, by the use of the
pipe.  No treatment had been used;  the sub-maxillary engorgement had
existed  about ten days.  We found the ulcer of the lip much irritated; the
engorgement was subacute in its progress;  the pus from the ulcer on the
lip was inoculated by two punctures on the  right thigh;  cataplasms Avere
applied  to the  SAVollen sub-maxillary glands.  18th. The  punctures had
produced nothing; the wound on the  lip was cauterized with argent, nitr.
and  dressed with vin.  arom.  21st.  The engorgement had nearly disap-
peared ; the ulcer on the lip was half dried  up; it  was again cauterized.
Dec. 1st. The wound Avas  quite healed; no induration remained, and the
patient left the hospital on  the 8th.

  Case XVII.   Ulceration of the tongue and finger of a doubtful appear-
ance ; inoculation without result.
  Bel----, aged 48, entered Dec.  8,  1835.  This  patient had  never had
any  chancres;  at  the age  of thirty, he was affected with  blenorrhoea;
which lasted three weeks, and then disappeared Avithout any treatment;
since then, he had felt no symptom Avhich  Avould lead us to consider the
blenorrhoea as depending on concealed chancres ; there had been no indu-
ration in the canal of the  urethra.   Four months  previous,  Avithout  any
known  contagious  cause, he  became feverish  from too severe  fatigue; a
few  pimples appeared about the base of the  tongue; at first,  there  had
been  much  pain.  Now the upper surface, near the base of the tongue,
was ulcerated; on some points were  granulations, and in the intervals be- 
 206        CLINICAL  AND EXPERIMENTAL  RESEARCHES---

 tween them, deep excoriations;  the diseased surface is larger on the right
 than on  the  left;  there Avere on the ulcerations, grayish  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 ulcerated spot,
 covered with a crust in layers.
   11th.  Some pus taken from a wound in the tongue, which appeared 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 Avas in-
 oculated  on the right thigh ; the surface of the tongue was cauterized, and
 a gargle  of conium and morella prescribed; the finger was  dressed with
 calomel  and  opium cerate.   14th. The inoculations failed;  the tongue
 Avas much less inflamed; the same  treatment  was continued.  16th. A
 fresh inoculation of the pus taken from the tongue was also without re-
 sult.  By the 30th  the patient was  cured, and left  the hospital.

   Case XVIII.   Tumor and ulceration on the posterior part  of the penis ;
 inoculated without  result.
   Fo----, aged 28, entered  Feb. 21, 1837.  This  patient had  never  had
 chancres; about five years previous, he had had  a  blenorrhoea followed 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.   In consequence of great exer-
 tion and  fatigue, a tumor appeared near the root of the  penis; it had ex-
 isted about a Aveek when we saw him; pus had rapidly formed,  and  the
 tumor opened spontaneously, and presented  a considerable ulceration.  23d.
 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.   30th. 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 in the edges of
 the cicatrix nor in the abscess;  the patient was dismissed cured.

   Case XIX.  Cancer uteri inoculated without result.
   Nev----Marie, aged 32,  entered May 8, 1834.   It Avas difficult to trace
 out the  evident cause of the actual state of this patient from among the
 antecedents: her menses appeared at the age of fourteen, and  she continued
 to enjoy a good state of health  till the age of twenty, Avhen she had her first
 child; tAvo years later  she  had a  second;  from this time forward there
 was an irregularity in the menstruation, then, at long intervals, copious
 fluor albus.  A year previous to  her coming to the  hospital, she contracted
 a blenorrhcea, Avhich at  its commencement  caused  no pain.   Her husband
 had a chancre, but she had no ulceration, at least not on the  external part 
INOCULATION OF SECONDARY  SYMPTOMS, ETC.
207
of the sexual organs.  Six months later, the discharge, Avhich seemed to
have decreased, returned  with great intensity, and a state of progressive
marasmus soon ensued.  The patient consulted a surgeon, Avho stated she
had an engorgement and hypertrophy of the cervix uteri, and prescribed a
bath every second  day, and ordered her to be bled once a week, a mucila-
ginous tisane, pil.  conii, and local  baths with morel and raallows: this
treatment had been continued  with absolute rest for six months; but hav-
ing obtained no amelioration, she determined upon coming to the hospital.
On examining with the speculum, an ulceration was found at the orifice of
the uterus of a lardaceous  appearance, with a sero-purulent secretion with-
out  smell,  and general induration without hypertrophy.  Some of the
pus Avas taken from the cervix, and inoculated by three punctures made on
the  left thigh.  Injections  of decoct, conii c. morell.,  pills of hydrarg.
iodid. and fol. conii Avere prescribed.  13th.  The inoculations had produc-
ed nothing;  the ulceration  progressed slowly, but the destruction and in-
duration were still increasing.  24th. The carcinomatous nature of the affec-
tion was every day more evident.   A tampon,  covered with mel. iod., was
placed on the cervix.  26th. The darting pains were very acute.
   June 11th.  A  careful  examination Avas  made in order to  ascertain
whether the  operation would be practicable.   Opiated injections were pre-
scribed, and the pil. opii given at bed-time; the use of the iodine was sus-
pended.
   July  6lh.  The affection still increased, though slowly; the patient was
advised to go to the Salpetriere.

   Case XX.  Chancre, blenorrhoza, indurated  ulceration  of the lower lip;
inoculated unsuccessfully.
   Laure____Franchise,  aged 21 years, entered March 25, 1834.   Two
months since, for the first time, this patient contracted  follicular chancres
 of the  inner  face of the external labia, and an urethro-genital blenorrhoea.
A  chancre was formed mechanically by the  laceration of the  fourchette.
On the lower lip is seen an  ulceration on a broad base,  resembling an ul-
 cerated mucous tubercle; it  commenced by  a pustule.  There had been
 no medical treatment.
   26th. A bath, emollient  lotions, and edulcorated barley-water were order-
 ed.  28th. The chancres Avere dressed Avith a pommade of calomel and
 opium; emollient injections were used.
   April 8th. The pus from  the ulceration of the labium was inoculated on
 the left side  in two places.  12th. The inoculation  failed; the follicular
 chancres were cured ; the chancre of the  fourchette was cauterized with
 the nitrate of silver.  The patient menstruated. 22d. On examining with a
 speculum, the uterus was found  to be healthy ; the vagina was red ; the
 uterine secretion  is transparent;  injections and tamponning Avith decoct.
 alb. are used.  28th. The chancres are cured; the discharge  has much
 diminished;  pills  of the carbonate of iron are  prescribed for a scrofulous 
208        CLINICAL AND EXPERIMENTAL  RESEARCHES—
habit; the injections and tampons are  continued, and the patient is dis-
charged cured May 15th.

  Case XXI.  Chancres, phymosis; dubious pustule at the navel inoculated
without result.
  Aug----, aged 20, entered Jan. 24, 1837.  This patient for a month had
been affected with chancres on the prepuce, followed by a balanitis and
phymosis; the inflammatory state had been of short duration.  We could
easily uncover the glans, on Avhich were some  excoriations;  some of the
chancres Avere healing.  About ten days previous a pustule appeared near
the inferior part of the navel, and folloAved in its development the course
of the pustules from inoculation; at first, red and pointed, it soon became
raised and almost umbilicated; the epidermis broke and  shoAved a small
ulcer, which we found covered with  a crust like that of ecthyma; the base
was indurated.  When the crust was removed the wound presented all the
characters of a chancre;  the edges Avere ragged; the base 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 Avith
vin. arom.; the excoriations on the glans were also superficially cauterized.
  28th.  The  inoculation had produced no effect; the same treatment was
pursued.  31st. The excoriations  on the glans were healed; the chancre
on  the prepuce  Avas nearly dried up;  it was  slightly touched with the
caustic; the wound on the abdomen had become  much less and Avas granu-
lating ; its base was but little  indurated.  In a feAV days time the patient
left cured.

  Case  XXII. Chancre, rupia, exostoses, osteocopic pains ; inoculation of
the pus of the rupia without result.
  Des----Antoine, aged  36, entered Aug. 22, 1835.  The affection had
continued five years; at first he had a chancre on the glans, which did not
disappear till he had been treated for a month with mercury.  Fifteen
days after the cicatrization of the ulcer, some crusts of impetigo appeared on
the scalp, and also a syphilitic eruption ; on the arms Avere some pustules of
ecthyma; these symptoms Avere treated with pills of mercury, frictions, and
fumigations with hydrarg. sulph. rub.   Nevertheless  the disease progress-
ed ; exostoses Avere developed on the forehead, and the joints became vio-
lently painful.  On the malleolus externus of the right foot,  extensive ul-
cerations were formed;  on the back and arms an eruption  of rupia ap-
peared; at length the symptoms had nearly disappeared, and the patient
thought himself cured, when, soon after his leaving the hospital  of St.
Louis, the same symptoms returned,  and also acute osteocopic pains;
about the middle of the under part of the arm, tubercles of the cellular
tissue formed, and produced extensive ulcerations.  On entering, some pus
Avas taken from one of the ulcerated pustules of rupia on the deltoid re-
gion, and inoculated on the right thigh by two punctures;  pills of hydrarg. 
INOCULATION OF  SECONDARY SYMPTOMS,  ETC.        209
K>did., decoction of hops, and anti-scorbutic sirup were prescribed ;  the ul-
cers were dressed Avith opiated cerate ; slight blisters were applied to the
forehead and other parts in which the pains Avere felt.
  Aug. 6th. The inoculation of the pus of the rupia had produced nothing,
the pains were somewhat less; blisters were ordered to be again applied
on the folloAving day.  10th.  Some pus, taken from an ulcer on the  arm,
was inoculated by two punctures on the left thigh.   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, from the
use of flying blisters'and general treatment; the ulcerations Avere better;
the arm is nearly cured; the wound in the malleolus presented  several
cicatrized points.  28th. The back and  arm are cured,* the osteocopic pains
have subsided: the Avound of the foot is nearly cicatrized.  All was going
on well, and by the  2d of October the  patient was  quite  cured and left
the hospital.

  Case XXIII. Indurated chancre ; rupia inoculated unsuccessfully.
  Clem----, aged 26 years, entered July 1, 1836.  This patient had been
affected  with  chancres several times.   Noav there was induration in the
place Avhere a chancre had been cicatrized for twenty  days;  the face and
body are covered with an eruption of psoriasis guttata ; on the knee and
thigh are  ulcerations  caused by  rupia;  this young man has scrofulous
temperament.
  July 2d.  Inoculation is made in the left thigh in two places, with pus
taken from one of the ulcerations  of the right knee.   Pills are ordered of
the proto-iodide of mercury with cicuta, a tisane of saponaria, with  sirup
of gentian and iodide of iron, in doses of eighteen grains daily.  6th. The
inoculation has failed.  There is ulceration of the penis, which is  dressed
with aromatic wine.  14th.  The  eruption is paler;  the ulcerations of the
rupia are better.   17th. The granulations on the knee are cauterized; the
penis  is well.  20th.  The base  of the ulceration of the rupia is nearly
cicatrized in every part, and on the 26th the patient  is cured
                                 27 
A  TABLE  OF  THE  INOCULATIONS
                   f8ata in tfte fflnlt OTarlrs,

                           1831—1837.

SYMPTOMS WHOSE  PUS  PRODUCED THE  CHARACTERISTIC
                            PUSTULE.

                        PRIMITIVE  SYPHILIS.

Chancres in the ulcerative or progressive period—
On the penis.........        .      347
At the anus   ....            .         .             .9
Concealed in the urethra (larve)    ...        .    •   •    .   21
On the lips...........        3
In the throat......;                          ]
On other parts..........        8
Primary pustules—
On different parts consequent on coition, on the inner parts of the thigh, or
  from artificial'inoculation........    .   59
Virulent abscess, or encysted chancres—
In various situations..........18
Symptomatic lymphitis, or chancres in lymphatics—
Inoculated upon the day of their being opened, or later    .    .   .    .   II
Symptomatic bubo, or ganglionary chancres—
Inoculated the day they were opened.......42
    '    "   following day*........229
                      En tfie fftmuU Wavlss,

                           1831—1836.

                        PRIMARY SYPHILIS.

Chancres in the ulcerative period—
On the vulva..........            239
  "   vagina     .......        .             2
  "   cervix uteri.........            22
• Of these latter, 214 had been inoculated -without result on the day of the opening. 
TABLE OF THE INOCULATIONS.
211
Concealed    •    •
At the anus
On the lips
In the throat  .
In different parts
Primary pustules—
On various seats consequent on coition;  on the internal surface of the thigh,
  or from artificial inoculation........
Virulent abscess, or encysted chancre—
In various situations......•    .    •    •
Symptomatic buboes, or  ganglionary chancres-
Inoculated upon the day of their being opened      .....
   «      «    the following day or later    ....••
 6
28
 4
 2
 6
27
21
46
                  En tije JBale antt jfonale SEatlr,

                             1831—1837.

           SYMPTOMS WHOSE PUS PRODUCED NOTHING.

                       SYMPTOMS OP TRANSITION.
                                                                     fi2
Chancres in the period of reparation.......

                           SECONDARY SYPHILIS.

Mucous tubercles, or pustules in various parts.....221
Secondary ecthyma.......              *
    "     rupia   .    •.........
Ulcers  (consequent on mucous tubercles, ecthyma, rupia, or impetigo)—
In the  nasal fossae..........
                                                                      14
On the lips        ..........
    «    palate...........
In the  throat                •.......
    i                                               ....     41
At the anus       ........

                            TERTIARY SYPHILIS.

Tubercles ulcerated in the whole thickness of the skin in various situations    21
Tubercles in the cellular tissue or gummy tumors ulcerated, on various seats    11
Periostoses having suppurated........
Caries............

      VENEREAL AFFECTIONS, NOT DEPENDANT  ON  THE SYPHILITIC VIRUS.
                                                                      39
Primitive buboes...........g
Sympathetic   "..........
Blenorrhoea in the acute stage—                                        g2
Of the glans and prepuce (balanitis) 
212
EXPERIMENTS  OF  DR  MAIRION.
In the urethra...........293
  "    vulva...........    31
In the vagina...........82
  "    uterus...........27
At the anus  ...........,  36
Ophthalmia  ..         .........6
Blenorrhcea in the chronic stage having various seats    .     .     •     .112
Ulcerated SAvelled testicle          ........3

 NON-CHARACTERISTIC  SYMPTOMS WHICH SHOW THEMSELVES  AFTER VENEREAL
                AFFECTIONS, WHETHER SIMPLE OR VIRULENT.

Vegetations, either ulcerated or not, having various forms and seats .     .    28

 AFFECTIONS NOT  DEPENDANT ON VENEREAL DISEASES.  COMPARATIVE  EXPERI-
                       MENTS WITH  NEGATIVE RESULT.

Atonic ulcers of the legs.........6
Simple ecthyma...........5
Herpes.............4
Scorbutic ulcers    ...•>.......2
Scrofulous........... •     •     6
Caries.........•     .     .     .     4
Simple ulcerated stomatitis   .........     8
Ulcerated eczema intertrigo.........     2
Otitis.............2
Cancer of the uterus..........5
  "       " rectum..........6
  "       " breast..........2
  "       " penis     ..........     3
  "       " nose..........     4
Abscess  on  various parts.........15
  I may here add, in support of these tables, the result of some experiments, made
with the same vieAV 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  be submitted to in-
oculation ; of the 228 who were inoculated, 85 had primary ulcers, 24 suppurated
buboes, 84 blenorrhcea, 7 excrescences, 28 constitutional symptoms.

                              Primary Ulcers.
  "Of the 85 cases of primary ulcers, 53 produced  upon inoculation  chancres,
whose syphilitic nature Avas proved by their pus being inoculated, and  producing
others resembling them, which being also inoculated, produced ulcers of the third
generation, and so on, till the specific properties of the chancrous molecule were
destroyed by chemical applications,  or exhausted in the natural progress of the 
EXPERIMENTS OF DR.  MAIRION.
213
  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 suc-
  ceeded ; 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, Avhose progress and result I have ever found uniform and constant.
     " In 32 cases of ulcerations, inoculated in various stages of their existence with-
  out effect, the  puncture Avas followed by a slightly inflamed  areola, having the
  little wound produced by the lancet in  the centre; these symptoms generally dis-
  appeared in less than twenty-four hours.   Sometimes I have observed the epider-
  mis a little raised, which by an unaccustomed eye  might be taken for the primary
  pustule of chancre; but this error would soon be rectified, as the raised epidermis
  soon returns to its natural state, leaving no trace of the inoculation.
     " Numerous  inoculations were made in the same  year, Avith pus taken from
  wounds, ulcers, fistulous passages, and always with negative result.

                                    Buboes.

     " From our experiments with the pus from buboes, we arrived at the following
  conclusions:—
     " 1. That syphilitic ulcers are often complicated with buboes, which  is less fre-
  quently the case with simple ulcers, and they but rarely accompany blenorrhcea.
     " 2. 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 during the stationary period.
     "3. That the idiopathic buboes always suppurate, whatever treatment may be
  used.
     " 4. That the pus of buboes, which accompany  chancres, and have suppurated,
  has generally produced the characteristic pustule of the chancre upon inoculation.
     " 5. That  the buboes which have accompanied ulcers, the specific property of
  whose pus had been disproved by inoculation, have never, even when they have
  suppurated, produced any result upon inoculation.

                                   Blenorrhcea.

     " Of 85 cases of blenorrhoea, which came under my observation, 4 were  founa
  by inoculation to be of a syphilitic nature, (concealed chancres, chancres larves,)
f  and produced chancres, which again produced others; 80 submitted to the same
1  test, produced no result, whatever number of punctures were  made, or at Avhat-
  ever 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 inoculation." 
 
PART THE THIRD.
THERAPEUTICAL  SUMMARY
                        CHAPTER I.

EXPOSITION OF THE METHODS  OF TREATMENT WHICH HAVE PROVED
      MOST SUCCESSFUL AT THE HOPITAL  DES VENERIENS.

  As this title shows, and as I announced  in the commencement
of the work, I do not intend 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 and fully as possible, the in-
dications which have directed me in the choice of the methods era-
ployed, without entering into the history of the symptoms, which
will be understood  from the sketch which I have traced out.
  And first, 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  comprises two very distinct orders;  the first in
eluding chancre, and all its consequences from infection of the sys-
tem, and  whose cause is  the venereal virus ; for this order, the term
syphilis ought to be retained;  the second embracing the non-viru-
lent  affections, such as blenorrhcea, and its  consequent  diseases,
which never depend  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. 
216
PROPHYLACTIC TREATMENT OF  THE
  After this division, based on a close observation of facts, I shall
proceed to the consideration of this third part, commencing with a
short exposition of the prophylactic treatment in general.

   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, deserves
the greatest reproach, especially where affections so terrible in their
consequences are concerned.
  But what contrasts  in science, and those who practise it!  For
whilst on one  sit1^, 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  Academie
Royale de Medecine,  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 Avill  still
be the case Avith  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 bestowed the  principle of  preservation
in opposition to all things which attack our existence, has certain-
 y not desired  that man's ingenuity, otherwise so prolific in its re-
sources for preservation, should  remain inactive, 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 true bene-
factor and preserver;of his  race, who should discover the  true
secret of preserving  us from the most terrible contagion which  ever
threatened mankind.
  To the honor of the Societe des  Sciences Medicales de Bruxelles,
it has  not been  afraid to offer, as  a prize question, the following
important inquiry:—
   " What measures of medical police are best adapted to arrest the
propagation of the venereal disease V 
PRIMARY VENEREAL DISEASES.
217
  I hope this example may not be lost, and that similar and  more
enlarged questions may be proposed; for the most efficacious means
will always be beyond the jurisdiction of a medical police.
  In the present state of science, what prophylactic means can be
opposed to the primary affections ?  It is not my aim to examine
all the various means  proposed by credulity and ignorance, or the
theories, more learned than useful, which emanate from men of just
celebrity:  my remarks will be strictly practical.
  It must be apparent, that it is necessary, by all known and justi-
fiable means, to isolate the patients, warn them  of their danger,
and of the harm they may produce ; that it is the  duty of the sur-
geon Avho undertakes so  delicate  a mission, to examine with the
most scrupulous attention  those Avho can become the source of in-
finite infections, such as the licensed prostitutes.  The examination
ought here to be neither slight nor illusive ; the internal and more
concealed^  as Avell as  the external parts of the genital  organs
should  be  examined,  for  the  source  of  the  poison, which it  is
wished to avoid, often lies in the depth of the vagina, on the cer-
vix of the uterus, or even in its cavity; and in these cases, neither
an  external  examination  nor  the  toucher would suffice, and the
speculum  alone  could Avarn  them  of the danger.  I think that I
have  rendered  some  service to science by applying the speculum
in the study of venereal 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 othenvise, may
serve as a guarantee, they must at least  be repeated every third
day;  experience having shown me, that the chancrous pus is con-
tagious on the third day after inoculation, and sometimes even on
the second.  From the foregoing, it must  be evident, that  the ex-
aminations, as at present conducted, are very insufficient;  one class,
those who live by themselves, (en caste, as it is called,) being ex-
amined only once a month, while those who are grouped together
in houses of prostitution, every eighth day.
  Under the  head  of prophylaxy, must be included every means
which, by destroying the focus of disease,  diminishes its propaga-
tion :  such are, amongst others, the hospitals and  gratuitous  con-
sultations which are provided by the judicious  administration of
the Paris hospitals.   It is, in fact, by facilitating the means of cure,
                               28 
218
PROPHYLACTIC TREATMENT OF  THE
and pointing out those which can  prevent the disease, that the
greatest success is to be looked for.  The fear of the disease re-
strains less; and most frequently, corporal or moral  punishments
have only produced bad results ; for neither the confinement in the
castle of Germain des Pr£s, nor the. whip at the Bicetre, had been
attended with 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 Avhipped,
were become such, that these punishments naturally fell into disuse
  The following anecdote may not  be amiss :  Many parents re-
gard a visit to the syphilitic  hospital as a part of the moral edu-
cation of their sons, so that they can say,  " Look, if you fear not
God,  fear disease!"    One day we  had a visit of this character,
and the father, to give his son  a good lesson, requested me to show
the patients.    I did  so, and  the young man remarked,  " You
have  here many who  are  suffering  extremely;  but«it  is con-
soling to  think they can be cured."    Generally  the fear of
disease does not prevent exposure, but its effects afterward.
  The prophylaxy is to be considered  under two distinct heads;
the first concerns the  individual who may infect, and the second,
the one Avho may become infected.
  For the former, besides  the  before-mentioned visitations, and
which ought  to extend to men who may infect  the prostitutes,
cleanliness, the  use of lotions and injections, ought  to be recom-
mended, with chlorides and  soap, and the other means best calcu-
lated  to clean and disinfect by chemically changing the morbid se-
cretions.  If in general, women were more cleanly and careful of
themselves, the venereal disease 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 free  use  of the chlorides,
soap,  and all the means which can cleanse and disinfect, by chemi-
cally  changing  the material  of the morbid secretions; remember-
ing that the more the suspicious tissues are washed and cleansed,
the less liable  are they to  infection.   Before the act of coition,
a scrupulous examination of the organs, to ascertain that no lesions
exist. Here the alkaline lotions, &c, are hurtful, as they are liable
to wound  the surface, and thus cause a peculiar liability to infec- 
PRIMARY VENEREAL DISEASES.
219
tion;  but astringent lotions, on the contrary, may have a beneficial
effect.  And amongst the most efficacious may be mentioned,  a
solution of alum, acetate of lead, wine alone or with tannin, pro-
vided they be well  applied, and for a sufficient time.  Fatty sub-
stances are much less to be depended upon.   Every lesion of the
skin,  which may be discovered after a connexion,  ought to be im-
mediately cauterized to prevent further consequences.  Every part
should be carefully washed with alkaline and saponaceous lotions,
and  also with the chloride,  sufficiently diluted not to act as ir-
ritants. 
CHAPTER H.
              TREATMENT OF VIRULENT  AFFECTIONS.

                       PRIMARY SYPHILIS.

                     Section I.—Chancre.

  The prophylaxis of chancre being frequently badly understood,
most improvident persons who expose themselves to its contagion
are victims of it.
  Before commencing the study of the curative treatment of chan-
cre, we must mention, that the primary syphilitic ulcer may often
heal without any treatment, and often notwithstanding bad treatment.
Yet, as the spontaneous healing of chancres is most frequently uncer-
tain and sIoav, and the patient remains during its  duration exposed
to general infection, and to the chances of serious local affections,
the conscientious and scientific physician ought never to be neglect-
ed ; and all  his efforts  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
poison, as that of the viper, or of any rabid animal, for instance,
it is necessary to destroy it at once;  yet, in the  case of chancre,
which is in  all respects so  analogous to it, absurd theories, sup-
ported by great names, throw a doubt over the means which ought
to be  adopted for its treatment.
   However,  in order to judge properly of the treatment required
by chancre, we must consider it under its various forms, in its  re-
gular or irregular state,  and with or without complications.
   Whatever form a chancre may assume in its commencement, it
ought to be treated by the abortive method; for there is no authen-
ticated instance  of  ulcers destroyed within the first five days after
infection, having afterwards  given rise to  secondary  symptoms,
if these ulcers existed alone and without other actual complications. 
TREATMENT OF  CHANCRE.
221
If, hoAvaver,  it be  acknowledged that chancres ought  to be de-
stroyed 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, deserves a moment's consideration.
  Hunter, who was of opinion that chancres ought promptly to be
destroyed, says, without distinguishing the forms they may at first
assume, that  cauterization is  preferable to extirpation, Avhen they
are situated on the  glans, whose less acute  sensibility excites less
pain, and  exposes less  to hemorrhage; whilst excision is better cal-
culated for those cases  in which the skin is affected, and  where
the whole extent of the disease could hardly be  reached by the
caustic.   Valuable  as  are the precepts  of  Hunter, and although
they are sustained by Ribes, we  may yet more exactly fix the indi-
cations for their  employment, by regarding the difference Avhich
chancres present at their commencement.
   1.  Pustule at  the commencement.—This form, the most rare in
ordinary contagion, and  which may be  easily  confounded, during
the first days of its existence, with eczema, or herpes, yields,  when
attacked early, to a single cauterization, if thorough.  The caute-
rization of the pustule, which can certainly precede the  syphilitic
nicer, and Avhich Ratier terms the ectrotic method,  would have
been less  contested, if  the author of this method had properly de-
scribed the period of its appearance, of its  mode of development,
and the consequences of the pustular period of the chancre, and if its
existence  had not been  denied by physicians from want of experience
or observation. Therefore, Avhenever, after a suspicious connexion, a
pustule is found upon the organs exposed to the contagion, whatevei
its nature may be, and without an exact diagnosis being requisite,
it must be ruptured, and its  base well cauterized; for no bad effects
would be  felt, even Avere 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 exposed
by the.rupture of the pustule can be reached.   Whenever the pus-
tule is situated on moveable tissues  which can  easily be removed,
the excision might be made, did  not  the patients generally manifest
great repugnance to  any operation of this  kind, however  slight.
When, however, recourse is had to the excision, it is always better 
222
TREATMENT OF CHANCRE.
to remove rather  more than less than  necessary, as the sc*md  tis-
sues will rapidly heal; I usually use the curved  scissors for the
operation.
   2.  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 Avell as every suspicious ulcer, under similar circumstan-
ces, to be cauterized or  excised.  Every ulcer under these circum-
stances requires similar treatment.
   3.  Virulent abscesses.—A chancre can succeed an abscess pre-
ceded  by a phlegmonous process, and be seated in a follicle, the
cellular tissue, a lymphatic vessel, or ganglion.  Whenever, in con-
sequence of one  of these conditions, in which chancres are con-
tracted, the parts exposed to infection present an engorgement of
one or more follicles, the excision must be practised without  hesita-
tion, and followed by an application of nitrate of silver.
   When we have 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
must 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 and
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 Ave  have just pointed  out  not acting sufficiently deeply, it
often happens, that there is difficulty in destroying at once  all the
infected part, and  the  chancre is developed.   Then, at wnatever
period of  its  duration  it  may be, 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 unfortunate prejudices in vain contend, is,
as may be  easily ascertained, the result of daily observation.  I have
found in the patients affected with constitutional syphilis, who have
come  under my  observation,  that the  chancres had never lasted 
TREATMENT OF  CHANCRE.                223
less than ten, twelve, or fifteen days, and in the majority, their ex-
istence 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 alloAved to remain, the chances of constitutional
infection Avould 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, nei-
ther 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-syphilitic.
   In those cases,  however, where the tissues in Avhich the chancre
is situated are engorged, or when it has acquired considerable ex-
tent, the nitrate of silver no longer acts with sufficient energy, and
then, imitating the effect of gangrene, which it is  known, Avhen it
attacks a chancre, brings it to the state  of a simple lesion, I have
obtained very  successful 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, a line or two of the healthy
parts beyond.  One objection to this method is, that in many cases,
from the extent requiring  to be  cauterized, some of the  adjacent
parts, which ought to  be carefully treated, would be too  much
 exposed;  otherwise, where it is applicable and properly applied,
it will produce the most beneficial  results.  It ought  also to be
 stated, that after caustics are used, the parts cauterized often become
 oedematous,  and greatly swollen; therefore, they  ought to be re-
 jected, for cauterizing chancres on the internal surface of  the pre-
 puce or glans of  an individual, with any symptoms of a phimosis
   A chancre that  cannot be attacked  by these means, or which,
 notwithstanding their employment, still  retains its specific charac-
 ter, requires other treatment.
   I.  Although, in general, ulcers or wounds ought not to be dress-
 ed too frequently, for fear of disturbing the process of cicatrzation,
 yet this is not the case with  chancres in the period of progress, for 
224
TREATMENT OF CHANCRE.
here the secretion becomes a permanent cause of disease, and ought
not to be allowed to remain  long.   Hence  the dressings should
be reneAved three or four times a day, according to the quantity of
the secretion.
  II. As it is enjoined (with some exceptions that we  shall  men-
tion hereafter) that the diseased parts should  be  exposed,  care
must be  taken  not to allow the cutaneous  chancres  to become
covered with a  crust, as the pus Avill collect and  undermine the
neighboring parts.
  III. So long  as a chancre remains in the period of ulceration,
the cauterization with  nitrate of silver must be repeated, as often
as upon the eschars coming aAvay the characters of  this period are
found either on  the base or edges;  but as soon  as  the reparation
commences, the  use of the cautery, on the parts which are healing,
must be suspended, and it must be used only on  those Avhich are
ulcerated.
   IV. All greasy substances are generally hurtful in the treatment
of  chancre; but mercurial ointment is  still more so,  except in a
feAv cases.  Nothing is more common, than to see chancres multi-
ply, 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 folloAving 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 Avhen  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 my clinique at the Hopital des Ve-
nenens,  can satisfy themselves of the good effects of this treat-
ment, which, if well  applied, is never followed by successive chan-
cres, as is so often the  case Avith  other dressings.  The  aromatic 
TREATMENT  DF  CHANCRE.
225
wine diminishes the purulent secretion, and by modifying its surface,
lends to promote the cicatrization of the virulent ulcer, and by act
ing as an energetic astringent on the neighboring parts, renders them
incapable of being inoculated. In some cases, the secretion continues
very copious, and I then find the vinous decoction of  tan  succeed
perfectly   If there be pain, and if the application  of the wine
increases it,  an addition of  eight or ten grains of opium to the
ounce will  be found to answer well.   We ought to remark, how-
ever,  that  in  some subjects, who still continue to suffer, the pains
disappear upon the dose of opium  being  augmented,  Avhilst  in
others, it must be decreased.
  In  some  cases, however, the use of the wine ought to be suspend-
ed for a time, or relinquished altogether; thus, in some patients,
upon  the suppuration ceasing, the ulcer remains stationary ;  dress-
ings with  an emollient  decoction, or Avith opiated cerate,  ought
then to be  substituted for some days; in other cases, the ulcer being
accompanied with induration, 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 cau-
terization resumed  only  when it becomes necessary to repress the
exuberant  granulations.   Frequently only the epidermis  is  want-
ing to complete the cure; the surface of the ulcer becomes level
Avith  the neighboring parts, remains red, and  yields scarce any se-
cretion, but yet does not heal; then the superficial application  of
the nitrate  of silver, so as just to  Avhiten the surface, without caute-
rizing deeply, suffices to  terminate it.  v
  VII. When the chancres are regular and free from complication
the local treatment suffices, and leaves no induration on their seat.
During the treatment the patient  should be kept as still as possible,
submitting  to a treatment suited to the constitution. In fact, on this
point there is no strict system ; in  robust subjects, antiphlogistics
are called  for, while a  strict diet and  the  system of local and
general antiphlogistics adapted to strong and powerful indi\riduals,
would prove most  injurious  to weak and lymphatic  habits;  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 re-
                                29 
226
TREATMENT OF CHANCRE.
membered, 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
they were seated are returned to the normal state, the patient may,
after some days of health, again be permitted sexual intercourse;
but this is not the case if induration remain upon the parts 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
varieties of chancre requires.
  I. Concealed chancres, (chancres larves.)  When the urethra is
the seat of the chancre, and it is complicated with symptoms of
acute blenorrhcea, recourse must first be had to antiphlogistic treat-
ment :  leeches to  the  perinseum and penis ; emollient  opiated fo-
mentations ; baths and  copious draughts of mild fluids.  I  give,
every evening, two opium and  camphor pills, to prevent the erec-
tions, Avhich distend the diseased surfaces and cause them to crack,
thereby augmenting the ulceration.   If small abscesses form on
the points of the  canal,  occupied by  the chancre, they must he
opened  early ; as soon as the inflammation has subsided, injections
must be made with aromatic wine at first, mixed with equal  parts
of a decoction of poppy  heads,  and  aftenvards used alone, if no
irritation be produced. Often, when the blenorrhoeal symptoms are
not too  intense, the cauterization  with  nitrate of silver, by means
of Lallemand's caustic holder, may be used from the commence-
ment ;   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 applica-
ble to it; only Avhere it can be borne,it is advisable to keep a small
bit  of moistened lint between  the lips of the meatus urinarius, to
prevent their touching.   The blenorrhcea, which, under these cir-
cumstances, accompanies the  chancre, disappears with it,  when it
alone is the cause, or yields, when it is only a concomitant affection,
to remedies for blenorrhcea, Avhich must be employed at the same
time.
   When the chancres are seated in the depth of the vagina, on the 
TREATMENT OF CHANCRE.
227
cervix uteri, or in its cavity, the speculum ought to be applied each
time they are dressed, that they may be cauterized, and the neces-
sary 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.   The bowels ought to act freely, and
it is advisable  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 that of
the feces, this  must be omitted; the  dressings must  either be ap-
plied 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 Ave have seen done,  and  make
an incision in  them, wThich would unavoidably cause the disease to
extend.
   II. Superficial chancres.   In most 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 this catarrhal inflammation.   In  this case
a  superficial cauterization and a piece  of fine dry  linen placed be-
tween the glans and prepuce will  cause their  disappearance in a
few days; but if they still remain, the whole treatment indicated
above must be applied.
   III. Phagedenic chancres.   When a phagedaenic chancre, what-
ever  may be its variety, has destroyed the frenum, produced a fistu
lous passage,  or detached portions of  the soft integuments, they
must be divided or excised ; for they are not in a condition to allow
of adhesion.  Thus, for instance, when the frenum is perforated, it
ought first to be  divided  by small  curved  scissors, one blade of
which should be introduced through the opening, to cut first near the
glans, and then the part adhering to the prepuce; the whole subja-
cent  ulceration, thus exposed, should then be well cauterized, and
also the bloody points resulting from the operation.
   A. Phagedenic pulpy chancres.   We must here carefully ex-
amine the circunistances which may have given rise to them. Fre-
quently the dwelling of the patient is unhealthy, cold, and damp, in
which case the disease becomes better as  soon as  he changes it 
228
TREATMENT OF CHANCRE.
From this cause, chancres contracted in warm countries, and then
carried into a more northerly climate, often become aggravated in
a frightful degree, and, on the other hand, in contrary circumstan-
ces, they often have a rapid and happy termination.  This migh1
explain certain effects produced by transferring a patient from one
hospital to another, or from northern cities into those more pleas-
antly situated.
  In  this  variety of chancre  there is generally some visceral de-
rangement under Avhose influence it seems to develop itself.  Thus,
as we have already said, most frequently  it is kept up by a bad
state of the digestive organs; in this case our principal efforts must
be directed against this cause ; if it be allowed to remain, or if it
be increased by injudicious treatment, we cannot  hope  to cure the
syphilitic ulcer Avhich  is dependant upon it.
  In fulfilling the therapeutical indications which may be presented,
by the different  pathological states Avhich attend this  variety of
chancre, Ave must  be careful not  to  fall  into  a  common error of
attributing the disastrous 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 recourse to the use of the pretended specific,
and administer mercury in doses proportionate to the strength of
the specific cause they Avish to neutralize.   Let it be remembered,
that the principle  of the  syphilitic diseases  is alwrays the same, as
,n variola, and the differences only depend upon the individual pe-
culiarities, and treat this disease, like all others, rationally.
  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 in-
flammation and nervous irritability.   It is by no means uncommon
to see these ulcers, Avhen approaching the period of reparation, re-
lapse  under the influence of mercury into their  former  state, and
chancres which AA'ere at first limited and regular, become phagedaBnic,
simply from the  employment of mercury.
  Whatever may have been the origin of the variety now under
our consideration, Avhether it has succeeded to a chancre on the
skin,  the  mucous  membranes, or to  a virulent bubo, the most ad- 
TREATMENT OF CHANCRE.
229
vantageous treatment, and that which has been most frequently and
promptly folloAved by success, has consisted in the  employment of
cauterizations, joined Avith  dressings of aromatic wine:  in these
cases, the cauterizations  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 Avith the dressings ; for the morbid  secretion,
being very copious,  ought  to be frequently removed.  There are
patients in whom the disease is not arrested, until after the  almost
continual employment of a kind of irrigation.  Care must also be
taken not to crack the edges of the ulcer in renewing the dressings;
for every erosion becomes inoculated, and favors the imbibition of
the virulent pus  and the progress of the disease.
   It has been advised, Avhen  the local inflammation is very acute,
to apply leeches to these chancres.   I am  very cautious in this re-
spect, the result  by no means  according Avith the expectations Avhich
some practitioners have of it; for, besides the difficulty of making
them bite on ulcerated  points, the ulcer will immediately increase
in the depth of the Avounds they make.   Nor is  it proper to apply
leeches in the neighborhood of a syphilitic ulcer,  as each bite which
is touched by the pus becomes a new chancre.  When the local in-
flammation requires an evaeuation of blood, the leeches ought to be
applied  at some distance, and on parts Avhich 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 cica-
trized.  In these cases, complicated Avith 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  gelatinous substances.  The diet ought to be  pro-
portionate to the general state of the health and the local affection;
at the same time absolute rest must be observed.   If these chancres
be accompanied  with much   pain  and irritability, which may  exist
with or  without much inflammation, opiates must be  employed
locally or internally.  The parts  should then be dressed Avith an
infusion of opium.
   Here, too, the cauterization with arg. nitr. forms a potent  auxili-
ary.   We must not be deterred from using it by false doctrines in
regard to pain and inflammation.   It is frequently  the most effica-
cious sedative and certain antiphlogistic Avhich can  be applied, and 
230
TREATMENT OF CHANCRE.
those who follow rny course have often heard the patients them-
selves earnestly desire its re-application.   The acute pain it excites
at the moment of its being applied soon abates, and gives place to
an improvement, 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 dress-
ings with fatty substances, and more particularly with cerat. opii.
   The phagedaenic chancre may, hoAvever, progress or remain sta-
tionary.  In these cases, where the cause cannot be discovered,
sometimes  cataplasms  made with carrots, melted Avax, or ung. di-
gestiv. have been found to succeed.   The most  powerful caustics
have been  employed, as the butter of antimony, caustic potash, and
also the actual 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,
emollients,  antiphlogistics,  narcotics,  or dressings with wine, the
chancre continues to progress, or remains stationary, I employ  the
following treatment:—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 undermined edges of the skin be 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 Avine is applied  and re-
newed, as in the case   of simple  chancres.  Under this treatment,
the ulcer soon becomes clean, and  healthy granulations appear;
thus, the cavity becomes filled, and the skin again adherent.  Some-
times 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 granulations appear.
   Should  this  treatment, which daily experience authorizes me to
recommend, not succeed,  and  the disease continue to  progress, I
prefer the application of the Vienna  paste as  a   cautery, followed
by such dressings as may  be required by the state of the local af-
fection. 
TREATMENT OF CHANCRE.
231
  Frequently, in this kind of phagedaenic chancre, the edges of the
ulceration are  so  much undermined, and become so thin, that it
would only be a loss of time to attempt to procure a re-union.  The
changed tissues should then be destroyed.  To act efficaciously and
promptly, it is important to establish distinctions.  When an ulcera-
tion has succeeded 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 extent of the integuments to be removed, I
prefer the curved scissors to give them  the form  best adapted for
cicatrization.  Here we must avoid, as much as possible, those de-
formities which, in certain  regions, remain as indelible Avitnesses
of an affection, Avhich it is always desirable to conceal.   But, when
the ulceration tends to extend,  nothing can be more  hurtful than
the use of a sharp  cutting instrument, which, far from limiting the
affection, aggraA'ates and augments it, unless the neAv-made Avound
be immediately cauterized ;  therefore it would be far better in this
case merely to have recourse to the use of caustic, and  always first
to the Vienna paste.  For not only can we define exactly the parts
we wish to remove, but we may at the same time completely destroy
the virulent  surface, or, at  any rate, protect the neAv  edges of the
ulcer from a too  rapid inoculation, by interposing an eschar and
by a kind of vital reaction, the absence of which is frequently one
of the principal causes of the progress of the ulcer.
   From  our remarks in another place, must we in all  cases, re-
nounce mercurials and anti-syphilitic remedies ?   It is true, that in
most cases  of these affections, mercury, sudorifics, &c, are more
prejudicial than useful:  there are, hoAvever, instances in which they
have produced good results; but Ave are at present unable to indi-
cate  the precise circumstances in which mercury is useful, or even
indispensable.  If the disease progress, notwithstanding the means
pointed out above, I have then recourse to this medicament, Avhich
was so long  and often considered as specific ; first, in local applica-
tions, and then as a general agent internally, or by, the skin, ac-
cording  to circumstances, which I  shall  afterwards  describe.   1
continue the local or general use separately or combined, according
to the effects obtained, if there be improvement; but if the disease 
232
TREATMENT OF CHANCRE.
increase, I suspend them.  In  those cases where, according to an-
cient errors, it is thought necessaiy to begin  by mercurials, Avhich
I Avould not advise, we must not be so blind  as to continue  their
use when we see their evil results.   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, and frequently emollients, local  or gen-
eral antiphlogistics  are indicated, and powerful in the hands of those
who know how to use them.
   B.  Indurated phagedenic chancres.  Induration, one of the es-
sential 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
after cicatrization, and Ave know  what  may then happen.  Most
frequently the induration,  having a tendency to increase, not  only
prevents the formation of the cicatrix, but may, by the interstitial
compression it  causes, produce  gangrene, and  give  the  ulcer a
phagedaenic form.  As in this case there is generally little inflam-
mation or pain, our efforts must generally be against the induration.
   In the most simple cases  of indolent  indurated chancres, the
dressings ought to  be renevved two or three times a day with fine
lint and a thin layer of calomel  and opium, or mercurial cerate.
 Should the  suppuration be too great, a lotion of vin. arom. may be
 applied  each time, and before the dressings are reneAved; if that
 be not sufficient, the dressing may consist of the wine alone. When
 there is much nervous irritability and inflammation, or if the gan-
 grene progresses, a concentrated solution  of opium should be pre-
 ferred, till  the affection be brought  back to the simple  state by
 means of emollients  and  antiphlogistics simultaneously employed.
 In indurated chancres of small extent, cauterization, Avhich cannot
 go beyond the limits of the affection, is much less efficacious than
 in other circumstances; but yet the nitrate of silver finds its  appli-
 cation here also ; it modifies the surface, often arrests the  progress
 of the gangrene, and during the reparatory stage, checks  the gra-
 nulations, which have sometimes a tendency to become spongy.
    WhateATer  may  ha\-e  been  the form at the commencement and
 the seat of the chancre, the induration may remain after the  cica- 
TREATMENT OF CHANCRE.
233
Inzation, and being generally a sign of future symptoms, requires
peculiar attention.  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 employed Avhere its  extent was
small and defined, or Avhen the induration  had undergone a  sort of
cartilaginous transformation, 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, A\'hen  applied to the mucous mem-
branes, they generally produce irritation and return of the ulcera-
tive period, especially if rancid mercurial  ointment be used.
   When  the induration occupies a great extent, other local means
may be used Avith advantage.  Caustics which act deeply,  the dis-
section of the indurated parts, and then the combined  use  of blis-
ters, dressed Avith ung.  hydrarg. and compression.  Unfortunately,
this poAverful agent, which is much more efficacious than the others,
is not always applicable, as we shall afterwards  see;  it is only in
those indurations which accompany or follow buboes,  that we can
really draAv advantage; for in those which are seated on the genital
 organs,  and especially on the mucous membranes, we must  re-
nounce its beneficial influence.
   If  a well directed local  treatment  often  produces  a complete
 cure, most generally it requires  a long time,  and is  then imperfect.
 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 con-
 sidered the sole type of primary syphilis, and mercury as the only
 specific to be opposed to it.
   Without entering here into a discussion which would carry me
 beyond my limits, it is certain that if mercury has not incontestably
 a specific action in this particular form oT 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 cures more rapidly.
    If, according  to  the physiological  doctrine, the cure of chancre
                                30 
234
TREATMENT OF  BUBOES.
be reckoned from the day of its cicatrization, Avithout regarding
Avhat remains,  it will  sometimes appear  more rapid Avith simple
treatment, and the patients Avill be under treatment in the hospitals
a shorter time; but  if Ave Avait, before Ave pronounce a  patienl
cured, till all induration has disappeared, there Avill be a great dif-
ference  in favor of the mercurial treatment; the induration in the
first case remaining a very long time, and even till the more frequent
vroduction of secondary symptoms.  Although I acknowledge the
perhaps analogous properties of other medicaments, the mercurial
treatment being one of the most powerful and certain, I have re-
course to it Avhenever  a certain degree of induration  accompanies
a chancre, and prevents it from cicatrizing, or remains after it is
superficially healed,  and more  especially Avhen, by its excess, it
gives it a phagedaenic  form.  As injurious  as  mercury is in other
varieties, so beneficial  is it  in this case.
   C. Gangrenous phagedenic chancre from excess of inflamma-
tion.  Here the inflammation, which gives the  peculiar  form to
this variety of  chancre, is  the  principal point against which Ave
must direct  the treatment; we must disregard for  a moment the
primary cause ; in fact, hoAV many symptoms have we seen to fol-
Ioav from the mercurial treatment applied  empirically and for the
specific  cause; I repeat  it, the inflammation is the principal dis-
ease to  be treated by the most powerful means.  The worst results
ensue from Avant  of  attention to this fact, and an empirical treat-
ment of the specific cause with  mercury.  If, however, notwith-
standing a rational and judicious treatment, gangrene supervene,
it must  be treated  as in ordinary cases unconnected with syphilis;
it is  not till this symptom  has disappeared, that other medication
is indicated, and the chancre w7ill have returned  to  the state of
a simple ulcer, which  the  means already pointed out Avill rapidly
cause to cicatrize


                     Section II.—Buboes.

  Wherever and at Avhatever depth a bubo may be seated at the
time of its appearance, when only a slight tension  of the tissues
exists, rest, Avhich may be regarded as the best prophylactic, and a 
TREATMENT OF BUBOES.
235
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 ha^e very
frequently observed, that in individuals who wear Avell-made band-
ages for hernia, the buboes are seldom developed on the side of
this compressing apparatus.
  When  compression cannot be endured, or when nevertheless
the tumor  increases, we must have recourse to another abortive
method, for I am  satisfied that the termination of buboes  by a
prompt resolution,  a kind of scattering, and by avoiding the sup-
puration,  is of the  greatest  consequence  to the patient.   If the
incipient bubo be not actually the seat  of a very decided phleg-
monous action, and have been preceded by a chancre, I prefer the
folloAving  treatment, which may be called mediate cauterization.  I
cover the  tumor with a blister, always proportional in size to the
part affected; 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, tAventy grains to the  ounce of distilled
water;  this is allowed to remain t\vo or three hours, and it can be
secured by strips of plaster, if  it be feared that the patient may dis-
place it.   This caustic application, for which a solution of sulphate
of copper, tAvo 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 eschar must be produced, penetrat-
ing part  of the dermis.  This eschar,  generally of a grayish or
brown color, and but seldom  black, is  generally thicker than the
part of the skin destroyed, AAThich seems at first to become infil-
trated, 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  com-
presses 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  is continued.  I have not found it advantageous to main-
tain  the suppuration when it Avas desired to annihilate the affec-
tion  of A\diich we  are speaking.   I continue this treatment, re-
peating the  application  of  blisters and the caustic solution as 
236
TREATMENT OF BUBOES.
long as the tumor remains, unless  acute  inflammatory symptoms
appear.
  As the treatment with blisters and caustic solution has the in-
convenience of producing great pain, and in some individuals  an
indelible cicatrix, it must only be had recourse  to Avhen a chancre
has  preceded, and the development of a  \Tirulent  bubo is feared.
When the engorgement is consequent on a simple blenorrhoea, a
non-specific excoriation, 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, emplastrum  de vigo, iodide of lead  with cicuta,
simple  or  resolvent cataplasms, absolute rest, and,  Avhen pain
exists, local depletions by means of leeches, and  emollients with
sedatives and  narcotics, especially laudanum,-freely applied.  By
these means many simple engorgements,  situated  near parts pri-
marily 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, with-
out regarding  the variety.
   If the  local inflammatory symptoms  cause a  rather intense
febrile action in a robust individual, general bleeding from the arm
said  local depletion must be  used; otherwise  leeches alone will
suffice,  but too  many ought  to be applied rather  than too  few—
tAventy, thirty, or forty.  In  applying leeches, we must  not lose
sight of the possibility of suppuration, and when there is  ground
to believe  a  ganglionary chancre  or virulent  bubo exists, they
must be applied  around the  base of the tumor; if the danger of
suppuration be imminent, they must be applied at a still greater
distance.  To  the use  of leeches,  must be  added general Avarrc
baths, (as the  hip baths here are not of much use,) emollient cata-
plasms, 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 Avhen the  buboes are  deep seated.   Loav
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 ahvays without benefit in indolent
buboes -} but  in acute buboes, especially where there is a  phleg- 
TREATMENT OF BUBOES.
237
monous tendency  or  complication, this  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 often remove this symptom
by acting up*on the deep-seated inflammation.  It will sometimes be
found that  cataplasms  of linseed  meal produce an  eczematous
eruption, which may be  very extensive; in this 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.
   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 resolvents.   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
drachm of ung. hydrarg. well  rubbed in, and then covered Avith a
cataplasm, if there be any pain; or the compression may be ap-
plied either  by means of a spica  bandage  and  graduated com-
 
238
TREATMENT OF BUBOES.
presses, a strong hernia truss, or an instrument  contrived for this
purpose;  this consists of a small oval pad, covered with leather,
and attached by a strap, which proceeds from that part of the pad
which is  situated in the inner part of the inguino-crural fold, goes
to the inside of the thigh, turns around it, passes on "its outside,
goes across the abdomen, and then descends obliquely to the pad,
and is attached by a buckle on it.
   If  the  gums become affected  by the mercurial frictions, or any
other bad symptoms ensue,  the ung. pot. hydriod. may be substi-
tuted, alone or with iodine.   If either the mercurial plaster or oint-
ment has been used, the skin must be Avell  cleaned before the iodide
of potass ointment is applied, as  otherwise a new and very caustic
composition will be formed, which may cause considerable inflam-
mation 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 ener-
getic and expeditious  treatment be desired, blisters and the caustic
solution should be  employed, Avhich have  been  found by far the
most  rapid in their action, in  a long and refractory disease.
   In  this case, as in the abortive method, the tumor must be cover-
ed with a blister, and, twenty-four hours later, lint dipped in a so-
lution of corrosive sublimate applied.  When the eschar is formed,
it is to be treated with mercurial ointment, covered Avith cataplasms;
when the eschar falls  off, the suppuration  must  be maintained, by
being touched every t\vo or  three days with a brush Avet with the
sublimate.  Should  it, hoAvever, cicatrize, fresh blisters  are to be
applied,  and this treatment  continued  till  the tumor has entirely
disappeared, or till pus is formecL
   Sometimes, however, it occurs, that  after having been  pretty
rapid, the progress of the resolution is arrested, notAvithstanding the
continuance 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  applied.   In many cases, a cure which is otherwise
impossible, is obtained by employing these means  alternately.
   Whatever may be done, some engorgements do  not yield, par- 
TREATMENT OF EUROES.
239
ticularly those seated  in the deeper ganglions.  In  some happily
rare cases, there is a schirrous or carcinomatous degeneration, into
whose history and treatment Ave cannot now enter ;  but most fre-
quently, in cases of virulent buboes, the obstinate engorgements and
indurations depend  on  scrofula, or on a principle which produces
induration in  chancres.
  Buboes of  a scrofulous nature, or whose scrofulous complications
have been excited into development by venereal affections, when
treated with alkaline and sulphur baths alternately every othei day,
united with the preceding means, and the general treatment, Avhich
Ave  shall soon point out, often  come  to a  successful termination,
which must  only be waited for with patience.   In  this case, the
crushing of the ganglions might, as a last  resource,  be  attempted,
as M. Malgaigne has proposed; but Ave must  remember it is very
painful, and  may produce symptoms which should render its em-
ployment  rare.   I have sometimes  succeeded by applying every
second or third day frictions on the skin, Avith  a little tincture  of
iodine, which may be diluted with water, Avhen 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, Avhich covers it, with the Pate de Vienne (a layer half
a line Avill suffice.)   If  the  eschar is removed, the  thus denuded
ganglions are  to be covered with ung. hydrarg. and cataplasms;
the  successful  result  is often very  rapidly obtained.   If Ave are
obliged to attack the ganglions themselves with the paste, we must
be very cautious in its application, and only remove very thin lay-
ers  at a time, redoubling the precaution  the nearer the  more im-
portant parts  are approached.   With patience, Ave have often de-
stroyed thick and compact layers of ganglions, which no other
remedy Avould affect.  This  practice  is much better than the use
of setons  and  escharotics.
  When the  induration  of the bubo depends on that of chancre,
we  must pursue the treatment recommended for indurated chancre.
  Acute and  indolent buboes may  terminate in suppuration, Avhich
is more frequently the case Avhen a chancre has been the cause  of
them.  If much inflammation accompany the  suppuration, leeches 
240
TREATMENT OF BUBOES.
and antiphlogistic treatment are required, Avith the restrictions alrea-
dy mentioned.   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  of preventing the further development
of the abscess.
   WThen the inflammatory symptoms are subdued, a  question of
great,  importance  presents itself  to our consideration.  Ought we
in all cases to attempt the resorption of the pus, to avoid opening
the abscess, or is it better to give it  an issue as soon as it is formed 1
I do not wish to question the good  faith  of those Avho say, that by
employing certain methods of treatment, the spontaneous or artifi-
cial opening of the greater number  of buboes might be avoided, of
whatever nature they may  be; but I can affirm, from daily expe-
rience, that when pus is decidedly formed, whatever may be done,
resorption takes place but in a very feAV cases, and that, if it be
attempted to procure it in other cases, there is great risk of serious
consequences.  Blisters and the caustic lotion, Avhich are so  advan-
tageous before the suppuration has taken  place,  may still, if the
cavity be of little extent, and the skin has not become thin, and if
the buboes be not virulent, produce a complete resolution without
opening;  but should the suppuration be  copious, the cavity  con-
siderable, the skin  thin, and deprived of its cellular tissue, in Avhich
case the solution  no  longer  produces that thickening Avhich  was
previously 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 number of holes like a  sieve, which has led to the belief
that it is only a simple purulent perspiration.
  If, hoAvever, this result Avere the  most frequent, by favoring the
re-union of the skin Avith the subjacent parts as the pus is evacua-
ted, the method would still be favorable;  but, unfortunately, this is
not the case,  and whilst this treatment is employed, the cavity ex-
tends, the pus accumulates, the skin becomes undermiried,  till the
eschar falls, and then it may not be of sufficient depth to alloAv 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
previously employed, as soon  as we are assured of the existence of 
TREATMENT OF  BUBOES.                 241
pus, Ave must give it issue.  It is not necessary to enter into a de-
scription of the signs Avhich denote suppuration, and which are to
be found in the history of* abscesses generally;  but I must mention
that the elastic tension of the ganglions often deceives, and leads to
a belief in the presence of pus, Avhere in reality none exists.  Some-
times the suppuration is deep-seated, and enveloped  in indurated
masses, Avhich mask it and prevent  its detection; yet if the tumors
in Avhich the presence of pus is suspected be carefully examined, a
point Avill 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  passage
with the deeper parts of communication.   We  are sometimes as-
tonished upon opening these buboes to see  an enormous quantity
of pus escape, Avhen the fluctuation had only 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 direction of the inguinal  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 censecutive collections 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 mak-
ing the incision, the  skin  is threatened Avith gangrene, or becomes
thin and bluish, it is incapable of being re-united  or cicatrizing, and
must, therefore, be destroyed.  For this purpose  either a bistoury
or cuiwed scissors may be used;  but I prefer the Pate de Vienne,
with Avhich we can remove as much as Ave desire : not only do Ave
by this means  remove the useless parts, but also, as we said Avhen
treating  of phagedaenic chancres, a healthy  inflammation is excited
in those which  remain, and in some  cases of virulent buboes  a
prompt neutralization.  It ought to be understood, that if we  have
to do  with  a  gangrenous bubo  with  excessive  inflammation, we
must first have recourse to antiphlogistics and incision, and the in-
dications which gangrene in general presents.
   After opening the bubo,  it is useless to  press out the pus very
                                31 
242
TREATMENT OF BUBOES.
forcibly, Avhich causes great pain;  fomentations and  emollient 01
opiated cataplasms must be applied.  In case the opening is small,
and a non-virulent bubo exists, a bit of lint between the lips of the
wound is necessary, during the first few days.
  In simple buboes everything goes on as in ordinary or scrofulous
abscesses ; but in some particular cases, as  especially  Avhere there
is a ganglionary chancre, the  edges of the incision  ulcerate, the
cavity continues to extend, or at least remains  stationary.  Then,
after the second day from the time  of the bubo being opened, or
as soon as the patients require my services, I fill the cavity with
poAvdered cantharides  and cover the  whole with  a blister.  The
next day, if any induration be present, I apply ung. hydrarg., and
dress  the cavity Avith the  aromatic Avine; otherwise I dress the sur-
face of the blister Avith cerate, and cover it Avith 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 accu-
mulations of pus laid open.   Detergent irritating injections, which
so often succeed in cases of simple fistulae, are little to  be depended
upon in virulent buboes ; compression in the regions  in which the
pus is situated is not much more advantageous, as surfaces affected
Avith  virulent  ulcers  cannot unite, and the  parts  ought in such
cases to be exposed.
   In  all cases when the granulation is  tardy and  sIoav, powdered
cantharides, placed in the cavity and covered Avith dry lint, excites
the production  of granulations, which, when  excessive or atonic,
ought to be  cauterized, or stimulated with nitrate of silver, like
every wound  Avhich is cicatrizing.   Should any induration remain,
after  the cicatrization, 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
general treatment ought not to be neglected.
   The acute stage requires,  as we  have said, antiphlogistic treat-
ment proportionate to the degree of the disease and strength of the
subject; but  Avhen these  most  common indications  are  attended 
TREATMENT OF BUBOES.
243
to,  others, of not  less importance, present themselves.  The lym-
phatic habit and scrofulous complication bemg very frequently met
with in individuals affected with buboes, we  must use bitters and
tonics, and Avhen no contra indication exists, they ought to be com-
bined with a strengthening regimen, particularly when the system
is much exhausted by copious secretion of pus.  In these cases, I
have derived great benefit from the use of proto-iodide of iron, in
doses of ten, twelve, to twenty grains per diem, with a decoction of
hops or saponaria and sirup of gentian.
  As regards the antisyphilitic treatment, properly so called, the
presence 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 gan-
grene, hemorrhage, fever from  resorptions,  &c, but we cannot
here enter into a detailed examination of these symptoms 
244              PROPHYLACTIC TREATMENT OF
             ORDER  I.

VIRULENT AFFECTIONS.
   Section II.—CONSTITUTIONAL  SYPHILIS.

                   § I.—General Remarks.

  From the foregoing considerations, we  have seen that we pos-
sess an infallible criterion by which Ave can distinguish and diag-
nosticate the primary symptom of syphilis ;  but this is not the case
with regard to  those  resulting from  general infection.   The well
characterized and  recognised antecedent  in the  absence of any
other appreciable cause ;  the form in each  case ; the peculiar pro-
gress ;  the concomitants,  and the results of certain treatment, gen-
erally lead to a rational, but more often doubtful diagnosis, when
symptoms are concerned, which other causes than syphilis can pro-
duce or considerably modify, such as certain cutaneous, glandular,
or osseous affections, &c.   However, if the  diagnosis 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 tu-
bercle, if well defined,  after having once seen it.   Are there any cir-
cumstances unconnected with the syphilitic  virus Avhich can produce
it 1   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, that which occurs most frequently 1
  However they may have  explained them by the action  of the
syphilitic virus, or by the  doctrine of the sympathies, all Avriters on
syphilis are agreed,  that the primary venereal affections may give
rise to  consecutive lesions of the various tissues of  the system, but
more especially of the skin, the  mucous membranes of certain
parts, the cellular tissues, lymphatic, fibrous, osseous system, &c,
of the  eyes, testicles, &c 
CONSTITUTIONAL  SYPHILIS.
24b
  Except by inheritance, there is no primary constitutional syphi-
lis; in those cases which have been thought such, the prunary
affections had escaped notice, as is frequently the case in women;
or had been concealed by the patients, under  circumstances in
Avhich  it would  have been dangerous  for them to  have acknow-
ledged them, Avhich, in order to  avoid being deceived, ought al-
ways to be borne in mind, particularly in cases of nurses.
  In order  not to wander from the path proposed, and enter into
discussions  which would be out of place here, I shall now proceed
to consider, Avhether  there exists a really prophylactic treatment
for the symptoms of general infection.


    § II.—Prophylactic  Treatment of  General Syphilis.

  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 them-
selves the trouble to observe, will find, as Ave before stated, that it
may be spontaneous, or take place under the influence of a host of
different  medicines,  to which no specific properties  can be at-
tributed ; 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  commences, our  endeavor
must be to prevent the consecutive (secondary or tertiary) affec-
tions.  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
constitutional 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  erosion or  solution of continuity,  which appears  after  a
coition, be  destroyed,' not  only where the connexion  is of a sus-
picious nature,  but in  every case ; for this  symptom  is  unfortu-
nately overlooked by the greater number of patients, whom horrible
consequences too frequently undeceive Avhen it is too late, and un- 
246
prophylactic treatment of
der circumstances in which the moral and social  position would
seem to protect from every chance of infection.
   As, hoAvever, in most cases, the primary symptom is allowed to
progress, and the patients only apply for advice at a later period,
the chances of destroying this symptom before absorption has been
alloAved 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.
   Be this as it may, I can most positively affirm, that, contrary to
an opinion professed  by many, and by Dupuytren in particu-
lar the  destruction of chancres by  caustic or other local appli-
cation cannot be  regarded as favoring the  development of consti-
tutional  affections by the repercussion, or throwing  of the virus
into the  system; all Ave  can say is, that when  cauterization has
been employed 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
prophylactic 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 to secondary affections.
   But  is  there  any treatment  Avhich, besides the  specific cause,
the peculiar poison, favors the development of the  syphilitic tem-
perament and diathesis ?   Yes, and it is that Avhich does not destroy
the virus and radically cure the primary affection.  Thus it is not
mercury more than sudorifics or  antiphlogistics, but it is that the
medication  has  been injudiciously  or insufficiently administered.
Mercury has not only been accused of aiding the production  of
constitutional symptoms, but some  inconsiderate enthusiasts, car-
ried av/ay by the  love of novelty, have even asserted that mercury
was the sole cause of all the frightful affections which syphilis pro-
duces.   If indeed syphilis was of rare occurrence;  if it were with
us, as the oriental plague, of which many write without ever hav-
ing seen it, theie might be some excuse for these paradoxical pro-
positions ; but as it is to be met in our streets  and  fills our hospi-
tals, to refuse to see is voluntarily to forego the use of one of the 
CONSTITUTIONAL  SYPHILIS.
247
senses, which ought then not to be appealed to in making other
observations.  To convince me that mercury can produce the bad
effects  Avhich are imputed to it, I must be shoAvn a subject, Avho,
under its  influence  alone,  and  Avithout having had  any specific
antecedents, has afterwards been attacked Avith 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 Avith blenorrhcea,  and Avho
Avere  formerly  treated  with mercury,  as  is  still the case Avith
some surgeons, how many have been found  later to present con-
stitutional symptoms, besides those who have had urethral or con-
cealed chancres 1 If, on the other hand, the actual population aboA'e
the age of fifty  were interrogated, Ave  should be astonished at  the
number of persons who have, under the influence of  the old doc-
trines, undergone mercurial treatment, Avithout eATer having experi-
enced anything of it.   This number is indeed  so large, that the
amount Avould  appear exaggerated, unless Ave Avere  able to have
it actually verified by the individuals.
   We  undoubtedly see every day the most severe cases  of syphi-
lis, in patients who have most of them used mercury; but have the
explanations always been free  from prejudice, and especially from
the spirit of party doctrines 1 Do Ave not generally find, that those
patients Avho are stated  to have  used a mercurial treatment, have
not undergone  any influence from it, either from the form in Avhich
it was  administered having only had a purgative action, or that the
pills being  in a manner petrified, like those formerly used in  the
Hopital des Veneriens, passed through the digestive canal Avithout
losing an  atom  of their substance.   Would it  then not be more ra-
tional  to  say,  and  in  accordance with hundreds of facts which
might  be adduced, that there are some patients with Avhom  the
treatment has been  insufficient or badly administered ? Is not this
proved  by the  successful issue of  a more methodic treatment  of
these same individuals 1  Are not others completely refractory to the
treatment 1  Do Ave not, on the other hand, find that all forms of con-
stitutional syphilis do not yield to the same treatment, any more than
the same  treatment  can in eA-ery case prevent their development?
and lastly, that in some individuals,  the most unfortunate of all, but 
248         TREATMENT of  constitutional  syphilis.
incontestably the least numerous^the disease develops itself never-
theless, and becomes the more formidable  as  the remedy cannot
arrest it, and undermines  the constitution 1   These latter circum-
stances have undoubtedly been  better understood and better appre-
ciated of late, and much credit  is due to those Avho have aided the
researches  by their  works,  as  Thomas Rose, Guthrie, Rust, Bru-
ninghausen, Richond, Jourdan,  Devergie, Desruelles, Fricke,  &c,
although some  of them may have somewhat exaggerated the cir-
cumstances they observed.
   The numerous observations which I  have been enabled to make,
lead me  rather to consider a mercurial treatment as curative, than
prophylactic of certain symptoms.
   HoAvever, in the question   before   us, which has  never been
solved, Ave must  say, that the  surgeon who leaves an indurated
chancre without  general treatment, 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 symptoms disappear.
   Whilst speaking of the prophylaxy, we ought to mention that all
persons are not susceptible of  general infection, a fact Avhich has
been overlooked  and  not properly appreciated by many Avriters;
that peculiar conditions are required for it to take place, and that
especially after the infection has taken place, in order  that its ma-
terial manifestation may be effected, certain accidental or  rather
assisting circumstances are  requisite, Avhich 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 de-
velopment.   The same  is the case in  the change from foetal to
extra-uterine life; from pregnancy, and from the time of the cessa-
tion of the menses, which has been so well  observed by Thiery de
Hery.*   The same influence results from a  disordered  state of the
digestive  canal,  anterior  or   concomitant  cutaneous  affections,
habitual irritations of the throat  and mucous membrane of the

   * M. Pailloux, a  distinguished physician, thought that the cessation of the
menses was one of the principal causes of ulcerations of the throat in females;
forgetting that this  could  not be true of men, Avho are much more frequently
affected with it. 
SECONDARY  AND TERTIARY AFFECTIONS.           249
mouth, frequently owing to the use of a pipe, irritated hemorrhoids
scrofula, or  other  diathesis.   Further,  a Hoav, a  fall, want of
cleanliness, and over exertion of certain parts, produce the same
effects.
   From  the  preceding  general views, into whose details we Avill
not enter, it results  as the most prominent point, that in every in-
dividual exposed to the  primitive infection, to prevent further con-
sequences, attention ought to be  paid to the  general  health and
proper action of the functions, and to the maintenance of health
by proper hygienic precautions, or  by the rational treatment of
any diseases not dependant on syphilis, but which might  actually
co-exist with it.


  § III.—General  Remarks  on the  Treatment of  Secondary
                   and  Tertiary Affections.

   All the consecutive affections of chancre may, like the chancre
itself, heal  spontaneously, often without any  explanatory cause;
at other times, in consequence  of certain more or  less apparent
conditions, such as  accidental perspiration, change of diet, climate,
or occupation, 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,  constitutional syphilis is  perhaps the one which most
decidedly requires the aid of  art.
   This principle  being  established, Ave will say that if difference
of opinion exists as  to the treatment required by the primary symp-
toms among physicians,  there is still greater as regards that of con-
firmed syphilis.  The following is the result of my clinical experi-
ence,  and the treatment it has led me to adopt.
   1.  Time at which the treatment ought to commence.   The first
symptoms which make  their  appearance after a chancre, ought to
be treated as promptly as possible.   The serious nature  of syphilis
depends only on the time allowed it to undermine the system.
   2.  Conditions.   No age nor habit is  an absolute contra-indi-
cation of treatment.
   As  regards women, the period of gestation, far from being an
                              32 
250        GENERAL REMARKS ON THE  TREATMENT OF
 obstacle to energetic means being  adopted, requires yet more at-
 tention and judicious promptitude.   I haAre seen more abortions in
 syphilitic women Avho Avere not treated, than in  those who had
 been  timely submitted to a  methodic medication.  The same js
 the case during the period of suckling.
   3.  Climate.   Seasons.   Climates and seasons are never abso-
 lute impediments;  undoubtedly a  temperate  climate  and warm
 season are  preferable, but yet, under opposite circumstances, Avhen
 the symptoms are urgent, an immediate treatment is  preferable to
 delay.
   4.  Syphilis without complication.  When constitutional syphi-
 lis exists alone and uncomplicated,  and  at its commencement in
 an  individual enjoying a good constitution, and  who has never
 been  tormented  Avith  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 neAV primary syphilitic
 symptoms have been acquired.  When  the affections  are of a slow
 chronic nature, as some diseases  of the skin, scrofula, organic affec-
 tions, &c, the syphilis must be attacked, if its treatment does not
 aggravate the concomitant disease,  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
 Avhich 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 the antiphlogistics
 ought  to be  considered as the  principal means to be employed,
whenever any symptoms of super-excitation, and particularly in-
flammation, exist.   There can be no certainty of  success Avithout
strict  regard being paid to this rule.  Whatever the nature  of the
 affection may be,  if inflammation  be  present, the antiphlogistic
method must first be used, according to the seat, extent, local in-
 tensity, and  sympathetic  reaction.   But  dangerous  as  it is  to 
SECONDARY  AND TERTIARY AFFECTIONS.           25
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 compli-
cations 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
Avhich 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 Avhenever the subject affected
with irritable inflammatory venereal symptoms is robust and vigor-
ous, a spare  diet will produce  a  happy modification, and cause a
number  of symptoms, 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 Avithout dis-
crimination to all cases, is, notwithstanding the powerful authorities
who support it, one of the worst means that can be adopted.  Thus
in weak debilitated  individuals with a  scrofulous habit,  a spare
diet aggravates the disease, whilst a generous, tonic diet is a prin-
cipal  condition  on which the success of the treatment  depends.
This assertion may be verified every day in the wards of my hos-
pital, where patients who at home Avere destitute of every thing,
will be  found quickly to recover their  strength and health under
 the influence of a better diet, Avhilst others,  accustomed to plenty,
droop and only become re-established by quitting the abode  and
 nourishment of an hospital.  The diet must  therefore be regulated
 oy the more or less inflammatory nature of the disease, the strength
 of the patients, 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 affections, and especially in those which have their seat in the
 skin itself.
    9.  Remarks upon the influence of the digestive canal.   If it be
 requisite in the treatment of the  secondary affections that the func-
 tions of the skin should be undisturbed,  it is  equally important that
 the digestive organs  should be  perfectly free.  Without attribut-
 ing to them supremacy of action in the economy and the arbitrary 
252         GENERAL  REMARKS ON THE TREATMENT OF
  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 in the affections of the osseous and lymph-
  atic systems.
     10. Sudorifics.  As a general  medication, sudorifics have been
  too much lauded, and there seem to be too many cases in their fa-
  vor to  alloAV of their curative influence being entirely denied.
  Without, however, fully adopting the views of Cullen, particularly
  as regards sarsaparilla, I must say that in well characterized con-
  stitutional symptoms, this substance, or those which resemble it, are
  far from possessing all  the power which  has been attributed to
*  them, and Avhich commercial 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
  rational 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 adjuvantia to the mercurial treatment.   They are  more-
  over indicated and very  useful when  circumstances  forbid the use
  of mercury ; when it has been  injudiciously administered, and has
  produced ill effects, or Avhen its use has to be suspended.   In  the
  affections  of the osseous system, and more particularly Avhen sup-
  puration exists, they  are used alone, if not as active and curative,
  yet as a moral medication, on account of their common reputation,
  and the confidence most patients place in them.
    Further, as regards the  moral or mental treatment, if we may
  be alloAved to employ the term, we must have recourse to sudori-
  fii.s for patients affected with syphilophobia, who, being haunted by
  a a idea of  a syphilitic affection improperly treated,  or, as they ex-
  press it, badly cured, believe themselves  a prey to the most  incon-
  gruous symptoms, of which they really possess no  trace; in such
  eases we may conscientiously do Avith these medicaments, calling
  chem correctives, or depuratives, Avhat  it would  not be  allowable
  to do with mercurials.
    Amongst the sudorifics,  giving the first place to sarsaparilla, al-
  though it is not always certain,  except from other diaphoretic indi-
  cations, I  greatly prefer the tisane  de Feltz, where  not contra-
  indicated.   I usually employ the form communicated bv Boyer, Avho 
              SECONDARY  AND TERTIARY AFFECTIONS.          253

received it from the son of the author.   Guiacum, 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 sometimes succeed.   I  administer sudorifics in
the form of tisane, (diet drink,) when the circumstances of the pa-
tient alloAv of it; otherwise, if they must conceal their treatment,
in the form of sirup.
   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.   ToAvards evening,  and
upon going to bed, they are to be given warm and in someAvhat
larger quantity.  I have derived benefit from adding, in these cases,
a little acetate of ammonia.
   11.  Tonics, antiscorbutics, fyc.  According to the habit or the
complications, tonics, antiscorbutics, or antiscrofulosae ought never
to be neglected; thus, I administer either alone or  combined Avith
mercurials, quinine, bitter and  other extracts, iron, and particularly
the  proto-iodide of iron, which  has  been  so useful to me in the
treatment of scrofula in its simple form or  combined with syphilis,
and also iodine, internally  or locally, not,  strictly speaking, as an-
tisyphilitic, but as a treatment for these frequent and troublesome
complications.
   12.  Remarks on other medicaments.   Before we come to the
consideration  of mercury, Avhich has  and  still does, in spite of all
that has  been  said against it, enjoy so just a celebrity, I must say
a word upon some substances which it has been attempted to sub-
stitute for it.
   In studying the history of therapeutics, it is very obvious  that
if a disinterested love of humanity and science has directed the la-
bors of many, far  more have been  influenced by other  motives.
Each  has desired  a peculiar treatment, a  nominal method, Avhich
might furnish a pretext  for making a book, or publishing a pro-
 spectus.
   I shall not  pause to examine those  means  to  which these re-
proaches may apply;  I  shall only relate what I have found from
 experience, concerning the preparations of gold and silver, &c.
   1 have always found  gold, as a general method in primary af- 
254         GENERAL REMARKS ON  THE TREATMENT OF

fections, useless.   In the consecutive constitutional  affections, its
effects are most uncertain; most of the symptoms reputed to have
been cured by this medicine, are far from being incontestably of a
syphilitic nature, and where it has been administered in well char-
acterized cases, or where other methods, and especially mercury,
had  failed, it has  not appeared  to me proved, that the cure ought
not to be attributed rather to the suspension of the medicine, which
was in this case hurtful.
   NotAvithstanding the encomiums Avhich have been passed upon
the treatment Avith gold by its author, and those learned men who
have  imitated him, I only employ it when I have no other resource;
but this is only my personal opinion, and does not attack  the in-
teresting Avorks which have been published upon  this method.
   All the preparations of silver have appeared to me, upon trial,
according 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 syphilis,
commencing with small doses and  gradually increasing  to  the
enormous dose of fourteen and sixteen grains  per diem, I have ob-
tained no result, but a derangement of the digestive organs, which
obliged me to discontinue its use.
   13. Mercury.   We must  then  give  a  preference to mercurial
treatment in confirmed syphilis, Avhen not otherwise contradicted.
Mercury is not an absolute specific, but it is the  most certain and
poAverful remedy Ave yet possess,  and it will, notwithstanding the
objections which have been raised, maintain its  rank, as a thera-
peutical agent.
   My method.  The method  of applying the mercurial treatment
Avhich 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 medica-
ments mercury ought to be referred, some of the effects which it
produces are constant and incontestable, and must be admitted even
by its greatest opponents.  These effects  are either pathological
modifications, or  curative results.   But  it must not be supposed
that mercurials, in invariable doses for all subjects, will always act;
for there are some patients, who, to a certain extent, resist their 
SECONDARY AND TERTIARY AFFECTIONS.          255
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 al-
Avays been acknoAvledged, and as  a proof I  may mention  the at-
tacks which have latterly been  made upon this poAverful  medica-
ment.
  Guided alone by clinical observation, and profiting by this simple
and so practically useful  condition, we must not conclude that a
mercurial treatment has been unavailing, because it has been con-
tinued a long time, or repeated Avithout results; we must not re-
gard it as hurtful because, being administered in doses ill propor-
tioned to the disease, or the patient, it may have produced momen-
tary 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.
   In order  to obtain  from this medicament the advantage which
we have  a  right  to expect, Ave  must employ it in suitable doses,
Avhich, as Ave have before said, cannot be the same  for all patients.
The proportions of these doses for each individual must be ascer-
tained by gradually increasing them, until a favorable modification
 of the affection we are treating be obtained, or until symptoms arise
 Avhich cause us to desist.  These increasing doses, Avhich are so
 necessary in many cases, have appeared to me still more so Avhen
 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  gradation.   From  the foregoing it will  be
 easily understood, that  it is impossible  precisely  to  fix  the daily
 dose of the medicament, and that great difference  of opinion  may
 exist upon this subject.  Moreover, Ave must in some manner reckon
 upon  the action  of each separate dose, and not upon  the total
 quantity taken, at least  not in an  absolute manner,  and  that  one
 individual who may have swallowed a hundred grains of sublimate
 for instance, in small doses within a long period,  will be less  af-
 fected than  another who has taken upon the whole a less quantity
 but in  doses  better suited  to his constitution, and within a much
 shorter time.                                               _ .
    We must reduce to their proper value the symptoms which limit
 the doses,  or require the  temporary or entire suspension of  the 
266         GENERAL  REMARKS ON  THE TREATMENT OF
medicament; thus one of the inconveniences of the mercurial treat-
ment Avhich is  noAv pretty generally acknoA\rledged, though form-
erly considered  a favorable symptom, is its  action  on the mouth.
Mercurial stomatitis (ptyalism or  mercurial salivation)  must be
placed foremost amongst the bad effects Avhich mercury produces.
If, in some rare and exceptional cases, Ave find the venereal symp-
toms improve under its influence, we see them  more  frequently
aggravated, especially when they are situated in  the cavity of the
mouth, or at least, in the greater number of cases, they remain sta-
tionary during the course of the salivation.
   If it be settled that salivation is useless  in the cure, the  progress
of which it sometimes retards, and that it  always  constitutes a dis-
ease, if not most frequently serious, yet always  very tedious  and
painful;  the greatest care must be  taken to avoid it, by discon-
tinuing the use  of the agent which produces it, as soon  as the mouth
becomes affected.   The use of mercury must indeed be Avholly sus-
pended if the stomatitis is developed, to allow this affection to sub-
side, when Ave  may return  to  the same treatment, beginning Avith
Aveaker doses, which may afterwards 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
one of the scale by Avhich to regulate the dose  in practice, we
ought to be able to take all possible advantage of it, and  not be
deceived by accidental affections unconnected with it.   In order to
do this,  we must, before we commence a  treatment, ascertain the
state of this cavity, and take into consideration the bad dispositions
Avhich, if I may be allowed the expression, too soon excite the ac-
tion of the medicament in it.
   Next to stomatitis, derangement  of the stomach and intestines
is  most frequently observed under the influence of mercury, espe-
cially when administered internally.   Here too, taking the  previous
conditions into account, the doses must either be diminished or sus-
pended, according to the foregoing rules.
   The same course must be pursued in case of the rare and dubi-
ous hydrargyriasis or mercurial eczema, Avhen 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, 
SECONDARY  AND TERTIARY AFFECTIONS.          257
in short, every morbid symptom unconnected with  syphilis;  but
which, having been  developed under the influence of the medica-
ment, Avould necessarily increase if its use Avere continued.  If the
affection Avhich mercury produces serve to regulate its employment,
its curative effects are a still better  guide.  Thus, as long  as a dose
amends the symptom treated, itv should be  adhered to,  and  only
augmented Avhen its efficacy ceases.
   The  preparation to Avhich  I  now  give the preference, not only
in the treatment of the secondary symptoms, but also of the primary,
is the proto-iodide of mercury, commencing  Avith  a single grain in
the form of pills.
   In some patients, according to the rules laid dovra above, the
daily dose has been increased  to six grains,  and the total quantity
sometimes to two hundred, by its being continued till the complete
disappearance of the symptoms.  My experience has led me to the
folloAving conclusion ; that the most poAverful 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  proto-iodide of mercu-
ry, I ought not, Avithout entering into details foreign to  the limits
of this Avork, 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 remains  Avithout effect or  produces inconvenience.
   13.  Opium.  Opium,  Avhich some have placed amongst the
specifics in venereal diseases, is of the greatest utility in their treat-
ment.   Its employment is indicated whenever the nervous symp-
toms are prominent amongst those Ave have to treat.  The extreme
irritability of any organ in particular, or of the system  in general,
and  pain, either the mother or the  daughter  of inflammation, often
require it, either as  the sole medicament, or as an adjuvant.   We
find  the use  of opium peculiarly  required during the employment
of mercury, to enable the digestive canal to  support this remedy,
when  the stomach Avould othenvise reject it.  Opium corrects the
tendency mercury has to purge, and  prevents cholic  and the gri-
ping in the stomach Avhich some patients feel, particularly in using
sublimate.
                               33 
258      SPECIAL TREATMENT OF  SECONDARY AFFECTIONS.

  Its effects, as regards salivation, are not so well ascertained.  Its
direct action on the mouth is perhaps rather to repress the saliva-
tion, or at least to allay the pains which accompany it; but in the
digestive canal, by frequently producing constipation, it incontesta-
bly predisposes to it, a  circumstance which  deserves  the  greatest
consideration.  As a correcter of mercury, opium is advantageous-
ly employed in removing, or even  preventing, the tremors Avhich
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.



        § III.—Application of the General Precepts to
                       Particular  Cases.

             special treatment of secondary affections.

   Syphiloids.  The cutaneous eruptions, or syphiloids, are the most
 frequent symptoms of constitutional syphilis, and  appear the soonest
 after the primary affection, or, when inherited, after birth.  These
 eruptions, which are seated on the skin and certain regions  of the
 mucous membranes, seldom occur  before the  fourteenth day  after
 the appearance of a chancre, and do not  develop themselves  gen-
 erally till  after the fourth, fifth,  or sixth week, or even later.
   The forms  under which the  syphilitic eruptions present them-
 selves, 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 eruption, the period at Avhich it occurred, the seat
 it occupies, and the influence which concomitant diseases may ex-
 ercise over it, the temperament  of the patient,  and the  treatment,
 both  hygienic and therapeutic, 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 period of roseola, or simple  maculae;  by a gradual resolution; 
          SPECIAL  TREATMENT OF SECONDARY AFFECTIONS.      259

by suppuration Avhen they give rise  to  the  formation  of pustules,
which  may be followed by ulceration;  and lastly, by  indurated or
ulcerated tubercles.
  In the absence  of other causes, Ave must refer to chancre or in-
heritance for a rational diagnosis; and  in cases of lenticular, her-
petiform, syphiloid and mucous tubercle, to the peculiar appearance,
Avhich  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 con-
sidered characteristic, never appears till very late, and is only well
defined in the spots Avhich follow the cure of the forms which have
attacked the skin more deeply, never leaving  any trace upon the
mucous membranes.
   A venereal scabies does not exist. Syphilitic patients may most
assuredly be  affected Avith the  itch, but it is not syphilitic; the
syphilitic virus never produces the itch.
   When the syphilitic eruptions are accompanied  or  preceded by
fever or super-excitation, antiphlogistic treatment ought first to be
employed; then recourse must be had to mercury, aid ed by antiphlo-
 gistics, if the irritation  still exist,  and in other cases to 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, vapor baths may be used ;
 but fumigations with cinnabar are highly efficacious.
   In the squamous   or the pustular forms, Avithout 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, Avith ointment of proto-iodide
 of mercury, have often  proved successful, united Avith gelatinous
 baths.   Here also,  in cases which resist, baths with sublimate, re-
 peated every or every other day, according to the effects produced,
 as mercurial agents, are very often useful.   But there is one of
 these  forms  Avhere a cure is effected with  an astonishing rapidity.
 I mean that  of mucous  tubercles  or  papulae.  Whatever its seat
 may be, whether in the  anus, vulva, groin, between the toes, um-
 bilicus, or axilla,  at the same time as the general treatment,
 which it requires as a secondary symptom, is employed the local 
260      SPECIAL TREATMENT  OF SECONDARY  AFFECTIONS.

mediation, Avhich from the rapidity of its result is truly specific,
is as follows:
   The diseased parts  are  first  to be washed, if they are  not in-
durated, Avith pure chloride of sodium, which in the contrary cases,
or where there is too much irritation, should  be diluted Avith water,
so as to  excite  a  slight  tingling without pain.   Then, after the
washingc, Avhich are to be  repeated twice a day, the diseased parts
are to be sprinkled with calomel.  Eight or ten days of this treat-
ment will cause enormous  masses  of these eruptions to disappear,
Avhich perhaps, situated betAveen the toes, have  for many months
prevented the patients from walking.  Those which are situated in
the nostrils, on the internal  surface of the  lips  or cheeks, on the
edges of  the tongue,  the palate,  tonsils, &c, must not be  con-
founded with the superficial,  spongy,  and grayish ulcerations,
which  mercurials sometimes  produce,  and  which  always com-
mence on  the gums, and particularly the loAver, and those of the
last molar teeth.  Besides the general treatment, which alone almost
always suffices, and the local use of simple or  mucilaginous gargles,
sweetened  Avith honey, cauterizations with liquid nitrate of mer-
cury, Avhich are less painful than on cutaneous tubercles, greatly
accelerate  the  cure.   In  the  acute pustular period, Avith  copious
suppuration, we  must not be  precipitate with the use of mer-
curials ; we must first have recourse to sedatives  and antiphlo-
gistics,  carefully examining what gives the  syphiloid this form,
which  scarce  ever  is  the sole  product of syphilis.  The  special
treatment  ought not to commence till all other  indications have
been fulfilled.
   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 Ave said  elseAvhere on chancre, which
they resemble in many respects, especially as regards their treat-
ment.   We must here bear in  mind, that ma:ry ulcers,  reputed
syphilitic, may be  maintained  by  conditions  unconnected with
syphilis, and Avhich  must by no means be neglected.
   The ulcers which are seated  in the  throat are either the conse-
quence  of  mucous tubercles, or  they assume  the appearance of an
indurated  chancre, or  folioav  the course of phagedaenic gangre-
nous ulcers, from excess of inflammation.  In the tAvo first cases, 
         SPECIAL TREATMENT  OF SECONDARY  AFFECTIONS       261

which require mercurial treatment, gargles, with cicuta and morella,
with corrosive sublimate, will  be found very beneficial; cauteri-
zation with the acid nitrate of mercury only succeeds in cases of
mucous tubercles; it is less efficacious, when  not injurious, in cases
of true indurated ulcer.   In phagedaenic ulcers, opiated and nar-
cotic gargles, and when the inflammation has abated, cauterization
with hydrochloric acid, and gargles Avith quinine, ought to be put
in the foremost rank, reserving the  general treatment in case other
indications  should afterwards require it.
   In ulcerations  of the  pharynx,  the uvula is  often  destroyed;
when it is nearly  detached it should be removed, instead of wait-
ing till it drops;  I have seen a patient nearly suffocated by its fall-
ing on the glottis Avhilst he Avas asleep.  When the velum pala-
tinum has been divided by syphilitic ulcers, the state of the tissues,
and the nature of the cicatrices, either render  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 osteitis, 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  tertiary affections, Avhere it commences in the
bones themselves.
   Syphilitic  iritis.   Secondary syphilitic ophthalmia,  most fre-
quently accompanies the syphilitic eruptions' of the skin.  It seldom
appears as an isolated  symptom, and frequently, though  not al-
ways, presents  a  deformity of the  pupil, which  becomes  elliptic,
or rather egg-shaped;  having its  large axis directed  downward
and outward,  and  with  alteration  of  the color  of the  iris, which
sometimes presents excrescences on its pupillary margin and anterior
surface ;  excrescences Avhich have  been regarded as true condylo-
mata.  Albuminous effusions often  take place in the chambers 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, undergo all the
alterations  which occur in cases of non-specific inflammation, and
from which the symptomatology differs but little.   The  inflamma-
tory period of this  affection, the consequences of which may be so 
262     SPECIAL TREATMENT OF  SECONDARY AFFECTIONS.

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 photopho-
bia 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, Avhilst those on  the temples and
forehead are dressed with ung. hydrarg., and renewed  as often as
they dry up  under this  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, Avhich is  peculiarly sedative  for the  eye,
ought not only to be employed as  frictions around the orbit, but also
in the nostrils, and internally, combined with the proto-iodide of
mercury, which I here also  prefer to calomel.  Besides these  spe-
cial indications, there are those which simple ophthalmia generally
presents.
   Syphilitic testicle.  Syphilitic sarcocele, which must not be  con-
founded with blenorrhoeal epididymitis.   This disease of the testi-
cle, the consequence of symptoms Avhich we have  before consider-
ed, is seldom found as a  sole sign of a  secondary  affection; com-
monly preceded or accompanied by other symptoms of general
infection, it frequently attacks only one  testicle at a time, although
both may be affected.*  When the testicle is affected, it becomes
indurated, increases  in volume, and  is  pear-shaped;  sometimes it
is unequal, and becomes relatively  heavy.   The disease  is  fre-
quently 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  gonorrhceal epididymitis  may  be the  cause  which
favors its development, without the  blenorrhcea having  any other
influence over this affection, or being its specific cause.
   Syphilitic  sarcocele may often be complicated, which renders
the diagnosis a ery  obscure; in dubious diseases  of  the testicles,
therefore, the patient must be examined as to the  antecedents, and
before  amputating this  organ, Ave  should recollect the prudent
course pursued by Dupuytren, Avho, before having recourse to the 
        SPECIAL TREATMENT OF THE  TERTIARY SYMPTOMS.     263

operation, submitted his patients to an anti-syphilitic  treatment,
and thus saved a great number of testicles, which othenvise would
have been excised.
  To the general treatment, which almost always succeeds alone,
ought be added, to accelerate the cure, repeated applications of five
or six leeches every six or eight days, along the cord.   If the pa-
tient  can rest, half a drachm  of ung. hydrarg. fort, may  be ap-
plied to the scrotum, and the diseased parts should  then be covered
with emollient cataplasms ;  but should there be no pain, and if the
patient cannot keep  quiet,  the scrotum should be enveloped in
emplastr. de Vigo c. hydrarg.,  or recourse be had to compression,
in the same manner as we advised for the blenorrhoeal 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 recognise their existence, Avithout 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 Avho have  not taken mer-
 cury.   The  nails fall off, particularly when their matrix becomes
 the seat of the eruption.
   Here the curative treatment is that  of the  affection which pre-
 cedes or accompanies it.
   For the falling off of the hair, besides, the general treatment, the
 head must be  shaved and rubbed  with stimulants, ointment Avith
 proto-iodide of mercury, or  tincture  of  cantharides diluted with
 alcohol.
    As regards the nails, they must not be pulled out, as in  cases ot
 simple onyxis; we must wait till they fall off, or  detach them par-
 tially by applying to their diseased  matrix  the  local treatment ad-
 vised for mucous tubercles.


      §V.—Special Treatment of the Tertiary  Symptoms.

    According as the ravages of syphilis extend in depth, and the con-
 secutive affections Avhich  it  causes are removed  from the com- 
264     SPECIAL treatment of the  tertiary symptoms.

mencement of the general affection, we find them gradually losir*
their specific characters, Avhich, much less prominent in the second-
ary 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 Avhich may be grouped under the title  of tertiary affec-
tions, from the order in which they are developed, is very obscure
Most frequently they appear  only a very long time  after  the pri-
mary infection; and as other causes may produce similar effects, it
is  sometimes impossible to distinguish them.  Being, as Ave before
stated, non-contagious, they are only transmitted by inheritance,
in so far as they produce effects in the habit and  organization of
the children, without any specific character, and Avhich may gen-
erally be classed under the head of scrofula.
   The signs by which we can determine the diagnosis of the ter-
tiary affections  are drawn from their acknoAvledged  frequence,
after the appearance of primary syphilis; the absence of all other
causes, (Avhen under dubious circumstances,) and  especially as lead-
ing to a more  certain diagnosis from  the existence of characteristic
secondary symptoms, 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 con-
sequence of a chancre, after the  lapse of a longer or shorter period,
unless some  sign  of general infection has been developed at a
prior period, or still exists.
   Be this  as  it may, recognising, as we do, the syphilitic virus as
the regular cause of the tertiary symptoms, we must, however, ad-
mit,  that if it undergoes a modification in the secondary symptoms,
in consequence of  which, as we have  seen, it is no longer ca-
pable of inoculation, this modification is here still greater; and  if
we might hazard an  hypothesis to explain some facts, whose im-
mediate cause is difficult to discover, Ave would say, that the viru-
lent  cause still exists in the secondary affection, whose  existence it
maintains by its presence, but it is completely transformed in the
tertiary affection.
   Here is a therapeutical fact of great importance.  The more 
         SPECIAL TREATMENT OF  THE TERTIARY  SYMPTOMS.     265

the disease penetrates into the system, losing  its  specific  nature,
and  undergoing the  transformations which tend to assimilate it to
diseases of another nature, the  more difficult does the  treatment
become.   The mercurial treatment presents something remarkable
to those Avho will attentively observe its action: thus Ave find it of
little  efficacy, and indeed  often hurtful, in the primary  affection;
during the period of  progression or increasing ulceration, it then
becomes poAverful, as  soon as induration manifests itself in the chan-
cre,  and  shoAvs its greatest efficacy when  the  characteristic gen-
eral infection is in the period of incontestable secondary affections,
again losing its curative properties in the tertiary affections,  and
the more so, the further they are  removed  in their form from the
preceding.
   Deep-seated  tubercles  of  the skin  and mucous membranes,
(lupus syphiliticus.)    These tubercles  most frequently  affect the
alse and  lobulus of the nose,  and  sometimes  shoAV themselves on
the glans, where they  may be mistaken for superficial mucous tuber-
cles ; I have found  them on the tongue, cervix uteri, &c, which
then resemble schirrous or carcinomatous indurations.
   Generally complicated with scrofula or herpetic affections, their
progress  is sIoav, and  unattended with pain ; they deform the parts
on Avhich they are seated,  and  are inclined to penetrate  deeply,
becoming more  and more  indurated; then, undergoing a kind of
ramollissement, which is soon followed by an  ulceration, the pro-
gress of Avhich is difficult to arrest, and which destroys all  the tis-
sues which the induration had attacked.
   These tubercles may appear alone or in  considerable  numbers,
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, Avither,
and without ulcerating, terminate by transforming themselves into
a kind of crust on the  skin, of a horny nature, which leaves, on fall-
ing off, a spot most frequently 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 com-
plications Avhich may co-exist with the  syphilitic  element, which
is never the sole cause of  their  production.  When  all the indi-
cations which scrofula, cutaneous, or other concomitant  affections
                              34 
266     SPECIAL TREATMENT OF THE TERTIARY SYMPTOMS.

may present are fulfilled, Ave must recur to the mercurial treatment
In these cases, we derive much benefit  from mercury, combined
with conium, and the  success is  often  complete when aided  by
other therapeutical  agents, according  to  the  case  Avhose  history
and  rules  for  their  administration we have  stated.  The  local
treatment requires, whenever  any irritation exists, the application
of emollients and narcotics ; opiated cataplasms, fomentations Avith
decoctum papaveris, conium, &c.   If any inflammation exist, a feAV
leeches ought  to be applied  at some distance from the indurated
spots.   Lastly, if the  tubercles be in an  indolent state, the dress-
ings ought to  be repeated  once or twice  a  day Avith honey and
proto-iodide of mercury, continued  as  long as it  does not irritate.
When the  disease still  persists, a cauterization Avith the acid  ni-
trate of mercury must be employed, but not so as to suddenly ex-
tend too deep, in order to avoid the inflammatory action, Avhich is
always injurious.  This method often  produces with the  general
treatment pretty rapid  cures, especially when it has been early ap-
plied.  Dressings of chloride of soda and calomel,  as recommended
for mucous 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
produce inflammation.   It must be remembered, that the treatment
ought to be purely antiphlogistic, as long as any inflammation ex-
ists, whatever may be the internal treatment indicated, and  follow-*"
ed according to the general  state, and  the other symptoms  which
may be present.
   Osteocopic pains.  These pains do not alone constitute a disease;
they may,hoAvever, undoubtedly exist alone, continue a time, and
then disappear  without leaving any  perceptible change of structure
in the regions where they were situated;  but most frequently they
are the first  apparent symptoms, as in  most inflammations of a
periostitis or osteitis,  and that especially Avhen they become more
confined to one spot.  The intensity of these  pains seems to depend
upon the difficulty with which the periosteum and medullary mem-
brane distend.  They are generally nocturnal, but  this  is not a
specific character Avithout exception, for the contrary often occurs,
and  diseases  unconnected with syphilis  may present the  same
phenomenon. 
SPECIAL TREATMENT OF TERTIARY AFFECTIONS.       267
     The  occurrence of osteocopic  pains, when other characteristic
  symptoms of  confirmed syphilis exist,  ought not to induce us to
  suspend the mercurial  treatment; on the contrary, this treatment,
  far from  producing these pains,  as has been asserted, soon calms
  them Avhen properly administered.  We must  not mistake rheu-
  matic for  osteocopic pains, if Ave Avish to obtain from mercury what
  we have a right to expect, nor confound them  with certain swel-
  lings of the  joints,  which  the  abuse of this medicament may
  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 con-
  stitute one of the most distressing  symptoms, depriving the patients
  of sleep, and thus  disturbing  all the functions.  It is in these truly
  desperate cases, and also in those Avhich are less intense, that the
  effect of blisters is quite astonishing.   In my clinical Avards, patients
  may be seen, who for six months and more had not been able to
  obtain an instant's repose, and Avho, when no change  of structure
  had taken place, have  been freed from their sufferings in 24 or
  48 hours.
     The blister ought to be applied directly to the seat of the pain;
  when it has draAvn, the epidermis should be divided, but not remov-
'  ed, to avoid giving pain.   The dressing of  opiated cerate should
  then be applied, and over it,  warm cataplasms, Avhich must  fre-
  quently be reneAved, so as not to alloAV them  to get cold.  When
  one blister is dry, another must be applied, and so on,  if the pain
  return.   In cases in Avhich the pain  returns too quickly after the
  cessation of the suppuration, perpetual  blisters must  be employed,
  instead of those recommended above.  I can assert that  by  this
  treatment, Avithout antiphlogistic  preparation, eighty out of every
  hundred patients may be cured ; in some important cases, however,
  the pain remains, in Avhich case a more energetic  local treatment
  is required, as it only yields  to a deep incision into the  diseased
  parts, by which a  true strangulation is  relieved.  The cessation of
  the suffering in these fortunately rare cases is often instantaneous.
     Periostitis.  The uncomplicated and idiopathic inflammation of
  the periosteum is  perhaps more rare  than is generally imagined. 
268       SPECIAL  TREATMENT OF TERTIARY  AFFECTIONS.

The loosening of this membrane and  effusion  under it, which thus
forms tumors adherent at their base, and which are termed perios-
toses, are most  frequently oAving  to  a superficial osteitis.  These
more  or less circumscribed tumors are generally situated on the
superficial  bones,  tibia,  clavicles, cubitus, radius, &c, and  at the
points Avhere these bones are nearest to the skin.   Sometimes they
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 moveable, and without  any  perceptible alteration.
Lastly,  they may undergo a spontaneous  resolution,  or  terminate
by suppuration and  form abscesses.   When  they are opened, the
bones are  found simply denuded, carious,  or  necrotic to various
depths,  and in the most  fortunate cases, already presenting a sur-
face covered with granulations.
   At first,  we must have recourse to  the treatment recommended
for the  osteocopic pains  Avhich accompany them, and under the
influence of Avhich they often  disappear, often even Avhen a very
considerable effusion has  taken  place.   If the  tumor  remain with-
out acute symptoms, an application of diluted tincture of iodine,
the strength of Avhich must gradually be increased, has often suc-
ceeded with me, as well as the application of blisters and solution
of corrosive sublimate, as in case of buboes.
   There are  some cases, in Avhich, after the  resolution  has pro-
gressed  Avith a certain rapidity, it suddenly stops:  then Ave  may
substitute a methodic compression, so Avell described and so happily
applied  by M. Lisfranc, avoiding causing an increase of pain; its
effects may be increased  byTthe simultaneous use of the mercurial
plaster,  or  that of conium with  iodide of lead.
   If, hoAvever, the periostosis has terminated by suppuration, after
having  endeavored to procure its resolution without opening it, we
must not wait till the skin becomes changed, and the pus has accu-
mulated in a large quantity, and denuded those points of the bones
which othenvise Avould have remained sound.   An opening should
be made Avith a bistoury  in the same direction  as the  axis of the
bones, so as to allow the pus to flow out freely.   The opening be-
ing made, the same treatment must be pursued  as in cases of simple
abscesses, or diseases of the bones, where these are affected.
   Syphilitic osteitis.   According to many writers on syphilis, this 
          SPECIAL TREATMENT OF  TERTIARY AFFECTIONS.       269

affection is owing to  a combination  of  the  syphilitic virus with
mercury; but we have repeatedly seen it, in the Avards of my hospi-
tal, in patients who have had characteristic, primary, and secondary
affections, but without  their having in any way employed mercu-
rials.   In fact, the occurrence of affections of the osseous system,
by no means  depends upon the employment or abuse of mercurials,
in the treatment of syphilitic affections; but, as  every  attentive
observer must  acknowledge,  their occurrence depends  upon  the
antecedent syphilitic affection, for it will be found that, in most
individuals affected Avith exostoses, either  a chancre and secondary
symptoms have existed, or a blenorrhcea, in Avhich case there must
have been a  chancre in  the urethra.   The development  of these
symptoms will never  be found to depend upon the absolute quantity
of mercury taken, but on a peculiar idiosyncrasy, or the  defective
treatment of  their antecedents, and their bad administration.
   Other causes than syphilis may give rise to osteitis, as Ave have
already said  in our general remarks; but whilst syphilis is one of
the most frequent, there  is no case  to prove  that  mercury alone,
except  what comes  consecutively on  the  alveola, in consequence
of a mercurial stomatitis, can produce similar effects, without vene-
real antecedents.
   Osteitis affects the same regions as periostitis;  it is sometimes
circumscribed, sometimes diffuse; it attacks the superficies or paren-
chyma of the bones.  SIoav or chronic in its progress, it often  as-
sumes a subacute form, and after remaining some time as  merely  a
simple osteocopic pain, the swelling it  causes betrays its existence.
The tumor arising from an osteitis is  either owing  to an  effusion
of the osseous matter, as in the formation of callus in fractures,  and
then constitutes an epigenetic exostosis of various form and volume,
Avith either a  broad or narrow base, and  smooth or rugged periphery;
or else the swelling depends upon the increase of the whole thick-
ness  of  the bone, and produces the parenchymatous  exostosis or
hyperostosis.
   Osteitis terminates in resolution, suppuration, caries,  necrosis,
and in induration (exostosis eburnee.)
   Resolution is easy, when the SAvelling depends on  the  organic
tissue, or an effusion  of coagulable lymph.  When the disease is
seated in the spongy bones, those oe the face in particular, suppura- 
270      SPECIAL TREATMENT OF TERTIARY AFFECTIONS.

tion is easy and frequent.  Necrosis, often  caused by the violence
of the inflammation, relatively to the vitality of the osseous system,
is  still more frequent from a sudden effusion in the tissue of the
bones, or from the loosening and destruction of the soft parts which
surround them, and which involves that  of their nutritious vessels.
Lastly, the termination in permanent  induration takes place when-
ever the  tumor is only OAving to an effusion of the inorganic saline
matter which enters into the composition of the  bones.
   The treatment of osteitis in the commencement must be the same
as that of osteocopic pains and periostitis.  When the osseous tu-
mor is developed, to the use of blisters, dressings of mercurial oint-
ment  on  the denuded surface (from half a drachm to a drachm per
diem) may be added.  Under  this  most  powerful  treatment, with
the internal exhibition of mercury when  not contra-indicated, and
sudorifics, proto-iodide of iron, (in complications of scrofula,) and
vapor  baths, Ave obtain results, if  opportunely  employed, such as
no other treatment affords.
   In these cases, the other resolvents (iodine, iodides,  &c.) local-
ly employed, as also compression, are most frequently void of any
decided effects.
   The treatment ought to be continued  as long as  any pain re-
mains, or the swelling increases or diminishes; but when it becomes
decidedly indolent and stationary, without  any other symptom re-
quiring active treatment, we must stop, and not  exhaust the system
by useless, and therefore  injurious medication.
   In ATenereal 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, particularly
when salivation is alloAved to ensue.  We do not say  its employ-
ment must ahvays be avoided, but  that its effect ought to be most
narrowly watched.
   Except as regards the syphilitic  element, Avhich  ought never to
be lost sight of, and which in a fe\v cases affords the best indication
without being the only one to be fulfilled, the treatment required
by syphilitic caries is the same as is applicable to i aries in genera!
Nevertheless, in caries, generally complicated with  necrosis of the
bones, of the face particularly, and which  must be distinguished from
the more superficial and less serious, which folloAv previous affec 
SPECIAL  TREATMENT OF TERTIARY  AFFECTIONS.      271
tions of the soft integuments, which Ave mentioned above, Ave must
not neglect to remove the diseased bones as soon as they are separa-
ted from  the sound  parts.  I have seen  the  worst consequences
ensue from the neglect of this pi'ecept, 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,
Avhose organic tissue has  been destroyed by suppuration, or has
perished, cannot  be regenerated by  any general  treatment, and
that Ave must not Avait till  the  remains are spontaneously thrown
out, as they form true foreign  substances, maintaining and propa-
gating 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 of  the upper jaw, the teeth
may remain  perfectly sound, firm, or loose in their alveolae, but
when they are  attacked above their neck, they  ought to  be ex-
tracted ;  for they only serve  to  retain portions of the dead  bone,
A\Thich, by remaining, 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,
Avhich is soon followed by suppuration  and ulceration of the 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 des H&pitaux, on  a case in which a  large  portion of
the upper jaAV became carious,  necrotic, and deprived of its  teeth,
 had become  loose in the fossae nasales, the soft parts of the  cheek
 having  remained sound.  These portions of bone beingtoo large
 to be  extracted through the   nostrils,  I removed them by first
 crushing them Avith the instruments employed in lithotrity.
   Before quitting this  subject, I Avould merely add, that the con-
tinued use of blisters, placed as near  to the diseased parts as possi-
 ble, affords the most advantageous  results.  I shall make no re-
 marks as to trepanning, the actual cautery, &c, Avhich come under
 the province of surgery.
   When an  osteitis has produced an exostosis, which has  become
permanently indurated, these tumors must not be touched, except
when they produce  too great a deformity, or interfere Avith import-
 ant functions; the epigenetic pediculated tumors may easily be re- 
272      SPECIAL TREATMENT OF TERTIARY  AFFECTIONS.

moA'ed.   A short time since I extirpated a tumor of this character
from the metacarpal bone of the index finger of one of our most
distinguished violinists, who has  since  regained  the  use of his
hand.
  The treatment required by necrosis is the same as is applicable
to it in  general; the special indications are  derived from the con-
comitant symptoms.
  Gummata, nodus.  Deep seated tubercles  of  the cellular tissue;
a kind of chronic furuncle situated in the subcutaneous  or sub-
mucous cellular tissue;  generally they do not appear till very late
after  the primary affection, and, except in a few less severe cases,
they are the consequence of a deeply undermined constitution, un-
der the  influence of syphilitic  cachexy.  These tubercles, which
are rarely isolated, but generally pretty numerous, and on differ-
ent parts of the body at the same time, commence by a small,
scarcely perceptible, but  hard tumor,  adhering  to  the skin by a
kind of  peduncle, and moveable on  the subjacent and neighboring
parts.   Their  increase is generally sIoav and without  pain, and
their  growth  is frequently five  or six months, or more.  They
then attain the size of a nut; still remaining very hard; they be-
come adherent on  all points of their surface, and then there is a
kind  of obscure fluctuation which gradually becomes  more  per-
ceptible.  The skin becomes  red, purplish, and then thin, and per-
forated  on several  points, from Avhich thin ichorous pus  escapes,
carrying Avith it the organic remains.  These openings  are suc-
ceeded  by extensive irregular ulcerations, the skin being under-
mined 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 toAvards  reparation and produce a cica-
trix, similar to those after extensive burns.
   The evolution of these tumors seldom occurs in  every part at
the same time ; most frequently they come in succession, so as to
occupy  months or years, notwithstanding  any treatment which
may be employed.
   They are sometimes  distant from  each  other, sometimes  ag-
glomerated. Those Avho have followed my lectures Avill remember,
that in  t\vo cases in my wards  the tubercles were  situated in the 
          SPECIAL  TREATMENT OF TERTIARY AFFECTIONS.       273

substance of the tongue.  These tAvo patients both entered for the
third  time, an interval of five  or six months having elapsed be-
tween each time.  To the touch their tongues appeared filled with
nuts.   The destruction  from ulceration was  each time  horrible,
and, to unaccustomed eyes, resembled cancers; but both have now
been  cured two years.
   The principal  aim of the treatment must be to sustain and re-
cruit the constitution by all possible means.   It must be remem-
bered, that Ave  have to deal Avith a long and serious disease, which
no medication  can cut  short in its development.   As these symp-
toms  generally appear in patients Avho have resisted the effects of
mercury, it  has therefore no power over it, and if its use be im-
prudently pushed far  enough to produce the symptoms which may
attend its administration, the severity of the disease  will be in-
creased.
   In  the affection under our consideration, mercury is only indi-
cated, Avhen at the bottom of the cavity, after the escape  of the
pus, ulcers, Avith indurated base and callous edges, remain.   The
general treatment Avhich succeeds best,  although it frequently does
not procure the resolution of these  tumors, is the internal exhibi-
tion of iodine, either alone or  combined with iron.  Bitters and
tonics, and that course of hygiene  adapted to scrofulous subjects,
also deserve to be placed in  the first rank.  In many cases, how-
ever, these tubercles  are the sole remaining  symptoms, and their
severity depends only on their purulent secretion and the ulceration
Avhich folloAvs them; so that  the  most  rational  treatment is to
destroy them in their commencement.
   M. Cullerier has suggested, that  they should be attacked with
blisters, and  the caustic solution employed for the treatment  of
buboes,  and this plan Avith him,   as  Avell  as myself,  has often
succeeded.  I  have also found their extirpation, Avhile yet hard,
and  before the adjacent parts are  affected, very advantageous.
From our remarks it  folloAvs, that our method consists, first, in
attacking these tumors by blisters  and caustic, Avhen they can be
reached  by these remedies.  If under the influence of this treat-
ment they continue to progress, I should extirpate them before they
suppurate, and heal the skin  by the first intention.  When sup-
puration is very evident, the pus ought to be allowed to escape
                             35 
274       SPECIAL  TREATMENT OF TERTIARY AFFECTIONS.

before the  skin  becomes too much  affected.   When suppuration
has ensued, and  even after the opening of the abscess, as long as
inflammatory symptoms exist, emollients and local sedatives should
be used; at a later period,  the ulcers which do not become clean,
should be dressed with simple digestive ointment, and after that just
like chancres.   Frequently  extensive ulcerations become atonic, as
m other cases  of this kind, independent of the antecedents, have
been  promptly brought  to  cicatrization 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  de-
termine their diagnosis.   It is not probable that there are tissues
which are fortunate enough to escape the ravages of syphilis;  but
to mention these would be to enter the entire field of medicine; and
until there are other modes   of discerning these obscure cases, we
must  content ourselves Avith saying, with Mercurialis, " Cum vi-
deretis morbum quempiam communibus remediis non  curari, putate
esse  morbum gallicum cognominatum."  And thus  Ave must  try
a treatment which may  succeed, when  the  more rational have 
TREATMENT OF BLENORRHCEA               275
                          ORDER II.

     TREATMENT OF NONVIRULENT AFFECTIONS.

                      § I.—Blenorrhcea.

   The treatment of blenorrhcea ought to be divided into, 1st, the
 prophylactic—2d, the abortive—3d, the curative, properly so called.
 The prophylactic treatment having been considered generally above,
 we will  proceed to  examine that which is  calculated to  prevent
 the development of the disease, after it has commenced; (abortive
 treatment.)   In the first place, the patients must not only be re-
 moved from the causes Avhich may have produced the disease, such
 as  every kind  of excitement of the sexual organs,  but  also all
 possible  antiphlogistic  means must be used.  The following is the
 result of my experience: Avhen an individual has exposed  himself
 to a blenorrhoeal affection, amongst the hygienic means then indi-
 cated, such as diet, rest, &c, baths and copious refreshing drinks,
 which  are generally considered as so important, are far from pos-
 sessing 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 inflammation;
 with regard to*baths, when Ave find with AA'hat facility 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  modi-
 fied ; here two  methods present  themselves, 1st, revulsion,—2d,
 direct medication.   As  all the varieties of blenorrhcea  require mo-
 dification in each, we shall further develop the following principles
 in the proper place.
  What  is to be done, when  the abortive treatment has not been
 employed or has failed, and the disease has become confirmed ? As
blenorrhcea in the acute stage presents the characters of a catarrhal
inflammation, the treatment  ought to be essentially antiphlogistic.
The abstraction  of blood will  form the basis, and local depletion 
276
TREATMENT OF BLENORRHCEA.
    will be found  the most  advantageous.   Leeches  as has  before
    been observed, as is generally observed  in  inflammations  of the
    membranes,  are very valuable, but  they must be used Avith cer-
    tain precautions;  they ought never  to be applied on loose dupli-
    catures of the skin,  Avith intervening cellular  tissues, as on the
    eyelids, skin  of the  penis, &c, wherever the blenorrhoea may be
    situated, as they may cause (Edematous swelling and a gangrenous
    erysipelas; when applied at some  distance  from the seat  of the
    disease, they are equally efficient, provided their number be in pro-
    portion to  the  gravity of  the disease.  Another no less important
    point to be observed is, that leeches ought  never to be applied
    upon a declivity, or Avithin reach of  the diseased organs, that their
    bites may not become soiled by the morbid  secretions; for  if the
    blenorrhoea be complicated with chancres, they will be transformed
    into so many syphilitic ulcers.
      The use of general or partial baths during this period has been
    much  praised ; generally they ansAver 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 very hot  or very cold baths have
    very different  properties  from those properly termed  tepid,  and
•   which depends upon the impression made upon the patient; so
    that the proper degree of heat depends upon the feelings  of each
    individual, and not upon the thermometer.   A temperature  which
    would render a bath exciting,  Avould be very hurtful, 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 relaxation they  produce,
    very favorable in their effects; but in ordering them, we must pay
    attention to the individual disposition; for there are some  in whom
    they produce an excitement by their action on the nerves.  Their
    efficacy is  therefore relative, and sometimes their use must be alto-
    gether forbidden.  In all  cases, and  Avhatever may be the mucous
    membrane which is diseased, it is very important to free its surface
    from the morbid secretion.   Washings, injections, and local baths,
    will advantageously  accomplish this  end;  but these different means
    must  be judiciously employed, duly weighing the good they pro-
    duce,  Avith  the  inconveniences  which   sometimes  attend  them 
TREATMENT OF BLENORRHCEA.
277
They ought never to be so used as to fatigue the organs, or to invite
the fluids to them.   We must also facilitate the functions of the
parts diseased, or modify  or even suspend them  if possible, Avhen
they are the cause of irritation.
   The patient's drink should be diluent, copious, simple, agreeable,
and  easily procurable fluids.   There is no  proper  medicine  pos-
sessing these properties to so great a degree, that it  should be em-
ployed in preference  to  others.   It is better for the patients  to
have a drink Avhich pleases them, provided it is  not stimulant, for
the  tisanes generally  prescribed  are more agreeable  to the pride
of the physician than to the taste of the patient, Avhile both should
remember, that it is only necessary to drink a good deal of Avater, in
Avhich there is  no treason.   The diet must be more or less re-
stricted, according to the intensity of the  inflammation  and the
state of the patient.  When the affection is  severe and intense, it
should be absolute ; in less violent cases, Avhen the digestive organs
are  healthy, we must permit the use of broths, milk, and fruit, and
avoid all exciting food and drink.  The utility of perfect rest is not
less apparent than in other cases of inflammation.
   Under the influence of the treatment Avhich Ave have just de-
scribed, the symptoms of the acute stage  may  completely disap-
pear ; sometimes it has  sufficed to alloAv the disease to exhaust
itself, only removing the causes Avhich produced it; but  more
frequently it becomes chronic,  in Avhich case another treatment
 must be employed.   When it is bordering on the acute stage,  we
 must not too  soon abandon the  employment  of antiphlogistics;
 but at the same time neither ought Ave recklessly to continue their
 use, as  they  often  favor its  prolongation.   A very  favorable
 methodic transition consists in suspending the use of the too relax-
 ing agents, and employing  direct resolutives, which must be suc-
 ceeded  by revulsives, the properly so called antiblenorrhagics and
 astringents, either general or local tonics used in the same manner,
 excitants, &c, as soon as the acute symptoms or pains diminish or
 disappear.
   We will examine the  antiblenorrhceal medicaments, as  they will
 best apply to the several varieties.
   Frequently, however,  notwithstanding the use of remedies, the
 blenorrhcea or the  chronic  state remains; in which case we must 
278          SPECIAL  TREATMENT OF ELENORRHCEA-
endeavor  to  discover  the cause Avhich maintains it.  Sometimes,
without inquiring about  the  existence of any change of structure
in the tissues, upon the disease  not haA'ing  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 former
of these means is not  proved in  most of these cases, the latter is
quite unjustifiable.
  An antisyphilitic treatment has frequently been employed, either
Irom ignorance of the  cause, or from  a conviction of the syphilitic
nature of blenorrhcea, and has sometimes been  attended with suc-
cess.  In cases in which the discharge is only the consequence of
concealed syphilitic ulcerations, the  results of  the  treatment  are
more decided and  easier to understand.   But  the antisyphilitics
which are employed, may influence other diseases, beside those de
pendant  on syphilis.   May they not, by  acting as revulsives or
tonics, so modify the system as to produce  a cure 1   For my own
part, I never employ antisyphilitics, nor  especially mercury, in
blenorrhoea, except they be positively indicated, as Avhere every
other treatment has been resisted, or true syphilitic symptoms 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.


          § II.—Special Treatment of Blenorrhcea.

             First Species : Blenorrhcea in Women.

                        /■ of the vulva,  -v
     Varieties..........< ~^^_ nferus' i a'one or variously combined.
                        ' -------urethra, J

  The prophylactic treatment of blenorrhcea in the female presents
nothing peculiar, which has not been already mentioned;  only we
must insist on extreme cleanliness, on account of the extent of the
surfaces, and the facility with which  infecting matters are arrested
in the folds of the external and internal genital  organs.
  Women rarely consult a medical man early enough to allow of 
FIRST SPECIES :  BLENORRHCEA IN WOMEN.          279
the blenorrhcea being cut  short in its development, either because
they do not acknowledge the disease until it is too late, or because
they do not at once perceive it.   However, if applied soon er.ough,
that is, within the first two or three  days, astringent injections and
applications  would be generally crowned  with success, in cases
where the vulva, vagina, or uterus is affected;  whilst copaiva and
cubebs have sometimes succeeded in urethral cases.   If slight in-
flammatory symptoms should  already exist, the application of a
few leeches near the vulva might be added.
   But, as we before  said, Ave have rarely  an  opportunity of pre-
venting the development  of blenorrhcea in women, and we must
therefore obtain 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.  General baths are most useful, and
whenever the state of the parts will allow, vaginal injections should
be made, whilst in the bath, Avith the same Avater, Avhich might be
mucilaginous or gelatinous.  These  injections are peculiarly  effica-
cious in vaginitis and uterine blenorrhcea.
   Should the acuteness of the symptoms require  the employment
of leeches, (if no secretion  takes place in the fold of the thighs, and
the alteration of the skin constituting an extra-genital blenorrhoea,)
they should be applied on  the exterior  of the  external  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 tOAvards the inferior parts, and tends to irritate
the wounds they make.  In the  contrary  cases, the leeches must
be applied in the fold of the thigh.  When the blenorrhcea, and
especially uterine  blenorrhoea,  is attended with febrile reaction,
great benefit will be derived from general depletion.  The patient
should drink freely of some  agreeable beverage, but the quantity
taken does not require to be so large as in men, as  the heat upon
 voiding the urine is by no means so intense.   The local treatment
is however the most important.  Where the vulva and  external
parts are affected, cleanliness, and emollient  and slightly narcotic
fomentations, Avith decoctions of roots  of  marshmallo\vs, morella,
and  poppies, will  be found very beneficial.   The  parts  diseased
ought to be isolated; thus the  thighs should  be  prevented from 
280          SPECIAL TREATMENT  OF BLENORRHCEA--

touching the external labia, Avhich should be separated  from each
other by a tampon of fine lint, dipped in emollient narcotic liquids.
When the inflammation is very acute, and the introitus vulvae  is
either naturally very small, or has become so from the inflammatory
swelling, Ave must confine ourselves to external  applications, and
even avoid injections, as even the introduction of  the  olive-shaped
canula  may produce  too much irritation.  This generally occurs
in young children and virgins;  but  as  soon  as injections can be
employed, they should be used several times daily.
   When the entrance to the vagina can be dilated Avithout giving
pain, a tampon of fine lint, dipped in the medicated fluid, and moist-
ened two or three times a day, should be introduced, as  it supplies,
in a manner, the place of cataplasms.   When the  uterus is affected,
emollient fomentations  and cataplasms should be  applied to the
body.   Here also, as in metritis generally, Ave may employ vaginal
cataplasms prepared with rice or  flax-seed;  but as they ferment in
these parts, I generally prefer  fomentations  with the  tampon,  as
mentioned above.   I never order  leeches to be applied on the cer-
vix uteri, as in case of the existence of virulent ulcers in the inte-
rior of this organ, they would probably be  transformed into as many
chancres.  The tampons ought, if  possible, to be reneAved tAvo  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 pessary has been introduced into the vagina, it  ought  at once
to be remoAred.
   Acute urethritis is seldom accompanied  by retention of urhie, 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, Avhich ought  to  be introduced Avith the parts
exposed, notwithstanding the objections raised, as less pain will be
caused, than if the surgeon had to feel his Avay.   I have found  in
two nervous subjects, in whom  the strangury seemed to depend on
spasms, that a tampon, soaked in a solution of belladonna, sufficed
to relieve the symptoms.
   The swelling of the nymphae and labia, Avhich we  have com-
pared to a  kind of phimosis or paraphimosis peculiar  to women,
yields generally to rest and antiphlogistic treatment; but when the
swelling is considerable, with serous infiltration, incisions must be 
              first  species: blenorrhcea in  women.         281

 made in it, as gangrene from  excessive  inflammation only occurs
 in cases of neglect,  and Avhere 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  the general strength  of the  patient,  and lint,
 dipped in a solution of extract of opium, applied.  A urethro-geni-
 tal blenorrhcea may  be complicated Avith simple abscesses, whose
 detailed history we shall not enter upon here.  We may, hoAvever,
 remark, that as these abscesses are generally the result of a violent
 inflammation, their development will be prevented by the treatment
 Avhich is used to combat  it,  and more especially when we avoid
 any further irritation of the already diseased parts.
   Thus, in cases of acute blenorrhcea, Ave ought not to use the spe-
 culum, although I can affirm, that during seven years of  practice,
 and the treatment of hundreds of patients, I have never seen a case
 at the Hopital des Veneriens, in Avhich these abscesses have been
 developed in consequence  of the use of this instrument, as some
 have thought.   The females affected  with this symptom have
 never been subjected to its application.   Wre can conceive that the
 contrary may occur, although this instrument cannot then  be con-
 sidered the efficient cause, unless employed contrary to all rules.
  These abscesses sometimes depend upon the inflammation of the
 cysts, which  some A\romen 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 phlegmonous inflamma-
 tion, and if the pus be  not  alloAved  to  escape, infiltration of the
 loose cellular tissue surrounding the rectum, and lastly, perforation
 of this intestine occurs, thus forming either complete or incomplete
 fistulas, according to the point where it opens into the vulva.
  The vaginal abscesses ought to be opened by a large incision,
'jarallel to their axes:  the  pus is often broAvnish, with the odor of
foecal matter from the neighborhood of the  rectum, although no
communication with  this intestine may exist.  When the abscess
is the consequence of  an  inflamed cyst, the matter is stringy, and
glairy in many cases.  If these fistulae are yet in an early stage,
before their passages have undergone the mucous transformation,
compression, by means of  a tampon introduced into the vagina,
generally suffices to. obliterate them.   When this means has failed,
                              36 
 282          SPECIAL treatment of blenorrhcea--

 cauterization of the passage, with nitrate of silver, either in powder,
 by means of a director, or better Avith  M. Lallemand's instrument,
 has often succeeded.  I have derived much benefit  in some cases
 from traversing the fistula with a probe, co\rered Avith 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 sur
 face, tincture of cantharides has been introduced in the same man-
 ner,, to  excite the  development of  the granulations necessary to
 obliterate  the cavity.
   In one case which had  resisted  these various treatments, I  ob-
 tained a cure by introducing into the fistulous passage the urethro-
 tome, Avhich is employed to di\Tide  the meatus urinarius, and thus
 scarifying its whole length  in several points of  its circumference.
 When the fistulae  are of but little extent, the shortest method is to
 treat  them like common fistulae in ano.
   Ovaritis, considered  as a complication  of blenorrhcea, requires
 antiphlogistic treatment, commensurate Avith the  intensity of  the
 symptoms.   Leeches applied to the lateral  and loAver parts  of  the
 abdomen, anus, and sacral region, general depletion, aided by emol-
 lient fomentations and cataplasms, generally succeed.  The bowels
 ought to be kept open by gentle laxatives.   Here,  as  in orchitis,
 frictions Avith mercurial ointment, made  upon the  abdomen, may
 promote the resolution.
   When  the acute stage is passed, reATilsives, such as blisters to
 the inner surface  of the thighs, frictions Avith 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 blenorrhcea in Avomen, whether complica-
ted or not, resists the most judicious soothing treatment,  and is ag-
gravated by the use of mercurials.  In some of these cases, in Avhich
the red  and turgid mucous  membranes afford a  copious purulent
discharge, attended with acute pain, which neither rest, depletion,
emollients, nor narcotics can assuage, I have  obtained astonishing
results from the use of nitrate of silver.
   A superficial cauterization with solid nitrate of silver, or a solu-
 tion of it, applied by means of lint, has faATorably modified the  in-
flamed surfaces and produced a solution of the disease.  After the 
FIRST species: blenorrhcea in  women.
283
use of the nitrate cf silver, a tampon of dry lint must be employed,
to prevent the contact of the parietes of the vagina.
   As has been seen, when the disease is  fully developed, and in
the acute stage, we  never use the antiblenorrhceal  medicaments,
such as copaiva and cubebs, &c, for if they are not ahvays hurtful,
they are at least without effect.
   When the acute stage has yielded, while the sedatives  are con-
tinued,  such as diet drinks, regimen, repose, and baths,  Ave must
hasten the cure, so as not to alloAV the chronic state to become es-
tablished, by  employing  resolvent  applications and injections.
The fluid I prefer, is either a solution of crystallized 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 tampons 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  ahvays 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 decoction of oak bark, Avith equal parts of the solution of
 sulphate of alum.   In the chronic state, Avhen sensibility exists, and
 there is a kind of permanent irritation of the tissues, I substitute a
 decoction of mallows with  the alum.  Zinc, extract of ratanhia,
 sublimate,  alum, &c,  may  be  successively employed.   Injections
■with alkaline chlorides have only appeared to me suitable to some
 cases,  in which the vaginal discharge was offensive, or  where ul-
 cerations existed; Avhen the blenorrhoea  is situated  in the vagina
 or vulva, the medicaments mentioned are applied in the same way
 as the emollients ; but when the discharge is situated in the uterine
 cavities, it  frequently escapes their action.   In order to  reach the
 cavity of the cervix uteri with  resolvent  tonic or astringent reme-
 dies, a syringe, such as is employed for injecting a hydrocele, should
  be used ; these injections, however, continue  only for a moment;
  if we WAsh  them to be more permanent, the clyso-pompe of Charriere
  should he  used. 
284        SPECIAL TREATMENT  OF BLENORRHCEA--

   Some discharges, Avhich 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 unfavora-
ble conditions of heat and moisture.   It occurred to me, Avithout
knowing that  Ambrosius Pare had proposed it, to isolate the  dis-
eased surfaces, by means  of  a  speculum fenestratum, and  there-
by allow the  continued  introduction of  the  external  air, as  the
parts Avhich are most  exposed to it heal the quickest.   But as I
found some difficulty in applying it, I was obliged to relinquish its
use.   Latterly, the following  process has succeeded Avell Avith me;
I fill the vagina, without much distending it, Avith dry lint, reneAV-
ed two or three times a day, according  to the  quantity of the  dis-
charge, which in the cases which terminated successfully, was white
and milky, and proceeded from  the vagina alone.   But Avhen the
chronic stage or the blenorrhcea is accompanied by a change of
tissue, it is that Avhich we have to contend Avith, in order to procure
a cessation of the discharge.   If any vegetations exist, they must
be treated as we shall presently describe.  Ulcerations and papular
granulations must be cauterized either Avith nitrate of silver, Avhich
is to be preferred, or with nitrate of mercury, by means of a bit of
lint;  the parts to which it is to  be applied having previously been
cleaned Avith a piece of dry lint.    Should the mucous secretions,
as those on the cervix, be too  adherent, they must first be coagula-
ted with the liquid caustic, so that they may be removed with the
pincette.    The energy with which  the caustic  is to be  applied,
must be in proportion to the affection.   Its 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.  Under these circumstances, I have suc-
ceeded by sprinkling calomel  on the diseased parts, and then ap-
plying dry lint.  After each cauterization, a tampon must be ap-
plied,  moistened  according to  the case with one  of the  before
mentioned  liquids.
   Like other portions of th ; mucous membrane of the sexual organs,
the internal surface of the womb in chronic discharges is frequently
the seat of ulcerations, which  the means  hitherto pointed out can-
not cure.   We must here, as in the ulcerations of other parts, modify 
             first species:  blenorrhcea in women.         285

fhe surfaces in a more powerful manner; but the greatest precau-
tions  are  necessary in cauterizing the interior of so delicate  an
organ, the reaction of Avhich Avould be so poAverful; for whilst the
most poAverful caustics applied to the orifice of the cervix  generally
produce no  pain,  fluids scarce  possessing  any caustic properties,
being introduced into the caArity of the uterus, may cause the most
serious consequences.
   Wearied Avith the protracted continuance  of certain uterine dis-
charges, I made some attempts to cure them.  I first  used an  in-
jection of one part nitrate of mercury, and eight of water.   Some
patients had  very Ariolent hysterical attacks; one  of  them had a
cerebral congestion, Avhich caused  a  momentary  apprehension  of
apoplexy.   These symptoms, Avhich all arose a feAv minutes after
the injections, yielded very rapidly to  antispasmodics, and in  the
case with  cerebral congestion, Avhen a quantity of blood Avas taken
from the arm.   Although the affections submitted to this  treatment
were either cured  or partially so, I was obliged to reduce the  doses
to avoid the serious consequences.  Thus, I subsequently obtained
some cures with one  part of nitrate of mercury, to twelve of Avater,
Avithout producing the symptoms I before mentioned ; but yet  the
action of these injections was  not ahvays unattended Avith  pain,
or some nervous reaction of an hysterical character.   To avoid  the
inconveniences of the acid nitrate of mercury, I then substituted six
grains of  nitrate of silver to the ounce of water, and found that in
some  instances a  chronic purulent uterine discharge was cured af-
ter t\vo or three  injections,  made at  eight  days of  interval,  and
others after the second only.   I may here  remark, that  nitrate of
silver, applied to the cervix and ca\Tity of the uterus, frequently acts
as an emmenagogue.   We may from the  foregoing conclude, that
uterine injections of  a  solution of nitrate  of silver ought to form
a poAverful means of treatment in uterine catarrh,  and particularly
in uterine blenorrhcea.
   The antiblenorrhoeal treatment by internal medication is far from
possessing an  absolute  efficacy in utero-genital blenorrhcea, as it
seems in  Avomen to act only on some isolated varieties.   In like
manner,  the ergot of rye appears to  me, in the few cases in Avhich
it has been of service, only to influence uterine blenorrhcea, and to
be inert in cases where the vagina  and vulva Avere affected.    Co- 
286
SPECIAL  TREATMENT OF BLENORRHCEA--
paiva and cubebs appear to have no decided  action on the vagina
or uterus, whilst a urethral  blenorrhcea  is in women, as in  men,
poAverfully influenced by them, so that Avhat we shall  say with re-
gard to urethral blenorrhcea in men, will be equally applicable  here.
Sometimes, however, a local treatment is  required by alterations of
tissue ; thus it is not rare to find vegetations originating in the in-
terior of the urethra, constituting Avhat Avere formerly termed ca-
runcles or carnosities; these maintain  discharges, which cease  when
they are  destroyed by incision or cauterization.
   Some  time since,  I was called on by Dr. Sorbier to operate on
one  which protruded from  the  meatus urinarius, and occupied the
Avhole extent of the urethra, arising from  near  the  neck of the
bladder.   In many cases, chronic urethral discharges, which are
more frequent and obstinate than is generally supposed, only yield-
ed to injections made in the same manner and Avith the same fluids
as Ave shall point out, when we come to treat of blenorrhcea in men.
Under some circumstances, even  cauterizations with nitrate of sil-
ver, and  made with  the porte caustique  of Lallemande, have ter-
minated  discharges, which  were  probably kept up  by  erosions?
whose presence Avas betrayed by  great sensibility during cathe-
terism.
   After the cure of vaginal  and  uterine blenorrhcea, I advise  injec-
tions of cold  water to be continued for some time, once or tAvice  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 blenorrhcea in females is  of the great-
est importance, it may not be  amiss to give some details as to its
mode of application.
   I. Fomentations and injections ought to be  tepid, Avhen  com-
posed of emollient  liquids; but  cold when resolutives, tonics,
astringents, &c, are applied.
   II. The injections  may be  made Avith  the  common female
syringe, Avith a long  curved  canula, terminating in an olive-shaped
end, pierced with holes.  The portion of the canula extending  to the
curve should be of sufficient length to extend into the vagina, and not
wound the neck of the uterus; but the patients should be instructed
not to introduce the instrument more than an inch or two beyond the 
            FIRST  SPECIES! BLENORRHCEA  IN  WOMEN.           287

annulus vulvae;  where  acute  inflammation exists, a gum elastic
canula is better. In children, or where the hymen exists, a straight
canula, with a conic end, must be employed.   The position of the
patients should be attended to;  many females place themselves in a
bidet to use the injections, when the liquid escapes without reach-
ing the diseased parts, and often the higher parts of the vagina.  I
have ascertained this by placing a tampon of dry lint on the neck
of the uterus itself and of the speculum, and then injecting it with
colored liquids; each   time  the  lint  was  withdrawn  unstained.
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
injection, causes it to act as a local bath.
  Vaginal  cataplasms  can only  be  applied  where the annulus
vulvae  is of sufficient dimensions.
  It has been proposed lately to foment  or  bathe the neck of the
uterus  by a bottle  having the shape of  a  horn, the neck  of
which  can  be  introduced into  the vagina, and can discharge the
fluids contained  in  the  bottle to the neck  of  the uterus and  into
the peri-uterine cul-de-sac.  As the vulva fits  exactly the neck of
the instrument, the liquid cannot escape  externally,  and from the
SPECULUM  CHAIR, 
 288          SPECIAL TREATMENT OF  BLENORRHCEA -•

 influence of the difference  in the temperature of the portion con-
 tained in the genital organs and that  found in the bottle, Avhich has
 also an opening  by Avhich the pressure of the atmosphere acts on
 it, that a current is established of the fluids, which touch the  neck
 and adjacent tissues.   Cloquet has  in  some  cases  used  Hall's
 double sound Avith great success.
   To administer uterine injections, the patient must be so  placed
 as to allow of the introduction of the speculum, and to expose the
 neck of the uterus, for which purpose Acton's chair will be found
 useful.   The fluid, Avhether 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
 fines into the orifice of  the  cemx uteri;  this portion  of  the  tube
 must be covered Avith some fatty substance, and its  dimensions
 must not be such as entirely to fill the orifice, but permit the reflux
 of the injected fluid.
   As the caustic injections  ought  to be alloAved  to remain but a
 short time, I have had a syringe  constructed by Charriere, com-
 posed of two pumps, with separate pistons, terminating in a double
 canula;  one contains the  caustic fluid,  the other water, so  that
 either can be injected at pleasure, Avithout remoA'ing the instrument.
 I first inject the  caustic  fluid, Avhich I allow to remain  a minute or
 two, after which the Avater is forced  in so as to wash the surfaces.
   Urethral  injections are made Avith the  same  syringe as in  men
 To prevent the  fluid entering the bladder,  the posterior part of
 the urethra must be compressed against the pubis, Avith the finger
 introduced into the vagina.
   Tampons are  applied either by the  patient or surgeon;  to intro-
duce them, an injection  must first  be used, of the same fluid  as is
used to moisten the tampon, made  of lint, and sufficiently large to
fill without distending the vagina, which must  next be  introduced
into the genital organs. Women, in applying it themselves, attach a
piece of tape to  the tampon, long enough to  AvithdraAv it from the
genitals, and use a finger to push the lint as far as possible, so as 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 themselves, those ap-
plied by a surgeon  are far  more efficacious.   When the  surgeon 
SECOND  SPECIES '.  BLENORRHCEA IN MEN.           289
places the tampon himself, he ought to use the speculum, by which
means he can carry it Avith certainty to the cervix, and distribute it
to all parts of the vagina, keeping it there Avith forceps till he Avith-
draws the instrument.
  It may be proper to remark, in concluding these  observations,
that sometimes Avhen a solution of acetate of lead has been em-
ployed, its color becomes changed, and in some women the tampon,
after remaining twelve or fourteen  hours, becomes  quite black;
this seems to be oAving to the formation of a sulphuret of lead; for
this has  been most frequently observed in Avomen  affected with a
fetid discharge, or  Avho have  the annulus vulvae  greatly dilated,
and thereby allowing  the easy introduction of the mephitic air,
when the boAvels 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  straight  canula, like the  instruments  employed  in
lithotrity.   By means of this instrument the caustic is held firmly
and very easily applied.
             Second Species; Blenorrhcea in Men.

         C of the glans,  balanitis, ^ ^geu^o blenorrhoea ?
Varieties. <-------prepuce, posthitis, 5               '> alone or combined.
         (-------urethra, blenorrhoeal urethritis,       )
             External Blenorrhoea.—Balanitis and posthitis.

   When the external blenorrhcea  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 inflamma-
tion is not excessive, the method which I have found to  succeed best,
is  passing  the pencil of nitrate  of silver gently  over the diseased
surfaces, so as  to  cauterize them superficially, after  Avhich it will
suffice to place a bit of dry linen  around the glans, draAving  the
                             37 
290          SPECIAL TREATMENT OF  BLENORRHCEA--

prepuce  again over it.  After this little operation, slightly reso-
lutive fomentations should be applied to the penis, consisting of
compresses, either dipped  in  cold water  or diluted liq. plumbi.
The linen should be removed twice a day, applying  each time 3
little lead water.
   The disease frequently yields to a single cauterization Avith ni-
trate of silver; but under some circumstances it  has to be repeated
two or three times, at intervals of tAvo or three days.
   Should the inflammation be very acute,  or complications exist,
especially  a  natural or acquired  phimosis, active antiphlogistic
treatment Avill often be required ; thus leeches must be  applied in
the genito-crural plica, at each side.   Emollient local baths of de-
coctum malvae,  linseed, tepid milk, the slightly narcotic decoction
of dulcamara or poppy heads, repeated injections of the above fluids
betAveen the glans and the prepuce are indispensable.  When there
is much oedema and but little inflammation, one or two slight in-
cisions on the lower part of the prepuce  produce a salutary dis-
gorgement.  When an erysipelatous state exists, the incisions seem
to hasten the termination in gangrene, whilst depletion, as directed
above, strict diet, absolute  rest, are of the greatest service; gen-
tle  laxatives are also frequently very useful. When gangrene was
threatened  or already existed, I have derived  much  benefit from
fomentations Avith 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 Avhen given in an enema with eight grains  of camphor.
Mercurial ointment applied betAveen the  glans and  prepuce, Avhich
some have  so highly praised, has appeared to me hurtful at some
period of the disease in Avhich it Avas employed;  but I have some-
times found  it  of service, Avhen, according to my method  of treat-
ing erysipelas, I have  applied it to the prepuce  when  this compli-
cation  existed.   I ought, hoAvever, to observe,  that I have found
mercurial ointment less advantageous in oedematous erysipelas of
the sexual organs, than in the other varieties of this affection.
  But under the circumstances \A?e have just mentioned, and while -
uncertain Avhether the catarrhal inflammation of the glans and pre-
puce is or is not attended  Avith syphilis, in  imitation of  the course 
SECOND SPECIES: BLENORRHCEA  IN MEN.           291
pursued  by my friend Cullerier,  I am never  in  haste  to oper-
ate for phimosis, unless there be  imminent danger of gangrene, or
that it  already exists; being  convinced by numerous  facts 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 Ave find an  external blenorrhcea maintained  in the
chronic state by a Avant of cleanliness, an herpetic affection, alter-
ations of tissue, such as  ulcerations, of which we have already
been treating;  by the presence of vegetations, and especially by the
existence of a permanent phimosis, either congenital or accidental.
   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, and  fomentations  of  the same
fluids along the Avhole of the  penis.  But here  also  an appli-
cation 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 inflamma-
tory phimosis, is to cauterize superficially 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 cauteriza-
tion frequently  suffices, and in  four-and-tAventy hours enables us
to uncover the glass.
   In the treatment of balanitis, neither mercurials, copaiva,  cubebs,
nor other anti-blenorrhceal medicaments are required.
             Urethral Blenorrhoea.—Blenorrhoeal Urethritis.

  We are often consulted By patients who are disturbed after hav-
ing exposed themselves to infection by a  suspicious intercourse.
Sometimes no symptoms yet exist;  in other cases the premonitory
symptoms have appeared;  slight itching in the urethra, especially
in passing Avater ;  a sense of weight in the penis and scrotum; and
sometimes a want to pass the water frequently, which is soon fol- 
292           SPECIAL TREATMENT  OF  BLENORRHCEA--

loAved by a little redness of the meatus urinarius, and an increased
secretion of mucus, but  not yet altered.
  These slight symptoms, Avhich a little fatigue and excitement
may produce, do  not announce the presence of a blenorrhcea, for
they frequently 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 en-
ergetic abortive treatment would certainly not be indicated ; but.it
ought to be remembered, that many blenorrhceas, after the ordinary
cause which  produces them, are only definitely produced by errors
in diet, and excitement  of  every kind, to which the patients some-
times continue to subject themselves.
  As soon as a person has just fears, he should be advised  to  sub-
mit to a judicious diet; rest, particularly of the parts affected ; a
mild diet, especially  avoiding fermented  liquors, which, like  beer
and cider, tend to produce the disease,  as  is proved by the obser-
vations  of Lombard and others which are made daily.   In  this
kind of prophylaxy, we must beware of  advising Avarm baths, as
they often suffice  to favor the development of the discharge.
  If, however, the blenorrhcea manifests itself Avith its pathognomo-
nic sign, that is, the muco-purulent discharge proceeding from the in-
terior of the urethra, Avhether there be pain or not, it ought to be
arrested  as  soon as possible after its origin, without any prejudice
or false doctrine intervening to prevent the treatment.
  The symptoms Avhich  may folloAv a blenorrhoea, are in direct  pro-
portion to its duration, and the development it is allowed to attain,
or to Avhich it is urged by' bad treatment.
, When a discharge appears, it has been preceded or  accompanied
by pain, or is indolent.  In the two former cases, it is  ahvays more
difficult to prevent the development of the disease than in  the lat-
ter.  The method Avhich  I have found to succeed best, is as folloAvs:
Avhen the discharge is  at  its  commencement, from the first to the
third or fourth day, and  pain, Avithout other signs of  a very acute
inflammation, be  present,  twenty, thirty, or  forty leeches ought
to be applied to the perinaeum, according to the strength of the pa-
tient ; and we AATill remark here, once for all, that whatever advan-
tage may be derived from applying leeches to the spongy parts of
the  canal, we  should never advise them, since  they are  quite as 
second species: blenorrhcea in men.           293
useful applied to the perinaeum, where they never cause oedema and
erysipelas,  which have occurred after they  have been applied to
the penis, as in all parts where  the skin is lined  with a very loose
cellular tissue.
  But at the same  time, as leeches are  applied  as a prophylactic
against inflammation, or at least to prevent-the increase of it, if it
already exist, the discharge may be suppressed by the internal use
of copaiva, cubebs, or their analogous substances.  It is to be observ-
ed here, that the doses of these medicines must be larger than those
required gradually to  suppress a discharge, as the end sought to be
attained requires a perturbatory effect, a sudden revulsion.   The
strictest repose ought to be observed,  Avith a rigorous diet, unstimu-
lating broths, cooked fruits, and small quantities  of diluent 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 ahvays  cut short the blenorrhcea, 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 fifteenth or twentieth day.
   I have generally found that AA'hen 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, al-
though in some cases injections alone, either of a resolutive, tonic,
astringent, or caustic nature, have checked certain  discharges at
their commencement.
   Should  the discharge  commence without pain, or any sign of
inflammation, abstraction  of blood is unnecessary,  and the action
of  copaiva,  or its substitutes, is in  most cases  sufficient.   Under
these circumstances, the common empirical method (by drastic pur-
gatives) is very successful.  One of the preparations frequently
employed is the vinous tincture of colocynth, but Avhich will be re-
jected by  every  judicious practitioner: in this  case, great benefit
may be derived from the employment of astringent injections alone,
Avhen there is little discharge, but when  more copious, associated
with interna medication.   A means for cutting short the develop-
ment of a blenorrhoea,  consists, according to the  proposition of Car-
 michael, in injections of nitrate of silver into  the urethra.   These 
 294          SPECIAL TREATMENT OF BLENORRHCEA--

 injections, Avhich are to be repeated twice a day, are composed of
 ten grains of solid nitrate of silver to the ounce of distilled Avater.
 I  haAre employed and prefer the folloAving method; I introduce
 into the urethra Lallemand's caustic holder, and then, exposing the
 caustic, I Avithdraw it, at the same time giving it a rotatory motion,
 so as superficially to cauterize the Avhole of the mucous membrane
 of the urethra.   If,  after the first cauterization, too much inflam-
 mation should supervene, recourse must be had to antiphlogistics,
 othenvise 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
 employment ought  to be more experimented on than hitherto has
 been  done, to ascertain  the best  mode of its application, and the
 precise circumstances under Avhich it ought to succeed.   The re-
 cent  researches  I have made allow  me to recommend, as at pre-
 sent most preferable, injections of weak solution of nitrate of silver,
 commencing with a  quarter of a grain to the ounce of Avater.   If
 after  a day or two there  be no increase of pain, nor diminution of
 the discharge, the 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 Avere at
 their  commencement,  by superficially cauterizing  the canal, and
 then introducing a bit of dry lint into the urethra, by a manipula-
 tion which we shall presently have occasion to notice.
   Unfortunately, Ave cannot ahvays succeed in the abortive treat-
 ment, either from the failure of the medicaments,  although judi-
 ciously employed, 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 ob-
 served, may, in a few rare  cases, have been of service, but  they
 cannot be quoted as  examples 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  the acute stage, some otherwise celebrated practitioners have
 advised recourse to be had  in the first instance to the anti-blenor-
 rhoeal medicaments,  at the head  of which  ahvays stands  copaiva.
This may sometimes succeed, but I think that all who have had the 
second species: blenorrhcea in men.
295
opportunity of seeing a great number of cases, and of accurately ob-
serving them, will confess that it generally  only oppresses the di-
gestive organs, causing them to revolt against a medicament; Avhich
at a later period may become necessary ;  sometimes Ave moreover
find the inflammation increase under the untimely use of anti-ble-
norrhceal remedies.  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 mallows  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 decoc-
tion of belladonna 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, especially in men, seek to modify it.   The more aqueous
it be rendered, the less hurtful it will be; and the more  frequently
the Avater be passed, the smaller will be the jet, as it depends on the
degree of contraction of the bladder, which also depends on the dis-
tention of  this organ.   We see, that of  two evils we must here
avoid  the Avorst;  for were it possible entirely, and Avithout danger,
to suppress the urine, it would be far preferable.
   The erections require peculiar attention,  Avhether they  are las-
civious or simply automatic, accompanied Avith 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 symptom, but generally it  nevertheless continues
or increases.   The patient should  be recommended to avoid cover-
ing himself too much in bed when the erections occur,  and also to
apply cold lotions to the penis.  Placing the naked feet on the cold
floor is frequently very  efficacious.   But the most powerful rem-
edy is the  use  of camphor,  combined with  opium, either in pills
or an  enema.   I have found  but  few patients who have not expe-
 rienced benefit from this treatment, and that is asked  for daily in
 the hospitals by those who have experienced its benefits.
    Whatever may be the degree of intensity of the blenorrhcea, the
 treatment  just pointed  out will,  when it is uncomplicated, suffice
 to combat the disease,  during the acute period of which not only 
 296          SPECIAL  TREATMENT OF BLENORRHCEA—

 the  actual anti-syphilitics, either mercurials or sudorifics, but the
 anti-blenorrhoeal medicaments, as copaiva, cubebs, turpentine,  and
 injections, ought to be excluded.  As long as there is much inflam-
 mation, injections ought not to be used; even emollient and narco-
 tic 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 blenorrhcea,  the patient must never
 be allowed to expose himself  to the least fatigue Avithout Avearing
 a suspensory bandage, Avhich ought to fit  exactly, so as not to* pro-
 duce any uneasiness in the organs Avhich it is designed to sustain.
   Although  mostly  urethral blenorrhaea  exists Avithout complica-
 tions, and may  be cured by the means we have just  pointed  out,
 cases sometimes unhappily  occur which  require a peculiar treat-
 ment.
   Sometimes a hemorrhage  occurs in  consequence of the urethra
 being ruptured  during an erection.   This hemorrhage, which in
 some cases  proves salutary, as a  means  of local depletion, may
 have been caused by the patients, who, with the intention of re-
 moving the painful retraction of the urethra in  the erection cordee,
 break, as they term it, the cord, by placing the  penis on a resisting
 flat surface, a table for instance, and then strike it pretty sharply.
 The hemorrhage is seldom great, and stops of itself, Avithout gene-
 rally requiring  any application. More absolute  rest must be insist-
 ed on than ever, and emollients and camphor 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  ves-
 sel, recourse  must be had to cold  applications to the penis, the in-
 ternal  surface  of the  thighs,  the perinaeum  and hypogastriurn
 Vinegar and Avater, or especially ice, generally succeed; acidulated
 drinks, lemonade, &c, are equally suitable.   The quantities of fluid
taken should  hoAvever not be too great, so as to require a frequent
 emission  of urine, which, by distending the canal, tends to recall
the hemorrhage by opening the  lips of the wound.   The peh'is
should be raised, and the patient not kept too wrarm  in bed. Should
the hemorrhage nevertheless continue in a sufficient degree to be-
 come alarming, a slight compression might  be  applied.  By com-
pressing  different parts of the canal,  beginning at the posteric 
SECOND SPECIES *. BLENORRHCEA IN MEN.
297
part, Ave might render the diagnosis more certain.   In one case, in
which the hemorrhage seemed to proceed from the membranous
portion of the urethra, it  Avas stopped by placing a rolled napkin
betAveen  the thighs, and  compressing the perinaeum.  A circular
and  slight compression might  be applied to the penis for the pars
spongiosa; it often suffices to stop the flow of blood, but frequent-
ly the hemorrhage returns the first time the urine is passed. Then,
however objectionable it is to place a foreign substance in the in-
flamed urethra, we must introduce a bougie, Avhich, by compressing
the vessels, stops the effusion of blood ; sometimes  additional cir-
cular external compression is required, but  great caution  must be
used  in its application.   Generally  this bougie may be  removed
after twenty-four hours, but when the hemorrhage has been great,
and  the  instrument does  not  excite  much  pain, it is advisable to
leave it a day or t\vo longer.   In all cases, if the bougie has been
removed  too soon, and the hemorrhage reappears, it must  be reap-
plied, if it be not merely a slight sanguinolent discharge.
   A  symptom of gonorrhceal urethritis,  Avhich requires  peculiar
attention, is the  dysuria  in its  different degrees to  complete  re-
tention.   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  in-
troduced  into the rectum.
   As long as the patient passes  his urine, we must content our-
selves with the means just pointed out, and  beware of having re-
course to other diuretic drinks than those mentioned above, as the
obstruction is not in the kidneys, but in the urethra, and depends on
the swelling of its tissues.
   When, hoAvever, the retention is great, or even complete, eathe-
terism must be employed ;  but it should always  be preceded by de-
pletion, in order  to facilitate it.  A curved elastic gum catheter is
to be preferred.   It has generally been found that a  middling-sized
catheter  (No. 8  or 10 for instance) was  more easy to introduce
than a very small one.  The instrument, lubricated Avith  an  oint-
ment containing  extract of belladonna, should be introduced very
slowly; it must in some measure make its way by compressing the
engorgement.  Without  discussing  catheterism he;e, a  question
                              38 
298          SPECIAL TREATMENT OF BLENORRHCEA-

arises, after the introduction of the catheter and the evacuation of
the urine, should the catheter be allowed to remain or be removed 1
The fear of increasing the existing inflammation by the presence of
a foreign body in the urethra 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,
Avhich may succeed, is  not Avithout objections.   Frequently after
having once  passed  the catheter Avith  facility,  the inflammatory
stricture Avhich required this operation  remaining or even increas-
ing, perhaps  from passing the catheter, renders the passing it a
second or third time  much more difficult, or even impossible; so
that I prefer,  whenever any difficulty is found on passing the instru-
ment the first time, to leave it in the urethra, and recur Avith 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 blenorrhoeal urethritis of not frequent occur-
rence, but nevertheless deserving  particular attention, is the pres-
ence of phlegmonous engorgements, either simple or OAving to  an
infiltration  of urine, which may occur in various parts of the ure-
thra, near the frenum, fossa navicularis, the pars spongiosa, or  poste-
rior parts.  These engorgements, at times of considerable extent,
are not generally so, and have the form of knots  encompassing the
canal.  They sometimes occur singly, sometimes several together,
and are frequently very painful.   Those which depend only  on an
extension of the inflammation of the  mucous  membrane of the
urethra, are more limited, their progress less rapid, and their ter-
mination 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 his-
tory  of which  we need not  enter.   These  engorgements, which
sometimes,  as we have said before, are OAving to the presence of
indurated chancres,  then depend on the specific  cause of syphilis,
and are  to be referred to concealed  chancres, most frequently
in the fossa navicularis, thus explaining the assertion of Wedekind,
that the existence of tubercles near the frenum was a pathogno-
monic sign of a virulent blenorrhcea.
  But as regards the treatment of  blenorrhcea,  complicated with 
SECCND SPECIES :  BLENORRHCEA IN MEN.
299
the above named symptoms, as soon as the engorgement is perpeiv
ed about the urethra, the antiphlogistic treatment ought to be still
more rigorously enforced.  The tumors resulting from the engorge-
ment must be carefully examined every day, and opened as soon as
fluctuation is perceived.
   Sometimes the skin is  attached to the points where the subcu-
taneous cellular tissue  is also inflamed;  but it is also  frequently
moveable, even when pus  is already present.   After  the opening
has been made, a small bit of lint should be placed in the Avound,
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 ex-
ists Avith 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.  In some
patients, Avhere these abscesses have been mistaken, or treated with
a hope of obtaining their resolution, I have seen very serious con-
sequences, such as the rapid propagation of the inflammation, the
formation of extensive  abscesses, and destruction of a greater  or
less portion of the 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 stated, to   Avhich should be  added,
emollient local applications, and fomentations in preference to cata-
plasms, which in some cases cause an oedematous swelling.  When
the acute stage is  passed, we must  have recourse  to  the  means
generally known as resolvents. Sometimes, during the acute period
of an urethral blenorrhcea, 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 
300          SPECIAL TREATMENT OF BLENORRHCEA--

the posterior part of the penis; but sometimes can be traced to the
inguino-crural region, Avhere it terminates in SAvollen  ganglions.
   These complications  of gonorrhoea  also require antiphlogistic
treatment; leeches are particularly serviceable, and should be appli-
ed on the penis and in the groin.
   During the acute period, or Avhen it has  seemed  to yield, the
neck of the bladder often becomes irritated or even inflamed, and
the patients are tormented by the frequence of the emission of urine
(tenesmus of the  bladder), accompanied by  some few drops of
blood; the urine is frequently thick and purulent.  The treatment
I pursue, and Avhich I seldom find fail, consists  in adding to the
local and general treatment, frictions Avith laudanum and emollient
cataplasms to the perinaeum and abdomen.   But a method, the
effect of which is  immediate, consists in administering a cold ene-
ma Avith a little laudanum, and which  ought to be retained in the
bowels.   The food and drink  should also be cold  and in  small
quantities.
   In cases of prostatitis, emissions of blood with half a drachm of
mercurial ointment applied  to  the  perinaeum with emollient cata-
plasms, produce most beneficial results; but the  ointment should
be renewed twice a day, and with a double quantity of mercury.
   The other complications which may exist,  constituting separate
diseases,  must be treated according to their nature, always having
regard to the most urgent  symptoms, either of blenorrhcea  or the
disease Avith wdiich it may be complicated.
   To sum up the foregoing, we may say, that the most poAverful
treatment in the acute stage of blenorrhcea and  its complications,
consists,  excepting a few particular indications,  in the judicious
employment of antiphlogistics.   If patients Avould carry out this
mode of treatment to its full  extent, Avith sufficient  patience, the
cure would be, if not the most rapid, yet the most certain.  This
opinion should be duly considered.
  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 only  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 
              SECOND SPECIES '. BLENORRHCEA  IN MEN.          301

erections may still be pretty frequent  and painful, the glans still
red, especially at the meatus, the penis, as sometimes occurs, in a
state of semi-erection, with a feeling of weight, I employ the medi-
caments more particularly termed antiblenorrhoeal, Avhich, hoAvever,
if they produce the least degree of relapse, ought to be discontinued,
and antiphlogistics again employed.  When the patients  first pre-
sent themselves to us in the chronic stage, Ave do not think it proper,
as some have  asserted,  ahvays  to commence the treatment Avith
antiphlogistics, Avhich here, as in a host of  chronic  affections,  far
from curing, only serve to perpetuate the evil.
   In the treatment of  urethral blenorrhoea after  the  acute period,
the quantity of fluid taken into the stomach ought  to be limited,
and the use of warm baths for the Avhole  body relinquished, as in
many subjects they maintain the  discharge, or even recall it.  The
local  baths should be nearly cold when near the acute stage, and
afterwTards quite cold.  They should  not be used long at a time,
and seldom employed except as a means  of cleanliness, unless  re-
quired as tonics or astringents.   In some cases of blenorrhcea, with
but slight discharge, depending on some error of secretion Avithout
alteration of tissue, partial baths of a solution of sugar of 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
increased to a tonic regimen, Avhen the disease  only consists in a
slight mucous discharge.   The use of good Avine and generous diet
suffice in some cases to put an end to discharges, Avhich have  re-
sisted other treatment.  The patients should continue the use of  the
suspensory, and carefully avoid every kind of fatigue, more particu-
larly when near the acute stage, nor commit any error of regimen,
 as the least fault of this kind may produce a renewal of the acute
 symptoms at the  moment when  the  cure  seemed complete.  Aci-
 dulated drinks are here of  great service.   Natural or  artificial
 chalybeate waters, the sirups of symphitum, quinces, ratanhia,  and
 tolu, ought more  particularly to  be employed when the acute stage
 has long ceased.  The boAvels  should be kept open, by means of
 laxatives, but should not be too  free.
   After the means Ave have just pointed out, there are other more 
302         SPECIAL TREATMENT OF BLENORRHCEA--

powerful medicaments, Avhich are employed to remove the morbid
discharge.   They may be divided  into internal or external revul-
sives, and direct or  local medicaments.   The internal revulsives
consist, as  Ave  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 those which secrete  the urine.   We shall add nothing  to
our previous remarks on purgatives, but will speak of copaiva, cu-
bebs, and turpentine.
   Copaiva.   I shall here relate the observations I have made,  as
regards its use, and which confirm those of some of the most dis-
tinguished authorities.  It is very evident that  copaiva has  a pri-
mary action on the digestive canal.  In some individuals, its action
on the stomach is more decided, in which case it produces vomiting;
but this observation  requires a little consideration, as  it is of  great
importance in practice; the vomiting does not ahvays  take place in
the same manner;  in many  persons it is only OAving  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  irritation, 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 Avhich sometimes compels  us en*
tirely to relinquish it.
   It is to be observed, that  the action of copaiva on the stomach
has generally no influence on the progress of a blenorrhcea, and con-
sequently 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 blenorrhcea must haATe 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 two
kinds of revulsion present yet other differences.   Ceteris paribus,
when conaiva does not purge, independent  of the peculiar  action 
SECOND SPECIES. BLENORRHCEA  IN  MEN.          303
which it may have upon the bowels, it is quite evident that a cer-
tain quantity passes through the kidneys.  The urine voided by the
patients contains a portion of it, as is to be found by the poAverful
smell.   It seems to me to be worthy of note, that urethral blen-
orrhcea  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
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
purgative action was developed; the contrary Avas the case in the
curative treatment of blenorrhcea in the chronic form.
   Copaiva, like all other 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  pa-
tients, or the peculiar state of the intestinal  canal;  so that it is im-
possible to  determine a priori A\That dose Avill be required to produce
or not  a  purgative  effect;  although,  according to the  laAvs of
therapeutics, purging will be in a direct ratio Avith the strength of
the doses, and  the irritability of the intestines.  Under some  cir-
cumstances, certain additions must be  made to  the copaiva, to de-
termine its action in the manner desired.  In the administration 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 formulae, and it seems that caprice rather than a well-directed
choice directs the employment of one or other of the preparations
If it be wished to obtain 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 as-
tringents.   If the action is wished to be more  especially directed to
the kidneys, a  combination with diuretics must be employed.
   Besides  our  remarks above, on  the action of copaiva, we some-
times see other effects produced after its use; the excessive vomiting
and hypercatharsis may indeed be considered as such; the patients
in these cases have a  feeling resembling sea-sickness.   At other
times, copaiva produces cholic, and during the epidemic at Paris,
we found  it occasionally the  exciting caTrse  of cholera.  When
given in large doses, copaiva  has produced very serious effects on 
 304          SPECIAL TREATMENT  OF  BLENORRHCEA—

 the  nervous  system; in my clinical lectures, I  showed a Avoman,
 in AA'hom its  improper  administration had  produced chorea Avith
 semi-paraplegia.  I was requested to see a young woman, in whom
 six  drachms  of copaiva, administered  in an enema, had an hour
 afterwards produced a severe cerebral  congestion, Avith  temporary
 hemiplegia.   Amongst the effects peculiar to this medicament, may
 be ranked a  cutaneous  eruption of greater  or  less extent, and a
 form generally resembling roseola, although it may assume that of
 urticaria, or simple erythema, and this, according to the individual
 and idiosyncrasies.   In a practical point of view it is Avorthy of
 remark, that these  symptoms Avhich are produced by copaiva, are
 almost always owing to  a bad state  of the intestinal canal, and
 that roseola shows  itself most frequently Avhen a saburral state ex-
 ists.  It is also generally during cold and Avet  Aveather, in spring
 and autumn,  that these   eruptions become epidemic, in all persons
 treated  Avith copaiva.  The cutaneous affection is ahvays 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 as-
 sert that its action is as  uncertain, as it  is  efficacious Avhen con-
 veyed into the stomach.   Copaiva balsam is frequently administered
 in substance,   in doses of  from  ten to sixty drops; Ansiaux and
 Ribes have, after the example of Bell and Swediaur, extended the
 dose to two ounces  per diem. Without adopting this practice gen-
 erally, we will not join with M. Jourdan in his condemnation of it,
 as without playing with the lives of our patients, there are circum-
 stances under  Avhich, after having proved  the susceptibility of the
individuals, the good effect can only be obtained  from this medica-
ment by giving it in the  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
 (corrective or adjuvant, it should be given uncombined.  Yet, besides
 the cases Avhich  require  other substances to be  associated Avith it, 
SECOND SPECIES: BLENORRHCEA  IN MEN.          305
m some subjects it produces so much disgust and  nausea when
given in a liquid form, that Ave are obliged to render it solid, and
give it in the form of pills.   Latterly it has been enclosed in divers
envelopes  or  capsules, Avhich have facihtated its administration
Avithout  disgust,  but Avhich 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 dis-
turbed.   For  this reason the  patients generally prefer taking it
morning  or  eArening.   It  is by no means uncommon for persons
who are  taking  copaiva  for  the first time, especially in the alco-
holic form, as given at the end of  the work, to find the taste very
agreeable ;  but the illusion seldom lasts long, for the first eructa-
tions produce -repugnance  to take the medicine Avhich Avas formerly
pleasing.
   Most patients can  bear this medicine better 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
vomiting, or repugnance on the part of the patients, copaiva can-
not be introduced 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 Avhen in  bed.  The rec-
tum should be previously cleared by a simple evacuative enema, a
certain time previous to that containing the medicine, othenvise it
would not be retained, as the already excited contractions of the
rectum Avould 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 Avhatever manner this remedy may be applied, it seldom ar-
rests the discharge  at once;  generally Avhen  it  has been sup-
pressed  it returns, if  the medicine  be discontinued, and again dis-
appears Avhen it is resumed, so that to obtain a durable effect it
                               39 
306          SPECIAL TREATMENT OF BLENORRHCEA--

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 mucn in the
treatment of blenorrhoea, and which was then  eulogized  by the
English, is, notwithstanding the opinion of the author of the Phar-
macopee Universelle, an  excellent means  of suppressing  gonor-
rhoea!  discharges.   Sometimes  less efficacious  than  copaiva, it
has, hoavever, 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
powerfully exciting  action influences  more  particularly the di-
gestive organs, irritating  the stomach and small intestines, Avithout
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 tAvo 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 pre-
ferred  for individuals and in seasons in which cutaneous eruptions
are to  be feared.
   Turpentine.   I have found the  anti-blenorrhoeal action  of tur-
pentine far inferior to the two former substances, although it has
sometimes succeeded.
   As external reATulsives in the treatment of chronic discharges in
men, blisters applied to the  internal surfaces of the  thighs  and
hypogastrium have  been of service, and this means has appeared
to me  particularly serviceable Avhen an  herpetic complication has
existed.  Dry frictions and vapor baths  have  also arrested ob-
stinate urethral discharges.
   Injections.  Much has been said for and against the employ-
ment of this mode of treatment.   Their employment is sanctioned
by great names, but  Avithout going into detail, we will  state the
reasons for and  against  their employment.   It is evident that in
general, in the treatment of any disease, local medications are the
most effectual where the diseased organ is attainable, and the more
 serially is it the case  in an  affection generally admitted  to be 
SECOND SPECIES :  BLENORRHCEA IN MEN.
307
of a purely local nature.  On one side the most rapid cure being
the most favorable, and  injections being the means by Avhich it is
to be obtained, they have necessarily been  preferred in a host of
cases.   To  Avhich  may ba  added, that  they form  an  easy and
cheap 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  injections,
and that Avhich has caused them to  be rejected by those Avho are
averse to them, is the  property Avhich has been attributed to them
of  producing strictures.  A modern author, to whom Ave are in-
debted for many  excellent pathological Avorks, and amongst others
on the diseases of  the urethra, quotes a case in which a single in-
jection produced  a  stricture.   But upon careful examination it will
be found, that most strictures of  the urethra only occur in patients
who have  had a blenorrhoea several  times, or one of  very  long
duration, or Avhich remained unarrested.   Many  patients have
never used  injections, or have used them at  too late a period, Avhen
alterations  of tissue had already occurred.   If strictures have oc-
curred 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 in-
jections.   I have found that the judicious use of  injections affords
 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 Ave have  before said, are al-
 ways in proportion 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 fre-
 quently their development is only a coincidence, or to  be attributed
 to the  improper use of the remedy.   Thus, under some  circum-
 stances, 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 
308          SPECIAL  TREATMENT OF BLENORRHCEA--

astringent  manner  they may produce induration.   But in these
cases the surgeon or the remedy is to be blamed.
  Moreover, at the time Avhen the researches  Avhich appeared the
most conclusive  against the  use of injections AA-ere  made,  this
treatment being most  frequently used, most of the patients affected
Avith stricture had of course been submitted to it; but if a  similar
inquiry were instituted at  the present day, an equal  number  of
strictures Avould be found in subjects Avho  have .never used injec-
tions.  This latter examination would be attended with great diffi-
culty, as the individuals Avho have  strictures are generally those
Avho have  had obstinate discharges, for the cure  of Avhich every
kind of medication  has been employed before  an examination was
made,  which showed  the organic alteration.
  Wlien  it is required to  suppress  a discharge in its commence-
ment, I prefer the alteratiAre 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, lau-
danum, &c.  Where  all sensibility  has disappeared,  and only a
Avhitish gleet remains, tonic injections of red Avine, either alone,
or combined with tannin or sugar, sometimes 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, Avithout hurting the meatus urinarius
Avith the canula of the instrument.   The patient  should be seated
on the edge of a chair with the penis raised, the lips of the orifice
gently pressed against the canula,  to prevent the reflux of the
fluid, Avhich should be allowed to run 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 injec-
tions must be gradually diminished, and  soon altogether discon-
tinued ; for the treatment which has produced the cure  may recall
the  disease if injudiciously continued.
   I cannot conclude my remarks on injections Avithout saying one
word  upon a new  preparation, Avhich I have  lately employed  at
the Hopital des Veneriens  ; I mean  the iodide of iron, (iodure de
fer).  Iodine had already been employed in the treatment of gonor- 
SECOND SPECIES: BLENORRHCEA IN  MEN.
309
rhcea  by Richond and Henry;  and it occurred to me that its com-
bination Avith iron might produce still better effects.  The folloAV-
ing is the result of my researches :
  In some patients affected Avith obstinate gonorrhoea, the injec-
tions with iodide of iron have arrested the discharge in  four or five
days.   In others, this medicament produced at first some  pain, re-
producing  the  acute stage  and changing the nature  of the dis-
charge, Avhich  from being  muco-purulent,  became serous and
tinged Avith blood.   In these cases, by suspending  the treatment,
the disease completely disappeared in seven or eight days.   Some
other  patients Avere obliged  to discontinue this remedy, from  its
causing too much irritation.
  The iodide of iron, Avhich has afforded me a considerable degree
of success, deserves to  be better examined, in order to  ascertain
the conditions  of its decomposition, Avhich hitherto has caused its
effect to vary.   To attain  the same end, in some patients, one
grain of the iodide  of iron has sufficed, whereas in others, the dis-
proportionate dose  of eighteen grains to the same quantity of fluid
has been required.
  Although blenorrhcea in its divers periods may yield  to a variety
of treatments, without one being superior to another, yet it some-
times resists every method Avhich science can devise.  In these cases,
the urethra should be attentively examined, for which purpose a
variety of instruments may  be employed, and Ave shall frequently
detect, at various 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,
Avithout  any other  signs being requisite,   the precepts of Lalle-
mand must be folloAved; the  solid nitrate  of silver must be con-
veyed to this point, by means of his  caustic holder.  I apply the
cauterization in cases Avhere  even no  morbid sensibility exists; but
where a discharge  has resisted every othei treatment,  I introduce
the curved instrument  as far as the prostatic region,  and expos-
ing the caustic, withdraAv 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 parietes of the urethra separate, as in
the treatment of balanitis.  This strip of lint is introduced with  the 
310         SPECIAL TREATMENT  OF BLENORRHCEA--

greatest facility, by means of  an Indian rubber canula, Avell oiled,
and introduced  to the posterior part,  of the urethra.   One of the
ends has a loop made Avith a thread, so as to afford a resting point
for a style, Avhich holds it Avhilst the canula is withdrawn;  Avhen
this is done, the style is also removed, Avhilst 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 re-
placed two or  three times in the tAventy-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 in-
ternal treatment.   When  the running  depends  on an organic al-
teration of the urethra, this must be treated, othenvise the best plan
of treatment will fail.
   Stricture of the  urethra.  Frequently, only a slight hypertro-
phy exists,  and temporary dilatation suffices:   an   elastic  gum
bougie should  be worn for five  or six minutes every evening, be-
ginning Avith the sizes which can be introduced with  little trouble,
and gradually  increasing their dimensions,  as  they pass  with
greater  facility.
   When the mucous membrane is little softened, which shows it-
self by  easily bleeding, cauterization, combined with  dilatation, is
an excellent method of treatment.
   When any ligatures  exist, they must be divided.   These liga-
tures, formed by plastic  tissues,  have a  tendency  to reproduce
themselves after being once divided.   Here permanent dilatation
would be advisable, and should at first be powerful, at least as much
so as the irritability of the canal will permit.
   In the  case  of indurated or callous  strictures, Avhich sometimes
exist with a considerable shortening of the canal, it is necessary to
ascertain  if the induration be not the consequence of an urethral
chancre.  If the- induration be OAving to a chancre, the treatment
for indurated chancre  must be  applied, and it  then  yields  with-
out mechanical means.
   When a simple blenorrhcea hay  caused an induration and callus,
unconnected  Avith the syphilitic virus, cauterization  imprudently
employed may  produce serious consequences.   Scarifications pru-
dently made, and combined with a gradual dilatation, aided by 
              SECOND species: blenorrhcea nsi MEN.          311

 dsolvents, applied botn internally and  externally, must be  pre-
scribed.
  If actual excrescences exist in the canal, the existence of Avhich,
admitted by  Galien, Daran,  &c,  cannot be denied by those who
have  never  seen  them, dilatation  combined  with  cauterization
often succeeds.  The excrescences which may sometimes be recog-
nised by bleeding from the canal, Avithout the instrument having
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  bou-
gie, 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 be first subdued, and  Ave must not  be
rash with the direct applications, 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 de-
scribed ; 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 dila-
tation made  in the evening.  In some  patients, an interval of a
day should be allowed betAveen;  in which case there will be less
difficulty in passing the instrument, and it will be borne with greater
facility.
    Generally I prefer the instrument  made of gum elastic.   For
 permanent dilators, curved bougies are less liable to fatigue and
 hurt the surface of the bladder.  For  temporary  dilators, very sup-
 ple conic bougies are required; and when only one point requires
 dilatation, sounds or bougies a ventre, as they are called, Avhich
 have been condemned by some practitioners, are decidedly prefer-
 able. Rapid  dilatation, by the large metallic sounds of Mayor, cannot
 be  used in  all cases without  danger,  and are useful  only  Avhen
 there is spasm, small bands, and hypertrophy, without friability or
 induration of the urethra.
    Blenorrhoeal epididymitis.  All diseases  of  the testicle may
 exist during  or after the course of  blenorrhcea.   Some  diseases, 
312         SPECIAL TREATMENT OF  BLENORRHCEA--

although in their nature foreign to blenorrhcea, are influenced by
it, or modify it in their turn.
   But there  is one which shoAvs itself as  a frequent and  regular
consequence, namely, an  engorgement of  the  epididymis, which
should be strictly termed blenorrhoeal epididymitis, and which has
been improperly designated orchitis, gonorrhceal testicle, &c.
   The  affection  of which we are  now  speaking does not  occur
once in three hundred cases, during the first wTeek of the existence
of a discharge; generally it is after the second, but especially the
third or later, that it becomes developed.  The same proportions
exist after an acute or chronic state of a running.
   Besides the discharge, AA'hich is in some degree the special cause,
the sine qua  non, the most constant occasional  causes are fatigue,
constipation, the use of excitements of every kind, and the Avant of
a  suspensory bandage.   According to my observations  upon pa-
tients affected Avith epididymitis, about one in twenty of them will
be found, in whom  it showed itself after the use of the special anti-
blenorrhoeal  medicaments, so  that  it  is not absolutely correct  to
say that this affection most frequently depends on the sudden sup-
pression of a discharge, by the  use  of the  ordinary medications.
The contrary may be maintained, namely, that  the  sooner a ble-
norrhoea is cured, the more speedily is the  patient protected from
epididymitis.
   It has at all times been observed, that the left testicle Avas more
frequently affected  than the right.   This proposition has been as-
sailed from an abstract  of twenty cases, but it is nevertheless true.
The reason of this greater immunity of the right testicle is, accord-
ing  to  the observations made  in  my wards at  the Hopital des
Veneriens, as folloAvs:—all the individuals who carry the scrotum
on the left side of the seam of the trousers, 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, Avhich was in an individual, the
seam of Avhose trousers 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 
SECOND SPECIES:  BLENORRHCEA  IN MEN.
313
There may be some exceptions, but the principal cause which de-
termines the side, is that which we have just mentioned.
  As regards the symptomatology, the folloAving is what  occurs:
the first part  affected, that in which'the disease commences, and in
which it may continue Avithout extending further, is the epididy-
mis.  No blenorrhoeal affection of the testicle occurs Avithout epi-
didymitis  being  present.   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 the epi-
didymis, the cord is affected, and  more particularly the vas defer-
ens ; but the  affection  is never confined solely to it, but  the epidi-
dymis is ahvays  implicated.
  A fact, important to be observed as regards the disease  of the
epididymis and vas deferens is, that there  are  two  varieties of
epididymitis: the one  sympathetic, Avhen the  epididymis alone is
affected, the other from succession, or from continuity of  the tissue,
or by extension  of the inflammation, when it  extends from the
urethra  to the canalis ejaculatorius,  and thence to the vesicula
seminalis, vas deferens, and lastly, to  the epididymis, as demon-
strated  by pathological  anatomy, and  as I  demonstrated  to the
Academy, by a  preparation I presented there.   This distinction
is by no  means  unimportant, as  regards the prognosis and the
treatment.
   If the disease increases in  intensity, the neighboring  parts be-
come affected, either  from  the extension of  the inflammation  or
hinderance in their functions; it is thus that the affections  of the
tunica vaginalis occur; sometimes it  becomes inflamed, and  pro-
duces all  the symptoms common to the inflammations of  the serous
membranes:  pseudo membranes, serous or  albuminous pus, san-
guinolent exhalations; at other times, and which is most  commonly
the case, Avithout partaking of the inflammation, it presents the
symptoms of symptomatic dropsies, which arise from a hinderance
in the circulation.  In all cases, epididymitis is the cause of  these
symptoms, which never exist alone.
   The SAvelling in the epididymis may occur either gradually  or
suddenly; the effusions in the  tunica vaginalis are more  rare when
the swelling  occurs slowly.
   If the  disease continues to progress, the  cellular  tissue  of the
                             40 
 314          SPECIAL TREATMENT OF  BLENORRHCEA—

 scrotum, and even that of the cord become affected, and the same
 result  occurs  as in the tunica vaginalis;  either oedema from de-
 ranged circulation, or an actual phlegmonous state.  Finally, the
 skin of the scrotum, the veins of Avhich may only be SAvollen, and
 the capillary  circulation increased, sometimes  presents the  char-
 acters of erysipelatous  inflammation.  The body of the testicle,
 however, which most frequently remains unaffected, and only suf
 fers from pressure, the greater and more painful when to the en
 gorgement of the epididymis is added a hydrocele, may, however,
 in some cases participate in the disease.  Without, in this place,
 entering into the details of symptoms and their course, Avhich are
 too well known to require  our consideration,  we may state, that
 the last parts which have become affected recover first.  Hydrocele
 in particular yields the more quickly, when owing to an inflammation
 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 pre-
 vails, that the discharge, which is often much diminished during the
 course of an epididymitis, never entirely ceases, or at least it does
 not occur more than once in two hundred cases; the more abund-
 ant 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, either does
 not influence this disease or else  aggravates it.
  As a diagnostical sign, one of the most constant  is  the co-exis-
 tent 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
seriousness 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 bandage, the antiphlo-
 gistic treatment  of the  blenorrhcea, and anti-blenorrhoeal medica-
 ments  administered at an early period; then, for the curative
 treatment of the epididymitis, rest in  a  horizontal  position,  keep-
 mo- the testicle elevated* general blood-letting, and leeches armlied 
SECOND SPECIES: BLENORRHCEA IN MEN.
315
on the course of the cord and to the perinaeum;  and at the same
time with the antiphlogistics, the application of compression.
  By means  of compression, Ave obtain the cure of  sympathetic
epididymitis in five or six days.   When well applied, it  prevents
the development of hydrocele, and indeed it may permit of the pa-
tients continuing to follow their  occupation without feeling any ill
effects.
  Compression is applied by means of bandages of emplastr. c.
hydrarg. from six to eight lines broad.   The diseased testicle being
then carefully 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 insertion 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 form a kind
of basket, as  is seen in the cut.
COMPRESSION OF THE TESTICLES. 
316          SPECIAL  TREATMENT OF BLENORRHCEA--
  If this dressing is to succeed, the sufferings of the patient Avill
diminish from the moment of its being applied, and at length en-
tirely cease.   If this be not the case, it must immediately be re-
moved ;  for if it increases the  pain, 't has  either been ill applied
or does not suit. We must not, however, allow  ourselves to be de-
ceived by some little pain  proceeding from the fust band pressing
the skin, and Avhich is generally only felt the following day or later.
It will in this case suffice to cut the band, in order to  allow the
patient to support the rest of the dressing.   OtherAvise the dressing
should not be renewed, except when  the organ has decreased, and
become loose under it.
   To obtain, by the foregoing means, a radical cure, and to pre-
vent a relapse at the same time as  the epididymitis is treated, the
discharge should be repressed instead of excited ; for as long as it
remains, it continues  to  be the cause of the disease, which it fre-
quently reproduces.
Third Species:  Blenorrhcea common to both sexes.

                       of the eyes
Varieties . . .
*
■ anus
• mouth   <"
• nose, &c. '
                        First  Variety.

              Blenorrhoea oculi:—Ophthalmia gonorrhoica.

  This  disease is undoubtedly more frequent  in men than in avo-
men, and far more frequent in infants, immediately after birth, 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 blenorrhoeal mat-
ter 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, Avhich may then convey the irritating matter into the eyes,
and the infant to  come in contact  with  it, in passing through the
infected vagina.   Were it owing to sympathy, the disease would
certainly be more common.   Simple catarrhal opnthalmia may de- 
THIRD SPECIES: BLENORRHCEA IN BOTH  SEXES.       317
velop itself,  during the existence  of an urethral blenorrhoea, as
under any other circumstances, and thus render the diagnosis some-
Avhat obscure or even impossible, as there is no difference between
simple catarrhal and blenorrhoeal ophthalmia, except in the cause,
which is often difficult to determine, and in the more serious con-
sequences of this latter variety.
  The first thing to be urged in the treatment of blenorrhoeal oph-
thalmia, is prompt  and energetic employment of the treatment, as
hesitation involves most frequently the loss of the eye.
  After haATing recommended the patient to avoid everything that
may irritate the organs of vision, as touching them with the fingers,
soiled with the muco-pus of the blenorrhoea, we ought, as soon as
the first symptoms  of ophthalmia  show  themselves, and  Avithout
waiting till it becomes fully developed, or for a more certain diag-
nosis, to pursue the folloAving 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 nostril, the temple, and around the
eye affected,  carefully  avoiding the eyelids.   This being done, the
eyelids  should  be everted  without fatiguing them by too great a
pressure, and then  a stick  of nitrate of silver gently passed OA^er
them, so as to whiten  the surface of the palpebral conjunctiva, and
then still more superficially that of the bulb.
  After this  cauterization,  which, to succeed, must not be very en-
ergetic, an injection of cold Avater must be made betAveen the eye-
lids, 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
Avith compresses, dipped in a cold decoction of poppy heads.   But
as in this serious ophthalmia, much sympathetic irritability, or even
successive inflammation of the deeper seated parts exists,  the pain
is often very  acute and attended with photophobia.  This latter
symptom, and  the consequences  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  great-
est 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 
318          SPx       UEATMENT  OF BLENORRHCEA--

the mucous membrane with a small hooked forceps, and removing
it with the curved scissors.   When it is only an oedematous che-
mosis, the chances of success are far greater than Avhen the chemosis
depends on an actual  phlegmonous and indurated state; in which
case the excision generally becomes impossible, and only alloAA'S
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 mucous membrane,  it almost immediately  changes  the nature of
the secretion, Avhich  from  muco-purulent becomes sero-sanguino-
lent. When an application has succeeded, after this artificial secre-
tion, the oedematous swelling of  the palpebrae decreases, the con-
gestion and  inflammation of the conjunctiva become less intense,
and the disease progresses towards resolution; to complete Avhich,
a derivative in the back of the neck, (a blister or seton,) and some
collyrium should  be used; 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 con-
tinues or increases,  we must return to the application of nitrate of
silver ahvays 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 dis-
ease, I have sometimes repeated them twice in the same day.
   At the same  time as this energetic treatment  is employed  and
repeated as  often as  the intensity of the symptoms require, and
without Avaiting from  one day to another, so  as always to be behind
the symptoms, which  progress Avith such rapidity, Ave must not fail
to act upon the intestinal canal, not only  to keep it free, but thus to
diminish the causes  of cephalic congestion, and to benefit by a poAv-
erful revulsion.    All the accessory treatment required by catarrhal
ophthalmia in general, is applicable and ought not to be neglected.
If the  primitive discharge  is  diminished during the blenorrhoeal
ophthalmia, it is never completely suspended, and there is  nothing
gained by reviving  it, opinions to the contrary notAvithstanding.
   Anti-blenorrhoeal medicines, as copaiva, cubebs,   &c, have no
action on this disease, in whatever manner they may be adminis-
tered.   The  same  is  the case with the anti-syphilitics,  such as
mercurials. &c. 
THIRD SPECIES: BLENORRHCEA IN BOTH SEXES.       319
                        Second Variety.

                         Blenorrhoea ani.

  This is unquestionably the most rare of all the forms, yet it often
occurs in Avomen and little girls, in consequence of the discharge
of blenorrhoeal  muco-pus  flowing from the* vulva.  Blenorrhoeal
discharges from the anus also frequently accompany or  follow the
development of chancres in this region, or are the more frequer>
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 subdued, resolvent
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 o,r 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 ■
copaiva 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 Avhich many patients who  use it
 in other cases complain.

                         Third  Variety.

              BlenorrhcEal affection of the  mouth, nose, &c.

   It is evident that all mucous membranes  may be affected Avith
 blenorrhcea or blenorrhoeal affections;  but these affections are very
 rare.   In all cases, if they can affect the mouth, it is certain, from
 the conditions in which the patients are  often placed, and the fre-
 quency of genital blenorrhcea in females, that the instances of  it
 would be more common.   The treatment, when they  do  exist, re-
 quires  nothing which has  not already been indicated. 
320
SPECIAL  TREATMENT  OF
            § III.—Excrescences, or Vegetations.

  Excrescences, which vary in form and appearance, and are call-
ed caulifloAver, pear-shaped, &c, do not seem, strictly speaking, to
be the consequence of the syphilitic virus, as in the opinion of all
good observers, and as may be seen every day, they are frequently
developed under the influence of causes  entirely unconnected with
syphilis.
  In the treatment of these excrescences, the following conditions
must  be considered;  either there is only a  hypertrophy of  the
tissues without epigenic increase, improperly stated by some Avriters
on syphilis amongst the vegetations, and which constitute the mor-
bid changes of structure, to which the name of condyloma is appli-
ed, or else  there is an actual production of neAV tissues, vegetations
properly so termed.
  The treatment of condylomata is either that of indurated chancres
or mucous tubercles.
   When Ave have to do with true vegetations, either  the indura-
tions  depend on a  chancre, of Avhich they are then the conse-
quence, or  they have  arisen on  unindurated tissues.   In the  first
case the specific induration must be removed, as directed when
treating of indurated chancres, and then, if theyhaATe not  fallen off
or Avithered during  the treatment, they must be excised.  When
there was no induration at the commencement, excision  should at
once be had recourse to, for Avhich purpose the curved scissors will
be found  most  convenient.  The  part  should immediately after-
wards be enveloped in compresses, moistened with cold Avater;  rest
and simple lotions till cicatrization will suffice to complete the cure.
In some cases,  Avhere the little Avounds  suppurate, they must be
dressed either Avith a little simple cerate or  aromatic wine.  When
the excision, Avhich should embrace the Avhole thickness of the
skin,  or mucous membrane on which the  vegetations are seated, is
Avell 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 Avould be requisite to prevent the inoculation
of fresh-made Avounds.  When,  hoAvever, there are chancres  still 
PHYMOSIS AND PARAPHYMOSIS.
321
capable of  inoculating,  I prefer  waiting till  they are  cicatrized
before excising the vegetations.
  We may undoubtedly destroy the excrescences by caustics alone,
sometimes Avith nitrate of silver, but especially Avith liquid nitrate
of mercury;  but Avhen they are provided Avith a foot-stalk, excision
is far preferable; only in cases where the base  is broad, or the pa-
tients fear the knife, I have recourse to these or other means, opium
paste, calomel, poAvdered savine, &c.
  As regards the strictly speaking antisyphilitic treatment, it is
only indicated Avhere  the concomitant  symptoms require  it;  as to
the vegetations  alone, those Avhich  are really epigenetic, Avithout
specific induration, there can only be a loss of time.   The precepts
of the ancients were, first, institute  a general methodical treatment;
that is, take during a stated time a certain quantity of  mercury.
Mine are, first, destroy the vegetations; and I  frequently cure my
patients if three or four days, adopting no other treatment, unless
other symptoms require it.


                IV.—Phymosis and Paraphymosis.

  Phymosis  is either  complete or incomplete,  permanent or tem-
porary.  The permanent  may  be  congenital or  acquired; it may
exist Avith excess  of  length  of the  prepuce, Avith a prepuce not
covering the Avhole of the glans, Avith excess of length of the frenum;
there may be adhesions to the glans, either old or new, complete or in-
complete.  The temporary may be either inflammatory or oedema-
tous, complicated Avith erysipelas,  considerable tension, gangrene,
balanitis,  blenorrhoea, chancres, vegetations, herpes, perforations
of the prep :ce,  difficulty of passing the urine, or complete reten-
tion. • There may have existed a  little narrowness  of the margin
of the prepuce before the development of the phymosis.
  Temporary phymosis occurs  in individuals who could previously
easily uncover the glans: it readily yields Avithout an operation.
  Permanent phymosis, Avith  too great a length  of prepuce, or
with indurations on the margin of this  cutaneous  covering, requires
circumcision, if it  be desired to cure  one deformity by producing
another   When recent  adhesions, easy to be  destroyed, are pre-
                               41 
322                  special treatment of

sent, they must  be dissected;  Avhen they are too intimate,  and
especially too extensive, we must content ourselves Avith removing
sufficient of the  prepuce to uncover the meatus urinarius.   When
the frenum is too  long, it  should be resected; if vegetations be
present, they must be  removed ;  if there be chancres, unless there
be urgent indications, we must Avait  till  they are cured before
operating, so as  not to  expose ourselves to the risk of increasing
their extent, by  inoculating the  wound Avhich results from  the
operation.  If the  operation be performed, the chancres still exist-
ing, they should, if possible, be removed at  the same time.  In this
manner the Avhole disease, which may yet  be only local, may be
removed at once.  At other times, if they be allowed to remain, im-
mediate cauterization is necessary.  When there are perforations
of the prepuce, they ought to be removed in the operation.
   If the prepuce is short, the section of the superior part, accord-
ing to the old method, may suffice.  If the prepuce is#nly strait-
ened by the vegetations Avhich are developed between it and the
glans, a slight incision Avill suffice ; otherwise the incision must be
carried  to the level of the base of the glans.   It ought to be re-
membered, that  after making the superior incision and removing
the angles, a long strip of skin corresponding to the frenum re-
mains, which constitutes a  real deformity.
   In some cases, I take a fold of the skin of a certain extent, and
thus remove a flap, AA'hich leaves a division in the form of a V, Avith
its basis on the margin of the prepuce, and its summit toAvards the
base of the glans.
   The section of the  lower part  of  the prepuce, after the method
of Celsus, an operation which  Cloquet has much improved, does
not expose  the  urethra to be wounded, more than the upper sec-
tion.   In most cases, hoAvever, I reject it, particularly in cases of
phymosis, Avith excessive length of the prepuce, for it occasions a de-
formity similar to  that seen in hypospadias.
   Preferring circumcision,  the folloAving is the  method I adopt:
   First period.   The penis  being relaxed, without stretching the
skin which forms  the prepuce, I draw with ink a line Avhich fol-
lows, in all its circumference, the oblique direction of the base of
the glans, and about an eighth of an inch from it.
   Second period.  I next draw the prepuce forward, and fix it be- 
phymosis and paraphymosis.               323
CIRCUMCISION AS PERFORMED BY  M. RICORD.
tween the  blades  of a common dressing forceps, placed directly
before the glans, the inked line held by an assistant.
  Third period.   The portion  of the  prepuce Avhich projects be-
yond the forceps is to be held by the operator with his left hand, whilst
Avith his right he makes  an incision with a bistoury, following the
line traced Avith the ink.
  Fourth period.  After this section, the mucous lining, Avhich by
its anatomical disposition does  not allow of its being drawn for-
ward like the skin, remains entire and covers the glans ; to avoid a
secondary phymosis  or paraphymosis,  it  should be  immediately
divided.  I do this by dividing this mucous membrane by  a single
cut Avith 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 together, I remove the frenum
with them.   The results of circumcision, according to my method,
are more successful  than other processes, as may be seen at the
Hopital des Veneriens.  The cure is complete in tAventy or twenty-
five days; no deformity ever remains, nor is there any fear of a con-
secutive phymosis or paraphymosis supervening.
  After the operation, the artery of the  frenum, or some of the
prepucial  branches, often bleed  considerably;  they must, in  these
sases, either be tied  or torsion applied.   The penis must  then be 
324          SPECIAL TREATMENT OF  PHYMOSIS, ETC.

constantly covered Avith cold Avater, to avoid erections and inflam-
mation ;  to avoid the erection, the patients should also have cam-
phor, given in form of pills.  The interrupted suture presents no
advantages.
  Paraphymosis, Avhich is only a phymosis removed behind the
glans, Avhich it compresses, and thus  produces all  the  symptoms
Avhich result from strangulation, requires that the parts should be
again reduced to their normal position.  WhenShe constriction is but
slight, it may  be  reduced by methodical  compressions.   For this,
the penis is enveloped in a compress soaked with cold Avater; it is
then taken in  both hands, and the compress is removed;  the penis
is held  Avith  the left hand, and the base  of the glans is  pressed
Avith the right, so as to force it into the ring of the prepuce behind
it.   Sometimes the penis is grasped behind the strangulation, be-
tween the index and  middle fingers, while the thumbs compress
the sides of  the glans  and  force it through the  strangulations.
Should oedema exist, incisions must be made, so as to degorge the
tissues before  attempting the reduction.  But w-henever the strangu-
lation is considerable, or there are ulcerations of the strangulating
tissues, adhesions, inflammations of the glans, threatened or actual
gangrene, and more especially Avhen the  paraphymosis has suc-
ceeded a phymosis, it Avould be absurd to persevere in reducing it,
putting the patient to useless pain, and  only substituting a phy-
mosis for a paraphymosis, which would at a later period require an
operation.
   In this case, I make an incision with a straight bistoury on the
dorsal side of the  penis, Avhich divides the whole  skin  from the
point of strangulation, going backAvard as far as the glans.  The
incision is made Avith a straight and narroAV-bladed bistoury, Avhich
is introduced  under the skin, entering under the  band formed by
the prepuce behind the  glans.   The  mucous lining of the pre-
puce, which produces an oedematous  sac, must also be divided in
the same direction  and in its whole extent.   The  operation is in
fact only the  operation of phymosis,  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 folloAving
  formula:—
             R.  Decoct, conii et solani    .    .     gviii
    Mix.         Extract, gum. opii   .    .    .     gr.viii

                      Solutio plumbi acetatis.
             R.  Plumbi acet. crist.   .    .    .     3i
    Mix.         Aquae distill.....gviii
  For balanitis, lotions for the vulva, and applications to leech-bites.

                          Solutio opiata.
             R.  Aquae lactucae       .    .    .     gviii
    Mix.         Extr. gum. opii      .    .    .     3i—ii
  In gangrenous affections.  When the irritability increases, the quantity
of opium must sometimes be decreased.

                   Solutio ammonie hydrochloratis.
             R.  Aquae.....gviii
    Mix.         Ammoniae hydrochlor.    .    .     3 ii
  For resolvent applications and fomentations, particularly applicable in
the treatment of buboes.

                       Tinctura iodin. diluta.
             R.  Aquae distill.    .                  giii
    Mix.         Tinct. iodinae   .    .     .    .    3i
  The tincture may be increased to six drachms to the same quantity of
water.  It is employed in  the treatment of buboes, hydrocele accompany
ing epididymitis, &c. 
326
SPECIAL formulary.
                        Soda chlonnala dilula.
              R.   Sodae chlorin.....§ii
    Mix.          Aquae.....§vi
  The quantity of soda may be increased till a slight tingling sensation and
heat are produced.  Used in the  treatment of mucous tubercles, &c.

               Solutio hydrargyri bichloridi concentrala.
              R.   Hydrarg. bichlor.    .    .     .    gr. xx
    Mix.          Aquae dist.                         §i
  For the cauterization of vesicated surfaces in the treatment of buboes.

                     Vinum aromaticum, (Ph. Fr.)
              R.   Spec,  aromat.* Cod.      .     .     giv
                  Vin. rubr.       .  * .     .     .     ftii
    Mix.          Spirit aromat.*      ...     gii
  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 astrin-
gent, two scruples of tannic acid to eight ounces of the  wine.

                      Vinum aromaticum, c. opio.
              R.   Vin. aromat.....§viii
     Mix.          Ext. gum. opii   .    .     .     .     3ss.
  The foregoing preparations of wine are employed as dressings for chan-
cres and ulcers.

                         II.—INJECTIONS.

  The emollient, sedative,  and narcotic  injections, consist of the  same
liquids as those mentioned above for lotions.

                  Tnjectio plumbi acetatis pro urethra.
              R.   Aquae rosar.....gvi
     Mix.         Plumb, acet. crist.                  Sii

                           Idem pro vagina.
              R.  Aquae.....ILii
     Mix.         Plumb, acet. crist.   .    .    .     3iii—§i
   Gradua.ly increased.

           Injectio sulphatis  aluminis et potasse pro urethra.
              R.  Aquae rosar.    ".    .    .    .     §vi
     Mix.         Alum, et potass, sulph.   .    .     gr. xviii

   •Both the above preparations contain a host of articles.  I have found the Sp
 rosmarinsD or Sp. lavend. co. an excellent substitute for them. 
SPECIAL  formulary.
327
                           Idem pro vagina.
              R.  Aquae.....ft-"
    Mix.          Alum, et potass, sulph.    .     •     3 hi
  The alum is increased to the ratio of an ounce to the pound, according
to the effect obtained, and the greater or less degree of irritation in the dis-
eased surfaces.
                      Injectio c. vino pro urethra.
              R.  Aquae rosar.....§1V
    Mix.          Vin. rubr.       .    •    -    •     iu
  The quantity of wine may be increased, and if it does not cause any ir-
ritation, it may afterwards be used alone.

                         Idem c. acido tannico.
               R.  Vin. rubr.                         §vi
     Mix.         Acid, tannic.....gr.xviii
  When  used for the vagina,  the quantity of the tannic acid should be
doubled and gradually increased, according to the effects produced.
  For the vagina are also employed concentrated vinous infusions of Pro-
vence roses.
                         Injectio zinci sulphurici.
               R.  Aquae rosar.....§VUI
     Mix.         Zinc,  sulph.....Si
   To which a scruple of laudanum may be added.

                        Injectio argenti nitratis.
               R.  Aquae dist.....^viii
     Mix.         Argent, nitr. crist.   .    .     •     gr.n
   The nitrate of  silver may be  increased, till a favorable result be obtain-
 ed, if irritation be not produced.
   If a caustic solution be required :—
               R.  Aquae dist.      ....     §i
     Mix.         Argent, nitr.....gr-*

                          Injectio ferri iodidi.
               R.   Aquae dist.      ....     SVI
      Mix.         Ferri iodid.....S"r-iu"
    The quantity may be increased to nine grains to the ounce of water, but
 care is required to avoid irritation.

                            Ill—COLLYRIA.

    For emollient, sedative, or narcotic collyria, the fluids  must be used  as
  mentioned under No. 1. 
328
SPECIAL FORMULARY.
                               C. xinci.
              R.  Aquae rosar.....giii
                  Zinci sulph.....gr.vi
     Mix.         To which may be added Tr. opii    gtt.xx

                          C. argenti nitratis.
              R.  Aquae dist.     ....     gm
     Mix.         Argent, nitr.....gr.iii

                       IT.—GARGARISMATA.

  The emollient, sedative, and narcotic  gargles are prepared in the same
manner as the fomentations, &c.
                                       «
                        G. c. hydrarg. bichlor.
              R.  Decoct,  conii et morell.    .     .     gviii
     Mix.         Hydrarg. bichlor.    .    .     .     gr.ii—viii
  This is used in case of ulcerations of the throat, after the acute period.

                     G. aluminis et potass, sulph.
              R.  Aquae lactuc.....gvii
                  Alum, et potass, sulph.    .     .    3i
     Mix.         Mel. rosat.     ....     gi
  In cases of apthous  affections and mercurial  stomatitis, without too
great inflammation.

                            G. cmchonte.
              R.  Cort. cinchon. rubr.   .     .    .    5ii
     Mix.         Aquae.....gxii
  Boil to gviii,  to this, Avhen strained, add  extr. opii gr.viii, in cases oi
gangrene; or 3ii tinct. cochleariae, should there be a scorbutic tendency, or
permanent ramollissement of the gums.

                       G. c. acido  hydrochlorico.
              R.  Aquae lactucae        .     .    .    gvii
                  Acid, hydrochlor. fort.     .    .    gtt.xx
     Mix.         Mel.  rosat.....3-i
  In apthous affections and mercurial stomatitis.
  To combat mercurial salivation, I prefer applying the fuming acid, hy-
drochlor. fort, to the gums and tongue when this is ulcerated.   We must
be careful not to touch the  teeth  with the acid.   The  hydrochloric acid is
a most poAverful remedy for mercurial salivation;  the application should
be repeated  every day,  or every other day.   The  bleeding  of the surface
ought not to be an obstacle.  The acute  pain it produces, soon ceases and 
SPECIAL FORMULARY.
329
nothing equals its beneficial effects.  Of course,  the peculiar indications
which may present themselves must not be neglected.*

                         V.—CERATES, &c.

                          Unguent, opiatum.
              R.  Axung......fci
    Mix.         Tr. Opii.....§i

                             C. plumbi.
              R.  Cerat......51
    Mix.         Liq. plumb, diacet.   .     .     .    5i

                       Unguent, hydrarg. opiat.
              R.  Unguent, opiat.-
    Mix.         Ung. hydrarg.  .     .*    .     . aa §i
  Used  in cases Avhere the mercurial ointment is too irritating.  The gray
ointment contains only tAvo ounces of mercury to the pound of lard.

                          Ung. hydrarg. dup.
              R.  Axung.
                  Hydrarg......aa |i

                        Unguentum digestivum.
              R.  01. terebinth.....3i
                  Vitel. ovi                          ii
    Mix.         01. hyperic.....§ss
  Mix  the yolks of eggs in a mortar Avith the turpentine, and gradually
add the oil of hypericum.  In poulticing phagedaenic chancres, alternate
dressings with the ointment and wine are highly useful.

                      Unguent, hydrarg. chlorid.
              R.  Hydrarg. chlorid.                   gr. vi
    Mix.         Cerat. opiat.    .     .     .     »    3ii

                         Unguent, belladonna.
              R.  Extr. belladon.  ...         3ss
    Mix.         Axung.....         gi

                           U. hydrarg. iodid.
               R.  Hydrarg. iodid.      .    .    .    3i
    Mix.         Axung......si
   The  quantity of the iodide may be increased to two drachms, if too great
irritation be not produced.
   • In No. 11. (1837) of the Journal (Experience,) Ave find curious and important
researches of M. Grudin, proving that mercury is found in substance in the saliva
of individuals salivated by using it.
                                 42 
330
SPECIAL FORMULARY.
Mix.
          Mel. iodatum.
Mel.
Hydrarg. iodid. .
                     Unguentum potass, hydriod
             R.  Potass, hydriod.
    Mix.         Axung.....
  If to the above be added two grains of iodine, it
tass. hydriodid. iodatum.  The  unguent,  plumb.
same manner as the ung. potass,  hydriod., the iodide of lead being substitu-
ted  for the hydriodate of potash.
giss
3i
     3ss
     §i
forms the  unguent, po-
iodat. is formed in the
                 Pommade du Goudion of M. Emery.
             R.  Goudion   ....     1 part
    Mix         Axung.....8 parts
  M. Giraud proposes the following formula:—
             R.  Axung......&i
                 01. pyrelain.....giv
  This pommade does not stain the linen.

                        VI.—EMPLASTRA.

      Emplastrum c. hydrarg. (de Vigo) according to the codex.*
  This plaster is spread upon muslin, instead of diachylon.

                   Emplastr. conii c. plumb, iodid.
             R.  Emp. conii      .     .     .    .     3i
    Mix.         Plumb, iodid.....gi
  This is used  in the  treatment of buboes,  and especially in chronic en-
gorgements of the testicles.  If twenty grains of antim. et potass, tart, be
sprinkled upon a plaster of emplastr. 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.

  • Emplatre de Vigo. c. mercurio consists of
Emplast. simpl.	ft.iiss	Myrrhae	dr.v
Cerae pur.		Pulvis croci	dr.iii
Resinse .	aa oz.ii	Hydrarg.	oz. xii
Gum. ammon.		01. terebinth. .	oz. ii
Bdellii		Styracis liquid. .	o:. vi
Olibani .	aa dr.v	01. lavend.	dr.ii
For this I substitute the emplastr. ammoniac, c. hydrarg.—P. L. 
\
SPECIAL FORMULARY.
331
  They are rendered resolutive by using them cold, and adding the decoc-
tum album, or a solution  of sal  ammoniac; or narcotic and sedative, by
adding laudanum.  They  should  always be used  between two cloths, or
two pieces of muslin, and the mode of applying them to buboes  may b«
seen ha the annexed cut.
                        INGUINAL BANDAGE.

                        VIII.—ENEMATA.

                           E. c. copaiva.
             R.   01. copaivae    ....    ?ii—vi
                 Vitel. ovi.....'
                 Ext. opii.....gr.\
                 Aquae.....l^
  Given in cases in which the copaiva cannot  be administered by the
o >uth.
                    E. c. camphora et opio.
           R.   Camphorae     ....   gr.x
              Ext. opii.....gr.i
               Vitel ovi.....i
              Aquae.....§vi.
To prevent the erections, Avhen the pills do not succeed. 
4
332                    SPECIAL  FORMULARY.


                       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 alcohol.

                            X.—BATHS.

  Gelatinous baths are made by adding from one to two pounds of glue;
alkaline baths by the same quantity of subcarbonate of potass.  If subli-
mate 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.
  For sulphurous baths, the inodorous, according to the process of M. de
Quesnuille, should be preferred.                 ,

                   XL—FRICTIONS, UNCTIONS.

  Frictions should only be used Avhere the parts are not irritated;  in other
cases, unctions are called for.
  The regions to be rubbed should be shaved, and  the frictions should be
made in the direction of the hairs, otherwise an eczema pilaris might be
caused. Unless  certain local indications are  to be fulfilled, the  axillarv
space should be selected, and double mercurial ointment used.
  Frictions should be made every other day, alternating from one axilla to
the other.   The  quantity used should be from half a drachm to a drachm,
  This ointment is  used also  to destrov the pediculi pubis.  The friction
is made at night; the next day a bath is used, and soap-suds likewise, so
as to leave no  ointment on the skin; three frictions are generally sufficient

                          XII.—PILULJE.

                 P. hydrarg. bichlor. co. (Dupuytren.)
              R. Hydrarg. bichlorid.       .     .  gr.l-5th—l-4tn
                 Ext. aquos. opii      .     .     .  gr.l-Uh— 1-hali
                 Resin, guiaci    ....  gr.iv

                          P. hydrarg. iodid.
              R. Hydrarg. iodid.
                 Extr. lactucae   .    .    .     .  aa 3ss
                   "   gum. opii  ....  gr.ix
                   "   guiaci                       §i
                     To be made into 36 pills. 
*
                         SPECIAL FORMULARY.                    333

  In cases of inveterate affections, accompanied with  much induration of
the tissues, two or three grains of pulvis. fol. conii may be added.
  These pills 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. comp.
             R.   Hydrarg. chlorid.                   3i
                  Pulv. fol. conii
                  Sapon. castil.....aa 3ii
                      To be made into 24 pills.
  These pills are  employed in the treatment of the engorgements which
remain after a blenorrhoeal epididymitis, commencing with one and increas-
ing every five days to the number of six, unless the symptoms  of mercuri-
ahzation occur, and then the number must be diminished, or their use be
entirely suspended.

                         P. opii c. camphora.
             R.   Camph......3ii
                  Extr. gum. opii      .    .    .     gr.viii
                  Mucilag. q. s.
                      To be made into 16 pills.
  Given in doses of 2 to 3 every evening, to allay the irritation in the neck
of the bladder and the erections.

                        Copaiva, Cubebs, SfC.
  Copaiva, cubebs, and turpentine, are used as potions, pills, boluses, mix-
tures, as they are given in substance.   Every physician has his formula.
The following of Chopard has become classic:—
R.  Resin, copaiv.  .
    Alcohol.
    Syr. bals. Tolut.
    Aquae Menth. piss.
    Aquae flor. orang.
    Alcool nitr.
aa §1
                                                        3n
  Dose  from tAvo to six table-spoonfuls daily.  The copaiva capsules are
extremely useful, as the patients bear it better.
  I prefer cubebs in powder, or mixed in Avith bread, or enclosed in capsules,
to its use in the form of cubebine, which I think less efficacious.

                XIIL—LIQUOR. VAN  SWIETEN II.

  There are  several forms of this liquid,  and that most generally used is
as follows:—
              R.   Hydrarg.  bichlorid.   .    .    .  gr.viii
                  Sp. vim rect.....% iss
                  Aquae dist.      ....     gxivss 
334
SPECIAL FORMULARY.
  One ounce contains half a grain of sublimate.  The dose is two drachms
per diem, increased to four.  To be taken in  three or four doses, at inter-
vals of four to six hours, so as not to interfere  with the meals.  It may be
given in milk, in a cup of tisane, sarsaparilla, gum  water, or any mucila-
ginous drink, to which may be added a small quantity of syrupus papaveris,
if it cause pain in the stomach or intestines.

                 XIV.—TISANES.  DIET DRINKS.

                        Tisane of Sarsaparilla.
             R.   Sarsaparil.      ....     gii
                  Aquae......ft.ii
  Boil to one half, and take a glass daily.  The sarsaparilla  may be  ma-
cerated for 24 or 48 hours, and not be boiled.  It is sweetened with sugar,
or sudorific sirup.   It is better for some irritable stomachs to add half an
ounce of gum arabic to the pound of tisane.

                          Tisane of guiacum.
             R.   Guiac. rasp.....|i
                  Aquae.....fc.i
                           Boil to one half.

                           Tisane defeltz.
             R.   Rad. sarzae incis.    .    .    .     giii
                  Gum. arab.....3ss—3ii
                  Antim. sulph.....§iv
                  Aquae.....ft.vi
  Boil to half—the antimony being enclosed in a piece of cloth, and sus-
pended in the fluid.   Three or four wine-glasses  a day should be given,
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 without salt, to avoid the  decomposition of the antimony, held in
suspension  or mixture by the tisane; some have then thought that the de-
coction  holds none of it in solution, and only gives to it a small quan'ity
of arsenic.

                         Decoctum Zittmanni.
                                 No. 1.
             R.   Rad. sarzae     .     .     .    .     gxii
                  Aquae.....Ib.ii
                  Sacchr. alumin.      .     .    .     giss
                  Hydrarg. chlor.      .     .    .     gss
                  Cinnabaris     '.    ^    .         gi 
SPECIAL  FORMULARY.
335
                  Fol. sennae      ....    §iii
                  Rad. glycyrrh.....giss
                  Sem. anisi
                  Sem. feniculi   .     .     .     .  aa gx
  The sarsaparilla and water  should be boiled together a quarter of an
hour, and then the sacchr. alumin. calomel, and cinnabar 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
  This is termed the strong decoction.
  The Aveaker is made as follows:—

                                No. 2.
  To the residuum of No. 1, add—
                Rad. sarzae     .    .    .    .     gii
                Aquae     .                        ft.xxiv
  Boil and add—
                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 tase naif a pint of No.  1, to be drunk  warm, and keep his bed.  In the
 afternoon, a pint of the No. 2.  And again, half a pint of No. 1 in the eve-
 ning the two latter doses to be taken cold.  This  to be continued for four
 days, on the fifth, a purgative is  given.  The treatment is  then to be re-
 peated for four days, and again followed by a purgative.  If then after an
 interval of a Aveek it be required, the foregoing treatment must be repeated.
 The diet should be strict.
   The decoct, alb. frequently referred to is given  thus, in the codex  Phar.
 franc.
             R.   Phosph. calcici (cornu. ustum. P. L.)   3 ii
                 Medullae panis    .     .     .    .    3vi
                 Gum. arab......3ii
                 Sacchr. alb....... 3i
                 Aquae simpl......gxxri
   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.

                             XV.—SIRUPI.

                             S. sudorificus.
             R.   Rad. sarzae
                 Lig: guiaci.....aa gvi
                 Aquae......fc.rv 
336                    SPECIAL FORMULARY.
   Macerate 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.

                      S. sarzae co. (de Cuisinier.)
                 Rad. sarzae     ....     gxxx
                 Aquae.....Ib.xxiv.
   Infuse for 24 hours, and then boil down to lb.\i\i.  Repeat this operation
 wice.  Strain and mix these three decoctions, then add—
                 Flor. borag. off.
                   "  rosar. alb.
                 Sem. anis.    .    .         .     aa gn
                 Fol sennae.....giss
   Boil this down to half; strain  and add—
                 Sacchr. alb. et mel.                 aa Ib.ii
   Two to four ounces may be given daily.  It is suitable for patients who
are subject to  constipation.  When it purges gently, it may be advan-
tageous, but when it gripes or  produces diarrhoea, its use must be sus-
pended.
   To the foregoing sirups may be added mercurial preparations, and par-
ticularly  sublimate.   I prefer the cyanide of mercury, 4 grains to the
pound, which is less liable to be  decomposed than the deuto-chloride.
   A drachm should be given night and morning, gradually increasing to
naif an ounce per diem.   Should it purge, I combine  Avith it the sudorific
sirup, to which I add 8 grains of extr. opii to the pound.

                         Syrupus ferri iodid. ■
            R.   Syrupi sudorific.....Ib.i
                Ferri iodid......3i
                    Dose : 2—6 drachms per diem.

                         S. ferri et ratanhie.
            R.   Syr. tolutan......Ib.i
                Ferri sesquicarb.
                Extract, ratanhiae   .     .     .     .  aa 3n
   Dose: 4—6  drachms per diem, used in  blenorrhoea and  mucous dis-
charges.

                             S. caimans.
            R.   Syr. papav.  .....    giv
                 "  amygdal.     ....    gxiv
   To this sirup  may be  added, two drachms of nitrate of potass:  to be
given during the acute stage of blenorrhoea, in linseed tea  or barley water.
I have given here only the formula  most used by me, and for others I re-
fer to the excellent formulary of my friend Dr. Foy. 
 
I 
CONTENTS.
                                                                  PAGE
Translator's preface.......>    •    .     3
Author's preface..........5

                       PART  THE  FIRST.
              CRITICAL  RESEARCHES AND GENERAL REMARKS.


                             CHAPTER I.

The existence of the syphilitic virus proved by inoculation    ...    8
Means of propagation of syphilis.......50


                             CHAPTER II.

Inoculations  serve to distinguish from  each other the  reputed  primary
    symptoms of syphilis.........53
Section I.—Blenorrhoea.........54
  "    II.—Chancre..........68
  «   m.—Bubo..........69
  «   IV.—Mucous  tubercle........76


                            CHAPTER III.

Inoculation distinguishes primary from secondary symptoms    ...   80
Classification of the symptoms of syphilis (Note)      ....     80

                             CHAPTER IV.

Inoculation serviceable in the therapia.—
Section  I.—In the prophylactic treatment    ......   84
  «    II.—Treatment of syphilis.......89
  «   in.—Treatment of diseases unconnected with syphilis      .    .   93
  u   rV.—Choice  of the method of treatment.....94


                             CHAPTER V.
Inoculation may be applied to sanatory regulations and forensic medicine    96 
338
CONTENTS.
                      PART THE SECOND.


                CLINICAL AND EXPERIMEN" AI RESEARCHES.


                             CHAPTER I.

Practical observations.—                                            page
Section I.—Inoculation of the pus of chancre, simple and complicated, in
              its various forms and periods......9'J
  "    H.—Inoculation of the muco-pus of blenorrhcea, simple and com-
              plicated, and in its various seats       .         .     .    128
  u    HI.—Inoculation of the pus taken from buboes   ....  152
  "    IV.—Inoculation of the pus of the secondary and of other reputed
              venereal symptoms.......         193

A tabular view of the inoculations made 1831—37.....210
Results of Dr. Mairion's experiments......212
                       PART THE  THIRD.

                       THERAPEUTICAL summary.

                             CHAPTER I.

Exposition of the methods of treatment which have proved most successful
    at the hospital for venereal diseases......215
General remarks..........215
Prophylactic treatment  of the primary venereal diseases  ....  216

                             CHAPTER H.

Treatment of virulent affections........220

                           Primary Syphilis.

Section I.—Chancres........         ,  220
   "   II.—Buboes..........234

                   Secondary  or Constitutional Syphilis.

Ssf^TioN I.—General remarks........244
   "   II.—Prophylactic treatment.......    245
   "   IH.—Secondary and tertiary affections  ......  248 
                               CONTENTS.                            339

                                                                    PAGE
Section IV.—Application of the general  precepts to particular cases.—
             Special treatment of secondary affections   ....  258
             Syphiloids.........258
             Ulcers..........260
             Syphilitic iritis.......    .    261
             Syphilitic testicle........262
             Falling off of the hair and nails.....263
   "     V.—Special treatment of the tertiary symptoms     ...  263
             Osteocopic pains       .......    266
             Periostitis.........267
             Syphilitic ostitis........268
             Gummata,  nodus........272

                             CHAPTER in.

Treatment of nonAiirulent affections.......275
Section I.—Blenorrhcea    .........    275
       n.—Special treatment of blenorrhcea in women   ....  278
              «      «           "         men   ....    289
              "      "           "      common to both sexes  .     .316
   "  HI.—Excrescences or vegetations......320
   "  IV.—Phymosis and paraphymosis.......321
Special formulary
325 
 
RECOMMENDATIONS.                 5
 From  Valentine Matt, M. D.,  Professor of Principles and Opera!urns
          of Surgery, and Surgical and Pathological Anatomy.

   The subscriber is personally acquainted with Dr. Ricord, and has seen much
 of his practice, not only in his Hospital, but in private, and can bear testimony to
 his merits as a Practitioner, and also to the value of his  <; Piactical Treatise on
 Venereal Diseases," now about to be translated for the  general use  of the Pro-
 fession in this country.  The present translation is offered to subscribers at Jess
 cost than the French edition at Paris.
                              Valentim: Mott,  M. D., Prof, of Surgery,

                       From Dr. J. K. Rodgeis.
   The work of Ricord is one of the very best which have been published on Vene-
 real Diseases, and I  think  that a good English translation will  prove of great
 service to the Profession.
                                       J. Kearney Rodgers, M. D.

   From Willard Parker, M. D., Professoi of Surgery and Surgical
                               Anatomy.
   I have seen Dr. Ricord in his Hospital, and have been very much interested in
watching his experiments and his practice.   1 regard the result ot  liIs labors  ol
more importance than anything which has appeared since the days of Hunter, and
it  gives me great pleasure to  know that  so valuable a work as his " Piactical
Treatise on Venereal  Diseases" is to be presented to the Profession in the JrJng-
lish language.
                                          Willard Paukxr,  M. D.
 From Granville  Sharp P iltison, M.  D., Professor  of General, De-
                   scriptive, and Surgical Anatomy.

  I im pleased to learn that M. Ricord's work on Venereal  Disuses  is about to
be translated and published in this country.  The eminence of this distinguished
gentleman in his profession, and the very extended opportunilies possessed by nun
for the observation of Venereal Diseases, must render his Treatise a  most  ara-
ble addition to ovr Medical Literature.
                                     Granville S. Pattison, M.  D. 
                           RECOMMENDATIONS

  From. John  W.  Francis, late Professor of Obstetrics in the College
                      of Physicians and Surgeons.

  M. Ricord's " Practical Treatise on Venereal Diseases" is a substantial addi
Lion to our stock of sound professional knowledge.  The vast industry and exten
sive practical information of this intrepid and philosophical examiner, have led tc
the overthrow of many popular errors, and the confirmation of important sanitary
axioms in the treatment of a formidable class of direful disorders.   The reprint
ot n is  book  in  this  country will do vast good, and none need doubt that the task
vqiill be ably  performed by his American editor.
                                              John W. Francis, M. D.
         From Alfred  C. Post, M. D., Professor of Surgery.
  M. Ricord's Treatise on Venereal Diseases'  » generally acknowledged, by those
who are best capable  of judging, to be one of the most valuable on the subiect
which has ever appeared.   I doubt, not that every subscriber will be fully repaid
f<u  I he small expense he  will incur,  ty tr.L urge amount of original and usefu
iii&rmaiion which he will receive.
                                                Alfuep  C. Post. M. D 
 
 
 
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