has tumors which distress her greatly. See what the disease can be.". Before entering the wife's chamber, I made another examination of the husband, and found him as pure as he was on the day of his nuptials. But it was not so with his wife; I found mucous papules confluent and developed, in such a way as to render it certain that the starting-point of the accidents dated anterior to the marriage. Convinced that the husband had had no influence in this sad affair, and that he could not have given a disease which he did not possess himself, I said to the woman in a firm tone: "Madam, you are diseased; and it is not your husband who has rendered you so. If I become your confidant, I also become your accomplice. If not, I remain the physician of your husband."

I soon obtained a painful and distressing confession, which gave me the solution of this sad enigma.

I relate this incident, because it presents this interesting fact, that, since his marriage, the husband had not passed two days without repeated connection with his wife; and yet he had remained absolutely free from disease.

I have not finished my remarks on mucous papules. Allow me to return to them in my next letter.

You are

MY DEAR FRIEND: I return to mucous papules. aware that, according to many syphilographists, this secondary accident is contagious. Among the proofs invoked in support of this doctrine, it is necessary to note the hypothesis according to which the successive development of these mucous pa pules upon the parts of the skin contiguous to those on which the accident was first developed is considered the result of contagion. Thus, we see patients in whom these papules are at first developed on the side of the scrotum; if others chance to be developed upon the inner part of the thigh, the partisans of this opinion attribute them to contagion. If from one side of

the anus, these papules gain the opposite side, they still cry contagion, and so in other cases. Those of my brethren who profess this doctrine-among whom there are some in high places-simply forget one little circumstance; they neglect to consider the cause which produced the first patch; that is to say, the state of constitutional infection in which the patient is placed, a state which may produce a second and a third patch, for they do not all appear at the same time. The consideration of the preference these patches exhibit for a given seat can in nowise come to the aid of the doctrine of contagion. If it is a fact that there is contiguity of skin where these patches appear, it is equally certain that there also the acrid secretions are more active; that the skin has, in these places, a tendency to mucous transformation, as in the vicinity of the genital organs, the anus, &c. How otherwise explain by contagion the development of mucous patches from one axilla to the other?

I shall therefore remain convinced, until the contrary is proved, that when mucous tubercles, which have been admitted to be primitive, are believed to have been contagious, there must have been an error in diagnosis. It may be useful to call to mind the fact that a chancre, at the period of reparation, often takes on the granulating aspect of mucous patches; that it sometimes undergoes a veritable metamorphosis, and becomes, in situ, a secondary accident the nature and physiognomy of which are those of mucous patches.

If its commencement has not been observed; if the evidence furnished by the neighboring ganglia has not been invoked, so modified may the remains of the margin of ulceration and the character of its base have become, as to render the differential diagnosis exceedingly difficult, especially to eyes unaccustomed to observe, and to fingers unskilled in manipulation. If to this difficulty, you add the fact that there are particular seats where primitive accidents are not usually observed, or where the transformation of the chancre is especially easy and rapid, such as the lips, the tongue, and the nipples, you will see how easy it is to be deceived.

All those poxes, occasioned by a lascivious kiss, or by the utensils of the table, by pipes, by razors, by masks, &c., have

no other origin. And how frequently have these circumstances been made the honest pretexts for dissembling in relation to other contacts! The mask particularly has always-and even in our day-proved a very convenient means of dissimulating a compromising diagnosis.

Even in certain religious customs, my dear friend, proofs of secondary contagion have been sought. In this category have been ranged the syphilitic accidents transmitted to children by the process of Hebrew circumcision. But these accidents find their natural explanation in the presence of primitive accidents in the mouth of the peritomist. Allow me to say here that I have been among those who have most contributed towards inducing the Israelitish Consistory of Paris to reject the ancient and dangerous practice of sucking.

Many physicians are absolutely unwilling to take into account the facility with which chancre passes to the secondary state. They occupy themselves only with its seat; and when they see a chancre in the mouth, they are led, from this circumstance alone, to consider it as a secondary accident. This is a grave error, and it gives me occasion to say that primitive ulcers are much more common in the mouth than in the anus. The latter, indeed, I find more rarely than formerly, both in hospitals and in private practice. It appears to me that certain shameful practices are diminishing in frequency, and that this is a favorable symptom of progress in public morality. Be this as it may, do not conclude from the simple fact that a chancre has its seat in the mouth, that it is a secondary ulcer. Do not forget the famous genito-labial nerve of Voltaire-a pleasant witticism which it is sometimes necessary to regard in a serious aspect. I know a professional brother, in high position, who is firmly convinced that an ulcer of the cheek was communicated to him by a secondary kiss.

As I have told you that I had often seen persons, affected with different varieties of mucous papules of the genital organs, transmit no disease in their sexual relations, I shall also say that I have seen a number equally great with mucous patches of the lips, of the tongue, of the throat, live with their families, and indulge in all usual buccal contacts, with the same impu

nity. I know a gentleman, residing in the suburbs of Paris, whose lips and tongue have, for the last six months, exhibited mucous tubercles. This gentleman has had all possible relations with his mistress; and though he is very negligent in regard to his treatment, for he is convinced that his accidents cannot be contagious, he has continued his connection without ever communicating any infection.

It is in regard to the transmissibility of these secondary accidents from the nurse to the nursling, and vice versa, that this question becomes especially important. The fact of this transmissibility is generally admitted. Hunter, however, denied it; and many close observers partake of his opinion. This is so grave a question that you cannot refuse me permission to give some developments in regard to it. It concerns public hygiene, and often has special relation to legal medicine. As fraud, bad faith, and cupidity may be brought into play, it is important to be on one's guard against all the causes of error, and not to accept with complacency the dicta of persons who may have more or less interest in deceiving us.

In consulting the archives of science, and seeking the basis on which the opinion of the transmissibility of secondary syphilitic accidents from the nurse to the nursling, and reciprocally, is found, we are astonished at the slight value of the facts which meet the eye, as well as at the meagreness of detail which has satisfied so many eminent men. M. Bouchut, for example, in a memoir recently published (Gazette Médicale, 20th April, 1850), has collected all the facts which appeared to him most positive. Now, read this work, in other respects interesting, and you will be convinced that the greater part of these assumed facts are inadmissible; that the observations which appear most conclusive are deficient in essential details, and are so incomplete that M. Bouchut himself is forced to acknowledge the fact; to such a degree, indeed, that he finally admits his conviction on this point to be rather moral than scientific.

Here are my own observations on this point: I have seen instances in which the nurse and the nursling were mutually charged with propagating the infection. Generally, I have been able to go back to a primitive accident in one or the other, and

thus find the regular starting-point. Sometimes, I have ob served merely simple coincidences. In cases where it has been impossible for me to go back to the primary cause, the infants had been presented to me only five or six months subsequent to being placed with a nurse.

For many years, I had a ward of nurses at the Hôpital du Midi, where I often received women affected with simple leucorrhoeas; I gave them infants to suckle, sent to me from the Maternité. These infants had secondary accidents; but never, so far as my observation extended, did these nurses become infected.

On the other hand, nurses exhibiting very manifest secondary accidents, have given the breast to infants supposed to be affected with syphilis, but in which were observed, in reality, nothing but eczematous, impetiginous eruptions, or varieties of porrigo; yet in no instance did these infants become infected.

My learned and illustrious friend, Dr. Nonat, who had for a long period the care of the nurses dependent on the administration of the hospitals, has arrived at the same conclusions; and he does not believe in the transmissibility of secondary accidents from nurse to nursling, and vice versa.

In my private practice, I have witnessed numerous facts of this kind. The following is one which I saw in connection with my friend, Dr. Chailly-Honoré. The subject was an infant born with an hereditary syphilis, in which, six weeks after birth, there supervened various accidents, mucous papules of the ano-genital regions, moist squamous papules of the body and members, and deep ulcerations of the lower lip. Well! this child was given to a nurse at the moment of its birth. We were able to observe both it and the nurse during the eighteen months that the suckling lasted. The ulceration of the lip lasted three months; this ulceration was scarcely cured, when, in spite of careful and prolonged methodical treatment, a new ulceration manifested itself upon the velum palati, which also resisted treatment several months. Now, this nurse remained free from all infection; she enjoyed, and still enjoys, perfect health.

Certainly, this fact is well worthy of attention. I have just observed an analogous case with my associate, M. Bassereau;