dents manifest themselves after the second or third day from the puncture. Every one who has studied the inoculation of syphilis knows that, when it does not immediately succeed, it is because it is negative.

Nevertheless, we can conceive that a superficial puncture, in which the virulent pus is deposited on scarcely denuded surfaces, may require a somewhat longer period to produce its effects. The first puncture made by M. Robert de Welz was very superficial, and it failed to produce its effect after the first day; so that, in this case, there was something which might be said to resemble incubation. But the second puncture, which I made myself, followed the regular course. "What does that prove?" may be asked by those who support the doctrine of the influence of the general state. "The first puncture had a slow development, because the organism was not sufficiently impregnated. The effects of the second puncture were, on the contrary, rapid, because the virus had then invaded the whole economy." "This is all very fine," I will reply; "but here is a circumstance which slightly mars this beautiful theory. M. de Welz made a third puncture, which, too superficial like the first, gave the usual result."

This, my dear friend, is the explanation of the incubation. Without the assistance of this key, we understand how, in cases of ordinary contagion, virulent pus, applied to more or less denuded surfaces, soon gives rise to a more or less rapid morbid action. We know, by daily observation, confirmed irrefragably by the recent experiments of M. Cullerier, that virulent pus may remain in contact with healthy surfaces without producing any alteration in them, or without undergoing alteration itself; but we also know that surfaces constantly bathed with virulent, acrid, and irritating pus, which excoriates before it acquires a specific character, finally become eroded; and thus the pus itself produces those conditions required for successful inoculation. In this sort of vesication, a period of greater or less duration must elapse before those specific effects, which simulate incubation, appear.

For example, virulent pus is inclosed in a fold of the vulva, of the vagina, of the prepuce, or in the interior of a follicle;

it is only after the pus has been thus deposited, for a longer or shorter period, that, passing through the successive stages which I have just indicated, it acquires the power to inoculate. In all this, we observe no specific effect, but a physical and material fact, which visual observation daily demonstrates to those who are competent to discern. How many patients are there who, at first thought to be affected only with a balano-posthitis, finally exhibit symptoms of chancre! If to this circumstance, you add the negligence of patients; their well-known lack of observation relative to matters which concern themselves—in consequence of which they are prone to regard as the period of incubation the time which simply elapses between exposure to the cause of infection, and its apparent manifestation-you will find, my dear friend, with respect both to chancre and blennorrhagia, the explanation of those pretended incubations whose duration is of so elastic a nature as to vary between a few hours and several weeks, or even months.

You see that I am entering deeper and deeper into these important syphilographic questions. In my next letter, I shall treat of the different forms which chancre may assume.

May your favor, my dear friend, and that of your honored readers, still accompany me. This is my most valued en

couragement.

Yours,

RICORD.

LETTER XVIII.

MY DEAR FRIEND: I have related the history of positive inoculations in my last letter. When the inoculation fails, the punctured part is sometimes slightly irritated; but this irritation soon subsides.

Nevertheless, without seeking to deprive inoculation of any element of exactness which it may possess, it is necessary to recognize, with respect to syphilis, as well as vaccinia and variola, the existence of false pustules. If the examination of the case be slight, their existence may lead to error. My learned col

league, M. Puche, with honorable candor, acknowledges that he was deceived by these false pustules, when he formerly practised inoculations with the muco-pus of balano-posthitis. Consequently, he now accords less value than formerly to the observations contained in the memoir which he published on this subject. These observations he has studied with greater care, and for him they have changed their signification. You ought to understand, my dear friend, that I would not commit so great an impropriety as to speak thus without the formal authorization of M. Puche himself. My critics, then, who created so much commotion about inoculation with the muco-pus of nonulcerous balano-posthitis; who used this supposed fact as a weapon against my doctrines; and sought to prove from it that chancre did not alone furnish inoculable pus, and that the blennorrhagia which inoculated might not be ulcerous, can no longer make use of this argument apart from the above verification, which its author deems indispensable.

These false pustules acquire but little development. They are most frequently only simple bullæ, beneath which there is perceived a superficial vesication of the skin. Here we do not observe that complete boring of the derma, like that made by a punch, which we find in true inoculation. In some rare cases, a more serious inflammation may supervene, and produce something analogous to furuncle; but even in these cases, its progress is always very rapid, and its duration ephemeral, from three to five or six days at the most. Not only so, but its cure is effected without treatment.

Be this as it may, I have stated and I still state that, when the inoculation succeeds, the chancre always commences by a pustule. This fact is incontestable. This pustule can be reproduced at will.

Those syphilographists who have associated with primitive accidents so many phenomena which do not belong to them, would have done well had they also placed among them this ecthyma, which is developed under the circumstances I have just indicated.

It is true that our learned confrère, M. Cazenave, says that ecthyma may sometimes be primitive. In his Treatise on Syphi

lis, he even cites a very fine example of primitive ecthyma of the lip, the direct and immediate consequence of a contagion. But what M. Cazenave says of this case, so common in my experience, proves that neither Biett nor himself knew the true nature of this accident. Read the treatise of M. Cazenave, and you will be convinced that he does not consider the ecthyma, in the case referred to, as merely a stage of chancrous disease. According to him, the ecthyma which he calls primitive is always a syphilide-that is to say, the product of a constitutional infection; in a word, what I call a secondary symptom.

But M. Cazenave endeavors to establish the fact that ecthyma is always the result of a previous general infection, although this is the only accident by which syphilis commences. He confounds chancre the true primitive, contagious, and inoculable ecthyma―at its ecthymatous starting-point, with the secondary, constitutional ecthyma.

After having stated so truly that this accident might be the first and only result of the contagion, which, "aside from the influence of the virus, requires particular conditions for its development"-conditions which necessitate the inoculation of primitive accidents; M. Cazenave—wishing, I say, against his own reason, to bring ecthyma among the syphilides—gives, as examples of primitive pustular syphilides, two observations in which this accident was perfectly secondary, and regularly preceded by a primitive accident of the finger.

This error is very common among persons who are unacquainted with all the varieties of chancre. Was not this error committed by one of our unfortunate confrères, to whom M. Cazenave alludes? Was he not supposed to experience a constitutional infection d'emblée, and to present an example of primitive pustular eruption?-and yet our unfortunate confrère had had a chancre on one of the fingers of his right hand, which was followed by a sub-epitrochlean adenitis. To this adenitis supervened, in regular order, secondary accidents. All this I verified myself; and my verification was confirmed by my learned friend, M. Nélaton. It is true that a person who has not an extensive acquaintance with venereal diseases, although he has written much in relation to them, and was cognizant of

the ulceration upon the finger, pretended that it was only an anatomical tubercle which had given passage to the virus, without being itself inoculated. I am very much afraid that the brain of this person may have given passage to this fine story without being itself inoculated, in the transit, with a little semblance of truth and common sense.

I have not yet finished my remarks on primitive ecthyma. You, who read everything, sometimes from duty, often from taste, and always with profit to those who in their turn read your productions, must have been surprised to see in a Manual of syphilitic diseases, the author of which, as well as the work itself, we hold in great esteem, that the possibility of the production of a pustule by artificial inoculation, but not otherwise, was even admitted. In fact, M. Gibert resolutely denies that chancre, not artificially inoculated, can commence by a pustule. He asserts that this has been considered a stage of chancrous disease, through an error in diagnosis. I think that you already see on which side lies the error. I will say to M. Gibert: "If you admit that a pustule may be produced with the point of a lancet, confess that no great effort of the imagination is needed to find in the processes of ordinary contagion something which may act in the same manner-a nail, a hair, for example-without taking into consideration other circumstances, of which, as a syphilopathist, you must receive the lascivious and disgraceful confessions."

See, my dear friend, how many observers in high station are yet subject to error! Assuredly M. Cazenave and M. Gibert know as well as myself what an ecthyma is; and yet how does it happen that both always obstinately refer it to a state of general infection, and deny it to be a product of chancre? Because theory too often throws a deceptive gauze between the observer and that which he observes; because it is not sufficient, as another observer has just told us, to pass ten years in a venereal hospital, in order to see aright what transpires there, inasmuch as there are eyes which, alas! always gaze, but never see.

I ask your pardon, my dear friend, for my lengthened remarks on the pustular form of chancre. I have detained you on this subject, because, in my opinion, the time has at length