and if its pyogenic pseudo-membrane is destroyed, virulent matter is still reproduced with all its specific qualities. Hence we deduce the conclusion that there exists a sphere of virulent activity, the radius of which is proportional to the extent and duration of the ulceration. Consequently, and this fact it is important to bear in mind, the caustic must penetrate to a point beyond the area of specific inflammation, if we expect it to prove efficacious.

I have stated that every chancre, whatever may be its extent, is bounded by tissues which are not in a state of virulence, and that on these tissues a simple wound may be made which will easily cicatrize. This limit, beyond which the caustic must penetrate, it is difficult to determine. I can at least state that I have always been successful when I have cauterized the parts to an extent double that of the ulceration, and including the whole thickness of the tissues. It may easily be conceived that the extent of certain ulcerations, and their situation, may be such as not always to allow us to operate in this way. Consequently, cauterization frequently fails; almost always, in fact, when nitrate of silver is used. This caustic, the action of which is very superficial, is only adapted to the lightest and most recent accidents.

The Vienna paste is the best caustic which I have used. I have never failed with it when I wished to destroy a pustule only five or six days old. In this case, a single application almost always suffices to produce a dry eschar, which is detached little by little by a cicatrix that forms beneath it. If the eschar falls too quickly, or if it is forced off by the suppuration, nothing is left but a simple sore.

The arsenical paste has also yielded me very satisfactory results; but I have always employed it in a positive manner, that is to say, allopathically; for you know that this therapeutic agent, when used homoeopathically, has been said to be successful in the hands of a learned confrère.

The actual cautery is likewise an excellent remedial agent, the best perhaps that can be employed, were it not so frightful in the eyes of the patient, and were it not that we are unable to use chloroform whenever we wish to make use of this means of cauterization.

I am experimenting, at this time, with the mono-hydrated nitric acid, in view of the excellent results obtained from it in Belgium and England, as an abortive agent, not only in phagedænic, but also in simple chancres. In a great number of cases, in which I have perfectly succeeded with it, it would appear that the ulcerations can be neutralized without the necessity of destroying so much of the tissues as with the other caustics. Yet it must be acknowledged that its action is very painful; that the pain it occasions endures longer than that produced by the Vienna paste; and that, if the primitive ulcer be somewhat extensive, we are ordinarily obliged to make several applications of it at an interval of two or three days.

Whatever be the caustic employed, its application must be repeated as often as, on the fall of the eschar, there is perceived the lardaceous base peculiar to the period of progress. Afterwards, recourse ought to be had to a less powerful caustic, with the sole object of directing the cicatrization.

Hunter, who, as you know, was strongly favorable to the cauterization of chancre, also advised its excision. Whenever we can excise too prominent nymphæ which serve as the seat of primitive ulcerations; whenever we can remove a too lengthy prepuce, whose edge is affected; and whenever we can cut sufficiently far from the diseased parts, this operation ought to be preferred, because at the same time that we remove a disease we cause a deformity to disappear. But this operation is inadmissible whenever, as is usually the case, the seat of the chancre is such as not to allow us to cut to a sufficient distance into the neighboring parts.

Excision, like cauterization, is useless in indurated chancre. The most early excisions of the specific induration have never prevented the manifestation of the symptoms of constitutional infection.

In all cases, whatever be the means employed for the more or less rapid destruction of chancre-whether excision or cauterization-we should never forget to fulfil all the other indications which may be presented.

But allow me to finish this letter, my dear friend, or, if you prefer, this postscript to my last epistle, by repeating the

statement that the cauterization of chancre is an admirable remedial measure, and that it is yet, in a social point of view, the most powerful prophylaxis of the syphilitic disease that we possess, since, by its certain and prompt destruction of the contagious accidents, it obliterates the foci of infection. All the conclusions I have presented on this subject are deduced from many thousand facts, and from rigid and patient experimentation.

Permit me further to add, relative to the prophylaxis of chancre, that it would be a great error to suppose that, in proportion as accidents are developed, or contagion after contagion successively acquired, the chancres which supervene are less active than those which have preceded them, and that they gradually lose their intensity, as far as their number is concerned, and finally become incapable of further reproduction.

The reverse of this is frequently observed. The chancres which are contracted latest may be more active than the pri mary ones, and may even take on the phagedanic form, which most generally occurs when there exists a syphilitic diathesis, or syphilization (to use the expression of those who dislike the accepted term). So true, indeed, is this statement, that I consider the syphilitic diathesis as a cause of the phagedænic form of the disease. The proof of this fact I promise to furnish you, whenever you desire it, at the venereal hospital. Hereafter, however, I shall return to all these doctrinal points.

In the mean while, the laws deduced from experiments on animals would prove that the inoculation of the syphilitic virus gives essentially different results, according as it is practised on man or animals. These laws, if indeed they are laws, have, in no respect, thus far, invalidated what I have said on this subject. Therefore, let us await further developments.

You recollect, perhaps, that Frike, of Hamburg, who has also experimented on inoculation, thought he observed that successive inoculations gradually lost their intensity, and that their effect became null at the sixth experiment, when practised on the same individual. I have made eight consecutive experiments in the inoculation of chancre, and have never noticed the least difference between the effect of each experiment.

Frike, to whom I exhibited these results, was forced to confess that he had deceived himself.

In my next letter, I shall commence the exposition of my doctrine upon bubo.

MY DEAR FRIEND: First of all, let me give my excuses and regrets for my prolonged silence. I do not dare to call to mind. the date of my last letter. It is better to acknowledge one's errors than to give a bad excuse for them. I confess, then, that a long time has elapsed since I promised to speak of buboes. Give me credit at least for being logical; for, you know, I do not admit the bubo d'emblée.

Buboes, with due submission to Astruc, are as old as man, unless the first man was without lymphatic ganglia. They were well known to the Jews, who, according to Apion, were subject to them during their sojourn in Judea. Good King David appears to me to have been much afflicted with them. They form a very interesting and important subject of study.

You are aware, my dear friend, that for the ample treatment of this subject, the epistolary is not so well adapted as the didactic style; but I must restrict myself to the limits which I imposed upon myself, and which were accepted by you.

That which I am about to set forth, I have inculcated for so long a time that it may now be considered, in great measure, the property of the profession; and yet there are still those who have not forgotten what they learned at the school in 1828, and what is contained in the last edition of M. Lagneau.

Be this as it may, can bubo, regarded as a venereal accident, be developed unless another accident has preceded it? Can it be considered as the first consequence of an impure contact? Can it be assumed to supervene d'emblée? On what is this opinion, which dates back to the time of the mysteries, based? What is there to prove its truth? Analyze, my dear friend, all

the observations adduced in its support, and everywhere you will perceive a want of appreciation of causes, false analogies, errors in diagnosis, ignorance of the laws of evolution and their possible consequences.

Any contact, or connection, provided it be suspicious, no matter at what period it is developed subsequent to the appearance of the bubo, is considered a sufficient cause of its existence. The same elasticity is exhibited in the method of drawing conclusions relative to what is designated the period of incubation. With respect to the previous relations of the patient, it is always to the person who inspires the least confidence that the disease is traced, in order to explain a ganglionary engorgement whose cause cannot be found, and this is done without knowing, in most cases, what the infection of the accused person really is. According to this method of reasoning, every ganglionary engorgement which exists may be considered of a venereal nature. But if the simple contact of virulent pus with non-denuded surfaces is sufficient to occasion buboes, without previously producing other accidents, it follows that the bubo d'emblée, the rarest of all forms of bubo, even according to the partisans of this doctrine, should be the most frequent of all; inasmuch as the case in which excoriation follows contact with contagious parts are far more numerous than the instances in which contact produces excoriation.

In the multitude of patients whom we see in such large institutions as the venereal hospital of Paris, and in whom there frequently exist numerous chancres, furnishing a large amount of specific pus which soils the neighboring parts, are buboes ever seen to supervene, excepting by means of the lymphatics connected with these ulcerations? True, in cases of this kind, it is essential to guard against the illusions which misled M. Schals, of Strasbourg, and those who have so naïvely cited him.

To those who, like myself, have rejected the bubo d'emblée, the following query has been addressed: "Why will you not admit that the venereal virus may traverse the skin and the mucous membranes, so as to reach the ganglia, without necessarily inflaming or ulcerating them, since many other matters are ab