syphilis the unfortunate child subjected to the experiment? A scrofulous child, affected with a lupus, with such a skin as you are aware these patients possess; living, according to the above statement, among venereal patients, with no precautions taken in relation to it; with no guarantee whatever that the cicatrices, which are so apt to be irritated and excoriated in such patients, and afterwards to furnish an easy entrance to the contagious matter, in almost constant circulation in venereal hospitals, were duly protected! Thus, inasmuch as all the accidents subsequently developed cannot be attributed to the patient who furnished the blood, the two tubercles developed only thirty-four days after the experiment, are, in my opinion, due to another method of contagion, from which this little patient was not protected! For, whilst the evolution of the chancres with an indurated base occurred upon the thigh in the most regular manner (only in slightly gigantic proportions, since the base of the chancre attained the size of a pigeon's egg, which probably depended upon the concomitant pathological state of the little patient), another tubercle, of the same form, of a more common size, is seen upon the right shoulder, of which we neither know the cause, nor the time of its first appearance, and which is probably not the direct result of the inoculation, unless a blade of the scarificator may have gone astray. But what produced this tubercle of the shoulder? Whence comes it? No matter; its explanation is not attempted; it is sufficient to explain the development of the tubercles of the thigh, by the fact of the inoculation of the blood, without going farther. Yet this tubercle of the shoulder is not an accident consecutive to the first secondary accidents of the inoculation, for it appeared simultaneously with them; whilst the true secondary manifestations, which were perfectly regular, only appeared thirty-two days subsequent to the appearance of the primitive accidents.

These last accidents were verified by numerous and honorable confrères, whose knowledge I in nowise call in question. These gentlemen stated what they saw and recognized perfectly well. But, notwithstanding their number and the authority of their names, before which I am ready to bow, I should, had they offered their united testimony to certify that the infection could

have taken place only according to the theory of M. Waller, be convinced that M. Waller was not alone deceived.

But M. Waller is unfortunate. I believed that Wallace was dead; I had even the boldness to add a few words to his funeral oration. It seems that I have been deceived.

Be this as it may, had I commenced to read the Bohemian work at the end, instead of at the beginning, I might perhaps have dispensed with my remarks on this last and astonishing observation; for the violent attack of its author upon my friend Diday, of Lyons, would have led me to think that he did not believe in the possibility of inoculating constitutional syphilis, unless he restricted his belief in inoculation to secondary accidents, and held that tertiary blood is no longer virulent, notwithstanding the influence of this period upon the hereditary diathesis; the relations of which influence are brought forward by M. Waller when necessary. M. Waller is right in affirming that my friend Diday produced no result from tertiary inoculations; but M. Diday can, in turn, say to M. Waller that the latter has done no more than himself, in this connection, with secondary blood; for, if he cannot be exonerated from the charge of communicating syphilis to the patient of his first experiment, he ought to receive the most complete absolution for that of the second.

I will make a proposition to those who propagate among us the opinions of M. Waller: Let them present the facts which I have just cited to the Société Anatomique and to the Société Médicale d'Observation.

But they dare not do it!

In view of what I have stated, my dear friend, you will permit me to say to you that I have not made a single step towards acquiring a knowledge of the German language; and that 1 shall understand the new propositions of M. Waller, and his conclusions in regard to sanitary police and legal medicine, only when he shall give us observations which I cannot translate by simple common sense without the help of German, as I have been enabled to translate those he has just given us with so much pretension.

It is for you, and particularly for your numerous and im

partial readers, to decide whether I have gained my battle of

Prague.

Yours,

RICORD.

LETTER XXXI.

MY DEAR FRIEND: Previous to our excursion to Prague, we were studying the manifestations of constitutional syphilis.

I told you that, when no treatment had been directed against the chancre, these manifestations occurred within a given time, and pursued a certain order which allowed of their classification.

In fact notwithstanding the efforts of those who wish to envelop everything in obscurity-from the moment that the constitutional infection takes place as a result of the primitive accident, the patient has acquired what Hunter, with reason, designated the syphilitic disposition-that is to say, the syphilitic diathesis; and from that moment the accidents show themselves more or less quickly, and progress with more or less rapidity, in different situations and upon different tissues.

In the first place, in what may be considered as a period of incubation, up to a certain point, the first effects we frequently observe, are more or less marked disturbance of hematosis and of innervation.

Prior to any other manifestation, I have been able, in a great number of analyses of the blood, made with the utmost care by M. Grassi, and mentioned in the inaugural thesis of my pupil and friend M. McCarthy, to verify the diminution of the bloodglobules, the chloro-anæmia, which is about to accompany the secondary accidents properly so called, and which is often very marked.

At this period, too, and frequently before the appearance of any other symptom, and as a first consequence of the disease, vision becomes affected, and the muscular strength weakened; neuralgic pains in the head, and rheumatic pains of the memhers, also supervene. These precocious secondary pains, which

may also show themselves at the same time that secondary accidents become manifest, and which may return alone, or accompanied by the latter, are not found at any other period, unless they be systematically confounded with another order of pains. It is no part of my plan to write a detailed history of these varieties of prodromic neuroses or of the secondary period of syphilis-neuroses which are not invariably observed, which are often even wanting, but which possess the common characters which are of sufficient importance to deserve mention.

These neuroses consist of intermittent nocturnal pains, which are especially manifested under the influence of heat, especially that of the bed. Consequently, in patients who turn night into day, and vice versa, this species of attack is inverted. The pains of this period do not regularly return every time in the same seat, and, during the intermission, pressure does not occasion them. Indeed, some patients frequently experience relief at the moment of the greatest suffering, not only by exposing the painful parts to the action of cold, but also by compressing them. Motion of the members in which the rheumatoidal pains are seated relieves rather than increases these pains, which the patients only complain of in the neighborhood of the articulations, and at times in the dorso-lumbar region. In these cases, there exists no change in the color of the skin, no change of temperature, no tumefaction. In some circumstances, the feelings are simply those of lassitude, which ordinarily cease when other symptoms, such as the cutaneous eruptions, manifest themselves.

At this period especially of the precocious accidents, one of the most constant manifestations is adenopathies-adenopathies which may be designated, with the utmost precision, secondary buboes.

The affection of the lymphatic ganglia, at the secondary period, merits particular attention. It is, in some measure, characteristic of this period.

This variety of adenopathy is seldom wanting, when we know how to seek it, and it often constitutes one of the first proofs of the infection. Sometimes it is present from the third week, but oftener after the sixth, and thus succeeds to the indolent

multiple adenopathy which is invariably symptomatic of indurated chancre.

The seat which it prefers is the posterior cervical or cervicocephalic region. It is much more rarely found elsewhere. Nevertheless, I have seen other ganglia tumefied in a small number of subjects; but then it is necessary to be careful not to be deceived by other causes of ganglionary engorgement, and especially by primitive accidents at unusual seats, or by the strumous dispositions which everywhere favor engorgements of the lymphatic glands, but certainly less in the posterior cervical region than anywhere else.

The true secondary adenopathies never attain a very large size; they are indolent, and usually multiple; they never suppurate, or at least they never suppurate specifically; they never furnish inoculable pus.

Undoubtedly, as most observers have verified, this variety of adenopathy is only observed when the skin is already the seat of an eruption, which is usually superficial; but I can affirm that I have found the engorgement of the posterior cervical, of the occipital, of the mastoidean ganglia, in patients who did not present the least trace of an eruption on the scalp. My colleague at the Hôpital du Midi, M. Puche, says he has observed the same circumstance. It is certain that, if this variety of adenopathy is connected with certain forms of secondary accidents with which alone it is found, it is not always produced by these secondary accidents in the same regions; inasmuch as the indurated chancre produces its own ganglionary satellites, which, aside from this inevitable solidarity, are very analogous, and even identical, in other respects. At all events, if these two varieties of syphilitic adenopathy may sometimes be confounded, they can always be distinguished from that variety which is produced by the non-indurated and non-infecting chancre, the variety which suppurates, and which furnishes inoculable pus.

These secondary adenopathies are not to be found after a certain period. You will not see them produced, for the first time, at the late secondary period, and far less at the tertiary period of syphilis. If the late accidents are accompanied by diseased ganglia, seek and you will find sufficient reasons for