LETTERS ON SYPHILIS. ANFORD LIBI LETTER I. MY DEAR FRIEND: The new doctrine on Syphilis experiences the fate of every scientific discovery. For nearly twenty years, I have sought, by my teaching and by my writings, to make it penetrate the minds of my contemporaries. I see, however, that it is not equally understood by all. Certain adversaries still make objections to it-objections which I have a hundred times refuted; and, what is more curious, others seize upon objections raised by myself, and imagine, a little naively, perhaps, they can vanquish me with arguments introduced into this discussion by myself. At this I am neither astonished nor indignant. On the contrary, I find in it a new inducement to continue my work; and, far from complaining of my adversaries, I rather thank them for keeping my zeal on the alert. Thus, I am about to ask your permission to make an exposition of the true doctrines of the Hôpital du Midi, in your widely-circulated journal. Allow me to say that it is less an individual response, than a general exposition, which I intend to make. As I proceed, I shall encounter objections, and will endeavor to reply to them; I will also bear in mind, as far as I ought, a recent publication from the pen of one of your skilful co-laborers, who, in order to find followers, need not have gone modestly to the country to seek them. I will present you, my dear friend, a preliminary reflection suggested by the publication to which I have just alluded. Because an observer may not be permitted to see all the facts of a errors. particular part of pathology, and to arrange a general system, we must not hence conclude that this observer has accomplished nothing, has seen nothing, has established nothing-that his labors and his researches ought to be regarded as naught; and thus make a clean sweep of his teaching. This method of philosophizing in medicine, perhaps a little too common at this day, is convenient and expeditious; but it is neither true nor just. In Syphilography, particularly, it would lead to deplorable A serious study of the history of our art demands more moderation of language, more justice of appreciation. For my part, I am pleased to recognize and to proclaim that, instead of all Syphilographic literature being worthy of contempt, there is to be found in it, by those competent to observe them, interesting and curious observations, sound precepts, and even doctrinal absurdities which some find it good to exhume, while they discredit their source. Of a surety, the long discussions on mercury, guaiacum, sarsaparilla, &c., are not wholly devoid of utility; the history of blennorrhagia may be cleared up by the observations of those who have preceded us. Undoubtedly, the spirit of speculation and charlatanism have left too frequent traces of. their existence; but you will often find in them also the indications of a sound judgment, of a veritable scientific tendency, and of laudable efforts to arrive at a systemization and a doctrine. Besides, had these labors no other interest than that of reflecting the ideas and opinions of past times, they would not merit the contempt which has been so unjustly cast upon them. I would profess the same belief in regard to observers of modern times. Criticism, I know by experience, finds frequent occasions to exercise itself upon their works. But must we hence consider these works unimportant? Far from me be this injurious thought. On the contrary, I hold in great esteem the writings of Bell, of John Hunter, of Swediaur. The time has come to render full justice to the two Culleriers; to M. Lagneau, particularly, whose reputation was justly popular; and to all those intelligent and energetic workmen, by means of whose conscientious studies we have been enabled to advance with increased facility in the path they sought to open for us. Should I be unjust towards my contemporaries? God forbid, MLORD TIBI dear friend. Whatever may be our differences, it is with hearty pleasure that I render the most sincere homage to the works of MM. Baumès, Gibert, Cazenave, Cullerier (the nephew), Bottex, Ratier, Puche, Diday, Payan, Venot, in France; to Wallace, Carmichael, Babington, and my pupils Acton and Méric, in England; to Thiry and Herion, in Belgium; and to the remarkable publications of laborious Germany and of ingenious Italy. I do not then experience, either towards the past or towards the present, any sentiment of injustice or of disdain. You will excuse me for making this declaration very explicitly before entering upon the subject. I think it proper to say that I partake in no manner of the opinion of those exacting and difficult critics, according to whom both ancient and modern Syphilography is only a medley unworthy of attention. I believe, on the contrary, that this branch of pathology is as fertile as any other in useful works and valuable researches. However, the works of the ancients and moderns have not preserved this part of our science from the general revolutions impressed upon medicine by the physiological doctrine. The school of Broussais, in blotting out the past, had put everything in doubt. Was there a syphilitic virus? Did syphilis exist? You know how physiologism resolved these questions. The most extreme confusion reigned in science, and was transferred to the publications of the time. Doubt was everywhere; certainty nowhere. It was at this epoch that, surgeon by "concours" to the Central Bureau of the hospitals, it was my lot to enter the Hôpital du Midi. I there met an honest and loyal man, a serious and honest practitioner, M. Cullerier, who, having abandoned the family traditions, so to speak, had taken upon himself to doubt his own observations, and appeared no longer to believe what he had seen. Everywhere doubt had displaced belief. There was doubt concerning the cause of syphilis, doubt concerning its effects, and, as a consequence, doubt in relation to its therapeutics. And mark! that which was called the new doctrine was enveloped by a great scientific apparatus. M. Richond des Brus wrote an enormous book completely filled with facts; M. Des ruelles supported the new idea by statistics which were regarded as exact; all strove to combat the speciality of the disease and the specific nature of the remedy. History was largely laid under contribution by one of the most learned writers of our century, M. Jourdan, who, in one of the most remarkable works of our epoch, was pleased to take observers, one by one, and to put them in contradiction with themselves; an easy triumph, if the critic, in a rigorous and impartial analysis, does not know how to establish a marked difference between the ideas peculiar to the author, those which result from his researches and his observations, and those which he draws from the scientific media of his time. The first are useful materials, which it is necessary to preserve; the others constitute the prejudices of the epoch, and have only an historical value. Jourdan did not take this precaution; it sufficed him, in order to combat the specific nature of the disease, to indicate the confusion of opinion among our predecessors, and he did it with a luxury of erudition which would have been an ornament to a more healthy criticism. Such, then, was the state of opinion and of science when I entered the Hôpital du Midi. It was necessary to rebuild, according to some, a ruined edifice; according to others, only to consolidate it. That which was most of all necessary was to investigate the cause of Syphilis. Had it a special virus? Or, were venereal accidents the result of a common cause? For this research and this study, two methods of observation presented themselves to my mind. The first was the pure and simple observation of phenomena― a method practised by our predecessors, but which had conducted them to such contrary opinions. This method was followed by Devergie, and is not unlike that adopted by Vigaroux, by Blegny, &c., in their report, for example, of the case of three officers, all of whom, having connection with the same young girl affected with a discharge, became infected-the first with a urethritis, the second with a chancre, and the third with warts. It is true that Devergie failed to afford information on one small |