while the chancre furnishes inoculable pus, the balano-posthitis does not. (Hereafter we shall see that, in order that the pus of chancre may act specifically, conditions are necessary which are not always present.)

Adhering, then, to my first conclusion, and reducing to their just value these primary objections, I affirm that, when Harrison produced blennorrhagia with the pus of chancres, this pus either acted in the manner of simple irritants, or it produced a urethral chancre; this fact he did not verify. In the same way we shall see that, when Hunter produced a chancre with the pretended pus of a blennorrhagia, it was with the product of a veritable urethral chancre that he had to deal.

But if inoculation has proved that the cause, or causes of blennorrhagia, whatever be its seat in the two sexes, differs from the specific cause, from the virus which infallibly produces chancre, the consequences of blennorrhagia ought always, then, to differ from those of chancre; and yet how many cases of constitutional syphilis are attributed to blennorrhagia!

These are questions, my dear friend, which will form the subject of my next letter. We shall then see if it be possible to establish a differential diagnosis between affections which some wish systematically to confound.

You will first permit me to say a word on the incubation of blennorrhagia.

MY DEAR FRIEND: As I promised, I am about to say a few words to you concerning the incubation of blennorrhagia.

Incubation has been made a condition of virulence. Every virulent malady must present a period of incubation. Thus, those who admit that blennorrhagia is the product of a virus equally admit that this virus only produces its primary effects after a period of incubation of greater or less duration.

I say of greater or less duration, and this not without reason.

For the incubation of blennorrhagia, as well as for that of syphilis properly so called, authors have admitted a period which one can no longer conveniently determine. Its term has been fixed between several hours (Hunter and others), and fifty days and upwards (Bell). Here is certainly a very elastic contagion.

You know that this is far from being the case in virulent diseases, where incubation is incontestable. The limits of the period of incubation may be more clearly fixed in smallpox, in kinepox, in scarlatina, in measles, in hydrophobia. The instructive work of M. Aubert-Roche has even apprised us of the definite limit of the incubation of the plague, which never exceeds eight days. With respect to blennorrhagia, the case is different, as we are soon to see. There are here no certain limits.

What is this incubation of blennorrhagia, which I have been forced, even recently, to deny? We must understand it; it is a pure question of words. I do not deny that, between the action. of the cause and the appearance of the first symptoms of blennorrhagia, there elapses a longer or a shorter period; but is this an incubation properly so called? an incubation similar to that of variola or vaccinia? I contest the fact; and I explain the longer or shorter period which elapses between the action of the cause and the appearance of the phenomena, by the condition, by the particular susceptibility of the tissues which have been exposed to the influence of the cause. There is no more incubation than there is between the action of cold on the feet and the appearance of a coryza. A person does not have a discharge of muco-pus from the nose immediately after the application of cold to the feet; a certain time passes between the two acts. Do you call this time the incubation of the coryza? Why, then, use a similar expression in relation to blennorrhagia?

In those cases in which the blennorrhagia only appears a long time subsequent to the exposure to the presumed cause, is it not more rational to admit an unknown cause: a cause other than this pretended incubation, which nothing explains and which nothing authenticates? Is it not thus in nearly all inflammations? Is it possible always to arrive at the direct cause of a pneumonia, or of an arthritis, of a phlegmon?

Undoubtedly, in man, the most powerful cause of blennor. rhagia is sexual intercourse; but we should fall into strange errors if we attempted to refer all blennorrhagias to a virulent cause. I could cite you some very singular examples which prove the contrary; but I refer the reader to the interesting note with which you accompanied my preceding letter.

From this exclusive manner of considering the etiology of blennorrhagia, there often results, in practice, a singular method of interpreting facts. A man, affected with blennorrhagia, has had connection with several women; he hastens to make a kind of moral choice between them, and by elimination it frequently happens that the most innocent one is hit upon. This application of the law of suspicions has given rise to singular errors, of which I have often been the witness.

Hence, we conclude that the effects of blennorrhagia may be separated from the cause which produces them, but that there is no proof that the time which elapses between the action of the cause and the appearance of the morbid phenomena, is the result of a true virulent incubation.

I will not, my dear friend, be too unfaithful to my programme; but still, how is it possible not to enter upon some questions when they force themselves immediately on your notice? Such is the case with the specific seat of blennorrhagia. This seat, you know, has been much tormented. In man, it has been made to travel from behind, forwards; from before, backwards; to advance, to retire, at the will of the fruitful imagination of syphilographists. From the spermatic ducts, passing successively by the glands of Cowper, the fossa navicularis and the follicles of Morgagni, the seat of blennorrhagia has journeyed extensively. It is true that Bell, by establishing different degrees of blennorrhagia, caused its seat to retrograde. But it is not with these well-known questions that I wish to entertain you. I would, however, mention a strange preoccupation of Hunter. This great observer, you are aware, admitted a virulent blennorrhagia identical with chancre; he placed its seat in the fossa navicularis; but he asks whether this inflammation, which may be propagated step by step towards the posterior portions of the urethra, continues virulent beyond the fossa

navicularis! It must be confessed that the genius of Hunter permitted itself to be singularly governed by the spirit of system. Besides, in studying Hunter, we see his observing genius continually struggling with his theory of blennorrhagia. He is a victim of a false idea. Facts come incessantly to demonstrate this to him; but the theory is there to bind his intelligence, and, in place of uncloaking his theory by the facts, he seeks to make the facts agree with his theory. An illustrious example of the dangers of preconceived ideas in the culture of the experimental sciences.

In woman, Graff placed the seat of virulent blennorrhagia in the follicles which lie in the neighborhood of the urethra. Moulinié, of Bordeaux, one of our brotherhood, some years deceased, thought he saw in the vulvar glands, so well described by Bartholin, something like an organ of virulence, in a blennorrhagic point of view.

Amidst all these opinions, rigorous observation has shown that such portions of the mucous membranes as are most exposed are the most easily affected. Nevertheless, we must acknowledge that the urethral mucous membrane, in both sexes, is more frequently diseased, after sexual intercourse, than the other mucous membranes of the genital organs. This fact is an argument in favor of the partisans of virulent contagion. I will corroborate it by this proposition, which seems to me to be incontestable― that a woman affected with a urethral blennorrhagia may, generally, be considered to have contracted it from a man also affected with blennorrhagia. And this proposition, you see, may be important in legal medicine. Thus, for my part, I would be inclined to admit that a woman, in whom I found a urethral blennorrhagia, contracted the disease from a man. But does this fact furnish any support to the idea of the existence of a virulent contagion? No; for I explain it by this other fact, perfectly true and incontestable-that the pus furnished by the urethra is the most irritating of all pus with respect to certain mucous membranes.

While some syphilographists contest the existence of urethral blennorrhagia in women, others admit the existence of the disease in her only so far as the urethra is its seat. These two extreme

opinions are erroneous. Observation has led me to admit every variety of blennorrhagia on all the mucous membranes.

At this point, will you allow me to get rid of some other questions incidental to blennorrhagia? Henceforth I shall proceed more freely and more rapidly with respect to the great questions which remain to be treated.

If I examine the lesions of tissue produced by blennorrhagia, whatever be the mucous membrane affected, I find nothing which simple inflammation may not produce. Sometimes the part presents a light erythematous condition, without secretion. This is the dry gonorrhea of some authors, a ridiculous and absurd designation; in view of which one cannot help admiring the persevering efforts of M. Piorry to effect a reform in nomenclature. Sometimes it is a mucous, catarrhal element, and all its products, with which we have to do. Finally, there occur real phlegmonous complications, from which result in man the chordee blennorrhagia, and the tolerably frequent production of abscesses along the tract of the urethra.

But neither in the state of the tissues, nor in the nature of the products, do we find anything which can be compared with the accidents of syphilis, properly so called.

Are the consequences of blennorrhagia comparable to those of syphilis? This has been asserted, but not proved. Some analogy undoubtedly exists between the two, but what notable differences!

Thus, one of the first accidents which blennorrhagia may induce, and which resembles one of those produced by syphilis, is bubo. But, first, adenites are infinitely more rare as a result of blennorrhagia than as a result of chancre. Bubo is never met with in blennorrhagia, unless where the disease affects the urethra in either sex; the other varieties never occasioning adenitis. I am well aware that a physician of Belgium speaks of peri-auricular buboes, which are manifested in ocular blennorrhagias; but I confess that of these I am yet to meet an example. Finally, blennorrhagic bubo possesses this peculiar feature; it is frankly inflammatory; it has but little tendency to suppuration; and when this does happen, the pus is never inoculable.

Would you proceed to ascertain what blennorrhagia may pro