cidents, which is incomplete relative to some important points to which I must return. I wish that in these cases the disease be veritable constitutional syphilis. I admit that the appearance of these syphilitic accidents corresponds as to time with the occurrence of the blennorrhagia; but can we be sure, from this fact alone, that the patients had had nothing but a blennorrhagia-that syphilis could not have entered at some other door? My confrère of Lyons has somewhere said that I denied the possibility of a constitutional infection as a result of simple blennorrhagia, because I had never met with an example of it. On the contrary, it is because I have often had the opportunity of seeing patients in whom physicians, who think differently from me, have recognized only a simple blennorrhagia where I have found another door for the entrance of syphilis;—it is because of this, I say, that my convictions have become more and more strengthened.

When those who seek to show that a simple blennorrhagia should give rise to syphilis have told you that the patients presented ulcerations neither on the fingers nor on the genital organs, they think they have proved all it is necessary to prove. They forget the innumerable ports of entry which the surface of the body presents; secret, deceptive doors, which close almost as soon as they have opened, of which the patients have no knowledge, or which they have an interest in concealing. How many students have come to me from other hospitals of Paris, in whom nothing but a blennorrhagia had been found, and in whom I afterwards found chancres in peculiar situations! In this connection, I present a history, the analogues of which are frequently met in my practice:

A lady came to consult me for a disease of the rectum; the symptoms of which she complained were those of fissure. Upon examination, I found nothing at the anus; but the finger, introduced into the intestine, enabled me to recognize, opposite the internal sphincter, a fissure situated anteriorly, and reposing upon a hardened base. I proposed to operate; she refused. I then submitted her to injections of rhatany. Her treatment had lasted scarcely fifteen days, when I perceived an exanthematic eruption, having all the characters of a confluent

syphilitic roseola. Pushing the examination further, I recog nized the engorgement of the posterior cervical ganglia. The patient experienced nocturnal cephalalgia, and some crusts had already began to be developed in the scalp. No doubt could remain as to the nature of the accidents. I then examined the genital organs, but could find nothing there but a very simple uterine catarrh. I interrogated her as to the circumstances in which she had been placed relative to the contagion of syphilis, and she confessed to me that her husband was diseased; that he had ulcerations upon the penis; and that, from fear of communicating them to her, he had connection with her a preposterá venere. Then the nature of the deep fissure was un

veiled.

In this case, is it not true that, without the painful accidents determined by the fissure, ulceration would have passed unnoticed? It would then have happened that the only antecedent would have been a simple uterine catarrh.

But there exist still other causes of error which I must mention. This will be the object of my next letter

MY DEAR FRIEND: Let us continue the exhibition of facts and arguments which have been opposed to my doctrine.

There is an observer about whose works my opponents make much ado; and these works are, in fact, worthy of the greatest esteem. I have noticed them honorably in my preceding letter, and you see me disposed to accord to them all the value they deserve. This observer, whose conclusions have constantly been opposed to mine, is C. Martins. Well! how far do the results at which M. Martins has arrived elucidate the great question concerning the consequences of blennorrhagia as a cause of syphilis. Mark! it is precisely on account of his closeness of observation, of his scientific method, of his statistics in short, that the conclusions of this author have excited so much atten

tion. What, then, do his statistics show? I find them very favorable to my doctrines. Do I flatter myself in this? You shall be the judge.

M. Martins gives an account of sixty cases of syphilis. Now how many times did he note chancre as an antecedent? Fortysix times, my dear friend. M. Martins assures us that in fourteen cases only he met with no other antecedent than simple blennorrhagia, two of which had bubo, and two orchitis. But he adds that he did not diagnose the blennorrhagias, but was obliged to accept the testimony of the patients. You know what I think on this point. Undoubtedly here is testimony which we ought to believe; but I will ever contend that, when the question concerns a diagnosis so difficult as that of urethral chancre, the testimony of persons wholly strangers to the art, who are often unlearned and narrow-minded, who understand neither the importance nor the bearing of a question, is of very little value. Without doubt, the testimony of such persons is received in graver matters, in questions of life and death; but it does not follow that this testimony is always true, nor the judgments based upon it always equitable.

Allow me to offer a general remark, which is appropriate in this place. In many of the observations of M. Martins, as in many of those of M. Cazenave, and in nearly all of those of a great number of authors, you find in their summary these words: Several primitive accidents. These primitive accidents, which have consecutively brought on constitutional syphilis, are chancre and blennorrhagia. If my opponents, from whatever reasonable motives, attributed the consecutive infection rather to the blennorrhagia than to the chancre, we might examine the doctrine. But no; you know the fact-you have read it—and you ought not to have been the least surprised at it; it is en masse that they group these primitive accidents, without regard to the time which elapses between the appearance of the one and the other. To all they give the same value, and to all they attach the same results. In truth, does this indicate accurate science and rigorous observation? What would you think of a physician who should say to you: There is a man with hydrophobia; he has been bitten ten times-three years, two years, one year, six

months ago, and again quite recently. But his hydrophobia evidently depends upon the successive inoculations which he has undergone. Or, here is a variolous patient who has with impunity passed through five or six epidemics of smallpox; at the last the disease was developed; but this result was due only to successive contagions and infections.

I confess that I do not thus understand science. I am astonished that so critical a mind as that of M. Martins, who acknowledges with myself that blennorrhagia is most usually due to causes wholly foreign to syphilis; who is logically forced to admit that blennorrhagic antecedents, as causes of syphilis, are extremely rare, and that chancre is, consequently, the most frequent antecedent of pox-I am astonished, I say, that M. Martins, in arriving at the conclusion that a simple blennorrhagia can occasion syphilis, should be satisfied with the three observations of which he has made choice out of sixty, and especially with the one which I here present:

"An apothecary, aged twenty-three, contracts a blennorrhagia; but it incommodes him so little that he continues to pursue his occupations; he hunts; and even cohabits with women. An orchitis supervenes which requires treatment; the blennorrhagia is cured after six months. Seven years afterwards, an ulceration appears at the opening of the left nares, another on the internal surface of the lower lip. These ulcerations extend; the whole of the left half of the two lips is affected; afterwards they partially heal, in order to ulcerate at other points; the ulcerations are rounded, and the edges perpendicular; the cicatrices exhibit a thin, rosy skin, which is in folds. The patient, admitted to the wards of M. Biett, was cured in one month by the use of the proto-iodide of mercury. Shall we say that this patient, partly a physician, whom we saw scrupulously examine himself at the hospital, had chancres without knowing the fact?"

Yes, certainly, will I say that this patient had very well characterized chancres, from the description given of the case by M. Martins, who had neither seen nor recognized them, undoubtedly because of the abnormal seat which they occupied. As to the mode of contagion, M. Martins will not ask information of me, nor will I take it upon myself to indicate it. Besides,

he knows as well as I how these accidents may supervene, without supposing any trickery in the practice of the profession, even of this fine apothecary.

You know, my dear confrère, that chancres with a strange seat, and difficult to be discovered, are less rare than has been thought. I cited you one example in my last letter. There are several others:

Some years since, M. Lusterman, professor at Val-de-Grace, brought to me a lawyer, on whose lower eyelid, at the inner angle of the eye, was a hard, resistant, elastic tumor, with a red, granulated surface, tending towards cicatrization. This tumor had already been seen by several confrères; and, if my memory is faithful, men specially devoted to ophthalmology had been consulted; but its nature was still unknown. I was consulted to know whether it was dependent upon any more or less distant syphilitic antecedent. Prosecuting my examination farther than my confrères, I found the peri-auricular ganglia engorged, resistant, indolent, as well as those of the parotidean and sub-maxillary regions. The posterior cervical ganglia were themselves already tumefied. The surface of the body was covered with exanthematous spots, belonging to the best characterized syphilitic roseolæ. Lenticular dark red spots, leaving in some points, under the pressure of the finger, a tawny yellow spot. Absence of fever and itching.

To the great astonishment of M. Lusterman, my diagnosis was this:

Indurated chancre of the inner angle of the eye (successive engorgement of the peri-auricular, parotidean, and sub-maxillary ganglia); secondary cervical adenopathy; syphilitic roseola; precocious secondary accidents.

To the great astonishment of the patient, I said to him: "It is at most two or three months since you carried to your eye the contagious matter which inoculated you with syphilis."

Upon recovering from his surprise, the patient replied: "In fact, I recollect that, while sleeping with a woman, and after certain touchings, I was seized with a vivid itching of the eye. I raised my hand to it and rubbed it some time. It is since that time, in fact, that my eyelid became affected."