been called to the case too late, or because we have misunderstood them, we may be certain that, if the patient was affected with blennorrhagia symptomatic of chancre, six months will not elapse without the supervention of accidents, if the constitutional infection has taken place.

We must next examine whether, in the last analysis, it is not better to wait, in order to make a late diagnosis, the expiration of this time, than to prescribe, during the same period, a mercurial treatment which, after all, does not give us certainty. Yours, RICORD.

LETTER IX.

MY DEAR FRIEND: To-day it is my desire to bring to a close my remarks on blennorrhagia, by a few observations as to its treatment. You will understand that, in these letters, details would be idle and useless. I confine myself, in the questions which arise, to general points, the development of which will form the subject of a special and extended treatise, which I hope to be able to offer hereafter to the judgment of my brethren. In this work, I shall touch upon all the doctrines of the Hôpital du Midi; and I will close the subject of blennorrhagia by some considerations upon its treatment.

On witnessing the pertinacity with which certain syphilographists cling to old ideas concerning blennorrhagia, recognizing and admitting those only which are virulent, it would seem as though they at once subjected every discharge which they meet to mercurial treatment. Well! This is not the fact. Most of them are content with a rational treatment; and M. Vidal ranks himself among this number. His course is the same as my own, with a difference perhaps in my favor; for in what he has written on blennorrhagia, establishing nowhere an absolute differential diagnosis between virulent and benign blennorrhagia, he in no way speaks of an antisyphilitic treatment properly so called. Examine his Treatise on External Pathol. ogy, and you will be astonished, like myself, at finding my col

league adopt so mild a course of treatment, when his views rela'tive to the virulence of blennorrhagia are considered.

I have already alluded to the extraordinary and ridiculous custom of giving copaiba and cubebs for the blennorrhagia of bachelors, and of reserving mercury for every one that would marry. This two-sided therapeutics reminds me of the history of one of my old colleagues at the Hôpital du Midi. He had, in his youth, like many others, contracted blennorrhagias. At a later period he was about to espouse the daughter of an old syphilographist, who was a believer in the doctrine of precaution. He obtained the hand of his bride only on condition of being subjected to a long-continued treatment with the Liquor of Van Swieten. The treatment finished, the marriage took place. All who were intimate with this colleague, and even those who have been present at his clinical conferences, have heard his oftrepeated and bitter recrimination against this preparatory treatment. Besides, it was very useless in the case of our colleague, for he retained an habitual discharge from the urethra, which he was accustomed to present as a final and peremptory argument to those persons whom he did not succeed in curing of a similar inconvenience.

Others, with more apparent rationality, in admitting the virulent blennorrhagia, while confessing their inability to distinguish it from benign blennorrhagia, nevertheless prescribe, at all hazards, the mercurial treatment. Of this number is Hunter, and the method of reasoning he adopts to explain the treatment of blennorrhagia is quite singular. If Hunter had no other title to the gratitude and admiration of the learned, his writings would not have come down to us; and M. Richelot, your learned and modest co-laborer and friend, would not have endowed France with his fine translation of the works of the great English physiologist. Listen to Hunter. The following passage is one of no common importance:

"Whatever methods are used for the cure, locally or constitutionally, it is always necessary to have in view the possibility of some of the matter being absorbed, and afterwards appearing in the form of a lues venerea, to prevent which I should be inclined to give small doses of mercury internally. At what

time this mercurial course should begin is not easily ascertained; but if the observation be just that a disposition once formed is not to be cured by mercury, but that mercury has the power of preventing a disposition from forming, as was formerly explained, we should begin early, and continue it to the end of the disease, till the formation of venereal matter ceases, and even for some time after. The mercurial ointment may be used where mercury disagrees with the stomach and intestines.

"This practice appears to be more necessary if the discharge has continued a considerable time, and especially if the treatment has been simply by evacuants, for in the former case there is a greater time for absorption, and in the latter we may suppose a greater call for it, such medicines having no effect in carrying off the virus.

"To prevent a lues venerea being produced from absorption, a grain of mercurius calcinatus taken every night, or one at night and another in the morning, may be sufficient, but should be continued in proportion to the duration of the disease.

"The success of this practice in any particular case can never be ascertained, because it is impossible to say when matter has been absorbed, except in cases of buboes; and where it is not known to be absorbed, it is impossible to say that there would have been a lues venerea if mercury had not been given, as very few are infected from a gonorrhoea, although they have taken no mercury. It is, however, safest to give mercury, as we may reasonably suppose it will often prevent a lues venerea, as it does when given during the cure of a chancre or bubo, where we know, from experience, that without it the lues venerea would certainly take place."-Hunter's Complete Works.

I beg your pardon for this long quotation; you know it is not my custom to make extracts; but it seemed the more necessary to do so in the present instance, because this doctrine still serves as a basis for the reasoning and practice of a great number of syphilographists.

It

Is it necessary to dwell on the manner in which Hunter supposes constitutional infection to arise from blennorrhagia? is not the part actually diseased which infects; it is the secreted pus! Hunter evidently had not reflected on this singular mode

of infection; nor, indeed, have those who have followed in his footsteps.

True, this doctrine has been strangely modified and elaborated. Thus, you will find a modern syphilographist admit that, in blennorrhagia, the infection is not derived from that portion of the mucous membrane which is diseased, but from the surrounding healthy mucous membrane, this alone having the power to absorb the virulent pus; whence we must, my dear friend, draw this extravagant conclusion, that, if the urethra throughout its entire length be affected, no apprehension of consecutive infection need ever be entertained.

The mucous cells of Hufeland are also a product of the Hunterian doctrine. He held, you know, that the reason blennorrhagia so seldom infects is that the pus is enveloped in small mucous cells, whence it is not always at liberty to escape.

Let us return to Hunter, and to the painful surprise with which we see this great mind attempting to prevent infection by a mercurial treatment. He assures us that the longer the disease may have lasted, the more chances there will be of infection, and the greater will be the necessity of prescribing mercury; not being aware that, if the mercury merely acted in such a manner as to prevent infection, its administration would be useless after a prolonged duration of the disease, since the infection would be already established and the mercury have no further. influence on it. We are astonished at the confidence with which, in spite of his uncertainty as to the action of mercury against infection, he asserts its efficacy in doses so mathematically determinate. In the passage cited we find only a tissue of nonsense and of contradictions. The mercurial treatment most usually excites blennorrhagic discharges, and Hunter would have it continued up to the complete cessation of all secretion! How many patients, whose discharges do not dry up, would thus be condemned to a perpetual mercurial treatment? The colleague, of whom I have just spoken, would literally have been gorged with mercury. Under the weight of so prolonged a treatment, what would have become of an old soldier whom I treated, and who had contracted a blennorrhagia at the peace of

Amiens, and who still retained it in 1845, that is to say for more than forty years?

The whole of this doctrine of Hunter is deplorable nonsense. Allow me to produce as evidence of my correctness this strange confession: "The success of this treatment can never be established." And this still more singular admission: "We see but few who are affected with constitutional symptoms supervening on a gonorrhoea." Is not the whole question, dear friend, from the admission of Hunter himself, reduced to this: that mercury is only useful in the small number of cases in which blennorrhagia is due to an urethral chancre?

Thus even error itself confirms the correctness of the doctrine of the Hôpital du Midi.

Finally, in considering the treatment of blennorrhagia, we are led to notice the theory of the golden mean. M. Lagneau, who regards blennorrhagia as a slight syphilis, counsels against it a demi-treatment. Here we see peep out the demi-virus, the demi-virulence of our confrère of Lyons, M. Baumes.

Demi-treatment! Slight syphilis! Alas! my dear friend, there is unfortunately nothing slight in the pox, unless it be certain opinions of very grave men. Syphilis exists, or it does not exist. If there is pox, there is need of a complete treatment, as complete as possible; it is necessary to avail ourselves of all the guarantees which a severe and methodical treatment can supply. If the pox does not exist, mon Dieu! for what purpose is an anti-syphilitic treatment instituted?

How should simple and benign blennorrhagia be treated? I again repeat that, at present, I confine myself to the generalities of the question. First, one word as to the abortive treatment. You know all that has been said of repercussion; of the theory of the wolf shut up in the sheepfold. You know all the apprehensions which have been manifested relative to the metastases and peregrinations of the virus in the economy, occasioned by the abortive treatment of blennorrhagia. This doctrine has always astonished me, in view of the crowd of facts which practice daily presents to our notice.

First, it is incontestable that the greater part of the accidents to which blennorrhagia may give rise are scarcely ever