advises a "daily dose to produce a sensible or physiological effect for six months." The rule I invariably act upon is to continue the specific remedy for two or three weeks after the primary disease has disappeared, with all induration of the cicatrix; to advise the patient, when he leaves me, to live regularly, take a smart aperient from time to time, a vapour bath once or twice a week; and to avoid all causes which are likely to interfere with the general health, since it has been shown by Cazenave1 and others that accidental causes affecting the general health very frequently determine an outbreak of syphilis, and hence in confirmed cases regular attacks occasionally supervene in spring and autumn. The state of the mouth should be carefully examined before resorting to a course of mercury; sometimes a stomatitis may be present before the administration of this remedy, and we might thus be deceived in its effect, mistaking the inflammation of the mouth, which was previously in existence, for one which is the result of mercury. It is quite certain that many morbid conditions of the mouth and breath so closely resemble those produced by mercury, that without an examination of the mouth before resorting to a mercurial course, we might be led into great error. When the breath becomes fetid, and the gums tender, the mercury must be diminished in quantity, and the chlorate of potass given. Patients may also use slight astringent gargles, with the mineral acids.2 M. Desruelles, surgeon to the military hospital of Val-deGrâce, having the charge of the venereal department of that establishment, and a partisan of the simple or physiological 1 'Traité des Syphilides; Causes des Syphilides,' p. 529.-See also a remarkable case, and the remarks on it by Sir B. Brodie (Lectures on Pathology and Surgery,' p. 247), which fully bear out what I have said on this subject. 2 B Soda chlorid. solutionis (Beaufoy's); Tinct. myrrhæ, ãã 3ss.; R Aquæ destillatæ, 3vij; M. ft. garg. Aluminis et potassæ sulph., Dij; M. ft. garg. treatment of syphilis without mercury, entertains the following opinions as to its use: Certain chancres with a hard base, which leave behind them in healing an indurated cicatrix, are more frequently followed by secondary symptoms when treated without mercury, than if this remedy had been given. When venereal sores become stationary, or do not heal under the simple treatment, and the exhibition of mercury is not contra-indicated by the inflammatory or irritable condition of the sore, or certain states of the constitution, mercury may be advantageously used. Mercury is not to be employed when any of the viscera present symptoms of irritation, when the patient applies immediately after having contracted his disease, or when the sore heals quickly under the simple treatment. Mercury may be given when the local inflammation accompanying a venereal sore has been subdued, and the patient is prepared for its exhibition by diet and aperients, the sore remaining indolent, of a bad aspect, and not healing or appearing to be influenced by the simple treatment. This remedy may be also employed if the sores are complicated with inflammation or enlargement of the glands of the groin, or if any affection of the skin, as papular or other eruptions, make their appearance during the simple treatment, and there is reason to believe the constitution affected. CHAPTER III. ON INOCULATION, AS APPLIED TO THE DIAGNOSIS AND TREATMENT OF SYPHILITIC DISEASES. HUNTER practised inoculation, but not on an extensive scale. His experiments led him into numerous errors; they led him to conclude that a chancre and a gonorrhoea were the same disease, and that secondary symptoms, because they were not inoculable with a lancet puncture, were not contagious; opinions at variance with modern observation and the result of more extended experiments. M. Ricord has deduced from an extended series of experiments certain conclusions of great value and importance, which he has given to the world in his great work, 'Traité Pratique des Maladies Vénériennes; ou, Recherches critiques et expérimentales sur l'Inoculation, appliquée à l'étude de ces maladies.'1 A chancre is produced by a specific matter which is secreted by a chancre only, which matter produces a similar disease whenever placed in circumstances favourable to contagion. This is found in the pus which simple or non-indurated chancres secrete, and also in indurated chancres which furnish or have been made to furnish a purulent secretion. This specific matter is only secreted from the surface of a chancre during its first stage, that is, during the period of ulceration, or when the sore is indolent or stationary. At these periods only does a chancre secrete a virus capable of producing a similar disease by inoculation. When the sore begins to heal and a process of reparation has commenced, it is merely a simple ulcer, does not furnish a specific secretion, and is not capable of propagation by inoculation.2 1 Paris, 1838. 2 It would appear that these views were likewise entertained by Dr Wallace, who divides a chancre into two distinct stages or phases—the first If matter be taken from a chancre during the period of ulceration, and introduced under the epidermis by means of a lancet, it produces the following effects. During the first twenty-four hours the puncture becomes more or less inflamed; from the second to the third day it is accompanied with slight tumefaction, and presents the appearance of a small papula surrounded with a red areola; from the third to the fourth day the disease assumes a vesicular form, the epidermis being raised by a fluid more or less opaque, presenting at its apex a small dark point; from the fourth to the fifth day the contents of the vesicle become purulent, the apex of the pustule depressed resembling very much the pustule of smallpox. At this period the areola, which had progressively increased, begins to diminish or altogether disappears, particularly if the disease does not increase after the fifth day, however, the subjacent and surrounding tissues, which hitherto had undergone little or no modification, or were merely slightly oedematous, become indurated by the extravasation of a plastic lymph, which communicates to the touch the resistance and elasticity of cartilage. After the sixth day the contents of the pustule thicken, the pustule itself shrivels up, and is covered with crusts. These enlarge towards their base, and forming by successive strata, at length assume the form of a truncated cone with a depressed apex. If these crusts are detached, or if they fall off, we find under them an ulcer with the hard base of which we have spoken, extending through the whole thickness of the skin. The surface of this ulcer, of a deep red colour, is foul, covered with a thick adhesive pultaceous matter, almost like a false membrane, which cannot be removed by any attempt to clean the sore. The edges of the ulceration at this period as though it had been dug out from surrounding parts by a sharp circular instrument. The immediate vicinity of the sore is surrounded by a red, dark, or livid margin, more elevated than the surrounding parts. Such is the course which the inoculation of the syphilitic one of ulceration, the second one of reparation; he particularly insists upon the impropriety and danger of administering mercury during the first stage, that of ulceration. virus generally runs, when the inoculation is successful, and when the matter is taken from a simple or non-indurated chancre secreting pus freely. The The indurated or infecting chancre is very difficult to inoculate; it is the simple chancre, with a profuse purulent secretion and a soft base, which produces a characteristic pustule when inoculated. M. Fournier, in the notes to M. Ricord's Lectures on Chancre previously alluded to, gives a detailed account of forty-four cases of simple chancre which were inoculated; forty-four positive results followed. He adds fifty-five inoculations of indurated chancres which yielded no results. The indurated chancre cannot be commonly inoculated with the lancet puncture; but the following experiment made by Dr Faye shows that, under these circumstances, it is readily propagated by inoculation: "The patient had a true indurated chancre, from which the pus was tried with sixty inoculations by lancet puncture, on eight different persons, without the slightest effect. A small incision was then made in the patient's arm, and some threads moistened in the pus of his own chancre inserted into it daily. By these means venereal ulcers were obtained which yielded pus of great intensity, and which was readily inoculable. This experiment showed the fallacy as to the matter from an indurated chancre being regarded as non-inoculable."- Edinburgh Monthly Journal,' October, 1857, p. 364. Probably the mode of inoculation is in fault when indurated chancres fail to be inoculated. Such was the fact clearly in Dr Faye's case; although the lancet puncture failed, yet another mode of inoculation succeeded. The same takes place with respect to secondary symptoms, which although not inoculable by a lancet puncture, are commonly so in other modes which I shall presently allude to. That inoculation should succeed, it should be carefully performed. I always raise the epidermis with a new or carefully-cleansed lancet, and introduce the virus on the tip of a new vaccine point; this should be done two or three times, if the first puncture does not succeed. Primary venereal sores of a phagedenic character should never be inoculated. (See, in addition, On different Forms of Primary Syphilitic Inoculation,' by Mr Henry Lee, Medico-Chir. Transactions,' vol. xlii.) The ulcerations completely destroyed or arrested on the third, |