8. In his treatment of syphilis, he was thoroughly of the old school. He could not acquiesce in the modern idea of the curability of the disease without the use of mercury, His experience had been very extensive. He had seen many cases in which he ascribed the greatest mischiefs to what he considered an imperfect course; and he believed that a lengthened perseverance in the sovereign remedy alone succeeded in eradicating the poison out of the system. He ascribed the evils attributed to mercury, rather to its abuse, and to its being administered while the patient was attending to his usual employments, exposed to the open air of our variable climate.

We, in the present day, are more disposed to ascribe the success which has doubtless attended treatment such as his, to the diet and regimen to which the patient is always subjected when he is entirely under the care of a judicious surgeon.

9. In stricture Mr Walker's experience was very extensive, and he had a large share of success. His success depended much upon his accustomed assiduous attention to each individual case; but chiefly, he believed, to his thorough and unhesitating confidence in the use of caustic.

It is not my part to defend his practice in this respect. He was not aware of those more correct views and more simple treatment which have been placed before the profession in later years. Whether these views will be universally adopted and carried out in practice, I do not know; but I am convinced that many a sufferer will be relieved, will be cured, by the perineal incision. Mr Walker, however, was a successful surgeon, and his treatment, unphilosophical as it may appear to us in principle, and severe as it certainly was in practice, was yet the means of a radical cure in many inveterate cases.

He was too much in the habit of making a mystery of his plans of treatment, and he was unwilling to exhibit his instruments to others. Liberality was not a very general character of the surgery of a large class of our surgeons half a century ago. Without boasting too much, we may claim for surgeons at the present day a greater share of regard for the profession at large, instead of a selfish regard to their own personal pecuniary interest.

Mr Walker evinced a very warm, almost a paternal regard, for his apprentices; and to one of them, Dr John Graham Stuart, stationed as assistant-surgeon in the Company's service at Ahmedabad, he sent a set of the instruments which he used in stricture, between twenty and thirty in number, specimens of which I now exhibit. He accompanied the present with a letter, dated 19th February 1824, detailing his mode of using them; and it is this which I take leave to submit to the notice of the society. I do it in accordance with the wish of Dr Stuart himself, that others

should be made acquainted with the views of one whom he esteemed, and of whose success he was at times a witness. The whole. may appear to some, who do not know how imperfect the caustic treatment of that day was in the hands of others, as a piece of idle antiquarianism. But still the instruments have done good service in their day, and may do so still,-unless the cutting system is perfect, and in need of no help,-in the hands of one who has time and address to use them. The addition to the catheter, too, may be trifling, but it is one of great use in many cases; and the light, hollow, silver bougies are very elegant instruments. The plan of treatment described in the letter has been useful to many, and I do not think that the society will regret that it has been laid before them.

"I need not say with what pleasure I send the caustic instruments, and I hope they will be as successful in your hands as they have been in mine. I need not say the object of the instruments is to apply the caustic not to the anterior part of the stricture, but within it, and that this forms the great difficulty in the treatment, and cause of the tedious cure, particularly in the long or ribbon stricture, as it is called, which is generally more diseased also. I consider, therefore, an instrument that can convey the caustic with undeviating certainty in this manner is invaluable; and I am truly surprised that, with all the genius possessed by modern surgeons, quickened also by the sacra fames, nothing of the kind has ever yet been attempted in this way.

"The caustic used with the instrument is potassa, which should be as perfect and uninjured as possible by the air's action. It must be reduced to fine powder in a small china mortar. To this add from a third to two-thirds of Spanish soap, also in powder. After incorporating them, a little soft water must be cautiously and gradually added, till it gets to the consistence of a paste, or soft mass for pills; and must then be put into a small widemouthed phial, firmly corked or stoppered. I sometimes add a small quantity of very pure and finely powdered opium, previously rubbing it with the soap, but whether with any advantage I cannot say. It will be as well not to prepare much of the paste at once. I seldom prepare above a drachm or a drachm and a-half at one time.

"In using it, take a small portion out with a silver knife or probe, and put it upon a bit of soft leather, which rub upon the holes of the instrument, till they are filled. Then wipe it clean with a soft rag, that the paste may be nowhere but in the holes. It must then be oiled, and introduced with as much quickness as the feelings of the patient will admit, down upon the stricture, which you must now enter, and after remaining a few seconds

within it, move gently backwards and forwards three or four times, taking care not to go, if possible, beyond the limits of the stricture. After withdrawing it, I sometimes used to inject a syringe full of warm oil, which soothes the parts; and generally give an opiate, which is preferable per anum, by means of a small one-ounce syringe, which will convey an ounce of mucilage and 40 or 80 drops of laudanum with great ease.

Before introducing the caustic instrument, it will be proper to pass a full sized common or silver bougie down to the stricture, but not to pass it. This widens the passage, removes spasm, and

facilitates the introduction of the other.

"Should much pain, irritation, or suppression take place from the use of the caustic, I need not say fomentations to the perinæum, and opiate clysters, will be required, with the camphor mixture used for three or four times a day.

"I suppose you are aware that the slough produced by this caustic is quite different from that by the nitrate of silver. The latter is a tough tubular membrane, while by this it is gelatinous and bloody, as it acts at once, and dissolves the stricture, particularly if it is spongy and tender, of which we generally can judge by the feel in passing, by its bleeding readily, and by its being accompanied by a puriform discharge. When it is in this state, the potass acts powerfully, and brings away a great deal of gelatinous brownish slough.

"After the lapse of a few days, it may be as well to examine the stricture by the bougie, so as to ascertain if you have gained ground, and determine both the propriety of another application, and the size of the instrument to be employed; because a single application may have been sufficient to put the stricture in a state to be afterwards managed by the bougie; at the same time, as this mode requires the instrument to be firmly grasped by the stricture in order to its effectual action, we must enlarge the instrument as we gain upon the stricture, at the same time we must guard against undue irritation from the too frequent or too severe application of the caustic, and use as little of it as we can, till we know more of our patient, and what he can bear. Indeed, at all times, as a general maxim, I would say, never use the caustic when you can do your purpose by the bougie, though I know most strictures of long standing will not do without a few applications of the caustic; then the bougie acts with the utmost advantage, after the diseased surface is removed, which is the business of the caustic, and not of the bougie.

"I have often been surprised at the effects of a single application of caustic, when I have not had an opportunity of examining the patient for two or three weeks after it has been used and when, therefore, all invitation and swelling have left the parts. This should lead us not to be too hurried in renewing our applications; for, till the swelling subsides, we never can know what we have

gained, and better act with caution. Though some recover much sooner than others, I should say a week is the usual time.

"I do not think this caustic acts so readily upon healthy parts as the nitrate of silver. If, after one or more applications, therefore, you find the instrument, when withdrawn, clean, without slough, I should be disposed to consider the parts much improved, and perhaps not requiring the use of more caustic.

"After withdrawing the instrument, it should be cleansed from slough as well as caustic, by dipping it in hot water, and, with a bit of pointed wood or tooth of a comb, clearing the holes; and this will be completed by the aid of a brush, so as to remove all remains of caustic. The instruments are covered with leather slips, which I have used for many years. Too great attention cannot be given to preserve the polish of the instrument; the slightest scratch is like a file to the delicate membrane."

The letter contains directions for the construction of bougies armed with lunar caustic, which he considered an aid in some forms of the disease. He describes a valuable varnish with which he used to coat his bougies. He describes also silver bougies fitted with a joint ivory dilator for the stricture very near the extremity of the urethra, and some other ingenious mechanical contrivances. The letter was written in the confidence of friendship, without study. I have extracted those parts which related chiefly to the caustic treatment.

ART. V.-Cases which appear to prove that Secondary Syphilis is capable of being communicated to the Healthy. By JAMES STARK, M.D., F.R.S.E., Fellow of the Royal College of Physicians of Edinburgh.

ALMOST all recent writers on Syphilis are agreed that that disease is only communicable to the healthy while in its primary stage; but that, when it reaches its secondary and tertiary stages, viz., exists in the form of various eruptions on the skin and mucous surfaces (secondary), or of affections of the subcutaneous submucous, fibrous and osseous tissues (tertiary), it is incapable of transmission to a healthy person.

It

appears to me that in arriving at this conclusion, the medical men of the present day have gone too far to the opposite extreme of the old doctrine of the infectious nature of syphilis, and have allowed themselves to arrive at this conclusion, from experiments of a somewhat questionable nature. The chief experiments on which their conclusions are founded rest on the fact, VOL. LXXV. No. 187.

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that matter taken from secondary or tertiary sores, and applied to other parts of the patient's body, do not in him generate sores similar to those from which they were taken; and they hence jump to the conclusion, that secondary and tertiary syphilis are not contagious.

It does not appear to me that such evidence is of any weight in establishing such a doctrine. Matter from a sore may not be capable of raising a similar sore in a person who is suffering from secondary syphilis, and yet be capable of communicating infection to a person who is healthy.

As in matters of this kind facts are much better than theories, I beg to offer to the profession the three following cases of secondary and tertiary infection, in which I was enabled fully to trace the history of each case, and was forced to arrive at the conclusion that the disease was not propagated in its first or primary state, but unquestionably in its secondary or tertiary forms.

As these three cases were the only ones met with in the course of a seventeen years' practice, they are not recorded with the view of denying or disproving the general truth of the non-communicability of secondary or tertiary syphilis, but with the view of showing that exceptional cases do occur, and that they are perhaps more common than writers on syphilis are aware of. When a person contracts this disease primarily, he in general avoids his usual medical attendant, and seeks the aid of those who may have acquired some notoriety for their attention to cases of this kind. Buf if, after the lapse of months, he marries, and communicates secondary syphilis to his wife, the case comes unsuspectingly before the ordinary medical attendant, who, for the sake of the parties, wisely keeps the secret to himself; and if he omits to record it by publication, the knowledge dies with him, and is lost to the profession.

A. R., a servant girl, in the fourth month of pregnancy, contracted syphilis in the shape of primary chancre, from her paramour, but, by the employment of appropriate remedies, was perfectly cured before the seventh month. At the full term, 1st August 1834, she brought forth a female child, to all appearance healthy and free from disease; and, as she got a situation as wet nurse within a month, she gave her own child to Mrs M'D., an old woman of about 60 years, to bring up on the bottle or by the spoon.

On the 6th of January 1835 I was requested to visit Mrs M'D., for an affection of the throat, which gave her much uneasiness. I found her labouring under decided symptoms of syphilitic sore throat. The uvula was the seat of ulcerative action, and was more than half destroyed. There was a large perforated ulceration through the left velum palati, and the right velum pa