chancre and the urethra, or its absence; but it is very strange that he should seem to consider the simultaneous existence of gonorrhoea and chancre rare, as it is matter of daily occurrence.-J. F. S.

BENJAMIN BELL (a) denies the identity of gonorrhoea and syphilis. He says:-" The refusal of some patients to submit to the distress and inconveniency, the frequent result of a protracted mercurial course, and who, nevertheless, recovered from the usual symptoms of gonorrhoea, first suggested a doubt of the two diseases being produced by the same contagion. The symptoms and consequences of gonorrhoea are perfectly different from those which take place in lues venerea. Both diseases have appeared, at different periods, in the same countries; and, in some instances, they have remained distinct and uncombined for a great length of time." (pp. 2, 3.) As to the assertion "that gonorrhoea sometimes terminates in pox, and, therefore, that this of itself is a sufficient proof of the two affections being of the same nature," he says, "Were it certain that this ever happened no further evidence would be required, as a few well-marked instances would be conclusive; but every unprejudiced practitioner will admit that no sufficient proofs of it have ever occurred. In order to support this opinion, data must be received which we know to be inadmissible. We must admit, that a person with chancres only communicates to another, not only every symptom of pox but of gonorrhea, and that another, with gonorrhea only, gives to all with whom he may have connexion, chancres with their various consequences. This ought, indeed, to be a very common occurrence, insomuch that every practitioner should be able to decide upon it with certainty, if this opinion was well founded. Instead of which, it will be admitted by all, that the one disease being produced by the other is, even in appearance, a very rare occurrence." (pp. 6, 7.) BELL subsequently observes:-"As a further proof of the difference of the contagions of syphilis and gonorrhoea it may be remarked, that no stage of pox has ever been known to induce gonorrhoea, which surely would occasionally happen if the two diseases were of the same nature. We may also remark, that, in numberless instances, people have been poxed by the matter of syphilis being by accident applied to a cut or a scratch, as often happens with surgeons in the dressing of chancres and buboes; but no one ever heard of a pox being got in this manner from the matter of gonorrhoea. It has been said that chancres may be produced by insinuating the matter of gonorrhoea beneath the skin. But experiments upon this subject are productive of such anxiety and distress, that they never have been, nor ever probably will be, repeated so frequently, as the nature of it would require." (pp. 32, 3.) He, however, mentions some experiments made by two young gentlemen upon themselves with a view to ascertain the point in dispute. *** By the introduction of the matter of chancres as well as of buboes into the urethra, some pain and irritation were excited, but no gonorrhæa ensued ; and, by fretting the skin of the prepuce and glans with a lancet, and rubbing the parts with the matter of gonorrhea, slight sores were produced, but they never assumed the appearance of chancres, and they healed easily without mercury." (p. 34.)

BELL flatly denies HUNTER'S assertion, that "at Otaheite every form of the (venereal) disease has been propagated from one root, which, most probably, was a gonorrhoea;" by his statement, "when Captain Cook visited these islands, in his second voyage, we have authority for saying that gonorrhea had not then appeared in them." (p. 36.)

Having thus given an abstract of the opinions of HUNTER and BELL as to the dispute on the identity of gonorrhea with syphilis, it only remains to show that BELL's opinion that, for the reasons above assigned, experiments upon this subject "never probably will be repeated so frequently as the nature of the case requires," can no longer be maintained, as most conclusive experiments have been most ably and numerously made by HERNANDEZ and RICORD, by which the distinct nature of the two diseases is completely proved.

HERNANDEZ (6) had the opportunity of making his observations on galley-slaves, over whom he had perfect control. From these he selected three who had gonorrhoea, to furnish the necessary virus with which he experimented; and he justly observes :-"These experiments, made on seventeen persons, are the most numerous and perhaps the most careful that have been made, and furnish important results. In five of these cases the cure was quick, without internal remedies, and without the ulcers having any venereal appearance. In the others, there were obstinate ulcers, some possessing quite the syphilitic appearance, accompanied with general symptoms which seemed to confirm it. Surely such proofs did not exist in the cases I have mentioned, and yet they were regarded as decisive. Yet all depended upon known internal disorders; all the ulcers yielded to means calculated to destroy these disorders, but which have no virtue in syphilis. *** My experi(a) Quoted at the head of this article, vol. i. Virus Gonorrhoique et Syphilitique. Toulon, 1812. (b) Essai Analytique sur la Nonidentité des Quoted from RICORD.

ments prove that the ulcers which are produced, by inoculating the gonorrheal virus, are not syphilitic, and at the same time point out the source of errors which may render these experiments, which appear so simple and decisive, of little value. They show how eircumstances may change the nature of ulcers, or disguise them, and to such degree that it may easily impose on inattentive observers who do not foresee these cases of complication." (pp. 48, 9; Fr. edit., pp. 112-13.

The assertion that" one woman, having connexion with several men, could give chancres to some, and to others gonorrhoeas and buboes, whence the conclusion as to the identity of the nature of these different actions, the principle being always the same in all, and the difference only in the form determined by the locality and degree in which the cause acts," is now completely disproved by RICORD's observations:-"If such reasoning have remained for a length of time without refutation, it cannot," says he, "be now persisted in. Since I have applied the speculum uteri to the study of venereal diseases, the hitherto inexplicable enigmas are reduced to the most common and simple facts. With the aid of this instrument I have found that a woman may be affected, at the same time, with gonorrhoea and deep chancres of the vagina or uterus and the gonorrhoea alone show itself externally; apparently affected with gonorrhoea, she could very easily communicate chancres and gonorrhoea together, or only one of them, according to the predisposition of the persons who exposed themselves to the infection. But we can affirm, and from numerous observations, that whenever we have examined women who have communicated disease, we never found that a chancre had been produced by a discharge without ulceration in the sexual organs of the person who had communicated. Inoculation has confirmed what observation of ordinary contagion, better made with the assistance of the speculum, had established. In women, gonorrhoea, considered throughout, in the whole extent of the organs of generation, in its different phases of acuteness or duration, and inoculated in the same manner as employed for chancre, produced no result, whenever the mucous membrane was not actually the seat of chancre." (pp. 52, 3; Fr. edit., pp. 118, 19.)

In reference to the opinion that "the cause of chancre and gonorrhoea being the same, the difference in the form depended upon the tissues affected, and that thus the syphilitic virus applied to a non-secreting surface produced a chancre, and the pus of chancre, upon mucous membranes only, produced gonorrhoea," RICORD says, positively :-" We know that gonorrheal matter never produces chancre on the skin, and that, applied to mucous surfaces, when it acts, it only produces a discharge. The gonorrhoeal secretion, applied to the mucous membrane of the eye, has never produced chancres of the conjunctive coat, or of the eyelids, nor, on the other hand, has the muco-purulent secretion of gonorrheal ophthalmia ever produced chancres by inoculation or otherwise, although the eyelids are susceptible of being affected by chancre. We may add that the muco-pus of a balanitis or posthitis, consequent on an impure coition, or produced artificially by an irritant, has never furnished a result by inoculation, and that these affections, therefore, cannot be followed by symptoms of constitutional pox, whenever they have existed withont chancres." (p. 58; Fr. edit., pp. 129-31.) In regard to the two "pretty frequent and regular consecutive symptoms of gonorrhea, buboes, (yet far less frequent than after chancre,) and swelled testicle, I have ascertained, by inoculation, (that the pus from such buboes, the buboes being then in similar condition, does not inoculate, which, in this case, rarely terminate in suppuration, and with engorgements, or simple abscesses, the characters of which frequently correspond to strumous and not syphilitic affections. As to swelled testicle, which still more rarely suppurates, the pus never produced any thing by inoculation." (p. 58; Fr. edit., p. 132.)

The following are the inferences which RICORD draws from his observations on the inoculation of gonorrheal matter :

“ 1. The matter of gonorrhoea, applied to a healthy mucous membrane, causes gonorrhœal inflammation, so much the more easily, the nearer it approaches the purulent form, and therefore, contrary to the opinion of WHATELEY, the less mucous its nature.

"2. Under no circumstances can it produce chancre; but, as an irritating matter, like that of coryza for instance, it may excoriate the skin, with which it remains some time in contact, but it never produces a specific ulcer.

3. The consecutive, undoubted, and regular symptoms of gonorrhea do not furnish an inoculable pus.

"4. The symptoms of constitutional syphilis are not the consequence of gonorrhea. In all the cases in which authors mention that it was an antecedent, the frequency of which precisely corresponds with that of masked chancres, (chancres larves,) the diagnosis was not correct; the diseased surfaces not having been examined.

"5. Lastly, the only correct means of diagnosis, in the present state of science, is ino

culation. Every gonorrhoea which is tested by inoculation in its various periods, without producing any result, is only a simple affection, and incapable of communicating syphilis, whether primary in another subject, or constitutional in the one first affected." (p. 59; Fr. edit., p. 133.)

It is very commonly held by those who consider gonorrhoea and syphilis as distinct diseases, that in the former there is not ulceration, the gonorrhoea being, as described by WALLACE (a), a “ diffused and superficial disease, with increased and altered secretion, but without loss of substance or ulceration." (p. 233.) But, as RICORD observes, it is well known and proved by pathological anatomy, that, as the speculum shows us every day, gonorrhoea is often accompanied or followed by erosions, or more or less extensive destructions of the mucous membranes; but the ulcerated form of gonorrhea, if I may thus express myself, does not render it more capable of being inoculated than that which is not; the gonorrheal ulcers being essentially distinct from chancre." (p. 53; Fr. edit., p. 119.) The best account of gonorrhoeal sores and their consequences is certainly that given by TRAVERS (b).

"The distinguishing features of sores produced by gonorrheal matter are," says TRAVERS,"circularity, flatness without induration, whether raised or level, with the surface; seldom solitary, often several; the greater frequency on the anterior and posterior verge of the perpuce, or beside the frænum, i. e. at the angles of reflection between the layers of the prepuce, or the close and loose investment of the glans, than elsewhere. In the female, they are likewise commonly situated at the junction of the mucous with the cuticular membrane upon the labia, or at their inferior commissure. Their margin is blunt, but not indurated; the character of the granulation is spongy and indolent, and, though they clean readily, they heal slowly." (p. 13.)

"The proper gonorrhoea, or inflammatory secretion from the sound mucous lining of the urethra, while confined to it," says TRAVERS, "is incapable of producing secondary symptoms to the individual; its bubo, if present, is sympathetic, so is the sore throat, or inflamed membrane of the eye or nose, if one or all should follow; i. e. they have no character but that of simple and superficial membranous inflammation. As these unquestionably do sometimes follow, though in so slight a degree as to be scarcely noticeable, the circumstance can only be explained by attributing it to the same consensus partium which determines the selection of these parts for the specific appearances when the matter of secretion is absorbed, and acts as a morbid poison. But, when the matter of gonorrhoea is absorbed by an excoriated surface, and this surface becomes an ulcer, the matter which it secretes is capable of producing, by its absorption into the system, secondary symptoms in the individual. The absence of secondary symptoms in pure gonorrhea depends, therefore, not upon any difference in the quality of the matter, but upon a law of the animal economy, that the inflammatory secretions of the sound surface are not absorbed into the system." (pp. 10, 11.)

The secondary symptoms of the gonorrheal sore are as strongly marked," continues TRAVERS, "present as distinct a character as those of lues. The glands in the groin are oftener large and indurated, than otherwise, in protracted cases; but, as in proper gonorrhoea, the affection is sympathetic. The appearance of secondary symptoms is certainly not peculiar to these cases. The inflammation of the velum palati and uvula is diffuse and superficial; the surface is roughened with innumerable small and shallow indentations where ulceration has taken place. They are so slight as often to escape ordinary observation. They are seen chiefly upon the tonsils, uvula, apex, and edges of the tongue.*** The gonorrhoeal sore throat is accompanied by considerable irritability to stimulant fluids especially. The exacerbated ulcer of lues, with its abrupt highcoloured margin, is not more strongly characterized, or more readily distinguished. The cutaneous affections are slight, and, in character, presenting less variety than those of lues, so far as my observation enables me to speak. The papular and squamous are the most common, the pustular and tubercular occasional. The lichen and psoriasis upon the trunk and limbs, and the achor and acne indurata thickly distributed upon the face and the verge of the hairy scalp, are the forms which I have chiefly recognised." (pp. 14, 15.)

With regard to the gonorrhoeal sore throat, since it was first pointed out, many years since, by TRAVERS, I have continually observed it, I think quite as frequently when there was merely discharge without any sore, as when with it; and so surely does it accompany gonorrhoea that, if perceived in the throat, I invariably inquire if the patient have a clap, and scarcely remember to have found it absent. I think it has a very close resemblance to the non-specific aphthous sores in the mouth and throat indicative of mucous irritation in the bowels, and the sores are generally about the size, or somewhat less, (a) Quoted at the head of the article.

(b) Above cited.

than a silver penny, and are commonly accompanied with fulness of both tonsils and uvula.

I feel also pretty well assured that some eruptive affections of the skin are consequent on gonorrhoea, which are distinguished by their pinky stain from the copper stain of syphilis. But I am doubtful whether I have seen more than acne, lichen, and lepra.-J. F. S.]

160. The diagnosis of these several kinds of gonorrhoea is in many cases obscure and not to be determined with certainty by characteristic symptoms; but its mild course, the short continuance of the discharge, the condition of the patient previous to the disease, the perhaps ascertained state of health of the person from whom the contagion has been received, in most cases furnish the guide. All gonorrhoea which has a malignant course, in which swelling of the testicles, inflammation of the inguinal and of the prostate glands occur, may be considered as syphilitic. In syphilitic gonorrhoea of women the danger of general syphilis is always greater than in men, on account of the copious secretion of mucus, and the excoriations thereby produced.

[Almost all that can be said on the diagnosis of vaginal discharges has been already mentioned, in speaking of gonorrhoea in women, and leucorrhoea at par. 158. The contagious gonorrhoea, or true gonorrhoea of both women and men, has also been shown to be a disease distinct from syphilis, and, therefore, the swelling of the testicles, the inflammation of the inguinal and prostate glands are not to be considered, as CHELIUS holds them to be, syphilitic, but merely sympathetic, and not requiring the treatment necessary for the cure of syphilitic affections. HUNTER observes, in reference to this circumstance :"It sometimes happens, although but seldom, that the glands of the groin are affected in a common gonorrhoea with the appearance of beginning buboes, but which I suspect to be similar to the swelling of the testicle, that is merely sympathetic. The pain they give is very trifling, when compared with that of true venereal swellings, arising from the absorption of matter: and they seldom suppurate." (p. 61.) COOPER agrees with HUNTER that "buboes of this kind rarely suppurate, but only in very irritable constitutions. He distinguishes sympathetic from syphilitic bubo by "one gland only, in general, being enlarged in syphilis, but in a sympathetic bubo most frequently a chain of glands is affected. Of the two sets of glands in the groin, one just above PoUPART'S ligament, and the other about two inches, or two and a half inches, below it; the lower tier is seldom enlarged from sympathy, the upper frequently." (p. 269.)

That discharges from both the male and female genitals have produced, in some instances, gonorrhoea, and in other chancres, every one who has had the slightest opportunity must have observed; and hence has arisen the opinion, long held by many surgeons, that the diseases were one and the same. But the examination of the vagina with the speculum, so largely practised, and on such good grounds strongly advocated by RICORD, explains the cause of these two sets of symptoms, by showing that in the vagina, and often even on the cervix uteri, chancres may exist, whence may be produced a discharge, which, without such examination, carelessly pronounced to be gonorrhea, will cause chancre, or, if accompanied with gonorrhoea, may produce in one person chancre, in another gonorrhoea, and in a third both diseases at the same time, whilst the infecting party is presumed merely to have gonorrhoea. The use of the speculum, therefore, if only as a mean diagnosis, cannot be too strongly advised. In males it cannot be employed to examine the urethra; in such cases, therefore, it is well if the practitioner have any cause for suspicion, to inoculate the matter from the urethra into the patient himself. If the discharge be simply gonorrhoeal, no inconvenience will ensue; but, if a chancrous sore should follow the inoculation, it is a proof that the disease is syphilitic, and that it must be treated accordingly.

66

For the examination of the public prostitutes RICORD lays down some rules which, under any circumstances where suspicious discharges from the female genitals exist, should always be followed. "The examination ought here," says he, "to be neither slight nor illusive; not only should the external part of the organs be examined, but also the internal and more concealed, for the source of the poison which it is wished to avoid, often lies in the depth of the vagina, on the cervix uteri, or even in its cavity; and in these cases neither an external examination, nor the toucher would suffice, and the speculum alone can warn them of their danger." (p. 255; Fr. edit., p. 540.)

This able surgeon has also shown the importance of inoculating discharges from the sexual organs, in regard to medico-legal questions as to venereal diseases. "In questions

of rape, for instance, the consequences of syphilitic infection are often brought forward as a proof. Well! what practitioner would not, in the present state of science, seeing a man, affected with gonorrhea, accused of having violated a woman actually infected with chancre, have regarded this pretended coincidence as a proof of great value? But when it is incontestibly known that chancre alone can produce chancre, if the gonorrheal muco-pus of the individual supposed to be guilty, produces nothing upon inoculation, after having been properly tried, will it not be evident, in a case of recent infection, that he cannot be convicted? And, again, would it not be proved by the same mode of experimenting, that individuals accused of having communicated the pox, which must aggravate the position of all persons thus accused, have only caused by mechanical violence, or by the action of some morbid or normal secretion, simple inflammations." (p. 94; Fr. edit., p. 197.)

161. The cure of gonorrhoea is directed by its severity.

In slight cases the patient should drink whey, almond emulsion, linseed tea and such like, a mild diet used, abstinence from all irritating or heating things; rest, support of the testicles with suspensory bandage, frequent bathing of the penis in luke-warm water, which subsequently, also, for the sake of cleanliness, is to be continued.

If the inflammation and pain be more severe, the following additional treatment according to circumstances must be resorted to; bleeding, leeches at the root of the penis or its neighbourhood, and softening bread poultices.

Purgatives, recommended by many in gonorrhoea, are generally more hurtful than useful, and, if necessary on account of impurities in the bowels, should be of the mildest kind, as manna, tamarinds, and not salts, which irritate the urinary passages.

["The venereal inflammation (or rather the gonorrheal inflammation—J. F. s.) is not kept up," says HUNTER, "by the pus which is formed, but, like many other specific diseases, by the specific quality of the inflammation itself. This inflammation, however, it would appear, can only last a limited time; the symptoms peculiar to it vanishing of themselves, by the parts becoming less and less susceptible of irritation. This circumstance is not peculiar to this particular form of the venereal disease; it is perhaps common to almost every disease that can affect the human body. *** As the living principle in many diseases is not capable of continuing the same action, it also loses this power in the present, when the disease is in the form of a gonorrhea, and the effect is at last stopped, the irritation ceasing gradually. This cessation will vary according to circumstances; for, if the irritated parts are in a state very susceptible of such irritations, in all probability their action will be more violent and continue longer: but, in all cases, the difference must arise from the difference in the constitution, and not from any difference in the poison itself. The circumstance of the disease ceasing spontaneously, only happens when it attacks a secreting surface and when a secretion of pus is produced.***Gonorrhoea cures itself, whilst the other forms of the disease require the assistance of art. (pp. 36, 7.) Gonorrhoea may be cured while there is a chancre, and vice versa." (p. 38.) (It is very remarkable that, with these facts staring him in the face, HUNTER should have persisted in his opinion that gonorrhea and chancre were one and the same disease.-J. F. S.) "How far the gonorrhea in women is capable of wearing itself out, as in men, I cannot absolutely determine; but am much inclined to believe that it would: for I have known many women who have got rid of a violent gonorrhea without using any means to cure it; and indeed the great variety of methods of cure made use of in such cases, all of which cannot possibly do good, though the patients get well, seems to confirm this opinion." (p. 59.)

HUNTER has made an observation in regard to gonorrhoea, which every one who has had the least experience must accord with, viz., that it is "the most uncertain in the cure of any of the forms of this disease; many cases terminating in a week, while others continue for months, though under the same treatment. The only thing necessary to be done for the cure is to destroy the disposition and specific mode of action in the solids of the parts, and as that is changed the poisonous quality of the matter produced will also be destroyed." (p. 75.) This latter observation does not very well tally with what he says almost immediately after:-"We have no specific medicine for gonorrhea," although he comforts himself with "it is therefore very reasonable to suppose that every such inflammation gets well of itself; yet, although this appears to be nearly