investigation, and successful treatment. The treatment is almost wholly moral, and, we may say, without fear of contradiction, the rest is empirical. There is no part of our science, which demands such minute and laborious inspection, as diseases of the brain. A perfect knowledge of structure, of its change by morbid action, of its function in health and disease, is imperatively called for by every physician who makes them the subject of his inquiry. If any thing can urge the State to grant the aids we require, it must be carried home to the conviction of every member of the community, in the incompetency which assails us in our elucidation of this interesting inquiry. It is in vain, that we charge the physician with incapacity, it is absurd, to dignify his treatment as medical, when the means are withheld from him, of improving the sphere of his knowledge, by the only power which can enlarge it, or give certainty to his practice, by any data derived from the true source of its seat. We must be content to rely upon the experience of others, and become entirely dependent, without the power to correct false deductions, or improve upon our own knowledge. We may enact laws for the better government of Medical Societies, or we may legislate upon the legitimacy of colleges, yet we advance not one step in the true cultivation of medical science, if we neglect the first principles of medicine, without which all is uncertainty and doubt. Every profession is insulated but ours. There is a right to discussion in the community, which we are compelled to recognise, because we have no standard to which we can refer, save anatomy, which is so imperfectly studied, and, consequently, so little understood, that our facts are considered as speculations, and our proofs but a portion of the many theories which have passed away,-exposing us, at one time, to unsparing satire, and, at another, to the mortifications which must fall upon all problematical systems.

R.

ART. III.-Memoir on the Treatment of Venereal Diseases without Mercury, employed at the Military Hospital of the Val-de-Grace. Translated from the French of H. M. J. DESRUELLES, M. D. &c. &c. To which are added, Observations on the Treatment of Venereal Diseases without Mercury. By G. J. GUTHRIE, Esq., Deputy Inspector of Hospitals, Lecturer on Surgery, &c. And various Documents, showing the results of this mode of treatment in Great Britain, France, Germany, and America. Philadelphia Carey & Lea. 1830. pp. 247.

THE consideration of the origin, character, and treatment of the venereal disease, has for ages occupied the attention of writers, and been the occasion of many vague theories, much learned research, and innumerable specific remedies. While historians have thought its origin a subject worthy of inquiry, priests have deemed it not beneath the dignity of their office, to mingle their speculations with those of the most noted charlatans; and the names of the Bishop Torella, and of Santallier, will be found among those who have engaged in its investigation, either from honorable or less worthy motives. Prejudice, dogmatism, and gratuitous assumption, have almost invariably accompanied the discussions elicited by the subject; and, notwithstanding the contradictory opinions which have been enforced, and the various remedies that have been commended, there is perhaps no disease in the treatment of which the unvaried spirit of routine has been more grossly displayed. Guiacum, sarsaparilla, acids, gold, &c. have all had their advocates, and enjoyed a brief popularity; but in every instance they have in their turn submitted to what has been considered by a series of generations as the one infallible remedy. Mercury has held an uncontrollable sway, in spite of experiment; and facts, however adverse to its specific virtue, have availed comparatively nothing. Hunter said, that however slight a chancre may be, mercury should be given internally; and a hatred of innovation, indolence in investigation, or positive ignorance, has perpetuated an error, the origin of which may be traced long previous to his time. As physicians have learned, so have they taught; their early lessons have been adhered to, and the fair deductions of experiment have been considered as the speculations of some habitual innovator. It is this bigoted obstinacy which is the greatest obstacle to practical improvement; for there are but few

persons who do not find it a matter of extreme difficulty to divest themselves of old habits,-there is an obliquity in most minds, that perverts even the most forcible facts when in opposition to long adopted opinions. The truth is, mankind do not like to confess their errors, or to have their judgment or practice called in question. The spirit of the day, however, a spirit of inquiry, experiment, and inductive reasoning, is favorable to an abandonment of this evil; and if an ardor for investigation, and a reasonable openness to conviction, be more freely encouraged by physicians, if they become more willing to submit their belief to the test of truth, than stubbornly to adhere to their deviations from its indications, they will discover that scepticism in medicine, when kept within bounds, is far preferable to an immoveable tenacity to opinions, because they are the results of early instruction, or to systems of practice, because they have been long and complacently followed.

During the present century the attention of physicians has been particularly directed to the anti-mercurial treatment of syphilis by many British and Continental writers. The subject has been so fully investigated, both officially and in private practice, and the results have been so forcibly demontstrated, that it would be idle any longer to hesitate in believing hat this disease, in every form, may be cured without having, recourse to the remedy in question. This possibility has also been proven in this country, by a course of experiments successfully pursued by Dr. Thomas Harris, at the Naval Hospital in Philadelphia, the results of which may be found in the first volume of the North American Medical and Surgical Journal. This question being thus placed beyond dispute, the peculiar advantages of the antiphlogistic mode of treatment remains for consideration.

"To determine this point," says Dr. Hays, in his preface to the work before us, "it is necessary to ascertain, 1st, by which mode of treatment the disease is most readily cured; 2d, which mode of cure is most permanent; and 3d, and lastly, which mode of treatment is the pleasantest, and does least injury to the constitution of the patient.

With these points in view, we shall endeavor to give our readers such an analysis of M. Desruelles' work, as will, we hope, enable them to form their conclusions upon these inte resting questions.

The author says, that prejudice has not caused him to abandon the use of mercury; he had most implicit confidence in it. Conceiving, however, that a preparatory regimen was necessary

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for its safe administration, he adopted the use of a simple diet; but it frequently happened that many symptoms disappeared during this preparation, and he was compelled either to permit the patients, who were in fact cured, to leave the hospital without being specifically protected, or else forcibly detain them for the performance of this duty. This was considered as an inconvenience which could be only obviated by not curing them at once by simple treatment, but by giving mercury as soon as the symptoms should become less violent; he, however, discovered that the cure was not only retarded, but that the disease assumed new characteristics. On account of these observations,

he says,

"I devoted the year 1826 to these experiments; and, finally, being convinced that mercury was unnecessary, when the simple and antiphlogistic treatment has been rigidly pursued, I abandoned its use altogether, and since the first of January, 1827, up to the present day, I have not administered one single atom of mercury, whether my patients were laboring under the primitive or secondary symptoms of syphilis.

"For more than a year we have sought, without prejudice, for a single case where mercury should be substituted for antiphlogistics, but no one has presented itself. Whenever the cure is retarded, or we find new symptoms appearing, the cause can always be traced to the patient's having deviated from the proper regimen.

"Before I had acquired the habit of distinguishing by the aspect of the symptoms, whether my patients had deviated from the prescribed regimen, I thought that those ulcers styled Hunterian, required the application of mercurials, but a considerable number of facts have convinced me that I was wrong, and that the Hunterian ulcers will as readily yield to antiphlogistics as the simple and phagedenic."

Disproving, therefore, the specific character of the Hunterian chancre, he next observes, that the classification of primary venereal ulcers has been needlessly extended. It is from a variety of circumstances that the same simple ulcer may be made to assume different appearances; it may become excavated, with callous edges, if it be powerfully irritated, either locally, or by internal stimulation. Reduce the irritation by light regimen, by emollients, and simple washes, and the ulcer entirely loses this Hunterian character. Again, suffer ulcerated surfaces to remain in contact, as when chancres appearing upon the glans and prepuce are from their situation kept in this position, and you have the phagedenic ulcer, which will also occasionally assume a carcinomatous appearance. It is from the mere circumstance of contact that such are generally found

behind the crown of the glans, "one part on the glans itself, the other on the corresponding prepuce." Indeed, all those forms which have been made to depend upon the different nature of the sores, are the result of predisposition of individuals, moral effects, cleanliness, season of the year, seat of the ulcers, tissues affected, &c. Artificial means, says our author, may produce ulcerations upon the genitals, whose character will deceive even those most familiar with the disease. The deception, he says, has been successfully practised. This has also been asserted by Hennen, who observes, that by an application of kali purum, a sore may be made, whose specific character may be increased or diminished at will. This we can scarcely believe; we are not yet prepared to go the whole length in this peculiar doctrine, and we are yet to be convinced that any such sore can be produced independent of coition, or a condition of the secretions of the part, capable of proving contagious by such an act, Observation must, we think, have proved, that there is a distinctness of character in the venereal, differing from ordinary irritation, or local inflammations. The mere seat of the disease is not sufficient to effect such results; there must be a subsidiary cause, something which, if not a virus, as that term is generally understood, is at least sufficient to produce characteristics which we believe are not to be mistaken.

Ulcerations are classed, first, in the order of frequency as respects their seat; and, secondly, of their progressive decrease in the time necessary for their cicatrization. This is sufficiently simple, and will be found both convenient and useful; we therefore subjoin both classifications; and first, as respects their seat, they are found in frequency:

"1st. Behind the corona of the glans. 2d. On the internal sur. face of the prepuce. 3d. On the frænum. 4th. At the meatus urinarius. 5th. On the penis. I make no mention of those which appear on the periphery of the prepuce, as their frequency depends on the form and extent of the opening of that duplicature of the skin of the penis.

"Posterior to the corona glandis they are hollow, round, and frequently numerous; upon the glans they are generally of less extent and depth, and few in number; on the frænum they are for the most part found on its thickest part, which they perpendicularly divide into two portions-one corresponding to the glans, the other completely isolated; the latter either breaks of itself, or requires to be cut. On the internal surface of the prepuce they are pretty extensive, but only superficial, unless they become phagedenic. On its external surface they are large, round, and almost even with the rest of the skin when not irritated. At the aperture of the pre