in "frequent venesections and the administration of large quantities of Mercury, Scammony, Nitre, Agaric," &c., and it would be a great injustice to Hahnemann if we were to omit to mention that in § 84 he points out the great dangers attending the use of copaiba, cubebs, and balsams in general, in the inflammatory stage of gonorrhoea, though (§ 88) he admits their value after all irritability has ceased -a point which has only been duly adverted to by the bulk of the allopathic sectarians within the last few years. Most of us can remember the time when the administration of strong injections together with liberal doses of copaiba and cubebs was as much the rule in the ordinary treatment of gonorrhoea as the administration of quinine is (and with perfect propriety) the rule in a large proportion of cases of ague. Hahnemann also condemns in terms of becoming reprobation the infernal doctrine then (and it is to be feared, even now) believed in and acted on by some, viz. that a patient affected with gonorrhoea should seek his cure by means of having connexion with a pure virgin, a detestable counsel which probably took its rise from the fact having been observed that an obstinate gleet is at times cured by an act of coition.

Some may think that Hahnemann is guilty of an inconsistency in condemning the use of Mercury in the treatment of gonorrhoea (§ 67), while in § 125 he advises local fumigations of Cinnabar in gonorrhoeal ophthalmia, but we must recollect that in the latter case he is speaking of what he regards as a mere blennorrhoeic ophthalmia, a purulent conjunctivitis, consequent indeed upon gonorrhoea, but not itself of a venereal character. (See § 35 and note iv.) Hence the topical application of the mineral seems to be ordered rather for the sake of the local stimulation it produces than for its specific action as an antisyphilitic. Again, in § 121 he recommends the exhibition of a few doses of soluble Mercury in cases of orchitis resulting from a suppressed gonorrhoeal discharge, but this admits of a ready explanation either on the supposition that he orders it simply on account of the resolvent and discutient action of the drug, or because he is of opinion that in such cases

(as in those of severe posthitis referred to, § 126) "the disease has penetrated deeper," and developed into a true syphilitic affection (in the modern sense of that word)—a not unlikely occurrence on Hunter's supposition of the identity of the gonorrhoeal and syphilitic virus, and such as might readily happen (on that hypothesis), owing to the infection of an open fissure in the urethra by gonorrhoeal matter (cf. § 191). This also explains his recommendation of soluble Mercury in cases of obstinate gonorrheal gleet, where he directs the administration to be continued till the mercurial fever (not salivation) is clearly set up. Such passages as these also clearly demonstrate that while Hahnemann himself persists in calling gonorrhoea a purely local disease, he was nevertheless well aware that constitutional venereal symptoms might in some cases supervene, though we believe him to have been mistaken in the way he explains their occurrence. Although misled by the doctrines of Hunter as to theory, we can see that his own sagacity kept him from any serious error in the more important departments of practice and diagnosis. We may now pass from this section of the treatise, merely remarking that his classification of the different forms of gleet is peculiarly fortunate; closely resembling, and in some respects even excelling that adopted by high authorities at the present day. He arranges them thus: (1) gleet from irritability; (2) from local or general weakness; (3) from habit; (4) from urethral ulcers; (5) from stricture of the urethra; and he displays great acuteness in the directions he gives for the diagnosis and treatment of each variety.

We have already expressed our opinion that in the second section of this part of his work Hahnemann does not sufficiently clearly recognise or indicate the difference between hard and soft chancres; while at the same time we showed that he incidentally pointed out some of the chief distinguishing features of these two varieties, thus evincing his practical recognition of the distinction. It is worthy of remark, that from the description he gives of chancre (§ 260) he seems to have been more familiar with

the Hunterian than with the soft chancre, an experience directly at variance with that of surgeons of the present day, at least in Britain, since he insists strongly on the hardness of the base; and this may perhaps explain his so firmly maintaining that all chancres (at least according to his own observation) are followed by constitutional infection unless treated with mercury. As we before dissented from the doctrine of the identity of the gonorrhœal and syphilitic virus, so here again we freely acknowledge our conviction that on this other point also Hahnemann was in the wrong. Still, it must be remembered that even in the present day many allopathic sectarian surgeons, and some of them of the highest eminence, are here at one with Hahnemann; and it will, perhaps, long remain an open question whether the appearance of a hard or a soft chancre does not depend on the constitution of the patient, his personal habits, the mode of treatment to which he has been subjected and so forth, rather than on any specific difference in the nature of the infecting virus. Hahnemann's remarks upon the modifications in the appearance of the chancre according to its seat and rapidity of development (§§ 258 and 261-264 and 270), the diathesis of the patient (§§ 265—267), as well as his description of the normal course it runs up to maturity (§ 260), are such as might well find a place in any treatise on the same subject written at the present day. Like Ricord he regards venereal bubo as simply a chancre occurring in a lymphatic gland, but (in our opinion) he goes too far when he says that probably not a single case ever occurred where the local treatment of chancre did not give rise to bubo. Indeed he qualifies this assertion in a note to page 97, where he admits that "Girtanner's caustic alkali" may be successfully used locally a fact which he seeks to explain, however, by suggesting that this may have a specific anti-venereal power, and so destroy the poison at its seat. And it is also to be remembered that the strongest caustic with which he was familiar for this purpose seems to have been nitrate of silver (§ 276), and of this substance were employed in all cases to cauterize soft chancres, it would usually be found

wholly inefficient as a means of eradication, while the local irritation it would set up would be extremely likely to cause the appearance of sympathetic buboes. In the case of genuine Hunterian chancre it would, of course, be entirely useless, unless, indeed, we are to believe in those extremely rare and doubtful cases where a chancre has been professedly destroyed on its first appearance by the abortive treatment, without the supervention of secondary symptoms. To this Hahnemann refers with hesitation in § 277.

In § 368 Hahnemann admits the occasional but very rare occurrence of that vexed subject of contention, the "bubon d'emblée." But without further considering such questions on this head as are rather of a purely scientific than a practical interest, let us proceed to compare Hahnemann's treatment with that common in his own day and until much later times, and we shall be struck with the singular sagacity with which he detected the errors of the system then prevalent and anticipated so many of the subsequent modern improvements.

Very soon after the appearance of syphilis in Europe, in 1483, physicians seem to have discovered that they possessed in Mercury a specific antidote to this retributive scourge. Accordingly, this medicine, in some form or other, seems to have entered, more or less, into all the anti-venereal nostrums of the 16th, 17th, and 18th centuries. Then, as now, it was administered in three ways: by the mouth, by inunction, and in the form of vapour. But so uncertain was the strength of different specimens even of the same preparation; so widely did the various medicaments differ from one another in respect of the amount of the mineral they contained; so liable were they to undergo important changes from time and exposure to air; and lastly, so little was the real action or the true therapeutic value of the drug understood, that perhaps more harm than good was done by its employment. No symptom short of profuse salivation was held to indicate that the system was really under the influence of Mercury. Not a rare that by pushing the use of the drug so far its b was obstructed if not wholly lost, those pr

VOL. XXXII, NO. CXXVII.—JANUARY, 1874.

ficial action

rations were

E

the most highly esteemed which were found to salivate most certainly, most rapidly, and most severely. In time theories came to be formed upon the subject, and much learned folly was talked about eliminating the virus from the system by means of copious artificial evacuations such as this. Having persuaded their patients (and, we trust, themselves) that after sufficiently long and sufficiently severe salivation (duly accompanied, of course, by our old friends bloodletting, emetics, drastic purgatives, and depletory measures in general) the disease was assuredly worked out of the system, physicians readily induced the unhappy sufferers to submit to this treatment, and wisely took the preliminary precaution of burning off the telltale chancres which otherwise would have remained to bear witness to the continued presence of the patient's disease and the futility of their own modes of practice. Hahnemann, on the contrary, considering the presence or spontaneous removal of the chancre a valuable diagnostic mark of the continuance or departure of the disease, directs that no local applications whatever (unless for the sake of cleanliness) be employed, but that soluble Mercury be given by the mouth, in larger or smaller doses as might be necessary, until a distinct, even severe, accession of mercurial fever set in, and by this means he found that in a few weeks nearly all the chancres took on a healthy action, and healed of themselves. He seldom had occasion to use more than twelve grains of the drug during the whole course of treatment, and yet the disease was finally eradicated from the system. He found success to depend, not on the quantity of Mercury administered, but on the intensity of the mercurial fever set up. He deprecated the use of depletory measures, and directed that the patient should be put on precisely the same moderately nutritious, but unstimulating diet as is prescribed now-a-days. He dwells at length in the second part on the importance of attending to the patient's general health and individual diathesis before giving mercury at all, and the relation these considerations bear to the question of the doses in which the drug should be administered. He speaks of the non-mercurial anti