morphosis most willingly, and happy should we be could we induce our readers to encourage the work by subscribing to it, or rather, could we give them the means of following what must be their inclinations. Book societies and the schools of medicine should expend their patronage on what is truly a national publication.

XIII.

MÉMOIRES DE L'ACADÉMIE ROYALE DE MEDECINE. Tome Deuxieme. 1er et 2e Fascicules. Avec Planches. Baillière, Paris et Londres, 1833.

WE are indebted to M. Baillière for this and for many other valuable French works which we propose to notice. We propose, in the subsequent numbers of this Journal, to dedicate more space than we have lately done to continental medical literature, We are induced to do this for two good reasons-first, because it contains very much that is valuable, and secondly, because what it contains is inefficiently desseminated in this country. Our relations with France are becoming every day more close, and it is our mutual interest that it should be so. This is not more true politically than scientifically, and whilst we are as anxious as any to uphold our national reputation, we must candidly avow that France can boast of a body of scientific men, which would shed a lustre on the brightest era of civilized nations. Her institutions are, we speak advisedly, preferable to our own-they breathe a more liberal spirit, and encourage a more generous emulation. We are too much a people of shopkeepers.

We shall take all possible opportunities of laying before our readers the substance of the best French works that appear, and we venture to hope that our plan will not be unproductive of benefit. We cannot carry it into full operation in the present number, but shall merely content ourselves with a glance at one or two recent publications.

That now before us is the production of the Royal Academy of Medicine. It contains an elaborate paper by M. Breschet, which we will notice more at length by-and-bye, and memoirs from the pen of MM. Lisfranc, Ricord, Duchesne, and other gentlemen. The paper to which we will first direct attention is by M. Ricord, surgeon to the Hôpital des Vénériens, and purports to be founded on some facts which he has observed in that institution. We shall proceed to the consideration of the paper with as little preface as possible.

It would be impertinent in us to tell our readers that the venereal disease is surounded with difficulties; they well know that. But it might appear more startling to some were we to assert that the late investigations on the non-administration of mercury have been productive of much general delusion. Yet, startling as it may appear, such we believe to be the fact. Yes, we believe it to be the fact, that much delusion exists with respect to the practice of treating the venereal without the aid of mercury, and much as

the experiments of the army Surgeons have been lauded, and great as has been the benefit accruing from those experiments, we think they have been too implicitly trusted to, or too narrowly reasoned on. This may sound to many like a heresy: we will not at present attempt to defend ourselves, but we mention our opinion, not lightly taken up, as an evidence that the investigation is not exhausted, and that much is necessary to produce general conviction on any essential point. Hereafter we may enter more in detail, and develop more particularly such ideas as we may be led to entertain upon the subject. We must confess that we think there is an opening for a really good and practical work on this disease. But to proceed to notice the facts and opinions of M. Ricord.

ror.

Of one hundred female patients in the venereal hospital, sixty, according to M. Ricord's computation, are affected with discharges acute or chronic, the blennorrhea being always more common than the blennorrhagias. It is well known that women of the town are nearly always anxious to leave the hospitals as soon as possible, in order to return to their profession. As soon as the more prominent symptoms have disappeared, and when they are apparently approaching to a cure, they frequently elope. This is sufficiently common at the Lock Hospital in London. In Paris where, in order to follow their trade, they are under the necessity of possessing a certificate of health, it becomes an important matter to deceive their surgeons into granting it at as early a period as possible. The charge of the public health, on the other hand, being thus confided so especially to the surgeons, it becomes their duty to avoid intentional imposition and unintentional erNow it must strike very many, as it certainly has struck us, that whilst venereal sores are extremely frequent in men, they are comparatively rare in women. Of the tenants of the Lock Hospital the majority of males have or have had sores, whilst the great majority of females have discharges. And yet those females being of the lowest class of prostitutes w ould probably be, and no doubt are the chief means of propagating sores. How are we to account for this anomaly ? Are we to suppose that women having no sores will occasion them in men-that there exists therefore a considerable difference between the characters of the disease in the two sexes-or that sores do exist, but escape our notice. We shall presently shew that M. Ricord has in part explained this mystery, by shewing that ulcerations are not unfrequent in the deeper parts of the vagina, those parts where surgeons never search for them. But we doubt whether this is the whole of the truth, and we think, for reasons which we need not at present bring forward, that women are less subject to primary sores than men, and that males will contract sores followed, or liable to be followed, by secondary symptoms, from women that have merely discharges. To return to M. Ricord.

This gentlemen being convinced of the inefficiency of the usual method of examination, determined never to discharge a patient without inspecting the interior of the vagina and neck of the uterus by means of the speculem. The employment of this instrument has subsequently been enforced in every instance, and since it has been so, M. Ricord has been amply satisfied how inexact the common mode of exploration is. He entertains no doubt that the usual inspections of the public women of Paris are perfectly illusory, and offer no security. The fact has been already noticed by our own army

surgeons.

One gentleman, we at this moment forget who, but we think it is Dr. Hennen, remarks that he was frequently astonished at the results of the examinations of the women at Valenciennes. They were found to have merely discharges, yet sores of all descriptions were frequent among the soldiers who cohabited with them.

Acute Blennorrhagia. It is commonly known that the whole genito-urinary mucous membrane in the female may be the seat of gonorrhoeal discharge, but it is not commonly supposed that the urethra is much affected. M. Ricord, on the contrary, has found pus issue from that canal in ei ght cases out of twelve. The shortness of the canal, its position, and the frequency of micturition, frequently prevent this fact from being discover ed. But if a proper time be selected, and the finger introduced into the vagna, so as to compress the urethra from behind forwards, M. Ricord maintains that the fact will be found to be as he states it. All the females who had urethritis as well as vaginitis attributed their complaint to infection. M. Ricord has found acute buboes coexist with urethro vaginal blennorrhagia ;— he has not found this to be the case when the vagina only was affected.

The following are the results of examination with the speculum in the state of acute blennorrhagia.

1. The mucous membrane merely unnaturally red throughout its whole

extent.

2. In some patients this, attended with much heat, sensibility, and some tumefaction, has terminated without giving rise to discharge; in the majority of cases it has been succeeded by discharge.

3. In some women there were prominent patches, of various size, the redness of which was decided and terminated abruptly, whilst the remainder of the vagina was natural.

4. In some the vaginal mucous membrane presented a great number of reddish papulæ; in others it was merely spotted.

5. These different states coincided with vaginal secretions of different kinds: in one instance mucous and transparent, in another serous and red dish, in a third purulent.

6. In some of those with whom the secretion was reddish it sometimes became bloody; the reddest parts were then deficient in epithelium, and there was erosion of the mucous membrane; most frequently, however, these erosions gave rise to a purulent secretion.

7. One patient of very lymphatic temperament, affected with acute vaginitis, had the vagina studded with granulations, resembling the luxurious ones that form in scrofulous sores; in this case there was a profuse purulent discharge. M. Ricord has found a less degree of the same granular state. depending apparently on enlargement of the inflamed mucous follicles, in several patients affected with purulent discharges.

8. Three patients affected with recent purulent discharges, and sent to the hospital for gonorrhoea, had ulcerations of the vagina from three to six lines in diameter. The ulcerations were slightly infundibuliform, with excavated edges (bordés á pic) and greyish base. There was no ulceration of the external parts.

9. The different conditions of the vagina already mentioned were met with on the mucous membrane of the neck of the uterus, which in a number

of cases appeared alone affected. Sometimes that portion of the mucous membrane covering the os tinca was very evidently affected.

10. Along with the inflammation of the mucous membrane, the neck was often found enlarged, and in some cases the body of the uterus appeared slightly tumefied; the secretions of the mucous membrane of the neck were like those of the vagina.

11. In many patients presenting on their admission puriform matter at the orifice of the vagina, unaccompanied by symptoms of inflammation in the internal genital parts, and in whom the discharge had only lasted a few days, the vagina has been found healthy throughout its whole extent, whilst the os tincæ, tumefied and red round its orifice, allowed a great quantity of puriform mucus to escape from its cavity, or from that of the body of the uterus.

12. M. Ricord has observed, in upwards of a hundred cases, the following circumstance. The mucous or muco-purulent uterine secretions so frequently met with in company with other affections of the vagina, or the neck of the uterus, and frequently called "whites," have always a glairy consistence, like that of white of egg; those of the vagina, on the contrary, have not that consistence.

13. In the acute stage, M. Ricord has found that the ulcerations of the neck of the uterus are situated nineteen times out of twenty at the orifice, and once in twenty on the circumference of the neck, more or less contiguous to the cul-de-sac, formed by the vagina with the cervix. Out of six cases of the latter kind, the ulceration in four was situated on the anterior surface, and in two on the posterior. This is accounted for by the fact that in prostitutes the uterus is commonly anteverted, so that the superior face of the neck looks forwards, and is therefore most directly exposed to infection.

14. The ulcers of the neck, whatever have been their precise situation, were eighteen times out of twenty of the elevated kind—the ulcus elevatum. Often they were a sort of granulations and mucous tubercles; frequently they resembled granulations in groups; and in one patient there were true pustules with a white apex. In some there was erosion of the mucous membrane, such as has been adverted to as existing in the vagina. In others, and M. Ricord possesses six cases of this description, the ulcerations near the orifice, stretching into the cavity, or placed on the circumference of the neck presented all the characters attributed to the true syphilitic chancre. It should be mentioned again that in none of these patients were there any external symptoms, nor any internal ones calculated to raise suspicions as to the existence of the legions enumerated.

M. Ricord next describes the appearances observed in chronic discharges.

1. The posterior part of the vagina is more affected than the anterior, the reverse being commonly the case in the acute form.

2. In some patients the mucous membrane is whitish, almost granular, and furnishes a lactiform secretion staining the linen white. In some this secretion becomes caseous, as it were, on coming in contact with the air, or on drying. When viewed around the neck of the uterus it greatly resembles the sebaceous secretion between the male glans and prepuce; this state may be considered as that of leucorrhoea.

3. The vaginal mucous membrane may secrete a serous fluid, staining the linen white, and having sometimes a red zone.

4. Most commonly the discharges in blennorrhoea were purulent, yellow, or greenish. The mucous membrane was then sometimes pale, at others thickened in different parts, appearing as if deprived of epithelium, or often reddened and softened, and looking like the conjunctiva in chronic ophthal

mia.

5. Two patients presented in the posterior and deepest part of the vagina patches much redder than the remainder of the mucous membrane, bleeding easily, and giving rise to a purulent secretion. These patches were superficially ulcerated, and led M. R. to believe, prior to his examination with the speculum, that there was a slight loss of the substance of the uterus.

6. Along with the blennorrhagia M. Ricord found granular, pedicular, and cauliflower vegetations throughout the whole extent of the vagina, and on all the points of the vaginal region of the uterus. Sometimes the vagina alone was affected, sometimes only the neck of the uterus. In some of the patients nothing externally announced with any certainty the existence of these vegetations within, a more or less puriform chronic discharge being the only symptom. In one there existed at the base of a vegetation seated two inches behind the carunculæ myritiformes, a deep, elongated, irregular ulceration, appearing to have been the result of a laceration.

7. Catarrh of the uterus was found amongst the greater number of patients. The discharge from the os uteri was sometimes transparent, with the cervix pale; sometimes more opaque, with redness of the cervix, or even slight ulcerations of the orifice; sometimes purulent, with the cervix red and thickened. There existed also erosions round the os uteri, or even true ulcers, elevated or deep.

8. In one patient who had had many children, and in whom the cervix was much developed, with a very large orifice, nothing was seen externally; but on separating the lips of the os tincæ, by means of the speculum, there were seen on their internal surface ulcerations which extended into the uterine cavity.

9. These various ulcerations appeared to M. Ricord the most common cause of those interminable discharges, which, though termed leucorrhoeal, are not the less contagious.

10. Finally, in some females muco-purulent discharge issuing from the uterine orifice was the only appreciable symptom.

M. Ricord discovered on the cadaveric examination of two patients, who died in the hospital, the following facts. In one female, who was thought to be affected with blennorrhagia only, there was found a deep infundibuliform ulceration, with a hard base, situated an inch and a half behind the carunculæ myrtiformes. In the other were two ulcerations, having a character similar to that of the preceding, but irregularly elongated in form, one upon the anterior lip of the os tincæ, the other extending into its cavity; the last was a little rounded.

M. Ricord mentions one or two facts on the subject of contagion.

A woman of the town, who had been under treatment upwards of a month for an elevated ulcer of small extent on the left side of the os tincæ, with slightly purulent uterine catarrh, but without any decided vaginal discharge, was examined with the speculum on the day of her dismissal. The only