A treatise on venereal diseases

Book i V^4> GopightN

COPYRIGHT DEPOSIT

TREATISE on

VENEREAL DISEASES

BY

A. VIDAL, (de Cassis,)

SURGEON OF THE VENEREAL HOSPITAL OF PARIS ; AUTHOR OF THE TRAITE

DE PATHOLOGIE EXTERNE ET DE MEDECLNE OPERATOIRE,

ETC. ETC.

WITH COLOEED PLATES.

TRANSLATED AND EDITED

BY

GEORGE C. BLACKMAN", M.D.,

FELLOW OF THE ROYAL MEDICAL AND CHIRURGICAL SOCIETY OF LONDON; FORMERLY ONE OF THB PHYSICIANS TO THE EASTERN AND NORTHERN DISPENSARIES, NEW YORK.

NEW YORK: SAMUEL S. & WILLIAM WOOD,

261 PE..TIL STREET

Entered, according to Act of Congress, in the year 1854, by

SAMUEL S. & WILLIAM WOOD,

In the Clerk's Office of the District Court for the Southern District of New York.

THOMAS B. SMITH. HOLMAN & GRAY,

216 William St., N. Y. Cor. White & Centre Sts.

PREFACE OF THE EDITOR.

In preparing the Treatise on Venereal Diseases of M. Vidal for the press, the American editor has aimed to furnish the reader not only with a faithful translation, but also with the views of some of the leading British and American syphilographers. Messrs. Vidal and Ricord are both attached to the Hqpital du Midi, the great venereal hospital of Paris, but in many respects the doctrines of our author are directly opposed to those of his distinguished rival. The annotations of the editor will be found to correspond, generally, with the views of the author, and he has been personally assured by many of the most prominent surgeons in Great Britain and this country of their cordial assent to the doctrines here inculcated. To Mr. Samuel A. Lane, of the Lock Hospital, London, and to Mr. Langston Parker the distinguished syphilographer of Birmingham, he would return his warmest acknowledgments, as well as to Dr. Byrne of the Westmoreland Lock Hospital, Dublin, and to Messrs. Cusack, Porter, Adams, Egan, Fleming and Wilmot of this city, for their very polite attentions and for the communication of many valuable facts by which the object of his visit was greatly promoted.

Although American surgery can boast of none to whom the term syphilographer can properly apply, yet we may justly claim for Dr. Physick priority in the treatment of orchitis by the so-called Fricke's method, compression, ar>d it is with pride that we refer to the contributions of Dr. John Watson of the New York Hospital, " On some of the Remote Effects of Syphilis" published in the first and fifth volumes of i v EDITOR'S PREFACE.

the New York Journal of Medicine and Collateral Sciences, and to the elaborate paper of Dr. H. D. Buckley, " On Syphilis in Infants" in the first volume of the New York Journal of Medicine and Surgery for October,, 1840. The value of these can be better appreciated in another part of this work. Through the politeness of Dr. Yan Buren, the editor has recently had an opportunity of seeing (though too late to incorporate the details in his Notes) an instance of that exceedingly rare affection, tertiary syphilis in the infant. In this patient, there were nodes on the ulna and forehead, and enlargement of both testicles ! To Profs. Mott, Mussey, Gross, and Willard Parker, the editor would express his obligations. The article on Strictures of the Uretha, omitted in the Treatise of M. Vidal, has been supplied by a somewhat free translation of that in the author's well-known work on External Pathology. For the remarks under the head of Urinary Infiltration, and Urinary Abscesses, the editor is alone responsible. In illustration of these subjects he has also added a few woodcuts, borrowed from various sources, and although some may consider these topics as foreign to a special Treatise on Venereal Diseases, he is disposed to believe that the junior practitioner will not regret the liberality of his publishers which has enabled him to make these additions.

GEOKGE C. BLACKMAN.

New York, Jan. 1st, 1854.

Catth ml dDfftttftita,

Preface 1

Synonyms 13

Historical Sketch « 14

Syphilitic Yirus 19

Observation , . . . 26

Experiment 32

Inoculation , 33

Inoculation of Animals , 36

Syphilization , 40

Transmissibility of Secondary Accidents 49

Section I. — Blennorrhagia of the Urethra 72 Consequences of Blennorrhagia 88

Blennorrhoea 88

Uretrorrhagia 119

Urethral Pains 122

Perverted Sensations in the Urethra — Absence of Sensations 124

Blennorrhagic Orchitis , , 126

Blennorrhagic Prostatitis 139

Blennorrhagic Cystitis 146

Blennorrhagic Nephritis „ 149

Blennorrhagic Ophthalmia , ] 53

Blennorrhagic Arthritis . 158

Section VII.— Therapeutics 292

I. Mercury 293

External employment 293

Internal use of Mercury 300

Mercurial Compounds 301

II. Other Mercurial Preparations 305

III. Accidents produced by Mercury 305

Salivation and Stomatitis 305

Cholic and Diarrhoea, Mercurial Tremors 315

IV. Iodine 316

V. Iodide of Potassium 317

Accidents attributed to Iodide of Potassium 322

VI. Iodide of Iron 324

VII. Gold, Silver, Platina , 325

VIII. Double Salts , 328

IX. Sudorific Woods 329

X. Compounds, partly mineral, partly vegetable 330

Section I. — Syphilitic Eruptions — Syphilides 331

I. General Characters 332

IX Varieties 336

Exanthernatous Syphilitic Eruptions 337

Syphilitic Papular Eruption 338

Syphilitic Squamous Eruption 340

Syphilitic Vesicular Eruption 341

Syphilitic Bullae 344

Syphilitic Pustular Eruption 347

Syphilitic Tubercule 365

III. Causes 370

IV. Diagnosis 372

V. Prognosis 374

VI. Treatment 375

Internal Treatment 375

External Treatment 376

Section II. — Diseases of the Appendages of the Skin 378

I. Loss of the Epidermis 378

II. Alopecia 378

III. Onyxis 380

Section III. — Affections of the Mucous Membranes 383

I. Mucous Membrane of the Mouth 384

II. Mucous Membrane of the Nose„ 392

III. Mucous Membrane of the Genital Organs 394

IV. Mucous Membrane of the Epiglottis and Larynx 396

V. Mucous Membrane of the Ear 397

VL Mucous Membrane of the Anus and Rectum 397

Part IV. Peophylaxis Of Veneeeal Diseases

CHAPTER I.

Private Prophylaxis 488

CHAPTER II.

General Prophylaxis — Medical Police 493

ERKATA.

Page 3, line 15, for this city, read that city.

p. 23, line 14 of Editor's Notes, for indidated, read indurated.

p. 28, line 27, for coitres, read coitus.

p. 33, line 24. for insert forms, read invest forms.

p. 55, after last line of the text ; the following quotation from the Thesis of M. Helot, has been omitted : " My dear master, you have established the value of inoculation upon the petitio principii. This is always the case with those who are wedded to particular systems. For such I write not ; but for those who seek the truth ; and I believe that in this Essay, I have furnished them with the elements of conviction, drawn from three sources, viz. : analogy, observation, and experience."

p. 72, line 5, for vagnitis, read vaginitis.

p. 90, line 46, for stained liver, read stained linen.

p. 93, lines 18, 19, 25, for diatheses, read diathesis.

p. 95, 3d line from foot of page, for secreting, read secretion.

p. 107. 2d line of Editor's Note, for dilations, read dilatations.

p. 137, line 9, omit that.

p. 153, 4th line from foot, for ophthalmias, read affections.

p. 207, line 10, for involved into, read changed to.

p. 217, line 18, for preventative, read preventive.

p. 227, line 13, for reset, read resect.

p. 235, line 4, omit more.

p. 257, line 6, for concrous, read concours.

p. 263, line 20, for does, read do.

p. 268, line 37, for ecclusion, read occlusion.

p. 269, line 26, for certainly, read certainty.

p. 360, foe 1 * ^'"^"-^nsferred, read transformed.

Preface

Innumerable are the works on venereal diseases, but the majority have been written for the purpose, more or less candidly admitted, of establishing or overthrowing some particular doctrine. Many volumes have been devoted to the vindication or subversion of the dogmas that emanated from idealism, and the school of Galen, as well as from his successors, the chemists and the vitalists. The same is true of the school of Broussais, which so recently denied the existence of a venereal virus, and of those who believed, on the other hand, in the entity of this virus. These productions have sometimes exhibited marks of genius, and have been distinguished by their elevated and splendid diction, but they were designed only for those acquainted with the subject. I write for a different class, and for those who have but little time to devote to the study of these affections. I propose to collect such facts and opinions as are of practical application, and which have survived the wreck of systems, the founders of some of which showed themselves profound observers. With this view, I have selected a plan sufficiently extensive to embrace the most important practical details, and yet which, without having too wide a scope, will, I trust, enable all to comprehend the substance of our knowledge on the speciality now termed syphilography.

From the time that venereal diseases were first somewhat carefully studied, it has been admitted, that, shortly after the application of the virus, certain lesions are generally produced on the parts contaminated ; these are the primitiw venereal accidents. Again,- there are certain other morbid conditions, which are ordinarily observed subsequently to the above ; these are the consecutive venereal accidents. Under this by no means modern division, these affections may be advantageously studied. I have adopted it, believing it to be the most rational and best adapted to the purposes of instruction, and not as serving as the basis of any particular system.

Hunter recognized two varieties of the consecutive or constitutional disease, and M. Ricord having availed himself of this subdivision, includes all the accidents under the heads of primary, secondary, and tertiary vene-

S PREFACE.

real disease. In this species of triad, of ancient date,* this writer fancied that he had discovered the basis of a true classification, on which he has engrafted not only a system, but a system the exact symmetry of which was well calculated to captivate an age inclined to absolute certainty, whilst its apparent simplicity has been greatly admired by certain minds, which it is unnecessary here to characterize. A distinguished writer has remarked, that system and hypothesis are synonymous terms; now we know the result of subjecting the latter to a somewhat rigid criticism. Still this system seemed to withstand not only the force of reason, but of arguments based on clinical observation. It rested its claims upon experiment, the influence of which may be imagined during the period to which we have alluded. Its opponents were therefore compelled to descend to the same ground, and it was attacked with the same instrument, as it were, that had been employed in its establishment. Various were the experiments performed, and the proceedings adopted. Some of these proved, that chancre was not the only accident that admitted of inoculation, but that those termed consecutive might also be thus transmitted. Now as the system was based essentially upon the exclusive inoculability of chancre, these results struck at its very foundations. They likewise seriously compromised the classification dependent on it, as the only admitted distinction between chancre and the other accidents was thus destroyed. Other experiments showed that chancre itself, or the most virulent syphilitic poison, from some natural or accidental cause, was perfectly harmless when applied to certain individuals ; therefore, as the system boasted as its test for syphilis, the infallibility of chancrous inoculation, it found itself wanting in view of its practical application.

Thus, the immutable laws of experiment, proclaimed by M. Ricord, were annulled by experiment itself, and the promised certainty resulted in uncertainty.! It required but a slight knowledge of medical philosophy, and a little reflection upon the results of experiments, according as they are performed in the exclusively physical, or in the exclusively pathological order, to have anticipated what here occurred. Then came the cases proving that the secondary might appear after the tertiary accidents, and vice versa. The order of the system being thus compromised, what remained ? In the body of this work may be found the proofs of what has been here asserted. However, I shall be brief upon these points, for the main object of this work is to collect the practical truths which are the results of observation, and those which have survived the downfall of systems. Still

* Vid. "La methode curatoire de la maladie venerienne" of Thiery de Herry, and p. £59 of this work, where I have exposed this triad in its author's own words.

f In the Introduction, under the heads of Inoculation and Sypkilization, behold the glimmer thrown by the eloquence of M. Malgaigne, over the enormous breaches in the system of which this Professor was at one time a defender, and which had for its leader a friend of twenty years' standing!

PREFACE. xi

I have thought it my duty to warn the young practitioner against disappointments and regrets, there being nothing, in my opinion, more dangerous, either in study or in practice, than to invest mere forms with certainty, and to pronounce that to be infallible which can be but probability or uncertainty. After the two principal divisions, — primitive and consecutive venereal diseases, — will follow the section on infantile syphilis. In this, we shall discuss the questions of the hereditary descent of the disease ; its transmissibility from the child to the nurse, and from the nurse to the child. The importance of this chapter is evident, for, in the opinions there examined, the interests of the family, of justice, and of society in general, are involved, and yet the majority of French works on these topics are very incomplete ? In the fourth part, we shall consider the prophylaxis of venereal diseases, including general and private prophylaxis, and regulations of medical police.

In the Introduction, after a few observations upon the synonyms, may be found an historical sketch of the venereal disease. I shall express an opinion on the nature of the syphilitic virus, and its principal effects. The causes of error in observation will be shown • experiment justly appreciated ; the process of inoculation explained, whilst syphilization will be judged. This introductory chapter will conclude with some general observations on the transmissibility of secondary accidents.

Since I have stated, in the commencement, that I propose to make a resume of the facts, opinions, and therapeutics, constituting syphilography, my great indebtedness to my predecessors will be obvious. All shall be quoted with acknowledgment. I will submit' to the reader what experience has taught me at the Lour cine, in the female wards ; and what I have learned at the Hopital du Midi, during a service of more than ten years, since I became the successor of Cullerier, — the honest man, the sage practitioner.

Placed in a theatre so vast, I could not remain indifferent to questions by which science was agitated. I have ventured to discuss one of the most important, the transmissibility of the secondary disease. I think that, by experiment, I have decided it in favor of the contagion ists. My experiments have been repeated in France and in Germany ; all have produced a brilliant discussion in the Academy of Medicine. MM. Velpeau, Lagneau, Gibert, Gerdy, and Koux,* maintained, with their well-known abilities, the transmissibility of the secondary accidents, and what is without a parallel in the annals of the Academy, the opposite side of the question had but one defender ! If from France we pass to foreign lands, we shall find that the opinions of learned academicians are generally

* It will be observed that among these orators are two distinguished syphilographers, and three professors of the Faculty of Paris. Read their discourses in the Bulletin de VAcademie de 3fedecine, where they are correctly reported. (Nos. for Oct. et suiv. 1852.

xii PREFACE.

divided. We may see, particularly in the German press, how ably this doctrine has been sustained by Waller, Simon, and Droste.

To facilitate the study of the venereal accidents, the most important to be known, I have illustrated them by colored engravings^ from designs which it is unnecessary for me to praise since they were executed by M. Bion. The necessity of these will be admitted when we come to the chapter on the cutaneous affections, for we know the importance of the syphilitic tint in forming our diagnosis, and the difficulties which the student encounters who wishes a tableau of the principal varieties. He will find it here, true to nature.

Lately, some syphilographers whose tenets have been shaken, have allowed themselves to descant bitterly, or in a jesting tone. They have even written in the same style. Having no motive for sharing in the sentiments which have inspired a literature of this kind, having, besides, remarked that it has neither thrown light upon, nor advanced the questions in dispute, I have abstained from it, and have endeavored to speak as clearly as possible, the language of science, since it is the latter only which I have in view, and the interests of those who would become her earnest votaries

Introduction

The object of this is to assist the comprehension of matters which constitute the body of the work ; it contains also a critical exposition of the method of investigation, and generalities on the great questions of syphilography. Thus, after a few remarks upon the synonyms, and a brief history of the venereal disease, I will describe the method, observation, and experiment applicable to this specialty. I will speak of syphilization, and conclude with an article on the transmissibility of secondary accidents.

SYNONYMS.

The diseases which I am about to investigate have received an infinity of names, sometimes originating from their mode of propagation, sometimes from a prominent symptom, sometimes from the country accused of giving birth to the malady, or from the people who communicated it to strangers ; sometimes, indeed, from fable. Thus it was called venereal disease, from the fact that it was generally contracted during the venereal act ; verole signifies pustules on the skin, which are observed in certain stages of the disease, and which have been considered analagous to those of variola ; and it was called Mai francaise, Mai napolitain, because the French and the Neapolitans were supposed to have communicated the malady to other nations. Other people, too, have, in their turn, been accused, and have contributed in giving a name to this disease ; the Turks as well as the Germans, the Poles as well as the Moscovites, &c, &c. But it must be admitted that the French, in4his respect, have gained the greatest notoriety. Syphilis is the creation of Fracastor ; in his poem he imagines that the shepherd Syphilus, was the first who was smitten with the disease, which the gods, in their wrath, invented. I will not exhaust this subject, which might be made to fill many pages ; without interest, however, either in a scientific or practical point of view. The names still employed are these: Venereal Disease, Syphilis, Verole. Some physicians use them indifferently. Nevertheless, the first is generally adopted, as it indicates the most common source of the disease, viz., coitus, or other libidinous connections. Syphilis denotes that a virus, a morbid poison, has intervened, and that it plays a principal part, whilst verole or constitutional syphilis signifies that this virus has produced a profound change in the organism, constituting, indeed, a diathesis, a disposition, a temperament. This virus is sometimes inoculated by accident, by a wound, and the affections to which it gives rise may be entirely independent of any libidinous act. At present, there is a patient under my care, at the venereal hospital, who, in a strife, was bitten on the thumb by his comrade, and who was thus, at the same time, inoculated with a chancre.

HISTORY.

I shall be brief in my sketch of the history of syphilus, shrouded as it is in darkness, and from no point shedding light upon doctrine or practice. The point most obscure in its history is that of its origin. Is it as old as humanity ? Is it modern, and did it originate towards the end of the fifteenth century ? The vast learning of Astruc, the dates by him collected, and the commentaries which he has written in his efforts to solve these questions, have not in the least advanced our progress. We know, it is true, that Astruc is a believer in the modern origin of the disease, but we do not become acquainted with this fact until we have carefully perused his work unto the end. The majority of writers are opposed to Astruc, and maintain the doctrine of its ancient origin. To simplify the question, I should, in the first place, remark, that there are venereal affections which are not virulent or specific, as well as those that are. Now, no one can deny that the first have always existed; for in every age, inflammations, discharges, and ulcerations of the genital organs have been observed, caused by the too frequent indulgence in the venereal act, or by its performance during the menstrual period, or pregnancy, &c, &c. Thus, certain venereal affections had their origin in the earliest antiquity. The question remains to be settled, whether the specific disease, syphilis, in fine, is equally old, or whether it originated towards the end of the fifteenth century. In passing over the three principal phases in the history of these diseases, I shall endeavor to throw some light upon both of these questions.

Antiquity. — It is true that in antiquity the venereal disease had neither name, therapeutics, nor a special treatise. But Moses prescribed the observance of certain precautions to prevent the contagion of gonorrhoea (profluvium seminis,) the blennorrhagi of modern times. Hippocrates alludes not only to ulcers on the penis, but to pustules and the loss of the hair. Celsus is more remarkable still, for if rightly interpreted, we find that he was acquainted with almost every kind of ulceration on the penis, and with our present notions, it is possible to recognize in his descriptions, not only chancre but several of its varieties ; as the common, and even the indurated chancre. Still further, Celsus points out the complication of phimosis, and of paraphimosis. But scientific distinctions could not have been established by Celsus, and it would be unjust to exact from him a diagnosis, to which many physicians, even in our own day, are incompetent.

In ancient times, everything was regarded as a result, and variety, of inflammations ; a specific canse was unknown, and the connection of the different symptoms was not recognized. However, one fact, that of contagion, known to the most eminent, should have aroused the attention of the ancients ; thus, Galen, with his genius, traced blennorrhagia to contagion, and his followers, in this as in other matters, adopted the opinions of their leader. As we depart from antiquity the elements of the disease become more distinct, and so connected as to constitute the venereal disease with its special forms. Thus the Arabs and the Arabists are very instructive in a historical point of view ; Avicenna and Aretus describe a peculiar disease of the throat, which the latter calls the Egyptian disease, and supposed it to be confined to young people. The fact of its being contagious is distinctly noticed, and William of Salicet, Lanfranc, and B. Gordon had some idea of a specific cause : they note the deplorable consequences of carnal connection with unclean females, affected with discharges which even then they designated as virulent, (virulentes;) they refer to inguinal abscesses, genuine buboes having their starting point, the penis, and marked the cutaneous eruptions as constitutional affections, classing them with lepra. These abscesses were noticed not only as cold or hot, and distinct from their cause, but as having their starting point on the penis. Thus, we find this remarkable passage in William of Salicet ; " And the bubo occurs when a man has a disease of the penis from connection with an unclean woman, or from every other cause, which gives rise to an accumulation of corruption in this organ, which corruption being unable to find an exit, returns to the groins, according to that law of affinity which these parts have with the infected organ." Lanfranc, who was a pupil of William, speaks of abscesses in the groin that follow ulcers on the penis : jScepe provenit aposthema in inguine propter ulcera virgce, proptera quod est decensus humorum ad ilia loca* Further, Lanfranc advises a method of prevention, which I will mention when I discuss the subject of prophylaxis. I will add, that even before the fifteenth century there existed, as for example in London, regulations of medical police for certain houses of prostitution.

There can then be no doubt of the existence, in antiquity, of local non- virulent venereal diseases, and there is strong presumptive evidence also, that there were those of a specific nature, which produced both local and constitutional symptoms. Thus, it is very probable, that more than one syphiloid affection might have been found in that confused mass of cutaneous diseases, and among those lepers so often noticed among the ancients, and which have not yet disappeared, as is maintained by the hygienists. What led to the use of mercury after the epidemic of the fifteenth century? It was the success obtained in the earlier ages, when it was employed for the cure of those diseases which were confounded with lepra, and among which were the syphilides. Is this not another

* Pract. III., doctr. II., cap. II.

proof showing the connection existing between the affections observed before the fifteenth century and those which occurred subsequently to this period? Further, as I have already stated, the diseases called leprous, have not yet disappeared ; but, having been more carefully studied, and better specialized, the part that lepra plays in the production of these affections, has been reduced to so narrow a compass that it would seem no longer to exist. That belonging to syphilis could not be shown without understanding the dependence existing between the primitive and the consecutive accidents, the cutaneous eruptions ; now this dependence was unknown to the ancients; ignorant of the interval between the phenomenon of inoculation (primitive accident), and that of infection (consecutive accident), these two elements of the same malady have passed for two distinct diseases, proceeding from a different ' cause. Perhaps this kind of incubation of the consecutive affection, was in ancient times of longer duration, from circumstances which we cannot appreciate, and thus a new obstacle has been added to our progress.

Fifteenth Century. — During this epoch many persons were smitten with a scourge which has been represented as cruel and disgusting. The skin of the afflicted was covered with numerous pustules, agonizing pains racked their limbs and head, resembling those now called osteocopes rhumatoides ; these were accompanied with sleeplessness, scalding of the urine, and fever. It was particularly during the latter part of this century (1495), and at Naples, whilst it was occupied by the French army commanded by Charles VIII. , that this scourge was most violent, and counted its greatest numbers of victims. The rapidity with which the disease spread, the extent of country over which it travelled, gave to it the character of an epidemic ; on which account, this period in the history of syphilis has always been known under the name of the epidemic of the fifteenth century.

But if, as was thought by some authors, this was a new malady, others again regarded it as a degeneration or aggravation of another disease. It was a kind of maranique pest, or indeed, an affection analagous to the epidemic lichen of Hippocrates, or a meutagra, having also an epidemic character. It is not surprising that, at this epoch, a certain conjunction of the stars should have been regarded as its cause ; and still less that the atmosphere, the breath of speech, should have been considered the vehicle of the morbific principle. "What first struck the observer, was the state of the skin covered with pustules, and the pains in the limbs with which the patient was tormented. The lesions of the genital organs were unknown, or appeared of but little consequence, compared with those which shortly followed. It is even probable that these lesions, which at this day are called primitive accidents, were sometimes completely absent. For my own part, I am inclined to think that such was the case, especially since I have proved in so positive a manner, the transmissibility of the pustular form of the syphilidesof the pustular form ; indeed, at a certain period, the pustules ou the skin may be transmitted from a diseased to a sound person.

Whatever may be the explanation, the disease was considered not only as epidemic, but contagious, and different nations accused each other of having spread the plague. When the American origin of the disease was invented, these mutual accusations of European nations were somewhat checked. It was supposed that the Spaniards, on their return from the conquest of the new world, had brought with them a new malady, which they scattered in Italy, where, at that time, was stationed a French army. This opinion of the American importation, has found and still counts, many advocates. Numerous serious objections have been urged against it. M. Eicord, for example, who believes in the exclusive inoculability of the primitive affection, thinks it very astonishing that this should have retained its virulence during the long voyage of the Spanish sailors, and the long time which must have passed before their arrival in Italy. To this we may reply, that the consecutive affections may also be inoculated, and that the disease of the army in Italy having been specially characterized by the existence of pustules, these might have occurred among the Spaniards during the voyage. But there is a still more embarrassing objection against the doctrine of importation, based upon the immunity of the Spanish ports, when these voyagers ' first landed, and where they resided, and this too, after the long continence which had been forced upon them. Thus, it is well known that the greater part of the crews of Columbus remained at Seville, and yet this city did not suffer from the disease supposed to have been imported by these navigators. They could, therefore, have been dangerous only to the Neapolitans, and this too after having failed to contaminate the Spaniards ! Besides, when the Spaniards arrived in Italy, this, like other European countries, was already infected. Swediaur goes so far, indeed, as to assert, that Europeans, the Spaniards — carried the disease to the new world. But I know not why the believers in the American importation of syphilis, would find no trace of it in antiquity; for, admitting their opinions to be true, we are compelled to ask, how did it originate in the new world. The question then of the first origin of syphilis, according to this view of it, is only shifted, not solved.