Gonorrhœa ...

Preface To The Third Edition

rT^HE favorable reception which the first two editions of my -*- monograph received from the medical profession is a sufficient reason for avoiding material changes in the present edition of the work. I have merely attempted to add the experiences and advances which have been made since the appearance of the second edition. During the last few years much attention has been devoted to the subject of gonorrhoea, and our knowledge in this direction has been considerably enlarged. The possibility of more ready culture of the gonococcus, and greater precision in the question of mixed infections, constitute important achievements. On the other hand, I have been able, through the great kindness of Professor Weichselbaum, to make the first systematic anatomical examinations of chronic urethritis. These points form the principal changes and additions to be found in the present edition. The two additional plates (VI and VII) are intended to illustrate anatomical conditions. I have also endeavored in other ways to keep the work up to the modern standpoint. Ma}' this edition meet with the same good fortune as its predecessors.

The Author.

Vienna, June, 1893.

Contents

PAGE

Chapter I. Blenorrhcea In The Male And Its Complications

Urethral Blenorrhoea, . . . . 23

Anatomical and Physiological Remarks, 23

Chapter II. Acute Urethritis

Infection, 41

Acute Anterior Urethritis, 46

Posterior Acute Urethritis, ......... 62.

Diagnosis and Differential Diagnosis, ..... e . 73

Anatomy, 81

Treatment, SO

Oversight of the Remedies, ......... 97

Local Remedies, 105

Methods, 117

Treatment of Anterior Urethritis, 119

Treatment of Acute Posterior Urethritis, ...... 132

Chapter III. Chronic Urethritis

Chronic Anterior Urethritis, 143

Chronic Posterior Urethritis, ........ 145

Secretion, 149

The Infectiousness of Chronic Gonorrhoea, 154

v vi Contents.

PAGE

Localization, 155

Pars Anterior, 171

Pars Posterior, .... 175

Chapter IV. Complications Of Blenorrhcea In The Male

Balanitis, 207

Follicular and Cavernous Infiltration and Abscesses, .... 215

Inflammation of Cowper's Glands, 222

Prognosis, Treatment, 226

Inflammation of the Prostate, 226

Chronic Prostatitis, 232

Inflammation of the Epididymis, 236

Diagnosis, Prognosis, 252

Inflammation of the Seminal Vesicles, 258

Inflammation of the Bladder, 259

Prognosis, Treatment, 267

Inflammation of the Renal Pelvis and Kidney, 270

Contents. vii CHAPTER V.

BLENORRHCEA IN THE FEMALE.

PAGE

Urethritis, 277

Vaginitis, 282

Chapter VI. Complications Of Blenorrhcea In The Female

Vulvitis, 290

Diagnosis, 292

Inflammation of Bartholin's Glands, 293

Acute Bartholinitis, 294

Chronic Bartholinitis, 295

Inflammation of the Uterus and its Appendages, .... 297

Chapter VII. Complications Of Blenorrhcea In Both Sexes

Gonorrhoeal Rheumatism, 302

Blenorrhagic Endocarditis, 312

Blenorrhagic Exanthemata, 315

Blenorrhagic Ophthalmia, 315

Blenorrhagic Adenitis, 316

BLENORRHCEA OF THE SEXUAL ORGANS.

HISTOET.

Although the views concerning the antiquity, development and origin of constitutional syphilis are very divergent, and the documents and data which testify to the knowledge of this plague in the time of the Jews, Romans and Greeks are so scanty and obscure, that we must strongly doubt whether this mooted question will ever be definitely settled, nevertheless we may maintain with positiveness that blenorrhoic disease of the genitalia are as old as the human race. At all events they can be traced back historically almost as far as the history of man, and appear at the same time as the latter out of the mythical obscurity of legends and tradition. We find at least, among the cultivated nations of antiquity as well as of the Middle Ages, in part appropriate descriptions of the symptoms of blenorrhagic affections, in part unmistakeable indications that the etiology, the contagious character of the disease, had not escaped observation. This original clearness and correct knowledge gave way to confusion when, almost coincidently with the discovery of America, syphilis traversed Europe as a pandemic, — whether as a new disease may be doubted, but at all events with hitherto unknown virulence. The relatively mild and harmless symptoms of blenorrhcea were of no importance compared with the severe manifestations of syphilis, the majority of which also started from the sexual organs, and thus blenorrhcea sank into oblivion, at least among medical writers. And in the same measure that the violence and malignancy of syphilis gradually diminished, bienorrhoea again became the subject of observation and study; the knowledge that both diseases were localized generally in the genitalia, often occurred together and were both contagious, led to their being grouped together, and to blenorrhoea being regarded as a symptom of syphilis. Although this view did not remain unopposed, it prevailed for a long time, and not until the middle of the eighteenth century did the number of voices which advocated the separation of blenorrhoea from syphilis become greater and their importance more and more considerable. Finally, the separation became definitive in the thirties of the present century.

Thus we can distinguish three periods in the interesting history of blenorrhoea, the first period — until the occurrence of S3 T philis — in which blenorrhoea stood alone; the second — until 1830 — which represents the period of confusion; the third period, beginning with 1830, and which continues to the present time.

First Period: until the occurrence of Syphilis as a Pandemic. — Numerous texts prove that blenorrhoea was known to the civilized nations of antiquity, and that it was also regarded by them as contagious.

Thus the Jews knew blenorrhoea very accurately, and in Leviticus hi. 15, Moses not alone gives a description, but also sanitary and police regulations which testify to accurate knowledge of the disease.

Whether the words used concerning David's disease in Lev., Chap, xv., refer to this affection must remain in doubt.

Maimonides describes blenorrhoea clearly. He says: the fluid escapes without erection and without a feeling of pleasure ; the appearance is similar to that of barley dough in water, which is dissolved, or coagulated albumen, and is the result of the internal disease; it is also essentially different from the seminal fluid and mucus, the latter being more homogeneous. Maimonides mentions seven causes of the disease, including amorousness and excesses.

Blenorrhoea was also well known to the Greeks and Romans. Thus, Herodotus relates that the Scythians, who had violated the shrine of Yenus-Urania, were attacked by the morbus femineus of the vouffo^Xeta. Hippocrates speaks of the sensation of burning during micturition and of the white discharge of women. Oelsus mentions ulcers in the urethra and the discharge of bloody, purulent matter from the canal. Corresponding- texts are found in Juvenal, Martial, Dioscorides, Scrihonius Largus, Sextus Placidus, Pliny and Galen. Galen, in particular, separates satyriasis, the escape of semen from the erect penis, from gonorrhoea, the escape of semen without erection. Aretaeus distinguishes vaginal blenorrhcea from fluor, and Marcellus Empyricus, Physician to the Emperor Theodosius, mentions remedies.

The statements of writers of the Middle Ages concerning blenorrhcea are more numerous and detailed, above all those of the Arabists. Thus, we read in Johannes Mesue, who lived in the tenth or eleventh century: Si vero in via et ductu urince ulcer a sunt, cognoscuntur ex dolor e magis in urince egressione et sanie egrediente ante urinam. Ulcera virgce et apostemata sunt proportionalia ulceribus et apostemalibus testium. Haly Abbas speaks of an urethritis which is accompanied by a white discharge and pain in urination. Phages discusses burning during micturition. He recommends bolus armena, dragon's blood and injections in purulent discharges from the urethra. Serapion also discusses blenorrhcea, ulcers in the urethra, which provoke pain and purulent discharge. He defines gonorrhoea as increased involuntary discharge of semen and recommends hemp seeds against it. He also gives a good description of the suppurations of the female genitalia, which result from excessive coitus. Ebn Sina describes clap as follows : Sentitur acuitas et mordicatio in egressione et quandoque est cum ea ardor urince, et est color ejus ad citrinitatem declivis. In the eleventh century Abulcasem used injections of a mixture of vinegar and water in gonorrhoea.

In the other writers of the Middle Ages we also find descriptions of blenorrhcea, as well as some police ordinances for the prevention of its spread by prostitutes. Gariopontus discusses gonorrhoea, and Michael Scotus, physician to the Emperor Frederick I., recognizes its infectious nature. Rogerius, a physician of the twelfth century, treats of reumatisatio virgce: Quando reumatisant humor es ad canales virgce, et faciunt ibi pustulas et apostemata, si fiat de calida causa, cognoscitur per calorem, per punctionem et arsuras, per rubor em et inflammationem membri. Si fiat de causa frigida, cognoscitur per remotionem punctionum, et mordicationem et per exclusionem ruboris; in utraque causa difficultas mingendi. Lanfrancus, a pupil of "William de Saliceto and a distinguished physician of the 13th century, speaks de apostematibus virgce in the following terms: Aliquando repletur virga ventositate grossa, ipsam cum dolor e nimis extendente, cum autem cessat materice cursus, si vero apostema testiculi induretur. Constantinus Africanus recommends remedies against strangury. Joannes Ardern, a physician of the 14th century, recommends sedative injections against blenorrhoea. Guido de Cauliaco speaks, in his Surgery of burning and disease of the penis from intercourse with a diseased woman. Joannes de Gaddesden recognized urethritis and epididymitis, he was also acquainted with vaginitis. Similar statements are found in Yalescus de Taranta, Gulielmus Vareguana, Magninus, Joannes Arculanus, Joannes de Tornamira, Antonio Cermisone and many others, which leave no doubt that blenorrhcea was very well known, was regarded as contagious, and treated with local remedies. That the contagious character of blenorrhoea was generally recognized is shown above all by some police ordinances which have come down to us. Thus, Beckett reports an ordinance of the Bishop of Winchester for the houses of prostitution of Southwark, a suburb of London, which, eighteen in number, are said to have been under the supervision of this Bishop. This ordinance dates back to the year 1162. One of its articles reads as follows: De his qui custodiant mulieres habentes nefandam infirmatatem, and begins thus: "That no Stewholder keep noo woman wythin his hous, that hath any sycknesse of Brenning," or, as is said in a similar ordinance of this Bishop, " the perilous infirmity of burning."

An ordinance concerning the establishment of a house of prostitution in Avignon, which is attributed to Johanna I., Queen of both Sicilies, is dated August 8th, 1347. The fourth article of this ordinance reads : " The Queen commands that the superintendent and a surgeon appointed by the authorities examine, every Saturday, all the whores in the house of prostitution. And if one is found, who has contracted a disease from coitus, she shall be separated from the rest and live apart, in order that she may not distribute her favors, and may thus be prevented from conveying disease to the youth."

All these quotations show sufficiently that blenorrhoea existed in antiquity and the Middle Ages, that its nature and contagious character were recognized, and that prophylactic and therapeutic measures against it were adopted. Then towards the end of the 15th century syphilis appeared upon the scene, and spread rapidly with hitherto unobserved intensity. What wonder that the attention of the medical public was directed exclusively to the new and malignant disease, that blenorrhcea sank into comparative oblivion and that thus begins

The Second Period, that of Confusion. — It would be going too far to assume that the newly developed syphilis had cast gonorrhoea into complete oblivion. This is not true. It was merely that the new and interesting disease diverted attention and study from the old and known, but without causing it to be forgotten. Thus, the contemporaries of the first great epidemic of syphilis speak incidentally of blenorrhoea as a disease long known, or they do not mention it at all in the treatises devoted to the new affection. Thus, Grunpeck (1496), Fracastor (1530), Mattheoli (1536), Massa (1536), do not mention gonorrhoea; Johannes de Vigo (1513) in his Surgery, in the chapter de auxiliis cegritudinum virgce — speaks in detail of blenorrhoea and its treatment. Alexander Benedictus (1510) discusses syphilis and clap separately, as does Marcellus Cumanus, a military surgeon of the Venetian Army during the period of the first epidemic (1495). Jaques de Bethencourt (1527) relates the history of a chronic blenorrhoea. Paracelsus (1530) also recognized blenorrhoea, and mentions it as a possible complication of syphilis, like dropsy, podagra, paralysis, icterus and catarrh. In England Simon Fish (1530), Andrew Boord (1546), Michael Wood and William Bulleyn (1560) describe blenorrhoea, particularly in women, as a distinct disease, separate from syphilis. It seems to have been very widespread among prostitutes.

In opposition to these views Musa Brassavolus (1553) appears to have been the first to regard blenorrhoea as a S3'mptom of syphilis, and, like the latter, as a new disease, whose origin dates to the year 1531. Nevertheless Brassavolus did not believe that symptoms of syphilis could develop from gonorrhoea. Gabriel Fallopius, the pupil of Brassavolus, coincides in this opinion of the syphilitic character of gonorrhoea. In a treatise published in 1563 we read: "the final symptom is Gallic gonorrhoea. Thirty years may elapse before this discharge begins." Tomitanus also accedes to the opinion that blenorrhcea is a symptom of syphilis, and this belief prevailed for nearly two centuries. The results of this view were serious. Every clap was regarded as of equal importance to syphilis, and subjected to the most vigorous treatment with mercury, guaiac and sarsparilla. A few warning- voices were raised, for example P. Haschard (1554).

It was not until the beginning of the 18th century that the opposition began, at first timidly,then more boldly, and thus the third period in the history of blenorrhcea was inaugurated. Cockburn's (1715) statement that blenorrhcea was not usually followed by symptoms of syphilis, remained unnoticed. This is also true of Boerhaave's (1753) admission. Balfour (1767) asks very timidly : Nonnie potius suspicandum est, longe diver sam esse materiam, quam lueni paruit, ab ea, ex qua gonorrhoea efficitur. Hales (1770) was the first to advocate the complete separation of the gonorrhoea and chancre virus, and Ellis (1771) made a large step in advance by making experiments subservient to his views. He also distinguishes the virus of syphilis from that of blenorrhcea. He says: "It seems most probable that there is something in the venereal particles of matter, in a gonorrhoea, which is very different in its nature and figure from that of the pox. * * * * The virus of the gonorrhoea, if exposed to any part denudated of its skin, will not form a chancre, but will heal with a little styptic wash, and any soft dressing, as I have observed in several cases." Bayford (1773) opposes Ellis' views because he never succeeded, with the aid of the microscope, in detecting any difference between the pus of clap and chancre. Tode (1774) combatted the identity of the virus of clap and syphilis, and likewise Duncan (1777), who adduces as an argument the fact that the inhabitants of Otahiti were acquainted with syphilis long before clap was imported among them. Harrison (1781) and Swediaur (1784), also employed the experimental method, but were led by their investigations to support the identity of both viruses. And thus the syphilidologists at the end of the 18th century were divided into two camps — the identists who believed in the identity of the virus of clap and syphilis, and their opponents, the dualists. Once again the scale turned in favor of the identists. John Hunter entered the arena. There are few names so popular in our specialty, and when Kicord and Sigmund are mentioned to-day, Hunter

BlenorrJioea of the Sexual Organs. y

is usually added as the third. Unfortunately with but slight justification. Not that we deny to Hunter ardent, even passionate devotion to his profession, great gifts and scientific earnestness, but it is rare that such qualities have produced poorer fruits, and have done less to forward a science than in the case of Hunter, very much to the disadvantage of the beginning freer development of our specialty. With the object of checking the battle between the identists and non-identists, and of getting at the truth of the matter, Hunter performed (May, 1767) upon himself, it is said, the following inoculation experiment, which proved so momentous to our science. One Friday, as he relates, he inoculated the gonorrhceal pus into the glans and prepuce by means of two incisions with a lancet. Both incisions were converted — that on the prepuce more rapidly, that on the glans more slowly — into pustules and superficial ulcerations, which were accompanied by inflammatory symptoms. Both spots were then cauterized repeatedly and slowly healed. During recovery swelling of the inguinal glands occurred, about three months later an ulcer appeared upon the tonsils, and three months later a copper-colored pustular eruption, i.e., symptoms which could certainly be attributed to syphilis. Despite all previous experience this experiment was sufficient for the investigator, who was very quick in arriving at conclusions, to draw the inference that gonorrhceal pus may produce chancre. This single experiment involved a standstill — yes, a retrogression of more than sixty years — since even the shallowest follower of Hunter felt himself justified, relying upon Hunter's authority, his inoculation experiment and "personal experience," in breaking a lance for the unitist theory.

It is true that Hunter distinguished a venereal from a simple clap, which could develop from other causes, or even spontaneously, but he did not clearly describe their differential diagnostic signs. And so began anew the struggle between the unitists and dualists, the former maintaining, through Hunter, the upper hand. Howard's (i 787) opposition to Hunter's doctrines passed unnoticed. If the dualists claimed that constitutional syphilis never develops after clap — that the virus of clap never produces chancre, that of chancre never produces clap — that mercury cures syphilis but not clap — that clap and syphilis developed at entirely different periods — that clap generally recovers spontaneously, syphilis never without the aid of art, — the answer given by the unitists was always the same. It is true, they said, that syphilis develops after a neglected clap, though not so often as after chancre — it is claimed that chancre virus does not produce clap and vice versa, but experience proves the contrary; that mercury is not necessary to the cure of gonorrhoea is owing to the fact that the clap virus in the urethra is outside of the circulation, and its absorption is made difficult by the increased secretion of mucus; however, many gleets are not curable without mercury. Buboes, like clap, also existed prior to syphilis, and are nevertheless undoubtedly syphilitic in character.

Benjamin Bell (1794) was the first who, based upon a series of experiments, secured a hearing for his opposing views. Starting from the theory of the unitists that the same virus produces ulcers upon the glans penis and clap upon the mucous membrane of the urethra, he raises the following objections : a. Chancre should be more common than clap, since the outer surface of the glans is more exposed to infection than the mucous membrane of the urethra, b. Chancre should always be complicated with clap and vice versa, since the pus from ulcers of the glans always passes into the urethra, the pus of clap always reaches the glans. c. The pus from the urethra is often so acrid that it excoriates the glans and prepuce but does not cause ulceration, d. Even the smallest chancre produces general infection, e. Clap and the erosions of the glans produced thereby do not give rise to syphilis. /. Chancre pus placed in wounds produces the venereal disease, the pus of clap does not, as the inoculation of two physicians with gonorrhoeal pus showed. It would also be necessary to assume that a person who merely had a chancre conveys clap to another, and vice versa. Clap is a discharge of pus-like material from the urethra, and is a local disease in every case; clap and chancre were present separately in different countries at different times. Mercury, which cures syphilis, is useless in clap.

Clossius (1797) coincided with Bell's opinions, Evans and Le Bon (1789) strengthened them by experiments, but Hernandez (1811) first exercised a decisive influence and became a forerunner of Ricord on account of the large number of his experiments (he inoculated seventeen convicts with gonorrhoeal pus, always unsuccessfully).

Blenorrhcza of the Sexual Organs. g

The dispute concerning- the identity of the virus of clap and syphilis led to the adoption of two extreme views. The investigations and experiments of Caron (1811) not alone induced him to deny the identity of the two poisons, but he denied the virulence of clap. Thus, Caron and his adherents, Jourdan (1826), Richond de Brus (1826), Devergie (1836), Desruelles (1826), taught that clap is devoid of any virus, that it is neither a virulent nor a contagious disease, but a simple genuine inflammation. In Germany, on the other hand, the careful study and observation of gonorrhoea and its course had led to its entire separation from syphilis, but its purely local character was also denied. It was regarded as a general disease and spoken of as a " clap diathesis." In the works of the adherents of this view— Authenrieth (1809), Ritter (1819), Eisenmann (1830)— we read not alone of clap but also of various sequelae or metastases, such as lung- clap, ear clap, g-onorrhoeal meningitis, clap ulcer, clap neuroses, gonorrhoeal amaurosis, congenital and acquired clap diathesis.

Upon this confusion entered Ricord. Supported by large experience, critical and brilliant dialectic powers, but unfortunately, at the same time, deaf to all justifiable opposition to views which he had once regarded as correct, Ricord as the result of 667 inoculations, established the doctrine (1831 to 1837) of the non-identity of the virus of clap and syphilis, and advocated it so clearly and pertinaciously that all opposition soon ceased and this view seems settled for all time.

Although this question was settled, there developed with and on account of Ricord a new struggle, the struggle concerning the etiology of clap, and this we will consider in the folio wing- section.

Etiology.

Rieord's numerous inoculations and the acute reasoningwhich accompanied them definitively separated gonorrhoea from syphilis, and although an identist voice was occasionally raised, the theory of the identists like that of Caron and Eisenmann secured no adherents, although some distinguished specialists, like Yidal de Cassis and Simon, still favored it and now and then broke a lance for it. For the great majority g-onorrhoea remained permanently separate from syphillis.

io BlenorrJioea of the Sexual Organs.

But now arose a second important question : If clap is not produced by the syphilitic virus, is it the product of a virus at all, or is it a simple, non-virulent inflammation ? In addition to syphilitic clap — produced by the syphilitic virus, and which, in consequence of its development from the syphilitic virus was followed by syphilitic secondary symptoms — the adherents of the unitist theory, Brassavolus, Hunter and many others, had distinguished a simple genuine clap, which was supposed to occur as a simple catarrhal disease from various causes or even spontaneously. Now that the syphilitic clap disappeared, it was natural that the second variety, the simple clap, alone should be supposed to exist.

And this, in fact, was taught by Bicord. He denied the virulence of clap, and regarded it as a simple catarrh which may be due to various irritants. Among these irritants he attached the chief importance to gonorrhceal pus, which reproduced gonorrhoea merely by irritation, not as the result of a virus or contagious principle. But other secretions, menstrual, lochial and puerperal discharges and leucorrhcea, may also act as irritants and produce blenorrhcea. The same effect was said to result from acrid injections, introduction of instruments into the urethra, mechanical irritation, the ingestion of acrid food and drink. Even sexual excesses in perfectly healtlry individuals, or mere long protracted sexual excitement and protracted erections without coitus or sexual contact, were said to produce clap. Bicord based these views in part upon previous experience, especially Swediaur's experiments, in part upon confrontations. He laid special stress on the fact that in confrontation in cases in which the male partner had acquired clap, the female was often found entirely healthy or often sufered merely from leucorrhcea, menstruation, etc., and the development of the clap must be attributed to one of the above-mentioned causes. Finally, he called attention to acclimatisation, which renders one accustomed to it insensible to such irritation, but affects the new-comer with blenorrhcea. From all these experiences Ricord concluded that blenorrhcea is not a virulent disease, that it may develop without inoculation, that it may be acquired from the most innocent girl, the most virtuous wife. In his easy manner of presenting his views he even went so far as to devise a prescription for the means to be employed for surely acquiring blennorrhcea. I reproduce it, since it not alone contains the quintessence of his views on this subject, hut also furnishes an admirable characteristic of Ricord himself : " Do you wish to contract clap ? This is the way. Take a pale, lymphatic woman, blond rather than brunette, and as leucorrhceic as possible. Dine with her; begin with oysters and continue with asparagus, drink a good many dry white wines and champagne, coffee, liqueur. All this is well. Dance after your dinner and make your partner dance. Warm yourself up, and drink a good deal of beer during the evening. When night comes, conduct yourself bravely; two or three acts of intercourse are not too much, more are still better. On waking do not fail to take a long warm bath and to make an injection. If this programme is carried out and 3^ou do not get the clap, it is because God protects you."

These statements of Ricord first led to the experimental production of blenorrhoea by the introduction of genuine pus. Thus, in two individuals, Voillemier introduced into the urethra bougies which had been smeared with pus from an abscess of the thigh and neck. The bougies remained in the urethra an hour without producing clap. Other similar experiments proved negative, but the production of clap was always successful when the pus was taken from another clap or from conjunctival blenorrhoea (which was soon recognized as identical), as shown by the experiments of Pauli, Guyomar and Thiry. Not alone was the difference between blenorrhagic and genuine pus determined in this way, but the advocates of the virulent nature of clap, the virulists, raised other objections based upon observation. Thus, it was emphasized that in properly regulated marital life, the development of clap was not observed despite leucorrhoea, menstruation, or even the ichorous discharge of a uterine cancer. This is also true of localities which are shut off from communication with the outside world, and thus prevent little opportunity for the importation of clap, despite vigorous sexual intercourse or even excesses on the part of the inhabitants. Thus Rosolimos relates that the Greek farmers, who are very continent before marriage and are very faithful in marriage but commit the greatest excesses are unacquainted with gonorrhoea. Michaelis reports that the physicians practising in Lippe often did not observe a case of clap for years. Milton states that for several years he was the sole practitioner in a small town, and during this time treated several cases of clap, all of which proved to be imported, while he did not observe a single case acquired in the town, although there was no lack of opportunity for such acquisition. Further arguments are deduced from the course of blenorrhcea and comparisons with traumatic and chemically-produced urethral catarrhs. Thus, traumatic and chemical catarrhs develope immediately after the noxious action, have no tendency to propagation, but rather a tendency to spontaneous rapid recovery. On the other hand, virulent blenorrhcea has a period of incubation, a tendency to spread over the entire mucous membrane, and if not treated it does not heal spontaneously but passes into a chronic condition. The anti-virulists, who attributed the development of clap directly to the irritant action of the pus corpuscles and regarded the intensity of the action as proportionate to the number of pus corpuscles in the secretion, were told that a minimum amount of mucous secretion, and one very poor in pus corpuscles, from a beginning or a chronic blenorrhcea, would suffice to produce a violent clap.

In this way the struggle lasted for more than forty years, and sides were taken by very prominent writers. Among the anti-virulists were Acton, Hacker, M. Robert, Fournier, Langlebert, Geigel, Mueller, Bumstead, Tarnowsky, Jullien; among the virulists were Baumes, Hoelder, Reder, Milton, Belhomme, Martin, Lebert, Sigmund, Zeissl, Diday. Finally, the latter began to gain ground, the anti-virulistic theory lost more and more supporters. One circumstance contributed materially to this change. A group of investigators were not satisfied with discussing the question of the existence of a virus in an academic manner, but attempted to discover the nature of the virus itself, and to determine its action.

The theory that the virus of syphilis was a virus animatum was held at a remarkably early period of our specialty. Thus, in 1710, we read in a, it is true, very little known author, Deidier : u I believe that the venereal virus consists of nothing else but living maggots, which produce ova by copulation and which readily multiply as do all insects. These being assumed venereal diseases are explained much more readily than by any other hypothesis. . . . These maggots hatch and produce others and in this way we can assume the propagation of the venereal virus. How can it be supposed, as is done, that pox could be carried from the Orient into Europe, and then pass, by commerce with a single prostitute, into the French army and thus to France, were it not for the venereal maggots which furnish a prodigious number of ova and which always find, in foul semen, the degree of putrefaction requisite to make them hatch ? " However naive the conception, the chain of thought is correct, and this man divined what could not be proven until two hundred years later.

The followers of Deidier also adhered to the theory of the virus animatum, which the} 7 sought to discover. Donne (1837) called attention to the presence of an infusorium, which he called " trichomonas vaginalis," in the pus of blenorrhcea vaginae, and he concluded from his investigations that: 1. Purulent vaginitis is very often blenorrhagic, and that the purulent discharge ordinarily contains the trichomonas ; 2. When it does not result from venereal infection, I am forced to conclude that it does not develop on account of these animalcules. Further investigations showed that the trichomonas was an accidental appearance, which is also present in healthy vaginal secretion. Jousseaume (1862) reports the discovery of an alga, which he called genitalia, in blennorrhagic pus. This discovery also proved illusory. Salisbury (1868) found threads of fungi and spores, which he called crypta gonorrhoica, in blenorrhagic pus; these were said to multiply in epithelium cells and to be found in the epithelium of the orifice of the urethra. Hallier (1868) published a similar discovery of a fungus with schizosporangia, which he called coniothecium; he produced cultures.