that it may be varied in its character, and in its influence and effect, by the stage of the disease, and also by the particular state of the general system of the person affected.

It is further my opinion, that the character of the sore produced by the application of this virus, does not by any means depend solely upon any specific difference in its nature, or any particular degree of its concentration; but that, in passing into another system, it becomes subject to a new and a different influence, and consequently that the sore to which it there gives rise may exhibit any character which that other system may at the time have the power of conferring upon it. Something of this kind must take place, otherwise it would be difficult to account for the fact of several men contracting disease from the same source within a few days (I may even say a few hours) of one another, and exhibiting sores of totally different characters. We have every day opportunities of verifying this fact.

In regard to the question-" whether the virus of chancre and gonorrhoea be identical or otherwise," I find more difficulty in giving an answer. The appearance of ulcer and gonorrhoea together, in the same person, is no rare occurrence, and I have ascertained it satisfactorily that they have been contracted from the same source and at the same time; and we have evidence every day to prove that such may also take place in different individuals, one contracting a sore and another a running, from the same person. If, then, we assert the co-existence of two distinct poisons, we must suppose that some persons are susceptible of being affected by the one kind of poison and some by the other; which, in reasoning from analogy, we are perfectly authorized to do, for we know that some persons appear not to be susceptible of being affected by either, but may be exposed to the risk of infection with impunity. But what the laws are which regulate this infection, I do not at all understand. I have observed that one kind of affection prevails more generally at one time than another; but I have not observed that this has been the case at any particular season of the year more than another, nor that it has been influenced by any particular state of constitution preva. lent at the time, or by any local circumstance that I have been able to dis

cover. Although we can no longer avail ourselves of the argument for a diversity of poisons-that one requires the use of mercury for its cure, while the other does not, or that one is followed by secondary symptoms, while the other never is-yet, as it has not been satisfactorily proved that the matter of gonorrhoea can produce a chancre capable of propagating its own kind, nor vice versû, and as gonorrhea has been found to prevail extensively, and for a long period of time, without the appearance of any other venereal affection, we have some grounds for believing that they are not identical, but distinct venereal poisons. But I confess it is a subject of difficulty. With regard to the origin of venereal virus, I have no hesitation in saying that I am of opinion that the virus of gonorrhoea is capable of, and frequently does arise spontaneously; but I doubt very much whether this is ever the case with the virus of chancre.

From my own experience in the treatment of this disease, the question is at rest in my mind as to the necessity of the employment of mercury, being convinced that there is no form of the disease, primary or secondary, that may not be cured without its use.

With all the attention I have been able to bestow on the characters and appearances of the primary affections, which I have had opportunities of ob serving, I have not found that I could predict, with any thing like an approximation to certainty, whether any one more than another would be followed by secondary symptoms, or of what character these symptoms would be; neither could I say, from the appearance of the secondary symptoms, what the character of the primary affection had been. Certainly the small superficial ulcer without induration, and which heals generally within a period of fifteen days, is less frequently followed by constitutional symptoms than any other; yet it is followed sufficiently often, and by a sufficient variety of appearances, to prove that it is not an exception.

I have never seen but two cases, on which I could rely, of secondary symp. toms consequent upon gonorrhea alone, without some other primary affection having at some time or other existed. These were mild papular eruptions, and very easily removed. As it is not yet ascertained what the utmost limit of

time may be which may elapse before the secondary symptoms make their appearance, I should hesitate to ascribe the appearance of these symptoms to gonorrhoea, if I found that any other primary affections had existed within the period of one, or even two years; for instances have occurred to me of the period being extended to the latter, if reliance could be placed on the veracity of the persons.

I have no doubt it will be found, that the average period of time which may elapse in this climate will very far exceed that which ever elapses in Europe. This may perhaps be attributed partly to the influence of climate, and in part to the constitutions and habits of the

persons.

It remains only to take notice of a case of this disease, which, occurring in a strumous habit, exhibited a train of cachectic symptoms of great severity, which ultimately proved fatal.

This man was sent on a monthly detachment to an outpost; and a few days after leaving head-quarters an ulcer appeared on the prepuce, which continued to enlarge, and about a fortnight after the appearance of the ulcer, an eruption broke out on his skin; and in this state he presented himself at the hospital on being relieved from detachment, having in the meantime used no medicine whatever.

The ulcer was situated on the prepuce, about the size of a shilling, with deep, irregular surface, discharging a dark-coloured ichor, and very painful; and the constitutional symptoms were a very general eruption of copper-coloured tubercles and blotches, most numerous on the face and lower extremities; a quick pulse, with dry, hot skin, and altogether a great deal of constitutional

irritation.

Under the antiphlogistic regimen, and the use of fomentations, poultices, and other local applications, with the free use of opium internally, the severity of the symptoms was mitigated, but the progress of the cure was very slow. At the expiration of six weeks, however, the ulcer was healed, and the tubercles had desquamated, leaving the skin sound but discoloured.

Hitherto no mercury had been used; but it was considered that a small quan tity, in conjunction with the other remedies, might now be serviceable in exciting a new action in the constitution,

328.-XIII.

and restoring the general health. Accordingly, five grains of the compound calomel pill were given every other night for three weeks, the antimonials and sarsaparilla being continued.

Every symptom of the disease being removed, and the general health good, he was discharged from hospital. Exactly a fortnight afterwards he returned, complaining of pain in both ears, dizziness in the head, with great deafness, loss of appetite, constipated bowels, and an extensive erythematous inflammation in the fauces. The occurrence of these symptoms he attributed to cold.

Blisters behind the ears, and on the nape of the neck, with issues and detergent gargles, improved the sense of hearing a little; but the sensation of noise and confusion of the head continued; and in the meantime symptoms of pulmonic disease began to manifest themselves, and in a short time assumed the character of phthisis.

The intellectual faculties were now implicated, and he continued in a state of fatuity until dissolution.

The following were the appearances on dissection :

On

Cranium.-The sinuses and venous system of the brain generally, were loaded with blood; and serous effusion had taken place to some amount beneath the arachnoid membrane. The substance of the brain, when sliced, exhibited numerous bloody puncta. opening the left lateral ventricle, very extensive disease presented itself, the whole of the corpus striatum, and the substance of the brain outwards to the dura mater, being converted into a soft, pulpy, darkcoloured mass, much resembling fungus hæmatodes. The structure of the cerebrum and cerebellum in other parts was firm and healthy, and but little fluid existed in the ventricles.

Thorax. Much serous fluid was found in the pericardium; the heart itself did not appear to be diseased. The left cavity of the chest contained about a quart of serum, having a quantity of gelatinous matter floating in it; the lung being compressed and hepatized. This organ, when cut into at its lower part, exhibited numerous crude tubercles, but in the apex several large vomicae had formed. The right lung also contained tubercles, but in a much less advanced stage than those found in the left side.

Abdomen.-The liver was enlarged 3 N

and granular; and the gall-bladder onethird filled with attenuated bile. The membranous viscera were sound, but the mesenteric glands were extremely diseased; their substance being tubercular, softened in the centre, and containing green-coloured puriform matter.

THOMAS CLARKE,
Surgeon, 72d Regt.

CASE OF DOUBLE UTERUS,

WITH OTHER ANATOMICAL PECULIARITIES.

To the Editor of the Medical Gazette. SIR,

PERHAPS the following case, of a uterus presenting some anatomical peculiarities, may be worth inserting in your valuable journal.—I am, sir,

Your obedient servant,
D. ADAMS,

Student.

Guy's Hospital, March 4, 1834. A woman, æt. 38, was brought for dissection (under the regulations of the Anatomical Bill), Feb. 11, 1834. The external genitals were in their normal state; and the hymen was remarkably perfeet, having an annular opening scarcely sufficient to admit the end of the little finger. The uterus, on its exterior, was divided by an anterior and posterior vertical depression, into symmetrical portions. On making the sections, as re

presented in the accompanying sketch, the two superior thirds of the cavity were divided by a septum into nearly equal canals, extending outwards and upwards to each cornu, where the fallopian tube terminated as usual, pervious. The neck of the uterus, which occupied about the lower third, presented nothing remarkable, having an opening common to the two canals. The ovaries were unusually large; and in one there was a cyst, containing more than a drachm of jelly-like fluid.

In the same subject were observed two or three other anatomical appearances worthy of being noticed. The whole of the right kidney had been entirely absorbed, leaving only the membranous capsule, enlarged. to at least five times its natural size, and containing nearly a pint and a half of coagulable serous fluid, pushing the duodenum and ascending colon forwards. The ureter attached to the inner and lower part of this capsule was completely obstructed by two strictures, between which it contained some fluid, like that in the sac. The left kidney was much enlarged, and its pelvis had begun to assume the cystic form observed on the other side, being sufficiently large to hold one or two ounces of urine. The ureter on this side was somewhat contracted, but did not impede the flow of urine through it. The bladder was large, but healthy.

approach some digest of those practical measures of reform which the legislature may safely and beneficially effect. Such a review, however, requires that the principles by which such plans of reform are to be tried should be well understood; else, in attempting reformation, we may only plunge more deeply into error. At such a moment it behoves all who have reflected on the subject, and who have the welfare of the profession at heart, to submit freely whatever views of it they may deem of consequence, or which can furnish any aid or guidance to the Committee of the House of Commons, in the important investigation in which they are engaged. With this view, and with these feelings, are the following remarks, in exposition of a complex question, submitted for consideration.

On a subject so complicated and extensive, on which so much ignorance prevails, and where so many conflicting interests and prejudices are to be reconciled, it is not wonderful that great diversity of opinion has been displayed; and if propositions incongruous and absurd have been urged by the respective parties, with a confidence for which the wisdom evinced affords but very slight ground, such efforts for the attainment of a great public benefit should be regarded not only with indulgence, but, so far as the efforts are concerned, with approval. The good intentions of the parties we have no right to impugn; and their errors of judgment are harm less, because the whole subject must undergo the scrutiny of a tribunal, which will bring to its consideration those principles of sound political science, which the profession itself, in its zeal for reformation, and divided as it is into separate and conflicting interests, would be too apt to overlook.

It may seem strange to make the assertion, but my persuasion is, that the profession itself, as now constituted, is no competent judge of what its political organization ought to be; and that the

constitution most suitable and beneficial for it, would be far better adjusted by minds less under the bias of personal feeling, and more imbued with political science, than by any body of the profession. In this I mean not to speak slightingly of the general intelligence or information of my professional brethren, who, I am well convinced, posess, as a body, as much general know

ledge, enlightened sagacity, and liberal sentiment, as any other that exists. But it would be difficult to ascertain how the collective body, as represented by the higher intellect and superior cultivation, really judges on the subject; for no means exist by which such a decision could be accurately or distinctly obtained. Circumstanced as the profession has long been, and still is, it affords no facilities for collective deliberation, or for that patient and mature investiga tion which would lead to conclusions in which all the inquiring parties could concur, each surrendering to the force of reason and of truth those “idols of the mind" by which even the strongest intellects are more or less swayed. We find it consisting of several branches, some originating in legislative enactments of old date, others superadded by the slow but sure operation of public opinion, and public necessities. Each of these has hitherto pursued its own course, regardful only of its own aggrandizement, and reckless of the inJuries which its special advancement might inflict on the other departments; while no provision existed for consolidating the whole into a consistent and efficient system of medical polity, or for establishing a general medical council, formed by deputations from the separate incorporations, in which each of these might uphold its special interests, and the whole co-operate harmoniously in all such arrangements as involve the collective interests of the profession, and the well-being of the community.

To the want of some such collective council may be ascribed much of the confusion which has crept into the profession, deranging its organization, and going far to confound all ranks and degrees; and much of the discordancy which so signally marks the reforming projects with which the periodic press has of late teemed. The evil, so far as it is one (for with it in its progress much good has also been conjoined), has sprung from each branch pursuing its own ends, as if no other were in existence, and without reference to the functions performed by the other departments. In this way have arisen errors both of omission and commission, such as could never have occurred if the profession, instead of being intrusted absolutely to separate and independent governments, had in its constitution possessed some means of bringing these