Have M. Ricord or M. Victor De Meric ever seen a case of glanders in man? It bears as much resemblance to the venereal disease as it does to the mange in dogs. Let us at once refer the origin of the disease, with Coradinus Gilinus, to the junction of Saturn and Mars, Jan. 16th, 1496; or that of Jupiter and Mars, Nov. 17th, 1494; or revive the theory of the learned Wendelinus Hock de Brackenaw, who refers this calamity to the year of God, 1483, because in the month of October of that era there were four planets in Libranamely, Jupiter, Mars, the Sun, and Mercury. Such statements are quite as satisfactory, and infinitely more clean, than Van Helmont's visions of intercourse with an infected mare. M. De Meric commences his work with modesty : "I may not," he says, on the present occasion, follow the ravages of the disease through the length and breadth of the world, trace its effects in different climates, describe its decrease and occasional exacerbations; compare it with the sibbens of Scotland, the yaws of the West Indies, and the black disease of Canada; but I shall just stop to inquire what aspect syphilis presents in this country in our own refined state of society." (p. 5.) He then proceeds to speak of the rather large proportion of chancres which become phagedænic; of gangrene of the prepuce and glans; of intractable secondary or tertiary ulcers; of carious skulls, which now, as of yore, lead the sufferer to the grave. He speaks, too, of “our fair delinquents, once adorned by freshness and youth, turned into objects of disgust and commiseration." "We all know," he adds, "that a man may have had a chancre and a suppurating bubo, and remain for the rest of his life perfectly free from any taint whatever. Such an individual should not be said to have suffered from syphilis; his frame is not infected, he has simply had a venereal ulceration, followed by a glandular complication. The words chancre and syphilis might, then, advantageously be reserved for the more serious complaint; and it would at once be plain that syphilis is to be classed with other blood-diseases, as cancer and scrofula." (p. 6.) We will not here enter into a disquisition upon the meaning of blood-disease; nor stop to inquire how far cancer, or even scrofula, may be the better understood upon such a basis. Who has detected morbid changes in the blood of those suffering from either malady? And wherefore is it that the life-endowed cells, which end in the development of the tissues, may not have more to do with the development of malignant disease, than the composition of the circulating fluid? The cancer or scrofula which comes from our parents cannot be eliminated by bleeding, nor cured by transfusion; nor can the disease be transmitted by inoculation. We will, then, drop the term blood-disease, as in this instance too vague for useful investigation. Mr. De Meric looks down upon some practitioners who believe that "the poison of syphilis may be generated spontaneously; that frequent promiscuous intercourse, coupled with uncleanly habits, may cause the development of syphilitic ulcerations." We will ask the author whether it be not true that the poison of typhus is generated spontaneously in crowded habitations? that the poison of typhoid fever comes spontaneously from decomposing fæcal matter? And may not the same be said of every other morbid yet non-tangible influence which acts injuriously on the human frame; we know it not, save by its effects. Just as promiscuous intercourse develops syphilis, so does overcrowding induce typhus, or bad drainage develop typhoid fever; we have no need to descend for explanation to the pathology of quadrupeds. Now, nobody denies that there is a syphilitic poison. MM. Ricord and De Meric may therefore spare both argument and illustration in proof of what is known. But when we proceed to the next step: "Nor does the analogy between syphilis and other contagious diseases stop here, for it is extremely probable that the organism is insusceptible of two syphilitic infections,"* we must request the reader to suspend his belief. And before entering upon this point, we will inquire into the nature of primary syphilitic ulcers. M. Ricord asserts that there are two forms of chancre—one the chancre mou, the simple or non-infecting chancre; the other the indurated or infecting chancre. He proceeds to explain that the excess of relative frequency of the simple chancre may be explained as follows:-1. The simple chancre is the most abundant source of the chancrous virus; it is the form of ulceration which secretes pus endowed to the highest extent with the property of contagion, and which retains for a long period the faculty of inoculation. 2. It creates no immunity against a renewed contagion of a chancre of the same kind-that is to say, against its reproduction upon the same individual. The indurated chancre is only produced once upon the same subject. To the natural inquiry, are these statements true as regards English experience, we answer unhesitatingly in the negative ; they are contradicted by daily evidence of hospitals wherein syphilitic disease is witnessed on a large scale. In the first place, can chancres be recognised in this primary form as infecting and non-infecting? We entertain very strong doubts whether M. Ricord himself would encounter a heavy responsibility in determining this point. He might succeed at a guess; but he could not lay down clear and unmistakeable rules. What are his own words upon the point? "You will remark, that in those places where the induration is most exuberant, it also persists longer than in any other region. On the other hand (and I hasten to point out this fact to you now, in order that you may see the contrast), there are certain anatomical regions where indurations are ill-defined, in which their presence is with difficulty recognised, and from whence they rapidly disappear."+ How convenient! The infecting chancre must have a hardened base. If the hardness cannot be felt by the uninitiated, it is due to inexperience. If it cannot be felt by the experienced, it has disappeared, having been short-lived! If constitutional symptoms appear after a proper interval, the indu "Indura rated base must have been there; perhaps parchment-like. tion," says M. Ricord, "so difficult to recognise in deep-seated regions, is but a transitory symptom. When once produced, a few days will suffice to allow it to disappear." We cannot pretend to meet this circular sort of argument, which may be thus expressed :— No variety of sore, except that with the indurated base, will produce secondary or constitutional syphilis. If a patient suffer constitutionally, the primary sore must have been indurated. If the surgeon have no remembrance of "induration," he must have overlooked it. If the sore, to appearance, be soft throughout, there must have been a transitory induration; subsiding in a few hours. We ask what species of argument is this? Is it not akin to the Hunterian doctrine, that all syphilitic sores require the use of mercury? If a suspicious-looking sore get well by simple means, it cannot be syphilitic? The experience of London hospitals does not support such assertions; on the contrary, it gives them daily refutation. The character and appearance of the primary sore are chiefly modified, as Mr. Lawrence has for many years pointed out, and as has been shown again in a modern work (Coote on the Treatment of Syphilis'), by the tissue to which the poison is applied. There are distinct and recoguisable varieties of sore on the glans penis; the orifice of the prepuce, the integument of the penis; the integument of the body. Induration at the base occurs chiefly at the reflexion of the prepuce on the glans; but may, in rarer instances, be seen in other situations. An indurated chancre is very rare indeed in the female. Sores are sometimes superficial for a few weeks, and then become indurated at the base just as the process of cicatrisation is complete; but the induration is never transitory. Now, M. Ricord, in commenting on the fact that of two primary sores possessing the same faculty of physiological or artificial reproduction, one produced contamination of the organism, the other left the organism unscathed, inferred that the virus was the same, but that some constitutions resisted and others not. But, in 1852, M. Bassereau, one of his pupils, published a work on syphilitic eruptions, wherein he endeavoured to prove that differences as to constitution, mode of life, sex, age, and climate, had nothing to do with the development of constitutional syphilis or its non-appearance. From a large number of cases collected at the Paris Lock Hospital, he took one hundred, who, after chancre, had suffered constitutionally; and an equal number whose chancres were not followed by secondaries, and who had had no treatment capable of warding off systemic syphilis, and found in these two series of cases the same proportion of lymphatic temperament, weak frames, bad hygiène. He took into particular account the fact that the same person may, at short intervals, take first a soft, then a hard chancre; and also that patients have been known to present soft chancre successively through a certain number of years, and to contract at last an infecting sore, which contaminated the economy.t Finally, by confronting the person infected with the individual who had been the cause of the contagion, he found that all those patients t Op. cit., p. 62. * Lectures on Syphilis, by V. De Meric, p. 20. who presented chancres followed by constitutional symptoms, had taken the disease from persons affected in exactly the same manner. He likewise found that individuals suffering from chancres which had remained local symptoms, and had not infected the economy, had been diseased by persons with whom the chancres had also left the organism untouched. From these observations M. Bassereau has founded his theory, to which M. Ricord has yielded a willing assent-namely, that the cause of this difference lies in the poison itself. "The chancre which taints the frame appeared only at the epidemic of 1495, and from that period were those fearful constitutional symptoms observed which are rife up to the present moment. The soft chancre, M. Bassereau believes, is as old as the world; the hard, with its dismal train, began its reign, and that in the most ruthless way, towards the close of the fifteenth century."* We admit that temperament exerts a dubious sway over the development of secondary syphilis. But not so sex or climate. Out of 200 males admitted into the venereal wards of St. Bartholomew's Hospital, 92 had constitutional symptoms. Out of 200 females, only 54 were similarly affected. Climate, too, exerts a most marked influence when combined with proper diet and regularity of habits. The convicts at Gibraltar are reported by Mr. Nesbit, one of the Government surgeons, to be rarely sufferers from systemic disease, although most of them have primary syphilis in one form or another at the time of conviction and banishment. But it will be replied, there is no direct evidence that any of these persons were suffering from an indurated chancre, or that exact form of ulcer to which M. Bassereau refers. To this we can make no reply, except that surely among so many who are sufferers, there must have been some the subject of the infecting chancre. But in addition to this, secondary symptoms already existing slowly subside under the influence of proper hygienic rules, and do not recur. We positively deny the statement that the indurated chancre, as understood in England, is the only infecting sore. It is of course difficult to demonstrate the point, because of the shifting nature of the ground taken by those who support the opposite doctrine, and affirm that the induration may be transitory, or insensible, or involved in some complication. The following case is, however, to the point: In 1843 a young lady left an evening party clandestinely in company with a gentleman, and never returned to her family. After a few months she was left to her own resources, when she contracted disease. There was a small sore at the entrance of the vagina, quite superficial, which healed under the care of an experienced surgeon, without any specific treatment. About one month afterwards she suffered from feverish symptoms, and soon after a mottled eruption came out over the head, chest, and extremities (lepra syphilitica), then ensued ulceration of the fauces and iritis. Six months afterwards she aborted. Her subsequent career was such as might have been anticipated; she died four years after of phthisis brought on by intemperance; but she *Lectures on Syphilis, by V. De Meric, p. 21. was supported by a gentleman who had been a former friend, and who lived with her up to the date of her death. It is remarkable that he never was infected. The answer of the Ricord school to this case may be anticipated; the induration was overlooked, in the female such an accident being highly probable. A man, aged thirty-five, was admitted from the out-patient department into St. Bartholomew's Hospital, January 30th, 1846, having contracted venereal disease a month previously. He said that a small sore first showed itself on the left side of the penis behind the glans, and rapidly increased in size. Upon his admission there was seen a large black circular sloughing sore on the left side of the body of the penis behind the corona glandis, and penetrating the reflected lining of the prepuce; a large spreading phagedaenic sore (secondary or inoculated) upon the opposed surface of the prepuce, a large oval phagedænic sore upon the inner surface of the right side of the prepuce, the long diameter about the width of a shilling. The prepuce was swelled, but not in a state of paraphymosis. The prepuce was divided; proper measures were adopted, namely, nutritious diet and soothing applications. On February 3rd the slough had separated from the first sore; but the phagedænic ulcer on the right side of the prepuce was extending. On February 5th, hyd. cum creta was ordered, but given up on the 10th, the sores appearing to become fouler in aspect and deeper. Finally, they healed by simple treatment, and the man was discharged March 11th. Was this an indurated sore? If so, our ideas of hardness-of the Hunterian chancre-must undergo a revolution. The ulcer was phagedænic, and the hardened base was absent. Now, March 24th he returned to the hospital with rupial spots over the body, and indurated swellings on the cicatrices of the prepuce, and painful periosteal swelling of the right leg. He left the hospital April 7th: he was re-admitted June 2nd, with a foul ulcer the size of a split-pea at the base of the glans penis behind and to the right of the frenum; and a phagedænic ulcer the size of a half-crown upon the right fore-arm. He says that he had had connexion with a healthy female ten days previous, having been in perfect health up to that time. Since that period we have lost sight of him. Mr. Lawrence, who had the charge of this case, examined the female with whom this man had had connexion; there was no trace of syphilis, and she had never had disease. The case is reported in the 'Medical Gazette.' In 1841 a medical man consulted the same surgeon for a thickened and elevated knot, the size of a sixpence, on the dorsum of the tongue, and superficial ulceration of the mucous membrane of the velum palati and fauces. He had consulted many practitioners, most of whom considered the affection to be due to gastric disturbance. Upon inquiry it was found that eight months ago this gentleman had suffered from a slight excoriation of the prepuce, which had healed without special treatment in about four days. There had been no induration. It would be idle to go on multiplying these cases. They represent the daily experience; they seem, in conjunction with others, to confirm the opinion that the |