8. De la Contagion Syphilitique. Par ALFRED FOURNIER, Docteur en Médecine, &c.-Paris, 1860. pp. 130.

On Syphilitic Contagion. By Dr. ALFRED FOURNIER.

9. A Treatise on Syphilis in New-born Children and Infants at the Breast. By P. DIDAY, Surgeon to the Hospice de l'Antiquaille, Lyons. Translated by G. WHITLEY, M.D., New Sydenham Society. London, 1859.

10. De la Transmission de la Syphilis par la Vaccination. Par A. VIENNOIS, Interne à l'Hospice de l'Antiquaille à Lyon. (Archives Générales de Médecine,' 1860.)

On the Transmission of Syphilis by Vaccination. By Dr. A. VIENNOIS. THE history of the progress of the knowledge of venereal diseases during the last century presents us with three tolerably well-marked periods. During the first we have the Hunterian doctrine prevailing -viz., that the various forms of syphilis and gonorrhoea depend upon one and the same poison. If any doubt still remain, observes Hunter, with respect to the two diseases being of the same nature, it will be removed by considering that the matter produced in both is of the same kind, and has the same properties, the proofs of which are that the matter of a gonorrhoea will produce either a gonorrhoea, a chancre, or the lues venerea; and the matter of a chancre will also produce either a gonorrhoea, a chancre, or the lues venerea.

In support of his opinions, Hunter relates the following experiment performed upon himself:-Two punctures were made on the penis with a lancet dipped in venereal matter from a gonorrhoea, one puncture was on the glans, the other on the prepuce; on the third day there was a teasing itching on those parts, which lasted until the fifth day. Upon this day the part of the prepuce where the puncture had been made was redder, thickened, and had formed a speck. In another week this speck had increased and discharged some matter. There seemed also now to be a little pouting of the lips of the urethra ; there was also a sensation in it in making water, so that a discharge was expected from it; a fortnight from the time of the inoculation on the glans there was considerable itching, and three days later a white speck was observed where the puncture had been made. This speek, when examined, was found to be a pimple full of yellowish matter. chancre on the prepuce broke out several times after it healed up; that on the glans never did break out again, but for a considerable time it had a bluish cast. Ulceration of the tonsils, and copper-coloured blotches on the skin followed these inoculations, and the time the experiment took from the first infection to the complete cure was about three years. This experiment of Hunter's has been explained, and explained away in many different ways. But it has always been left, like the remaining piece of a Chinese puzzle, an awkward fact, which could in no way be made to fit in with the theories of syphilis of the second period to which we shall refer.

The

The usual way in which Hunter's experiment has been accounted for, has been by supposing that a concealed chancre existed in the

urethra which furnished the inoculated poison. In order to clear up this point, we must anticipate some circumstances which will be more fully dwelt upon in the concluding part of this review. It will there be shown that the observations of modern pathologists, both in this country and abroad, have established the fact that the sore which produces constitutional symptoms, which Hunter's evidently did, does not secrete well-formed pus. It is impossible, therefore, that we can conceive that Hunter mistook the secretion of an infecting sore for the discharge of a gonorrhoea. The fact then still remains, that Hunter inoculated what he believed to be gonorrhoeal matter (and he would naturally select a well-marked case), and produced local and general syphilis. This fact is in direct contradiction to all the teaching of the second period in the history of the progress of syphilis to which we shall allude; and, moreover, the kind of sore produced and the period at which it appeared are at variance with all that was generally, if not universally, received for so many years as the result of M. Ricord's influential and wide-spread opinions.

The accuracy of Hunter's experiments and observations forbid us for a moment to conceive that the results of his case are not fairly and fully given. We might refer to some of his other experiments, and see the care and accuracy with which they are recorded, although it may be they have, in some instances, been misunderstood by his successors: we will adduce one instance only. "A man," says Hunter, "had been affected with the venereal disease a long time, and had been salivated, but the disease broke out anew. He was taken into St. George's Hospital affected with a number of pocky sores, and before I put him under a mercurial course, I made the following experiment: I took some matter from one of the sores upon the point of a lancet, and made three small wounds upon the back where the skin was smooth and sound, deep enough to draw blood. I made a wound similar to the other three, with a clean lancet, the four wounds making a quadrangle; but all the wounds healed up, and none of them ever appeared after." Now, this experiment of Hunter's has been repeated a very great number of times, and always with the same result; and the conclusion drawn from the experiments by Hunter's successors has been that secondary syphilis is not inoculable. This proposition -namely, the non-inoculability of secondary syphilis was upon which Ricord and his followers based many of their opinions, and one upon which a course of lectures was recently delivered at the Medical Society of London. But what was Hunter's own conclusion from his experiments? It was that the matter derived from a secondary syphilitic sore was "not capable of acting in some respects on the same body or same state of constitution as that matter does which is produced from a chancre."* How correct and careful Hunter's conclusion was, and how erroneous the conclusions of those who thought they were following in his track, we shall hereafter attempt to demonstrate. It will not, then, explain Hunter's experiment just quoted either to say that there was a chancre in the urethra or that his observation was not accurate. The stubborn facts which he

Hunter on the Venereal, p. 292, ed. 1786.

has narrated remain, although they have been ignored or explained away, during some thirty years, by those who profess (although not always correctly) to be Ricord's followers.

For an explanation of Hunter's experiment we must again antici pate somewhat of that which will be more fully considered in a subsequent part of this article. Ricord showed, by a great number of experiments, repeated in various ways, that the inoculation of gonorrheal matter on the skin was followed by no result, and he concluded that it was, therefore, incapable of producing syphilis. A link in the chain of reasoning is here, however, wanting. It has now been demonstrated that the secretion of one kind of syphilitic sore is not capable of being inoculated, to use Hunter's expression, on the same body that produced it. But it would be manifestly absurd to conclude that this kind of sore was incapable of being transmitted by inoculation at all. Now, in one case, as in the other, those only have, as a rule, been inoculated who have already had the disease, and therefore it is clear that the fact of the non-inoculability of the secretion can only be proved, in one case as in the other, by trying it on patients not previously affected. That Ricord drew a clear line of distinction by his experiments between the ordinary gonorrhoea and one form of chancre every one must admit; and all praise is due to him in this respect. But we say that it is not absolutely proven that a discharge from the urethra (independent of any sore) cannot be inoculated, any more than it is proved that the secretion from an indurated sore cannot be inoculated. In both cases the fact must be tested by observation or experiment upon patients who have not previously been affected. The secretion from a primary or secondary syphilitic sore produces no effect when inoculated upon the same body; we might naturally, therefore, expect that it would produce no effect when applied to the urethra of the same patient. But it does not follow that this same secretion will produce no effect when applied to the urethra of another patient, nor that the result of that application may not in its turn be again communicated; nor are we altogether wanting in facts in illustration of this subject. Cases* have recently been published in which the contact of a secretion, which undoubtedly gave rise to an infecting sore, also produced in patients before uncontaminated a discharge from the urethra. This discharge was observed to differ from the ordinary discharge of a gonorrhoea, and is described by Mr. Henry Lee as being more viscid and tenacious in its nature, in not being accompanied by the same amount of ardor urinæ, in its short duration, and often abrupt termination."

What, let us now ask, would be the effect of inoculating this secretion, produced by the contact of matter which had also produced an infecting sore? What would be the result of inoculating this upon a patient untainted by syphilis? To this important question we have no recent experiments which will furnish an answer, but it appears more than probable that the solution was furnished many years ago by Hunter's experiment upon himself; and we feel sure that the

Medico-Chirurgical Transactions, vol. xliii. p. 67.

truthfulness of Hunter's description, and the accuracy of his facts, as far as his experiments go, will hereafter be fully acknowledged.

During the second period which we have marked out the doctrines of Ricord were triumphant, and were represented in this country by Mr. Acton's work, and more recently by Mr. Maunder's accurate and careful translation of Ricord's lectures.

Instead of one syphilitic poison which gave rise alike to gonorrhoea and the various forms of syphilis, M. Ricord very clearly demonstrated the existence of two poisons, one of which would produce gonorrhea, and the other syphilitic ulceration; this ulceration, which Ricord so carefully and accurately represented and described, always, or with rare exceptions, follows a very definite course. The diseased action commences within twenty-four hours of the application of the poison. The skin is red and slightly raised; a vesicle forms, and then a pustule; and the sore left when this breaks has the well-known characters of the soft or suppurating chancre.

It appears that neither Ricord nor any of his followers recognised for many years any other form of inoculation than the one now described. Although much stress was laid upon the different physical characters of two classes of chancres when fully developed, yet even as late as the year 1858, M. Ricord describes them as originating nearly in the same way, as being alike in having no period of incubation, and as originating of necessity by contact from a similar primary syphilitic disease. In these and most other particulars Ricord is followed by Acton. Now, in all the experiments performed by Ricord, his conclusions were deduced from experiments made on patients already affected; and the results which would follow similar experiments in those not thus affected were entirely overlooked. One kind of disease only was observed, and that as it occurs in patients whose constitutions were already under the influence of previous disease. It is now known that such patients are seldom liable to take syphilis which has infected their constitutions, a second time; and that when it does occur, it assumes a very modified form. So that, after all the experiments that have been made, and after all the discussions which they have provoked, it appears that Ricord and his followers gave their attention exclusively to one kind of syphilitic inoculation, and that that kind was one which produced only a local disease, not followed by any constitutional symptoms.

The foregoing observations apply only to M. Ricord's experimental illustration of the subject. Practically he distinguished very accurately the different kinds of chancre, and laid down with great clearness the appropriate treatment for each. These practical distinctions are followed by Mr. Acton, and where M. Ricord stops, Mr. Acton stops also. In the review of the second edition of Mr. Acton's work (see Review, July, 1851, pp. 162 et seq.), we had occasion to remark how closely Mr. Acton had followed M. Ricord; and we are still compelled to treat what we find in the third edition of Mr. Acton's work as the opinions, by no means always acknowledged, of M. Ricord. We will give an illustration taken at random. M. Ricord says, in his Leçons sur le Chancre':

"Le caustique employé doit être sur toute la surface du chancre et un peu au-delà. . .

"J'ai à vous proposer un agent nouveau, d'une merveilleuse efficacité, et à l'abri de tout reproche. Ce caustique, c'est l'acide sulphurique uni à la poudre de charbon vegetal, dans les proportions necessaires pour former une pâte demi solide." (pp. 50-51.)

Mr. Acton says, after a quotation from Ricord, which he does acknowledge:

"The caustic should be spread over the whole surface of the chancre, and a little beyond it.

"The caustic I prefer is sulphuric acid combined with powdered vegetable charcoal, in the proportions necessary to form a semi-solid paste. This paste applied to chancres by means of a little box wood, glass, or ivory modelling tool, to be purchased of artists' colourmen, immediately dries and forms a black crust, which adheres to the tissues, and is one with them, only falling off several days after the application, generally at the end of a fortnight." (pp. 304, 305.)

In some instances, indeed, it would have been much better if Mr. Acton had followed the progress of his teacher more accurately. Thus,

In the year 1838, M. Ricord writes, in describing the development of a chancre:

"Dans les premiers vingt quatre heures, le point piqué comme dans la vaccine, rougit; du second au troisjème jour il se tuméfie un peu et présente l'aspect d'une petite papule qu' entoure une auréole rouge; du troisième au quatrième jour, l'épiderme soulevé par un liquide plus ou moins trouble prend la forme souvent vesiculeuse, offrant, à son sommet, un point noir, résultat du dessèchement du sang de la petite piqûre; du quatrième au cinquième jour, la sécrétion morbide augmente, devient purulente, la forme pustuleuse se dessine, et son sommet, en se déprimant lui donne un aspect ombiliqué qui la rapproche de la pustule de la petite vérole a cette époque, souvent l'auréole, dont l'etendue et l'intensité s'étaient accrues, commence à s'éteindre ou à diminuer, sur tout si la maladie ne fait pas de progrès; mais à partir du cinquième jour, les tissus sousjacents, qui souvent n'avaient encore subi aucune influence, ou étaient seulement légèrement œedemateux, l'infiltrent et durcissent par l'épanchement d'une lymphe plastique qui donne au toucher la resistance, la sensation élastique de certains cartilages." (p. 89.)

55-XXVIII.

In the year 1860, Mr. Acton writes on the same subject:

"During the twenty-four hours succeeding the operation, the inoculated point becomes red; in the course of the second and third days the surrounding parts are slightly swollen and assume a papular appearance, or already traces of a vesicle are seen on the summit; on the third or fourth day a fluid, which is more or less transparent, is observed beneath the epidermis, and a distinct vesicle becomes apparent where the papula previously existed, and a dark dot is scen in the centre, owing to the coagulation of the blood which had escaped through the puncture of the lancet; from the fourth to the fifth day the vesicle assumes a pustular character, and a distinct depression is seen in the centre, so that it represents very distinctly at this period the small-pox pustule. The red areola, which has been hitherto gradually augmenting in intensity, now as gradually fades away; and the cellular tissue, which was slightly oedematous, becomes infiltrated with plastic lymph." (p. 270.)

4