affections a complete course and series of symptoms, some of which are of very doubtful reality. He scarcely succeeds in explaining the very remarkable changes the syphilitic virus must undergo, if his theory be correct. A poison in its original and graver form is so little irritant, that it produces no effect at all until a certain stage of quiescence is passed; and when awakened to activity the amount of local irritation it excites is unimportant. On the other hand, this contagious principle, if implanted in a soil unsuited for the general disease to germinate in, becomes a violent local irritant, exercising its influence without any delay. This influence, however intense, is entirely confined to local action. A change so surprising is probably too extraordinary to actually take place.

The analogy between chancre and the vaccinoid fails too in this respect; for vaccinoid, granting it a real existence, is not more, but less irritating than genuine vaccine lymph; its effects may be reasonably supposed due to the purulent condition of the matter inoculated, and would equally well arise if any other irritable secretion had been used. The sole effect of abortive vaccination is to excite immediate irritation amounting to the formation of a pustule, which cannot be propagated from individual to individual, or continued in a second inoculation even on its bearer; properties that notoriously belong to the discharge of the simple chancre. A more extended analysis of Clerc's theory is unnecessary; it should be studied in his own work, perhaps the best and most complete description of the local contagious venereal ulcer, and of the primary manifestation of syphilis, that has yet been written.

It will be inferred from the foregoing, that one form of the dualist theory will be adopted in my description of venereal diseases. The term chancre will be applied solely to that affection which is characterised by sharp irritation and ulceration, with the secretion of contagious matter at

the point of infection. The furthest complication of this inoculation is inflammation of the nearest lymphatic glands, either from sympathy or from entry into the gland itself of irritant matter from the sore. The term syphilis will be confined to the general or constitutional disease, that has phenomena at the point of inoculation, totally distinct from chancre. Any resemblance to that disorder, which the manifestations of syphilis occasionally assume, is entirely of an accidental kind, due sometimes to inflammatory irritation, or to concomitant infection of chancre with syphilis; an event often taking place.

SUMMARY.

The unicist theory, fast falling into oblivion, maintains th t one common principle excites constitutional syphilis, gonorrhoea, and local contagious ulcers. Benjamin Bell and Ricord demonstrated gonorrhoea to be distinct from syphilis. In 1852, Bassereau brought proof to show that of the two kinds of venereal ulcer, one is a local disorder, the other a part of the constitutional disease, syphilis. Those who agree with Ricord and Bassereau are dualists, and they form a constantly increasing majority. Clerc, acknowledging the existence of a non-infecting sore, supposes it to be excited by a principle degenerated or hybrid from the syphilitic virus. In this way, if the purulent secretions of a syphilitic sore are inoculated on a person who, from having had the constitutional disease, is incapable of again contracting that disease, the inoculated matter changes its character in the exhausted soil. It becomes a local irritant, contagious indeed, but confined in its influence to the neighbourhood of the insertion. This theory is not generally entertained. The view adopted in this book holds the principle producing the local contagious ulcer to be distinct from that producing true syphilis.

DIVISION II.

SYPHILIS.

CHAPTER I.

Definition-Course-Unity-Repetition-Duration.

Synonyms.-CONSTITUTIONAL SYPHILIS: Pox; Verole; Lustseuche; Maladie de Naples; Französische Krankheit; Morbus Gallicus.

Definition.-Syphilis is a specific disease communicated to the sound solely by contact with the fluids of the diseased. A certain interval exists between the absorption of the poison, and the manifestation of its effects. This poison is conveyed throughout the body by the blood; as all the tissues are contaminated, its effects are displayed on the surface as well as internally. The natural course of the disease is to recovery. After one inoculation the individual is exempt from repetition of the disease by new infection. The foregoing characters are common to all specific diseases. Syphilis differs from the others in its poison being strictly non-infectious; in its course being chronic, and liable to frequent relapses, but also capable of being greatly influenced by certain drugs.

OUTLINE OF THE COURSE OF SYPHILIS.-When the syphilitic poison has been inoculated, it gives no evidence of its presence for three weeks or a month; this period is

called its incubation. Then it reveals its presence by induration of the tissue at the point of inoculation, and by the formation of an elevated papule, which may, or may not, become an ulcer with a hard base. While this change is going on, and about eleven days later than the appearance of the papule, the group of glands nearest the point of infection slowly and painlessly enlarge. Within a few weeks from this, usually four to six, a coppery red macular eruption appears on the chest and abdomen, which lasts a few days. It may be unperceived by the patient before it fades, as it causes no discomfort. This rash is often preceded by loss of appetite, and even by fever or headache. After the disappearance of the first eruption various others appear, chiefly of a papular character, scattered over the surface of the body and the mucous membranes, especially the fauces and tonsils. Emaciation, and loss of strength, sometimes set in at this period, but more often the patient preserves his appetite and bodily power. Having made this progress, the disease may subside completely, and never revive. Nevertheless, it often happens, after two or three months of apparent quiescence, that a fresh eruption of a scaly, or less commonly, of a pustular character, appears on the skin, with excoriated patches on the fauces. They are accompanied in the more severe cases by rheumatoid and periosteal pain of the bones, iritis, &c. The affections become either continuous by fresh crops of eruption following closely on each other, or, they alternately vanish and return, during a period varying between two or three months, and two or three years. In which time commonly, the patient's strength and vigour are greatly lessened. Thus the second period of the disease terminates. Should it go further, as sometimes happens, a new series of morbid processes then occupy the body. If they attack the skin, hard tubercles. appear in that tissue, which are very prone to ulcerate.

But the internal organs-liver, lungs, brain, or muscles, -may be also the seat of similar solid formations, which materially impede and destroy the capability of the organ so afflicted to perform its functions. Syphilis, per se, is rarely fatal in adults; but by altering the structure of the organs of vital importance, it renders the patient unable to resist the inroad of inflammatory action set up accidentally. The course, severity, and selection of the organs to be attacked by the disease, are greatly influenced by external circumstances; thus, low diet, exposure to weather, season, climate, the strength of the patient's constitution, condition of his skin and mucous membranes, may all determine what particular organ shall be the locality in which the disease assumes activity.

These independent causes, to a great extent, determine the duration and severity of the disease in individual cases. The intensity of the action of the poison in the person from whom the contagion was obtained is probably quite powerless to influence its course when transmitted to others. This statement is true respecting acquired syphilis; but there appears some reason for believing that the offspring of syphilitic persons suffer from the disease, the more severely, the greater the activity of the poison in their parents.

Though the earliest symptom is as much a part of the general disease as any of the later ones, it has been found convenient, from the distinct character of the symptoms, to arrange them in three groups. First, those developed at the point of contagion-the so-called primary symptoms; next, the general superficial ones, called secondary; and lastly, those attacking the deeper structures, named tertiary affections. These sets of symptoms are usually separated by pauses. Not invariably; for now and then patients have symptoms proper to all three periods present together,