To adduce examples of contagion of syphilis, through the inoculation with the secretions of indurated chancres, would occupy space uselessly; the more so, as the question has been fully discussed by Alfred Fournier1 in a small pamphlet, and in Ricord's "Leçons sur le Chancre," edited by him. Both of these works contain a large number of observations to show that the general disease is contracted from persons with indurated sores.

Hitherto

The virus commonly loses its contagious quality when the tertiary period of the disease is reached. attempts to propagate the disease with secretions taken at this period have failed. I have met with but one exception to this rule, namely, a case mentioned by Bumstead 2 (and a doubtful case of Vidal's3). The former says, a surgeon operated on a patient for syphilitic necrosis of the skull who had had no secondaries for years. An abrasion of the finger was inoculated, a chancre and general symptoms followed in due order. After hearing full details of the case, little doubt was left in Bumstead's mind that this was an instance of inoculation of the blood in the tertiary stage of the disease.

The Natural Fluids of the Body.-Besides the discharges of the syphilitic eruptions, &c., some of the ordinary fluids contain the virus in a communicable form. The blood has been successfully inoculated in several instances. Of these the most clearly established is that of Dr. Bargioni, who was publicly inoculated on the 6th of February, 1860, by Professor Pellizari, of Florence, with the blood taken from a vein of the arm of a woman suffering from syphilitic eruptions. By this inoculation he contracted syphilis, and

L'Incubation de la Syphilis. A. Fournier, 1865. And Leçons sur le Chancre, 1858. Pièces Justificatives.

2 Bumstead's Venereal Diseases, p. 465. 1864.

3 Vidal's Maladies Vénériennes.

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2

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underwent the various stages of the disease; first, incubation of twenty-five days, then a papule which developed to an ulcer by the forty-fourth day. The lymphatic glands simultaneously enlarged, and macular eruption appeared on the sixty-fifth day on the trunk.1 Lancereaux quotes this case at length, and has also collected the results of twenty-three inoculations by different experimenters of the twenty-three, six were successful, the rest aborted. Among the observers were Waller, of Prague, Gibert, of Paris, Pellizari, of Florence, and Lindwurm,5 of Munich. They were each successful in one of their attempts. There were three other successful cases by the anonymous person whose observations were published in the Proceedings of the Medical Society of the Palatinate, in 1856, and which gave rise to so much discussion at the time. A little doubt, perhaps, on account of their anonymous publication attaches to those of the Palatinate, but those of Waller, Pellizari, and Lindwurm are free from uncertainty for their inoculations were made in public with the blood of persons suffering from general eruptions.

It is still unknown how long this fluid remains contagious, but all experiments made with the blood of persons tertiarily affected have failed to impart syphilis. The blood is also the vehicle of the poison whenever the disease is transmitted from the mother to the fœtus in utero.

The milk and saliva of a syphilitic person may possibly contain the virus in a communicable shape. Still there is no authentic case of syphilis being transmitted by such means.

1 Gazette Hebdomadaire, p. 349. 1863.

2 Lancereaux: Traité Historique et Pratique de la Syphilis, p. 619.

3 Casenave's Annales de la Syphilis et des Maladies de la Peau. 1850, 1851.

P. 184.

4 Gibert Traité des Maladies de la Peau, et de Syphilis.

1866.

5 Auspitz, Die Lehren v. Syph. Contagium. S. 217.
6 Archives Générales de Médecine, t. i. p. 603. Mai, 1858.

For, in the instances where these fluids have hitherto proved contagious, they have been mixed with secretions of syphilitic eruptions or excoriations.

The Semen.-We cannot safely assert that the semen per se is or is not contagious with the knowledge we at present have. Sexual intercourse should not be permitted to a man in whom the poison has been recently in activity, even when he is quite free from eruptions, or unhealthy secretions. Langston Parker1 and others are firmly convinced the semen alone will communicate syphilis to a woman without rendering her pregnant also.

Contagion occurring when the Virus is mixed with the Secretions of co-existing Diseases.-The frequent co-existence of syphilis with the local simple chancre is an instance, and without reiterating the arguments for and against the identity or non-identity of the contagious principles in these affections, the following results of observation may be briefly stated-If matter of a soft chancre be inoculated on a person who is also suffering from syphilis, it is very often contaminated with the syphilitic poison; and thus, if again transplanted, it may convey to the new soil both diseases. Should the fresh patient have already suffered syphilis, he is not capable of a second attack, and the fresh inoculation produces no repetition of syphilis. The effects are confined to the production of a local ulcer. On the other hand, if he is virgin from syphilis, the poison probably takes effect; his chancre hardens when the incubation period of syphilis has elapsed, and general eruptions ensue. The explanation in this case being, that to the characters of the local ulcer, those produced by the activity of the syphilitic virus are added, and the sore becomes the seat of

1 Evidence before the Committee on Venereal Disease in the Army and Navy, 1865. Q. 3339.

two different diseases. There is good reason for believing that the virus of syphilis, and the principle that excites local ulcers, are not antagonistic, because Sperino and Baumès, by mixing pus of soft chancres with vaccinal lymph and inoculating the mixture, produced both a chancre and vaccine disease.1 Boeck, however, failed in attempting to do the same thing: his chancrous pus took, but the patient had no symptoms of vaccinia, and was subsequently successfully vaccinated.

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Vaccination has long been accused of communicating syphilis. Some remarkable outbreaks of syphilis among newly-vaccinated children have recently given rise to much discussion of the subject. Viennois, of Lyons, has collected and published an analysis of two different instances on record, which is also included in a reprint of a discussion on this question in the French Academy of Medicine in 1865, published by Baillière, to which are added Pellizari's experiments in inoculating the blood of syphilitic Though many of the cases are evidently only instances of syphilis breaking out in children about the time of their vaccination, in some of them syphilis was positively inoculated by the vaccination. A wellauthenticated instance is recorded in the Medizinische Zeitung of Berlin, for the 3rd of April, 1850.-At the beginning of 1849 small-pox prevailed in the town of K. Ten families were re-vaccinated on the 14th and 15th of February from one infant, who, six days after, was discovered to have syphilitic eruptions on his body.

persons.

1 La Syphilis Vaccinale, p. 279.

2 Idem, p. 386.

3 Gazette de Hôpitaux, Mars, Avril, Mai, 1862.

De la Syphilis Vaccinale. Communications de Depaul, Ricord, Blot, Jules Guérin, Trousseau, Devergie, Briquet, Gibert, Bouvier, Bousquet, Pellizari, Palasciano, Philipeaux, et Auzias Turenne. Baillière, Paris, 1865.

Nineteen, being nearly all these persons so vaccinated, had syphilis three or four weeks after the vaccination, ulcers appeared at the site of the inoculation, and in most of the nineteen, sore throat, headache, and eruptions on the skin, appeared in due course, and mercury was employed for their cure. The vaccinator, a veterinary doctor, was sentenced to two years' imprisonment and a fine of fifty thalers.

Another authentic instance1 is that where a second German doctor (Hübner) was tried and punished for having, in 1852, inoculated thirteen children with vaccine lymph from a syphilitic child; of these five escaped entirely. In the rest the points of inoculation became slow spreading ulcers, and three months afterwards general eruptions appeared over the body. In New York, in August, 1854, Monnell published a minute account of the ulcer on the arm, and the subsequent eruption of the body, that followed a case of vaccination.

Henry Lee, in his work on inoculation of syphilis, and in the "Lancet" for 1863, has related some observations collected by Viennois, in support of the doctrine; since then, Lancereaux has collected 19 observations of syphilis being propagated by vaccination. They include 351 individuals vaccinated from syphilitic children: 258 of them were inoculated with syphilis, the rest escaped. The most remarkable outbreak of syphilis by vaccination, of late years, is that which occurred at Rivalta, near Aqui, in Piedmont, in 1861. Dr. Pacchiotti,3 of Turin, who was employed by the Italian Government to report on the attack, has published an account of it. The facts are shortly these. In

1 Reported by Sée, in the Gazette Hebdomadaire, 9 Mars, 1855. Lancereaux: Traité Historique et Pratique de la Syphilis, p. 643. 1866. 3 Pacchiotti: Sifilide Trasmessa per Mezzo della Vaccinazione in Rivalta, presso Aqui. Turin, 1862. Quoted by various writers; Viennois, in the Gazette des Hôpitaux, Lancereaux, loc. cit., Henry Lee, and others.