May, 1861, an apparently healthy child, named Chiabrera, was vaccinated at Rivalta with lymph sent from Aqui for the purpose. Ten days after this vaccination (June 7th), 46 healthy children were vaccinated at one sitting from this child. Again, on the 12th of June, 17 other healthy children were vaccinated from one of the 46. Thirty-nine of the 46 received syphilis with the vaccine disease, and seven of the second series of 17, making a total of 46 out of 63 children in a mountain village simultaneously inoculated with syphilis. Some months elapsed before the vaccination was suspected to be the source of the children's bad health. By the 7th of October, when attention was drawn to this spreading disease, six of the 46 syphilised children had died, without receiving any treatment, 14 were recovering, and three were in a precarious condition. Twenty-three were dispersed through the country, and their condition was unknown until further researches traced them out. In addition to the children, twenty women suckling them were inoculated with syphilis from the children. Through the mothers the disease had reached some of the husbands, and even the elder children of the different families.

The mode in which the first child, Chiabrera, was infected has remained unexplained. He did not receive it through the vaccine lymph, because he had the vaccine disease in its regular course, and the changes proper to the point of vaccination were duly developed in the vaccine scar. It did not come from his mother, because the first manifestation of the disease (initial syphilis) did not appear in her until the 8th of October, some time after the child had been marked with general eruption. This shows she took the disease from her infant. Neither was the child, in all probability, infected by his father, because the latter was quite free from the disease when the mother contracted it, and continued so during the two years which elapsed after

Chiabrera was born. Dr. Pacchiotti, who thoroughly investigated all the points of this case, believes the disease was communicated to Chiabrera by a strange woman, known to be syphilitic, whose breast he had sucked a few times. The other children, without exception, showed by the form and course of the disease, that their infection had taken place at the site of the vaccination.

From the analysis of the various instances of contagion by vaccination, the following conclusions are gained :—That syphilis is undoubtedly propagated by vaccinating healthy children with the vaccine matter of syphilitic children. When a batch of children are vaccinated in this way, some escape, others receive, syphilis. To explain this, Viennois supposes that the vaccine lymph per se does not contain. the syphilitic virus, but that it requires the admixture of the blood; hence, when the child escapes syphilis, he has had no blood inserted with the lymph. On the other hand, when he takes syphilis in this way, a drop of the syphilitic child's blood has been mingled with the lymph.

When vaccinia and syphilis are simultaneously inoculated, the former runs its course during the incubation of the latter, so that the child has the two diseases independently. When the incubation of the syphilis has expired, a hard, elevated excoriation, or ulcer, forms at the point of inoculation, the glands of the axilla enlarge, and subsequently the general eruptions appear.

Vaccination appears also to have another influence. If syphilis be latent in a child, the vaccinal fever hastens its appearance; hence, syphilis sometimes makes its appearance in children shortly after vaccination, and has been supposed to have been communicated by the vaccination, instead of only being roused to activity.

In support of the belief that the special secretions of co-existing disease do not contain the virus, Lance

1

reaux says that Diday attempted, without success, to communicate syphilis by inoculating the discharge of pustules excited in a syphilitic person by over-doses of iodide of potash; whence Diday infers that the secretions of specific eruptions in syphilitic persons only are contagious.

Besides these better defined affections, which are occasional sources for multiplying syphilis, the fluid discharges of ordinary inflammation of mucous surfaces will convey the virus. Cases are on record where a vaginal discharge, without ulceration, appearing in a syphilitic woman, has sufficed to communicate syphilis to her companion, who had previously approached her with impunity. Gonorrhoeal discharges in syphilitic persons probably also impart syphilis to healthy individuals; leading to the belief in former times that gonorrhoea and syphilis were the same disease.

Leucorrhoeal Discharges.-It is a question of much practical interest whether chronic vaginal and leucorrhoeal discharges, from which prostitutes are seldom entirely free, may not become vehicles of the disease if the woman is also syphilitic. There is no positive evidence to decide this question, but it is unsafe to pronounce a woman so afflicted not liable to communicate the disease. Whenever the discharge proceeds from ulceration of syphilitic origin, it is certainly very contagious.

Interval which elapses before the virus enters into the system.-Clerc, of Paris, made some experiments on children? respecting this. He vaccinated children by a single puncture through the skin: one hour afterwards he destroyed the tissues for some distance round the puncture, with solid nitrate of silver. Notwithstanding this caustic application, vaccinia followed in due course, and a second inoculation of vaccine lymph had no effect.

Somewhat different results followed the experiments of

1 Loc. cit., p. 614.

2 Oral communication.

Aimé Martin,1 who has published notes of seven cases of vaccination he performed on infants. The punctures were destroyed with Vienna paste, at periods varying from one hour to twenty hours after their insertion. This treatment prevented the development of proper vaccine vesicles in all of the seven; but the children were all vaccinated again, to ascertain whether they had undergone the constitutional vaccinal fever, or whether the poison had been removed before absorption. In five children this repetition had a negative result; in the sixth a genuine vaccine pustule formed after thirteen days' incubation; and in the same a pustule appeared three days after the second vaccination, which had no distinctive character of vaccinia. Bouley and others found a very short time necessary for absorption, by experiments at the French Veterinary School of Alfort. At that institution horses were inoculated with glanders, and the inoculation was cut out one minute after insertion, but not before the glanderous poison was absorbed, and the disease followed. Sheep also were subjected to a similar experiment, for variola ovina. In them also the disease followed in due course. The more investigation is carried on in this direction, the more reason is there to believe the interval between insertion and absorption of the poison to be very short. The following case shows that twelve hours is ample time. In July, 1858, a gentleman applied to me with the following story:-That morning, about four o'clock, during violent intercourse, he had felt a sudden snap. On awaking, a few hours after, he found the bed and his clothes much stained with blood, so that he must have bled freely. He discovered the frenum to be torn across; this made him anxious to know if there were any means to insure him against the chance of syphilis. At 3:30 p.m. of the same day, I examined the part, and found that the frenum was

1 Thèse de Paris, p. 23. 1863.

torn down, the wound slightly swollen, but otherwise quiet enough. Ricord's views were then in vogue-that destruction of the sore within five days of its existence would prevent syphilis, and I assured him that cauterisation would remove all danger of the disease. To make sure, I destroyed a considerable layer of tissue with fuming nitric acid. In due time the eschar I made separated. The surface healed very quickly, and my patient's satisfaction was extreme. This was the end of July. In the latter part of August he called again, and showed me the cicatrix, which he said that morning he noticed to have altered. It was clearly indurated. Presently the glands in the groin enlarged, and general syphilis followed, which lasted a couple of years. The induration increased in the cicatrix, but it never ulcerated again.

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Clerc recites instances of the uselessness of ablution after intercourse, to prevent absorption. Among others, he relates the case of one of his pupils, who says:- "On the 10th of July, 1853, I had sexual intercourse with a prostitute, and I washed myself immediately afterwards. The following days I examined myself with much care. I detected absolutely nothing. On the 15th of July I left Paris for my father's house. I still took care to examine myself for the first few days after my arrival, but as nothing appeared, I thought myself free of any venereal disease; when, on the 7th of August, while I was being shaved, a smarting pain on the penis attracted my attention. I went home at once, to see what was the matter, and I found on the right of the frenum a very small excoriation, slightly prominent, of yellowishgrey colour. I cauterised it, that day and the following, with solid nitrate of silver, all to no purpose, for in the beginning of October the general eruption followed."

Traité Prat. des Maladies Vénériennes, pp. 45, et seq. Paris, 1866.