surely, and without any period of incubation (in the ordinary acceptation of the term), in the formation of a small quantity of matter which always has peculiar properties. This matter is pus, and pus which has the property of always reproducing its specific action when again applied to another part of the same body, or when inoculated upon another person. This pus is therefore called specific. To the naked eye and to the microscope it presents all the characters of ordinary pus; but it has, in addition, its specific qualities, which are known only by their effects. Even to the naked eye and to the microscope this secretion of the suppurative form of syphilis has characters which distinguish it from the secretion of the indurated sore, or of the infecting form of syphilis. It consists of well-formed pus; and each globule is of nearly the same size, and distinct from the rest. If, in any

doubtful case, some of the secretion from a sore be mixed with a little dilute acetic acid and placed under the microscope, the distinctive characters. of the pusnuclei will be seen, as represented in the accompany

Microscopic appearance of secretion from a suppurating syphilitic sore treated with dilute acetic acid, X 700.

ing woodcut.

The appearances produced are quite distinct from those which are afforded by the secretion

from an infecting sore treated in the same manner, as will be more fully shown in another lecture.

When this specific pus has produced its natural effect either in a lymphatic vessel or in a lymphatic gland, the fresh portion of pus thus generated produces a fresh specific irritation, and this irritation produces an abscess, which, breaking externally, discharges its contents. In such a case the matter in the interior of the gland, or lymphatic vessel, constantly retains its specific characters; but that which during the process of suppuration is formed outside the vessel or gland is ordinary non-specific pus. As the disease advances, these two secretions may be mixed together, and then the whole acquires the characters of the specific fluid, and the surface of the whole sore will become inoculated.

Lymphatic absorption from a suppurating syphilitic sore then necessarily produces a suppurating bubo. Any attempt to prevent such an affection from suppurating is entirely futile. The disease within the lymphatic system is the same, and runs a similar course as that upon the surface of the body.

The disease now described is not beneficially influenced by mercurial treatment; and inasmuch as it has no tendency when left to itself to infect a patient's constitution, any mercurial treatment in order to prevent such an infection is entirely superfluous. The suppurating syphilitic sore will sometimes be tedious in healing, and a variety of applications may be tried sometimes without producing any apparent effect upon the course of the disease. In a case lately under my

own care at St. George's Hospital, a sore of this nature lasted four months, apparently little influenced by treatment; but the patient at the end of that time. made a very good recovery, and now remains well without having taken any mercury.

The suppurating syphilitic sore has been often repeatedly inoculated for the supposed purpose of producing what has been termed syphilization. But inasmuch as the disease, however often repeated, remains a local one still, no constitutional or permanent effect can be produced in this way; still less can any condition of the system be produced which would render it insusceptible to the infecting form of the disease. It must, however, be admitted that when a patient has already constitutional syphilis, the symptoms which have developed themselves will often disappear under this so-called syphilization. It is principally efficacious in diseases of the skin, and these are probably removed, under the circumstances, in consequence of a kind of counter-irritation produced by the repeated inoculation of the syphilitic matter, and suppuration of the inoculated points.

One very important and interesting fact will require especial notice with regard to the so-called syphilization—viz., that after repeated inoculations have been made on a part, that part becomes less and less susceptible to the influence of the poison (see Plate 1), and a time arrives at which the inoculations will cease to secrete pus, and then they will no longer be inoculable. If fresh matter, however, be used, the inoculations will again succeed; but these will gradually lose

their effect, as at first. This process may be repeated until a part is no longer susceptible to any inoculation from the secretion of a suppurating syphilitic sore. But then a fresh part may be inoculated, and the same process repeated. Under this mode of treatment it is said that a time ultimately arrives at which no further inoculation can be effected from a suppurating sore upon any part of the body. Even then, however, after the lapse of a certain interval, the suppurating syphilitic sore may again be communicated, but always without imparting any constitutional or syphilitic taint to the patient. This subject will be considered more at length in a future lecture.

22

LECTURE II.

SYPHILITIC INFECTION.

SYPHILITIC infection of a patient's system, as far as it can be traced by local symptoms, commences as a crack, an abrasion, or a pimple. These affections, in the origin, are often extremely difficult to recognize. They frequently do not present any characters by which they can be distinguished from similar results arising from a variety of accidental causes, and they may be masked by the coexistence of other local venereal complaints.

Syphilitic infection at its first appearance generally attracts but little attention. It is attended with no inconvenience, and the patient is willing to believe that it is "nothing"-an opinion which has been but too often endorsed by the surgeon. As the disease declares itself, it assumes one of three forms, which are all modifications of the adhesive kind of action:

1. The cuticle may appear as if peeled off from the upper part of the glans penis, or a circumscribed patch may remain for days together, presenting a livid or purple colour. The structures below are not infiltrated, and therefore there is no specific induration.