clearly contradicted by the nature of the secretion, and by the test of inoculation. The patient was, therefore, directed to discontinue the mercurial course which he had commenced two or three days previously, and was treated by steel pills and other nonspecific remedies. In Plate IV, Figs. 4 and 5 are copied from a drawing made by Dr. Westmacott after the phimosis had subsided, and when the artificial inoculations were healed. At this period the secretion from one of the original sores on the penis was still purulent. The patient was kept in the Lock Hospital until he appeared quite free from any disease, and for a considerable period afterwards presented himself occasionally as an out-patient at King's College Hospital. He was last seen on the 31st of May (seven months after infection), without the least trace of constitutional disease.

In this case, then, the evidence afforded by the nature of the secretion, and by the test of inoculation, corrected the erroneous impression that would have been and was conveyed by the sense of touch alone.

There are cases, however, in which neither the sense of touch, nor the nature of the secretion, nor the result of inoculation, will give positive information as to whether the patient will have secondary symptoms. These are the mixed cases, in which a twofold inoculation has taken place. They occur, for the most part, in those who have never suffered from constitutional syphilis, for the obvious reason that in those who have so suffered, inoculation of one kind can rarely and with difficulty be performed.

Twofold inoculation may occur either in the same or in different parts, at the same or at different times. When it occurs in the same part and at the same time, the results of the inoculation of the secretion from the suppurating sore will first develop themselves, and, subsequently, the results of the inoculation of the secretion from the infecting sore. depends upon the different period of incubation which naturally belongs respectively to each kind of disease.

This

The cases in practice which have led to the greatest confusion are those in which the inoculation of the secretion from a suppurating sore has followed, after the lapse of three or four weeks, on the same spot, the inoculation from an infecting sore. We have, then, the results of two kinds of action, and their respective products in close proximity. The suppurative inflammation does not, then, prevent the infection of the patient's constitution; the adhesive inflammation does not prevent the appearance of the "specific pustule." The means of diagnosis, which would refer these mixed sores either to the infecting or to the suppurating class exclusively, are therefore absent.

There is at present (Nov. 1862), in the Lock Hospital, a man who was admitted with a single ulcer on the prepuce, surrounded by a considerable amount of general induration. The glands in the groin were enlarged, but not distinct from each other. The secretion from the surface of the sore was purulent, and when inoculated produced the specific pustule. As the irritation subsided around the sore, the induration

became more accurately circumscribed, and in the course of a few days a specific papular eruption appeared upon the patient's skin.

Although, in such cases, it may be very difficult to form a correct diagnosis at once, yet by watching the course of the symptoms this may be done with much accuracy.

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LECTURE XIII.

TRANSMISSION OF SECONDARY SYPHILIS.

THE Contagious character of secondary syphilitic affections was generally admitted before the time of Hunter. In the experiments which he made he was led to the conclusion that the products of constitutional syphilis were "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 (primary) chancre." He says that the secretion from a chancre generally when absorbed produces a bubo, but that we never find a bubo arising from a secondary syphilitic sore. When there is a venereal ulcer in the throat, no buboes appear in the glands of the neck. Venereal sores on the arms, or even suppurating nodes on the ulna, do not as a rule produce swelling of the axillary glands, although these will very certainly be affected if syphilitic matter from a primary chancre be inoculated on the skin of the arm. Again, when syphilitic blotches or nodes form on the legs and thighs, the specific affection of the glands in the groin, which accompanies primary infection, does not occur.

These considerations so far biassed Hunter's mind,

that he came to the conclusion that the secretions from the secondary syphilitic affections were not inoculable. He mentions, however, that it was asserted in his day that ulcers in the mouths of children derived from constitutional and hereditary disease, produced the same disease upon the nipples of women who suckled them. That is, the children were contaminated either by their mothers or fathers; the child received the disease by hereditary descent; and the nurse was infected by the child. If," Hunter observes, "it were possible to contaminate once in this way, it would be possible to contaminate for ever. How far the observations upon which the before-mentioned opinion is founded have been made with sufficient accuracy I know not."

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As has been already fully pointed out in a previous lecture, Hunter committed the grave error, in which he was eagerly followed by a host of subsequent writers, of supposing, because the syphilitic poison was not inoculable as a rule upon the person who produced it, that, therefore, it was not inoculable upon a person who had not previously had the disease.

Experiments and observations have now been made with sufficient accuracy, and repeated a sufficient number of times, to show that the circumstances contemplated by Hunter actually do exist, and that syphilis may be communicated in this way, and that it may be so communicated from one patient to another an unlimited number of times, so long as the poison is brought in contact with a person not previously infected. With the increased light which modern investigations have shed upon this subject, it is not unin