any period of that existence give rise to a suppurating bubo.

Sometimes one gland only is involved in a case of syphilitic infection; but generally there are several. Each gland becomes enlarged without causing any pain or inconvenience to the patient, and without his being aware that anything unusual is taking place in the part. The enlargement is confined to the gland structure itself, and does not involve the surrounding cellular tissue. Each tumour may become the size and shape of the dried shell of an almond; and I have been in the habit of describing this peculiar affection as the amygdaloid condition of the inguinal glands. Each separate gland may be felt rolling in its bed of loose cellular tissue, and the unaffected skin will move freely over it. These glands are very hard, and give very much the same sensation to the touch as the induration of a primary chancre. The peculiar hardness depends upon the fact that this newly effused plastic material is confined to the gland, and accurately circumscribed by its capsule.

Lymphatic glands affected with specific induration do not suppurate. When the disease is uncomplicated this may be received as a universal rule. Yet in practice we every now and then hear of buboes suppurating in connexion with infecting sores. Some of these are scrofulous buboes; some are buboes arising from some accidental cause of irritation; and some are buboes which occur upon the accession of secondary symptoms, and in consequence of some eruption on

D

those parts of the skin, whence the lymphatics which empty themselves into the glands, arise.

When all these sources of error in diagnosis have been guarded against, there will still remain a few cases in which an infecting chancre has apparently given rise to a suppurating bubo. The number of such cases has not been ascertained statistically, but they are very few indeed, and probably not even so great in proportion as the cases in which an infecting sore retains its auto-inoculability after the development of its specific induration. The exception in both classes of cases depends, in all probability, upon the same cause, namely, a twofold inoculation upon the same part.

A very remarkable circumstance remains to be noticed with regard to lymphatic absorption, both from the suppurating sore and from the primary infection. The glands into which the absorbent vessels directly enter are those only which are affected. These are called the glands first in order. The glands second in order that is, those glands which receive their lymphatic vessels only from other glands, are never affected with the specific action peculiar to any form of primary syphilitic disease. It is evident, therefore, that no form of syphilitic action can find access to a patient's system through the lymphatics. The specific action ceases with the first system of glands with which the affected matter is brought in contact, and therefore the affection of the lymphatic glands may be looked upon as a part of the primary symptoms. An inguinal gland affected with specific induration would,

no doubt, if no other cause of infection existed, produce constitutional disease; but it would be by means of the blood that circulates through its diseased structure, and not by the passage of the poison into the circulation through the thoracic duct. In the same way a chancre infects a patient's constitution by the morbid action communicated to the blood circulating through its texture, and not by lymphatic absorption.

When once the general system of a patient is affected with syphilis, the same disposition to the effusion of plastic matter may occur in any situation as was manifested at the original seat of the disease. This disposition to plastic effusion may be traced in every stage of the disease. We have considered it in the primary infection, and as giving rise to the peculiar characteristic induration of the lymphatic glands. In the secondary forms of the disease the same action may also be traced in effusion of lymph upon the iris; in the deposit of tubercles in the cellular tissue and in various internal organs; in nodes upon the bones ; and in various kinds of papular and tubercular eruptions upon the skin. All these different forms of secondary disease may be referred to the same tendency to plastic effusion; the effused material, if allowed to remain, being influenced by, and becoming part of, the structure in which it occurs.

A German writer, Dr. Hermann, has very recently published his views on syphilis; and he believes all syphilis to be local, and to require no constitutional treatment. He entirely ignores any general syphilitic infection of a patient's system, and consequently con

siders mercury and iodine as injurious. It is evident that this gentleman's observations, if correctly made, must have been confined to one class of cases only. In a work published not long ago by Mr. Labatt, nearly all the cases observed were, from peculiar circumstances, instances of the local or suppurating form of the disease; and Dr. Hermann must, from some unexplained cause, have met exclusively with the same. class of cases.

In the treatment of syphilitic infection cauterization. is of no avail, as far as the prevention of constitutional symptoms is concerned. The period of incubation which has elapsed before the disease manifests itself forbids the idea that the poison can then be destroyed by the application of caustic to any particular part. Practically the same truth is found unfortunately to be but too evident. Infecting sores, that have been destroyed on the very day of their appearance, have subsequently continued to spread, and have produced their natural consequence. Even if an infecting sore be cut out, the infection of the patient's system will not thereby be prevented. The diseased action has already spread to other parts, and has already perhaps commenced in the lymphatic glands before any visible indication of its existence presents itself. A sustained, judicious and constitutional mode of treatment is the only one that can be relied upon in the treatment of this disease.

37

LECTURE III.

SYPHILIZATION (SO CALLED).

BOTH the suppurating and the infecting variety of syphilis, described in the preceding lectures, may be modified by various circumstances, two of which, viz., syphilization and lymphatic absorption, require a separate consideration. It has been shown that the secretion from an infecting sore, when the specific induration has once taken place, can only be inoculated again upon the same individual under exceptional circumstances. The secretion from the suppurating sore, on the other hand, may be reinoculated a great number of times. It has, however, been found that when thus repeatedly inoculated, the first chancre produced lasts longer than the second, and the second longer than the third, and so on. Hence arose the idea, that by a succession of inoculations a point might be arrived at, after which the system would not be susceptible of any fresh syphilitic infection.

In the debates which have taken place upon this subject, much useless controversy has arisen from a want of distinction of the different kinds of syphilitic action. Prolonged and animated discussions have taken place