INTRODUCTION.

INFECTIOUS discharges from the genital organs of both sexes, and ulcerations on those parts, must have been known in olden times, even in the remotest antiquity. There is an allusion to an "unclean seminal discharge" in the third book of Moses (Leviticus, chap. xv), and the sanitary regulations prescribed by Moses himself indicate conclusively the actual infectious nature of such seminal discharges. It is likewise seen, from the writings of the old Greek and Roman physicians, that they treated ulcers of the genital organs which were caused by contagion.

causes.

At the end of the fifteenth century many persons were attacked, as in an epidemic, with morbid phenomena, especially diseases of the skin, whose origin the physicians of those times regarded as being due partially to telluric and partially to astral These affections were supposed to originate in a general deterioration of the cardinal secretions of the body and the liver as being the fountain of the disease. Not until it became apparent that these diseases prevailed among the troops of Charles VIII, which occupied Naples in 1495, and occurred especially among those women with whom they had sexual intercourse, did many physicians become convincd that the diseases in question originated by transportation from one person to another this transportation or infection occurring especially during sexual congress, and starting with an affection.

of the genital organs. These circumstances led Fernelius

and Bethencourt to call this disease venereal, or the veneria, and also "lues venerea." For the same reason it was also called mentulagra (from mentula, penis), when it attacked men, and pudendagra when it attacked women. At the time when it prevailed as a pest it received various names, based

mainly upon geographical grounds. The French called it "mal de Naples" and "la grosse vérole"; the Spaniards, "las bubas" (pocks). The Germans and Italians called it "mal de France"; the Poles, the "Dutch disease"; the Dutch and English, the "Spanish"; the Orientals, the "French"; the Portuguese, the "Castilian"; the Persians, the "Turkish"; and the Chinese, the "disease of Kanton" (Kouang tong Tschouang). But all these designations were supplanted by the name of syphilis, which has been universally adopted. This term was first applied to the disease by Hieronymus Fracastorius, deriving it from a shepherd by the name of "Syphilus," whom he apostrophizes in an ode, as the first to suffer from this disease because he had offended the gods. Others derive the name syphilis from the Greek word apλós, broken; others, again, from the words oùs and pixía.

The infectious discharges from the genital organs are called in males, "gonorrhoea"-fluxus sive profluvium seminis, from yový, semen, and peîv, to flow; in females, "fluor"; in German, "Tripper." The terms blennorrhoea and blennorrhagia mucifluxus, from τὸ βλεννος, oι ἡ βλέννοα, mueus, and ῥεῖν, or pnyvóval, were first used by Swediaur.

We are indebted for the designation of the word "chancre," as applied to a sore on the genital organs originating from sexual intercourse, to the French, who substituted the word chancre for cancer, which Celsus had selected to designate this disease. With the word cancer Celsus wished to describe the spreading, corroding, malignant character of the ulcer. The physicians of the thirteenth and fourteenth centuries selected. the words "caries," "caroli," or "taroli pudendum," to designate such malignant contagious ulcers.

THE VENEREAL CONTAGIONS.

FERNELIUS was one of the first to properly comprehend the connection between diseases of the genital parts and syphilis. He suggested the hypothesis of the existence of an animal poison which he called the venereal poison. This virus, Fernelius believed, developed not only in the purulent secretion of certain ulcers of the skin and mucous membrane that originate during sexual intercourse, but also in the muco-purulent discharge of the inflamed or catarrhal affected mucous membrane of both sexes. From these two affections of the genital organs, Fernelius contended that the venereal virus passes into the secretions of the body and then attacks sometimes one organ and then again another. He was therefore of the opinion that syphilis, until then such a mysterious disease, resulted from well-known affections of the mucous membranes and of the skin covering the sexual organs, which we to-day desig nate as chancre and gonorrhoea (clap).

The opinion that gonorrhoea and chancre were the commencement of syphilis prevailed till the second half of the eighteenth century. In the year 1767 Balfour, an English surgeon, positively asserted that gonorrhoea and syphilis were essentially distinct diseases. Balfour's assertions, however, were stoutly opposed by John Hunter, who, in 1767, first instituted comparisons between the two diseases by performing inoculations with the secretions of venereal catarrhal affections of the mucous membranes and of venereal ulcers of the skin. Hunter inoculated the penis and prepuce (whose is not stated) with pus which he derived from the urethra of a patient presumably affected with gonorrhoea. As ulcers developed from these inoculations, upon which induration of the lymphatic glands of the right groin soon supervened, and a few months later ulcers of the tonsils and a roseola eruption

became superadded, which symptoms of constitutional syphilis were promptly cured by mercury, Hunter deemed the identity of gonorrhoea and chancre as complete, and consequently also of the contagion of gonorrhoea and syphilis as conclusive. The difference in the form of the manifestations of this contagion he believed to be due only to the differences in the anatomical structures upon which the lesion was produced. Upon the secreting mucous membrane the poison in question produces a catarrhal, upon the general cutaneous covering an ulcerative, process.

The first one to oppose Hunter in this matter was Benjamin Bell, of Edinburgh. He adduced the following facts: Two young persons scarified the skin of their glans penis and prepuce with a lancet, and allowed bits of charpie dipped in gonorrhoeal matter to remain in contact with the scarifications for forty-eight hours. In one of the young men a balano-blennorrhoea ensued; in the other, some of the dripping pus gained an entrance into the urethra, in consequence of which a catarrhal disease developed in two days in this canal. On the other hand, one of the experimenters, by carrying the pus of a venereal ulcer of the skin of the genital organs upon a probe several millimetres deep into the urethral canal produced a painful ulcer at this place, which was followed by a suppurating bubo. Notwithstanding this and many other similar experiments, the virus of gonorrhoeal with chancre contagion was supposed to be identical till the thirtieth year of the present century, when Ricord first took sides in the matter. By the aid of Récamier's vaginal speculum, which was used very little by his predecessors and contemporaries, Ricord disproved Hunter's views, by the fact that venereal ulcers may exist upon the mucous membrane of the vagina and of the neck of the uterus, and consequently the vaginal discharge may be tainted with that of the chancre. From 1831 to 1837 he performed 667 more inoculations with gonorrheal matter, and from none of these did any chancre-ulcers result. Finally, Ricord proved that not infrequently the matter that exudes from the urethra is due to a chancre-ulcer situated in that canal, which upon inoculation produces a pustule from which a chancre will develop.

With these and other experimental researches all apparent contradictions were explained, and the independence of the gonorrhoeal contagium was incontestably proved in every way, both as regards its indirect as well as its direct effect.

With the progress of science and more carefully observed clinical facts it soon became manifest that not all chancres were followed by syphilitic lesions. Hunter, who, although he looked upon gonorrhoea and ulcers on the genitals arising from sexual contact as the effects of one and the same poison, nevertheless maintained that not all the ulcers on the genital organs are of syphilitic nature. He only designated such ulcers. on the genital organs chancre that were followed by syphilis. According to Hunter, the chancre was distinguished from all other sores on the sexual organs by a dense, hard, sclerotic base and by elevated indurated borders (Hunterian induration). All otherwise constituted non-indurated ulcers on the genitals were, in his opinion, not chancres; they were simple, ordinary, non-infectious ulcers or secondary syphilitic sores. These secondary syphilitic sores were said to be distinguished from the primary sores by the fact that they were not callous, did not spread rapidly, produced no adenitis, were not auto-inoculable, and healed rapidly. At first, Ricord made no distinction between the indurated and non-indurated ulcers, calling them both ulcerating chancres, and deeming both to be the effects of one and the same virus. He called the virus "chancre-poison or primary syphilitic poison," which in some cases-not, however, in all-is followed by syphilis, and which, according to the grade and phase of development, he embraced in the category of secondary and tertiary affections. Gradually, however, he approached the position held by Hunter, in so far as to admit that only that chancre which was situated upon a hard base, or left behind it a hard cicatrix, was capable of producing general syphilis, and such chancres he therefore called "infecting chancres." The induration thus established was looked upon as a criterion of commencing blood-poisoning. The reason why induration resulted in one case and not in another, he maintained, was not due to the difference in the character of the virus, but partly to its more or less weakened power to infect (virulescence) and partly to the difference of