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CHAPTER III.

ANALYSIS OF THE PRECEDING CASES.

UNTIL within a few years anterior to the present date, it was the prevailing belief among both British and Continental practitioners, that secondary syphilis, or lues venerea, as this form of disease has been heretofore denominated, was not communicable from person to person. The doctrine is that which was promulgated by Hunter, and is founded upon experiments of the following kind: "A man had been affected with venereal disease a long time, and had been several times salivated, but the disease still broke out anew. He was taken into St. George's Hospital, affected with a number of venereal sores; and before I put him under a mercurial course, I made the following experiment:-I took some of the matter from one of the sores upon the point of a lancet, and made three small wounds upon the back, where the skin was smooth and sound, deep enough to draw blood. I made a wound similar to the other three with a clean lancet, the four wounds making a quadrangle; but all the wounds healed up, and none of them ever appeared after." In another case, a man labouring under secondary syphilis was inoculated with matter from a chancre, and also with matter from his own sores. "The wounds impregnated with the matter from the chancres became chancres, but the others healed up."

Hunter appears to have entertained the belief also, according to the following quotation, that the product of a secondary venereal sore has ceased, at this epoch, to be venereal in its nature:-" When the matter (the venereal poison) has got into the constitution, it from thence produces many local effects on different parts of the body, which are in general a kind of inflammation, or at least an increased action occasioning a suppuration of its own kind; it is supposed that the matter produced in consequence of these inflammations, similar to the matter from a gonorrhoea or chancre, is also venereal and poisonous. This I believe till now has never been denied ; and upon the first view of the subject, one would be inclined to suppose that it really should be venereal: for, first, the venereal matter is the cause; and, again, the same treatment cures both diseases; thus mercury cures both a chancre and a lues venerea; however, this is no decisive proof, as mercury cures many diseases besides the venereal. On the other hand, there are many strong reasons for believing that the matter is not venereal.' It seems a strange perversion of pathological law to regard the consecutive phases of one and the same disease, capable of producing the same phenomena which immediately supervene upon a primary affection, as not belonging to the same category.

The same author is equally incredulous as to the infectious properties of the blood, the saliva, or the breastmilk of one labouring under secondary syphilitic disease, and doubts the possibility of its transmission to the fœtus in utero from a mother so infected, except by direct application of the same kind of matter which produced the disease in her. On the last-mentioned point he says: "It is also supposed, that a fœtus in the womb of a syphi

litic mother may be infected and have the disease from her, as though it were naturally interwoven with it. This I should doubt very much, both from what may be observed of the secretions, and from finding that even the matter from such constitutional inflammation is not capable of producing the disease. However, one can conceive the bare possibility of a child being affected in the womb of a diseased mother, not indeed from the disease of the mother, but from a part of the same matter which contaminated the mother, and was absorbed by her."

His opinion on the subject of contamination through the medium of the breast is contained in the following extract:-"It has been supposed and asserted from observation, that ulcers in the mouths of children from a constitutional disease, which constitutional disease was supposed to be derived from the parent, produced the same disease upon the nipples of women who had been sucked by them, giving it, as it were, at the third hand; that is, the children were contaminated either by their mothers or fathers having the disease in form of a lues venerea (of which I have endeavoured to show the impossibility); the child was the second, and the nurse was the third. If, however, it were possible to contaminate once in this way, it would be possible to contaminate for ever." The case which he adduces in support of this opiniontoo well remembered, doubtless, to require transcription here-instead of supporting his argument, has, in my opinion, a contrary tendency. It has been shown by experiment, as will be presently stated, that not only does the matter of secondary sores produce, by inoculation, phenomena similar to those from which the matter Hunter On the Lues Venerea, 1786, p. 291 et seq.

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was taken, but constitutional effects also, in every point resembling those which appear, after the usual interval, as the result of an uncured primary affection.

The failure of inoculation of secondary syphilitic matter to produce an immediate local effect, Hunter deemed sufficient to disprove its infectious nature altogether. This seems to me to be a refutation of his own teaching respecting the habitudes of the venereal poison, for he states that the average time required for the development of lues venerea, after the absorption of the poison, is six weeks, sometimes much longer; it would therefore be unreasonable to expect an immediate reaction upon the part where the matter was inserted, or even to look for it at all in that precise situation, as a necessary manifestation, since, becoming a disease of the blood, its deposition takes place, as to time, in accordance with laws peculiarly its own, and upon such parts as are most susceptible of being acted upon by it.

The results, therefore, which Hunter obtained, led him to the conclusion, that diseases apparently arising from secondary inoculation, whether through the saliva, the blood, the breast-milk, or any other medium, and regarded by previous observers as venereal, were, in reality, in their nature not so; that the sequela of syphilis were no longer, as such, to be considered syphilitic. This doctrine, spite of the multitude of daily accumulating facts tending to disprove its validity, was maintained for a series of years with a degree of sectarian waywardness to which it would be vain to seek a parallel. Thus we find Mr. S. Cooper, who, in his elaborate compilation, may be considered fairly to represent all or most authorities of credible acceptance up to his day, entertaining in 1830, forty-four years after the promulgation of

Hunter's theory, the same unaltered opinion. In his remarks upon Mr. Hey's cases of secondary inoculation he says:-"The late Mr. Hey, of Leeds, gave it as his opinion, that a man might communicate lues venerea after all the symptoms of the disease had been removed, and he was apparently in perfect health. This sentiment is not only repugnant to the authority of Mr. Hunter, but to common observation and all sound reasoning." Mr. Cooper saw reasons for changing his belief on this subject, as stated in another edition of his work published eight years later.

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Within the last few years, opinions have undergone a material change respecting the nature and habitudes of venereal affections. Practitioners of the present generation, taken as a body, if not better informed than those of the age immediately preceding, are at least better disciplined, more practically inquisitive, and consequently feel greater confidence in their own powers of discrimination. They are more carefully observant of facts as they present themselves, more willing to allow phenomena to represent what they really mean, more patient in inquiry into their history and the bearing of collateral circumstances, and less hasty in drawing conclusions with a view of adapting them to preconceived theories. I speak generally. The astonishing revelations of certain physiological and pathological mysteries beforetime

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1 Dictionary of Practical Surgery, 1830, p. 1210. It should be borne in mind, that Mr. Hey was not a compiler, but a man of more than ordinary talent, and of great practical experience. He was a careful observer of facts as they naturally presented themselves, and has left many valuable and lasting contributions to the science of medicine. The opinions which he expressed in the Paper from which the above quotation is made, were the result of forty-six years' observation they should not, therefore, have been so lightly disposed of.