mann, who inoculated himself more than two thousand two hundred times without being rewarded with this fortunate saturation, supreme desire of syphilisators ?* No, gentlemen; I repeat to you, there exists no immunity against the contagion of the simple chancre. In all cases, as yet, no one has been refractory to the first inoculation. The simple chancre is a grain which takes root upon every soil, and which reproduces itself infinitely upon the same ground. All that is required is, that the grain be good and fit to germinate. In default of man, are animals refractory to this virus? Remark, gentlemen, that I only speak here of a single variety of the primitive venereal ulcer,—the simple chancre. Of all the experiments undertaken up to the present day respecting this subject, the result is, that we have never been able to produce upon animals by direct inoculation an ulceration developing itself extensively and continuously, as is usual with the chancre in man. It limits itself to a small wound, the result of the puncture; and this wound presents this remarkable character,-it proceeds rapidly to cicatrisation. It is true that if one collected the pus found upon the surface of this ulcer, and replanted it in man, one could reproduce a chancre. But it may be that the virus which serves for this inoculation is only the human virus transported to the animal, and preserved upon it, as in a dépôt, after the manner of a grain transplanted in a new soil. This is certain, that, transplanted upon animals, the chancre rapidly dies. A puncture, a small drop of pus, a scab, then a rapid cicatrisation, result from the insertion of the virulent pus. Instead of germinating and extending itself as in man, the chancre lingers and dies upon the animal like a grain upon a foreign soil. Can one believe, after this, that the chancre (observe that See Note III. I still speak of chancre in general, reserving the infecting chancre for after-consideration), can one believe, I say, that the chancre is in reality transmissible to animals? Upon this point I am undecided, and my colleagues of the Midi, MM. Puche* and Cullerier, absolutely refuse to admit it. II. SEAT-PARTICULARITY RELATIVE TO THE CEPHALIC CHANCRE; We come now, gentlemen, to another question of greater interest, that of the seat of the chancre. When I considered the two chancres as the result of one poison, I said, without distinction, the chancre can be developed in every region of the body. But to-day, since renewed study has led me to separate most completely these two varieties (I might almost say these two kinds), I modify my proposition. The indurated chancre, gentlemen, may show itself everywhere. The surface of the body, from the head to the feet, belongs to it. But is it the same with the soft chancre? Permit me, gentlemen, to arrest your attention upon a very singular fact, the secret of which escapes me, and I ask you to meditate at leisure upon this inexplicable mystery. I have shown to you, in my wards, numerous examples of the soft chancre developed on different regions of the body, upon the genital organs, upon the thighs, upon the legs, the arms, the abdomen, the back, the chest, &c. I have shown them to you everywhere—everywhere, except on one point,-the cephalic region. It is a fact, gentlemen, that during five-and-twenty "I have attempted the inoculation of the chancre upon a considerable number of animals (rabbits, cats, guinea-pigs, fowls, &c.), and have never obtained a single positive result. I affirm that the puncture does not even produce local irritation when left to itself."-M. Puche, comm. oral.-A. F. years of practice, I have never met with a single wellauthenticated case of soft chancre developed upon the face or upon the head; and notwithstanding, I can count by hundreds the examples of cephalic chancre which have been presented to my observation. I have met with them upon all the regions of the head, whether upon the lips, or upon the tongue, or upon the eyelids, or upon the forehead, or upon the nostrils, or, indeed, upon those points where their presence appears to be most inexplicable, even in the middle of the hairy scalp. Therefore, gentlemen, I say, all these chancres belong always and most surely to one single and same kind of chancre-to the indurated species. They are attended by all the symptoms peculiar to constitutional syphilis. Not one remains free from induration, not one confines itself to the limits of a local lesion, without reacting upon the economy, without the phenomena of general infection.* Once, however, I believed my researches crowned with success. It was upon a patient who had been sent to me from Bordeaux by my excellent colleague, Dr. Venot. This patient presented upon his lip an ulceration of the phagedænic form, simulating at first sight a perfect chancre. The base upon which the ulceration rested only offered a very slight inflammatory thickening, but was absolutely free from the specific induration of the infecting chancre. *I do not refer to a fact which I published formerly. That observation, relative to a soft chancre of the gum, would appear to furnish an exception the most conclusive, had I not become, since the time when I noted this case, much more observant. I remarked in that observation that there was a non-indurated chancre of the gum, contracted with a woman having chancres, and not followed, after the usual period, by constitutional symptoms; but I should have added that I did not see the woman who had communicated this ulceration, and that the only evidence of her having chancres consisted in the patient's statement! It is equally important to observe that I did not have recourse to artificial inoculation, as a last criterion; and that, consequently, the correctness of the diagnosis and the absolute value of the observation may be doubted.-RICORD. I quite thought at first that it was a soft chancre of the lip affected by phagedæna. It was in vain that I explored the submaxillary region in order to find a bubo, symptomatic of the soft chancre: I could not establish the least glandular enlargement. Further, when I came to analyse more attentively the ulceration before me, I recognised rather the characters of a variety of lupus than those of a veritable chancre. The patient objected to inoculation, and the nature of the affection remained at least uncertain. Since that period, gentlemen, I have never observed a second, analogous to the above case. My colleagues of the Midi have not been more fortunate than myself. MM. Puche and Cullerier still affirm that they have never met with a single instance of the soft, non-infecting chancre on the cephalic region. Let us overstep the bounds of this hospital. Let us interrogate the annals of science; let us search the statistics, French and foreign. Do you know with what information this inventory will furnish us? Two cases of labial chancres, non-infecting, not followed by constitutional syphilis. But these two observations, the first of which belongs to my pupil and friend, Dr. Bassereau, and the second, to one of my colleagues, are not, perhaps, sufficiently complete to be taken into serious consideration, and to constitute an exception to this rule, which, up to the present time, appears to be general:-induration, constant; the character of the cephalic chancre, most certainly infectious. Pardon me, gentlemen, this severity towards others, as well as towards myself; for one cannot surround himself with too many guarantees against error in a question of this kind, the solution of which involves the most weighty doctrines respecting syphilis. I do not deny the existence of the soft cephalic chancre; I do not contest the possibility of its occurrence. On the contrary, I believe that it ought to exist, and long to find it, for, I repeat, I require it for a new point of doctrine. But I can only speak to you of facts, and I maintain in consequence this proposition-" that up to the present day there does not exist one well-authenticated case of soft chancre developed on the face, or, still more generally, of chancre mou céphalique." And yet, gentlemen, it is the soft chancre which is the most fertile source of virulent pus; it is the pus of the soft chancre which is the most easily and for a long time contagious; it responds the best to inoculation. Why, then, is the cephalic region refractory to its powerful virus? That, gentlemen, is an all-important question, the value of which you will better understand when I shall have discussed before you the mode of transmission of different varieties of the chancre. The apparent immunity of the cephalic region against the contagion of the soft chancre is a fact worthy of note, and which I regret to see eluded by puerile excuses or unacceptable interpretations.* But putting aside this exception as yet inexplicable, the one and the other variety of primitive ulceration may be met with everywhere, upon the whole extent of the teguments. And if the chancre, whichever it be, affects more often certain organs,-as, for instance, the glans and the vulva, and certain parts of these organs in particular,―that depends, you readily understand, only upon the manner in which it is contracted, and not upon any special tendency of these parts to inoculation.† |