share of influence. In other words, I am disposed to admit (without, however, absolutely affirming it) that a chancre assumes one form rather than another, not only on account of certain dispositions peculiar to the individual who contracts it, but also on account of the source from which it is derived. This analogy in the affections, presented by patients who had contracted the contagion the one from the other, I had long since remarked.* And, indeed, in a certain number of cases in which I had an opportunity of examining conjointly the infected couples, I invariably discovered a singular analogy of form between the symptoms of the infected patients and of those who had transmitted to them the infection. But as it so rarely happens, unless in certain special investigations, that we meet with patients under these conditions, and as it likewise rarely happens that we are enabled to determine with certainty the exact circumstances under which the contagion was originated, I did not attach any great importance to my first observations, nor did they at first arrest my attention; but subsequently syphilisation, like an epidemic, appeared, and showed me experimentally (a result very far from the aim and the intentions of syphilisators) this constant relation existing between the affection transmitted by means of the lancet, and the ulceration from which the pus used in the inoculation had been derived. The examples were then but too numerous; so that from that time I advanced this opinion, "that the different forms of the disease might depend not only on the conditions of the individual on whom the cause acts, but also on differences in the causes and in the virus.†

*It is probably to Bell we ought to attribute the honour of having been the first to signalize with precision the relation existing between the primitive and the transmitted affection. It was whilst treating of phagedænism that the celebrated surgeon of Edinburgh advanced this opinion in

extenso.

+ This opinion is to be found expressed almost in the same words in the letters of Mr. Ricord, Letter XXXIII.

The doctrinal interest which is attached to this question did not fail to provoke special investigations on the contagion, and on the propagation of chancre in each of its varieties. Mr. Bassereau, was amongst the first thus engaged, and you already know what were the results of his laborious investigations. Only, his object was more that of establishing a parallel of infection or immunity between individuals infected one by another, than to compare, in their initial form, the chancres of contaminated subjects. Thus an important part of the question has escaped his notice. But I shall reserve, for the present, this difficult and contested point: I shall return to it when describing the characters of the chancre, with a soft base, of syphilitic subjects.

Mr. Clerc admits, as well as Mr. Bassereau, the transmission of the infecting chancre in its own species, but I fear that the examples he has cited in support of his opinion are too scanty to convince his readers. The Lyons school has also made this question the object of its study. Messrs. Diday,

Rodet, and Rollet are inclined to conclude, from the results of their personal experience, that each of the varieties of chancre is transmitted separately in its species.*

*

Up to this point the accordance is perfect. But there is at Marseilles one of my former pupils, now a distinguished surgeon in that city, who protests against this division of syphilis into two nosological species. Mr. Melchior Robert, a zealous champion of the unity of the virus, denies this necessary relation of the chancre with the chancre which produced it. According to him, the two species are often crossed; and, in fact, the different varieties of the primitive affection are simply to be considered "as manifestations of a single principle, the various effects of which depend upon

* The opinions of the school of Lyons have been reproduced by Mr. Ach. Dron, in a recent thesis of great interest.-De Double Virus Syphilitique, Paris, 1856.-FOURNIER.

conditions extraneous to the virus," and, consequently, to the infection.

In the midst of the dissentions which almost invariably attend questions so intricate and difficult as the one we are now discussing, I determined to recur again to observation, and to submit these various theories to a strict analysis of clinical facts. During the course of this year, a series of investigations have, therefore, been undertaken,-investigations already described, and the results of which, relative to the transmission of the simple chancre, are already known to you. I now only have to inform you concerning those relating to the infecting chancre. There are, as you all know, two different modes of studying the propagation of chancres; we can refer from the infected to the infecting subject, that is to say, re-unite the contaminated couples; or else, what is no less interesting as well as demonstrative, follow the transmission on several subjects whose infection is derived from the same source. We have viewed the question under this light, and here are the results of this double investigation:Fifty-nine observations collected by my actual INTERNE,* and the greater part verified and confirmed either by yourselves and myself, or else by such of our colleagues as have aided us in our investigations, prove to us the similarity that exists between the affections developed on either side, in patients who receive and in those who transmit infection. In all those cases in which we have been able to refer to the origin of an indurated chancre, we have invariably found an affection of a similar nature; at all events, whenever it was transmitted by a subject free from any anterior infection. In all those cases in which we have followed the transmission of chancre on several patients who had derived the infection from the same source, we have always found the same affection on the different contaminated individuals; that is to

See Note X.

say, an infecting chancre, followed by all the affections of constitutional syphilis. This law of "relation" is constant; no exception has been produced, nor has a single contradictory fact come to throw any doubt upon this new doctrine of the transmission of the infecting chancre in its own species Some of these observations, which you have followed in my wards, are such as to command conviction: I shall briefly recall them.*

* Here are, in detail, the observations cited by M. Ricord;-the importance of the doctrinal questions attached to them will, I hope, compensate for their length.

Obs. I.-The girl P— (Clemence) contracts a chancre towards the end of January, 1856. She almost immediately communicated it to two young men who shared her favours; D- (Stephen) and V (Augustus). The father of the latter, an old man of seventy-three years of age, has connexion with this girl during the month of February. He also contracts a chancre. I have been able to obtain complete avowals from these four patients, and to follow in each of them the development of the disease, as follows:I.-P- (Clemence), aged 23; robust constitution; sanguine temperament. First venereal affection, according to the patient. Towards the last days of January, perceived a large, hard, and ulcerated “bouton" on the left labium. This ulceration did not cicatrize until about the

middle of April. Some time after the appearance of this (pimple, "bouton"), the glands of the left groin became enlarged. The patient followed no treatment. In the month of May, I found on her a brownish, rounded, and truly specific cicatrix, situated on the cutaneous surface of the left labium; the base of this cicatrix is still surrounded by a distinctly appreciable induration; bi-inguinal adenopathy, hard, multiple, and indolent, well defined on the left side, only slightly so on the right; mucous tubercles on the greater and lesser labia; erythematous roseola, disappearing; posterior cervical adenopathy.

II.—D. R▬▬ (Stephen), aged 27; lymphatic temperament; no venereal antecedents. R- had been cohabiting with the girl Clemence, without having had connexion with any other woman for a month; when, in the first week of February, he perceived a slight ulceration on his penis, at the level of the corona. From this time forward he abstained from coitus. The ulceration enlarged, but remained indolent. The patient did not present himself at the Midi until the month of March, when M. Ricord and myself recognised the following state:--Typical indurated chancre on the corona; bi-inguinal adenopathy, multiple, hard, and indolent, well defined on both groins. A mercurial treatment was immediately prescribed, but the patient only followed it for a few weeks. The 23rd of May he entered

K

The girl C January, 1856.

contracts a chancre on the vulva, in This becomes indurated, and is accompanied

the Midi, in the following state:-Indurated cicatrix of the chancre; biinguinal adenopathy still persisting; confluent papular roseola, of several weeks' date; cephalæa; scabby eruption on the scalp; alopecia; bi-cervical adenopathy; mucous aphthæ in the pharynx. The mercurial treatment was followed, without any fresh casualty, from the 24th of May until the 10th of August. From this period I repeatedly saw the patient at the consulting-room of the Midi, and found on him successively, in September, mucous aphthæ on the lips; in October, labial and lingual aphthæ; finally, in December, ecthyma.

III.—V———— (Augustus), aged 20; lymphatic temperament.Gonorrhoea in 1855. Connexion with the girl Clemence in the last week of January; previous coitus" dating the 1st of January. No subsequent coitus. The chancre was perceived by the patient in the first days of February. Treatment:-Lotions, with the decoction of marsh-mallow. In March, mercurial treatment prescribed by M. Ricord at the hospital. In May, actual state:-Indurated cicatrix of the chancre on the corona ; bi-inquinal adenopathy, multiple, hard, and indolent; papular eruption, which first manifested itself a month ago; confluent buccal mucous aphthæ dating five weeks; alopecia; posterior cervical adenopathy; sore throat; cephalæa. Mercurial treatment; rapid cure of the affections. Up to the 25th of August, no fresh affection.

IV.-V- –, aged 73 (father of the preceding patient). V—— had a single connexion with his son's mistress. For several years he had had no connexion with any woman. Some days after, a few pimples made their appearance on the inferior surface of the integuments covering the penis; these "boutons" were frequently covered with scabs, and were slow in cicatrizing. During the month of April, general cutaneous eruption; sore throat; cephalæa; violent ocular inflammation. No treatment. I did not see the patient until the month of May, when I found him as follows:-Total loss of strength; prostration; intellect sound; chancres parcheminés on the inferior surface of the penis, commencing to cicatrize; base clearly indurated; a few small glands, hard and indolent, in the groins; the adenopathy is, however, ill defined; confluent papular roseola of the trunk and members; mucous tubercles on the scrotum; mucous aphthæ of the amygdalæ; violent sore throat; ecthymatous eruption on the scalp; alopecia by handfuls on the parts of the head which time had respected; no cervical adenopathy; violent ophthalmia; eyeballs red, and greatly injected; vision almost lost. (The patient is in such a state of suffering, that I can no longer prolong this examination.) Died in the ensuing month.

OBS. II.-The girl P, aged 19; lymphatic temperament; contracts in November, 1855, two chancres, with indurated bases, seated on the fourchette. These chancres, after the interval of a few days, are followed by bi-inguinal adenopathy, hard, multiple, and indolent. No specific treat