is inevitable with the infecting chancre. The symptomatic bubo of the simple chancre is an acute bubo, monoglandular, often arriving at suppuration. The pus it secretes may be a virulent pus, susceptible of reproducing, by inoculation, the characteristic pustule of chancre. Add, that this bubo is produced almost indifferently at any age, at any period of the chancre. The bubo of the indurated chancre, on the contrary, is developed "à froid," without pain; it is an essentially indolent, multiple bubo, reproducing in the glands the induration peculiar to chancre; it never sup. purates solely by the influence of the diathesis, and never secretes the specific pus in those rare cases in which an extraneous cause determines suppuration. Its epoch of apparition is PRECISE, almost certain; and coincides with the induration of the chancre, or follows it closely.

Let us now come to the question of origin, of transmission, The simple chancre is originated by a simple chancre, and is reproduced in its own species. The infecting chancre is originated by an infecting chancre, and is also transmitted in its own form. It is true, that the indurated chancre inoculated upon a syphilitic subject gives rise to an ulceration with a soft base, analogous in aspect to the simple chancre; but, as I have told you elsewhere, this analogy is probably only apparent, for the ulceration thus developed may reproduce in its turn an indurated chancre upon a virgin subject. Finally, the investigations on contagion establish between these two varieties of chancre differences far more considerable, perhaps, than the symptomological considerations previously developed. But it is, especially, the question of prognosis which makes of the two chancres completely independent nosological species; I might almost say, opposed. The simple chancre is a local lesion, without influence on the economy: it is a chancre without syphilis. The indurated chancre creates a diathesis, engenders a general state, a morbid

M

temperament: it is the initial expression of a constitutional affection; it is the exordium of syphilis.

You see that under whatsoever aspect we consider these two chancres, we find nothing but differences. Symptoms, clinical forms, inoculation, contagion, prognosis, everything in fact, contributes to present them to us as two absolutely distinct species. Up to this point, gentlemen, we have confined ourselves within the limits of observation. We have only described the symptoms of each, and compared them, without entering into the doctrinal reason of the differences which this study furnishes us at each step. But I feel that this simple clinical exposition is far from being satisfactory to you: you demand a conclusion to these premises. You would have me, whilst discussing one of the most grave problems of pathology, investigate with you whether there exists or not, for each of the two chancres, a special cause, a peculiar source. You require a doctrinal formula, a THEORY (this is the great word!) which gives you the key to open the sense of the preceding facts; and your restless minds are already agitating the question of the duality of the syphilitic virus. Well, gentlemen, this conclusion that you require I cannot, and, I believe, nobody can, at the present day, give you; for the light is but commencing to dawn upon this important question. Many points (perhaps you are going to forget it at the moment I conclude), many points are still involved in doubt, and require fresh investigations and new efforts. The veil that covers these questions has not yet been raised; perhaps also all the data of the problem are not yet known. We must, therefore, delay the solution; we must wait. Nevertheless, whatever may be the information furnished by the future, it appears to me well established that, from this day forward, the unity of the syphilitic virus can be in no way compromised. Syphilis stands alone, and cannot be separated, so to say, into two

different morbid entities. Even should we succeed in demonstrating that the two forms of chancre belong to two distinct pathological species, we should still have done nothing to negative the unity of the virus; that would only prove that, side by side with syphilis, there existed another affection manifesting itself, like the former, by the initial symptom of a contagious and virulent pus, but not exercising, like it, an infectious influence on the economy. We should be bound to infer from that, not, as has been too lightly advanced, the duality of syphilitic virus, but the existence of a second venereal or chancrous virus, independent of syphilis; in other terms, we should acknowledge two kinds of virus, the one appertaining to syphilis, and producing the infecting chancre, the other an alien to syphilis, developing the simple chancre. The duality of the chancrous virus is, as yet, but an hypothesis which the future will judge; the unity of the syphilitic virus is a truth determined by experience and time.

NOTES AND CASES.

NOTE I.

ON THE INITIAL AFFECTION OF CONSTITUTIONAL SYPHILIS.-Statistic of 1856.

"CHANCRE is, therefore, the necessary exordium of acquired syphilis" (page 2).

ence.

M. Ricord has written elsewhere, "No syphilis without chancre, or without a syphilitic father or mother. Acquired syphilis derives its origin NECESSARILY from a chancre." This great law respecting the origin of syphilis, which M. Ricord has energetically defended during so many years by his writings, at the tribune, and in his clinical lectures, has now been sanctioned by time and experiDesirous, however, of giving a fresh proof to his pupils of this year, M. Ricord had requested me during his clinical lectures to take notes of all the observations made on patients admitted into the wards for affections of constitutional syphilis. This was the origin of the following work.* During the year 1856, 826 patients affected with various kinds of constitutional syphilis were admitted into the wards of the hospital, or observed among the out-patients. These patients may be classed in two groups, as follows:

Patients having secondary affections 759

* I must add, that this work has been completed since the time it was read by M. Ricord at his clinical lectures. I have annexed to it the statistic of the last quarter of 1856, so that the following table contains the whole of this year's proceedings.

Now, on the 826 patients, the chancre could be recognised 815 times as a prelude to constitutional affections,—and that, either by the statements of the patients, or by the results obtained by our investigations; eleven cases only appeared to me as forming an exception to this law, that is to say, that on eleven patients affected with syphilis, the chancre could not be retraced AS THE ORIGIN, with certitude, or else that the patients attributed to another source the affections they presented.

But let us attentively analyze these eleven cases.

1 and 2. Two patients, the one aged eighteen, the other twenty-five, never previously affected with any venereal disease, manifest almost identical symptoms, viz., the former, gummy tumour of the velum palati and an ulcerated tubercle on the posterior parietes of the pharynx; the second, a gummy tumour of the velum. Notwithstanding the absence of precise indications, M. Ricord did not hesitate to attribute the affections presented by the two patients to an hereditary diathesis. These two cases, therefore, cannot constitute an exception to M. Ricord's law, simply relative to acquired syphilis.

3. We have here a patient admitted into the hospital with the following symptoms:-confluent and hypertrophical anal aphthæ, secondary balanitis, specific bi-inguinal adenopathy, cervical bubo, alopecia, cephalæa, etc. This patient denied, in a formal manner, any venereal antecedent. A minute examination led us to discover on the scrotum the existence of a rounded, whitish, wafer-like cicatrization-an undoubted indication of an old and deep-seated ulceration, the origin of which might be specific. The patient, in fact, confessed that, four or five months previously, he had been affected with a large " bouton," developed on the seat of the actual cicatrization, and which had persisted during several weeks. The base of the cicatrization did not present any induration; but the existence of the inguinal adenopathy gave