Actual state on January 15th: Three simple chancres, with soft base, seated upon the margin of the prepuce; two simple chancres, with soft base, upon the corona; a simple chancre of the frænum. Gonorrhoea. Roseolar eruption on the decline. Scabby eruption of the scalp. Posterior bi-cervical adenopathy. Headache. Adenopathy, bi-inguinal, hard and indolent.

Treatment:-Chancres dressed with the aromatic wine. One grain of the proto-iodide of mercury daily; bitter infusion; cubebs.

Feb. 1st. The chancres persist. Acute adenite of the left groin. Leeches; cataplasms.

9th. Suppuration and opening of bubo. In the course of a few days, the wound resulting from the opening becomes chancrous and extended. Undermining of the skin. Veritable glandular chancre.

Dressed with a solution of potassio-tartrate of iron. Continue mercurial treatment (two grains daily). Cicatrization of the chancres towards the end of February. Bubo healing slowly; cicatrized in the course of May. The constitutional symptoms resulting from an infection anterior to these last chancres developed themselves with remarkable intensity: thus, in January, condylomata about the anus; in February and March, squamous eruption; in June, ecthymatous eruption, psoriasis over the trunk, aphthæ on the tonsils; in July, relapse of the ecthyma; confluent aphthæ of the lips, of the tongue and throat; in November, syphilitic iritis.

CASE II.-N-, aged twenty-two years. Scrofulous subject. History:-Indurated chancre in 1855, with bubo, hard and indolent, treated by M. Ricord; followed, after an interval of some months, by syphilitic ecthyma. Since that epoch, no venereal accident. Intercourse with the girl C on 29th of December, 1855. Previous connexion four weeks before. Chancres observed by the patient towards January 2nd, 1856. Actual state on January 15th: Several small chancres, with soft base, on the frænum, the prepuce, and glans.

Acute adenite in the left groin; on the right side, some glands, hard and indolent. Brownish maculæ upon the inferior extremities and upon the trunk; vestiges of the old ecthymatous affection. Posterior cervical adenopathy.

Treatment:-Aromatic wine, cataplasms.

January 19th. Bubo was opened.

February 5th. Chancres are healing.

No other constitutional affection up to the day of leaving the hospital. CASE III.-L-, aged twenty years, of lymphatic temperament.

Gonorrhoea in 1855, treated by copaiba: cured in two months. No consecutive symptoms. Intercourse with the girl C on December 31st. Previous intercourse at the end of November. Chancres observed on January 4th.

Actual state on January 10th: Two simple chancres, with soft base; one E 2

seated upon the margin of the prepuce, the other upon the corona. No glandular affection.

Treatment:-Aromatic wine. Chancres healed by the end of February. No constitutional affection.

This patient was under observation until August, 1856, and had not shown any constitutional symptoms.

CASE IV.-C-, aged twenty years. Constitution very robust. Sanguineous temperament. No antecedent venereal affection. Intercourse on December 29th, 1855, with the girl C—. Previous connexion, four months before. Chancres observed on January 2nd.

Actual state on January 7th: Simple chancres, with soft base, on the prepuce and frænum. No glandular affection. Treatment:-aromatic wine. Chancres healed towards the end of January. No consecutive symptoms.-A. F.-E. C.

Allow me to call your attention to the fact of the development of the same variety of chancre upon several individuals whose condition differed, inasmuch as two of them were under the influence of a previous syphilitic taint.

The woman C has intercourse in the last week in December, 1855, with four individuals.

Of these four persons, two were under the influence, at this time, of a syphilitic diathesis, contracted some months previously; the third had only been subject to gonorrhæa; the fourth had never been subject to any venereal affection.

Now these four persons contract, at the same time, chancres of an exactly similar nature,-simple chancres, without indurated base.

The two first were subjected to inguinal buboes which suppurated; the constitutional symptoms following a previous infection pursue their usual course. The two last are subjected to no constitutional symptoms.

In terminating my lectures on the simple chancre, I make this proposition:-" The simple chancre appears to spring from a simple chancre, and to propagate itself solely after its own kind."

I shall now proceed to consider the infecting or indurated chancre.

PART III.

THE INFECTING CHANCRE, THE INDURATED CHANCRE.

GENTLEMEN,-With the indurated chancre, we enter to-day the domain of syphilis.

The special character of the kind of chancre which we are about to study is not only the induration by which it is accompanied, but, above all, the general influence it exercises on the system, its effects upon the organism, and the diathesis which it establishes.

We now commence the history of a constitutional affection.

I.

MAN ALONE IS SUBJECT TO SYPHILIS; ANIMALS ARE UNAFFECTED BY ITOF THE INFECTING CHANCRE-QUESTION OF SEAT-DEVELOPMENTINDOLENT CHARACTER-PRIMITIVE FORMS-ASPECT OF THE ULCERATION -COMPARISON, DE VISU, BETWEEN THE TWO VARIETIES OF CHANCRE.

The general description of chancre which I gave you at the commencement of these Lectures will have made you, in great measure, acquainted with the indurated chancre. I shall only have, therefore, to insist upon those points of its history which present a special character.

You already know that it is a variety of chancre to which man alone is subject. If the transmission of the simple chancre to animals might have raised a doubt, here all uncertainty ceases. It is an established fact, that notwithstanding the numerous attempts that have been made to inoculate animals with the infecting chancre, none as yet

have produced the specific pustule, nor given origin to a well-defined and uncontested case of syphilis. I therefore repeat, with all syphilographs of the past, I proclaim, with my two learned colleagues, MM. Puche and Cullerier, that animals are unaffected by the syphilitic poison, and that it is not transmissible unto them; so that this disease is the sole property of man, and unshared by the lower animals.

I further told you that the indurated chancre might manifest itself on any part of the body, from head to foot ; whereas, in speaking of the simple chancre, I was obliged to make certain restrictions, and to define the limits within which it might appear: here, on the contrary, neither limits nor restrictions are required. The infecting chancre may develope itself everywhere, on the extremities, the trunk, the neck, and even the head itself—a region inaccessible to the simple chancre. No region is exempt from it; it

takes root in any soil.*

Mucous membranes are affected by it, as well as the skin. You all know how frequently it is met with at the vulva, upon the glans penis, on the mucous lining of the prepuce, &c. I have met with it on the lips, on the tongue, on the conjunctiva, on the pituitary membrane, on the neck of the uterus, in the vagina, at the anus, in the rectum, &c. &c. Perhaps the mucous membrane of the intestinal canal, below the pharynx and above the rectum, is equally apt to be affected by it; but, as far as I am aware, no attempts have as yet been made at direct inoculation by laying bare any part of the intestinal mucous membrane. At all events, all the attempts which have, up till now, been made to produce inoculation on the stomach by the administration of pills containing syphilitic pus have proved fruitless.

You will, however, easily perceive that such experiments

*See Note V.

were far from fulfilling the conditions necessary for contagion.

But I hasten to describe the development of the indurated chancre, and to define its characters.

The chancre which becomes indurated, or, in other words, the infecting chancre, generally developes itself in a slow and insidious manner. A certain time is necessary in order that the inoculating pus may, so to say, prepare the ground for its development. Here we might admit a true incubation, if we were to place confidence in the opinion of patients; but direct experiment has proved beyond a doubt that this incubation does not exist, in the true sense of the word. The phenomena which follow the insertion of the virus are almost immediate; only the first symptoms are slight, and easily overlooked by an inexperienced person. Also, the veritable début of the indurated chancre is generally altogether unobserved by patients. This supposed period of incubation, which separates the moment of contagion from the epoch at which it is first perceived, is, therefore, a period of inobservation. Add to this, that the infecting chancre is an ulceration essentially indolent in its development. It most frequently commences, extends itself, acquires depth, and establishes itself, without causing the least sensation of pain. Thus, patients who generally judge of the serious nature of a disease by the pain it produces, regard this ulceration as an insignificant excoriation or "écorchure," to which they attach no importance. It often happens that, with careless patients, it passes entirely unperceived; and we are often consulted by patients having large indurated chancres, the existence of which they never even suspected.*

We frequently find upon the person of patients who consult us for secondary symptoms, large indurated scars, or ulcerations, still persisting, which without us would have passed entirely unperceived. If you had not been frequent eye-witnesses of such cases, I should most likely bring a smile upon your lips when I tell you that individuals often innocently