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refusing admittance to certain injurious agents; or of retaining them until those agents had undergone a change, such as would render them comparatively innocent when admitted into the general circulation. These principles were illustrated particularly with reference to the morbid actions induced by the inoculation of the syphilitic virus. The primary forms of syphilitic disease I then ventured to divide into four principal varieties—namely: 1st, those in which the application of the poison, or of some irritant applied either with the poison, or shortly afterwards, produced mortification of the infected part; 2ndly, those in which the contact of syphilitic matter produced true ulceration—that is, an action in which the absorbents played a part and took up portions of the infected tissue impregnated with syphilitic matter; 3rdly, those in which a free suppuration was produced, and in which the secretion from the sores consisted principally throughout their course of well-formed pus globules; and 4thly, those in which the morbid action induced consisted of a specific adhesive inflammation. From tables which I read before the Society, it appeared that the first form of disease was not necessarily accompanied by either swelling or inflammation of the absorbents; nor was it followed by any constitutional symptoms: that the second was as a rule accompanied by violent inflammation of the absorbent glands, but was not followed by secondary symptoms; that the third was not ordinarily accompanied by swelling or inflammation of the glands, and was not followed by secondary symptoms: that the fourth was accompanied by an indolent swelling (but not inflammation) of the glands, and was, as a rule, followed by some form of constitutional disease, unless this was prevented by mercurial treatment.
Soon after the period to which I have referred, I iad reason to believe that these different forms of disease were not all equally communicable in the same way. It appeared to me that the adhesive form of inflammation was not capable of being communicated by inoculation as readily as the suppurative form. More than one occasion offered itself for publicly discussing this point, and I was told in friendly criticism that I had not selected my cases for inoculation rightly—that, in fact, I had inoculated some sores during their period of repair, and some previously to that period, and that this had given rise to the differences 1 had observed. As the time advanced, fresh opportunities presented themselves of testing the troth of the doctrine, and in 1856 I published in the 'British Foreign Medical and Chirurgical Review' several cases where inoculation with the lancet in the ordinary way had failed, and yet when every doubt seemed to be removed as to the cases being genuine primary syphilitic sores in a period of progress. The importance of such observations could not be doubted if the experiments had been rightly performed; for in that case, what became of the inoculation test as the sole means of distinguishing primary syphilitic affections from other diseases? This test had been loudly proclaimed from one end of Europe to the otber as the only one that could be relied iipon as a certain indication of a primary syphilitic sore; and any opposition to this universally-received doctrine at the time I speak of, was regarded as originating in some mistake. Nevertheless, those who were in the habit of seeing inoculations most frequently performed had their secret misgivings upon the subject. It was, for instance, in the year 1851 that Professor Bocck, travelling through the Northern part of Italy, became attracted by the new doctrine of syphilization. On his return to Christiania, he resolved to try the new plan as soon as he was, to use his own words, "able to obtain some inoculnble virus." This was not until the month of October, 1852! Are we to suppose that during the firet months of the year 1852 there was no -ich thing as a primary chancre in Christiania; and that the disease during that time was not communicated there by natural intercourse? Or may we not rather see the lurking impression on the Professor's mind, that one form of syphilitic disease was much more easily inoculated than another? In a town where syphilitic disease was known to be as rife as in Christiania, we must take for granted that the Professor had under his care many cases that he well knew were genuine cases of primary syphilitic disease; but from what he had witnessed, ho instinctively believed that the secretion of one particular kind of sore would serve his purpose best, and for this he waited.
Although those who practised inoculation were everywhere asking for good pus for their experiments, the universal belief nevertheless obtained that all chancres during the period of progress were alike inoculable. Very few at that period seem to have thought of asking themselves the question, how are the sores which do not furnish good pus communicated? or, whethers there was any difference in their mode of being propagated? The dictum of M. Ricord was very universally received, and the characteristic pustule produced by inoculation was as universally acknowledged as the test of a true primary syphilitic sore. M. Ricord had said that the inoculation, when properly performed, never failed, and that the results were regular, characteristic, and uniform.* As usually happens after a theory has been too hastily received, a period of undue reaction now threatens to set in From the hasty generalization, that all rimary syphilitic sores are equally inoculable by the point of the lancet, we now ear that the indurated variety of chancre is not inoculable at all, upon the patient who has it. In the 'Gazette Medicale dc Lyon' for the 16th of January last, M. Rollet asserts, that as secondary syphilis is not inoculable on the patient, so neither is the primary infecting sore :—
"La syphilis secondaire n'est pas inoculable au malade; mais le chancre infeetant ne l'est pas davantage." (p. 36).
"Inoculez la syphilis a la lancette . . . . meme 1'accident dit primitif, le chancre infeetant, ct vons n'obtiendrez pas davantage la pustule d'inoculation."
"II n'y a qu'une maladie venerienne qui soit inoculable par piqure au malade luimeme, et cette maladie, e'est le chancre simple, et son derive le bubon chancreux."
Here we have one kind of chancre alone acknowledged, as capable of being communicated, by inoculation upon the patient himself, with the point of the lancet; a complete revolution in doctrine since the year 1856.
In the last work published under the direction of M. Ricord,f that distinguished Professor still clings to the belief that sores affected with the specific adhesive inflammation may be inoculated in the same manner, and that the inoculation will produce the same result as in sores affected with the specific adhesive inflammation. He says:—"Ce que je viens de dire de l'inoculation et des developpements dn chancre, se rapporte presque aussi bien & l'une qu'a l'autre de ees varietes." Farther on in the work, however, M. Ricord's faithful expositor and distinguished pupil, M. Alfred Fournier, gives a table of 99 cases in which the secretion from an indurated chancre had been inoculated. The result was negative in 98 instances, and positive in one. In this case, however, the specific pustule was produced. As no explanation is given of this apparently strange exception, it is not impossible that this may have been an instance of a suppurating sore having become originally inoculated upon a sore affected with specific adhesive inflammation; or of the converse, of the base of the sore having taken the specific adhesive action, while the original inoculable pns was still being secreted from some part of its surface. This explanation has suggested itself to me as probable, from the somewhat analogous results obtained by clinical observation. During parts of the years 1855-56,1 examined 100 cases of sores, in which the secretion appeared to be well formed pus. These were considered to be local suppurating sores, and were treated accordingly without mercury. Two only of the whole number returned to me with secondary symptoms, as the result of the primary suppurating sores. Now, in both these cases, upon making a further minute inquiry, it appeared that the patients had subjected themselves to more than one source of contagion shortly before the appearance of the primary disease. It is therefore quite possible that one form of chancre may have been inoculated upon another, and so have masked the diagnosis; and in M. Fournier's case I am inclined to believe that this is what actually did occur, because he does not note that the characteristic pustule which was produced differed from the ordinary pustule resulting from the inoculation of a suppurating sore.
Are we, then, to believe with M. Rollet, that the secretion of the indurated syphilitic sore cannot be inoculated upon the patient affected? Are we to make a complete revolution in our opinions, and from believing, as formerly, that all primary chancres
were equally inoculablc by the point of the lancet, now hold that the indurated variety cannot be inoculated at all upon a patient who has once been affected?
As in 1856 I hesitated not to express my belief that all primary syphilitic chancres were not alike inoculable, and that inoculation was therefore no proper test of an ulcer being syphilitic; so now I venture to affirm tlfat it would be error to suppose that indurated infecting sores—those affected with specific adhesive inflammation—are not inoculable at all upon the patients themselves. This I would do upon three distinct grounds: ^
1st. From the result of direct experiment in inoculating the secretion in the ordinary way.
2ndly. From clinical observation.
3rdly. From the result obtained by inoculation, when the sores from which the secretion is taken have been subjected to certain kinds of irritation.
1. In the beginning of the year 1856 a medical student became diseased for the first time. He inoculated himself on the thigh, and presented himself to me three or four days afterwards. The inoculation succeeded, and became a small, hard, button-shaped induration, exactly resembling the original: a small point of whitish lymph was at first visible in the inoculation, but both sores subsequently remained as small, hard, circular indurations, furnishing scarcely any secretion from their surfaces. In this case, the student had, it is believed, applied some caustic to the sore before he inoculated himself. Here, then, we have an unequivocal case of an indurated sore (subject, probably, to previous artificial irritation) producing, when inoculated with the point of the lancet, not the characteristic pustule, but an indurated sore like itself.
2. The same point may be demonstrated by much more numerous instances, although not so conclusively in any one case, by clinical observation. There is a man now in the Lock Hospital with an indurated cicatrix upon the upper part of the thigh exactly corresponding to a similar induration upon the extremity of the prepuce. There was in this case other causes of local irritation; but no one upon seeing the case would doubt that one induration had been communicated by inoculation from the other. Cases are not very uncommon in which opposed surfaces, of the labia, for instance, present well marked indurated sores of exactly the same size, shape, and appearance. There can here, again, be no doubt that this affection is communicated from one situation to the other by inoculation. But in all the cases which I distinctly remember there has been some cause of irritation superadded to that of the specific adhesive inflammation.
3. The most interesting proof of the inoculability of the secretion of an indurated sore is afforded by the conversion of the adhesive into the suppurative inflammation by the artificial application of irritants to the part. The experiments illustrating this subject have very recently been performed.
Having observed that the indurated sore was inoculable under certain states of irritation, a blister was applied to some indurated sores, and subsequently they were dressed with the ung. sabinae. By these means I obtained a free secretion of pus from these sores, and it was found that the secretion, before incapable of producing any effect upon the patients themselves, could now be inoculated. The results of these inoculations have been quite different in their course to those which follow ordinary inoculation from suppurating sores. Pustules have sometimes been produced, but these have shortly dried up, and the inflammation consequent upon the punctures has soon declared itself to be of the adhesive character.
Case 1. Bridget C , aged seventeen years, was sent to me by Mr. Hewett, of St
George's Hospital, in August last. She had suffered from a thick yellow discharge between two and three months, and two months previously two small places formed upon the upper part of the left thigh. On the 26th of August she was admitted into the Lock Hospital. The places on the thigh then presented all the appearances of wellmarked indurated primary chancres. They wero oval in form, with their edges slightly raised, and these, together with the bases, presented the characteristic abruptly-terminating induration. The surfaces of these sores were covered by a scanty tenaceous secretion in small quantity. Upon making a microscopical examination of the discharge from the sores, no pus globules could be detected. The secretion from these sores was carefully inoculated with the point of the lancet upon the patient's thigh.
Aug. 28th.—The inoculation was repeated. There was at this time no indication of the sores having a tendency to heal.
Aug. 31st.—No resnlt from the inoculations.
The two sores had now been dressed for two days with the unguentum sabinae, and yielded an abundant secretion, distinctly purulent. The secretion from each sore was inoculated in several points in two distinct places on the thigh.
Sept. 2nd.—Inoculations have produced an appearance of small incipient pustules in both places. The secretion from one of these little pustules was inoculated on the thigh lower down.
Sept. 4th.—The inoculations from the inoculations had succeeded.
One of the inoculations of the 31st of August had produced a small pustule. The others had produced only vesicles. The skin over one of these was broken.
Sept. 9th.—Inoculations from inoculation, performed on the 2nd of September, have dried up.
The inoculations first in order, of the 31st of August, have entirely lost their puriform character. They now appear as circular patches, yielding a serous secretion containing epithelial scales. The original chancres were now in process of healing. A drawing was taken by Dr. Westmacott, and shows the original sores in process of repair, and the inoculations as they appeared upon the tenth day.
Sept. 11th.—The inoculations first in order are desquamating and of a light-red colour.
The inoculations from the inoculations appear as small red pimples, which are gradually fading.
Sept. 14th.—The inoculations are losing their colour, but still present distinct oval patches of red skin, from which epithelial scales are thrown off.
Sept. 17th.—Original chancres were skinned over; the inoculations were fading and desquamating.
Sept. 23rd.—Inoculations from inoculations were still visible, and appeared as shining scales of discoloured epithelium.
Sept. 25th.—A few faint secondary spots appeared on the body. The original sores were quite healed, leaving slight induration. The corresponding glands in the groin were still indurated.
A second drawing was made by Dr. Westmacott, and shows the appearance of the inoculations on the 26th day.
Oct. 4th.—A third drawing was made by Dr. Westmacott, showing the remains of the original sores, of the inoculations on the 35th day, and of the inoculations from the inoculations.
The patient now left the hospital, but again presented herself on the 8th of October. The cicatrices of the original sores were still red and rather tender. The inoculations appeared as brown spots, the colour of which gradually faded into that of the surrounding skin. Some small brown spots marked the situation of the inoculations second in order.
Iu performing these experiments, it is necessary to select sores which are not liable to be inoculated from a different kind of secretion; otherwise we may in fact be inoculating the product of a suppurating sore, when we suppose that we have only an indurated sore to deal with. This is probably what happened in the following case.
Joseph B , aged twenty-seven, was admitted into the Lock Hospital on the 25th
of November last. He then had a simple chancre on the upper part of the prepuce of five weeks' duration. Below this was a well-marked specific induration, which he said had never been ulcerated. This had existed four weeks. Near the fnenum was a third sore, which had existed for three weeks, and was surrounded by some amount of induration.
Dec. 7th.—The secretion from the induration, which had been made to suppurate artificially, was inoculated upon the patient's thigh.
Dec. 12th.—A large prominent pustule with a depressed centre has formed as the result of the inoculation. The pustule was destroyed by the application of a drop of strong nitric acid, and the sore which was left then readily healed.
In this case, although it was intended to have obtained the secretion from the induration only for the purpose of experiment, yet the result being so different from that which occurred in other cases, made it probable that the secretion from the upper sore has run down and imparted its specific qualities to the abraded induration ; a superfdelation may thus occur, which requires to be guarded against in all similar experiments. The products of a suppurating sore may thus be inoculated by accident from the surface of a specific induration, and there is good reason to believe that the converse of this may take place—viz. the specific adhesive inflammation may be communicated under the mask of the secretion from a suppurating sore.*
The cases and observations which have now been laid before the reader will be sufficient to establish the fact, that although the secretion from indurated sores is not inoculable (upon the patients having those sores) with the point of the lancet under ordinary circumstances, yet that it can be so inoculated, either in the early stage of the disease, or in a subsequent stage, after the sores have been subjected to artificial irritation. The result of the inoculation in these two cases is not the same, and they both differ widely again, from the results obtained by the inoculation of a naturally-suppurating sore. These considerations support powerfully the idea that the indurated variety of chancre differs essentially in its physical characters from other kinds of syphilitic sores, and we cannot but conclude that those who described (as was so common in the text-books upon syphilis some three or four years ago) the gradual conversion of the sore produced by the ordinary pustular variety of inoculation, into the indurated chancre, as of ordinary occurrence, had never in reality witnessed what they professed to teach.
In conclusion, that which has been advanced in the present communication may be summed up in the two following propositions:—
1. That a primary syphilitic sore which upon inoculation produces the characteristic pustule, is not one which, if left to itself, would, as a rule, be followed by secondary symptoms, and therefore is not one which requires mercurial treatment.
2. A primary syphilitic sore affected with specific adhesive inflammation is not, under ordinary circumstances, inoculablc by the lancet upon the patient himself; but that in its early stage, or after it has been subjected to certain kinds of irritation, it may bo so inoculated; and that then it will give rise to some adhesive form of inflammation.
HALF-YEARLY REPORT ON MICROLOGY.
Assistant Physician to St George's Hospital, and Honorary Secretary to the Pathological Society.
Part I. Physiological Microloot.
EPITHELIAL SYSTEM AND HAIR,
On Uterine Epithelium.—Dr. C. Robint has communicated a paper of which a part is devoted to the alterations undergone by the epithelium of the body of the uterus during gestation. He states that whilst the cylindrical epithelium of the neck of the uterus retains
* This is prohably what occurred to Hunter. He believed that he had inoculated himself with gonorrhoea] matter
only; bat be produced " a thickened sore," which was followed by secondary symptoms, t Brown-Sequard's Journal de la Physlologle, p. 00. Jan. 1858.