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"3. Iritis, when it occurs in the progress of syphilization, and where mercury has not previously been employed, does not require any local treatment I have always succeeded in healing it speedily by steadily continuing the inoculations."

sWe have now endeavoured to lay before our readers a complete account of the position of syphilization in Norway up to the summer of this year (1858). The more we have examined into the subject, the more does it urge itself upon our attention. If the cures were disputed, if the fact that by repeated inoculations of chancre matter very serious cases of constitutional syphilis are cured, were denied, then we should deem it first to be our duty to inquire into the truth of the success of this treatment. Its success however is not denied, the rarity of relapses also after its employment is not questioned; the only matter in dispute is the modus operandi of the treatment. That it is empirical in the fullest sense of the word we at once concede, but its success in so intractable a disease as secondary and tertiary syphilis calls for our earnest consideration. Of the theory of its operation the less that is said the better; we think Dr. Boeck is in error if he still holds to the identity of action between syphilization and vaccination; while on the other hand we do not consider Professor Faye to have proved by experiment his assertion, that the cure is only brought about by a depnrative suppuration. We should not ourselves imagine that such a purely mechanical process would tend to invigorate and restore the health of the patient, while it is well known that under syphilization almost all the patients improve in condition; on the other hand, we cannot believe this to be the result of the circulation of the venereal poison in the blood; we cannot understand how this could improve the health when introduced for months together, while a single venereal infection acts so Qeleteriously upon the system. WTe shall look with anxiety for further documents on this subject, and especially for the essay promised to us from the pen of that learned and aente observer, Dr. Danielssen of Bergen. Syphilization is now practised in many parts of Norway and Sweden, and we have such full confidence in the honesty, truthfulness, and skill of our Scandinavian brethren, that we are convinced they will investigate the whole subject thoroughly; and the result, be it adverse or favourable, will assuredly be a boon to medical science.

Since the above was written, we have received from Norway Dr. Danielssen's promised essay 'on Syphilization in Syphilis and Leprosy.' It is a modest pamphlet of 125 pages; but we regard it as one of the most important contributions yet made to the elucidation of the curious subject of syphilization. Dr. Danielssen had visited Paris shortly after Auzias Tnrenne's doctrine and practice had been so summarily condemned by the French Academy of Medicine; but it was not until the autumn of 1853 that he was enabled to follow Boeck's experiments at Christiania; for Bergen, though in the same kingdom, is yet many days' journey distant from the Norwegian capital. After having convinced himself at Christiania of the real efficacy of this mode of treatment in secondary syphilis, it occurred to him to test its efficacy in a non-syphilitic malady, which had hitherto proved intractable to ordinary remedies—viz., the leprosy of the western coast. Dr. Danielssen's reasons for adopting this mode of treatment are bold and peculiar—

"According to my knowledge of spedalskhed (leprosy), it has no connexion with syphilis; the maladies are radically distinct, and therefore neither analogy nor experience inclined me to the belief that syphilization, as it was then employed, would have any beneficial effects on leprosy. It appeared to me, however, that if I could infect the leprous patients with universal syphilis (constitutional syphilis), it might follow that the syphilitic poison might prove superior to that of leprosy, and that thus the system might be brought to that of a person labouring under constitutional syphilis, and might so become subject to the ordinary process of syphilization." (p. 2.)

Dr. Danielssen accordingly inoculated four leprous patients with the syphilitic virus in 1854, and the characteristic pustules were produced. The resulting chancres were left to themselves, in the hope that they would ultimately produce constitutional syphilis. After remaining open for five weeks they began to close, and by the end of the seventh week they were entirely healed. No secondary symptoms, however, ensued, although years have now elapsed since the experiment was made. Meanwhile Professor Boeck continued his researches, and distinctly proved, according to Dr. Danielssen's testimony, that svphilization could effectually disperse the symptoms of secondary syphilis especially if they had not previously been treated with mercury. Boeck also decidedly proved that this method of treatment was devoid of all danger, and it became incumbent on all those who undertook the treatment of syphilitic disease, and who did not regard mercury as an infallible specific in that malady, to make trial of the new remedy.

Dr. Danielssen did not commence the regular practice of syphilization in the Hospital at Bergen till 1856. In August of that year, we saw a good many patients undergoing this treatment under his superintendence, and here, as w^ell as at Christiania, they expressed themselves well satisfied with the process. Up to December, 1857, he and his colleague, Dr. Bull, had treated 25 cases of secondary syphilis in this manner, and Dr. Danielssen had likewise subjected 23 lepers to a similar course of treatment. He had now, however, relinquished his ingenious but singular idea of producing constitutional syphilis in lepers, in the hope of destroying the latter diathesis, and merely confined his experiments to the question, whether syphilization would directly influence the leprous onstitution or no.

It will be remembered by our readers that Boeck is little disposed to admit the great distinction established by Ricord between the simple soft chancre and the indurated chancre. In regard to syphilization, Dr. Boeck evidently considers the one as not more virulent than the other; while Dr. Danielssen regards the distinction as in every way important. Many chancres, observes Dr. Danielssen, continue primary throughout their whole course, and produce no effect upon the constitution. The hard chancre (chacre infectant indure) he considers to be the true syphilitic sore, the simple soft chancre he looks upon as of more bastard character, and unable to produce the wellknown specific effects on the constitution. Both chancres he believes to arise from the syphilitic virus, but he regards them as much distinct as vaccine matter is from the virus of variola. Vaccine virus has never produced small-pox, but its action is undoubtedly prophylactic of that disease. Here, however, in Dr. Danielssen's opinion, all analogy between the action of syphilization and that of vaccination ceases; and the former remains, as he observes, a new fact in practical medicine, the explanation of which will not be obtained till after further and more extended researches.

Dr. Danielssen at first gave full credit to Boeck's assertion, that under syphilization the virus actually passed through the constitution, and so produced its beneficial effects.

"Under this impression," observes he, "I commenced my course of inoculations, both in cases of secondary syphilis and of leprosy, but experience has now convinced me that syphilization is not dependent for its effects upon the long-continued influence of the syphilitic virus upon the entire organism. We have not here to do with a new physiological fact, but with a pathological process, which, in its consequences, is of vast importance for practical medicine. It appears to me that we must first, in order to explain the operation of syphilization, seek to ascertain whether the virus by repeated inoculation really passes into the system, or whether its operation is confined to the immediate vicinity of the artificial chancre—in a word, whether its operation is universal or local."

Dr. Danielssen's opinion is decidedly in favour of a mere local action, and this he supports by five or six well detailed and interesting cases, where artificial inoculation, arrested long before the so-called immunity was produced, never gave rise to any constitutional symptoms. Two of these cases were in leprous subjects, and one was where the patient was syphilized for chronic eczema, which was not of syphilitic origin. We have only space for the remarks on these cases.

"It appears from the above details, that neither one chancre, nor two, nor three, nor six, nor thirty-six, nor one hundred and thirty-six have in the preceding cases induced secondary syphilis, and that, therefore, the direct operation of the inoculations has been exclusively limited to the spot where the chancres had shown themselves. If such be the case, we are justified in assuming that no greater number of chancres will produce a different result. And this is confirmed by our experience; for with one exception, to which we shall subsequently allude, not one of those individuals, previously free from all syphilitic taint, whom I have syphilized, have been affected by secondary syphilis; nor have they shown any signs of the existence of the venereal diathesis in their systems. Nor, in those already affected with syphilis, have I observed under syphilization the slightest evidence of their having imbibed the pouson afresh. So far from seeing in syphilization a new physiological fact, as Boeck denominates it, I have, on the contrary, found it confirm a long established axiom—viz., that the simple soft chancre does not affect the system, and consequently does not produce constitutional syphilis. Among the many thousand artificial chancres that I have seen, I have not observed one (with a single objection) which was not of this character, both in my own practice and in that of my colleagues, and as inoculated on every part of the body. Even on the face, the soft chancre followed inoculation, contrary to Ricord's experience, who had always observed the indurated chancre there." (p. 22).

Dr. Danielssen, however, does not deny the possibility of affecting the system by artificial inoculation of syphilitic virus, but he believes that it can only arise when the virus is taken from an indurated chancre.

The fresh outbreaks of syphilitic disease, after syphilization has been for some time employed in certain cases, are no proof of a fresh absorption of the poison, as such symptoms frequently occur under any mode of treatment. Moreover, if Ricord's axiom be true, that constitutional syphilis can only occur once in the same individual, it is not possible that any absorption of the virus could take place. One of Dr. Danielssen's leprous patients , who had been under syphilization for upwards of two months, died of pleurisy and effusion dependent on the former malady. Dr. D. ventured upon the rash, and, to our minds, inconclusive experiment of inoculating three or four other patients with the effused matter from the pleural sac. He produced dangerous phlebitis, but no syphilis; and from hence he argues that no absorption of the syphilitic virus takes place under the ordinary process of artificial inoculation.

We now come to the grand question of immunity, on which Professor W. Bocck in his earlier writings laid so much stress. Dr. Danielssen does not believe in the constitutional change alleged to be produced previous to this effect; he regards immunity to the syphilitic virus as a simple loss of reacting power in the skin, and which it sooner or later regains. He has satisfied himself that when the integument, from external or internal causes, has lost its vitality, it is no longer sensible to the inoculation of the venereal poison, but the inoculations succeed again when the skin has recovered its vital powers. Dr. D. had long treated cases of leprosy with large doses of tartrate of antimony, and he had found that an anaemic condition of the skin was sooner or later produced by this medicine, during the prevalence of which condition the skin seemed to be insensible to the action of the syphilitic poison. Upon his restoring the natural "turgor" of the skin by iodide of potass, he has found that the supposed immunity no longer existed; the skin had, under the influence of this drug, recovered its vitality. In certain individuals with a remarkably loose and pale skin, he has remarked that the inoculation punctures produced at first no result whatsoever; but that after the lapse of two or three weeks, when the general health had been restored, these very punctures suddenly took on their characteristic action, and formed large chancres of undoubted syphilitic origin.

A remarkable instance of this kind is given at p. 34 of this essay, where a leper was inoculated with syphilitic virus, unfortunately, in this single instance, taken from an indurated chancre. In this individual, syphilization from simple chancre virus had been carried on previously to the extent of nearly 400 inoculations, and at first the virus from the indurated chancre produced no positive results. A month after, however, the cicatrix of an old chancre broke up again, and produced a regular indurated sore, and soon after the unmistakeable signs of secondary syphilis made their appearance.

Dr. Danielssen has also found the supposed immunity to be of very local character; the nates and thighs becoming insensible to the virus, while it could still be reproduced in full vigour on other parts of the body. He, however, thinks it possible that a general immunity may for a time ensue, when the vitality of the integument has been lowered by repeated inoculations.

All this therefore proves to us, that the immunity which follows syphilization is solely dependent upon the condition of the integument, and is absolutely distinct from that which results from vaccination or after the exanthemata. Nor is Dr. Danielssen at all disposed to admit that even this temporary immunity is complete to all syphilitic virus.

The operation of the process of syphilization must therefore be considered as strictly local, and as incapable of producing any constitutional change in the system.

"This, however," observes Dr. Danielssen, "is of less importance in a practical point of view; for the grand feature of the process is the curative effect of the continuous inoculation of chancre virus. It is now established beyond all doubt that secondary syphilis can be healed in this manner; but whether the cure will be permanent, whether relapses will subsequently occur, time alone can show. That the operation of the treatment is strictly local, I do not regard as a reproach; on the contrary, I look upon this as inviting still more to a trial of this new method of cure, without being terrified by the many phantoms that have been conjured up against it . With the exception of the pain that occasionally results from the earlier chancres, I have not seen any untoward results from syphilization; and although my experience in regard to the mercurial treatment of syphilis does not entirely agree with that of Professor Boeck, and though I do not look upon mercury as a destructive fiend, yet I agree with him that the mercurial treatment of syphilis is so often uncertain, and that the cases are so very liable to relapse, that we should be thankful if we have now obtained another mode of treatment which, fraught with less danger, promises a more favourable result." (p. 38.)

Dr. Danielssen considers it to be an interesting pathological phenomenon, that secondary syphilis can be healed by the protracted suppuration consequent upon continuous inoculation of chancre virus; but he does not look upon this fact as absolutely standing alone in pathology. In tertiary syphilis nature herself produces deep suppurations, and ,if the strength holds out, all secondary symptoms disappear during the process. Of the 25 syphilitic patients treated at Bergen, 21 suffered from secondary and 4 from tertiary symptoms: 15 of these had never taken mercury, and were all speedily cured by syphilization alone. In those who had previously taken mercury, and whose system was debilitated, iodine was occasionally employed; but all were cured, and only one relapse has occurred, and this was but of temporary duration.

In no one instance did syphilization produce any favourable effect in leprous disease, the terrible malady proceeded unchecked in its career.

We look upon this pamphlet of Dr. Danielssen's as by far the most valuable essay that has yet appeared on the subject of syphilization.

While the practice of inoculation with the syphilitic virus in secondary cases has been most diligently pursued by Boeck, Sperino, and others, the theories advanced by these authors as to lhi)^)ioJtis operandi of syphilization have been confessedly unsatisfactory; as they invphwd, pathological and physiological contradictions which could not and would not be received by the scientific world. The doctrine of Professor Faye relative to the depurative action of syphilization was the first to indicate the true line of operation of this treatment; but, unsupported or nearly so, as it was, by personal experience, it would have had but little influence on the profession. To Dr. Danielssen, in our opinion, is to be accorded the honour of having satisfactorily solved the problem, of having cleared up the doubts and difficulties that environed the subject, and obstructed the progress of a really valuable method of cure. Syphilization has now, for the first time, been brought fairly within the limits of modern science; it is no longer a wild empiricism, but will receive the calm consideration of the Profession.


Review XI.

1. Veber die Wirkung warmer Sitzbader. Von Dr. L. LbbmAnk. ('Archiv des Vereins fllr gemeinschaftliche Arbeiten zur Forderung der wissenschaitliche Heilkunde.' Band i. p. 521; Band ii. p. I.)

On the Effect of Warm Sitz-baths. By Dr. L. Leumann.

2. Die Sooltherme zu Bad Oeynhausen {Retime) und das gewdhnliche Wasser. Von Dr. L. Lehmann.Gdttingen, 1856.

The Saline Baths of Oeynhausen and Ordinary Water. By Dr. L. Lehmann.

3. Das Thermalbad in Bad Oeynhausen. Von Dr. L. Lehmann. (' Archiv des

Vereins,' Band iv. p. 18.)
The Warm Bath of Oeynhausen. By Dr. Lehmann.

4. Versuche uber die physiologische Wirkung des Kochbrunnens zu Wiesbaden. (' Archiv des Vereins fur wiss. Heilk.,' Band iii. p. 59.)

On the Physiological Action of the Saline Baths of Wiesbaden. By Dr. Neuraiter.

5. Die Bedeutung und der Werth arithmetischer Mittel mit besonderer Beziehung auf die neueren physiologischen Versuche zur Bestimmung des Einftusses gegebener Momente auf den Stojfwechsel. Von Professor Radiche in Bonn. (' Archiv fur physiologische Heilkunde.' 1858, p. 145.)

The Importance and Value of Arithmetical Mean Values in the Determination of Certain Influences exerted upon the Metamorphosis of the Tissues. By Professor Radiche.

The study of the final products of tissue change (the products derived fromihe substances which have played their part in the stage of life, and which einfrge from the skin, the lungs, the bowels, or the kidneys) has lately undergone a great development. The new modes of examining the urine, which render feasible a rapid determination of its chief ingredients, the improved appliances for collecting the perspiration, as adopted by Schottin and Funke, the greater accuracy of the mode of determining the carbonic acid and water of the breath, and the important observations of Marcet on the intestinal excretions, seem to indicate that we. are approaching a time when the physician will not only be able exactly to know what enters the body, but will be able to give an accurate numerical determination of what comes out of it.

Already, especially in Germany, we see these methods applied to physiological, therapeutical, and pathological inquiries, and in the midst ot much that is unsound, untrue, and misleading, it is impossible not to recognise the fact that what is $ virtually a new field has been thrown open for investigation, and that important discoveries may reasonably be expected. At present it is, however, desirable to observe that no little caution and careful criticism is necessary in order to prevent a flood of crude and deceptive observations overwhelming the sterling facts of acquired science. That the experiments should be exact and careful, is of course only what we expect from all w ho are engaged in these inquiries. But when conscientious and exact quantitative analyses of the urine or the pulmonary excretion have been made, an incorrect way of stating the results may vitiate all the conclusions. On subjecting to a mathematical analysis some of the latest observations of the new school, Professor Radiche of Bonn* has shown that the common mode of reckoning averages is liable to grievous error, and that exacter methods of calculating results must be used if anything like mathematical certainty is to be introduced mto physiologico-chemical inquiries. Some of the best conducted experiments—as those of Mosler on the action of water, Beneke on sea bathing, Kaupp on the influence of chloride of sodium on urea—are shown to be more or less vitiated by inherent errors in the mode of calculating the mean results of their experiments, so that possibly all these elaborate and apparently conclusive experiments may have to be again performed. But after careful experiments have been properly calculated, it still remains to draw well-founded conclusions; and this is a matter of such difficulty, that almost every conclusion at present come to, must be regarded as merely provisional. As an mstance of our meaning, we will select one substance only, urea. Urea can now be quantitatively determined with great ease and considerable accuracy; suppo-ng in any case that

* Die Bedeutung und der Werth aritnmettaeher Mittel, Archlr fur pbys. Hcllfc, 1898, p. 145.

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