2 LECTURES ON CHANCRE. PART I. GENTLEMEN,-A poet has written : "L'homme absurde est celui qui ne change jamais ;" that is to say, he who esteems his own opinions more highly than truth itself. I applaud this maxim; therefore you will not be astonished, if, in the course of my Lectures, I modify somewhat the doctrines which I have hitherto professed. Defined generally, syphilis is a contagious disease, engendered by a virus, and commencing by commencing by a peculiar affection, the chancre. The chancre presents this special character: that it is always the consequence of an affection analogous to itself, and that it necessarily becomes the source of a similar affection. In other words, it is at the same time the effect and cause of the virulent specificity. The chancre springs from a chancre, and can alone reproduce it. I need not remind you of the doctrines of the confusionists of all ages, who give to this disease many sources of origin gonorrhoea, vegetations, bubo, &c. Time and observation have dissipated these errors, and thrown a light upon the true source of syphilis. B Syphilis springs from the chancre, and recognises no other origin: this, gentlemen, is a fact abundantly proved daily, and one which the vain efforts of some few discordants fail to cast a doubt upon; it is a fact which the experience of twenty-five years upon a vast field allows me to proclaim without hesitation, and for which I do not fear the contradiction of generations to come. As I have stated elsewhere, the chancre is to syphilis that which the bite of the mad dog is to hydrophobia, and unless hereditary, there can be no constitutional syphilis without this primitive affection. The chancre is, then, the necessary exordium of acquired syphilis.* This But must the chancre give rise to syphilis? affection, does it always present the same form? Are its consequences invariably alike? These questions, gentlemen, will afford us matter for consideration to-day; they are the chief points upon which I wish to arrest your attention in the course of these Lectures. Let us now consider what clinical observation teaches. The pathological manifestations following a chancre are far from being identical in all cases. In one instance the chancre is followed, after an interval of a few weeks or months, or even later, by constitutional symptoms which invade, in turn, the different organs, the skin, the mucous membranes, the viscera, the bones. In another case, on the contrary, the chancre limits itself to an action purely local, neither interfering with the economy nor entailing any general infection; at the most it sometimes extends its influence as far as the glands which receive the lymphatic vessels from the affected region. In the first case a diathesis is established: it is the economy which is infected. In the second, the chancre *See Note I. remains a local lesion, and limits its effects to the region upon which it is developed. What is the secret of the variety in the consecutive manifestations of the chancre? Before and since the time of Hunter, up to the present period, syphilographs have explained the reason of the variability of the disease, by a sort of reaction of the organism upon the virulent principle. It was to the difference in the constitutions, temperaments, sexes, idiosyncrasies, &c., that they attributed the difference in the manifestations of the virus. Admitting as incontestable the unity of the cause, they believed in the identity of the effect, and saw only in the variety of forms the result of individual influences. According to this theory, the chancre was a single grain, which ought to produce different fruits, depending upon the nature of the soil in which it was called upon to develope itself. Such, gentlemen, is the ancient doctrine, the doctrine of the unity of the virus. In the face of and adverse to it, have arisen in our times doctrines which tend to explain the variety of syphilitic manifestations by a plurality of causes. It was in 1815 that we began to doubt the opinion which considered the different effects of the virus to be due to peculiar idiosyncrasies. Carmichael was the first to raise the standard of revolt against the old ideas. He proposed to admit four poisons, each leading to certain particular forms of constitutional symptoms. But this fanciful doctrine was unable to sustain a rigid analysis, and was soon discarded.* This hypothesis of Carmichael was already nearly forgotten, when I, in my turn, in my lectures and writings, * An Essay on Venereal Diseases, and the Uses and Abuses of Mercury in their Treatment. By R. Carmichael. First edition. 1815. advanced this opinion:* "that the variety of the morbid manifestations following chancres depended not only upon the condition of individuals, but also upon a certain variety of causes and of virus." This opinion, which I then advanced under a doubtful form, has since that time been developed by one of my best pupils, who has endeavoured to give to the doctrine of the duality of the virus the authority of historical proof. Resolving the question which I left undecided, Dr. Bassereau has referred the difference of the manifestations consecutive to chancres to a diversity of causes and to a plurality of sources. According to this doctrine, the chancre is no longer a morbid unit, but a mixed manifestation belonging to two distinct pathological species. Of these two species, one, the simple chancre, would be the contagious ulcer of the genital organs, known to and described by ancient authors, Celsus, Galen, &c.; the other, the infecting chancre, would be the primary symptom of an affection of new origin-" syphilis." † There no longer exists here the influence of the soil to modify the grain; it is the variety of the grain which gives birth to different germs. But let me mention another theory. Instead of keeping, as in the preceding doctrine, the simple chancre and the infecting chancre distinct, Dr. Clerc, also one of my pupils, considers them only as two varieties of the same virus. According to him, the simple chancre is only a modification of the infecting chancre it is the result of the inoculation from an infecting chancre upon a subject already affected by constitutional syphilis. Each of these chancres transmits itself singly as a distinct pathological species, and the consequences of contagion are determined, not by any peculiar individual predisposition, *Lettres sur la Syphilis, XXXIIIème Lettre. † See Note II. |