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Sac /ru e llf 




THE NEW SYDENHAM 

SOCIETY. 



INSTITUTED MDCCCLVIII. 



VOLUME XLI. 



/ 



A TREATISE ON 



SYPHILIS 



HISTORICAL AND PRACTICAL. 



BY 



Dr. E. LANCEREAUX, 

MKAD OF THS CUNICAL DKPAinifBI«T OF THB FACfDLTT OF KBDICIMB IN PABU, 

LAURKATB OF IHS FRENCH INSTITirnON, 

OF THS FACITLTT OP MEDICINS, AND OF THX DfPBRIAL ACASK1CT OF MXDICINB, 

MEKBBR OF THB BIOLOOICAIi 80CIBTT, BTC. 



IN TWO VOLUMES. 
VOL. II 



TRANSLATED ST 

G. WHITLEY, M.D. 



THE NEW SYDENHAM SOCIETY, 

LONDON. 



HDCCCLXIX. 



London and Aylesbory : 
Printed by Wats-^n and Hasbu.. 







TEEATISE ON SYPHILIS. 



Ajbticlb Vn. — ^Apparatus of Rbspieation, 

\|?Phb difference of texture and of functions of the organs which enter 
into the composition of this apparatus induces us to study separately 
the affections of the larynx^ the trachea^ the bronchi^ and the paren- 
chyma of the lungs. 

§ 1. Sjfphilitic affeetiana (jfthe larynx. 

Morgagnif Epist.42, Nos.39 and 48 ; Epist. 44, No. 15, trad, de Destouet. 
AUenhofer, Rossische Sammlang fur Naturwissenschftft und Heilkunde, 
Bd. i. Heft 1. Thomanriy Ann. institat. med. clin. Wirceborg, Vol. I. 
Sawkina, The London Med. and Phys. Journal^ 1823. Trousseau et Belloc, 
Traite pratiqne de la phthisie laryngee cedemateose. Paris, 1837. Barth, 
Bulletin de la Soci6t§ anatomique, t. xv. 1849, pp. 170, 172. Sestter, Traits 
de Tangine laryng6e oed§matease, 1852, 88. Nilaton, Gazette des hdpitaux, 
1855, No. 50. MichaeliSf Wochenblatt der K. K. Gesellschaft der Aerzte 
in Wien, 1855, No. 37. Rul-Ogez^ Gazette des hdpitaux, 1856, No. 112. 
Jones, British Medical Journal, 1859. Gunter, Prager Viertel^jahrschrift, 
1857. Pitha, ibid,, 1859. Virchow, in Archiv fur pathol. und physiol. 
Anat., XY. Lahbiy Bulletin de la Societe anatomique, July, 1857, p. 210. 
JSuffuier, Soci^t§ de chirui^e, et Gazette des hdpitaux, June and July, 1856. 
Hansen, Hospit. Tidende, 1859, No. 1, and Schmidt's Jahrb., Bd. cv. p. 311, 
Fan Buren, Maladies syphilitiques du larynx, in New York Medical Times, 
July 7th, 1860. Czermack, Der Kehlkopfspiegel, &c. Leipzig, 1860. See 
alto Archiv. g6n§rales de m§decine, t. i. p. 207, 1860. Melch. Robert, 
Nouveau Traits des maladies veneriennes. Paris, 1861, p. 554 et seq. 
Buhle, Die Eehlkopfkrankheiten. Berlin, 1861 ; and Archiv. de m§decine, 
255, t. L, 1861. Gibb, The Lancet, January 5th, 1861 ; case in which a 
necrosed cartilage was coughed up. Gilewski, Wien. med. Wochenschrift, 
No. 18, 1861. Gebhardt and Both, Archiv fur pathol. Anat, 2nd series, 
1 i., first paper. Turck, Ohservat. sur les ulcdres syphil. des parois de la 
cavite pharyngo-nasale, in Allgem. Wiener med. Zeitung, 1861, No. 48. 
Turck, Rechercbes cliniques sur di verses maladies du laryn]^, de la trachea 

b 



2 ACQUIRED SYPHILIS. 

et da pharynx. Paris, 1862, p. 18. Briddon, Affections syphilitiques du 
larynx, Americ. Med. Times, December, 1862, p. 327. Otto Jenistius, De 
laryngitide syphilit. Dissertat. inaug. Greifswald, 1862. E. Hamilton, 
Syphilitic laryngitis, Dublin Journal, xxiii. G, Lewin, Ueber Krankh. 
einzelner Theile des Kehlkopfs., &c., Virchow's Archiv. xxiii. p. 587, 1862. 
Davies, Med, Times and Gaz,, 241, May, 1862. Lud. Turck, Die syphilit. 
Erkrankung des Kehlkopfs., Allgem, Wien, med, Zeitung,, viii. 43, 1864. 
Dance, Eruptions du larynx survenant dans la p§riode secondaire de la 
syphilis, 1864. 

The syphilitic lesions of the larynx which supervene in the course 
of the period of general eruption have the mucous membrane for 
their exclusive seat and^ as we know^ extend superficially rather than 
in depth. The opposite of this occurs in the affections of the tertiary 
period ; the anatomical modifications observed in it are deep and cir-r 
cumscribed. Moreover^ while the functional derangements in the 
former were slight and transient, we are struck with the degree of 
severity which these same derangements acquire in this latter phase 
of syphilis^ and of their sometimes indefinite persistence. 

Anatomical Study. 

The syphilitic laryngopathies do not differ, as regards their 
nature, from the manifestations already known ; but as they vary 
with the tissue in the midst of which they develop themselves, 
we believe that, to make our description of tiiem clear and simple, 
we cannot do better than remind the reader of the anatomical 
constitution of the larynx : mucous membrane and sub-mucous con- 
junctive tissue, cartilages and fibro-cartilages, muscles, vessels, and 
nerves ; such are the various parts, any one of which may become 
the starting-point of the morbid process. 

We shall inquire further on what may be the influence of syphilis 
upon the nerves of the larynx. Let us mention here that Bouisson * 
has pointed out the presence of gummy deposits in the muscles of 
that organ. And now let us study the changes most frequent in the 
larynx, those of the sub-mucoi^s tissue and of the fibro-cartilages. 

At an already advanced period in the evolution of syphilis, which 
is the transition period of some authors, but which appears to us 
rather to belong to the period of gummy products, the mucous mem- 



Gaz. Medic., 1846, v. 595. 



PEBIOD OF GUMMY PRODUCTS. 3 

• 

brane of the larynx sometimes becomes the seat of an eraption to a 
certain extent comparable to a tubercular syphihde. This eruption, 
which has been observed several times by Cusco, who has given it 
the name of " papulo-tubercular/' was characterised in two cases by 
the presence, upon the surface of the inferior vocal cords^ of promi- 
nent, greyish tubercles, of about the size of a millet-seed, by a simul- 
taneous tumefaction of the superior vocal cords, and by an old injec- 
tion of the supra-glottal portion of the mucous membrane. 

It is at this same moment, or at least in this same period, that Turck 
observed the existence of more or less numerous ulcerations, which 
had their favourite seat and most marked characters upon the epi- 
glottis. When at all persistent, these ulcerations show a tendency 
to extend in depth, and end by perforating the epiglottis completely. 
All round the ulcers, or even upon the whole remaining portion of 
the epiglottis, the mucous membrane is injected and generally pre- 
sents considerable tumefaction, which may continue after cicatrisation. 

The aryteno-epiglottidean folds, the mucous membrane covering 
the arytenoid cartilages, and the inferior cords, are so many points at 
which these same lesions are also met with. When they occupy the 
inferior vocal cords, the ulcers may spread in an antero-posterior 
direction and reach simultaneously both these folds. Variable in 
extent, they are surrounded by a zone of inflammation and frequently 
accompanied by irregular excrescences, or by erosions of the mucous 
membrane of the posterior wall of the larynx. When deep, they 
leave behind them a deformity of the vocal cords, a contraction of 
the larynx^ and adhesions, all circumstances which indicate an ad- 
vanced period in the evolution of the disease. 

Side by side with these lesions, we observe, in the larynx and 
beneath the mucous membrane, or in the thickness of the fibrous 
tissues, deposits analogous to the gummy deposits in other parts of 
the body. These deposits show themselves, sometimes in the form 
of yellowish bands^ more or less extensive and prominent, sometimes 
in the form of circumscribed deposits. In the former case, the epi- 
glottis or the larynx are very especially afiected ; but we sometimes 
see the trachea and the bronchi participate in this change, as occurred 
in a case related by Wagner. Beneath the mucous membrane is 
seen a yellowish protuberance of firm consisteuce or somewhat soft, 
and which has often been described as a simple thickening either of 
that membrane or of the subjacent parts.* In the latter case, the 

• See Barth, Sur la laryngite syphilitique (SociHS anat.j tt. x. and xv.). 

b2 



4 ACQUIRED SYPHILIS. 

anatomical modification appears in the form of vegetations (Hansen)^ 
bnt it is most frequently represented by small, firm, rounded tumours,* 
of the size of a pea or a lentil, which pass through the same phases 
as gummy tumours of the other organs, that is to say, that after be- 
coming softened, they terminate in deep, more or less irregular ulcers, 
with a greyish, indurated floor, and slit edges, differing, consequently, 
from the superficial ulcerations which belong to the secondary period. 
The cicatrices which follow them are hard, whitish, thick, and fre- 
quently, by the retraction which they undergo, produce contractions 
and deformities more or less considerable in the canal of the larynx. 
This is not, however, the only evil consequence of these changes ; 
there is another which is frequently still more serious, I mean cedema 
of the glottis, so well studied by Sestier. In a table inserted by that 
author into his work, chronic syphilitic laryngitis figures fourteen 
times in 157 cases, as starting-point of the oedema of the glottis. 

The syphilitic change in the larynx does not always confine its 
action to the fibrous tissues ; in certain cases, it invades the carti- 
lages. Are these affected primarily, or secondarily in consequence of 
a modification of the mucous membrane ? The question is difficult 
to solve. There is reason, however, to believe in the existence of a 
primary syphilitic perichondritis ; but however the case may be, the 
\lcerations which are seen to supervene under these conditions are 
extensive and irregular ; their edges are soft, greyish, and split, while 
the cartilage is more or less denuded and changed, often necrosed, 
and sometimes displaced and encrusted with calcareous salts. 

These various determinations are not always easy to specify, and, . 
if it be possible, by the aid of the microscope, to distinguish syphilitic 
ulcers from epithelial ulcerations, which are for the most part isolated 
and whose edges are always indurated, it is sometimes impossible to 
differentiate them from scrofulous or tubercular ulcerations. Syphi- 
litic ulcers, however, as Barth remarks (Bulletin de la Soc, anat., 
15th year, p. 151), develop themselves from above downwards, 
occupy by preference the anterior surface and become cicatrised, to 
reproduce themselves at different points of the organ, while tuber- 
cular ulcers proceed from the lower portion, or even from the trachea 
towards the pharyngeal opening, do not become cicatrised, and invade 



* Wilks, The syphilitic affections of the internal organs, gives a plate 
which represents a tumour of this nature situated in the upper part of the 
larynx. 



PBBIOD OF GUMMT PBODUCTS. 5 

chiefly the posterior surface of the epiglottis. Before they soften, 
syphilitic deposits upon the larynx cannot easily be confounded with 
tubercular granulations, which are always numerous and very small. 

Symptomatic Study. 

The symptoms which correspond to the lesions described above are 
objective, or functional. 

The objective or physical symptoms now revealed by examination 
with the laryngoscope have the same characters as the lesions de- 
scribed above. Thus, ulcerations more or less deep, often multiple, 
with or without necrosis of the corresponding cartilages, such is 
what they present. It is not always easy, however, to ascertain the 
exact state of the different parts of the larynx. In one case of this 
Idnd, Turck met with an absolute impossibility of seeing the parts 
situated beneath the glottis, on account of a secondary inflammation 
of the superior and inferior vocal cords. Apart from the characters 
proper to this inflammation, there was seen, on the external half of 
the two inferior vocal cords, a longitudinal band strongly serrated, 
which could only be regarded as the upper edge of an ulcer situated 
upon the posterior wall of the larynx, which presumption was verified 
at the post-mortem examination. 

The functional symptoms consist in derangements of phonation 
and respiration. 

The change in the voice is generally very manifest and persistent. 
Whether there be swelling or destruction of the vocal cords, or ob- 
struction of the glottis by smaU tumours, this phenomenon is most 
frequently observed, but in different degrees, of which the most 
complete is the total loss of the voice. The patients experience a 
sensation of uneasiness or pricking, and sometimes actasd pain in 
the region of the larynx. In cases in which the existence of peri- 
chondritis was suspected, this latter phenomenon manifested itself 
with greater intensity by night than by day. 

The derangements of respiration, which are more or less distress- 
ing, are subordinate to the anatomical lesions. The patients expe- 
rience a sensation of dyspnoea and have a short cough, with or with- 
out expectoration. The expectoration, when there is any, is mucous 
or purulent, streaked with blood, and if the perichondrium be 
affected, may contain detritus of mucous membrane or of fragments 
of cartilage, as occurred in a case given by Dr. Gibb. It is clear 



6 ACQUIRED SYPHILIS. 

that, under these circumstances, the derangements of respiration 
may vary from simple uneasiness to the most complete dyspncea. 
We may remark also that the symptoms of cedema of the glottis 
are sometimes added to the preceding ones ; the oppression is greater, 
the respiration whistling, inspiration is painful and more difficult 
than expiration, and attacks of sofiFbcation supervene which may 
carry off the patients. In other cases, we observe all the signs of a 
rapidly fatal asphyxia, as, for instance, when a fragment of cartilage 
becomes introduced into the air-passages. 

Besides these different phenomena, there exists sometimes a greater 
or less difficulty of swallowing resulting either from the narrowing 
of the lower part of the pharynx by the enlarged larynx, or from 
the spasmodic irritation of the muscles of that organ, or else from 
the change in the epiglottis. It should be known however that, 
according to the experiments of Magendie, the destruction of this 
covering does not always sensibly impede the passage of food into 
the stomach. This at least is what is proved once more by the fol- 
lowing case ; — 

Very advanced cachexia, syphilitic ulcerations, destruction of the epiglottis* 

Obs. XLII. — Josepliine M., set. 35, charwoman, entered the Beaujon 
Hospital, October 6th, 1856, in a state of weakness and marasmus which 
rendered her almost unable to speak. This patient, whose skin was 
slightly puffed, presented a complete discoloration of the integuments. 
She had been suffering from diarrhoea for some days ; on the lower lip 
was seen a deep ulcer, with perpendicular edges, and near the tip of the 
tongue was another ulcer, larger and not so deep, with a greyish, sanious 
floor. She had cough rarely followed by expectoration, extreme difficulty 
of breathing, resonance of chest on percussion, indistinct vesicular mur- 
mur, and some r&les at the base of the lung. There were no accessions 
of suffocation, but a marked change in the voice. 

In spite of considerable effort, the patient could scarcely make herself 
heard ; swallowing was easy, but attacks of cough sometimes supervened 
which appeared to result from the passage of foreign substances into the 
larynx. She was ordered protoiodide of mercury with opium, and 
cauterisation with the acid nitrate of mercury. Under the influence of 
this treatment, great improvement was observed in the state of the ulcers 
upon the lip and tongue, which showed a tendency to cicatrise. Never- 
theless, the weakness resulting from the advanced state of cachexia and 
the difficulty of breathing rendering the condition of the patient always 
more alarming, death ensued on the 14th of October. 

Post-mortem examination. — The ulcers of the mouth were in the pro- 
cess of cicatrisation, the epiglottis had entirely disappeared, and it was 



PEHIOD OF GUMMY PRODUCTS. 7 

with difficulty that some greyish or whitish gangrenoas detritus were 
discovered at the point which it had normally occupied ; one of these was 
turned hack and rested upon the anterior surface of the pharynx. The 
aryteno-epiglottidean folds, which were partly destroyed, were not cede- 
matous ; the superior vocal cords were also partly destroyed, the inferior 
were intact^ The other organs were, unfortunately, not examined. 

The coarse of syphilitic affections of the larynx is slow^ continii- 
oas, progressive^ but also susceptible of becoming rapidly very acnte 
in consequence of complications which may supervene, and espeoially 
of cedema of the glottis. In most of these affections, three periods 
are recognisable^ particularly in those which are the effect of a gummy 
deposit : a period of formation, a period of ulceration, and a period 
of reparation, e^h of which has its special phenomena. The dura- 
tion of these affections varies with the extent and depth of the 
organic lesion ; but sometimes there are derangements which persist 
indefinitely. 

The termination may be favourable when the mucous membrane 
alone is affected or the absorption of the syphilitic deposits is facili- 
tated sufficiently early by specific treatment. Too often, this termi- 
nation only takes place at the cost of complete aphonia, the con- 
sequence of the destruction of the cartilages, of the inferior vocal 
cords, or of a greater or less contraction of the larynx. In addition 
to the evil of being followed by a cicatrix which always produces 
manifest narrowing, the perichondritis presents this other danger that 
it may become the starting-point of oedema of the glottis, a serious 
complication often followed by death. But what is most to be feared 
in such cases is necrosis of the cartilages, a dangerous affection 
capable of causing instantaneous death, when a sequestrum becomes 
entangled in the air-passages (obs. Labb^). Death is not only the 
consequence of a rapid asphyxia, but sometimes follows a slow 
asphyxia, or may be occasioned by the concomitant lesions of the 
riscera and the cachexia which accompanies them. Lastly, the pro- 
fuse purulent secretion which proceeds from the ulcers is a cause of 
gradual weakening which terminates in consumption. The patients 
then succumb as if they had been affected with laryngeal phthisis. 
In a case of perichondritis with necrosis of the cartilages which we 
had an opportunity of observing, death was caused by the existence 
of metastatic gangrenous deposits in the organs, which deposits had 
for their starting-point crangrene developed around the necrosed 
cartilages. 



8 ACQUIRED SYPHILIS. 

Dia^no8i8.--'Bj the account of the best authors on the subject^ 
the syphilitic changes in the larynx examined with the laryngoscope 
have no distinctly marked specific character, and consequently the 
functional derangements which they produce also do not present any 
special characters. In general, however, it is from the superior to 
the inferior parts that, unlike tubercular or scrofulous lesions, the 
laryngeal manifestations of tertiary syphilis develop themselves. 
The individuals affected with them have the voice more or less 
changed ; they usually suffer during the act of swallowing, or from 
pressure made upon the larynx. They are most frequently, at the 
same time, the subjects of ulcers, or at the very least of cicatrices, 
having for their seat the tonsils, the velum palati, or its pillars, the 
base of the tongue, or the posterior wall of the p^jgrynx, and even 
if these various lesions be wanting, the persistence of an affection of 
the larynx without a determinate cause should excite a suspicion of 
syphilis. The diagnosis, in such a case, will be facilitated also by 
the antecedents of the patient. The absence of any pulmonary 
lesion at the apices of the lungs is another circumstance by which 
we may profit for our diagnosis, as it may serve to eliminate tuber- 
culosis. 

Prognosis. — Syphilitic laryngopathies may become cured com- 
pletely so long as there is neither ulceration nor necrosis of the car- 
tilages. It is rare however, even then, for the voice not to become 
changed. The prognosis becomes serious, on the contrary, whenever 
there are deep ulcerations. The patients, under these circuiAstances, 
are not only in danger of losing their voices definitely and more or 
less completely, but are threatened with more or less rapid asphyxia. 
Nor is this all, for deep-seated ulcerations of the larynx keep up a 
suppuration which exhausts the patients and may even become a 
source of infection, or, if the physician be fortunate enough to 
obtain cicatrisation, the cicatricial tissue gradually occasions a nar- 
rowing of the calibre of the organ which, in certain cases, may 
necessitate an operation, and most frequently tracheotomy. We saw 
this in a woman under the care of Piorry, upon whom Maisonneuve 
performed that operation. 

§ 2. Syphilitic affections of the trachea and bronchi, 

Morgagnij Epist. 44, No. 15 ; Epist. 58. Benj, Bell, Treatise on venereal 
gonorrhoea and the venereal disease. Two cases of asthma observed in 
syphilitics and cured by mercurials, and which were very probably nothing 



FSBIOD OF OUMMT PB0DUCT8. 

else than cases of tracheal or bronchial affections. Dittrichf Prager Viertel- 
jahrschrift, 1849, fi<L i. p. 269. TForthtngton, Medico-Chirarg. Transact . 
t. xxv., et thdse de Chamal. Saint-Arromann, Des gommes da tissa 
cellulaire et des muscles. Thdse de Paris, 1858, p. 17. Moissenet, Union 
midtcale de Paris, October 28th, 1858. Vigla, Bulletin de la Soci6t^ 
mgdicale des hopitaux, xiv. No. 3. p. 223 ; et Union mSdicalef February 
19th, 1859. Chamal, Quelques considerations sur les r6tr6cissement8 
cicatriciels de la trach^e. Tbdse de Paris, 1859. H, Bourdon, Des r6tr6- 
cissements de la trach^e-artdre. Union mSdieale, nouy. s^rie, t. xxi. p. 150, 
1864; et Gaz, des hopitaux, 12, 1864. Moissenet, Union midicale, nouy. 
s^rie, t. xxi. p. 340, 1864; et Gaz, des kdpitaiix, 33, Forster, B^tr^cisse- 
ment de la trach^e par une cicatrice syphilitique, in Handbuch der 
patholog. Anatomie, p. 113. Leipzig, 1862. TFagner, Archiy der Heil- 
kunde. Heft 3, 1863, p. 221. JS, Vidal, Union medicale, nouy. sSrie, t. xxiii. 
p. 77, 1864. BoecJcel, B^tr^cissements syphilitiques de la trach^e, Bulletin 
de la Society de chirurgie, 1864 ; et Gaz, des Mpitaux, iii. 1864. Lancereaux 
Gaz. held., 1864. 

It is possible^ up to a certain point, to find in old authors^ and 
especially in Morgagni^ cases analogous to those of which we are 
about to make use. But we cannot do better^ in this respect^ than 
refer the reader to the excellent inaugural dissertation of J. B. 
Cayol,'^ in which are to be found collected most of the cases of tracheal 
ulcerations formerly known. 

Anatomical Study. 

Trachea, — In an anatomical point of view^ the syphilitic affections 
of the trachea have the greatest analogy with the lesions of the 
larjnx, which is, moreover, easily explainable by a certain conformity 
of structure. 

The lower part of the trachea is their most frequent seat; in seven 
cases in which the origin of the change was evident, this was met 
with five times t on the level of the last rings of the trachea, 
from which it was prolonged into one or other of the bronchi. I 
two cases in which the post-mortem examination was not made, but 
in which tracheotomy was performed without affording rehef to the 
patient,} there is reason to think that the morbid lesion could not 
have had any other seat. Twice,§ however, it has been observed in 

* JRecherches sur laphthisie trachiale, Thdse de Paris, 1810. 
t Observ. by Moissenet, Vigla, Virchow, Wilks and Lancereaux 
(Obs. XXIL). 
X Cases by Trousseau and Bourdon. 
§ Case by Worthington, second case by Wilks. 



10 ACQUIRED SYPHILIS. 

the upper part of the trachea^ immediately beneath the cricoid car- 
tilage. Whatever their primary seat may be, the tertiary changes 
in the trachea appear to develop themselves first in the sub-mucous 
tissue rather than in the thickness of the mucous membrane itself. 
The cases already known enable us^ in fact, to follow their succes- 
sive phases. In a certain number of cases, there has been observed 
a more or less extensive thickening of the sub-mucous tissue (diffuse 
change) ; at other times it is a circumscribed, local lesion^ a rounded 
tumour which may justly be compared to a gummy tumour. 

In a case of syphilis with gummy tumour of the liver and lungs^ 
Wilks found the sub-mucous tissue of the trachea much thickened 
by recent, fibrinous (gummy) deposits, analogous to chancrous in- 
duration. The deposits which occupy the seats mentioned above 
are, in general, indistinctly circumscribed ; the small tumours are^ 
on the contrary, sharply limited. They are of the size of a lentil or 
a pea, or may attain the dimensions of a half-franc piece. In 
Moissenet^s case, there existed, i of an inch above the contraction, 
three irregularly rounded patches of the size of a half-franc piece, 
slightly raised above the surrounding surface, of a pale yellow colour, 
of a soft consistence at the centre, and with an uneven, mammillated 
surface. Such is the first stage of the syphilitic change in the 
trachea. Not causing death of itself, we can understand that it 
rarely presents itself to the eye of the observer. But, it will be 
said, the ulcerations and contractions of the trachea do not always 
present this mode of evolution, or at least they do not all pass 
through this first stage. Our answer to this is that it is possible to 
verify, in one and the same case, these various phases of change 
(obs. Moissenet). 

More frequently, ulcerations have been observed ; these ulcera- 
tions, rounded and of greater or less depth, have their floor formed 
by the cartilaginous rings, or by the surrounding tissues when these 
rings have been completely destroyed by ulceration. In a case seen 
by us, the floor of the ulcer was formed by a fibrous stratum con- 
taining in its thickness one or more lymphatic glands (Obs. XXII. 
Vol. I. p. 251). 

The cicatrices which follow characterise the third phase in the 
evolution of the morbid process: it is frequently the only lesion 
observed at the post-mortem examination. Consisting of a whitish 
or pink tissue in the midst of which are found the cartilaginous rings 
more or less changed and broken up, these folded or radiating cica- 



PERIOD OP GUMMY PBODUCTS. 11 

trices^ in the form of bridles^ occupy a part or the whole of the cir- 
cumference of the trachea ; they take^ in certain cases^ the place of 
several cartilaginous rings. Hence the possibility of the collapsing 
of the walls of the trachea during inspiration. But the great evil of 
this change is^ to contract the air-passage and^ sometimes^ to diminish 
its length. This^ as has been observed in some cases> may occur to 
such an extent that it is scarcely possible to introduce a female sound 
or even a quill. As regards the shortening of the tracheal tube, this 
sometimes attains an extent of several centimeters. Let us point 
out, lastly, as a secondary consequence, the dilatation of this tube 
above and below the contracted portion and the hypertrophy of the 
longitudinal elastic fibres (Ghamal). 

Bronchi. — ^The various changes which we have just described are 
met with also, in their successive phases, on the surface or in the 
thickness of the bronchial tubes, but chiefly in their principal divi- 
sions. Small gummy nodules have been observed by Wagner in the 
thickness of the walls of the bronchi. In a case given by Dittrich, 
there existed beneath the bifurcation of the large bronchi deep 
alcerations an inch in diameter, covered with a purulent exudation; 
/he surrounding sub-mucous tissue and the wall of the right bronchus 
jFcre thickened and lardaceous. Several of the cases related by 
Virchow make mention of the existence of hard, wrinkled cicatrices 
on the surface of the bronchial tubes, an arrangement met with in 
one of our own observations. Like the cicatrices of the trachea, 
those of the bronchi give rise to a more or less considerable degree 
of contraction. But side by side with this contraction, we generally 
observe the dilatation of the air-tube ; this is a circumstance which 
we ourselves have noticed on several occasions. Usually, when the 
bronchial ramifications are affected, the parenchyma of the lung is at 
the same time changed by fibrous deposits which render it indurated 
and occasion a retraction altogether peculiar. It is to be remarked 
that never, in any of the cases quoted, was there any tubercular 
change in the lungs. 

To sum up, we find again here the same anatomical forms as we 
have already studied, and as the cnanges in question have manifested 
themselves sometimes soon after the secondary period, sometimes ten 
or twelve years later, it would perhaps be possible to find in this 
circumstance a sufficient reason for comparing the one set to tardy 
syphilitic eruptions, the other to gummy deposits. This view ap- 
pears justified, moreover, by the fact that the ulcerations were more 



12 . ACQUIRED SYPHILIS. 

namerons whenever the manifestation supervened soon after the 
secondary period. The following case is a good example of the 
morbid determinations of syphilis in the air-tubes. 

Ulcerative syphilitic bronchitis. 

A young man had contracted, while travelling, syphilis for which he 
took mercury, but in an irregular and inefficient manner. In the autumn 
of 1838, he was attacked by disease of the throat, with hoarseness, ulce- 
ration of the velum palati, a copper-coloured eruption on the skin, 
nodes, nocturnal pains, and profuse sweating. His condition gradually 
got worse and, in the month of August, 1839, the patient, who was con- 
fined to his bed, was excessively weak and emaciated ; he had frequent 
and very troublesome cough, copious purulent expectoration, and sym- 
ptoms which left no doubt as to the existence of some disease of the 
larynx. His chest was perfectly resonant, but a thick, mucous rhonchus 
was plainly heard throughout both lungs. He was ordered quinine and 
iodide of potassium, but sank completely exhausted, September I5th. 

Small ulcerations existed on the mucous membrane covering the larynx ; 
there were none in the trachea, but beneath the bifurcation they appeared 
afresh, becoming more and more numerous in the smaller ramifications. 
In the smallest divisions of the bronchi there was a continuous series of 
ulcerations; isolated ulcers had apparently run into each other. The 
bronchi were filled with purulent matter, and the lower lobes of the lungs 
were slightly congested.* 

Symptomatic Study. 

The preceding study already enables ns to understand that the 
symptoms which correspond to the syphilitic lesions of the trachea 
must vary according to the stage of the anatomical evolution, and 
this appears really to be the case. 

The commencement of the affection, generally insidious, attracts 
very little attention from the patients; they scarcely notice a slight 
difficulty of breathing, they cough little, but they have a sensation 
of slight tickling, as if by a foreign body at some point of the air- 
passages, and chiefly towards the upper part of the sternum. To 
these symptoms are sometimes added loud, whistling inspiration, 
oppression on going upstairs, and fits of suffocation recurring more 
particularly at night and accompanied by cough without expectora- 
tion (Bourdon's case). Later on, probably when one or more ulcers 
exist, the cough is more frequent ; dry up to that time, it is now 



* Sadowski, of Prague, quoted by G. Lagneau. Thdse de Paris, 1851. 



PERIOD OP GUMBIY PRODUCTS. 13 

followed by muco-pnrnlent expectoration sometimes stxeaked with 
blood (Vigla's case), or by greenish yellow nummular expectoration 
(Bourdon's case). The voice is little changed and auscultation re- 
veals no abnormal sound. The derangements of respiration may 
persist^ but are sometimes seen to diminish^ especially when an ap- 
propriate treatment has been adopted (Bourdon^s case). In these 
cases^ a certain degree of improvement manifests itself^ but we must 
take care not always to regard this as the commencement of a definite 
recovery. It is^ in fact, only a period of arrest^ during which cica- 
trisation takes place. This once effected, the lesions often reappear 
in proportion to the amount of contraction of the cicatricial tissue, 
and this time derangements more marked, more serious, and more 
permanent supervene and are, at the same time, less accessible to in- 
ternal means. The dyspnoea, which is felt afresh, is progressive ; 
the cough is capricious and the whisding inspiration so marked as 
to constitute a true roaring. But the most important phenomenon 
and, at the same time, the most distressing to the patients, consists 
in accessions of suffocation which often occur without any very ap- 
preciable cause. These accessions, in the intervals of which more or 
less oppression continues, are usually renewed to an extent to place 
the life of the patient in danger. At this same period, we observe, 
moreover, in certain cases, two symptoms to which Demarquay justly 
attaches great importance, viz., the sinking of the larynx and the 
immobiUty of that organ during deglutition and during speech. 

Such are^ to sum up, the chief functional derangements which 
belong to the syphiUtic changes in the trachea. To these derange- 
ments let us add an altogether peculiar sensation of hardness of the 
trachea, a diminished mobility of that organ upon the surrounding 
tissues, and lastly, the possibility of seeing, by the aid of the laryn- 
goscope, either the ulcerations, or the contraction itself. It is thus 
that in a case of contraction of the trachea situated, it is true, at a 
high point in the air-passage, Turck was enabled to form a perfectly 
positive diagnosis ; for he ascertained, at the moment in which his 
patient uttered a piercing cry upon a very high note, that the sound 
was produced during expuration by the vibration of the whole 
length of the edges of the contraction, which played the part of 
the vocal cords, these remaining perfectly motionless and gaping 
widely. 

When the syphilitic change involves only the bronchial tubes, the 
symptoms differ somewhat from those which we have just been 



14 ACQUIBBD SYPHILIS. 

analysing. According to W. Munk,* these symptoms do not ap- 
pear, in general, until after the affections of the throat, and as if the 
disease reached the larynx, then the trachea, and lastly the bronchi. 
In the earlier periods, the phenomena are almost the same as those 
of simple catarrh ; but the voice is more changed, and there are in 
the larynx a constant dryness and irritation which gradually reach 
the chest, the patients experience a sensation of painful constriction 
behind the sternum, and most frequently the irritation, continuing, 
causes a short and frequent cough, a symptom which has given rise 
to a suspicion of the existence of tubercular phthisis. When the 
disease has continued some time, the mucous secretion furnished by 
the air-passages does not fail to present the characters of suppura- 
tion ; it is then that hectic fever sets in, if it did not exist already. 
Thus, dyspnoea more or less intense, a cough which is usually capri- 
cious, and mucous or purulent expectoration : such are the evidently 
little characteristic symptoms of the tertiary change in the bronchi. 
Let us insist upon the circumstance that this change, itself always 
rare, is not accompanied, in general, by any of the physical signs 
which indicate an extensive induration of the lungs. 

Course^ duration, and termination. — In the preceding description, 
we have sufficiently made known the course of the pathological pro- 
cess to render it unnecessary to revert to that point. Its evolution 
is slow, its duration, which is in general of several months, is less 
long however, on account of the functional importance of the organ 
affected, than that of most of the other syphilitic manifestations in 
the viscera. 

As regards its termination, this is rarely favourable, which appears 
to result from the difficulty of recognising the change at its onset 
and of treating it sufficiently early. Death, when it is a question of 
lesions of the trachea, is, therefore, comparatively frequent. It 
generally supervenes in a fit of suffocation, more rarely from general 
exhaustion. Cachexia is a rather rare consequence of the syphilitic 
affections of the trachea and larynx, unless they coexist with changes 
in the abdominal viscera. 

Diagnosis, — Dyspnoea, a peculiar whistling sound during inspira- 
tion, genuine roaring, the voice retaining almost its usual tone, pain 
or the sensation of a foreign body at some point in the air-tube^ and 

• See London Medical Gaz,, April, 1841, and Gaz, mid, cfePam, p. 661, 
1841. 



PEEIOD OP GUMMY PRODUCTS. 15 

later on accessions of sufPocation without appreciable pulmonary 
cause : such are the signs which must serve as the basis for the dia- 
gnosis of the syphilitic affections of the trachea, and to which may 
doubtless be added some symptoms furnished by the auscultation of 
the trachea, hitherto perhaps too much neglected in such cases. 
These affections will not be confounded with the changes in the 
larynx, which generally occasion more or less considerable modifica- 
tions of the voice; but they might be confounded with certain lesions 
of the trachea which produce contraction of the air-tube. The 
absence of any symptoms of pulmonary tuberculisation will be of 
great use in rejecting the idea of the existence of an anatomical 
change in the trachea of tubercular origin. There is one disease 
however which, as has been very well shown by Professor Tardieu,* 
is capable of producing lesions closely resembling those of syphilis, 
viz., glanders. In such cases, the diagnosis must rest, above all, 
upon the antecedents and commemoratives of the patient ; but it is 
unnecessary to insist upon this point here, for we purpose comparing 
these two diseases with each other further on. Tumours which com- 
press the trachea cause evils which might lead to error ; amongst 
these tumours, aneurism of the aorta, one of the most frequent, is 
recognised by symptoms altogether peculiar to it. As regards the 
solid tumours of the anterior mediastinum, as they soon project be- 
yond the upper edge of the sternum, they usually become appreciable 
to the touch. Other lesions also are important to know, as they 
too may lead to error : epitheKal cancer of the oesophagus is amongst 
this number. This change, of which I have had the opportunity of 
seeing several examples,! sometimes perforates the trachea, projects 
into its cavity, and contracts, more or less, its calibre. Hence 
dyspnoea, tracheal whistling, accessions of suffocation, all symptoms 
which may lead to the idea of a syphilitic contraction in the trachea. 
The difficulty of swallowing, and sometimes also the change in the 
voice which results from the invasion of one of the laryngeal nerves 
by the epithelial product, are signs which, in combination with the 
commemoratives, will serve to clear up the diagnosis in these difficult 
cases. The commemoratives of the patient, the absence of symptoms 



* Tardieu, De la morve et du farcin chroniqties ehez rhommej &c. Thdse 
de Paris, 1843. 

f Lancereaux, Deux cas de cancer ipithelial de Vasophage (JBuU, de la 
Sociite anat.j 1861). 



16 ACQUIRED SYPHILIS. 

indicative of the existence of pulmonary tubeicolisation^ and the 
long doration of the evil, are so many circmnstances which will aid 
in recognising the syphilitic bronchopathy. 

Prognosii. — The prognosis of the syphilitic affections in question 
is unfavourable whenever the change occupies a large extent and 
occasions a notable contraction of the trachea or large bronchi. Cica- 
tricial contraction is the most serious^ for aU specific medication is 
then useless. 

§ S. SyphUUic affecUoM of the lungs. 

Nicolas Massa points to asthma and diarrlioea as symptoms consecutive 
to gfummy tamours, Aphrodisiac as, p. 45. Portal, Observations sor le 
traitement de la phthisic pulmonaire. Paris, 1792. J, Frank, Traits de 
pathologie interne, t. iv. p. 267, chap; iv. 27, trad. Bayle. William Munk, 
Med, Gaz,, April and May, 1841. A. DumouUn, Thdse de Paris, 1848, 
p. 40. Lagneau, Des maladies pulmonaires causees on influenc6es par la 
syphilis, 1851. Thdse de Paris. JRicord, Iconographie, pis. 28 and 28 bis. 
JBudd, Diseases of the liver, p. 419. London, 1857. Spencer Wells, Med, 
Times, July 3rd, 1858. S. WUks, Transact, of the Path. Society of 
London. Guy's Hospital Reports, 3rd series, Vol. IX., p. 34. Cornil, 
Bull, de la Soc. anat., 1861, et Pihan Dufeillay, ibid. Hutchinson and 
Jackson, Med. Times and Gaz., October 11th, 1862. JE, Wagner^ Archiv 
der Heilkunde, 1863, p. 361. Leipzig. A. de Maux, Maladies pulmonaires 
syphilitiques, Annales de la Soci6t6 de m^decine de Gand, January and 
February, 1864. Laneereaux, Des 16sions visc^rales susceptibles d'etre 
rattach^es k la syphilis constitutionelle, Gaz. hebd., 1864. 

The physicians of the last century were already acquainted with 
pulmonary syphilis ; with them it was venereal phthisis (phthisis a 
lue venerea). Most of them described under this name an affection 
of the lungs caused by the venereal poison^ differing from that pecu- 
liar condition which we call cachexia. Morton,*^ devoting to this 
form of disease^ chap. vii. of his PMAisiology^ gives a case which is 
not wanting in interest. Baglivif writes in his Praxeos Medicm: — 
''Certb constat phthisin saepissime esse morbum secundarium a 
variis morbis principalibus^ v.g. lue venerea/' &c. Hoffmann $ gives 
two cases of venereal phthisis which he discusses and criticises. 



* R. Morton, Opera medica, Lugduni, 1737, p. 107. 
f Baglivi, Opera medica, Lugdani, 1745, p. 200. 
X F. Hoffmann, Opera omnia. Geneva, 1748. De lue venerea, p. 424, 
t. iii. c. iv. 



PERIOD OF GUMMY PRODUCTS. 17 

Morgagni * also qaotes two examples of it^ but thinks^ and in this 
lie inclines to Morton's view, that the veneieal disease has no other 
action than that of favouring the development of the change in the 
longs. Astruc f insists upon pulmonary symptoms connected with 
syphilis. Tode^ Schwarze^j: and Meza § also admit venereal phthisis^ 
of which they give some cases. Sauvages^j] following Morton's ex- 
ample^ makes of this disease the eighth variety of his forms of 
phthisis^ and his view was afterwards adopted by Cullen and Mac- 
bride. Schroeder IT says, when speaking of the venereal poison :— 

'^Producit inflammationes, spasmos^ tumores et 

tubercula, in variis partibusnec non raro in pulmonibus.'' J. P. 
Frank ** names the action of the syphilitic poison upon the lungs 
amongst the causes of hsBmoptysis. De Horne,tt OarrSre, JJ and 
Tandon §§ have seen serious affections of the lungs become cured 
under the influence of a specific treatment. Swediaur |||| and Sauce- 
rotte^TT speak of syphilitic pulmonary phthisis. Portal *** treats of 
it at considerable length. Joseph Prank fff recognises three periods 
in it. Petit-Badel m gives some cases of it which he takes from 



* Morgagni, De Sedibus et causia morhorum, t. ii. epist. xxii. arts. 10, 11, 
and 15 ; t. i. p. 525, trad. fran9. {Encyclop. des sciences midic,). 

t Astruc, De nwrbis venereis, in 4to, t. i. p. 425. 

t Schwartze, DissertaUo observationes qtMsdam continens, 

$ Meza, Societatis JSdvniensis CoUectanea, 1774, Vol. I. art. 21. 

II Sauvages, Nosologie mithodig[ue, trad. Nicolas, 1775, t. iii. p. 457. 
Nosologia methodica. Amsterdam, 1768, t. ii. p. 457, 

^ Th. G. Schroeder, Tractattts tnedictts de pleumonide ejusque speeiehus, 
Gottingen, 1779, art. De Pleomon. Syphilit, p. 70. 

** J. P. Frank, Medecine pratiqtie, t. ii. p. 308, trad. Goudareau. Paris, 
1842. 

ft De Home, Differentes mSthodes d*administrer U mercure, t. ii. p. 447 , 
1779. 

XX Carr^re, Maladies vSnSriennes chroniques, sans signes evidents, pp. 64 
and 181, Obs. V. 

$$ Tandon, Traitement et gaSrison d'tme phtMsie vinSr, par la mSthode de 
Huguenot {Ann, de la Soc, mid. de MontpeUier, t. L p. 176). 

Ijjj Swediaur, Maladies vSniriennes, 4^® gdit, t. ii. p. 169, 1801. 

m Saucerotte, Journal de mSd, de Corvisart, 1812, p. 750. 

*** Portal, Observat, sur le traitement de la phtkisie pulmonaire, Paris, 
1809. 

ttt J- Frank, TraitS de pathologic interne, t. iv. p. 167, ch. iv., trad. 
Bayle. 

XXX Petit-Radel, Cours des maladies sgphiUtiques, t. ii. p. 3. Paris, 1812. 

c 



18 ACQUmSD 8TFHIUS. 

Lairej. On this subject Yan der Kolk expresses himself as follows:'^ 
'' Etolim non laro in perscnitando cadavera sypluliticoniin^ qui dum 
Viyebaot phthisici Tidebantnr, inveni in puLnonibns, pi«cipiie in 
medio lobo^ ulcus quoddam seu pus collectum sine ullo tuberculo 
emgentL'^ lu shorty without spending more time upon the various 
facts further contained in scientific records^ let us mention^ as an 
instance of the agreement between the earlier observations and 
modem researches^ the work of Munk f upon the specific diseases 
ol the lungs and the inaugural thesis of G. Lagneau4 

Two doctrines have hitherto been advanced^ of which the one 
omsiders certain pulmonary diseases as produced directly by syphilis, 
while the other regards syphilis as a simple occasional cause of those 
diseases* We shall see further on what is to be thought of this 
latter opinion. However this may be, and if it be far from impro- 
bable that a certain number of cases of venereal phthisis published 
by the earlier writers referred to changes in the trachea or bronchi, 
it is none the less true that at the present day no doubt can be 
retained of a direct influence of syphilis upon the parenchyma of 
the lungs. DifiFiised or circumscribed, the lesions resulting from 
it leave behind them cicatrices, and consequently assume the ana- 
tomical types peculiar to the other organs. 

Anatomical Study. 

Diffused form. — Interstitial pneumonia. — ^The facts upon which 
rests the evidence of this anatomical modality of pulmonary syphilis 
are, as yet, few in number, but sufficient however to leave no doubt 
in the mind. The seat of this modification is variable : sometimes 
it occupies the upper or middle lobes, sometimes it is confined to 
the lower lobes, and thus it is reasonable to believe that it may in- 
vade almost indiscriminately the different parts of the lungs, but 
without attaining any considerable extent. The portion of paren- 
chyma afiected is harder, firmer, elastic, resistent to pressure, friable, 
and impermeable by air, and, consequently, does not crepitate. Sit- 
uated near the surface of the lungs, the change is sometimes marked 
at its commencement by a protuberance, and later on by a greater 

* Van der Kolk, Obaerv, anatomo-patholog,, 1826, p. 129 et seq. 
t London Med. Gaz,, April and May, 1841. 

X Lagneau, Des maladie$ pulm, causees on infltiencies par la syphilis, 
Paris, 1851. 



PERIOD OF GUMMT PRODUCTS. 19 

or less amount of depression^ the result of the retraction of the 
newly formed tissue. In a case related^ by Yidal^ there existed 
around the bronchi an indurated mass of a bluish grey colour^ 
which had a certain analogy to green sea marble. This mass^ which 
took the place of a portion of the parenchyma of the lung^ pre- 
sented on pressure a resistance such that it might have been taken 
for a periostosis. It had for its seat a portion of the lower lobes. 
The rest of the lung was supple and soft to the touch. Nowhere 
could the least trace of tubercles be found. Wilks mentions haviog 
seen induration of the pulmonary tissue in a certain number of cases 
of venereal disease^ but hesitates to connect this lesion with syphilis. 

In a case observed by ourselves, the lesion occupied the lower 
part of the upper lobe of the left lung. In this neighbourhood^ 
the surface of the lung presented a large depression with radiating 
folds; the parenchyma was replaced by a firm^ resistent^ fibrous 
tissue, in the midst of which were seen numerous yellowish points^ 
with a slightly granular surface, formed, on microscopical examina- 
tion, of granular nuclei and numerous molecular granulations con- 
tained in a fibrous web. The bronchi which entered this portion of 
the lung, for the most part dilated or contracted, terminated, some 
of them at least, in enlarged culs-de-sac. Their opaque walls, yel- 
lowish and thickened, were manifestly changed. Far from being 
rare, this change in the bronchi is rather the rule in cases such as 
those of which we are speaking. 

Ownmy tumours of the lungs, — ^The gummy tumours of the 
parenchyma of the lung, which were mentioned by Morton, Astruc,* 
and Fabre, have only really been studied in recent times, and, to tell 
the truth, the knowledge we possess of them is, even now, very 
imperfect. The cases, ten in number,t which we have been able to 
collate in adults, have taught us that the gummy tumours observed 
in the lungs of adults have no favourite seat, but are met with in- 
discriminately in the upper, middle, and lower lobes. However, 
when they occupy the upper lobe, it is rather the nuddle or lower 
part of it than the apex which is the favourite seat of tubercles. 

These deposits vary in number, and although there may sometimes 

* Astruc admits that the vital functionB of the lung may be affected in 
syphilis : Ist, by tubercles or gummy tumours, whether suppurating or 
not ; 2nd, by vomicae. 

t The authors of these cases are : Ricord, Budd, Dumoulin, Wilks, 
Spencer Wells, Comil, Lancereaux, Hutchinson, and Jackson. 

c2 



20 ACQUIRED STFHILIS. 

be only one, tliej are most freqnently multiple; they rarely exceed 
six or eight. They show themsdves in the form of greyish, or 
yellowish white tumoors^ scarcely irregular, rounded, of the size of 
a pea, an almond, or a large nut^ of a consistence firm at first, 
slightly elastic^ later on somewhat soft, and cheesy at the centre. 
Deposited in the midst of the parenchymatous web, these tumours 
are generally circumscribed by an indurated tissue, which is fibtous 
and grqosh (Obs. XLIII.), or pearly and shining (obs. Comil) ; 
this serves them as a shell and is not without importance in a dia- 
gnostic point of view. On section, this shell, or, better, this zone, is 
perfectly distinct from the central nodule, and while, resistent under 
ibe finger and evidently traversed by numerous vessels, it is formed 
of a fibrous tissue thoroughly developed, the latter is friable, little 
or not at all vascular, formed of scanty nuclear or cellular elements, 
more or less granular, and forming a part of the group of elements 
of conjunctive tissue. A dry product at first, gummy tumours of the 
lungs soon became necrosed and undergo the granulo-fatty meta- 
morphosis. Then it is that a change of consistence gradually takes 
place, and that the substance of new formation, primarily solid, 
becomes softened from the centre towards the periphery (obs. Wilks). 

Having reached this period, the substance in question may be 
partly or entirely absorbed ; but most frequently it is thrown off 
through the bronchi and in its place remains a cavity of greater or 
less extent, lined with caseous deposits and always circumscribed by 
a more or less thick, fibrous zone. The process by means of which 
this elimination is effected is little known ; but there is every reason 
to believe that it does not differ from that which obtains when 
elimination of gummy tumours of the sub-cutaneous cellular tissue 
(ulcerative inflammation) takes place. The cavities, as is the case 
with these latter lesions, are susceptible of cicatrisation; whence 
puckering, depressions more or less manifest, cicatrices in short, 
upon the surface of the lungs. 

CicaM^es, — ^For a long time, all cicatrices of the lungs were 
attributed almost exclusively to tuberculisation ; it may fairly be 
assumed, therefore, that relics of change of tubercular origin and 
syphilitic origin may have been confounded with each other. A 
certain number of cases given by Laennec,* Andral,t and some 

• Traiti de V auscultation, p. 58. Paris, 1831. See Obs. XIX. and XX. 
•f CUnique mSdicale, t, v. p. 68. Paris. 



PSBIOD OF GUMBCY FBODUCTS. 21 

other authors, would seem at least to give some appearance of truth 
to this view. In fact, although no mention is made of the existence 
of syphilis in most of the cases rebted by those authors, there is 
nevertheless reason to believe, on account especiaDy of the concomi- 
tant changes in the liver (see Obs. XIX. and XX. of Laennec) thai 
the cicatricial lesion of the lung might well have had syphilis for its 
cause. However this may be, we think, to judge from the cases 
observed by ourselves, and this opinion is shared by the illustrious 
anatomo-pathologist of Berlin, that we should restrict considerably, 
iu the lungs, the changes attributed to veritable tuberculisation^ and 
that many callous and slate-coloured cicatrices, many caseous indu* 
rations do not result &om a cured tubercle, but much rather from a 
gummy tumour modified by the fact of its evolution. The frequency 
of cicatrices of the lungs in cases of visceral syphilis* come at least 
in support of this view. 

SyphiUtic cicatrices of the lungs are observed equally in each of 
the lobes, either on their surface or in their substance. They co* 
exist with various syphilitic lesions occupying different points of the 
body or even of organs such as the liver, but never or rarely with 
true tubercles of Uie lungs. They are generally extensive, deep, 
radiating or star-shaped, and composed of a fibrous and indurated 
tissue, in the midst of which is sometimes seen a dry, granular, yel- 
lowish substance. In one of our observations they are describe as 
follows : — '^ Cicatrices, some radiating, others star-shaped, occupy 
each lobe of the right lung; and in the vicinity of them, the greyish, 
firm, indurated pulmonary tissue presents, towards the centre of the 
points of induration, a white and caseous substance. Some analo- 
gous cicatricial depressions exist on the surface of the left lung. 
That organ adheres to the diaphragm, which is also the seat of cica- 
trices and of small gammy tumours.'^ 

The adhesions of the lungs to the costal parietes are not rare in 
these cases, in which the pleura, generally thickened, participates in 
the change, so that it is possible to predict that a chronic and dry 
membranous plewrisy is, so to speak, a necessary concomitant of the 
diffused or circumscribed syphilitic lesions of the parenchyma of the 
lung. Much more rare in cases of tuberculosis, this form of pleurisy 
is almost an exception when there is cancer of the Ixmgs. 

Such are, after the most rigorous analysis we could make, the 

* See our observations. 



22 ACQUIEED SYPHILIS. 

changes which take place under the influence of syphilitic disease^ 
and develop themselves in the parenchyma of the lungs. But how 
are they to be recognised, and what is their specific power ? The 
diffused change^ chronic interstitial pneumonia^ is distinguished by 
its slight extent^ rarely invading a whole lobe, and is sometimes met 
with at disseminated points : moreover^ the neoplasm of which it 
consists presents itself in the shape of thick, fibrous septa^ between 
which is interposed a yellowish^ granular substance, to a certain ex- 
tent different to the marbled substance^ hard and brilliant on sec- 
tion, which belongs to ordinary chronic pneumonia, that is to say, 
to the pneumonia to which it is not yet possible to attribute any veiy 
determinate cause. 

Gummy tumours of the lungs, dry products with little vascu- 
larity, are especially distinguished by the presence round about them 
of a fibrous zone which is generally very thick. Tubercles, when 
they take on the form of rounded masses, may cause confusion ; 
b JgeneraUy, even onde, such circumstances, it i rare not to n.eet 
with tubercular granulations, which does not occur in the case of 
specific deposits ; moreover, tubercular neoplasms develop themselves 
most frequently on both sides of the chest, and have for their favourite 
seat the apices of the lungs. Almost entirely devoid of vascularity, 
and consisting of the elements of conjunctive tissue, these two pro- 
ducts have not, however, an identical evolution. Less rapid in its 
development, the gummy tumour is susceptible of a more complete 
organisation, and there are often found in it fibres of conjunctive 
tissue, an element always rare in tubercle, which is usually formed of 
nuclei atrophied, granular, deformed, and smaller than those proper 
to gummy tumours. The large granular cells (granular corpuscles) 
are not met with in the tubercular deposit as they are in the syphi- 
litic deposits. The tubercular neoplasm is drier, less fatty, less 
developed, to a certain extent, than the gummy neoplasm, and, con- 
sequently, enjoying a lower vitality, has a greater tendency towards a 
retrograde transformation. 

Symptomatic Study. 

The changes we have just been studying sometimes escape our 
means of physical investigation, and, as they do not always give rise 
to very appreciable functional derangements, it follows that they may 
pass unperceived and remain latent, at least for a certain time. 



• PERIOD OP GUMMY PRODUCTS. 23 

This is, ia fact, what happens in some cases of partial chr6nic pnea- 
monia, and of gammy tumours in the first period of their evolution. 
It is easy to conceive the difficulty of discovering these lesions while 
they are of slight extent; on the other hand, dulness on percussion 
and a circumscribed murmur, alone or accompanied by r&les, are the 
chief symptoms which present themselves on rare occasions. 

At a more advanced period, when dilatation of the bronchi has 
been added to the chronic pneumonia, the murmur, become more 
appreciable, coexists with larger or smaller r&les ; but, after all, the 
physical signs peculiar to gummy lesions of the lungs do not mani« 
fest themselves until after the breaking up of these new products, 
when they have produced in the thickness of the parenchyma of the 
lung one or more excavations of variable extent, for, from that mo- 
ment, the morbid phenomena change their character. To this phase 
refers, no doubt, the mention made by Astruc and some other authors 
of the last century of vomicse consequent upon the presence of sup- 
purating gummy tumours and of abscesses in the lungs. In any 
case," from that moment, new stethoscopic signs show themselves 
which do not di£Eer from those which are observed whenever any 
cavity exists in the lungs : a hollow murmur, confined to a particular 
region, and r&les more or less large, with or without vocal resonance, 
constitute these signs. 

A cough more or less obstinate, sometimes capricious, dyspnoea, 
oppression, and muco-purulent expectoration: such are the chief 
functional derangements. Let us add that haemoptysis has also fre- 
quently been seen to supervene (obs. Leudet and Obs. XLIII.). But 
these phenomena do not present, so far, any specific characters, and 
yet it is presumable enough that a micrographic examination of the 
matter expectorated would present someUiing peculiar. Inde- 
pendently of any febrilb condition, these various symptoms most 
usually coexist with that deep-seated modification of the organism 
known under the name of cachexia, and it is to be remarked that 
this general disturbance of the organism sometimes persists even 
when the changes recognisable in the stethoscopic signs authorise 
the supposition that cicatrisation of the cavities and a cure of the 
pulmonary affection have taken place. 

Cour9€y duration, terntmation. — The course of the syphilitic 
changes in the lungs has nothing peculiar in it, apart from the 
possible elimination of the gummy tumours. These tumours pre- 
sent the three phases of crudeness, softening, elimination and cica- 



24 ACQUIRED SYPHILIS. * 

trisation already pointed out for gummy tumours of the other organs^ 
and to each of these phases correspond^ necessarily^ different stetho- 
scopic signs. The duration of these affections is of several months. 
Their termination is most frequently favourable, when they are re* 
cognised sufficiently early ; it would be less unfavourable if, at this 
period of syphilis^ the lesions of the abdominal viscera did not com- 
monly occasion cachexia and marasmus. 

DiagnoM, — ^The various symptoms of which we have been speak- 
ing not havings as we have already stated^ any pathognomic charac- 
ter, it follows therefrom that the diagnosis of sjrphilis of the lungs 
rests chiefly upon the antecedents and commemoratives of the 
patient, and upon the nature of the concomitant affections. How- 
ever, certain pulmonary derangements may serve to clear up the 
diagnosis and to put us on the trace of syphilis. Thus a certain 
degree of dulness, with a blowing sound not preceded by febrile 
reaction, persistent and limited to one of the lower lobes or to the 
middle lobe^ in a cachectic individual the apices of whose lungs are 
intact and the liver diseased : such are the signs required for the 
diagnosis of the existence of a syphilitic affection of the lungs. The 
sudden appearance of abundant expectoration, the seat of the change 
in a limited extent, and especially on one side only of the chest, are 
circumstances which constitute a further presumption in favour of 
this same affection (see observations below). 

The tubercular change in the respiratory organs, which it is above 
all others easy to confound with the cases in which we are interested^ 
is distinguished moreover not only by a more rapid evolution and 
greater extension, but also further by its very special onset at the 
apices of both lungs. Should the anatomical change occupy one of 
the apices, or even both at once, it is easy to understand that the 
diagnosis will be of the most difficult and rd^uire all the sagacity of 
an enlightened practitioner. The course of the affection, the general 
condition of the patient, or still more his peculiar state of cachexia, 
and his morbid antecedents : such are the data upon which it will 
still be possible to found a diagnosis which an appropriate treatment 
may afterwards confirm. 

Prognosis. — The prognosis of pulmonary syphilis is unfavourable, 
not so much perhaps on account of the lesions in the lungs them- 
selves as of the syphilitic changes which, at the same time, usually 
prevail in the other viscera. Without forgetting that in such cases 
a cure is often possible, we must not lose sight of the fact that these 



PERIOD OP GUMMY PRODUCTS. 25 

changes, comparatively rare, never appear except at a very advanced 
period of syphilis and, consequently, at a time when the organism 
has abeady undergone a serious modification. If we bear in mind 
this consideration, we shall no longer be tempted, like Dr. CyConnor 
and some other authors, to regard as syphilitic manifestations lesions 
which, after all, are merely ordinary pnenmonias or pleurisies. 

In this article, in which we have shown ourselves as sparing as 
possible of details, we have based our description upon the ana- 
tomical change, the characters of which are always more precise and 
more certain than those furnished by the symptomatic derangements. 
The syphilitic phthisis and asthma described by certain authors, are 
not, in our opinion, anything else than symptoms connected with 
some of the lesions already studied and very especially with ulcera- 
tions and contraction of the air-passages. Our view of this ques- 
tion, which differs from that of Drs. Lagneau and de Naux, will, we 
hope, find imitators. 

The following instances of syphiUtic affections of the lungs ter- 
minating in death or recovery will serve to support what has been 
advanced. 

Chronic syphiUtic pneumonia. 

v., set. 45, sempstress, of strong constitution, entered the Clinical 
Hospital, April Ist, 1853, under the care of M. Pidoux, on account of great 
difficulty of breathing. For the last month she had experienced uneasi- 
ness and oppression, and some days ago was obliged to give up working. 
She pointed to her chest as the seat of her complaint ; her short, anxious 
and difficult respiration was performed in the upper part of the chest ; 
the base of the thorax was motionless and suggested the idea of some 
obstacle to the entrance of air into the lungs. Peroussion fully confirmed 
this supposition, by giving a dall sound which was more marked, how- 
ever, on the left side than on the right ; there was exaggerated resonance 
in the upper part of the chest Auscultation revealed bronchial respira- 
tion and a murmur in relation with the dulness at the apices of the lungs ; 
the breathing was puerile, exaggerated and rapid, the pulsations 65. 
There was no heat of skin ; the tongue was pink, the face slightly con- 
gested, there was no cephalalgia, the intelligence was perfect. A month 
ago, this woman spit a little blood for two or three days ; previously to 
that time she had never had any chest affection ) she had no expectora- 
tion, no cough, no evening fever, nor any night sweats. There was no 
emaciation nor any family history of phthisis. For some months past, 
walking and ascending stairs had caused great discomfort and palpita- 
tion. She had on her body traces of syphilitic ecthyma and rupia which 
gave evidence of very inveterate venereal disease. Thirteen years ago, 



26 ACQUIBED SYPHILIS. 

while suckling a child of her own, this woman consented to give the breast 
to a little girl who had her Ups ulcerated and coyered with mucous 
patches. 

Ulcers soon appeared around the nipple of the nurse, and a physician 
who saw her at that time gave her a certificate to the effect that she had 
contracted the disease from the child. She was then subjected to mer- 
curial treatment. The disease appeared to remain dormant for two years 
and then broke out again with great intensity ; there appeared mucous 
patches, ulcers upon the legs, then rupia the indelible traces of which are 
still to be seen. She had osteocopic pains. 

The patient then determined to undergo a Aresh treatment; Van 
Swieten's drops and iodide of potassium, without giving much relief to 
her pains, contributed to the cicatrisation of the ulcers. 

On admission into the Clinical Hospital, she took iodide of potassium 
and anti-spasmodics. In the evening, there was increased dyspnoea. On 
the 2nd, the patient could not breathe except in a sitting posture, the 
apices of the lungs dilating with force ; the pulsations of the heart were 
more violent and rapid. On the 3rd, these symptoms were still more 
marked ; the same treatment was continued. On the 4th, the oppression 
was very great, the face bluish. Symptoms of asphyxia were observed, 
which carried off the patient at 8 p.m. 

Post-mortem examination, thirty-six hours after death. — There was no- 
thing peculiar about the heart, the brain, or the abdomen ; the lungs alone 
were the seat of the lesions which had caused death ; the trachea was 
filled with a frothy fluid, but its mucous membrane did not present any 
redness or ulceration. On making an incision posteriorly into the bron- 
chial ramifications of the lower lobes, these were seen to be surrounded 
by an indurated mass of a bluish grey colour, having a certain analogy to 
green sea marble. This colour was deeper on the left side than on the- 
right. This indurated mass had replaced the pulmonary parenchyma 
which separates the air-tubes from each other. It fpresented great re- 
sistance to pressure, and might have been taken for a periostosis ; the 
rest of the lung was soft to the touch, elastic, yielding under the finger ; 
it was slightly reddish, though much congested. There was no trace 
of tubercle, either at the apex or base, or in any part of the body. The 
bronchial glands were black and indurated, without any tendency to sup- 
puration ; the bronchial filaments of the pneumogastric nerves, on each 
side, entered the indurated tissue, which rendered dissection of them 
almost impossible (Vidal de Cassis, TraitS det maladies vSneriennes, 2* 
edit., 1855). 

With this case, in which the diflfused form of the syphilitic change 
in the lungs cannot be contested, we shall compare two others 
already published by us in the Gazette Hebdomadaire, These cases, 
which are adapted to enlighten us concerning the most advanced 
phases of circumscribed lesions, will find their complement in the 
very interesting case given by Cornil. This case is, in fact, an ex- 



PERIOD OF GUMMY PRODUCTS. 27 

eellent example of these same lesions in the first period of their 
development. 

Probable syphilitic antecedents in the father. — Arrested development of the 
genital organs: peculiar conformation of the teeth and nose, — Osteocopic 
pains, alopecia, angina, deafness ; absence of menstruation, haemoptysis, 
signs of cavities in the lung. ^—Post-mortem examination. — Cavities in right 
lung, with pneumonia in neighbourhood of them ; cicatrices in the liver. 

Obs. XLIII. — Louisa R., st 41, laundress, related that her father had 
been the subject of ^ seyere disease which, so far as she had heard, was 
a syphilitic affection ; he was ill shortly before her birth, and she does not 
doubt that he was the cause of the various sufferings she has undergone 
from an early age ; she remembers that he had violent pains in one of 
his knees. Her mother was afflicted for seven years with pains in the legs 
and right arm successively ; she was afterwards seized vnth cholera, and 
finally died in 1852, after having had oedema of the lower extremities for 
a year. Of twelve children whom her parents had, only three survived, 
all the others died before the age of 3 or 4 years, but without the 
patient's being able to tell us what was the matter with them. As regards 
herself, this is what she told us : she does not know whether she had 
convulsions in infancy, but she relates that, from 8 to 11 years of age, 
she had pain in the eyes and became almost blind ; she afterwards had 
affections of the throat and her voice became so much changed as to be 
almost entirely lost. At 14, she was seized with deafness which partly 
disappeared, then returned and persisted. About this same period, attempts 
were made to produce menstruation, but in vain. At 18, she was taken with 
a slow fever, which gradually exhausted her. It appears that she was then 
advised to marry, but refused. At 22, she had intense pains in the head, 
vrith falling off of the hair. After that, until she attained her 38th year, 
she enjoyed tolerable health, suffering frequently from her stomach, and 
sometimes from vertigo, but never from convulsions or loss of conscious- 
ness. In April, 1859, she was seized with pleurisy ; she soon resumed 
her work, but on the 22nd of June found herself obliged to enter the 
hospitaL She then complained of pains in the dorsal region, and some 
days after, had haemoptysis ; this symptom recurred towards the end of 
the year and in the beginning of 1860. 

To get herself treated, this interesting patient was obliged to go into 
several hospitals. From February 18th to June 15th, 1860, her health 
was pretty good, but then copious haemoptysis supervened ; she believes 
that she spat up nearly a quart of blood in twenty-four hours. In 
October, she entered the Hospital de la Piti§, under the care of M. Marotte. 
It was then that I had an opportunity of examining her. 

She was a woman of small stature and little development. Her breasts 
were like those of a young girl before the age of puberty ; the mons 
veneris was completely devoid of hair, the vagina scarcely allowed of 
the introduction of the little finger; the hymen sci^Cpely existed, but 
there were no signs of tearing. Her voice was hoarse and snuffling ; her 



28 ACQUIRED SYPHILIS. 

teeth were small and notched ; her nose flattened towards the base ; her 
head almost bald ; she was pale without emaciation. Recent haemoptysis 
and the vomiting of food and medicine (cod-liver oil which she takes 
largely) were the reasons which had induced her to come into hospital this 
time. She complained, further, of pain in the shoulder and right arm, 
and of oppression in the region of the stomach. She was so deaf that I 
was obliged to write my questions to obtain an answer. Examination of 
her ears did not reveal any change. 

On examining her chest, I discovered at the upper and inner part of the 
breast, over an extent of several centimeters, the existence of a dull 
sound ; in this same region and towards the axilla* was heard a soft, 
jerking murmur, very different to the bronchial murmur ; a little lower, 
this murmur assumed a hollow character ; from time to time, and especially 
during efforts to cough, or to take a deep inspiration, sub-crepitant or 
cavernous r&les were heard. Posteriorly, the same phenomena more 
deeply seated. The left long was everywere intact There was frequent, 
hacking cough, with abundant and often bloody expectoration. The 
heart was healthy ; the spleen, the liver and the kidneys did not appear 
to be diseased. There was no want of intelligence, but it was easy to see 
that the patient had almost entirely lost the sense of smell. This condition 
has existed for ten years, if her account is to be believed. During that 
period, in fact, this patient has always remained stuffed up. She has 
little appetite and almost constant gastric derangements ; fever at times, 
with paroxysms towards evening. — She was ordered a flying blister and 
emollient drinks. — Her condition remained the same, her appetite small, 
and the emaciation increased, but her face, although very pale, was full 
and, as it were, puffy. The months of November and December passed 
without change, the haemoptysis recurred several times and the patient 
went out in January. 

On the 9th of March, she requested me to admit her again ; she was 
placed under the care of M. Gendrin. The emaciation has increased since 
she went out; the cough still continued and the expectoration was 
generally bloody. There existed in front, on the right side of the chest, a 
cavernous murmur which began to be heard at two or three fingers' 
breadth below the clavicle ; the same murmur was heard behind over a 
considerable extent of surface ; there was dulness on percussion at these 
points^ and mucous r&les sometimes very large. The left lung did not 
present anything abnormal. The liver projected beyond the edge of the 
ribs ; the heart was intact The fever, moderate at first, increased in in- 
tensity ; some days afterwards, the appetite became null, and there was 
diarrhoea ; the emaciation increased. The patient became more and 
more exhausted, fell into a state of marasmus, and succumbed March 
20th, 1861. 

Post-mortem examination, — The external examination of the body 
showed nothing remarkable except slight cedema of the lower extremities. 
The brain did not appear to be changed either in form or structure ; the 
nerves arising from it were healthy. The organs of the senses could not 
be examined, as we were requested not to disfigure the body. 



tEBIOD OF GUMMY PRODUCTS. 29 

Thor(%cic cavity, — The left lung was intact, or merely oedematous. In 
the right, on the contrary, was found an ulceration which occupied all the 
three*lohe8 ; the upper and lower lobes, however, were not invaded in their 
whole extent ; at its apex, the upper lobe was still somewhat crepitant, 
but lower down this same lobe was indurated ; several cavities were found 
iu it. Analogous cavities were met with in the middle lobe, and in the 
upper part of the lower lobe, separated from each other by septa which 
were frequently incomplete, or by fibrous bands of greater or less extent • 
the largest of these cavities might contain a pigeon*s-egg ; their walls 
were perfectly smooth and polished ; they were situated in the midst of 
a greyish tissue, which was firm and resistent 'to pressure, and not easily 
either broken up or torn. Nowhere was the least trace of tubercle found, 
and these cavities cut out of the indurated tissue sufficiently showed, 
moreover, that it was not a question of tuberculisation, but one of chronic 
induration of the tissue of the lung. 

Abdominal cavity. — The liver, larger than in the normal condition, pro- 
jected beyond the false ribs ; in colour it resembled a nutmeg; numerous 
yellow spots, slightly irregular, were seen on its surface, upon a brownish 
ground. Glisson*8 capsule, thickened in the vicinity of the suspensory 
ligament, adhered more or less closely to the diaphragm at several points. 
On the convex surface appeared deep furrows running in various direc- 
tions and presenting around them a thickening of the capsule ; the lips of 
these furrows were united by bands of conjunctive tissue ; the same change 
was met with again on the concave surface. Fibrous bundles lined the 
floor of these furrows ; beneath them, the parenchyma of the liver was 
little changed, the cells were granular and atrophied ; in the rest of the 
liver, there were a thickening of the fibrous web and abundant fatty 
granulations in the interior of the cells. The spleen and thyroid body 
were enlarged and somewhat indurated. 

The kidneys were healthy, the ovaries and uterus not more developed 
than in a young girl of 8 or 10 years. The ovaries, in a rudimentary 
state, did not contain any Graafian vesicles ; the uterus was compara- 
tively very small, the mons veneris extremely smooth. Menstruation 
had never taken place, and everything led to the belief that she had 
never had sexual intercourse ; this was, moreover, almost impossible, on 
account of the extreme narrowness of the vulva and vagina. 

The reality of the syphilitic affection here might be disputed ; but 
the information furnished by the patient, and that on several occa- 
sions, the premature death of most of her brothers and sisters, the 
arrest of development which she presented, the peculiar condition of 
her dental system, and the falling off of the hair without appreciable 
cause, as well as the characters of the lesions met with at the post- 
mortem examination, are, in our opinion, so many proofs in favour 
of syphilitic disease, and, moreover, how else could one account for 
the numerous symptoms presented by this woman from her birth 
until the moment of her death ? 



30 ACQUIRED SYPHILIS. 

Syphilis once admitted^ is it not reasonable to suppose that the 
pecoliar change in the lung as well as the hepatic lesion were a direct 
effect of that disease ? 

The slow evolution of the pulmonary affection, its localisation in 
a single lobe, with integrity of the apices of both lungs, the special 
changes in the iris and in one of the testicles, and the exostosis 
upon the tibia : such are the various circumstances which led us to 
admit, in the following case, the existence of a pulmonary manifesta- 
tion of syphilitic origin. Let us add that the anatomical condition 
of the blood glands also tended to strengthen this diagnosis. 



Gonorrhcaa and c?Mncre, iritis, hyperostosis of the tibia ; phenomena very 
similar to those of general paralysis. — Wasting, cachexia, — Death, — Slight 
change in the cerebral substance ; chronic pneumonia and gummy tumours 
in the lung ; pigmentary choroiditis, periorchitis. 

Obs. XLIV. — T., set. 42, entered the Hospital de la Piti6, January 17th, 
1851. He was a tall, robust, fair man, and the only diseases he had had 
formerly consisted in a gonorrhcea and a chancre. He did not remember 
to have had any symptoms upon the skin or mucous membranes. Some 
years ago, he was seized with pain in one of his eyes ; examination of that 
eye showed sufficiently that he must have suffered from iritis, as evident 
traces of that affection remained : deformity of the pupil, and adhesions 
to the neighbouring parts. In the groin were found several small, isolated, 
hard and movable glands, but no cicatrix nor trace of buboes. The look 
was dull and fixed, the sight weak, the speech embarrassed and slow ; his 
walk unsteady and difficult; he could not remain long in an upright posi- 
tion ; his lower extremities were feeble and (edematous, but the urine did 
not contain any albumen. The right tibia was the seat of a hyperostosis ; 
the skin was smooth, pale, and thin. There was slight cough, with little 
or no expectoration, dulness on percussion two fingers' breadth beneath 
the spine of the left scapula, absence of vesicular murmur, and a slight 
blowing sound in the same neighbourhood ; there were resonance and 
normal respiration on the other side. The heart acted regularly and did 
not appear changed ; the liver and spleen were normal. The appetite was 
small ; there had been emaciation for some time, and his strength was 
failing from day to day. There was no fever. — He was ordered Van 
Swieten's drops. 

After a few days the embarrassment in his speech appeared to diminish 
as well as the weakness of his memory and intellectual faculties, he 
reasoned and answered questions more clearly. Ten days after, he had 
diarrhoda, a white tongue, anorexia, and slight fever. His medicine was 
stopped, he was dieted and took opium pills. The diarrhoea ceased, but 
the oedema of the lower extremities increased and reached the abdomen. 
Towards the end of February, the patient complained of more oppression ; 



PERIOD OF GUMMY PRODUCTS. 31 

he coughed frequently and had purulent expectoration streaked with 
blood, very analogous to that of phthisis ; his breath was fcetid and re- 
pulsive, there were large mucous r&les in the posterior part of the left 
long, commencing from the spine of the scapula, a murmur not well 
marked, slight dulness on percussion, and want of elasticity. The exist- 
ence of these signs towards the middle and lower part of a lung, especially 
when its summit and the lung of the opposite side were intact, and the 
concomitance of evident syphilitic manifestations, led us to believe that 
it might be a syphilitic affection of the lung. Unfortunately, the wasting 
of the patient and the advanced state of cachexia in which he was, ren- 
dered impossible any specific treatment. The oppression, the cough, and 
the expectoration continued ; a febrile condition with evening paroxysms 
supervened, the wasting made progress, and death occurred March 15th, 
1861. 

The post-mortem examination was made forty-eight hours after death. 
— The abdominal walls were slightly greenish ; there was oedema of the 
lower extremities, scrotum, and walls of the abdomen. The peritoneal 
cavity contained a little serum ; there was slight hyperostosis of the right 
tibia. 

Head, — ^There was very little hair upon the head, the cranium was 
normal, the meninges intact, the brain soft in places, there were brownish 
or yellowish granulations in the course of the vessels of the grey sub- 
stance and also some granular bodies. On the left side, the iris was 
covered with a whitish exudation and adhered to the crystalline lens, the 
pupil was deformed, there were exudative and pigmentary choroiditis, 
and some granulations in the course of the vessels of the retina. 

Thorfix, — There were adhesions between the right lung and wall of the 
chest and oedema at the base of that organ, which was otherwise healthy. 
The lower lobe of the left lung adhered closely, by means of thick false 
membranes, to the thorax and diaphragm. Two small softened tumours 
were found at the point of adhesion to the diaphragm. On section 
throughout its whole extent, this lobe, which was remarkably indurated, 
presented three large anfractuous cavities filled with a white granular or 
caseous matter ; hollowed out of the parenchyma of the lung, these 
cavities were lined with a layer of pultaceous matter, which did not differ 
from their caseous contents. The tissue of the lung was extremely hard 
in the vicinity of these cavities ; it presented, when cut, a smooth, grey- 
ish, marbled surface, resistent like India-rubber, and impenetrable by the 
finger ; the bronchi terminating in these cavities had their mucous mem- 
brane thickened, wrinkled, red, and granular. The upper lobe was not 
changed, but merely oedematous, and did not present the least trace of 
tubercle ; some of the bronchial glands were indurated, blackish, and 
smooth on section. The heart was normal. 

Abdomen. — The liver was not changed ; the kidneys presented, on their 
surface, some cicatricial furrows, but were otherwise healthy. — The two 
layers of the tunica vaginalis adhered to each other ; there was thicken- 
ing in patches of the tunica albuginea ; the substance of the testicles was 
yellowish and atrophied. The spleen and thyroid body were enlarged. 



32 ACQUIRED SYPHILIS. 

Some of the prevertebral glands, larger and softer than natural, presented, 
on section, a pink or yellowish colour (medullary aspect). 

In reference to the preceding cases, it is possible to bring for- 
ward a certain number of facts adapted to show the advantages 
which may be obtained by an appropriate treatment, under circum- 
stances apparently very serious, in which there was ground for sus- 
pecting syphilis. 

BrambiUa gives in his treatise on Phlegmon the following example 
which Swediaur and several other authors have thought it advisable 
to reproduce : — " An electuary was ordered for a phthisical patient 
whose condition was desperate ; by a mistake of the apothecary, the 
electuary was given to a venereal patient to rub himself with, and 
the phthisical patient received mercurial ointment, instead of the 
electuary, to take internally. The latter, not thinking anything was 
wrong, took of this ointment about as much as a nutmeg in size, 
two or three times a day, and was radically cured of his disease, to 
the great astonishment of his physician, who afterwards learnt acci- 
dentally from the apothecary how the thing had come about.'' * 

Swediaur {loc. cit. p. 169) also relates that Professor Prank cured 
radically, by a mercurial treatment, a case of phthisis accompanied 
by spitting of blood, purulent expectoration, and the most extreme 
emaciation. This is probably the case which J. Prank gives in a 
note to his Patholoffie interne (t. iv. p. 267). I find, he tells us, 
in my father's papers the following report: — "Ann. 1785, virum 
placentinum caravi, qui herpete venereo ad perinaeum laborans, simul 
ad pectus dextrum, de dolore conquerebatur, et post prsegressa jam 
sputa sanguinis, cumque febri lenta et emaciatione, sputabat exigua 
sputa purulenta cum punctis sanguineis ssepe remixta. Credidi 
eamdem herpeticam materiem pulmones exedere in parva licet super- 
ficie ; neque huic causae est multum puris fundere, sed in supei^cie 
potuis divagari amat. Curam mercurialem adhibui, et sputa et 
dolores pectoris plurimum diminuebantur, febris lenta disparuit suc- 
cessive et vires et naturalis forma emaciate corpori satis bene iterum 
restituebantur." 

Bichard Morton and Hoffmann have each seen a very analogous 
case. Amongst the numerous cases contained in Lagneau's thesis,t 

* Brambilla, TraUe du phlegmon, Swediaur, MaL syph, Paris, 1801, 
ch. xviii. p. 398. 
t Thhe cit, Obs. XXXIX. and XLI V. One of these observations, first 



PERIOD OF GUMMY PRODUCTS. 33 

there are two, rather incomplete it is true, but the symptoms of 
which, while thej had more than one point of resemblance to those 
of chronic pneumonia, appeared to be favourably influenced by a 
specific treatment. 

Leudet has given the case of a man of 35, who presented great 
emaciation, cough, dyspnoea on the least exertion, and slight frothy 
expectoration, in whom he found, together with Professors GrisoUe 
and Yelpeau, a slight dulness at the left apex, with harsh inspiration 
and prolonged expiration, and bronchophony without rales. Sub- 
mitted to a treatment with iodide of potassium, mercurial pills, and 
sulphur baths, this patient, who had at the same time syphilitic 
disease in the testicle, became cured in a few months ; the slightly 
changed voice regained its usual tone, the dyspnoea and cough dis- 
appeared, and there was a complete return of respiration at the apex 
of the left lung. The waters of Bagn^res-de-Luchon completed the 
cure ; the patient there regained his strength and flesh. 

Eecently, one of our teachers. Dr. Gubler, related to me the 
following interesting case : — " A pretty robust man, long rendered 
uneasy by a chest affection which he could not get cured, went to 
London for the purpose of being treated by a charlatan there. 
Having exhausted his resources, he returned worse than he went. 
He entered the Beaujon Hospital under my care, and I found large 
r^Qes and a kind of rumbling sound towards the apices of the lungs. 
Thinking there might be tubercular cavities, I gave an unfavourable 
prognosis ; things were at this point when I observed a syphilide 
which, according to the patient's account, was of the same date as 
the pulmonary affection. I gladly took advantage of this indication 
to administer iodide of potassium and was fortunate enough to see 
all the symptoms disappear with a rapidity which was truly sur- 
prising. The patient soon after regained his flesh. In tliis case, 
adds the learned physician of the Beaujon Hospital, the modification 
of the physical signs was too prompt to admit of a belief in the cica- 
trisation of cavities ; I am rather inclined to think that there was 
an induration of the lung which conducted the r&les produced in 
the bronchi.^' 



inserted in the Journ, de med,, 1826, t. xov., is related in the AnnaUs de la 
mid. phj/stoL de Broussaisy t. \ii, p, 576, as Pneumonie chrontque reputie 
venSrtenne : the other is taken from W. Munk's paper, Lond, Med, Ga%,, 
1849. 

d 



34 ACQUIBBD SYPHILIS. 

To these cases it would be easy for me to add several observed by 
myself and in which the syphilitic nature of the pulmonary affection 
did not appear less evident. But I shall content myself with giving 
the two following : — 

Obs. XLV. — Q., St 24, a flower-girl, entered the Hospital de la Piti6, 
May 23rd, 1861. She was a tall and strong woman. Two years ago, slie 
was seized with angina, which did not last less than two months ; she had 
formerly had two children, who had died in convulsions soon after hirth. 
On admission, there were partial destruction of the velum palati, cica- 
tricial depressions at the roots of the hair, and an elongated and whitish 
cicatrix in the vicinity of the right stemo-clavicular articulation. For 
two months, this patient has had shortness of breath, pains in the sides, 
dyspnoea, and a harsh cough, accompanied by an expectoration consist- 
ing of a clear fluid which contains yellowish grumous matter. Percus- 
sion gives a marked dull sound in the neighbourhood of the supra-spinal 
fossa and auscultation shows a decrease of the vesicular murmur at that 
point. There is heard, moreover, in the other portions of the lungs a 
laryngo-tracheal whistling which masks the vesicular murmur. She was 
ordered to take Van Swieten*s drops. Under the influence of this treat- 
ment, continued for more than a month, the cough diminished, the expec- 
toration and the dulness disappeared, and the breathing appeared to have 
returned to the normal condition. This patient left the hospital, June 
16th, in a state of almost complete cure. Apart from the change in the 
lung, shown here by the dulness and altered breathing, we may fairly 
ask, considering the existence of the tracheal whistling, whether the 
trachea or one of the bronchi was not diseased ? 

Obs. XL VI. — In the course of the month of April, 1861, I was called 
npon to examine a robust and well-formed man who had not in his family 
any tubercular antecedents. This man mentioned, as previous affections, 
a chancre, throat affections, and a very slight eruption. Apart from these 
symptoms, he had always enjoyed good health until the preceding January, 
when he had cough, difficulty of breathing, loss of strength, and emacia- 
tion. After having experienced several attacks of haemoptysis, he now 
had abundant, thick, yellowish expectoration. There was decreased re- 
sonance on the right side beneath and around the spine of the scapula, 
normal on the left side. In a large extent of the upper lobe of the right 
lung was heard a somewhat hollow murmur and rales, phenomena which 
induced me to diagnose the existence of a cavity. On the left side, the 
breathing was rough and exaggerated, without appreciable abnormal 
sounds. This patient was emaciated ; he had a yellowish, earthy colour ; 
his strength was failing day by day ; he had shortness of breath and 
dyspnoea and presented, at the same time, at the lower end of the left 
humerus, a hyperostosis which had almost the size of the fists of an adult, 
so that flexion of the fore-arm upon the arm could only be effected par- 
tially, although the articular surfaces had remained intact This last 



PBKIOD OF GUMMY PRODUCTS. 35 

affection, as to the origii^of which I could not entertain the least doubt, 
induced me to prescribe the syrup of the iodide of iron. The patient left 
for the country, and later on, when his health was a little improved, I 
gave him iodide of potassium. At the end of a year, the lower end of the 
humerus had regained its normal size, and the movements of the fore- 
arm upon the arm were free ; in the chest I found a marked improvement, 
there existed only a weakness of respiration and some r&les on the right 
side, without any appreciable murmur. The cough was less frequent and 
the expectoration idmost dried up. Struck with such a result and ob- 
serving the complete disappearance of the hyperostosis, I requested my 
patient to continue the treatment I had ordered him in the first instance, 
when he told me that he had never employed it. This assertion was in no 
way opposed to my diagnosis. I don't know, indeed, whether he told me 
the truth, but some time after his brother came to tell me that he had been 
seized with hemiplegia. Treated by ordinary means, this affection never- 
theless became ameliorated, but later on, another attack carried off the 
patient rapidly. 

Although wanting in anatomical verification^ these cases^ what- 
ever may be the value thought proper to assign to them, will 
serve at the very least to direct the attention of observers to 
syphilitic affections of the organs of respiration.* If they had no 
other advantage, we believe that they were not devoid of utility, for 
it is important to know that chronic lesions of the lungs, like those 
of the other viscera, are most frequently dependent upon a vice of 
the constitution. 

Abticle Vin. — ^Appaeatus op Inneevatign. 

Ulrich de Hutten, Paracelse. See Aphrodisiacus de Gruner, pp. 130 and 
134, pointing out the existence of syphilitic paralysis. Thierry de Siry^ 
La m^thode curatoire de la maladie v^nerienne. Paris, 1552. Van 
Swietefiy Comment, in Boerhavii Aphorismos, 1773. Prosty M^decine 
eclair^e par I'ouverture des corps, t. ii. p. 59. Paris, 1804. Lallemand, 
Recherch. anat. pathol. sur Tencgphale. Paris, 1830. Duhamel et 
Legrandy Recherches sur les d^sordres que le virus syphilitique pent 



* Professor Gintrac, of Bordeaux (see Ga%, hehd, de mSdecine et de 
chirurgie, p. 600. Paris, 1867), has recently communicated to the Medical 
Society of the hospitals of that city a case of syphilitic phthisis closely 
analogous to our own cases. Facts of this nature are, therefore, not very 
rare, and there is every reason to think that they will he observed still 
more frequently if attention be directed more especially to them. Consult 
Hermann Weber, Syphilitic disease in the liver, lungs, bronchial glands, 
dura mater, cranium, and sternum. Transactions of the Pathological Society 
of London, t. xviL p. 152. 

d2 



36 ACQUIRED SYPHILIS. 

causer sur le cerveau, Joum, de conn, mid.-chir,, 1835, p. 448. Ch. Bell, 
The nervous system of the human body, with an appendix of cases and 
consultations on nervous diseases. London, 1836. Buddy Cases of apo- 
plexy consequent upon syphilis. London Med, Oaz., 1842. JEbrard, 
N6vroses syphilitiques. Gaz. Mid. de Paris, 1843. Bayer, La Syphilis 
c6r§brale ou m§ningienne. Annales de thirapeutique, t. v., 1847-1848. 
Schutzenherger, Syphilis simulant les troubles enc^phaliques. Oaz, Med. 
de Strasbourg, 1850, p. 708. Bedel, Syphilis c§rebrale. Thdse de Stras- 
bourg, 1851. Lucas Champonniire, Joum. de mid, et de chirurg, pratiques, 
1851. Yvaren, Des metamorphoses de la syphilis, 1854; et Des lesions 
cer^brales li§es k la syphilis. Gaz. mid. de Lyon, 1858, No. 20. Faures, 
Gaz. hebd., 1855. Hildenbrandt, De la syphilis dans ses rapports avec 
Tali^nation mentale. Thdse de Strasbourg, 1859. Fr. Both, Syphilitische 
Gummageschwulst der harten Hirnhaut, aus der Klinik von Prof. Bam- 
berger. Aerzlich. Intellig.-BL, No. 37, 1859. Th. Munch, Hemiplegia 
syphilitica, aus Traube's Klinik, in Deutsche Klinik, No. 47, 1859. Gust, 
Bremme, De paralysi centrali syphilidem secuta, casus singularis, descrip- 
tione illustrata. Berlin, 1859. JE. L. Bertheraud, Recherches sur les 
n^vroses syphilitiques. Bruxelles, 1860. G. Lagneau, Maladies syphi- 
litiques du systdme nerveux. Paris, 1860. Griesinger, in Archiv der 
Heilkunde, 1860. Le Gros et Lancereaux, Des affections nerveuses syphi- 
litiques. Paris, 1861. L. Meyer, Allgem. Zeitschrift fur Psych., xviii. p. 
287, 1861. Tiingel, Chronische Gehirnkrankheit mit Beziehung zu con- 
stitutionell. Syphilis, in klinisch. Mittheilungen, &c., p. 89. Hamburg, 
1861. See also, ibid., Constit. Syphilis, p. 39, 1859. Ladreit de la 
Charriire, Des paralysies syphilitiques. Thdse de Paris, 1861, No. 569. 
Leubuscher and Henoch, Comm. a la Soci6t6 de medecine de Berlin sur les 
affections syphilitiques du system e nerveux. Deutsche Klinik, No. 6, 
1861, et Gaz. hebd., p. 268, meme annee. Jackson, Med. Times and Gaz., 
June 22nd, p. 648, 1861. A. Zambaco, Des affections nerveuses syphiliti- 
ques. Paris, 1862. Sonrel, Sur les paralysies syphilitiques. Th^se de 
Strasbourg, 1862. Goodwin, Syphilitic affection of the brain. The Lancet, 
July 19th, 1862. Bussell, Med. Times and Gaz., February 8th, 1862. 
Duncan, Cases of syphilitic insanity and epilepsy. Dublin Quarterly 
Joum., Feb. and May, 1868, Vol. XXV. JE. Wagner, Das Syphilom des 
Nervensystems. Archiv der Heilk., t. iv. p. 161, 1863. Schupp, Chronlsch. 
Hirnkrank. mit Beziehung zu constitutionell. Syphilis. Deutsche Klinik, 
22 and 23, 1863. S. Wilks, On the syphilitic affections of internal organs. 
Guy*s Hosp. BeportSy 3rd series, ix. p. 1, 1863. Westphal, Zwei Falle von 
Syphilis des Gehirus, Allgem. Zeitschrift fur Psychiatric, xx. 5 and 6, 
p. 481. Bussell, Syphilitic affections of the nervous system, Med. Times and 
Gaz., October 17th, 1864. Th. Beade, Tertiary Syphilis, in Dublin Joum., 
xxxvi. p. 324, Leven, Gaz. mSd. de Paris, 1864. Lancer eaux,^XM^e^ sur 
les lesions visc6rales syphilitiques. Gaz. hebd., 1864. Jaksch, Ueber 
Syphilis iunerer Organe. Prager med. Wochenschrift, t. i. 1864; et Sch. 
Jahrb., t. cxxii. p. 298. Max. Leidesdorf, Ueber Gehirnsyphilis. Wien, | 

Ztschr, med. Jahrb., xx. 2, p. 112, 1864. E. Winge, Meningitis spinalis 
gummosa, Norsk. Magazin, xviii. 1, p. 84. J 

I 



PERIOD OF GUMMY PRODUCTS. 37 

The syphilitic affections of the nervous system were not alto- 
gether unknown to the earliest syphilographers (Ulrich de Hutten^ 
Paracelsus, &c.), and already in the sixteenth century we meet with 
some observations concerning these manifestations. Nicolas Massa* 
relates a case of syphilitic mania which appears to have been con- 
nected above all with intense osteocopic pains. " A young man of 
25 had an impure connection ; he had deep ulcers^ accompanied by 
pustnles disseminated over the whole body. Every evening, at sun- 
set, he felt very intense pains in the head, the severity of which, 
reaching the ventricles of the brain, produced attacks of acute 
mania. This young man recovered completely under the use of 
some mild purgative remedies, Indian pills,'' &c. 

Thierry de Hery proved, as early as 1634, that syphilis may pro- 
duce nervous affections ; he quotes spasm and states that he treated 
a man suffering from epilepsy and syphilis by remedies adapted to 
the latter disease, and that this man was freed &om both his evils.f 

The celebrated work of Astruc contains numerous passages rela- 
tive to syphilitic lesions of the cerebro-spinal apparatus. Almost 
all the encephalic disorders are pointed out in it : hemicrania, ver- 
tigo, convulsions, epilepsy, paralysis, sciatica, insomnia, &c. ; but, 
unfortunately, Astruc confines himself to assertions only too vague, 
without occupymg himself more minutely with the characters proper 
to each of these manifestations. 

"We read in Van Swieten : J '* Saepe observantur cerebri Isesiones 
in lue venerea inveterata, a levissima vertigine ad lethalem apo- 
plexiam usque; pessimam epilepsiam, csecitatem, surditatem, &c. 
Vidi in lue venerea inveterata, quae tunc media ossa occupare solet, 
praecipue in cranio.*' That author regards syphilitic cerebral de- 
rangements as indirect or consecutive rather than primary. Benj. 
Bell § gives cases of syphiUtic epilepsy and mania which are full of 
interest. CiriUo || also thinks that epilepsy may be syphilitic, and 
brings in support of this view the case of a soldier affected there- 



* De morho gallico Hher, cap. vii. Aphrodisiacus^ p. 56. 

t Mith, curat, &c., p. 15. 

X Commentaria in H, Boerhavii Aphorismos. Paris, 1773, t. v. p. 371. 

§ Traits de la gonorrhie virulente et de la maladie vinSriennef t. ii. Paris, 
1802. 

II Traits complet 8ur les maladies venSriennea, trad. fran^. de Auber. 
Paris, 1803. 



38 ACQUIRED SYPHILIS. 

with. J. Frank, Maisonneuve^ Lagneau, Lallemand and Baum^s, 
point out the existence of cerebral derangements connected with 
syphilis, and more particularly epilepsy. Bicord, CuUerier, and 
Vidal, have seen and reported cases of like nature, with post-mortem 
examinations. Bayer, Beau, Briquet and Gu^rard {Ann. de thSrap. 
de Bognetta), Trousseau apd Pidoux, Schutzenberger, Tvaren, and 
several other authors have also left interesting observations on this 
subject. 

Most of these cases have been given in the treatises of G. Lag- 
neau and Gros and Lancereaux. Virchow, Wilks, Meyer, Tiingel, 
Ladreit de la Gharri^re, Zambaco, the author of this work, and 
several others, have added fresh observations to the history of syphilis 
of the nervous system. 

It is by the aid of these materials that we are about to attempt 
to trace successively the anatomical and semeiological characters of 
the affections of the nerve coverings, centres, and cords. 

§ 1. Affections of the coverings of the brain. — Syphilitic mening- 

qpathies. 

Anatomical Study. 

The dura mater is, of all the coverings of the brain, the one 
which most frequently undergoes the attacks of syphilis. Of the 
changes met with in it some are diffused and analogous to chronic 
pachymeningitis, others circumscribed and resembUng gummy 
tumours ; these two forms most frequently coexist. It also happens 
that the soft meninges, or even the encephaUc substance, and per- 
haps also the hones of the cranium, participate in the syphilitic pro- 
cess, and then the dura mater is found firmly united to the sub- 
jacent coverings by means of a yellowish substance, which sometimes 
penetrates as far as the nervous substance. 

Syphilitic pachymeningitis is external or internal according as one 
or other of the two layers of the dura mater is more particularly 
affected. External pachymeningitis (endocranitis) is most commonly 
accompanied by osseous lesions (thickening or atrophy, osteophytes). 
Internal pachymeningitis coincides rather with changes in the pia 
mater and brain. Numerous cases bear witness to the existence of 
this double manifestaticm. Bhodius ^ gives the history of a peasant 

* Nouvelle BihL mid., February, 1823. L. Gros et Lancereaux, he, cit, 
p. 252. 



PERIOD OF GUMMT PRODUCTS. 39 

affected with syphilis, in whose dura mater he discovered three soUd 
white concretions. In a case observed by Bayle and Kergaradec^* 
there existed beneath the dura mater^ which adhered to the bones of 
the cranium^ four hard tumours^ each of which was as large as a 
nut ; the pia mater and arachnoid were thickened, indurated^ and 
injected^ and the cerebral substance changed at several points. Bayer 
has given the following case : — 

A man 40 years of age, of vigorous constitution, was the subject of 
ulcers situated upon the velum palati and of sypliilitic ozoana ; he had 
osteocopic pains in the head and limbs, vertigo, weakness of the limbs, 
and deafness on the right side. He was afterwards seized with violent 
epileptiform convulsions, his fever increased, and he had coma soon 
followed by death. 

Post-mortem examination,— The membranes covering the right hemi- 
sphere were lardaceous, and adherent to each other and to the brain, 
chiefly towards the base. In the middle fossa, on the right side, there 
existed a tumour the size of a pigeon's-egg, closely adherent to the bone 
lardaceous, evidently formed of plastic lymph, and analogous, in all re- 
spects, to a gummy tumour ; the brain was softened at all the points 
where adhesions existed ; there were no apoplectic clots ; the portion of 
bone upon which the tumour rested was denuded and wrinkled. 

In a case of Sanson's, quoted by Lallemand^f the cranium was 
thickened, the dura mater friable in the vicinity of the anterior por- 
tion of the left hemisphere of the brain ; beneath^ there Was a trilo- 
bate schirrhous tumour, of the size of a small nut^ of a somewhat 
yellowish, greyish white colour, continuous with the dura mater by 
its external surface, and with the white substance of the brain by 
its inner surface, and possessed of considerable vascularity. 

In an analogous case, Yirchow has seen consecutive obHteration 
of the cerebral carotid J rapidly followed by blindness and after- 
wards by softening of the bra\n. We are indebted to Meyer for 



* Centur. i., Obs. XXXIII., Citation de W. James. Dictionnaire univ. 
de mid, t, iv. p. 978| trad. fran^. de Diderot, &c. Paris, 1847. 

t JRecherches anat, pathol, sur rencSphale, lettre vii. No. 2. 

X Boning, Deutsche KUnik, 1861, No. 43, and Passavant, Virchow's 
Archiv, t, xzv. p. 171, have seen, the one the internal carotid and artery 
of Silvius, the other the basilar artery similarly changed. In a case 
observed by Grafe, Archiv fur Ophthalmol, 1860, t. vii. p. 34, several 
vessels at the base of the brain were obliterated by the pressure from a 
large tumour. 



40 ACQUIRED SYPHILIS. 

several observations relative to the lesions witt which we are now 
occupied. Some of these, it is true, were doubtful as regards their 
syphilitic origin ; but the following one, however, leaves little to be 
desired : 

G, H. had, first of all, several epileptiform attacks, then persistent 
cephalalgia and vertigo, then incomplete hemiplegia on tlie right 
side, with difficulty of speech ; lastly, delirium and coma, trembling, 
jactitation and death. 

The external surface of the dura mater, in the neighbourhood of 
the left anterior lobe, was thickened, rough, wrinkled and injected ; 
the internal layer adhered to the brain over an extent of about three 
square inches, by means of a deposit of fibroid tissue, in which 
were found three dense, opaque, and whitish fibrinous masses ; these 
masses, which were of the size of a small nut, penetrated partly 
into the brain, the grey substance of which was no longer recog- 
nisable ; in the left corpus striatum there was a cyst as large as a 
small nut, evidently of apoplectic origin; the anterior half of the 
right corpus striatum was congested and softened ; there was an old 
thrombosis of the left internal carotid ; also, cicatrices and gummy 
tumours in the liver and serrations of the epiglottis."'^ 

Eoth has published a case which is not devoid of analogy with 
the preceding. 

A man 52 years of age, who had had a chancre upon the penis, 
had never observed any other symptom of syphilis. Six weeks after 
admission into hospital, this patient presented a semi-indurated 
tumour upon the cranium and complained, especially at night, of 
pains in the head, for which he was ordered mercurial inunction ; 
three days after, he had several epileptiform attacks ; the following 
day he had acute fever and pneumonia of the left lung, which was 
followed by death. A. star-shaped and extensive cicatrix existed 
upon the upper part of the chest. On the surface of the cranium 
were multiple cicatrices and anfractuosities due to rather small 
tumours of a yellowish white colour and fibrous ; in the neighbour- 
hood of the anterior portion of the left hemisphere of the brain, a 
smooth, circumscribed tumour traversed the dura mater and glued 
it to the adjoining parts ; the Pacchionian bodies were enlarged and 
numerous ; there were pneumonia and purulent pleurisy on the left 



• Allgem, Zeitschrtftfur Psychiatrie, xviii. p. 287 ; and Schmidt's Jahrb., 
t. cxiv. p. 312, 1862. 



PERIOD OF GUMMY PRODUCTS. 41 

side; tbe liver was large, its anterior edge tumefied, and about tbe 
middle of the right lobe were seen two superficial cicatrices ; more 
deeply seated were thr^ hard, rounded tumours, in juxtaposition ; 
the spleen was enlarged. The tumours of the dura mater and liver 
were of a greyish red colour and were due to hypertrophy of the 
cellular tissue with formation of multiple nuclei ; there were found 
in them several points in the process of fatty degeneration, a sort of 
mummification of the cells and nuclei already formed.* 

To the preceding cases might be added one given by Wagner, and 
several others which it would take too long to enumerate.f The 
existence of syphilitic lesions of the dura mater cannot, therefore, be 
doubted. These lesions sometimes consist in thickening of the mem- 
brane, on the surface or in the thickness of which is found a neo- 
plasm of greater or less thickness; sometimes they are dae to 
yellowish, caseous formations, diffused or circumscribed, in the form 
of tumours having the volume of a hemp-seed or a small nut, more 
or less vascular, and soft or susceptible of becoming softened in con- 
sequence of the retrograde metamorphosis which their constituent 
elements undergo. The convex surface of the hemispheres, the 
anterior part of the base in the region of the sella turcica chiefly : 
such is their usual favourite seat; in one case, Wagner met with 
this same lesion upon the falx cerebri. 

We have already stated that such changes are seldom confined to 
the arachnoid or pia mater ; but sometimes these membranes also 
are attacked primarily. Oildemeester and Hoyack have related a 
case of syphilitic change in those membranes, and Griesinger X and 
Ziemssen§ have seen others. Howitz describes, in two children 
bom of syphilitic mothers, a layer of yellowish fibrinous exudation 
in the course of the vessels of the arachnoid, in the region of the 
upper and under surfaces of the hemispheres. Luys and Blachez || 
have given an analogous and very interesting case, in which numer- 



• Bayerisches arztliches InUlligenzblattf 1859, No. 37. 

f See Bonet, Sepulcretum, 1679, p. 1669. Pruner, Kranhheiten des Orients. 
Erlangen, 1847, p. 194. NanD, Transact Pathol Society^ Vol. XI. p. 2. 
Dickinson, ibid,. Vol. XIII. p. 8. Murchison, ibid,, p. 251. Calmeil, 
Traits des maladies injlamm, du cerveau, Paris, 1859, t. ii. p. 260. 

I Archiv.fur Heilkunde, p. 73, 1" livr., 1860. 

§ Virchow's Archiv, 1858, t. xiii. p. 213. See also Leudet, Tungel, 
00. cit, 

II Gaz, hebd. de mid. et de chirurgie, Paris, 1861, p. 198. 



42 ACQUIRED STPHILIS. 

ons plasmatic nuclei were seen in the course of the small vessels 
which pass from the pia mater into the brain. In a case of West- 
phal^s, which we shall give farther on^ the arachnoid also was 
affected. 

From these cases it results that the syphilitic changes observed in 
the meninges may be compared to those in the parenchymas, since 
they assume very analogous forms. These membranes do not^ 
therefore, any more than those which envelop the heart, form an 
exception to the general law which appears to govern, whatever may 
be their seat, the anatomical modalities of constitutional syphilis. 
Pachymeningitis without hemorrhage, and tubercular meningitis 
especially, are the lesions the anatomical characters of which re- 
semble most closely those of diffused syphilitic meningitis; the false 
membrane which characterises the first of these lesions, free in 
general from any adhesion to the visceral arachnoid, differs distinctly 
from the lardaceous thickening oI)served in one of our observations; 
the small, rounded, whitish and altogether peculiar granulations of 
the latter render difficult an error which may already be avoided by 
taking into account the respective seats of the two lesions. 

Fungous affections of the dura mater, a name under which very 
dissimilar lesions are often included, such as epithelioma, fibro- 
plastic cancer, and fibroma, are distinguished from gummy tumours, 
some, such as epithelioma, by a histological constitution altogether 
peculiar, others, such as fibro-plastic tumours,* by their vascularity 
and a colour and consistence different to those of the syphilitic pro- 
ducts. Let us add that the base of the skull is the usual seat of 
'fibroma, while it is in the vault that gummy deposits are most com- 
monly met with. 

Symptomatio Study. 

The functional derangements which correspond to syphilitic de- 
posits of the dura mater evidently vary with the seat and extent of 
these lesions, and with the degree of compression which they occa- 
sion. In the cases in which the cerebral dura mater was affected, 
the symptoms observed were more or less violent headache, vertigo, 
epileptiform attacks, or even, more rarely, paralysis in the form of 
hemiplegia. If the dura mater covering the cerebellum was impli- 



* The tumour mentioned in a case of Baudot's appears to us to have 
been of this nature. 



PERIOD OF GUMMY PRODUCTS. 43 

cated, tbere were added to these symptoms nausea^ vomitings and 
even derangements of vision (photophobia). In support of what we 
are advancing we bring the two following cases : 

Cephalalgia. — Vertigo, — Hysterico-epileptic attacks. — Albuminuria. — Ery- 
sipelas. — Death. — Post-mortem examination. — Gummy deposits of the 
cerebral dura maters which was adherent to the subjacent membranes. — 
IndurtUion of brain. — Oummy tumours of the epiglottis. 

An unmarried woman of 40, domestic servant, pale and puffy-looking, 
went into hospital, March 15th, 1860. She had had for the last hY^ 
months pains in the head with vertigo, and a partial loss of strength. 
Four days after admission, she had an epileptic attack. 

April 14th, she had two fresh attacks, the last weaker, and in which, 
despite the loss of speech, consciousness remained intact. From this 
moment, there were lassitude, frequent cephalalgia, and puffiness of the 
face. 

April 18th^ she had another attack, hrought on by the sight of another 
patient, who was seized with convulsions ; these attacks were repeated 
July 19th and 29th and on the 4th of August Having left the hospital 
on the 15th, this patient came in again on the 28th. The oedema re- 
appeared soon after she went out. 

On the 3rd and 10th of September, she had loss of consciousness with- 
out convulsions. She was ordered diuretics which reduced the oBdema. 
In October, the patient became melancholy ; she had fits of oppression, 
buzzing in the ears, heaviness of the head, and crying. 

In February, 1861, the oedema was more considerable; the specific 
gravity of the urine was increased ; this fluid contained fine fibrinous 
cylinders, numerous blood corpuscles and a large quantity of albumen. 
The use of colocynth and gamboge was without effect. The dropsy 
increased and ascites supervened. There were no more convulsive 
attacks imtil April 3rd. After an attack which took place on that day, 
she had heaviness in the head, sopor, involuntary stools, a small and fre- 
quent pulse, and erysipelas of the left leg which had for its starting-point 
an excoriation of the skin. On the 5th, she had two epileptic attacks. — 
She died on the 6th. 

During the last few days of this patient's life, it was ascertained that 
she had belonged to the class of prostitutes, and that she had been in 
hospital formerly for a primary ulcer of the posterior commissure, and, in 
1857, for secondary symptoms. 

Post-mortem examination. — ^The dura mater was closely adherent to the 
oranium on the left side. On separating it, there was seen to exist a firm 
layer of exudation, of a yellowish white colour, situated between the bone 
and that membrane, to which it adhered. The internal surface of the 
cranium was spongy and without polish. The frontal bone was thickened 
and anfractuous on the left side. On the external surface of the right 
parietal bone there was a depression as large as a five-franc piece, Hi- 
defined, with osteophytes at its edges. The dura mater adhered to the 



44 ACQUIRED SYPHILIS. 

pia mater at this point, sometimes by cellular tissue with small areolae 
sometimes by a callous exudation, and, at three different points, by solid, 
elastic, dry, and yellow masses, which penetrated between the convolu- 
tions from which they were in part inseparable. The medullary substance 
corresponding to these masses was injected and partially softened. There 
was no change elsewhere in the nerve substance and a small quantity 
only of serum in the ventricles. There was no cicatrix on the pharynx 
or velum palati, but a firm, transparent tumefaction on the external sur- 
face of the epiglottis, and on its middle portion a dirty red protuberance 
which showed, on section, a yellowish and solid deposit one line in thick- 
ness. 

The aryteno-epiglottidean ligament was slightly oedematous, the larynx 
healthy. There was a large quantity of fluid in the pleurae. The lower 
lobes of the lungs were slightly compressed and these organs were soft 
and infiltrated. The heart was small and dotted with red points ; there 
were bloody striae upon the posterior surface of the left ventricle. There 
was pinkish serum in the peritoneal cavity and the liver adhered to the 
diaphragm by means of bands of fibrous tissue. On the surface of that 
organ were numerous depressions due to a callous tissue which extended 
from the serous membrane into the substance of the liver. There were 
granulations of a cirrhose nature but no gummy deposits. Tbe kidneys 
were somewhat hypertrophied, the cortical substance was tumefied and of 
a yellowish red colour ; on section, this substance was injected and soft. 
There were adhesions of the genital organs to each other ; the Fallopian 
tubes were distended with a watery fluid, the os uteri was the size of a 
pin*s-head at most. There was nothing abnormal about the external 
genitals. The tibiae were not enlarged. (Tiingel). 



Intense cephalalgia, nausea, vomiting, — Death, — Gummy tumours and adhe- 
sions of the meninges of the cerebellum. 

A merchant 33 years of age had been treated during several years 
for frequent relapses of secondary syphilis of a mild character^ Be- 
lieving himself cured, he married and begat a healthy child. In March, 
1859, he was seized with cephalalgia, nausea, and vomiting, which sym- 
ptoms were at first intermittent and afterwards continuous. The cephal- 
algia, bearable when he was at rest, was increased considerably by 
motion. The vomiting came on especially when the patient got up. 
There were photophobia, abnormal acuteness of hearing, and starting at 
the least sound. 

His appetite was diminished, all his food returned, his abdomen was 
drawn in, be had a slow pulse, his intelligence remained perfect, he had 
pain when his skull was pressed, but there were neither convulsions nor 
paralysis. 

All treatment was unavailing. In the beginning of April, Dr. Tiingel, 
who was consulted, hoped to arrest the evil by the aid of iodide of potas- 
sium, but on the 15th, the patient died of pneumonia. 



PERIOD OF GUMMY PRODUCTS. 45 

Post-mortem examination, — The body was emaciated, the dura mater 
bloody and tense, the brain firm and turgid, the lateral yentricles distended 
by a transparent liquid, and the ependyma thickened. The cerebellum 
adhered to the right side of the base of the skull, and, at the same point, 
the dura mater and pia mater were joined together by a solid, transparent 
exudation, having at its centre a hard and yellowish nucleus. The tro- 
chlearis nerve traversed the exudation, but its structure was not changed, 
any more than that of the other nerves. The basilar artery, which was 
somewhat drawn to the right, was not the seat of any lesion. The brain 
was healthy. — There was nothing abnormal about the velum palati. 

The lungs were infiltrated ; there were adhesions of the pleura on the 
right side, with red hepatisation, and on the left side congestion. There 
were milky patches on the surface of the heart. The left lobe of the 
liver was atrophied and shrunken ; there existed on its surface several 
funnel-shaped depressions. On the upper and lower surfaces of the right 
lobe were found several yellowish and irregular gummy deposits, which 
penetrated into the substance of the organ. The spleen was soft, the 
kidneys were injected but otherwise healthy. The mucous membrane of 
the stomach was of a greenish grey colour, thickened and a little softened. 
There was an indistinct cicatrix on the glans penis, without tumefaction 
of the neighbouring glands. (Tiingel.) 

It would be easy for us to give here a greater number of cases, 
but they would not prove more than the preceding. Prom the 
analysis of the facts known it results that syphilitic meningopathies 
present common symptoms, which are, cephalalgia usually continuous, 
localised in one point of the head, accompanied by vertigo and giddi- 
ness, and convulsive attacks analogous to those of epilepsy, the un- 
doubted connection of which with gummy tumours of the meninges 
has already long been known."*^ 

These affections present, moreover, special symptoms dependent 
upon their anatomical seat : thus, for certain portions of the brain, 
it is aphasia (Obs. I. of Tiingel) ; for the cerebellum, vomiting, 
staggering, photophobia, or strabismus, especially when the sub- 
stance of the cerebellum participates in the change. Contraction 
and paralysis are symptoms comparatively rare. More frequently, a 
slight obscuration of the intellectual faculties is observed, sudden 
losses of consciousness with or without convulsive attacks {syphilitic 
^lepsy). Are these attacks always the result of a material lesion? 



* Lties venerea epilepsta non raro parens est, gummositates et tuhercula in 
meningibusy in ipso quoque cerebro, vel exostoses in super/kie cranii interna 
producens. Lazerme, Tract, de morhis internis capitis, p. 270. 



46 ACQUIRED SYPHILIS. 

At present^ I do not hesitate to answer in the affirmative^ for no 
case has been recorded which would clearly prove the contrary. 
Moreover^ even in the cases which have been regarded as reflex 
epilepsy, there was at the very least a lesion of the bones of the 
cranium which by its presence modified, beyond doubt^ the cerebral 
functions. Further, the attacks in question have characters distinct 
from those of true epilepsy. 

They are sometimes seen to be wanting in certain peculiar attri- 
butes, such as the aura, the epileptic cry, the foaming at the mouth, 
the somnolent condition, &c. Sometimes a small number of muscles, 
or some groups only, become convulsed, and these muscles generally 
occupy the same half of the trunk ; various groups may be affected 
successively. They develop themselves usually without appreciable 
cause, at an advanced period of life, as has already been pointed out 
by Vidus Vidius and since noticed by most observers. Out of 
thirteen cases collated by my friend Dr. Gros and myself,* syphilitic 
epilepsy supervened ten times towards the age of SO, three times 
between 15 and 16, but of the latter individuals, one had been 
syphilitic from the age of 7, and the other two from the age of 14. 
In forty-three cases collected by Jaksch, thirty-one individuals were 
from 80 to 40 years old, eleven from 40 to 50^ and one only was 
20 years old. 

These attacks, which last from three to twenty minutes and more, 
have shown themselves from one to sixteen years after the first in- 
fection. In the cases in which a post-mortem examination was 
feasible, various anatomical lesions have been met with, but they al- 
most always reached the meninges, the bones, or the periphery of the 
encephalon, and much more rarely the deep-seated portions of the 
brain. A point which it is of importance to notice here and upon 
which we have already insisted elsewhere, is that evils such as cephal- 
algia, vertigo, &c., which most frequently precede the convulsive 
attacks, continue also during their intervals.f Sometimes it even 
happens that new derangements are added, such as paralysis of the 
muscles of the eye, or derangements of sight and hearing; later on^ 



• Loc» cit, p. 85. 

t Does not this fact, already pointed out by Vidus Vidius and by J. F. 
Maisonneuve {Rech. et obser, 9ur rspilepsie) and most of the observers who 
have followed, indicate, in itself, the existence of a permanent lesion? 



PERIOD OF GUMMY PRODUCTS. 47 

if the disease has not been arrested^ more extensive paralyses super- 
vene, the mental faculties become weakened^ and coma or prolonged 
convulsions are followed by death. 

Slow in their development, the syphilitic affections of the men- 
inges sometimes run a course which may be termed intermittent, 
especially at their commencement; more rarely continuous and pro- 
gressively increasing, they may last for years, if no complication 
supervene. In the cases which I have given, the termination has 
sometimes been the effect of the syphilitic manifestations, sometimes 
the result of an intercurrent disease (pneumonia, erysipelas, fee). 
Eecovery is, however, possible, and a considerable number of eases 
exist in which the rapid disappearance of symptoms very analogous 
to those of which we have been speaking appears to indicate the 
favourable termination of an affection of this nature. Moreover, 
when in a patient who has long been suffering from cephalalgia, 
vertigo, and epileptiform attacks without hemiplegia, we see a rapid 
and complete cure take place under the influence of mercurials, it 
is reasonable to believe that the case has been one of disease of the 
meninges, should that point of the diagnosis have been doubtful. 
In fact, an exostosis, or a periostosis rarely gives rise to similar 
phenomena, and lesions of the brain itself usually cause paralysis. 

Dia^fKms. — ^The age of the patients, the absence of hereditary 
epileptic antecedents, and the circumstance that the attacks which 
commenced in the course of a syphilitic affection have been followed 
by derangements more or less persistent, are so many points which 
may serve to differentiate the epileptiform syphilitic attacks from true 
epilepsy. Pachymeningitis and non-syphilitic tumours of the dura 
mater, affections which most closely resemble, symptomatically, the 
lesions in question, are distinguished, the one by the rapid and 
almost sudden appearance of acute symptoms generally characterised 
by contraction, somnolence, and other signs of compression, the 
others by a cephalalgia in general little intense and symptoms slowly 
progressive; but, besides that these affections do not present the 
filiation of the syphilitic lesions, they are exempt from the cachexia 
peculiar to individuals who have reached the visceral period of the 
latter disease. 

The prognosis of these affections is not necessarily unfavourable, 
and it is easy to explain this, seeing that the nerve substance is 
generally little if at all affected. There is reason to suppose that 
an early intervention would easily overcome them, and, even if some- 



48 ACQUIRED STPHILIS. 

what late, might still combat them with advantage.* In any case^ 
the prognosis is less serious than if the lesion were of less extent 
bat the result of a different cause. 



§ 2. Affectum* of tke eneepiaUc Mosi. — Sj/pUKHe encepialopalAies. 

More rare than the affections of the liyer^ more frequent, perhaps, 
than those of most of the other viscera, the syphilitic lesions of the 
encephalon do not differ essentially from the latter. They have their 
starting-point in the interstitial conjunctive substance, and present 
themselves with the same anatomical forms. 



Anatomical Study. 

DiffMedJbrm or syphilitie eneepkalUis. — ^The few cases which 
establish the existence of this anatooHcal form of syphilis of the 
nervous centres have generally been described under the name of 
softening or induration of the brain. 

In an epileptic woman who was also the subject of gummy peri- 
cranitis, Nic. Mediavia found, beneath the destroyed portions of the 
cranium, the cortical substance of the brain harder than in the 
natural state, being not less so than the tissue of the liver. In the 
same hemisphere, there was a cavity the size of a small nut, circum- 
scribed by livid and very soft walls, formed by the medullary sub- 
stance, and from which ran a liquid resembling serum in the midst 
of which swam some filaments (Morgagni, £pUL ix. 23}. 

In an officer who had long been suffering from constitutional 
syphilis, and who, during the latter part of his life had pains and 
stiffness in the neck, paralysis of the arms with numbness, and 
emprosthotonos in the upper part of the body, Virchow found the 
longitudinal sinus intact, and the brain depressed at its convexity ; 
the convolutions, which were flattened and small, contained but little 
blood; the cerebral substance, which was yellowish and very tena- 
cious, almost resembled leather in consistence. The ventricles of 
the brain were filled with serum. 

In a case observed by ourselves, at the same time that there was 
unusual firmness of a part of the cerebral substance, which appeared 



* Cases in support of tbis view will be found in our work upon 
syphilitic affections of the nerves. 



PERIOD OF 6UMMT PRODUCTS. 49 

as if it had been steeped in alcohol^ there existed a point of soften* 
ing at the extremity of the coma Ammonis on the right side, and 
effasion into the ventricles. The patient, who was 68 years old^ had 
had^ at 20^ an indurated chancre and^ six months afterwards, a syphi- 
litic eruption with alopecia. Intense cephalalgia^ sonmolenoe, and 
hemiplegia with falling off of the right npper eyelash; soch were 
the symptoms which were rapidly ameliorated by iodide of potaasinm; 
later on, embarrassment and then loss of speech^ dehriom and the 
phenomena of cerebral compression manifested themselves and were 
followed by death.* 

Meming has seen^ under similar circumstances, the medullary 
substance of the left hemisphere, at the posterior limit of the lateral 
ventricle, hypersemic and transformed into a mass having a laidaoeous 
appearance. Twice we have met with hypertrophy with wai^ dege- 
neration of the ependyma in cases in which constitutional syphilis 
appeared incontestable. In a case observed by Meyer, mention is 
made of the adhesion of the meninges, and^ at the same time, of the 
transformation of the cortical substance of the brain into a whitish 
yellow pulp; in the medullary substance, on the contrary, there 
existed several points of induration, of a transparent appearance, 
having at their centre a hard and whitish nucleus. In a histological 
point of view, these various lesions are characterised by the presence, 
in the midst of the nerve substance, and especially in the course of 
the vessels, of small rounded nuclei (conjunctive hyperplasis) ; the 
web is sometimes thickened, or there are found in it abundant fatty 
granulations when the neoplasm and the nerve elements consecutively 
affected are partly disorganised. We see that there exists in these 
different cases a true cerebral sclerosis, which only differs from non- 
syphilitic scleroses by a greater tendenqr of the elements of conjunc- 
tive tissue to undergo transformation. 

Cerebral softening is sometimes the consequence, if not the first 
and the last term of the lesion with which we are occupied. With 
syphilis, no doubt, is connected the origin of a c^tain number of 
cases of softening of the brain. Cases in which the existence of an 
induration and of a central softening are met with appear compatible 
with this view. We have already given one case in which this 
double change was found. FaurSs reports, in ih^Comptea rendua de 



* L. Gros and Lancereaux, he. cU, p. 242, Obs. CXXI. 

e 



50 ACQUIRED SYPHILIS. 

la Sod^td de m/decine de Toulouse (1858-1854^ p. 29)^ the case 
of a yonng woman of 2S, who advanced rapidly to syphilitic cachexia^ 
and in whom treatment with iodide of potassium had scarcely been 
commenced when convulsions followed by hemiplegia supervened. 
Death occurred at the end of six weeks ; the brain was found to be 
hard and sandy; there was a point of softening in the right optic 
thalamus. A case of TiingeFs, which we shall give further on, 
may be placed with the preceding. In other cases, the softening of 
the brain occurred still more rapidly and the encephalitis was more 
acute^ as is seen in an observation by Beynaud de Toulon {JrcA. 
gin. de mM,), in which^ together with softening of the corpus stria- 
tum^ was found sclerosis of the spinal marrow. A short time pre- 
viously, the patient had had double syphilitic orchitis. The follow- 
ing case, in which the softening had for its seat the protuberance, is 
a fresh example of encephalitis supervening without any other ap- 
parent cause than a syphilitic a£fection. 



Obs. XL VII. — Mrs. D., set 60, entered the Hospital de la Pitil, Dec. 
15th, 1862, under the care of M. Marotte. She was of good constitution 
and middle height, her skin dry and yellowish, she was cachectic-looking. 
Pustules of ecthyma, arranged in a circle, and ulcerations, were seen on 
the skin, in the neighbourhood of the right shoulder. The tibia of the 
same side was the seat of an exostosis. 

On being questioned concerning her antecedents, this patient admitted 
that she had had venereal disease. It was observed, on her admission, 
that her look was strange and stupid and her answers incoherent ; more- 
over, she had not the full use of her limbs, and frequently let fall objects 
which she had in her hands ; she could sew with difficulty only, on account 
of the trembling of her fingers. Under the influence of an antisyphilitic 
treatment, which was indicated by the cutaneous affection, the various 
phenomena underwent a very notable change, so that the patient was about 
to leave the hospital, when, in consequence of a visit from relations, on 
the 28th of December, she fell into a kind of coma, and was seized with 
convulsive attacks, which were repeated several times before her death 
which took place on the 31st of December. 

Post-mortem examination, — The pustules of ecthyma were in a great 
measure cicatrised. 

The cranium was intact, and the meninges were healthy ; some of the 
anterior convolutions of the brain appeared firmer than natural and a little 
atrophied ; the hemispheres did not present anything special. The pons 
Varolii was the seat of a softening which occupied about one-half of its 
superior and anterior portion ; at this point the nerve substance, less firm 
than usual, encroached with its injection and colour upon the neighbour- 
ing parts ; it was traversed by numerous vessels, and was of a reddish 



PERIOD OF GUMMY PRODUCTS. 51 

tint ; tlie nerve tubes were friable, broken, granular, and in their intervals 
were found very abundant round or ovoid nuclei. 

The internal membrane of the ventricles was everywhere covered with 
small prominent points, which gave it the appearance of a cat's tongue ; 
it was thickened and contained numerous amyloid corpuscles ; these same 
corpuscles were also met with in one of the optic thalami. 

The. spinal ependyma formed in the centre of the cord a small cylinder 
of the size of a knitting-needle ; it was formed of conjunctive substance 
and of numerous amyloid corpuscles, some of which turned blue on the 
application of tincture of Iodine. The medullary bundles were more firm 
in their upper portion than in the normal state. The cerebral arteries 
were intact and the trunk of the basilar free. The other organs were 
little changed ; the spleen was enlarged, as was also the thyroid body ; 
the liver was fatty and had cicatrices upon its surface. 

A pretty similar case presented itself recently at the Edtel-Diea, 
in the practice of our teacher, Professor Grisolle, where I had the 
opportunity of observing it with my colleague and friend^ Dr. 
H^mey. 

To jndge from these cases^ the anatomical characteristic which 
distinguishes syphilitic cerebral softening from softening of the brain 
from obliteration of the arteries would be the absence, in the latter, 
of any product of new formation. 

It would be easy for us to bring together here a greater number 
of cases of syphilitic softening of the brain» Qubian,"^ in a case in 
which Diday and Teissier, of Lyons, had diagnosed the possible ex- 
istence of cranial exostosis, found softening of the superior and 
anterior portion of the right hemisphere of the brain. Dufour f 
communicated previously a very similar case. But as regards these 
observations and many others, in which the state of the cerebral 
arteries was not taken into account and microscopical examination 
was wanting, doubt must necessarily exist concerning the cause and 
nature of the encephalic lesion. 

It is to be remarked that, cerebral softening has sometimes been 
observed during the course or at the end of secondary afPections : 
Ojor and Paurds each give an example of this. But there is good 
reason for asking whether the disease had not already arrived at the 
tertiary period. Some observations of Zambaco's do not appear 
more conclusive. 



* Oaz. mid. de Li/on, 1858, p. 342. 

t See Gros and Lancereaux, loc. cit, pp. 202 and 205. 

e2 



52 ACQUIBED SYPHILIS. 

Erom the preceding discnssion it results^ in our opinion^ that the 
brain may^ under the influence of syphilitic infection, become the 
seat of a change which^ according to its degree of acateness and its 
standings expresses itself sometimes by induration, sometimes by 
softening, modifications closely resembling histologically the diffused 
conjunctive hyperplasis which we have seen in other organs. In 
some rare cases, the encephalitis would appear not to have been 
partial only but generalised on the periphery of the encephalon, if 
we may judge from two very recent observations by Westphal.* 

(Xrcumscribed or gummy form. — Syphilitic gummy tumours of the 
encephalon not being sufficiently known as yet, it is of importance 
to trace carefully their anatomical characters. Distinguished observers 
have long since pointed out their existence. Bonet and Prost fur- 
nished cases which it is difficult to contest. An observation by 
Bayle and ]£ ergaradec shows us these tumours situated both in the 
brain and on its coverings. The anterior extremity of the left 
hemisphere was occupied by several bodies of a cartilaginous con- 
sistence, smooth and shining on section, not appearing fibrous under 
the knife, and adhering one to another. The sphenoid and ethmoid 
bones were partly destroyed ; the dura mater presented on its sur- 
face four hard tumours, of the size of a nut ; the pia mater and 
arachnoid were thickened, indurated, and injected ; there was also 
softening of the nerve substance in the neighbourhood of the cere- 
bral tumours. Ward and Tacheron have seen analogous cases, 
the syphilitic origin of which was less evident. Gjor, N^laton, and 
Tvaren have furnished examples which, by reason of the concomi- 
tant caries or exostoses of the cranium, leave less doubt concerning 
the diagnosis. In like manner, Gildemeester and Hoyack found in 
the anterior lobe of the brain a tuberculiform nucleus, consisting of a 
solid, amorphous, hyaline exudation, partly transformed into con- 
junctive tissue. Ludyer Lallemand points out in the left hemisphere 
of the same organ in the vicinity of the centrum ovale of Vieussens, 
the existence of a tumour of irregular shape, of the size of a small 
nut, surrounded by a smooth covering which adheres to the partly 
softened cerebral substance. In a case formerly communicated to 
us by one of our teachers. Dr. H^rard,t the right corpus striatum 
was the seat of two tumours which, on section, presented two dis- 



• AUgenu Zeitachrift fur Psychiatrtef xx. 6, p. 481, 1863. 
t Gros and Lancereaux, loc. cit. p. 255, Obs. CXXXV I. 



PEBIOD OF GUMMY PRODUCTS. 63 

tinct parts^ one cortical^ hard^ forming a resistent shell of a pinkish 
yellow colour, the other central and mnch less dense. Pillon read 
hefore the Medical Society the report of a case of two tumours^ one 
of which occupied the left half of the inferior surface of the pons 
Varolii^ and the other the optic thalamus of the same side. The 
suh-cutaneous cellular tissue contained gummy tumours."^ This same 
coincidence is met with again in a case of Meyer's, in which the 
anterior lobe of the left hemisphere of the brain presented, in its 
substance, a hard mass the size of a crown-piece, closely adherent to 
the cortical substance, and composed of whitish or yellowish opaline 
nodosities, varying in size from that of a millet-seed to that of a pea. 
The dura mater was the seat of an exudation of the same nature. 
In one of our own cases, the syphilitic deposit, which was situated 
in the cortical layer of the hemisphere and adherent to the meninges, 
was softened and confounded with the adjacent cerebral substance, 
the constituent elements of which had undergone metamorphosis. 
Lastly, the brain of a woman who died in the Hospital De le Charity, 
under the care of Dr. Pelletan, was presented to the Anatomical 
Society by Nicaiscf It contained several tumours of the size of a 
small nut, one of which had for its seat the right peduncle of the 
brain, while the others were grouped together in the midst of a 
fibroid mass which occupied the posterior comu of the hemisphere. 

The cerebellum is not exempt from this change. Ward % found 
in the right hemisphere of that organ a quasi schirrhous tumour of 
the size of a small nut and of a cartilaginous consistence. Wagner 
has twice observed the presence of gummy tumours in the substance 
of the hemispheres of the cerebellum, but in one of the cases given 
by that observer, the syphilitic origin of the change was, at least, 
very doubtful ; there was rather cause to believe it a case of true 
tubercle. 

Such are the various facts by the aid of which we may seek to 
define the anatomical characters of syphilitic gummy tumours of the 
encephalon. These deposits, which are generally multiple, occupy 
various points in the hemispheres of the brain, in the isthmus of 
the encephalon, and in the cerebellum ; they present tumours some- 
times isolated and generally surrounded by a fibrous zone, a kind of 

* Zambaco, Des affect, nerveuses syphilitiques, p. 490. • 

t See Nicaise, BuUet. de la SocUti anat, t. i., 1863, p. 186. 
X Ward, Nouv, Bibh med, t. vi. p. 368. 



64 ACQUIRED SYPHILIS. 

smooth and more or less adherent shelly sometimes groaped and 
joined together by a fibroid stratum. Yarjing in size from that of 
a pea to that of a nut or a wahiut, and of a whitish or yellowish 
colour, these tumours, of a firm, chondroid consistence, or soft and^ 
as it were, caseous^ have their favourite seat in the periphery of the 
encephalon, chiefly in the region of the anterior or posterior lobes 
of the brain. 

Consisting to some extent of a series of Buperposed layers^ these 
deposits do not differ from gummy tumours of the heart and liver, 
for we find in them almost the same amorphous stratum and the 
same constituent elements. Like the latter, they also present, 
according to Wagner^ an entirely peculiar arrangement by virtue of 
which the nuclei and cells are contained in fusiform alveoli situated 
in the midst of the conjunctive tissue. In one case* related by that 
author, some vessels of small calibre were obliterated and infiltrated 
with the cells; but there is reason to ask whether this was not 
rather a case of cancerous affection (sarcoma). We are the more 
disposed to adopt this supposition as clinical observation was entirely 
wanting. 

The metamorphoses which gummy tumours of the abdominal 
viscera undergo are met with again in the syphilitic deposits of the 
encephalon. In consequence of the granulo-fatty metamorphosis to 
which they are subject, these products gradually lose their consis- 
tence^ they become more and more soft and yellowish, decrease in 
volume and soon become confounded with the cerebral substance, if 
they be not separated by an organised covering. This explains the 
variety of their forms. 

The following case is adapted to show the course which this pro- 
cess runs. 

Secondary Bf/philitic symptoms ten years previously.^ Cephalalgia^ vertigo^ 
amblyopia ; weakr^ss of intellect with sudden hemiplegia of the left side, — 
Syphilitic tubercles on the face and neck. — Contraction of the rectum: 
treatment with iodide of potassium, — Disappearance of the syphilitic tuber- 
cles. Amelioration of the cerebral symptoms; later on, cachexia and 
death. — Yellowish deposits and lenticular gummy tumours in a great mea- 
sure changed into a fatty substance. 

Obs. XLVIII.-S., set. 31, entered the Hotel-Dieu, May 30th, 1861. 
Accoi^ing to the information then obtained, she had been treated ten 
years before, at Lourcine, for syphilitic symptoms. She had violent 
headache of two years' standing, with decreased power of vision, and 



J 



PERIOD OF GUMMY PRODUCTS. 55 

weakness of the intellectiud faculties. For some montks she had had an 
eruption upon the skin of the face and neck ; it would appear, moreorer, 
as if she had had epileptiform attacks ; lastly, some days before, she had 
been seized with apoplexy accompanied by hemiplegia. 

Present condition, — The cutaneous surface presented a sHghtly yellowish 
or bronzed tint ; on the chin and neck were seen papular protuberances 
of a brownish red colour arranged in the fonn of a circle ; there ousted 
in the neighbourhood of the ears cutaneous tubercles eridently syphilitic ; 
there was hemiplegia of the left side ; the leg could still be mored at 
wiU, but the arm was entirely immoTable ; sensibility was intact, at least 
to a great extent ; the labial commissure was somewhat drawn to the 
right ; vision was almost entirely lost upon the left side, but the eje ap- 
peared healthy to an ordinary examination. There was nothing unusual 
appreciable about the other oi^ans. At two or three centimeters from 
the anus, the finger encountered a kind of cicatricial disc which it was 
difficult to pass. There was transient diarrhoea. 

The coexistence, in this patient, of a syphilitic cutaneous affection and 
of cerebral derangements which had something altogether peculiar in 
their evolution and course, led Dr. H^rard to assume that he had to deal, 
in this case, with a double and perhaps triple manifestation of syphilis. 
Consequently, a specific treatment was adopted and the cutaneous tuber- 
cles gradually disappeared and the hemiplegia diminished without entirely 
ceasing. The treatment (iodide of potassium and pills with proto-iodide 
of mercury) was continued for several weeks, but did not prevent the 
appearance. of epileptiform attacks with strabismus, but without any 
biting of the tongue. After some months, the specific treatment, not 
having effected a complete cure, was abandoned. The patient remained 
in the hospital. The paralysis of the arm became more complete, the 
deltoid of the left side gradually became atrophied, and the shoulder ap- 
peared to sink ; diarrhoea supervened, slight at first, afterwards abun- 
dant, and, during the latter part of her life, she had frequent vomiting ; 
the cachexia steadily increased, the headache and vertigo reappeared, and 
the patient succumbed March 12th, 1862. 

Cranium. — ^The brain and meninges were pale and not injected; on 
section, the cerebral substance was discoloured; its consistence, dimi- 
nished at some points, appeared firmer than natural at others. On care- 
ful examination, there were recognised, on cutting through the cerebral 
substance on the right side, some yellowish masses around which that 
substance appeared torn and softened. There were yellow patches on 
the surface of the ventricles, in the vicinity of which were found small 
tumours of the size of a pea or a lentiL These tumours con- 
sisted of a dark-coloured central nucleus^ around which it was easy to 
extract with the forceps a kind of yellowish membrane. This membrane 
was composed of fibres of conjunctive tissue, of spherical granular bodies, 
of abundant fatty granulations, of oil globules, of crystals of fatty matter, 
and also of a few degenerated capillaries, while the central nucleus con- 
tained only granulations, for the most part fatty, fat globules, and de- 
formed granular nuclei. The cerebral substance, less consistent around 



56 ACQUIRED SYPHILIS. 

the yellowiflli masses, was manifestly ehanged. Some of these masses, of 
small volume and a greyish colour, contained a fibroid matter. The 
yellow patches presented the same colour as these masses, and there were 
found in them chiefly elements of fatty matter and detritus of conjunctive 
tissue and of cerebral substance. This lesion was met with again on the 
left side, although the right hemisphere was the principal seat of it. The 
grey matter of the convolutions did not appear changed ; some of the 
cells, however, were very granular and a considerable number of the 
capillaries were loaded with fatty granulations ; it was easy to recognise, 
with the naked eye, three layers, the middle one of which was of a well- 
marked yellowish tint. The bones of the cranium were thickened. 

Thorax. — Several tubercles were found at the apices of the lungs, some 
of the size of a lentil, others of a small nut, all formed of a dry, yellowish, 
granular matter. The rest of the lungs was healthy. 

The heart was loaded with fat ; the consistence of its walls was soft 
the valves and orifices were intact. There were some slight depressions 
on the surface of the liver. That organ did not contain any gummy 
tumour, but it was in an advanced stage of fatty degeneration. The cells 
contained, some of them crystals of mai^arine, others abundant granula- 
tions and fat globules. 

The spleen was not changed. The kidneys were of a yellowish colour 
they were large, soft, but not appreciably diseased. 

The alimentary canal, the eyes, and many other organs which it would 
have been of importance to investigate, could not be examined. The 
deltoid and the circumflex nerve, which here deserved especial attention, 
could not be examined on account of the little time allowed for the 
autopsy. 

The fatty, or more rarely, the calcareous metamorphosis is not 
always the last term of the syphilitic deposits of the encephalon. 
They may finish by being entirely absorbed, but not without leaving 
traces of their passage. Under these circumstances, in fact, the 
fibrous zone which circumscribed the central core may present the 
form of an empty cyst, of membranous layers, or lastly of cicatrices 
altogether analogous to the cicatrices of the other organs. In 
patients dying of syphilis, these remains of absorbed gummy pro- 
ducts have several times been taken for cysts. 

Lesions of cystic appearance and deal/rices. — A glance back at 
the facts hitherto published enables us to recognise that several 
cerebral cysts, regarded as simple coincidences, were nothing else, 
in reality, than the persistent envelope of a gummy tumour. These 
facts are : — 

A woman 45.years of age, who had ulcerating tubercles of the 
skin of the nose and cheeks, regarded by M. Cazenave as syphiKtic, 



PERIOD OF GUMMY PRODUCTS. 57 

snccnmbed after having suffered from derangements differing from 
those of cerebral haemorrhage. At the post-mortem examination, 
F^r^ol * fbond a peculiar change in the kidneys and in the intra- 
ventricolar lobule of the corpus striatum, a small cavity full of a 
greyish, serous fluid, capable of containing a small nut, and lined in 
its interior with a kind of thin membrane. 

Meyer f saw in one case the right hemisphere of the brain trans- 
formed into a cavity traversed by numerous cords in the form of a 
network and of which the walls consisted in a thin layer of softened 
substance. The optic thalamus and corpus striatum of the same 
side were atrophied. There were also gummy tumours upon the 
cerebral dura mater and in the liver. Epileptiform attacks, acces- 
sions of mania, and complete hemiplegia of the left side, such had 
been the phenomena observed during life. Our Observation XXX. 
(p. 344, Yol. I.) is a good example of this same arrangement. Another 
patient, who had had vertigo, headache, and epileptiform attacks, 
presented in the left corpus striatum a cyst the size of a small nut, 
of apoplectic origin by Meyer's account, but in our opinion resulting 
from syphilis, for there existed, moreover, three tumours situated in 
the midst of a fibroid tissue deposited between the dura mater and 
the surface of the left anterior lobe, softening of the right corpus 
striatum, and gummy tumours in the liver. This case may fairly be 
compared with the Observation GLYIII. of the Traiiddea maladies in- 
flammataires du cerveau of Dr. Calmeil. In that case, which was that 
of a patient who had previously presented unmistakable symptoms of 
syphilis, the whole of the right hemisphere was hollow and con- 
verted into a kind of pouch of considerable size, nothing remaining 
of the nerve substance which usually occupies the centre of the 
anterior, posterior, and middle lobes. The optic thalamus and 
corpus striatum were atrophied, or reduced to the condition of 
shapeless protuberances. Empty cells, numerous filaments, pseudo- 
membranous plates stretched out like network, were attached here 
and there to the inner walls of the bag which had taken the place of 
the cerebral substance. Still other cases exist which plead in favour 
of the doctrine we are defending. One quoted by Bristowe {Pa^i. 
Transact. ofJOandon, p. 21) makes mention of a cyst of the size of a 
small nut, situated in the anterior portion of the left corpus stria- 

* £uU, de la Soc, anatom,, 1856, p. 402. 
f Loc, cit, Obs. VI. 



58 ACQUIRED STPHIUS. 

tarn. The thickened dura mater contained seYeral gummy tomoios. 
The craninm was perforated^ and tnmonrs of the size of a small nnt, 
of lardaceons appearance^ were met with in the thickness of the 
frontal bone. The liver was hard, misshapen, and in a state of de- 
generation which gave it the appearance of a jellowiah schirrhons 
tissae. At some points it appeared possible to distinguish in its 
interior masses of encephaloid matter, and this matter was abundant 
in the lobnlns Spigelii. In a case of syphilis famished by Wagner, 
mention is made of the piesence, in the interior and posterior part 
of the left corpus striatum, of a kind of serous cyst in the form of a 
fan and of the size of a cherry-stone. 

Side by side with the preceding arrangement is another which 
differs only by the less extent of the anatomical change and with 
which it is equally important to be acquainted. 

Our Observation XL. mentions a dight depression resembling a 
cicatrix on the surface of one of the convolutions, and more deep- 
seated a bridle or greyish linear cicatrix, some millimeters in depth 
by about two centimeters in length. Meyer {loe. cU, Obs. YUI.) 
found, at the same time with osteophytes upon the internal surEBUse 
of the bones of the cranium, a change in the dura mater, with indu- 
ration of the transparent septum, sclerosis of the central portions, 
and depressions more or less deep in the right half of the pons 
Varolii and in the left part of the meduUa oblongata. These de- 
pressions of a greyish blue colour, true cicatrices, were continued 
downwards into the organ by irregular, striated, reddish grey pro- 
longations, of a lardaceons appearance. The greyish points con- 
sisted of a fine tissne with longitudinal strise and fatty corpuscles. 
The neighbouring substance was composed of detritus of nerve ele- 
ments, wasted nerve fibres, and amylaceous corpuscles. Analc^us 
cases would doubtless be found in Calmeil's rich work."^ 

We close this part of the inquiry here, although we have by no 
means exhausted the whole series of cases in which syphilis might 
be shown coexisting with a cerebral cyst. Let us add that this 
lesion is often found to be described by a paraphrase, on account, no 
doubt, of its imperfect resemblance to the serous bag known nnder 
the name of cyst in anatomical language. 



♦ Traits ties malad, inflamm. du cerveau, U ii. chap. vi. p. 231, Obs. 
CXLI., &c. 



PEBIOD OF GUMMY PRODUCTS. 69 

To sum up, gummy tumours of the encephalon present objective 
characters which vary with the phases of their pathological evo- 
lution ; resembling pretty closely, at a certain period, tubercle, or 
fibrous or cancerous tumours (glioma, sarcoma), they present, later 
on, an analogy with old serous or hsemorrhagic cysts. By their 
slight vascularity, syphilitic neoplasms are distinguished from can- 
cerous or fibrous tumours ; but they more closely resemble tubercle 
of the brain, with which they have probaby sevend times been con- 
founded. Tubercle of the brain, however, is not so clearly circum- 
scribed by a fibrous zone ; it undergoes more uniformly the fatty 
degeneration, and is often single and surrounded by granulations of 
the same nature. 

Apoplectic cysts have a rounded form, and their walls are impreg- 
nated with the colouring matter of the blood in the amorphous or 
crystalline state. The absorbed infarctus are distinguished from 
cicatrices by the concomitant change in the arteries. 

Symptomatic Study. 

The symptoms peculiar to the syphilitic lesions of the encephalon 
may be grouped under several heads which are not devoid of relation 
to the anatomical lesions already studied. A first group, which 
seems to answer more especially to cases of partial encephalitis, con- 
sists in derangements of motion, more rarely in derangements of in- 
telligence or sensation. Under these circumstances, the individuals, 
after having suffered more or less severe headache, are generally 
struck with paralysis. This most frequently assumes the hemiplegic 
form ; but sometimes it remains confined to one limb, or to a single 
group of muscles, those of the eye in particular. The outbreak is 
sometimes sudden, especially in the hemiplegic form. Most fre- 
quently progressive and incomplete, this paralysis is, in certain cases, 
accompanied by contraction or simple rigidity. The muscles do not 
usually become atrophied, which is easy to understand, since the 
centres are here the ordinary seat of the lesion. Convulsions are 
rare in such cases, unless gummy tumours be added to the encepha- 
litis or softening, as in the cases given by Faur^s and Tacheron. 

In a second group stand derangements much more rare, more 
particularly affecting the intelligence and characterised by difScultj 
of speech, dulness, and diminution with gradual loss of memory. 
Generally connected with a lesion of the periphery of the encephalon, 



60 ACQUIBED SYPHILIS. 

these derangements assume characters resembling those of genera 
paralysis and paralytic dementia. Two cases given by Westphal * 
belong to this second group. One of these cases relates to a man 
33 years old^ who had for a long time had persistent headache with 
dilatation of the right pupil^ projection, of the eyeball^ ptosis of the 
right eyelid^ and convulsive attacks with loss of consciousness. This 
patient^ whose memory gradually became weaker^ could not find the 
right word^ he stammered^ tottered in his gait^ and passed his motions 
involuntarily; iodine was given without effect. Later on, he grew 
stupid, and died. The left anterior lobe presented a cicatrix with a 
greyish floor and raised edges, in the neighbourhood of which the 
internal surface of the bone was covered with osteophytes. The dura 
mater adhered, near the fissure of Sylvius^ to gummy masses which 
penetrated into the substance of the brain; the right corpus striatum 
presented on section several points of softening, the left was simply 
injected; the pons Yarolii was of diminished consistence, the pia 
mater was thickened around the optic commissure, the right oculo- 
motor nerve was found to be transformed into a compact mass, and 
around the trigeminus existed a greyish gummy mass. The other 
nerves were free from any change. 

The following case presented successively, so to speak, both the 
symptomatic varieties in question. 

Old-standing syphilitic neuralgias, — Recent hemiplegia of right side, then of 
left, — Headache, insomnia ; frequent weeping unth distortion of the face. — 
Iodide of potassium, improvement ; later on, phenomena of general para- 
lysis ; cachexia » — Death, — Post-mortem exanUnation. — Hypertrophy of the 
hones of the cranium, yeUounsh masses fortned in great measure of fatty 
elements ; lesions of the kidneys, 

Obs. XLIX. — Madame G., set. 45, entered tbe Hospital de la Piti6, 
July 24tb, 1860. She denied having had any syphilitic antecedent, and 
related tbat ten years before she bad been seized with violent pains in the 
right side of tbe body, and more particularly in tbe right leg. These 
pains, whicb appeared to have followed tbe course of tbe sciatic and crural 
nerves, were not continuous ; they were sometimes felt during tbe day, 
but frequently at night, together with a violent pain at tbe base of the 
skull ; there was also insomnia. This state of things continued for about 
^ve years. During tbat time tbe patient was treated by several physicians, 



* Ueher Syphilis des Oehirn\ AUgem, Zeitschr, fiir Psychiatric, xx., 5 
and 6, p. 481, 1863. 



PERIOD OF GUMMY PRODUCTS. 61 

who exhausted the remedies usually employed for the cure of neuralgia. 
Yalleix, who applied deep cautery to her thighs, the cicatrices of which 
are still yisible, showed her as a curious instance of obstinate neuralgia. 
M. Marotte, under whose care she was subsequently placed, was led to 
have recourse to the use of iodide of potassium. The patient had not taken 
it for more than a week when the pains disappeared, and sleep returned to 
such an extent that she slept almost constantly, even during the visits of 
the physicians and of strangers. The treatment could not be continued 
long, the ,' patient wishing to leave the hospital; but since then, fresh 
pains have appeared almost every month, which always yielded rapidly 
to the use of iodide of potassium ; according to the patient's account, 
these pains sometimes disappeared on the very day after she began to 
take the medicine. 

Present condition.-^ July 31 st. — There is emaciation with a dry and scaly 
skin ; difficulty in speaking dating from the end of January, stupid ex- 
pression of face, frequent weeping, weakness of memory, but intellect 
still clear ; loss of muscular power on right side with difficulty of raising 
the limbs and carrying out the usual movements with them. Sensibility 
was intact. She had cephalalgia, insomnia and giddiness, but all the 
senses were perfect. She was ordered iodide, of potassium to the extent 
of twenty-two grains and a half per diem. 

The treatment was continued for a week, and the symptoms disappeared 
in a great measure; copious diarrhoea having supervened it became 
necessary to discontinue the use of the remedy. Three weeks after, com- 
plete hemiplegia of the left side supervened in a few days. The sphincters 
were paralysed and there was almost constant weeping. The patient 
scarcely answered to questions ; at every word which was addressed to 
her, she began to weep and to utter cries accompanied by very charac- 
teristic contortions, indicative of softening of the brain. She complained 
of intense pain with nocturnal exacerbations, localised in the back of the 
head, on the right side ; she had insomnia, vertigo, and debility. . Lying 
almost always upon her back, without strength and without will, she 
presented all the characteristics of an advanced state of cachexia. 

September 8th. — The attempt was made to administer the syrup of the 
iodide of iron, and under the influence of this medioine, continued for five 
days, the patient felt better, and the diarrhoea ceased. 

September 15th. — The iodide of potassium was resumed, to the extent 
of fifteen grains daily ; some days later, the dose was increased to twenty- 
two grains and a hidf, then to thirty and forty-five, with the addition of 
syrup of morphia. The patient bore this treatment, the appetite returned, 
and the paralytic symptoms soon disappeared. 

September 23rd. — She could raise her arm to her head and move the 
leg more readily ; the tendency to weep no longer existed ; the pain in 
the head, the insonmia, and the vertigo had almost entirely disappeared ; 
the improvement continued during the following days. 

On the 1st of October, the medQcine was given to the extent of fifteen 
grains daily, and on the lOth, it was suppressed altogether. At that 
period, the patient still suffered from general weakness, a little more 






62 ACQUIRED SYPHILIS. 

marked on the left side ; nevertheless, she could get np and walk about 
the ward, but not, it is true, without haying some falls. Some days after, 
there was loss of consciousness. About October 8th, she again complained 
of pain in the occiput, giddiness, and insomnia ; the tendency to cry re- 
appeared. On the 20th, iodide of potassium was again given to the extent 
of fifteen grains. On the 30th, there was a decided improvement. 
The treatment was not continued beyond the month of December, and the 
weakness in the limbs and headache soon returned. The patient went to 
the Salpetridre. During her stay in that hospital, she was placed 
amongst the incurables, and did not receive any further medical care. 
The muscular weakness increased, chiefly in the lower extremities, which 
became almost completely paralysed; the stools and urine passed in- 
voluntarily ; sensibility became lessened^ the least movement provoked 
laughter or tears ; she had frequent headache ; her memory was in a great 
measure lost, and she spoke with difficulty. She was able, however, to 
recognise those about her up to the time of her death. The cachexia be- 
came more and more marked ; the skin was yellowish and earthy-looking; 
there supervened oedema and profuse diarrhoea which, together with a 
bad habit contracted long ago by this patient, contributed to cause her 
death, which took place on the 18th of September, 1861. 

Post-mortem examinatiorif thirty-six hours after death. — Average tempe- 
rature. The walls of the abdomen and part of the trunk of the body were 
of a greenish colour ; there was no rigor mortis. The lower extremities 
were very oedematous ; there was no trace of cicatrices upon the body, 
but strongly-marked longitudinal ridges upon the nails. 

Head, — The hair was abundant, the hairy scalp easily separated ; the 
commissure of the lips was drawn slightly to one side ; the bones of the 
cranium were hypertrophied, their thickness being more than doubled 
they splintered under the hammer, but only on the application of consider- 
able force. A limpid and abundant serum escaped as soon as the cranium 
was removed ; the veins of the meninges were dilated and gorged with 
black blood. Some milky patches of slight extent were observed on the 
surface of the arachnoid of the left side ; the dura mater on the right side 
was dotted with blood and lined to a small extent with a very thin and 
transparent new membrane. The cerebral substance was everywhere 
softer than natural, the cortical substance somewhat yellowish. The lateral 
ventricles were dilated and contained a turbid fluid ; this same fluid was 
met with again in the ventricle of the septum. The fourth ventricle was 
comparatively less dilated than the preceding ; there were no granula- 
tions on the inferior surface of this ventricle, but a yellowish plastic deposit 
near the fissure of Bichart, behind the pineal gland ; there was adhesion of 
the lyra to the isthmus of the encephalon. The grey substance of the brain 
appeared intact except as regards colour. The brain was cut into thin slices 
horizontally and there were seen in the white substance, particularly at a 
short distance from the grey substance, yellowish spots or rather masses 
of about one centimeter in extent, formed of numerous granulations mostly 
fatty, of nuclei and granular cells, and of an amorphous and granular 
matter ; these masses were equally distributed in both hemispheres of the 



PERiaD OF OUMAfY PRODUCTS. 63 

brain. On the anrface "of the right corpus striatiim was a jellow patch , 
abont two centimeters in diameter, slightly prominent; the hrain sab- 
stance, softened in this neighbourhood, formed a sort of yellowish white 
magma. On catting through the corpus striatum and optic thalamus of 
the same side, a greenish yellow tint was observed in places. The corpus 
striatum of the opposite side was the seat of a mass of less extent than 
that of the yellow masses, but, like the latter, formed almost exclusiyely 
of abundant molecular and fatty granulations and also of granular glo- 
bules ; nowhere did any traces of haematine exist. In several parts of 
both the grey and the white substance were seen collections of fatty 
granules. These were most numerous in the course of the vessels. Some 
of the convolutions of the cerebellum were of a yellow colour and some- 
what soft. The pituitary body was large, firm, and yellowish ; there was 
no change at the origins of the cranial nerves. There was abundance of 
serum in the vertebral canal ; the spinal cord was not examined ; some of 
the lumbar vertebrae were the seat of hyperostoses. 

I7u>r€ue. — There was some turbid fluid in the pleurae ; there were mem- 
branous adhesions between the lungs and thoracic parietes. The apices 
were healthy ; some lobules in the anterior part of the base of the 
right lung were indurated and the corresponding bronchi were dilated. 
In this neighbourhood were found some fibrous tissue and plastic 
elements. 

The heart was soft and fatty. 

Abdomen, — The liver was small and slightly granular on its surface ; 
there were some milky patches in the vicinity of Glisson's capsule and 
multiple cicatricial furrows on the surface of the organ. Few in number 
on the right lobe, except towards its lower edge, the cicatrices were much 
more abundant on the lesser lobe, and especially in the neighbourhood 
of the suspensory ligament ; they ran in a horizontal or vertical direction 
and formed furrows of greater or less depth, the edges of which were 
generally united by means of cellular bands. The parenchyma of the 
liver was slightly resistent when cut into and creaked under the knife ; 
the fibrous tissue appeared to be more abundant than natural in it ; a 
great number of the hepatic cells contained fatty granulations. 

The spleen creaked under the knife ; it was enlarged, firm, and resistent. 
The prevertebral glands were for the most part increased in volume 
on section, they presented a whitish colour and medullary consisteDce. 
The thyroid body was hypertrophied. 

The kidneys were enlarged ; the fibrous covering was opaque and diffi- 
cult to remove. The external surface of the organ was granular, or rather 
studded with a large number of small depressions, which rendered it very 
uneven. On section, the cortical substance presented a marked yellowish 
tint ; the tubular portion was brownish. Some of the Malpigbian cor- 
puscles were enlarged, others smaller and circumscribed by a web of 
thickened conjunctive tissue; in the interior of the canaliculi existed 
numerous granulations and destroyed epithelial cells. 

The mucous membrane of the bladder was brownish and thickened ; 
the Fallopian tubes were adherent to the uterus. The ovaries were atro- 



64 ACQUraED SYPHILIS 

phied and fibrous ; their covering was whitish^ thickened* and resistent 
The stomach and intestines were healthy. 

The veins of the extremities, the cerebral sinuses, and the pulmonary 
artery were free. The aorta was the seat of some yellow patches in the 
neighbourhood of its upper currature ; the left internal carotid artery 
was partly obliterated near the cayemous sinus, by a membrane which 
terminated in a point and adhered closely to the wall of that vessel. This 
membrane, which was formed of nuclei and of cells of conjunctive tissue 
more or less changed, presented at some points a rusty colour due to the 
presence of numerous grains of hsematine and crystals of hsBmatoidine. 
The walls of the artery were not atheromatous at that point. In the right 
carotid was a coagulum which, adherent at both ends, obstructed only a 
small part of the calibre of the vessel ; it was composed of fibrine, nuclei, 
and cells of conjunctive tissue. 

General paralysis and paralytic dementia are thus^ in certain cases^ 
symptomatic forms undoubtedly connected with syphilis. To the 
cases which we have just quoted it would be possible to add several 
others, although, in reality, the forms in question are comparatively 
rare. A patient observed by Bauch, of Grsetz,* complained first of 
continuous cephalalgia ; he became forgetful, lazy, inattentive to his 
business, silly, then fell into a childish condition and finally into 
complete idiotcy : sight and hearing, weakened at first, were after-* 
wards entirely lost. The lower extremities, the bladder, and the 
rectum became paralysed and, lastly, coma supervened. This condi- 
tion, which had commenced more than six months before, yielded 
completely to the employment of mercurial inunction and of iodide 
of potassium internally. A patient treated by Bead, of Dublin,t 
could not keep his feet; he articulated very imperfectly, the arrange- 
ment of his ideas was very defective as was also his memory, and 
sight on both sides was considerably affected, and this whole train of 
symptoms yielded in three weeks to the employment of mercurial 
frictions upon the shaven hairy scalp. Hughes Thompson, of Glas- 
gow,J also saw a case of paralysis which gradually became general 
and was rapidly relieved by iodide of potassium. Analogous cases have 
been quoted by Cirillo, Delpech, Sandras, &c.§ The first case in 

* Quoted by Lagneau, junr., loc, ciL,, and {Ladreit de la CharriSre. 
Th^se de Paris, 1861, p. 56. 

f T?M Dublin Quarterly Journal of Medicine^ February, 1852. 

I Journal des connatssances mid, de Caffe, Oct. 20th, 1857, p. 17, from 
the Lancet. 

§ See these observations in the various works of Lagneau, junr., 
Ladreit de la CharriSre, and Gros and Lancereaux. 



PERIOD OF GUMMY PRODUCTS. 65 

Goodwin's memoir * deserves to be placed with the preceding, as 
also an interesting case given in Zambaco's work^f i^ which the 
post-mortem examination revealed the existence of softening at the 
periphery and of a tumour which was probably nothing else than a 
gummy tumour. 

Grailleton relates cases which come in properly here. A man con- 
tracted syphilis ; on two different pccasions he had constitutional 
symptoms ; two years later, he presented a paralysis of the levator 
palpebrse on both sides, diplopia, and amblyopia, and this man, who 
was previously intelligent, became almost idiotic. He scarcely 
answered to questions, his speech was embarrassed, and his gait 
tottering ; he recovered by the use of iodide of potassium. 

A woman 34 years of age, after having had, on two different 
occasions, secondary symptoms, suffered from nocturnal cephalalgia 
of the most violent kind. There were a progressive decrease of 
intelligence, melancholy, and hallucinations. These symptoms, 
which were little marked in the daytime, attained tl^eir maximum of 
intensity during the night. They, as well as the pains in the head, 
yielded rapidly to the employment of iodide of potassium. J 

Lastly, Leidesdorf § saw, in syphilitic subjects, two cases of de- 
mentia which were, the one very sensibly improved, the other rapidly 
cured by iodide of potassium. 

It would be easy to recall here cases of dementia, or even of 
mania, equally connected with syphilis. But these cases are not of 
a sufficiently positive stamp. Professor Griesinger || admits, how- 
ever, that the mental derangements connected with syphilis present 
themselves under forms varying from the most violent mania to the 
most complete idiotcy. Very recently, Dr. Berthier,1f a very distin- 



* The title of this observation is : Syphilitic affection of brain ; im- 
pairment of memory and mental power ; attack$ of great exhaustion ; alight 
paralysis. The Lancet, July 19th, 1862. 

t Loc. cit Obs. LV. p. 331. Compare Arthaud, Gaz, mSd. de Lyon, 

1858, p. 347. 

X Gailleton, Sur irois cos de syphilis constitutioneUe compUquh de sym- 
ptomes nerveux {Oaz, mid, de Lyon, October 16th, 1864). 

§ Contribution h la syphilis ciribrale dans ses rapports avec Valienation 
mentale {Medisdnische Jahrbucher, 1864, 4® livr.). 

II Archiv der Meilkunde, 1863, p. 471. 

^ Du dSlire US d la goutte, au rhumatisme, ^ la syphilis et aux dartres, 
dans Union med, de la Oironde, May, 1865, p. 211. 

/ 



66 ACQUIRED SYPHILIS. 

goislied psychiatric physidan^ has sought to refer to syphilis several 
forms of madness, such as certain varieties of delirium^ mania, &c. ; 
but the very incomplete facts upon which he relies are far from ap- 
pearing conclusive. To sum up^ certain syphilitic lesions of the 
encephalon may produce a totality of- symptoms very closely resem- 
bling the morbid conditions known under the name of general para- 
lysis and paralytic dementia ; we must^ perhaps^ also admit syphilitic 
mania. At all events, it is important to bear in mind that the course 
and evolution of these manifestations are altogether peculiar and 
different from what is observed when syphilis does not exist. 

Side by side with the derangements which always accompany a 
material lesion, let us point out a moral derangement which appears 
to attach itself by preference to the general modification of the 
organism. Sometimes, in syphilitics, the moral condition undergoes a 
very evident change, comparable, to a certain extent, to an analogous 
derangement met with in other morbid conditions, in gouty subjects, 
for example. Low spirits and timidity form the basis of the character 
of individuals thus afiected ; what they especially fear are the mani- 
festations of the disease with which they are affected ; they may be 
said, therefore, to be suffering from syphiliphobia. 

This condition has been remarked and studied by several observers; 
but Bru has given the most graphic picture of it, though perhaps a 
little exaggerated. " Theje present themselves at the hospitals," 
says that physician, '' many patients affected with syphilitic mania. 
It is necessary to satisfy them by making them undergo some mild 
treatment, but with a great appearance of importance, for the pur- 
pose of quieting them There are several degrees of 

syphilitic mania ; some patients are furious ; these are, in general, 
much alarmed at their own condition; some are less alarmed; others 
lastly, though convinced that they have the disease, do not concern 
themselves about the consequences, because they think that when 
once the disease has been contracted, it can never be got rid of, 

whatever may be the treatment opposed to it I have 

known several men affected with this moral disease, who believe that 
they had all the diseases mentioned in books : a dimness of sight, a 
buzzing in the ears, the slightest pain or headache, were all, for 
them, certain signs of syphilis.''* Such are the affections of the 



* Miihode nouvelle de traiter let malad, vSnir,, i, iL Paris, 1780. 



PERIOD OF GUMMY PRODUCTS. 67 

second group. To a third group would belong, lastly, a series of 
symptoms connected more especially with the presence of gummy 
products in the encephalon. Headache more or less violent and 
persistent, giddiness, vertigo, sudden loss of consciousness or attacks 
analogous to apoplectic attacks, sometimes somnolency or mere 
drowsiness, and delirium or coma, are the chief symptoms observed, 
accordingly as the tumour acts as an irritant body or by its size 
compresses the hemispheres. One character proper to these various 
symptoms is a mobility and transient nature not met with under any 
other circumstances. Clonic convulsions or epileptiform attacks are 
then frequently observed; contraction is a less common pheno- 
menon. 

Amongst the convulsive forms, it is well to point out chorea, 
which occupied one entire half of the body, in a case given by 
Costhiles and in another observed by myself at the Hdtel-Dieu under 
the care of M. Legroux.* In this latter case, the hemichorea fol- 
lowed upon hemiplegia treated for some days with calomel. At 
other times, mere trembling is observed, as has been pointed out 
twice by Schutzenberger. Lastly, in some patients, the only appre- 
ciable symptom was a tendency to perform gyrating movements or 
movements as in riding, as Neumann t saw in one case, or the in- 
capability of walking in a straight line, of which examples are to be 
found in the excellent work of Lagneau, and which appears indicated 
by the following case : — 

Tubercular and gummy syphilide, — Multiple cerebral derangements* 

Obs. L. — B.y aet. 39, entered tbe Hotel- Dieu under the oare of Professor 
Grisolle, June 21st, 1862. Of moderate strength and a good constitution, 
he had never had any serious disease, and asserted that he had never had 
any venereal affection or any lesion of the genital Organs. It was to the 
use of a pipe that he attributed the symptoms which induced him to come 
to the hospital. Two years ago, he had an affection of the throat, the 
exact nature of which he was unable to describe. Three months ago, he 
became the subject of an eruption, which still exists, and which presented 
itself in the form of pimples or tubercles arranged in a circle, of a coppery 
tint and occupying pretty symmetrically the posterior parts of the thighs, 
the groins, and the region of the kidneys. This eruption was also observed 



* See Gros and Lancereaux, Obs. LIX and CLIX. 
f Neumann, in Wien, med, Halle, iv. 2, 3, 1863, and Schmidt's Jahresh., 
t. 119, p. 166. 

/2 



68 ACQUIRED SYPHILIS. 

upon the anns, in the popUteal spaces, and upon the glans. ' On the pos- 
terior surface of both fore-arms, at about two centimeters' distance from 
the olecranon, were seen two rounded tumours, pretty firm and movable, 
of the size of a small nut. There was slight exostosis of the left clavicle. 
The tibiffi were intact. For about six weeks he had had vertigo, giddiness, 
intense headache and obstinate insomnia ; then, all at once, more violent 
accessions of vertigo, followed by loss of consciousness, without convul- 
sions. The same symptoms recurred and he was bled ; then supervened 
hemiplegia of the left side. The patient then determined to come into the 
hospital The paralysis, which was very incomplete, did not prevent him 
from walking ; but the patient pointed out that, in walking, he always 
inclined involuntarily towards the left He was enabled to reach the 
hospital on foot, he stated, by taking the left trottoir, the only one upon 
which he could remain. Although the mouth appeared slightly distorted, 
the hemiplegia of the face was, however, very doubtful. Since the last 
attack, his speech had. been embarrassed, his memory treacherous, his 
intelligence diminished and his expression heavy. There was no fever. 
The movements of the heart were dull and irregular ; there was extensive 
precordial dulness ; the liver appeared healthy. There was a yellowish 
colour of the skin. The diagnosis of the cutaneous affection not being 
subject to any doubt, despite the denials of the patient, there was reason 
to believe that the cerebral derangements depended upon a lesion having 
the same origin ; such was the opinion of a great number of physicians, 
and of M. Grisolle in particular, who ordered a specific treatment (iodide 
of potassium and Dupuytren's pills). 

In a few days, the embarrassment of speech diminished, together with 
the headache, the vertigo, and the paralysis of the left side ; but at the 
same time, the right arm became paralysed. The treatment was con- 
tinued. 

On the 27th, the patient had more power over the left side, but he 
dragged the right leg, which was more feeble, in walking. The dose of 
the iodide of potassium was increased to forty-five grains. 

On the 28th, the gummy tumours of the fore-arms were beconung 
absorbed, and the eruption was fading; the same treatment was con- 
tinued. The syphilide gradually disappeared, without leaving any trace, 
the tumours of the £Dre-arms also yielded, and the exostosis decreased. 
The cerebral symptoms afterwards diminished, and had disappeared 
almost entirely when the patient went out, July 11th. 

We have endeavoured to point out the numerous derangements 
which correspond to the syphilitic lesions of the encephalon^ but it 
would be erroneous to suppose that we should find^ in all the cases, 
one or other of the groups of symptoms described above. While 
it is not uncommon to meet with the coexistence of the various 
lesions of which we have spoken, it is not rare to meet simultane- 
ously with the various derangements just enumerated ; the following 
case is an instance too important to be passed over in silence. 



PERIOD OF GUMMY PRODUCTS. 69 

Syphilitic infection, — Exostosis,-^ Clonic convulsions, hectdache, melancholy , 
hemiplegia of left side, insomnia, epileptic attacks, delirium and coma, — 
Adhesion of dura mater to brain. — Diffused induration and softening of 
cerebral substance. 

A mercliant, 46 years of age, of sober habits, had gastric fever in the 
course of the month of March, 1859, and, daring his convalescence, was 
seized with clonic convulsions without loss of consciousness. These con- 
▼ulsionsy which commenced in the muscles of the tongue, afterwards 
passed to those of the lower jaw and left eye. From the 13th of March 
to the 10th of June, this patient counted eleven attacks somewhat weaker 
than the first and which were distinguished by a rotation of the head 
towards the left. On the 10th of June, he had convulsions in the left leg ; 
he fell down, but did not lose consciousness. In the interval, there 
existed a slight trembling of almost all the muscles of the face, and at 
the same time almost continual drawing pains in the head, especially in 
the neighbourhood of the right parietal bone. His sleep was bad, his 
spirits much raised or depressed. It was under these circumstances that 
the patient came into the hospital, presenting the ensemble of symptoms 
appertaining to chronic pachymeningitis. It was ascertained that, two 
years previously, he had had a painful tumour upon the right olecranon, 
from which there stiU remained a considerable enlargement of bone. 
He admitted having had syphilitic disease for several years. The organs 
of digestion being in a good state, recourse was had to inunctions with 
mercurial ointment. Some days after, there was exacerbation of the 
pains in the head, for which some blood was taken away locally. In- 
unction was made daily without producing salivation, but at the end of 
three weeks, anorexia and nausea supervened. 

The treatment was suspended at once and resumed some weeks later ; 
but, the gastric derangements having returned, the treatment was stopped 
altogether. At that period there was a decided improvement in his con- 
dition, the headache, trembling and convulsions having ceased. The 
patient, who continued to be timid, still got but little sleep. He made 
arrangements to go to Wiesbaden, when he was seized with sudden 
anxiety and refused to undertake the journey. From that moment the 
anxiety returned and the melancholic depression persisted. The pains 
in the head and convulsions were still absent, but from time to time the 
muscles of the face were affected with trembling and he had a feeling of 
uneasiness in the precordial region. 

Towards the end of the month of November, his condition became 
aggravated ; there was weakness and insomnia. December 6th, the pains 
in the head reappeared at the same points, and some hours after there 
was transient loss of consciousness, followed by paralysis of the whole of 
the left side. This paralysis soon decreased, but did not ceade entirely 
the patient cried frequently, had headache and more marked trembling 
of the muscles of the face. He was ordered iodide of potassium and 
cautery in the nape of the neck, but without success. 

In 1860, he had epileptic attacks with complete loss of consciousness, 



70 ACQUIRED SYPHILIS. 

the hemiplegia persisted, and sometimes conyulsions were added. His 
intellect, which was intact, was soon fatigued. He was almost unable to 
make calculations since the last attack. Such was his condition during 
that winter and the summer of 1860. 

In January, 1861, erysipelas developed itself, having for its starting- 
point the cauterised spot, and which, after haying invaded the whole of 
the head, ended by spreading to the trunk of the body. In February this 
erysipelas ceased, but the skin which covered the sacrum and .left ole- 
cranon became gangrenous ; the parts which had been the seat of the 
erysipelas continued cedematous ; there was extreme emaciation, delirium 
and violent cough without any appreciable lesion in the chest. On the 
2nd of March, coma suddenly supervened and death occurred the same 
afternoon. 

Post-mortem examination, — The right parietal bone was, on its internal 
surface and to the extent of a two-franc piece, spongy and vascular, and 
at this same point, the external surface of the dura mater was covered by 
a villous false membrane. The dura mater was adherent, to the extent 
of a five-franc piece, to the pia mater and cortical layer of the brain. 
The mass which caused this union was, towards its middle part, solid, 
consistent, dry, and elastic ; it dipped in between the convolutions, where 
it formed three conoid excrescences. These excrescences were partly 
indurated and yellowish, partly transformed into a granular pulp. The 
medullary substance in the vicinity, which was very hard, threw out 
callous prolongations as far as the centrum ovale, and contained a smaU, 
firm tumour of the size of a plum-stone, greyish at its periphery, dry and 
yellow at the centre. The medullary substance of the right hemisphere, 
of a lemon-yellow colour, softened in appearance but in reality firmer than 
usual, was traversed by a callous tissue ; in the vicinity of this change, 
some spots of softening were found, which occupied more especially both 
sides of the fossa of Sylvius. There existed a small quantity of fluid in 
the lateral ventricles, the ependyma of which was thickened. 

The liver was small and there was atrophy, chiefly of the left lobe. In 
the vicinity of the round ligament there existed a callous cellular tissue, 
without yellow nuclei. The spleen was soft. The other organs did not 
present any appreciable change. There was ulceration of the skin covering 
the olecranon (Tiingel). 

In this case are observed the chief deraDgements pointed out 
above. The coexistence of these derangements, the alliance of 
paralysis with convulsions or contraction, and headache more or less 
severe, are circumstances which, even independently of any concomi- 
tant symptoms, may put us upon the track of syphilis, for they are 
not usually observed in other diseases. Headache, insomnia, weak- 
ness of memory, paralysis of some of the motor nerves of the eye, 
and strabismus with derangements of vision are frequent symptoms 



PERIOD OF GUMMY PRODUCTS. 71 

in such cases^ and most commonly accompanied by a moic or less 
marked state of cachexia. 

The cutaneous sensibility may be exaggerated or diminished j but 
nevertheless, the changes which it presents are rare, so that their 
habitual absence may sometimes assist the diagnosis. To sum up, 
if the symptomatic derangements which correspond to the syphilitic 
lesions of the brain are numerous and varied, this depends partly 
upon the extent and partly upon the seat of those lesions. In this 
latter point of view there is one symptom little common which is to 
be pointed out : this is aphasia, otherwise termed the loss of the 
memory of words. Professor Schutzenberger* and Melchior Robert f 
have each had one opportunity of observing this phenomenon, which 
we have ourselves seen in a single case. Farther observation will no 
doubt enable us to recognise it more frequently. 

When the cerebellum is more especially the seat of the anatomical 
localisation, the symptomatic manifestations most common are 
nausea, vomiting, movements simulating those of intoxication, a 
tottering gait,t spasms of the muscles of the face or eye, and some- 
times derangements of vision. We have examples of most of these 
derangements in the following cases : — 

J. S., six montlis ill, complained of pains shooting through the head 
and appearing at two o'clock in the morning ; he sometimes had spasms 
of the muscles of the face. He had nausea and vomiting. Copious and 
repeated bleedings, purgatives, and mercury did not bring about any im- 
provement : the pains became distinctly intermittent and returned every 
other night. He was ordered forty drops of liquor arsenicalis. Death 
occurred suddenly. 

At the post-mortem examination were found congestion of the vessels 
of the pericranium and brain ; a large quantity of fluid in the ventricles ; 
coagulable lymph in the ventricles and upon the corpora striata ; and in 
the right hemisphere of the cerebellum, a schirrhous tumour, of the 
size of a small nut, of cartilaginous consistence, in contact with the oc- 
cipital bone, in which it had produced a commencement of absorption. 
(Ward, Nouv, BihL mid., t. iv. p. 368.) 

A woman 31 years of age, who had had an indurated chancre, mucous 

* Gaz, mSd, de Strasbourg, 1850, p. 200. 

t Traite des maladies vSneriennesi Paris, 1853, p. 385. 

X See observations by Hillairet and Greppo, Gros and Lancereaux, 
loc. cU. pp. 272 and 273. Gailleton, Gaz. mid. de Lyon, October 16th, 
1864, Obs. II. 



72 ACQUIBED SYPHILIS. 

patches, &rc., entered the LariboisiSre Hospital under the care of Dr. 
Duplay, having upon her upper extremities a very characteristic pustular 
syphilide. For several weeks this patient had complained of very violent 
occipital cephalalgia, with obstinate vomiting, and iodide of potassium, 
which had been given to her, had had no effect upon these symptoms. 
She soon grew weak and began to totter ; walking became more and more 
difficult and, in the beginning of March, 1863, she was obliged to keep 
her bed. In this condition, she could still carry out movements in every 
direction with the lower extremities in a preconceived direction ; she was 
able to co-ordinate her movements ; there was no paralysis properly so- 
called discoverable, but extreme muscular debility ; the upper extremities 
were in a similar condition to that of the lower ; there was muscular 
debility, but the power of co-ordinating the movements was intact At 
the same time with the diminished mobility of the limbs appeared con* 
vergent strabismus which increased to such an extent that the two eyes 
partly disappeared behind the eyelids, giving the patient a hideous ap- 
pearance. The strabismus was at first complicated with diplopia. Under 
the influence of the will, the patient could react partly against the stra- 
bismus and draw the eye outwards, but with difficulty. There existed 
here also, not paralysis, but a derangement in the locomotive system of 
the eye. Intelligence and sensibility had not been touched in this list of 
serious symptoms, and the other functions had equally remained intact. 
There was neither fever nor cough ; nutrition had been seriously affected 
by the prolonged vomiting ; the patient had become emaciated. A mer- 
curial treatment (two of Sedillot's pills daily) was begun the first week in 
March, and at the end of a week there was already a decided improve- 
ment ; the pains in the head were relieved, the vomiting decreased ; then 
the other symptoms gradually yielded ; the patient regained her strength 
and could soon sit up in bed, and stand upon her feet ; the strabismus 
also yielded, and after six weeks of the mercurial treatment, in April, 
1863, the pains in the head and vomiting had disappeared. The patient, 
who had recovered the power of motion, quitted the hospital cured of the 
strabismus and able to walk easily. The recovery was permanent. 
(Leven, Bulletin de la SociitS de Biohgte, year 1863, p. 150.) 

Another symptom which it is important to point out here and 
which is not very rare, is the appearance of sugar in the urine, so as 
to constitute a kind of diabetes, as has been observed by Leudet, 
Jaksch, and Diib.* In the following case, which we owe to the 



* See an observation by Leudet, MonUeur des sciences mSd,, 1860, 
p. 1189. Jaksch, Ueher die durch Syphilis hedingten Zdhmungen, in AUgem. 
Prager med. Wochenschrifi, 44-52, 1865, Diib, in Vierteljahrachrift fur 
die praktischs Heilkunde^ t. Ixxvii ; two cases of diabetes mellitus with 
syphilitic manifestations, and cured by a specific treatment. 



PERIOD OF GUMMY FRODUCTS. 73 

kindness of our friend Dr. Gentilhomme^ of Bheims, there was, at 
one and the same time^ both polydipsia and polyuria. 



Chancres and buboes in the groin in 1834 without secondary symptoms ; 
hemiplegia cured by iodide of potassium, — Multiple gummy tumours ; 
polyuria, 

Obs. LI. — D.» set. 54, entered the infirmary of Bicetre in the month of 
December, 1860, for gastric derangements simulating organic disease of 
the stomach. 

Antecedents, — This patient stated that he had had chancres on the glans 
in 1834, accompanied by a bubo in the right groin, which terminated in 
suppuration. 

When examined on admission, a very evident cicatrix was found in the 
groin. From these chancres no secondary symptoms residted, at least 
after a sojourn of two months in the Hospital du Midi. No trace of sym- 
ptoms was found either in the throat, on the skin, or about the anus, 
which could give the idea of syphilitic manifestations. In 1837, D. fell 
from the sixth floor into the street, alighting upon a hay -cart. Taken 
home in a state of unconsciousness, he soon came to his senses and re- 
covered rapidly from a dislocation of the right shoulder and a fracture of 
the clavicle. 

He resumed his work, and some time afterwards was seized with hemi- 
plegia of the right side, which came on slowly and progressively, without 
cerebral derangements. There existed, at the same time, very acute pains 
in the right side of the head, the same side as the paralysis of the limbs. 
For more than a year, D. was under treatment in various hospitals in 
Paris, but without benefit. Placed at last under the care of M. Boyer, he 
recovered rapidly under the influence of treatment with iodide of potas- 
sium. He returned to his work, but was again prevented continuing it 
after some time by a fresh paralysis, occupying this time the left side of 
the body. In other respects this paralysis ran the same course and was 
accompanied by the same symptoms as the first, but did not disappear, 
and D. was sent into the Bicetre Hospital for this infirmity. Since then, 
this hemiplegia almost entirely disappeared under the influence of iodide 
of potassium. 

Later on, this patient presented a very remarkable series of symptoms. 
First, three years ago, he had gummy tumours, in the lobe of the right 
ear and in the sub-cutaneous cellular tissue of the right thigh and knee, 
for which M. Desprds gave him iodide of potassium. Some of these 
tumours disappeared by resolution ; others, on the contrary, underwent 
softening. Those which had their seat in the lobe of the ear ended by 
completely destroying that appendage. Those which were situated in the 
leg left behind them small fistulas which are still visible on the internal 
surface of the tibia. The gummy tumours were of the size of small nuts, 
and were the seat of acute pains during the night. 

Present condition (April, 1861). — The patient keeps his bed. He is very 



74 ACQUIRED SYPHILIS. 

feeble and gieatlj emaciatedy and his general appeannce indieateB m veiy 
adranced state of cachexia. The skin is pale and somewhat yeOowish. 
The mncons membranes are pale and dUsoolonred. 

Eight months ago, he b^an to feel more thirst than nsnaL He drank 
nearij three quarts of tisane dailj ; this want has continued to increase, 
and he now takes about three quarts and a half daily and passes urine in 
proportion. The gams are soft and bleed; the teeth, spoiled and un- 
covered, are frequentiy the seat of very acute and very persistent pain. 
The breath is foul, the tongue red and burning ; swallowing is difficult, but 
there is nothing mbnormal to be seen in the throat. At the commence* 
ment of the disease, the digestive fdnctions were performed very regularly, 
but soon became deranged. The appetite gradually decreased. Digestion 
became difficult and even impossible. Immediately after taking a littie 
food, the patient felt pain in the stomach and behind the stemnm, he had 
m choking feeling and strange sensations which he compared to compres- 
sion of the stomach with m bar, and an inclination to vomit almost always 
followed by actual vomiting ; the pains did not cease until the whole con- 
tents of the stomach had been ejected. 

The belly was large and tiiere was generally constipation, but some* 
times colic and diarrhcoa. The abdomen was painful over its whole ex- 
tent, but chiefly in the middle of the right hypochondrium. There was 
meteorism in the left hypochondrium, in the neighbourhood of the 
stomachy and distinct dulness downwards as far as a horizontal line which 
would pass a littie below the umbilicos. To the extreme left of the right 
hypochondrium, the liver did not project beyond the border of the false 
ribs. The dulness indicative of the presence of the liver was prolonged 
far up into the chest. 

Palpation revealed in the neighbourhood of the epigastrium a tomour 
with a sharp edge, already indicated by percussion. 

In the chest were observed the following phenomena : the cough com- 
menced six months ago, from which time it has always gone on increas- 
ing. At present it is very freqaent and accompanied by an expectoration 
of yellowish frothy sputa. The cough prevents the patient from sleep- 
ing. He has never had haemoptysis. 

The patient complains of pains in the chest, resembling by their 
characters and seat intercostal neuralgia. These pains are very acute, 
especially in the right side of the chest and in the vicinity of the vertebras. 
They are evidently increased by pressure. In the parietes of the chest 
are felt nodosities of hard bodies, wbich are probably seated in the thick- 
ness of the muscles. The right subclavicular fossa is littie marked. 
Besonance is abnormal on both sides. In front, the breathing is loud and 
harsh ; behind, some bronchial r&les existed on both sides of the chest. 

There was nothing abnormal about the circulation. As regards the 
urine, merely an increase in quantity was observed : seven pints a day. 
The urine, examined on several occasions, never presented any trace of 
sugar or albumen. As regards the nervous system, the patient com- 
plained of very acute headache, which showed itself chiefly during the 
night. This pain was superficial and presented the characters of neuralgic 



PERIOD or GUMMY PBODUCTS. 75 

paiD. Its existence was Torj probably to be attributed to the presence of 
▼ery nomerons exostoses situated in the bones of the skull. These ex- 
ostoses were small and very little prominent ; they were rery appreciable 
to the toucb and even by the eye. 

The intellectual functions were very perfect. There was slight hemi- 
plegia on tbe left side, accompanied by some aniesthesia in theJeg. This 
hemiplegia, which was almost complete when the patient was admitted at 
Bicetre, decreased greatly in consequence of an antisyphilitic treatment 
to which be was subjected for the gummy tumours, exostoses, pains, &rc. ; 
but the paralysis had not yet disappeared entirely. There was no other 
phenomenon to be remarked on the part of the organs of the senses. 

As regards the skin, the lobe of the right ear was entirely destroyed. 
There existed several ulcerations covered with crusts on the internal sur- 
face of the right knee. Near the ulcerations some whitish cicatrices were 
observed. All these lesions were consecutive to small painful tumours, 
the size of small nuts, which had become transformed into pus. 

The condition of the patient grew steadily worse. The emaciation 
increased daily. There was constant vomiting and intense thirsf. The 
patient was tormented by pains which did not allow him a moment's rest; 
the cougli beoame more frequent. A little fever supervened, at first to- 
wards ewening, then it became continuous. The patient died on the 20th 
of April, with all the symptoms of broncho-pneumonia. 

The post-mortem examination was made twenty -four hours after deaths 

EncephaUm, — ^On the frontal bone were found flattened protuberances 
of irregular form and varying size ; the largest did not exceed the size of 
a half-franc piece. Their surface was smooth, but devoid of polish. Some 
of them projected to a considerable extent ; these latter were irregular and 
wrinkled on their surface. The pericranium covering these exostoses was 
easily detached. In the midst of these very numerous exostoses there were 
seen xipon the bones of the skull bluish spaces into which a scalpel could 
easily be pushed. At these points the osseous tissue was found to have 
disappeared and to have been replaced by fibrous tissue mixed with vessels. 
These bony ulcerations penetrated to thediploe. The periosteum was thick- 
ened at the points corresponding to the changes in the bones and easily 
detached. 

On the internal surface of the cranium, the dura mater adhered to that 
portion of the frontal bone which corresponded to the changes in the 
external surface of the bone ; on removing it, the same changes were 
observed as those existing on the surface of the bone. The depressions 
were very irregular both on the internal and external surface. The 
smaller ones were starlike, the larger ones varied greatly in form. Their 
size did not exceed one centimeter and a half in any direction. Around 
these depressions and over a large extent of the vatdt of the cranium, 
the bone was studded with points and furrows, which gave to its surface 
the appearance of a section of a testicle. 

The brain, which was examined with great care, was found to be per- 
fectly healthy in all its parts. At the base of the skull, the dura mater 
came away easily. No tumour existed, either in the bones or in the 



76 ACQUIRED SYPHILIS. 

fibrous coverings. The spinal marrow, nerres and organs of the senses 
were not examined. 

Organs of rettpirtUion, — ^The thyroid body presented a yery remarkable 
change in its texture. Its volume was neither augmented nor diminished, 
its consistence was very firm and yery resistent, but at the same time 
much more friable than usuaL Its colour was somewhat yellowish and 
its section surface shining. It presented, in a word, an appearance which 
might be compared to that of bacon slightly coloured with blood. The 
trachea and bronchi were healthy. In the lungs, adhesions existed on both 
sides. There was hepatisation at the base of both lungs and congestion 
throughout the rest of their extent ; at the apex of the right lung was 
observed a mass the siae of a nut, situated superficially ; this mass was 
very hard and presented the appearance of marble on section. There 
were seen in it some black parts separated by brilliant lines which 
appeared to be formed of fibrous tissue. This part of the lung was com- 
pletely impermeable to air. At the base of the right lung was an effusion 
of pus circumscribed by adhesions. At the roots of the limgs, the bron- 
chial glands, which were hypertrophied, indurated, and blackish, con- 
tained in their substance deposits of a yellowish matter, solid in some, 
softened in others, and resembling pus. These deposits presented the 
most perfect resemblancCj as regards external appearance and elemen- 
tary composition, to gummy tumours in their different stages of induration 
and softening. 

Alimentary canal and its appendages, — ^The stomach, which was full of 
fluid, was slightly dilated ; the matters contained in it passed with diffi- 
culty through the pylorus. There appeared to be a narrowing at this 
point ; the valve appeared more prominent than natural and thickened. 
The mucous membrane, which was healthy, was easily removed ; beneath 
it was found a highly developed muscular ring. The mucous membrane 
of the small intestines and a part of the large intestine was blackish and 
softened, especially in the neighbourhood of the ileo-csecal valve. The 
numerous lymphatic glands which receive their vessels from this part of 
the intestines were hypertrophied; they contained in their interior encysted 
masses, resembling deposits of pus. This change was exactly the same 
as that in the bronchial glands. 

The liver presented a very remarkable appearance externally. The 
right lobe was somewhat smaller than in the normal condition ; the left 
lobe presented at its upper part a small tumour of the size of a pea, which 
was yellowish and wrinkled on section, and friable in consistence. Its 
appearance was exactly the same as that of the pathological products in 
the bronchial and mesenteric glands. On the convex surface of the liver 
there were several analogous tumours, smaller than the preceding, being 
about the size of a millet-seed. In the same neighbourhood was seen a 
puckered cicatrix, running from before backwards, from the gall-bladder 
to the posterior part of the organ, seven centimeters in length ; whitish, 
fibrous, and depressed, this cicatrix was of great thickness, viz., a centi- 
meter or more. It adhered by the middle portion of its length to a volu- 
minous and strong mass situated in the substance of the liver. This mass 



PERIOD OF GUMMY PRODUCTS. 77 

was of the size of a large walnut ; its form was rounded, but yerj irregu- 
larly ; its surface was very uneven. It consisted of two halves, which 
moved upon each other. Its colour was whitish and its hardness such 
that it was impossible to attack it with the scalpel. This mass adhered 
very closely to the substance of the gland. Around this stony mass, the 
liver was hard and as it were fibrous at certain points ; in other places, it 
contained small yellowish tumours, about the sixe of millet-seeds, pressed 
against each other and closely resembling those which existed on the 
surface of the liver. The inferior surface of the liver did not present 
anything abnormal ; the gall-bladder was healthy and filled with green- 
ish bile. The hepatic tissue itself appeared to be perfectly healthy. 

Organs of circulation, — The pericardium, which appeared healthy, con- 
tained in its interior five or six spoonsfiil of purulent serum. The heart 
was large and very firm. There was no lesion of the orifices, but the 
muscular substance itself was greatly changed. On section, it appeared 
smooth, shining, discoloured, yellowish, and lardaceous. The muscular 
fibres of the heart presented a close resemblance in appearance to the 
thyroid body. Under the microscope, the muscular fibres were easily 
recognised, but they were infiltrated with a great quantity of granula- 
tions. 

Kidneys. — ^The kidneys were of the natural size, but they had under- 
gone a singular change : they were mammillated on their surface and 
traversed by furrows. The secreting portion was of a lardaceous, yellow- 
ish appearance. The supra-renal capsules themselves contained deposits 
of yellowish matter, of the size of a millet-seed, some hard, others 
softened. All these deposits resembled each other, di£fering only in size. 



The polyxiria symptomatic of a syphilitic localisation in the ence- 
phalon is sometimes simple^ sometimes accompanied by glycosaria or 
albuminuria. It existed at the same time as a large quantity of 
albumen in the urine of a patient of whose case the following is an 
abridged history : — G., aet. SO, perceived on the 15th of August, 
1865, that he had contracted a chancre on the prepuce. He took, 
at that time, twenty pills and Van Swieten's drops for three weeks. 
At the end of October, he went into the Hospital du Midi, where 
the chancre was excised. Cicatrisation took place with difSculty. 
He went out in December, after having taken iodide of potassium 
for twenty-five days and some fresh pills. During his stay in that 
hospital, he had cervical adenopathies, angina, and iritis. His 
general health remained good until June, 1866, despite occasional 
excesses in drinking. In the early part of June, rupia supervened, 
which invaded the extremities and trunk, and for which he had, in 
the Hospital St. Louis, vapour and sulphur baths. The eruption 
became cicatrised towards the end of August ; in September, he lost 



78 ACQUIRED SYPHILIS. 

strength, and had oBdema of the legs. On the 7th of September, 
this patient entered the Hospital St. Antoine, under the care of M. 
Lorain, who had the kindness to give me notice thereof. Large 
mottled cicatrices were spread over his body, the legs were cedema- 
tous, and his urine, which was copious and frequently passed, con- 
tained albumen. He had persistent headache, with nocturnal 
paroxysms, insomnia, giddiness, and frequent nausea. The liver, 
lungs, and heart appeared free from disease, but there was slight 
anaemia. He was ordered iodide of potassium and mercury, with 
quinine wine. On the 17 th of September, he had an epileptiform 
attack, and had six accessions in the course of half an hour, fresh 
accessions in the night, and delirium. Consciousness returned the 
following day, but his memory was weak, his sight affected, and 
there was slight hemiplegia of the right side. There was no vomit- 
ing or bad taste in the mouth, but oppression and some r&les in the 
chest. For several days, the pulse remained at 108 and the life of 
the patient was in danger. Nevertheless, the treatment was con- 
tinued without interruption and at the end of October recovery ap- 
peared insured, and the patient left the hospital, having no longer 
either oedema or albuminuria. His intellect was clear, his strength 
had returned, and he purposed soon resuming his usual occupa- 
tions. 

That syphilis was the cause of the symptoms observed in this 
patient is a point which it is impossible to doubt. What may be 
disputed is, the correlation of these symptoms and above all, the 
existence of a connection between the albuminuria and the nervous 
derangements. There is reason to believe, however, that the albu- 
minuria was dependent upon the nervous lesion, without which it 
would be difficult to explain its rapid disappearance. 

The course of the syphilitic affections of the encephalon is slow 
and progressive. Headache, insomnia, vertigo and giddiness are 
generally the first symptoms ; later on supervene convulsive attacks, 
paralysis, and derangements of the intelligence. These last sym- 
ptoms only appear at an advanced period, Uke the derangements of 
sensation, which are rare however. 

After a longer or shorter period, syphilitic encephalopathies be- 
come stationary or gradually improve. Their duration varies from 
some weeks to several years. Their spontaneous cure is rare, but in 
general they rapidly feel the influence of specific treatment ; their 
complete disappearance is only possible, however, when the nerve 



PERIOD OF GUMMY PRODUCTS. 79 

elements have retained their integrity. But^ as these elements almost 
always end by becoming changed after a certain time^ it follows that 
certain symptoms sometimes persist indefinitely, and amongst these 
symptoms may be placed^ above all, paralysis. Astnic had already 
recognised the difficulty of caring syphilitic paralysis, but he did 
not know the reason of it. 

Cases proving this difficulty are not very rare. We could give 
several instances of these difficult or even impossible recoveries, 
which had at first promised most &vourably ; but we shall content 
ourselves with quoting a single one, given us formerly by a dis- 
tinguished physician of Tongres, who desired our opinion con- 
cerning it. 

* Obs. LII. — X., a brewer, aet. 69, of a strong constitution, had always 
enjoyed good health when, at 32 years of age, he had a syphilitic affec> 
Hon "which he could not describe exactly. He knows that he had 
chancres, for which he took a large quantity of mercury. About a year 
after the first lesions, he was attacked by paralysis of the motor mnscles 
of the light eye and blindness. These symptoms quickly disappeared, 
but soon afterwards he felt weakness of the lower extremities, and then 
had partial paralysis of that part of the body. Blisters, moxas, sulphur 
baths, ergot of rye, and strychnia, &c., were employed successively, all 
which remedies were without effect. The paraplegia continued, and 
violent pain in the left foot had rendered this man's life very miserable for 
the last thirty years. Iodide of potassiimi was ordered, to the extent of 
fifteen grains daily at first, and increased successively up to thirty-seven 
grains and a half. Daring the first eight days, there vras a marked im> 
provement ; but the medicine was afterwards borne badly, its effect soon 
diminished and the improvement did not continue. 

In this case, and in many others of the same kind, the long dura- 
tion of the disease sufficiently indicates that the change had finished 
by reaching and destroying the nerve elements, and thus rendering 
a complete cure no longer possible. The change or even the 
destruction of a greater or less number of these elements by the 
contact of the syphihtic neoplasm is, then, the invincible obstacle. 
The derangements resulting from excifcation or compression disap- 
pear ; but those which, like paralysis, are connected with the ana- 
tomical modification of the cells and nerve tubes, necessarily con- 
tinue. It is a phenomenon of the same kind as that observed in 
cerebral haemorrhage, in which the clot of blood tears and compresses 
at one and the same time the nerve elements. 

Lastly, death may be the consequence of syphilitic lesions of the 



80 ACQUIRED SYPHILIS. 

encephalon when they are extensive, or when, being circumscribed, 
they occupy a part such as the medulla oblongata, the integrity of 
which is essential for the maintenance of life. There are cases also 

m 

in which epileptiform attacks, which had previously presented little 
danger, suddenly become redoubled in frequency and are followed by 
coma and deaths although the post-mortem examination does not 
always reveal the cause of this sudden and rapidly fatal termination. 

Diagnosis. — ^The diagnosis of syphilitic encephalopathies is gene- 
rally difficult on account of the numerous symptomatic forms which 
may present themselves. 

The succession and modality of the symptoms are here circum- 
stances which put us, at the very least, upon the trace of the spe- 
cific cause. Intense cephalalgia, persistent and obstinate, with noc- 
turnal paroxysms, giddiness, and vertigo, yielding rapidly to the use 
of mercury or iodide of potassium, is a symptom of great dia- 
gnostic importance. Insomnia, whether connected with this sym- 
ptom or not, is a symptom not less important or less frequent.'^ 

The other symptoms have nothing special, if we except the some- 
times transient character of the paralysis. Syphilitic hemiplegia has 
not, in fact, either the sudden onset or the stability of hemiplegia 
symptomatic of cerebral haemorrhage, or of softening succeeding the 
obliteration of an artery. 

Epileptiform attacks without aura, clonic or tonic convulsions 
without absolute loss of consciousness, preceded or followed by more 
or less violent cephalalgia, also constitute symptomatic forms worthy 
of being taken into consideration. 

But it is of importance not to stop at the examination of a single 
system ; every organ should be investigated carefully, and thus, with 
the aid of the commemorative symptoms, and taking into account 
the concomitant cutaneous, osseous, or visceral affections, and the 
cachectic condition which is rarely wanting under such circumstances, 
the physician will generally succeed in recognising, with the seat and 
extent of the lesion, the source from which it springs. It is thus 
that a certain malformation of the liver coinciding with slight ribu- 
minuria may, in a given case, possess a great diagnostic value. 



* Consult, on this symptom, Fracastor ; he, cit, Sigmund, in Archiv. 
de mid,, 1857, t. ii. p. 226 ; Reynaud, in Ann, des malad, de lapeau et de 
la syphilis^ t. ii. p. 312. 



PERIOD OF GUMMY PRODUCTS. 81 

In cases in which the totality of phenomena forms one of the 
symptomatic groups known under the name of epilepsy^ general 
paralysis^ paralytic dementia^ &c.^ the age of the patients and the 
circumstance that the derangements characteristic of the group in 
question do not date further back than the appearance of the syphilis ^ 
will be valuable indications. These indications most frequently 
suffice for the diagnosis of syphilitic epilepsy. As regards general 
paralysis and dementia^ the headache or insomnia which precede or 
accompany them, a peculiar mode of evolution, a jerking gait, in 
short, a peculiar character, are so many circumstances which dispose 
us to attribute to them a syphilitic origin and to distinguish them 
from analogous affections produced by drinking spirits. In alco- 
holism, in fact, the patient is troubled with dreams, illusions, and 
even hallucinations ; the power of sensation is always affected and 
the headache usually wanting. The same is the case with the para- 
lytic symptoms produced by lead, which have, moreover, for their 
most special seat the extensor muscles of the extremities. 

The diffused and acute lesions of the brain, such as meningitis 
and encephalitis, differ too much from the syphilitic affections of 
that organ for it to be necessary to discuss their distinguishing signs. 
I ought to mention, however, that in a patient under the care of 
Professor Grisolle, who succumbed to a cerebral affection which 
might be regarded as syphilitic, the symptoms had been little diffe- 
rent from those of meningo-encephalitis ; but that was a rather 
exceptional case. 

Lodged in the brain or situated on the surface of the meninges, 
tubercular, cancerous, and fibrous tumours give rise to derangements 
which it is not always easy to separate from those which belong to 
syphilitic tumours ; but by taking into account the age of the 
patients, their morbid antecedents, and the evolution of the disease, 
we shall most frequently succeed in suspecting, if not in distinctly 
diagnosing the nature of each of these changes. Thus, tubercles 
belong almost exclusively to early age ; cancer, on the contrary, is 
met with at a more advanced age. These changes are accompanied 
by a special cachexia, distinct from syphilitic cachexia. Fibrous 
tumours, which are often independent of any diathetic condition, are 
remarkable for the slowness of their development and by a course 
progressively increasing, contrarily to syphilitic neoplasms, which 
most frequently become arrested at a given moment in their evolu- 
tion. 



82 ACQUIRED SYPHILIS. 

There is no other affection except pachymeningitis^ with or without 
haemorrhage, susceptible of being mistaken for a syphilitic affection 
of the brain or meninges and requiring, to be distinguished there- 
from, the consideration of the various circumstances mentioned 
above. 

Prognosis. — When localised in the encephalon, syphilis is to be 
regarded as a serious disease, not only on account of the importance 
of the functions invclved, but also on account of the frequency of 
relapses. We often see, in fact, an amelioration or even a rapid 
recovery followed by fresh symptoms more intense than the first and 
more difficult to combat (Obs. XLV.). 

Statistics furnished by Dr. Gjor show that, out of thirty patients, 
five were cured, twelve improved, six did not experience any change, 
and seven died.* In 147 cases collected by Lagneau, junior,t a 
more or less favourable termination is met with eighty-three times, 
a fatal one fifty-seven times, that is to say, in about two-fifths of 
the cases. In seven cases, death was the result of an intercurrent 
disease. 

An examination of the cases, in accordance with the physiological 
data, shows that the most serious lesions are those which affect the 
parts most essential to life. Lesions of the bones or meninges, those 
which occupy only the periphery and convexity of the encephalon, 
are much less serious than those which reach the more deep-seated 
parts and the base of the skull. 

As regards the symptoms, it may be said that cephalalgia and 
insomnia are unimportant. Vertigo and convulsive attacks do not 
always enable us to predicate with certainty the issue of the disease ; 
but they are, in general, less to be feared than the paralytic sym- 
ptoms and the derangements of the intellectual faculties (idiotcy, 
stupidity, torpor, somnolency), which, of all the syphilitic disorders 
of the encephalon, are certainly the most serious. These symptoms 
are, however, the more serious in proportion as they are of longer 
standing, because there is then reason to fear that to the lesion itself 
inay be added a more or less considerable destruction of the surround- 
ing nerve elements. However the case may be, the syphilitic mani- 
festations of the encephalon are less formidable, even in the absence 



• Gjor, Norsk Magazin, t. xi. p. 794. Schmidts Jahrh., t. ci. p. 794 ' 

{^rch. demSdecine, May, 1859, p. 615). 

t Traits des malad. syphiUU du syttime nerveuxj p. 164, 1860. 



PERIOD OF GUMMY PRODUCTS. 83 

of any specific treatment, than any of the affections resulting from 
a different caase ; and it is especially when they are recognised and 
treated sufficiently early that these manifestations are least serious. 

§ 3. Syphilitic affections of the spinal cord, — Syphilitic 

myelopathies. 

Anatohical Study. 

The syphilitic lesions of the spinal cord do not differ from the 
encephalic lesions except by their seat and less frequency ; like the 
latter, they occupy, sometimes the coverings and more particularly 
the spinal dura mater, sometimes the nerve substance. 

A more or less considerable thickening of the meninges, with fre- 
quent adhesions to the surrounding parts, and gummy tumours situ- 
ated upon the internal or external surface of those membranes, such 
are the changes in the coverings of the spinal cord. Several cases of 
visceral syphilis make mention of one or other of these conditions. 
Dr. Voillemier, surgeon to the Hospital St. Louis, formerly showed 
us a sketch illustrating the presence of these deposits upon the in- 
ternal surface of the dura mater of the cord. An analogous example 
is met with in Zambaco's work."^ The circumference of the spinal 
marrow in the lower half of the dorsal and whole extent of the 
lumbar region was the seat of a gelatinous effusion of a gummy 
consistence. 

The anatomical derangements occasioned by syphilis in the sub- 
stance of the spinal cord itself present themselves under one of two 
forms, the diffused or the circumscribed. In the former variety, the 
spinal cord is indurated or softened, the ependyma is thickened, and 
new elements of conjunctive tissue, with or without amyloid cor- 
puscles, develop themselves amongst the nerve elements, which may 
be consecutively injured or destroyed. It is, consequently, a true 
sclerosis, the existence of which is proved by the following case 
which we owe to the kindness of our learned teacher, Dr. Potain. 

About the month of February last, there came into the H6teL 
Dieu a woman five months gone in pregnancy, who complained of 
gastralgia and violent pains in the head, and who had all the sym- 
ptoms of extreme chloro-ansemia. As the cephalalgia continued to be 

* Des affections nervemes syphilitiques. Paris, 1862, p. 251. 

y2 



84 ACQUIRED SYPHILIS. 

felt, especially at night. Dr. Potain suspected, in spite of the denials of 
the patient, the existence of a syphilitic aflFection. In fact, he found 
enlarged and not painful cervical glands, groups of enlarged inguinal 
glands, and several mucous papules at the ver^e of the anus. Mild 
mercurial treatment (proto-iodide of mercury) was commenced and the 
pains in the head diminished. A month after her admission into the 
hospital, the patient was safely delivered of twins, hefore the full 
time, which lived three days, and in which no sign of syphilis or other 
morbid symptom was observed during life. In one of them there 
was extreme debility. 

The post-mortem examination showed in both foetuses the special 
change in the liver described by Gubler, but in a small part only of 
its extent, the size almost of a large pea, in one at the lower border, 
in the other upon the anterior border and on the upper surface, near 
the falciform ligament. At these points was seen a semi-transpa- 
rent, yellowish colouration, somewhat opaline, hardness, and absence 
of vascularity, all the characters, in a word, of the change described 
as syphilitic. There was nothing remarkable in the other thoracic 
or abdominal viscera. 

The brains did not appear changed, and presented the soft consist- 
ence usual at that ag6. 

The spinal cord of one of the fcetuses appeared also to be in the 
normal state. The microscope showed in it well-marked nerve 
tubes. 

The spinal cord of the other foetus, on the contrary, was, in its 
whole length, diminished in size, hard, without any trace of division 
between the substances, and completely resembling a fibrous tendon 
except in colour, which was a reddish grey. Under the microscope. 
Dr. Potain could not discover either nerve cells or any distinct nerve 
tubes. The whole cord appeared to be formed of condensed lami- 
nated tissue, turgid and mixed with an abundant granular substance. 
The examination of the two cords was made simultaneously, and the 
considerable diflFerence in structure which existed between them could 
not be called in question. As regards the spinal meninges, no change 
appeared to have taken place in them. 

A case observed by ourselves is not, in an anatomical point of 
view, devoid of analogy with the preceding case. It was the question 
of a man 57 years of age, who sank under the effects of paraplegia, 
and who presented, together with myocarditis and deep cicatrices on 
the surface of the liver, softening with sanguineous exudation about 



PEBIOD OF GUMMY PRODUCTS. > 85 

the middle portion of the spinal cord in the cervical region. The 
primary change consisted in a hypergenesis of the conjunctive tissue 
with fatty degeneration of the capillaries ; but the syphilitic nature 
of this lesion must remain doubtful^ as it is not to be assumed 
solely on account of the coexistence of cicatrices in the liver. From 
what we know of the syphilitic manifestations in the viscera, there 
is every reason to believe that there existed a modification of the 
same kind in the cases related of syphilitic paraplegia without appre- 
ciable lesion : this appeafs the more probable as no microscopical 
examination was made.* 

The gummy tumour constitutes the characteristic lesion of the 
circumscribed form. Three cases with which I am acquainted point 
out the existence of this lesion. A case furnished by MacDowel 
shows integrity of the meninges and a slight softening of the dorsal 
portion of the spinal cord, in the midst of which existed a tumour of 
a yellowish colour, the size of a large pea, of very firm consistence ; 
this tumour projected, especially on the right; it was perfectly 
round, and smooth and polished on its surface, even when looked at 
with a glass. The nerve tissue around it was much softened, greatly 
injected, and spotted with yellow. There was no trace of tubercles 
in the lungs. The liver was cirrhose, the spleen enlarged and soft- 
ened; the kidneys were healthy. A case which forms part of 
Wagner's Eeport {ArcAiv der Heilkundey 1863) mentions the ex- 
istence of a tumour of the size and shape of a small nut, of a bluish- 
white colour, and yellowish at the centre, which occupied the centre 
of the left half of the medulla oblongata. Another tumour, the size 
of a nat and of lardaceous appearance when cut into, was situated 
in the left hemisphere of the cerebellum. The liver was everywhere 
adherent to the neighbouring organs ; but, like the author himself 
and Dr. Jaccoud,t one cannot help having some doubt as to the 
syphihtic origin of this latter change. 

In a paraplegic woman, who died at the age of 53, and who stated 
that she had contracted syphilis from her husband, Wilks found in 
the lumbar portion of the spinal marrow of the right side, a hard 
deposit of the size of a nut and three-quarters of an inch in length, 



• See Gjor, N<yr8h Magazin (xi. and xix., 1857). Ricord, CUnique icono- 
graphique de VH^pital des vSnSriem, Zambaco, Des affections nerveuses 
9yph%litique9i Parus, 1862. 

t La paraplSgie et Vataxie des mouvements, Paris, 1864. 



86 ACQUIRED SYPHILIS. 

sarrounded by the posterior roots of the nerves, to which it adhered 
closely. On section, this mass appeared to be composed of an 
opaque, yellow, amorphous substance, entirely similar to the sub- 
stance which formed the nodules found in the lungs and liver. C^ 
the surface of this latter organ existed the remains of a cicatrix.* 

To these lesions of medullary syphilis might we not add certain 
cases of grey or amyloid degeneration whichj^ in a symptomatic point 
of view, find their expression in ataxy of the movements of the lower 
extremities? Without giving a positive opinion on this point, we 
cannot refrain from pointing out that ataxy is frequently met with 
in individuals who have had syphilitic affections, and under such 
circumstances, it is allowable to suppose that the syphilitic diathesis 
may have an influence upon the amyloid degeneration of the spinal 
cord analogous to that which it exerts upon the waxy degeneration 
of the liver and some other organs. 

With the preceding lesions, effects of the localisation of the syphi- 
litic process upon one of the points of the spinal cord or its cover- 
ings, we must connect secondary changes resulting from a primary 
modification of the vertebral column. These changes, which differ 
little from those which would be occasioned by a foreign body com- 
pressing the medullary centre, are evidently subordinate to the ana- 
tomical derangement of the osseous system and to the amount of 
compression resulting from it. They consist in phlegmasia© with 
more or less softening and destruction of the nerve elements. 

As regards the vertebral lesions, they show themselves in the 
form of exostosis, caries, or necrosis. In a soldier whose case was 
published by Minich, of Padua, there was on the level of the second 
dorsal vertebra a painful projection which there was good reason to 
regard as a syphilitic exostosis when iodide of potassium was ob- 
served to effect the cure of a concomitant paraplegia. An analogous 
case has been observed by Piorry, and Dupuytren, Montfacon, and 
Leprestre, of Caen, have reported cases of syphilitic caries of the 
vertebr8e.t 



* See Hutchinson and Jackson, Med, Times and Oaz,, 1861, t. ii. p. 85« 
f See Leon Gros and Lancereaux, Des affections nerv. syphilite, 1861, Obs. 
CCXXXV., CCXL., CCXLL, CCXLIL, CCXLIIL Compare: Allain, 
Compression de la moelh ipiniere par une on plus'ieurs exostoses syphiUtiques, 
dans Moniteur des hSp,, 1858. Passavant, SyphiliHsche Lahmungen (Vir- 
chow's Archiv, xxv. 1862). 



PERIOD OF GUMMY PRODUCTS. 87 



Syhftoicatic Study. 

The symptoms which correspond to the syphilitic lesions of the 
spinal cord necessarily present differences^ according to the seat of 
the anatomical localisation at such or such a point of the coverings 
or of the cord itself. To attempt to point out all these symptomatic 
differences^ woold be to imdertake to speak of aU the cases known^ 
which is impossible ; consequently^ we shall confine ourselves to 
mating known the phenomena most generally observed. One of 
the most important is a localised pain in the back, sometimes intense 
and more violent during the night, when, without doubt, there is 
some lesion of the vertebral canal. A patient observed by Ch. 
Bernard complained of the sensation of a bar or constriction around 
the loiDs and belly. Sometimes it is at the terminations of the 
nerves of the extremities that the pain makes itself felt ; this pain, 
nevertheless, has never either the intensity or the rapidity of well- 
marked ataxy. The patients complain, moreover, of various sensa- 
tions of cold and swelling, which are felt more particularly in the 
extremities.* 

Tactile sensibility is sometimes affected ; it was greatly weakened 
in a patient of Houstet's, whose lower extremities were cold and 
had also lost the power of motion ; the same was the case in other 
patients treated by Sandras, Allain, Lagneau, sen., Petrequin, &c. 

A more common symptom, and one which is rarely wanting, is 
paraplegia. Most of the authors who have treated of this affection 
have recognised that it is sometimes connected with syphilis. J, 
Frank even goes so far as to consider syphilis as being one of its 
most frequent causes. Since Houstet,t who, in 1733, cured by the 
aid of mercurial frictions a man suffering from complete paralysis of 
both legs, retention of urine and stools, and impotency, several ob- 
servations more or less analogous { have been given ; but they do 
not all possess the stamp of absolute certainty in reference to a 
causal relation to syphilis. However the case may be, and if we 
confine ourselves to the cases most carefully observed, paraplegia 



• See an observation by Vidal de Cassis, TraitS des maladies vSniriennes. 
Paris, 1855, p. 486 ; and another of Landry's, quoted by Zambaco, p. 231. 

t Mimoire de VAcadSnUe royaU de chirurgk, t. iv. p. 224. Paris, 1819. 

t These observations and a bibliographical notice of them will be found 
in G. Lagneau's work and in our own. 



88 ACQUIRED SYPHILIS. 

almost always supervenes long after the appearance of the syphilitic 
diathesis, and has a slow and progressive outbreak rather than a 
sudden one : characterised by uncertainty and weakness in walking, 
it presents frequent oscillations, which is the peculiarity of a great 
number of syphilitic manifestations. 

Most commonly limited to the lower extremities, paralysis some- 
times invades the arms (obs. Landry), but it is rarely accompanied 
by contraction or convulsions. A patient of Cirillo's and another 
of Portal^s had, it is true, convulsive movements in the lower ex- 
tremities ; but it was not clearly established that these two patients 
owed their disease to syphilis. However that may be, these sym- 
ptoms, when they exist, generally form part of the early or late de- 
rangements which reveal the existence of a syphilitic affection of the 
spinal cord. 

Like the encephalopathies, the syphilitic myelopathies have 
moments of arrest in their course, and when, by means of an appro- 
priate treatment, an amelioration, almost amounting to a cure, has 
been attained, it is not uncommon to observe a relapse. In this 
manner, the syphilitic affections of the spinal cord generally have a 
pretty long duration. Eecovery may be incomplete or complete. 
Some cases establish the possibility of the final cessation of all func- 
tional derangements. 

Diagnosis, — ^The affections which simulate the functional derange- 
ments connected with the syphilitic lesions of the spinal cord are 
chronic partial myelitis or medullary sclerosis, and certain changes 
such as epithelial and fibrous tumours, which, by the compression 
which they exercise, cause symptoms very analogous to those pro- 
duced by syphilitic deposits. But, since no sign exists which is 
peculiar to those manifestations, it follows that the antecedents of 
the patient and the concomitant affections are almost the only bases 
for a diagnosis. 

The diagnosis of syphilitic myelopathies generally presents great 
difficulties, and if it happens that these affections sometimes pass 
unperceived, it is not uncommon, on the other hand, to see attributed 
to syphilis and treat-ed accordingly, cases of paraplegia which are 
anything but syphilitic. It is important, then, to be clear on this 
point, and on that account it must not be forgotten that the tertiary 
syphilitic lesions of the spinal cord have for their chief character- 
istics, like the cerebral, hepatic, and pulmonary lesions, to be dr- 



PERIOD OF GUMMY PRODUCTS. 89 

camscribed^ to be slow in their evolution, and to be insidious in their 
onset ; and thus it will be understood that these lesions, while they 
paralyse voluntary motion, generally leave intact, in part at least, 
the sensibility and, above all, the reflex movements of the extremis 
ties. But are we on this account to refrain in all cases from attribut- 
ing to syphilis a lesion which, having destroyed a certain extent of 
the spinal cord, shall have abolished motion, sensibility and reflex 
action P If it be possible to speak in the a&mative on this point 
as regards the manifestations of the tertiary period,^ I believe that 
we should be more reserved with regard to the possible lesions of 
the spinal cord supervening during the secondary period. I do not 
hesitate, however, to consider as non-syphilitic the following case, 
which several physicians have sought to connect with venereal 
disease : — 

A young Mexican, 25 years of age, contracted a chancre in April, 
1865. In May, he began to take pills with corrosive sublimate, 
which he continued to use for two months. Suspended for some time, 
this treatment was afterwards renewed and continued until December. 
In January, 1866, he had a slight cutaneous eruption, and periostoses, 
for which iodide of potassium was ordered, then suspended, and 
afterwards renewed until April, when it was given up on account of 
symptoms which it appeared to have occasioned, viz., glossitis, lassi- 
tude, cephalalgia and a general feeling of discomfort. The syphilitic 
eruption had then become eflfaced. In the beginning of May, this 
patient, generally addicted to drinking, committed numerous excesses, 
but especially in respect to women. On the 6 th of May, he felt 
formication and weakness in one of his legs. On the 8th, the same 
phenomena appeared in the other leg. On the 10th, both these 
limbs were raised with difficulty. On the 15th, motion was com- 
pletely lost in the right leg, being partly retained in the left. He 
had pain in the course of the lumbo-abdominal branches of the 
nerves, retention of urine and stools, a furred condition of the 
primse vise, soft and bleeding gums, a normal condition of liver, 
cephalalgia, and partial insomnia. 

On the 16 th, there was complete loss of motion in both the lower 
extremities, and sensation, which for several days had been obtuse or 
even extinct at several points of both legs, was almost entirely lost 
throughout their whole extent. There was pain round the waist, at 
the base of the thorax, with loss of reflex movements. On that 



90 ACQUIRED SYPHILIS. 

day, I was requested for the first time to see this patient, for whom 
I ordered cupping in the back and iodide of potassium. This 
treatment was continued for a month, without producing the least 
improvement. The paralysis continued as complete as ever and the 
patient had bedsores at several points subjected to continuous pres- 
sure. The urine was thick and there was catarrh of the bladder. 
These disorders were accompanied by fever and for a short time 
threatened the life of the patient. He conquered them, however, 
thanks to the Qonstant attention of those about him and began to 
improve, moreover, from the moment at which he was put upon a 
water-bed. The bedsores became cicatrised by degrees, and frequent 
injections into the bladder ended by improving the condition of the 
mucous membrane. In August, his general health was good, but 
paralysis of motion and sensation continued in the lower half of the 
trunk and lower extremities, with complete absence of reflex action, 
and retention of urine and stools. From that moment, all active 
treatment was given up, and the paralysed muscles, which had long 
lost there electrical excitability, became more atrophied every day. 
In October, 1867, there was considerable atrophy of all these mus- 
cles. The patient's general health was good, and he left Paris for 
Mexico. 

The complete destruction of the whole of the lower half of the 
spinal cord in tliis case is a point which cannot be doubted ; what 
may have been the lesion productive of this destruction, is a ques- 
tion more difficult to answer, but, as it cannot be assumed that a 
haemorrhage could occupy the whole of the lower half of the spinal 
cord and take eight days for its completion^ it must be admitted 
that this destruction was the effect of a myelitis extending rapidly 
to the entire lower segment. But a delicate point remains to be dis- 
cussed : How was this myelitis produced ? Was it produced by the 
syphilitic infection, or by the excesses ? These are the only two 
causes which it is possible to invoke. Had it supervened in the 
course of tertiary manifestations, this lesion of the spinal cord would 
have appeared to me certainly attributable to the venereal excesses, 
but at the period in which it was produced, that is to say during the 
secondary period, it does not appear to me that the syphilitic in- 
fluence should be rejected too readily. However, since secondary 
localisations of syphilis are rare^ if they exist at all, it is reasonable, 
in a case in which specific treatment did not produce any result, to 
abandon the hypothesis of a syphilitic origin. 



PERIOD OF GUMMY PBODUCTS. 91 

If complete paraplegia, accompanied by painful sensations in the 
course of the nerves and by contraction, indicates more particularly 
a lesion of the coverings ; on the other hand, complete paraplegia 
with reflex movements is rather the sign of a primary lesion of the 
spinal cord. 

Prognosis, — If we confine ourselves to the facts known^ it is diffi- 
cult to point out with precision the degree of danger of syphilitic 
myelopathies. Their prognosis necessarily varies, as is easy to 
understand, with the seat and extent of the change. Recovery may 
occur in certain cases, when treatment has been adopted before the 
nerve elements were destroyed, and thus the syphilitic lesions of the 
spinal cord are comparatively less serious than those of most of the 
affections of that organ. 

• 
• § 4. SypMlitic affections of the nerves. 

Like the encephalon and the spinal cord, the nerve trunks may 
undergo directly or indirectly the influence of syphilis; in other 
words, they may be affected primarily by a lesion involving a greater 
or less part of their extent, or secondarily in consequence of the 
compression produced by changes in the organs in their vicinity, and 
more especially in the bones. 

Exostoses, hyperostoses, lesions of the fibrous tissues, &c., are so 
many causes capable of modifying the integrity of the nerve trunks, 
and of deranging their functions. We have already, as is known, 
referred to changes of this nature the facial hemiplegias which super- 
vene at the commencement of the secondary period. Here we shall 
give little attention to these secondary lesions ; we shall devote our- 
selves rather to the consideration of the tertiary lesions, those espe- 
cially which directly affect the substance of the nerve trunks itself. 

Anatomical Study. 

Regarded from the point of view at which we are placed, the 
anatomical modifications presented by the nerve trunks are of two 
kinds, and reveal themselves either by a thickening of the web of 
conjunctive tissue (interstitial neuritis, diffused hyperplasis), or by 
the presence of nodules comparable to neuromas, but which, in 
reality, are nothing else than gummy tumours. 

In a woman affected with constitutional syphilis, and complete 



92 ACQUIRBD SYPHILIS. 

paralysis of the fifth pair, and who was subject to attacks of epflepsjr, 
Todd,* found the Gasserian ganglion and the nerves which emanate 
from it atrophied in consequence of the compression produced by 
false membranes {in consequefice of pressure from adherent mem- 
branes). A case already pointed out by Bayle and Kergaradec 
mentions the destruction of the olfactory nerves, and softening and 
diminution in size of the optic nerves. These same nerves, on the 
left side especially, were atrophied in a case related by Meyer (Obs. 
VIII.). In a case of Esmarck and Jessen's,t the oculo-motor 
nerves, knotty at their point of exit from the cranium, presented 
three times their normal thickness, and were transformed, together 
with the neurilemma, into a homogeneous, lardaceous mass, consist- 
ing of a finely granular substance. The left trigeminus was hyper- 
trophied and the auditory nerves of the same side were of a pale 
yellow colour. In a* case of syphilitic amaurosis, Dittrich % men- 
tions the transformation of the optic nerve into a dirty grey, flaccid, 
villous and fibrous mass. Virchow saw in the place of the right 
oculo-motor nerve a thick, reddish, and callous mass ; the left oculo- 
motor nerve was swelled and infiltrated with a reddish tissue, and 
the olfactory nerves were lost in a pathological tissue of new forma- 
tion. It would be difficult not to see in all these facts, despite the 
paucity of the anatomical details, a primary change in the nerve, 
the starting-point of which is the conjunctive tissue. From the 
moment that no mention is made of any other change in the vicinity, 
the true lesion, in all these cases, is evidently an interstitial neuritis. 
Let us now examine the cases in which lesions analogous to gummy 
tumours were observed. 

Dixon § observed in two cases of tertiary syphilis, partly in the 
coverings, partly in the substance itself of the optic, oculo-motor, 
rectus extemus and trigeminus nerves, small, very firm reddish or 
yellowish masses. Analogous deposits occupied at the same time 
the membranes of the brain and were spread around the internal 
carotid and basilar arteries. Rayney examined one of these tumours, 
which was of a pale yellow colour, hard and almost cartilaginous, 
and found it to be formed of a fibrous tissue mixed with granular 

* See Hutchinson and Jackson (loc. cit. p. 133). 

f Esmarck and Jessen, in Allgem, Zeitschr. fur Psychiatrie, 1857, p. 20 
et seq, L. Gros and Lancereaux, loc. cit, p. 288. 
X Trager Viertelfahrschrijif 1 849, t. i. p. 23. 
§ Med. Times and Oaz., October 23rd, 1858. 



PEBIOD OF GUMMY PRODUCTS. 93 

matter. Portal * relates that a woman long affected with syphilis 
(exostosis) presented at the back of the orbit a fungous tumour of 
the size of a strawberry, adherent to the bulb of the optic nerve. 
The sphenoid was carious in the vicinity of the optic foramen and 
the dura mater adhered to the bones. The cerebral substance was 
softened about the mammillary projections ; there was effusion of a 
reddish fluid into the ventricles. 

The cerebral nerves are the most usual seat of syphilitic localisa- 
tions, which show themselves more especially at their point of emer* 
gence. Lesions of the spinal nerves are less common. The sciatic, 
on account doubtless of its size and vascularity, and the trunks of 
the brachial plexus : such are, in the order of frequency, those 
amongst these organs the disorders of which it has been possible to 
connect with syphilis ; but the changes of which they may be the 
seat have not yet been, so far as I know, verified by post-mortem 
examination. However, to judge from the muscular atrophy which 
sometimes accompanies them, these changes do not differ from those 
of which we have just been speaking, so that the anatomical descrip- 
tion which has gone before may be applied to all the nerves in 
general. 

Symptomatic Study. 

A collective study of the symptoms which correspond to the 
syphilitic lesions of the nerve trunks is diificult by reason of the 
difference of physiological function proper to each of those organs. 
In fact, to take only the cerebral nerves most frequently affected, we 
see that there are some, such as the common motor oculi, the ex- 
ternal motor oculi, or the obliquus major, a change in which invari- 
ably causes, so to speak, paralysis of the motor muscles of the eye ; 
others, on the contrary, such as the trigeminus, in which the change 
reveals itself by preference in the form of pain ; others, lastly, such 
as the optic nerves, which produce derangements of vision. This 
circumstance induces us to study separately the functional derange* 
ments proper to ea^h pair of nerves. 

Nerves of the third pair or common motores oculi. 

The syphilitic affections of the nerves usually show themselves in 
the form of paralysis. 

* De la nature et du traitement de VipUepsie, Paris, 1827, p. 48. 



94 ACQUIRED SYPHILIS. 

Paralysis of the common motores oculi nerves or of the third pair 
is so frequent in the course of syphilis, that its existence alone should 
always suggest the idea of that disease. The facts hitherto observed 
have presented themselves sometimes in the course of the secondary 
period^ as happens in certain cases of facial hemiplegia ; sometimes^ 
and most frequently, in the tertiary period. The paralysis rarely 
occupied both sides, sometimes it was even limited to a single branch 
or to a single ramification of the nerve. One of the first phenomena 
of this paralysis is the falling or prolapsus of the upper eyelid, with- 
out epiphora, which depends upon the persistence of action of the 
orbicularis muscle. In certain cases, the branch of the levator 
palpebrse being alone affected, this phenomenon is unique. But, 
most frequently, the other branches participate in the change, and 
then external strabismus exists, and the eye undergoes a movement 
of rotation from below upwards and from without inwards, around 
its axis. At the same time the pupil is dilated and the iris has lost 
its mobility. Some patients complain, moreover, of diplopia, and of 
a certain amount of weakness of sight, for want of adjustment in the 
eye.* 

Such is, in its uncomplicated form, syphilitic paralysis of the third 
pair ; but frequently this paralysis is not isolated ; it exists with en- 
cephalic derangements,t which, moreover, are very useful in a dia- 
gnostic point of view, as it most commonly does not present any 
special character, and its origin is revealed only by the manifestations 
which accompany it. 



Pathetic nerves or fourth pair. 

Paralysis of these nerves, according to the cases published, rarely 
acknowledges a syphilitic origin, having been observed only twice in 
all : once by Mackensie J and once by Graefe.§ To the diplopia. 



• See Ebrard, Oaz, med, Paris, February 2oth, 1843, p. 221. Rayer 
and Badin d'Hurtebise. Th^se de Paris, 1849, pp. 17-22. Gh. Lagneau, 
loc, dt, p. 242. 

t See observations by Ebrard, Scbutzenberger, Sandras, Ricord, Yvaren, 
Deval Dupre, Herard, &c., in L§on Gros and Lancereaux, he, eit. 

X Traits des maladies de Vceil, trad. frau9. par Warlomont et Testelin. 
Paris, 1856, p. 519. 

§ ArchivfUr Ophthalmologies t. i. part ii. pp. 313, 318. 



PERIOD OF GUMMY PRODUCTS. 95 

which is the chief symptom of it^ is generally added a slight falling 
in of the cornea on the paralysed side. 

A characteristic of this diplopia is^ that the two images are placed 
one above the other and that they persist, whatever may be the point 
towards which the eyes converge. According to Follin, to cause the 
second image to disappear, it would suffice to turn the head towards 
the left if the right obliquus major were paralysed, and towards the 
right if it were the same muscle of the left side. 

External motor ea oculi or sixth pair. 

Observed by Eayer, Badin d^Hurtebise, Sandras,* Mackensie, 
Knorre,t iPoville, Moissenet, Landry, Behran,t Luton, § A. 
Maunier,]| the syphilitic affections of the external oculo-motor 
nerves manifest themselves in the form of paralysis. Like most 
of the syphilitic paralyses of the cranial nerves, they are sometimes 
preceded by pains which usually have their seat in the temporal, 
supra-orbital, and frontal regions of the same side, and which, in 
one case, were felt in the temporal region of the opposite side. In- 
ternal or convergent strabismus, diplopia, and a certain degree of 
weakness of sight : such are the chief symptoms of syphilitic para- 
lysis of these nerves. Beyran observed, moreover, contraction of the 
pupil with persistence of its contractility, which Luton has sought 
to explain by an anomaly in virtue of which the motor root of the 
ophthalmic gangHon was furnished by the external oculo-motor 
nerve. The eye is adducted. If the paralysis be incomplete, the 
efforts of the patient show themselves in slight jerks, which throw 
the globe outwards, without being able to keep it there ; but if the 
paralysis be complete, the eye, being retained inwards, shows only 
part of the cornea, the other part being concealed in the angle of the 
eye. Diplopia exists only when the patient fixes both eyes upon an 
object; with a single eye the sight is always distinct. The two 



* Journ, de mSd. et de chirurg, prat, Paris, 1851, p. 338, et Gaz, des 
MpitauXi October 30th, 1854. 

t Deutsche Klinik, 1849, p. 60. 

X Union Mid.j July, 1860, Syphilitic paralysis of external motor oouli 
nerve. 

§ Union Med., September 20th, 1860. 

II Paralf/sie syphU, de la sixeme paire {Union Mid., 1861, t. iL p. 394. 



96 ACQUIRED SYPHILIS. 

images are parallel or superposed^ according to the disposition of 
the object. Becovery, which is the usual termioatiou of this para- 
lysis^ is not retarded^ in general, more than from fifteen to thirty 
days, under the influence of an anti-syphilitic treatment. It is to 
be remarked that all other remedies are inefficacious. The prognosis 
is favourable. 

Facial nerves or seventh pair^ 

It is also in the form of paralytic derangements that syphilitic 
affections of the seventh pair reveal themselves. 

Facial hemiplegia of syphilitic origin is not very rare, as Ladreit 
de la Charriere mentions thirteen cases supervening, with some ex- 
ceptions, in the tertiary period, and not, as we have seen above, at 
the commencement of the secondary period. The lesion which pro- 
duces it is as yet very little known, on account of the small number 
of post-mortem examinations. Some authors have admitted in such 
cases, without any direct proof, a lesion of the fibrous tissue (in- 
flammation of the neurilemma) or of the bones (exostosis or peri- 
ostosis). M^niSre, by Bedel's account, saw in syphilitic subjects 
whose temporal bone appeared hypertrophied, swelling of the petrous 
portion and a change in the nerve of the seventh pair; it might also 
well happen, as it appears to me, that this paralysis should depend 
upon the presence of syphilitic deposits at the origin of the nerves. 
Usually preceded by acute pain, facial paralysis sometimes comes on 
suddenly, sometimes slowly and to a certain extent progressively, 
which appears already to show that various lesions may produce it. 
Its characters are well known : all the muscles of one side of the 
face are generally paralysed, whence the deviation of the labial com- 
missure, the difficulty of whistling, mastication, &c., as well as the 
impossibility of closing the eye. The orbicularis palpebrarum is 
most generally affected in this form of paralysis which usually results 
from a change in the nerve itself. The electrical excitability of the 
muscles is usually diminished or entirely lost. The persistence or 
the absence of this phenomenon shows whether the change is 
situated in the nerve centre or in the nerve itself. Deviation of 
the velum palati is the sign of a lesion in the vicinity of the origin of 
the nerve. 

In certain cases, concomitant derangements of sensation give 
reason to believe that the fifth pair is affected simultaneously. 



o 



■n m 

is" 

§5 



r 
r 



9 

O 



X 



3 

a 

3 

S 



• 

3 



PERIOD OF GUMMY PRODUCTS. 97 



jrpIuHtic fecial paralysis generally occupies one side only of the 
J Davaine * gives^ according to Ch. Bell, one case of double 
J "^ P paralysis of syphilitic origin. Usually more obstinate than 
• 8 ^ of paralysis of the motor nerves, this affection nevertheless 
I frequently ends by yielding to an appropriate treatment : in 
it words, its prognosis is favourable. The nerve may, however, 
)me atrophied and undergo a destruction more or less complete ; 
paralysis then continues indefinitely. 

I 

Yneumo^aslric and spinal nerves or tenth and eleventh pairs. 

I kere is not as yet, so far as we know at least, any positive case 
3. Pi proves that the pneumogastric nerves have ever been the real 
f a syphilitic localisation. 

is hiatus may result from the imperfect knowledge which we 

ss of the functions of the pneumogastric nerves, from the facility 

bnfounding the derangements which are produced by changes 

§ fcese nerves, and from the little care which is taken in looking 

khe lesions with which they may be affected. However the case 



£ |[be, there is reason for asking whether it is not to changes in 
^ bneumogastric or spinal nerves that are to be attributed cer- 
s. fcases of paralysis of the pharynx, certain asthmatic affections,t 
** jprtain gastralgic affections,! which have appeared to yield 
W rapidly to specific treatment? 

i 1 . . 

Hypoglossal and glosso-phart/ngeal nerves. 



The existence of a syphilitic lesion of the hypoglossal nerves has 
not yet been proved, and if, in certain cases of syphilis, mention 
is made of difficulty or impossibility of articulating sounds, this 
derangement is connected with a change entirely independent of 
those nerves. § 



• Memoires de la SociHS de htologte, t. iv., 1852. Consult : O'Connor, 
Paralysie double de la face, in Union MSd,, 1861, t. ii. p. 160 ; and Dublin 
Quarterly Journal, February, 1861. Maunier, HSmiplegie faciale, in Oaz, 
det hSpitaux, 1862, p. 27. 

t See B. Bell, TraitS de la gonorfhSe eirulente et de la maladie vSnSr, 
Paris, 1802, p. 638. L. Gros and Lancereaux, loc. cit. 

t Trousseau and Andral, quoted by Gros and Lancereaux, loc, cit. p. 67. 

§ See Lagneau, Affect nerv. syph. Paris, 1860, p. 322. 

A 



98 ACQIHRED SYPHILIS. 

No case, so far as I am aware, shows any syphilitic lesion of 
the glosso-pharyngeal nerves. 



Trigemini nerves. 

The symptoms connected with lesions of the trifacial nerve vary 
not only with the degree of compression or change in that nerve, 
but also with the branch affected, for we know that these various 
circumstances are capable of presenting themselves. Various sen- 
sations, pains more or less violent, and sometimes anaesthesia: 
such are, together with the muscular derangements on the part of 
the jaws, the symptoms observed in these cases. A female patient 
of Lallemand's * continued, after transient syphilitic hemiplegia, to 
have formication and numbness in the whole of the right side of 
the face, as if a cobweb had been applied to the skin. A similar 
sensation existed in the right half of the tongue and in the right 
thumb. A case related by Herard and Baudot f makes mention 
of a numbness of the right ala of the nose and of the neighbour- 
ing parts of the cheek and upper lip. 

The pain, which is perhaps the most constant phenomenon, 
generally occupies one of the lateral halves of the bead (Waton, 
Gu^rard, Rayer, Eadin d^Hurtebise, and Yvaren). It sometimes 
changes to tlie other side, as in tlie case of a patient of Guerard's, 
in whom it passed from left to right ; or it sliows itself on both 
sides at the same time (Benj. Bell, Graffenauer, Cruveilhier, and 
Yvaren). At other times, it remains limited to one of the branches 
of the trigeminus, or even to one of the ramifications of those 
branches, the frontal ramification of the ophthalmic. Some authors, 
as Plenck, Meckel, J. Frank, &c., have admitted syphilitic odon- 
talgia, but without bringing any fact in support of their view. 
Merely as a syphiUtic affection, trifacial neuralgia has no distinctive 
characters. More violent in the vicinity of certain points, it radiates 
in various directions; in a patient of Eayer's, it had at first its maxi- 
mum of intensity in the left temple, afterwards in the forehead, 
then in the left side of the nose, in the course of the external branch 
of the nasal nerve, which springs from the ophthalmic of WilHi. 



• jRecherches anat path, sur J^encephale, t. iii. p. 101. 
t Union medicah, Jan. 2nd, 1859. 



PERIOD OF GUMMY PRODUCTS. 



9^ 



Siout wishing to lay more stress upon the seat of these pains, 
us mention that they sometimes present nocturnal paroxysms- 
ik), and that they are, in certain cases, accompanied by derange- 
Bfts which show that the lesser or motor root of the same nerve 
participates in the change. In reference to a female patient 
red by Ozia-Aimar, and who recovered by the aid of a specific 
lent, it is stated : " Mandibulas frequenter agitabat (morbus), 
lintea continuo intra dentes habere cogeretar, quae identidem 
sbat ac dentibus conterebat.^^ 

two cases observed, the one by Waton,* the other by Schut- 

pger,t mention is also made of a trembling of the lower jaw. 

thesia and analgesia have been seen to follow these derange- 

; this was doubtless the indication of destruction of the nerve 

diagnosis of the syphilitic lesions of the trigeminus rests 
entirely upon the commemoratives and antecedents of the 

its. It is also important to take into account the concomitant 
stations. The prognosis is not unfavourable, provided that 

lent be not commenced too late. 



Spinal nerves. 

s exposed to the influence of syphilis than the cranial nerves, 
inal nerve trunks sometimes manifest, however, disorders of 
ty and sensation which it is impossible not to attribute to that 
These disorders show themselves in the form of contraction 
ralysis, and simulate neuralgia, analgesia, or anaesthesia, 
utzenberger points out in the patient who forms the subject of 
his observations a pain in the right arm and shoulder which 
ened without any known cause ; this pain was sometimes 
panied by cramps which drew the head towards the right 
Ider, and bv a contraction of the flexors of the fincjers. 
hen the intercostal nerves are affected, the pains occupy the 
of the chest, as was observed in a patient of Ebrard's who 
not sleep on account of a feeling of constriction and weight in 
loracic parietes. Piorry cured by a specific treatment an in- 



TO cases of venereal tic douloureux, Itec. p^r. de la Soc. de mid, 
'w, t. iv. p. 178. 

us. med. de Strasbourg, March 20th, 1850. Lagneau, loc. cit, p. 258. 

h2 



100 ACQUIRED SYPHILIS. 

dividual who was suffering from pains in tlie lambar and sciatic 
plexuses. 

There are to be found in our treatise on the syphilitic affections 
of the nerves,* three cases of sciatic neuralgia which had long re- 
sisted all treatment and which yielded as if by enchantment, when, 
the existence of syphilis being suspected, mercury and preparations 
of iodine were prescribed. Vandekeere f has contributed a case of 
ilio-scrotal neuralgia which was combated successfully by Van 
Swieten's drops. 

Side by side with the neuralgic pains connected with syphilis % 
are to be placed cases of partial paralysis, to which it is sometimes 
difficult not to attribute a specific origin. A man 42 years of age, 
treated for rheumatic pains in the back, neck, and arms, afterwards 
had atrophy of the upper part of the neck and left arm, with weak- 
ness of the muscles of those regions. The waters of Aix in Savoy 
had removed these pains ; the atrophy and weakness resisted even 
moxas and bhsters, when a syphilitic eruption suggested the ad- 
ministration of iodide of potassium, which .agent cured all these 
symptoms. § K very analogous case is given by Vidal de Cassis. || 
"We have been able to convince ourselves that a certain number of 
cases of partial paralysis, with atrophy and loss of electrical excita- 
bility of the muscles, the cause of which remained unknown, really 
resulted from syphilis. 

The following case, communicated to us by one of our best 
friends,ir comes in support of our observation. A woman 35 years 
of age, had contracted a chancre, seven years previously (1857) ; 
she had since had roseola, and for three months was subjected to a 

• Loc. cit p. 63. Compare : Cirillo, TraitS cotnplet sur les malad, vinSr, 
Paris, 1803. J. J. Plenck, Doctrina de morh, vener, Vienna, 1779. 
Zambaco, Affect nerv, syph., 1862. E. Bruueau, Sciatique syph, (Gaz, des 
hSpit., 1864, p. 118). 

t MSm, sur les formes insolites de la syphilis^ in Journ. genSr. de mSd. et 
de ehirurg, de Sedillot, t. cii. p. 310. Consult : E. Vaulpr^, Quelques fails 
de nivralgie syph, [Bulletin de tJiSrapeutique, Jan. 30th, 1852, and Ann. des 
malad. de lapeau, t. iv. p. 137). 

X Add to the above indications : Franceschi, Gas de syphilis tertiaire, in 
II Raccoglitore Medico^ 1848; and Gaz, mSd, de Paris, 1848, p. 614. 
Leubuscher, Deutsche Klinik, No. 6, 1861. 

§ Niepce, Moniteur des h6pitaux, 1853, p. 383. 

II Traits des malad. vSnSr,, p. 441, 1855. 

f Dr. Paul Rousseaux, now a distinguished physician at Vouziers. 



PERIOD OF GUMMY PRODUCTS. 101 

treatment with pills. The first symptoms completely disappeared. 
A year afterwards, she had pain and swelling in the right knee ; for 
a whole year, she had nocturnal exacerbations. Frictions were with- 
out effect. She was then treated for tertiary disease : forty-five 
grains of iodide of potassium daily. A cure took place in three 
months. The treatment was not continued. The pains returning 
two or three years later, she again took iodide of potassium. In 
November, 1864, she had fresh pains in the left shoulder ; the 
humerus was enlarged and deformed by the presence of exostoses. 
The muscles of the supra and infra-spinal regions were atrophied, 
the deltoid and pectoralis major had undergone the same change and 
scarcely responded to electric excitation. The patient had great 
difficulty in moving the jaws; the right eye, protruded from the 
orbit, appeared firmer than usual ; the tissues pitted under the finger, 
which left a depression as in oedema durum. 

Iodide of potassium was again administered. This treatment was 
continued until January 26th, 1865 ; she had, moreover, oedema of 
the lower extremities and albumen in the urine, but her condition 
afterwards became improved. 

In referring to the cases of partial paralysis given by Duchenne 
(of Boulogne), in his treatise upon local electrisation, I asked myself 
whether syphilis did not sometimes exist in them, and was led to 
beheve that such was the case in some instances. 

To sum up, most of the nerve trunks may undergo the influence 
of the syphilitic diathesis ; but, in spite of a change almost iden- 
tical, each nerve reveals its diseased condition by pecuUar symptoms 
in relation with the functions it has to perform. 

The cerebral nerves are those most frequently affected, then the 
sciatic, and lastly the other nerve trunks. 

The corresponding derangements not having any distinctive char- 
acter, it is important for diagnosis to rely upon the commemoratives 
of the patients and to take into account the nocturnal exacerbation 
of the pains. So long as there is no destruction of the nerve ele- 
ments, these affections may become cured. Later on, a cure must 
be regarded as difficult ; it is not perhaps impossible, as the nerve 
tubes are capable of reproduction, as has been proved by the valuable 
researches of Vulpian and Philippeaux.* 



* Recherches experimentales sur la rSgSneration des nerfs sSparSs dea 
centres nerveux, in MSm. de la SociSti de Biologiey ann^e, 1859. 



102 ACQUIRED STPHIUB. 

Splanchnic Nerves, 

The history of the painful affections of the viscera generally being 
as yet very incomplete^ it is not surprising that those of them which 
acknowledge a syphilitic origin should be little known. 

We were, however, formerly able to collect six cases in which the 
existence of a syphilitic change in the splanchnic nerves may, at the 
very least, be suspected (gastralgia, enteralgia, hepatalgia). The 
cases are borrowed from reliable authors (Trousseau and Rdoux, 
Andral, Portal, and Baumes), and in spite of the absence of anato- 
mical demonstration, there is reason to believe that the derangement 
of which they make mention depended rather upon a modification of 
the nerve than upon a material lesion of the organ affected. In any 
case, it must be admitted that painful syphilitic affections of the 
viscera are not serious, since they are, for the most part, cured with 
rapidity.* 

Abticle IX. — Appabatuses op the Special Senses. 

There was question above of the affections of the organs of the 
senses connected with the secondary period ; it remains for us to 
study here the tertiary lesions which affect the parts which form the 
apparatuses of the senses. Three only of these apparatuses will 
demand our attention ; more complicated than the two others, they 
each consist of a bony cavity in which is contained the organ to 
which the nerve of special sensation is distributed. 

§ 1. Olfactory apparatus. 

The mucous membrane, the bones, the cartilages, the olfactory 
nerves, all the tissues, in a word, which concur in the formation of 
this apparatus, may be singly or simultaneously affected. In accord- 
ance with our plan, we shall study successively the lesions peculiar 
to these various parts ; we shall, however, dispense with a formal 
history of them, these affections having been recognised by most 
authors. 

Ulcerative sypAililic rhinitUf syphilitic ozcena. 

One of the worst forms of ulcerative inflammation of the mucous 

* See L. Gros and Lancereaux, Affect, nerv. syph, Laboulbdne, Des 
vuciralgies, Th^se d'aggregation. Paris, 1860. 



PEBIOD OF GUMMY PRODUCTS. 103 

tnembranes is syphilitic rhinitis, an affection the more serioas as it 
is often overlooked and its existence not recosrnised until it has 
committed irreparable ravages. At first, the patient feels obstruc- 
tion in one of his nostrils, with pain in a fixed pcint, he presents the 
symptoms of a stoppage and of a state of catarrh, and expels from 
time to time a blackish, porous crust, tinged with blood on the 
surface ; an inodorous^ serous fluid, almost colourless^ is secreted at 
the same time as the mucus. 

So far the change is superficial. When deeper and more exten- 
sive, it occasions the permanent flow of a sero-sanious fluid the 
more foetid in proportion as the affection reaches more deeply-seated 
parts. When this change occupies the anterior orifice of the nasal 
fossae, there is seen, generally upon the septum or upon the internal 
surfixce of the alae nasi, a yellowish crust which covers an ulcer of a 
rounded form and fungous appearance. If seated higher up, it may 
sometimes be recognised with the rhinoscope. With the aid of that 
instrument, Tiirck was enabled to see upon the posterior surface of 
the velum palati confluent ulcerations covered with pus, and numer- 
ous vegetations about the posterior orifice of the nasal fossae and 
upper wall of the naso-pharyngeal space. 

When the change in the Schneiderian membrane involves the 
destruction of the bones or of the subjacent cartilage, or when these 
are affected primarily, we sometimes see considerable portions of the 
denuded bones or cartilages become detached and expelled. The 
liquid which then comes away is of a dirty black colour and extremely 
foetid. Under these circumstances, the sense of smell is weakened 
or entirely lost, the parts in the vicinity of tbe ulcers become 
swelled, red, and painful, the nose is changed in shape, falling in and 
becoming flattened if the septum be involved. Under other cir- 
cumstances, the skin which covers the cartilages of the nose first 
becomes inflamed ; it sometimes continues red and sensitive, then 
small ulcers supervene which, by their junction, sometimes form only 
a single wound ; the cartilages are gradually destroyed, and the nose 
assumes a somewhat hooked, thin shape, which has obtained for it 
the name of " sheep's nose.^^ These various changes, which end by 
the elimination of the bones and cartilages, were already known to 
Baillou. That author writes, in fact: — "There is a species of 
anosmia which supervenes in the tertiary period of syphilis, when 
the interior of the nostrils is eroded and ulcerated."* It is to these 

* Baillou, Paradigmat No. 47, et Sauvages, trad. fran9., t. ii. p. 213. 



104 ACQUIRED SYPHILIS. 

changes that the term syphilitic necrosis has been applied^ and under 
which they have been described quite recently.* 

Side by side with these lesions, let us point out gummy tumours 
analogous to those observed in the larynx; these tumours, apart 
from the derangements which they occasion directly, are a cause of 
secondary changes in the osseous and cartilaginous tissues.f 

The modifications which may involve the olfactory nerves usually 
produce more serious functional derangements; but the opportunity 
of observing them is rarely met with. Amongst the cases which 
prove the possible invasion of the olfactory nerves by syphilis, we 
shall quote an observation by Bayle and Kergaradec,j: in which 
there was destruction of those nerves, and another by Virchow in 
which they were lost, as it were, in a considerable disorganisation of 
the brain. The work which we ourselves published together with 
Dr. Qros contains analogous oases, but unfortunately the functional 
derangements were, for the most part, badly observed. However 
the case may be, the physiological experiments relative to the olfac- 
tory nerve are too explicit for us to refuse to admit that a change 
in them may be possible without a partial or total anosmia. 

The diagnostic signs of the syphilitic affections of the organ of 
smell vary according as one or other of the lesions pointed out 
above predominates. It is easy to recognise syphilitic erythema and 
mucous patches of the nose ; but the same does not hold good for 
the deep ulcerations and the derangements which they occasion, 
although the diagnosis of them, now facilitated by the employment 
of the rhinoscope, may be based upon the concomitance of other 
lesions of the same nature. 

The affections resulting from glanders, farcy, and scrofula re- 
semble, in some of their characters, the syphilitic lesions which we 
are examining. The rhinopathies which accompany glanders are, 
however, distinguished at their commencement by the presence, 
upon the mucous membrane in the vicinity of the anterior nasal 
orifice, of small rounded pustules, surrounded by a pink circle, and 
afterwards by sanious ulcerations differing from those produced by 
syphilis. The lesions peculiar to scrofula, slow in their evolution 



* G. LagneaUi in Gaz, hehdom, de midecine et de chirurgie, p. 441. Parisi 
1860. 
t St. Arromann, Thhe de PariSf 1858, p. 18. 
J Nouv. hihliotheque mid,, February, 1823. 



PERIOD OF GUMMY PRODUCTS. 105 

like those of syphilis^ are more difficult to distingmsh from these 
latter manifestations. The commemoratives and the fact that scro- 
fulous ulcers of the nasal fossae most frequently follow the softening 
of tuberculajr deposits, are circumstances which will come in aid of 
the diagnosis. Already, by the pains which it occasions, the head- 
ache which usually accompanies it,* and the foetor exhaled by the 
nasal fossae, syphilitic necrosis of the nose cannot be confounded 
with typhous necrosis of that organ, from which it differs, further, 
by its course and b^ the nature of the antecedent or concomitant 
manifestations. These manifestations constitute almost the only 
datum which can serve for the recognition of syphilitic anosmia 
resulting from a change in the olfactory nerves. 

If the syphilitic affections of the nose are not, in themselves, 
extremely serious, it should nevertheless be known that, when they 
are deep-seated and attack the bones, they may be followed by 
putrid or purulent absorption, or at the very least by deformity of 
the nose and embarrassment of the function of respiration. 

§ 2. Apparatus of vision. 

Lesions of the lachrymal ducts, 

G, LagneaUy Malad. syphil. des voies lachrymales, Archives de m^d.y t. i., 
1855. Bourgeois, Presse mSdicale beige, 5, 1863, in Schmidt's Jahrh., p. 233, 
No. 8, Aug., 1864. Zeissl, Ueber syphilitische Erkrankung. d. Thranen- 
wege. Wien. Wochenblatt, xvii. 11, 12, 1861 ; and Constitutionell. Syphilis. 
Erlangen, 1864. 

Syphilitic lesions of the conglomerate glands are not common ; 
but we have seen above that the submaxillary gland may be affected 
with syphilis. Dr. ChS-lonsf has given a case of change in the 
lachrymal gland supervening from the influence of the same cause. 

An individual who had contracted a chancre, had successively 
swelling of the lymphatic glands, iritis, ulcerative coryza, and 
swelling of both lachrymal glands. This swelling had gradually 
become so considerable that it formed on the outer side of the globe 



• Fred. Hoffmann, t. iii. pp. 442 and 198. B. Bell, t. ii. p. 146. 
Lagneau, Gaz, hehd., p. 441, 1863. 

t CliS.lons de Luxembourg, Adenitis lachrgmalis syphilitica {Freuss, 
Vereinszeitung, No. 42, 1859. 



106 ACQUIRED SYPHILIS. 

of the eje a snrprishig and fantastic protuberance, much larger, 
however, on the right side than on the left. The upper eyelid hung 
like a bag before the eve and was of a slightly red colour, especially 
in its outer half. Its upward motion was, however, but little afiected. 
On palpation, the edge of the tumefied lachrymal gland was felt to 
project the whole length of the lachrymal fossa. The swelling was 
not painful and did not occasion any other inconvenience than a 
slight degree of pressure and tension. No derangement of the func- 
tions of the lachrymal gland were observed, frictions with mer- 
curial ointment were ordered. The coryza, angina, and swelling of 
the lachrymal gland began to abate about the third or fourth day, 
and the latter even diminished in size so appreciably, that no doubt 
could be entertained of the specific action exercised by the mercurial 
ointment. The patient, after using an ounce of mercurial ointment, 
was completely cured. 

The lachrymal ducts and nasal canal in particular are generally 
the least spared, by reason, no doubt, of their fibro-osseous structure. 
Boerhaave, Saint- Yves, Astruc, Fabre, Gardanne, Hunter, Plenck, 
Swediaur, Wentzel, Demours, Boyer, Chelius, Walter, Cloquet, 
Lagneau, sen., Velpeau, Tavignot, and Yvaren, have pointed out the 
existence of syphilitic affections of these parts, which all of them 
attributed to an osseous lesion. B. Bell, Petit-Eadel, and Jourdan, 
speak of lachrymal fistulse of syphilitic origin. Quite recently, 
Lagneau, jun., has published on this matter an excellent report,* 
from which I shall borrow a part of the following details, and, since 
then, Zeissl and Bourgeois have added some new facts to those 
already known. 

The syphilitic affections of the lachrymal ducts have for their 
starting-point, either inflammation of the conjunctiva, or a lesion of 
the bones, and this difference of origin entails a difference in the 
period of their appearance and in the local means of treatment. 
Those of them which result from a modification of the mucous mem- 
brane of the sac or of the lachrymal ducts generally appear in the 
exanthematic period of the disease, at the same time as the erythema 
of the nasal and ocular mucous membranes ; but they are also seen 
to appear later, in the tertiary period. To this period belong the 
lesions of the bones. 



* Arch, de mSd,, t. i. p. 536, 1857. This report contains ten observa- 
tions, two of which were made by ourselves. 



PERIOD OF GUMMY PRODUCTS. 107 

A turgidity more or less considerable constitntes the chief phe- 
nomenon connected with the change in the mucous membrane ; later 
on, this membrane ends by becoming ulcerated, whence bridles and 
more or less considerable contraction at some point of the lachrymal 
ducts ; often even consequent epiphora. If it has for its seat the 
nasal canal, this change may be followed by a tumour which may 
end in a fistula. The osseous lesions (periostosis, exostosis, caries, 
or necrosis) afifect the os unguis, or the ascending apophysis of the 
superior maxillary bones, sometimes the angular apophysis of the 
frontal bone, and then, at the internal or inferior portion of the edge 
of the orbit is found, by the finger or by catheterism of the nasal 
canal, a hard, resistent enlargement of the bone, which most fre- 
quently facilitates the diagnosis. 

The possibility of curing by the aid of a specific treatment the 
syphilitic affections of the lachrymal ducts renders their prognosis 
less serious than that of the analogous lesions resulting from a 
different cause. In the cases in which obliteration follows a cicatrix 
of the mucous membrane, it is evident that local treatment must be 
combined with the general treatment. 

Lesions of the eyelids. 

The eyelids are variously affected by syphilis. CuUerier, 
Mackensie,* and Ricordt have seen chancres of the eyelids pro- 
duced by the kisses or by the fingers of an infected person ; a case 
of the same kind has been communicated to us by Dr. Alph. 
Diesmarres. Chancre of the eyelids is generally indurated and ac- 
companied, as in the case observed by Ricord, by preauricular and 
sub-maxillary adenopathies, which constitutes a valuable sign for 
precise diagnosis. The importance of this diagnosis is great, for it 
is easy to understand how serious a mistake it would be to remove 
this chancre under the idea that it was an epithelioma. 

In the secondary period, the syphilitic lesions of the conjunctiva 
consist in small, circumscribed, prominent, non-vascular patches, of 
which some are of a reddish grey colour, others yellowish or copper- 
coloured. These patches, as we have already mentioned, do not 



• Train des maladies de FcsU, trad. fran9. do Warlomont et Testelin, 
t. i. p. 174. Paris, 1856. 

t Lettres sur la syphilis^ 2° ^dit. 



108 ACQUIRED SYPHILIS. 

differ from eraptive patches upon the sldn, with which they may 
coexist.* 

In the tertiary period^ the external surface of the eyelids is some- 
times the seat of an ulcerative or even serpiginous syphilide which^ 
hy the cicatricial contraction which it occasions, is capable of pro- 
ducing ectropion. This symptom may also, of course, follow gunmiy 
tumours. 

Lawrence mentions having seen, in cases of syphilis, the eyelids 
tense and i«inful, covered with greyish round ulcers, the starting- 
point of which had been a cutaneous tubercle. It is important not 
to confound these ulcers with cancerous ulcers. 

Tertiary lesions most frequently occupy a more or less considerable 
portion of the thickness of the eyelids and are rarely limited to the 
conjunctiva. A case of gummy change in the conjunctiva has been 
given by Professor Magni, of Bologna ;t but nevertheless, despite 
the authority justly acquired by that ophthalmologist, this observa- 
tion, which we give here, does not appear quite incontestable. The 
case was that of a young woman of 1 8, who, after having had gonor- 
rhoea and ulcers, had a cutaneous eruption and iritis. Six months 
afterwards, she had oedema of the eyeUds, watering of the eyes, pains 
extending to both eyes, continuous, with nocturnal exacerbations; 
also photophobia, which was not constant but increased in intensity 
at times. Several tumours of the size of a pinVhead or a lentil, 
hemispherical in shape, were situated under the conjunctiva and par- 
took of its movements, with the exception of one of them which 
rested upon the perimeter of the cornea. These small tumours were 
of a whitish colour at their apices and red at their bases. In the 
free spaces of the conjunctiva there existed an injection of radiating 
vessels which formed groups having each for its centre one of these 
tumours, and the whole closely resembled the exudations observed in 
scrofulous conjunctivitis. As these tumours increased with great 



* Not unfreqaently there are observed on the sarface of the eyelids one 
or more nlcers belonging to the secondary period. Consult : Rirschler, 
JJeher secunddre syphU, Geschwiire des Augenliedes {hlepharttis syphilitica). 
Wien. med. Wochenschrift, xvi. pp. 72-74. Several cases of chancre of 
the eyelids have been given by ophthalmologists ; of these we shall speak 
farther on. 

f Kerato-conjunctivitis, in Giornale d'ofialmologia itaUana, 1863, and 
Annales d'oculistique, t i. p. 118, 1864. See J. Windsor, British Med. 
Jaum., J one 3rd, 1865. 



PERIOD OF GUMMY PRODUCTS. 109 

rapidity. Professor Magni determined to excise one of them, and 
discovered, on examination with the microscope, a quantity of new 
cells in the midst of a granular mass. Specific treatment caused the 
new products to disappear after several months only. 

The slowness of the cure and the absence of gummy lesions are 
the doubtful points of this case which induce us to wait for further 
facts before pronouncing definitely upon the nature of this lesion. 



Lesions of the cornea {chronic interstitial keratitis). 

The syphilitic ulcer of the eyelids, when it extends as far as the 
cornea, may produce a change in that membrane; but, indepen- 
dently of such cases, the cornea sometimes undergoes the more direct 
attacks of syphilis. Hutchinson has shown that a variety of chronic 
keratitis, peculiar to infancy, is undoubtedly connected with syphilis 
and not with scrofula, as has been supposed. Rare in cases of ac- 
quired syphilis, this afiFection is, on the contrary, a frequent mani- 
festation of hereditary syphilis, and, for that reason, we purpose 
giving the description of it further on. 

With tardy iritis sometimes coexists a variety of keratitis charac- 
terised by the presence of small, circumscribed, whitish points, on 
the posterior surface of the cornea (deep-seated punctuated kera- 
titis) ; but we cannot dwell upon this change here, any more than 
upon the afiFections of the choroid, which have been studied elsewhere 
(see Vol. I. p. 200). 

Lesions of the optic nerves and retina, — Syphilitic amaurosis. 

The syphilitic lesions followed by amaurosis, i.e., the more or less 
complete loss of sight, may be placed under three heads, accord- 
ing as the osseous system, the optic nerves, or the encephalon are 
more particularly involved. J. de Vigo and L. Botal quote cases of 
syphilitic amaurosis following lesions of the bones. '' Visum fuit,^' 
says Boerhaave, '^lamellam ossis cuneiformis quae ibi crassa est, 
exostosi laborasse, unde compressus fuit nervus opticus, et unde 
etiam amaurosis orta fuit, integris licet cerebro et nervis.^^* 



* Prailectiones publico de morhis octthntm. Pari si is, 1748, pars ii. 
cap. iii. p. 97. 



110 ACQUIRED SYPHILIS. 

Janin relates a case of eroding syphilitic nicer of the eyes ; * 
Astrac has left only very vague data on this sabject. Delpech saw 
a case in which caries of the sphenoid produced blindness. At pre- 
sent no other amaurosis is recoscnised than that which follows a 
change in the osseous system. The cases in this category f are not^ 
however^ without interest, and are still met with at the present day. 
The symptoms which they produce differ according as the anatomical 
localisation affects the orbit or is situated in the interior of the 
cranium; the syphilitic lesions of the orbit often produce exoph- 
thalmia, the more deep-seated lesions give rise only to the phenomena 
of compression of the optic nerve. Recent observations have 
proved that syphilis is capable of exerting a more direct action upon 
the nervous apparatus of the eye, and, thanks to the ophthalmoscope, 
we can now diasrnose these facts. 

In the case quoted by Bayle and Kergaradec, in which several 
syphilitic tumours occupied the base of the brain, the optic nerves 
were reduced to half their normal size, and so soft that they broke 
when touched. In a somewhat similar case related bv Courtin, the 
left optic nerve, from the commissure as far as the optic foramen, 
was pulpy^ reddish, and almost lost in inflammatory products of the 
meninges ; the left half of the commissure and the corresponding 
optic tract were diffluent, diminished in size and scarcely distinct. 
Dittrich has seen the optic nerves transformed into a greyish, villous 
and fibrous mass. Portal ascertained the existence of a fibrous 
tumour, of the size of a strawberry, which adhered to the bulb of 
the optic nerve. We here find, consequently, the two anatomical 
forms peculiar to syphilis. Nor is this all, for the optic nerve some- 
times becomes changed and atrophied in consequence of certain 
lesions of the hemispheres. Our Observation XXX. is an instance 
of this secondary manifestation, which appears to us to have been 
several times overlooked. 

The derangements connected with these various changes reveal 
themselves by physical signs almost identical and by functional dis- 



• Afem, et ohs, sur Vceil, p. 354. Lyons, 1772. 

f Compare for the lesions of the cranium or of the orbit : Demours, 
Sardaillon, Ballonius, Tacberon, Frost, Lallemand, and Verdier, Cb. Bedel, 
Guerard, Uerard, and Baudot, &c., in the works quoted by G. Lagneau 
and Gros and Lance rcaux. Demarquay, Traite des tumeurs de Vorhite, 
Paris, 1861. 



PERIOD OF GUMMY PRODUCTS. Ill 

turbances differing little from each other. At the outbreak of the 
disease, when the patient feels only a slight weakness of vision^ but 
examination with the ophthalmoscope already reveals a change in 
the optic papilla, the veins are distended and tortuous, the cajjillary 
vessels are noLore abundant, and there is an evident injection, a kind 
of oedema; later on, the arteries diminish in size, the field of the 
papilla, somewhat enlarged, with ill-defined greyish borders, contracts, 
and its colour changes from pink or greyish to white. This is called 
white atrophy of the papilla. This atrophy, in reality, may result 
from other causes than the changes in question; but nevertheless its 
existence should suggest the idea of the possibility of a syphiUtic 
lesion of the optic nerves or of the encephalon. 

Under these circumstances the sight gradually becomes enfeebled 
and sometimes ends by being entirely lost ; in the case of secondary 
lesion (intra-cranial tumour, Obs. XXX.), hemiopia may exist for a 
certain time. 

It is not always easy to know how to distinguish each of the 
manifestations of which we have just been speaking, to affirm from 
examination with the ophthalmoscope and from the functional derange- 
ment, whether it is a question of a direct or an indirect lesion, of a 
primary change in the bones, the optic nerves, or the encephalon ; 
fortunately, this distinction is of little consequence, since the same 
therapeutic indication avails for each case. 

The important point, under these circumstances, is to know how 
to trace out the syphilitic origin of the disease. But, to accomplish 
this, we must study the patient carefully, for it is by the antecedents 
and concomitant lesions, and also by the course of the affection in 
question, that it is possible to succeed in forming a diagnosis which, 
if not exact, shall, at least, be very probable. 

The prognosis of cases of syphilitic amaurosis is unfavourable. 
These affections being almost incurable, when there is atrophy of the 
optic papilla, it will easily be understood how important it is to 
institute an appropriate treatment at an early period. 

§ 3. Apparatus of hearing. 

Syphilitic deafness has long been known. Pare makes mention 
of it ; * Boerhaavef relates the case of an individual who, while 



♦ CBuvres completes, liv. xix. ch. xl. p. 467. Lyons, 1852. 



112 ACQUIRED SYPHILIS. 

suffering from syphilis, was struck at one and the same time with 
deafness and blindness; Van Swieten alludes to deafness as the 
result of certain ulcers of the pharynx caused by the venereal 
disease, and adds : " Sometimes these ulcers, which spread slowly, 
as is their wont, traverse the whole length of the Eustachian tube 
and completely destroy the internal ear. A disgusting ichor flows 
through the internal ear in the unfortunates whose throats have been 
eroded to that extent by this cruel disease.'^* 

Astruc speaks in the following terms of the syphilitic affections of 
the ears: "Lastly, syphilis sometimes causes hardness of hearing 
and even deafness, either from the destruction of the small bones by 
caries, or because, being inflamed, they have become incapable of 
performing their usual functions, or because the acoustic nerves are 
obstructed by spirits too gross, or compressed by arteries too much 
distended, or by nodes and ganglia formed in the vicinity of them, 
or by exostoses supervening in the bones which they traverse,'^ fecf 
LeschevinJ has published on this subject an observation which, 
without being absolutely demonstrative, nevertheless deserves to be 
quoted. "A young man of 27, after having had venereal chancres 
which were treated pallia tively in the beginning of 1757, began to 
feel very acute pains in the right ear ; some time afterwards, there 
appeared a sanious discharge from the meatus auditorius, and as the 
discharge decreased, the patient thought himself cured. Several 
months having elapsed, the pains returned and became even more 
violent than before. Lastly, they were followed by delirium, or 
rather by true mania which nothing could appease, and the patient 
died in January, 1758. The meatus auditorius was healthy, but the 
floor of the middle cavity was pierced and as it were riddled by 

• Commentar, in Boerhaavii Aphorism,, t. v. p. 369. Compare : Plenck, 
De morbi venerei doctrina, Venice, 1793. Swediaur, Traite complet de la 
mal, vSnSr. on syphilitique, Paris, 1801. Cullerier, Journ. de med, 
de SSdillotj 1814, xlix. p, 202. Itard, Traite des mal, de Voreille, 1821, 
t. ii. p. 185. Dominel et Leprestre, Arch, de med., Mars, 1830.- Deleau, 
Mech, 8ur les mal, de Voreille, Paris, 1838 (Obs. xii.). Davasse, dans These 
de Dumoulin, Paris, 1848, p. 44. Ricord, Clinique iconography 1851, 
pi. xxiv. obs. et fig. iii. Las^gue, Arch, de mid,, May, 1858, p. 603. 
Lagneau p^re, Ohs, rapportie par Lagneau fils, dans Maladies syphiUtiques 
du systeme nerveux, p. 511. 

t liOc. dt, t, iv. 

X Sur la thSorie des maladies de Voreille, &c., 1763, dans Prix de TAca- 
demie royale de chir., t. iv. p. 115. Paris, 1819. 



PERIOD OF GUMMY PRODUCTS. 113 

caries; all the cavities of the labyrinth and a great part of the 
surface of the petrous portion of the temporal bone were carious and 
worm-eaten." 

According to Swediaur^ sjphiUtic deafness may be caused by 
changes in the bones, by abscesses of the brain^ or by ulcers which 
affect the orifices of the Eustachian tubes. To these lesions^ B. 
Bell adds pustular eruption of the meatus and of the external audi- 
tory canal. Larrey* and Itard t have quoted cases of syphilitic 
deafness resulting from a change in the internal ear. Yering X ai^d 
J. Frank mention having seen cases of the same nature. " It results 
from the cases of internal otitis collected by me^^' writes the latter 
author^ '^that this disease most generally affects syphilitic subjects who 
are exposed to extreme injuries and cold.'' § On the other hand^ 
Kramer || asserts that it is not proved that syphilis has ever been 
the active cause of changes in the auditory nerves. Lagneau and 
Gibert have given cases of syphilitic deafness, without stating what 
had been the starting-point of the affection. In an interesting 
article upon the diseases of the ear,^ Triquet admits a form of 
syphilitic otitis, with an insidious onset and slow evolution, charac- 
terised by the presence of pustules having their seat upon the mem- 
brane of the tympanum, of which they cause perforation in some 
cases. Nocturnal pains and a cachectic condition accompany this 
affection. But, since the otitis observed by Triquet was met with 
during the secondary period, there is reason to believe that that 
author confounded the chloro-ansemia of that period with the cachexia 
of the tertiary period ; and the description which he gives appears 
to refer solely to eruptions of the mucous membrane of the meatus 
auditorius extemus. Like most of his predecessors, Triquet does 
not give any details, so that the information concemiug syphilis of 
the ear consists almost entirely of assertions which, although made 
by men of the highest merit, cannot suffice for the construction of a 
scientific theory. But what is wanted in such a case are facts, 
material proofs, without which the theory cannot be set up. 



* MStnoires de chirurg, rmUtairey t. ii. p. 444. 

t TraUi des maladies de VoreiOe, 1821, t. i. pp. 289, 400. 

X Aphoristnes, &c,, pp. 16, 22, 34. 

§ Traits de patholoff, interne., trad, fr., t. iv. p. 22. 

II Traits des maladies de VoreiUe, trad. fr. de Meniere, p. 34. Paris, 1848. 

H Journ, de mid, et de chirurg, prat,, July, 1863, p. 306. 

I 



1 14 ACQUIRED SYPHILIS. 

The field of the syphiliiic lesions of the apparatus of heaiing has 
not yet been sufficiently explored ; fresh researches mnst be made ; 
bat, in the meantime, let us som up our actual knowledge on the 
subject. 

Legions of the external ear. 

We have stated a short time ago that Triquet ascertained the 
presence of pustules upon the surface of the membrane of the tym- 
panum. Tidal had opportunities of observing cases in which these 
pustules occupied both meatuses ; on one side were seen a slight 
oozing and a prominent patch ; on the other side, the meatus audi- 
torius was ulcerated, of a duU red or brown colour, and there was a 
discharge from the ear ; the hearing was not at all affected. B. Bell 
also mentions the development of pustules at these same points. 
Baumds points out hardness of hearing and discharges of a greenish 
yellow colour. Ulcerations having a syphiUtic character have been 
observed by several authors ; some, easily seen, occupied the 
entrance to the meatus auditorius ; others, more deep-seated, could 
only be seen by the aid of the speculum auris. These latter have 
sometimes caused perforation of the membrane of the tympanum.'^ 
Thus the meatus auditorius extemus may become the seat of most 
of the cutaneous manifestations of syphilis, without excepting 
mucous patches, which are the most frequent of all these manifesta- 
tions and which sometimes become covered with soft and fungous 
vegetations. 

Lesions of the middle ear. 

Independently of the cases in which the middle ear may become 
changed from the extension of syphilitic lesions of the pharynx, 
direct inflammation of that cavity may be met with. In a case 
given by Betz,t the membrana tympani was thickened and perforated 
in about one-half of its extent j the malleolus, which was scarcely 
recognisable, adhered at its lower end, by means of a false membrane, 
to the parietes of the middle cavity ; the promontory was deformed, 
the cavity of the middle ear contained pus, and the mucous mem- 
brane was everywhere thickened and infiltrated, but not ulcerated. 



* Kramer traduit par Meniere, he, cit 

t Betz, VolUtdndige Taubheit nach Syphilis, Metnar,, viii. 5, 1863 ; aad 
Schmidfs Jahrb,, t. cxxi. p. 346. 



PERIOD OF GUIOCY PRODUCTS. 115 

Althoagh this case leaves some doubt as to the starting-point of 
the change, there is nevertheless reason for thinking that the cavity 
of the middle ear^ on account of the texture of the parts composing 
it, is favourably disposed to undergo the influence of syphiUs, and 
that to the consecutive lesions must be added direct lesions capable 
of causing deafness. 

Lesions of the internal ear. 

Whether on account of the difficulty of the examination, or from 
want of observation, no case as yet shows what modifications the soft 
parts of the internal ear may undergo in syphilis : all that we know 
is, that osseous lesions, exostosis or caries, are, in such cases, the 
usual causes of deafness. Already pointed out by Astruc, these 
causes have been indicated by Valsalva and other authors.* M^ni^re 
also quotes several cases of syphilitic lesions of the ear characterised 
by a thickening of the perichondrium or by hypertrophy of the 
temporal bone.t 

In addition to the influences which it undergoes on the part 
of the osseous system, the auditory nerve is sometimes aflfected 
directly, often even before leaving the cranial cavity. In a patient 
of Bayer's, J the deafness had for its very probable original cause a 
lardaceous tumour of the size of a pigeon^s-egg, which had devel- 
oped itself in the middle fossa. Cases of this kind are, however, 
rare. In the Observations CIX. and CXXIX. of our TraitS des 
ejections nervetcses sypAilitiques, the deafness appears also to have 
had its origin in an intracranial lesion ; but in one of these cases, 
recovery took place, and in the other it is not mentioned that the 
auditory nerves were affected. 

To sum up, the meatus auditorius extemus and the Eustachian 



* Valsalva, De aure humana tractatus, 1707. Compare : Al. Trajan 
Petronius, Aurium et ocuhrum Icesiones, in De morho gall, tract,, 1728. 
Fabre, Traiti des mal, v^n, Paris, 1773, p. 185. John Pearson, Ohserv, 
on the effects of various art, of the materia med, in the cure of the lues 
venerea. London, 1807. Larrey, Mim, de chirurg, et Camp, milit,, t ii. 
412, 1812. Delpeoh, Chirurg, clinique de Montpellier, February 1st, 1844. 
Landry, Oaz, hehd, de mid, et de chirurg,^ Marcb Uth, 1859. 

t Bedel, Thdsede Strasbourg, 1851. 

X Ann. de thSrapeutique et de toxicologie,J)QC., 1847. Compare: Briquet, 
ibid., "April, 1847. Guarinoni, Consilia medicinalia, Venetiis, 1610, 
pp. 27-44. 

i2 



116 ACQUIRKD STFmilS. 

tabe aometmies become the seat of fwpulir or uIoenitiTe eraptioiis 
which maj interfere more or less with the fimctioiis of the organ. 
These ernfitionsj which genenllj form a part of the aecondarj 
period^ do not diflfer from the syphilitic manifestations of the skin 
and mneoos membranes. Ihe nuddle ear, the internal ear, and the 
anditoij nerve, although susceptible of primaiy and direct mani- 
festations, are, most fieqoentlj perhaps, affected in consequence of 
a change in the petrous porti<m of the temporal bone. This is, at 
least, the conclusion to be drawn from the &cts known. 

I^ons so yarious necessarilj give rise to a variable qrmptoma- 
tology ; but we can onlj speak of the more frequent symptoms. 
The tinnitus annum alread j pointed out b j (jabriel Fallopius, who 
claims to have been the first to observe it, has since been men- 
tioned by A. Fard and many other authors. It is generally only 
the commencement of the deabess, as in a case given by Ad. 
Oenselius ;* it is usually followed by more or less complete loss of 
hearing. Most frequently unilateral when there is a change in the 
bones or in the pharynx, deafiness sometimes shows itself simulta- 
neously on both sides. Paina more or less violent with nocturnal 
exacerbations are sometimes felt in the neighbourhood of the ears. 
To these symptoms must be added those which result from the 
existence of material lesions of the bones or of the pharynx ; tume- 
faction, fistulous openings in the neighbourhood of the mastoid 
apophysis, and more or less extensive destruction of the pharynx 
and of the Eustachian tube. 

These various derangements are almost the only signs capable of 
guiding the physician in the diagnosis of the syphilitic afiPections of 
the ears; in other words, this diagnosis is based, not upon the 
functional derangement of the hearing, but upon an exact knowledge 
of the concomitant manifestations. In the absence of these mani- 
festations, when we have to deal with deafness dependent upon a 
deep-seated lesion of the bones or upon a modification of the audi- 
tory nerves, the osteocopic pains and the coexistence of neuralgic 
spots or of localised pardyses are circumstances which may serve to 



* Academue Ceaarete ZeapoldinO'^CaroUna not, eur. £ph,, 1717. In re- 
ference to a venereal subject whom be was treating, tbis autbor says : 
" Incipit laborare cum cepbalalgia imprimis noctuma lancinante conta- 
macissima, tinnitu aurium continue et tandem surditate." Centuria, xi. 
Obs. LXXXIV. p. 349. 



PERIOD OP GUMBfY PRODUCTS. 117 

enlighten tlie physician. In reference to the differential diagnosis^ 
let ns mention the existence of a pretty frequent suppuration which 
may senre to characterise scrofulous i^ections^ and the absence of 
suppuration and of ulcers of the mucous membranes as indicating 
lather the rheumatic nature of these same affections. 

The prognosis of the syphilitic lesions of the ear vaiy necessarily 
with the seat, extent, and nature of the organic modification. When 
limited to the meatus auditorius extemos, these lesions are of little 
consequence, and have no other danger than that of perforating the 
tympanum. They are more serious when the inflammation, extend- 
ing to the middle ear, produces exfoliation of the small bones, &c. 
With lesions of the bones or deep-seated otitis, the hearing is still 
more compromised ; nor is it less so when the auditory nerve is 
primarily or secondarily affected. 

In any case, when an apparatus so delicate as that of hearing is 
concerned, celerity is the most important element of the treatment ; 
otherwise, we run the risk of seeing irremediable lesions appear. In 
such cases^ the trained eye is most valuable. 



118 ACQUIRED 8TPHILIS. 



CHAPTEB V. 

HOBES OP EVOLUTION. — DUUATIOy. — TEBMIKATIONS. — ^BKLAPSES. 

TEAKSPOBMATIONS. OOMPIJCATIOKS. 

The stnd J of tbe evolution of syplulis is not the least interesting part 
of its histoij^ and^ althoagh we have sought^ in the preceding de- 
scription^ to follow this disease in its progiessiye oomse, it is not 
without advantage to revert here to the order of saooession^ and to 
the filiation of these phenomena. We shall follow^ therefore, with 
a rapid glance their development and concatenation. 

The syphilitic poison^ when brought into contact with the economy^ 
has entered it by the gate which science or chance has opened to it ; 
the absorption takes place and advances insensibly to the most deep- 
seated parts of the organism^ the whole of which undergoes its influ- 
ence. At the same time^ being submitted to the process of a kind 
of mysterious conception^ it becomes modified and developed, and 
its presence and effects are soon revealed externally by a first mani- 
festation. 

At the point of contamination appears a lesion called primary, at 
first altogether local, but which is soon accompanied by other 
manifestations, and especially by multiple and painless adenopathies. 

After a period of arrest, which is usually very short, varying from 
six weeks to two months, starting from the appearance of the primary 
lesion, there are seen to supervene, in the majority of cases, erup- 
tions of the skin and mucous membranes, disseminated and general 
eruptions the chief characteristic of which is, to be superficial, to 
leave no appreciable trace of their passage behind them, and to show 
themselves by successive bursts of from one to several months^ 
duration, with an interval which is usually very variable, by virtue 
of individual conditions and especially of various accidental causes 
to which these manifestations or their relapses are subordinate. 

This is the coarse of things during the whole period of general 
eruption, or of secondary localisations. What the extent of that 
period may be, is a point very difficult to decide. It may be said. 



MODES OF EVOLUTION. 119 

nevedlieless^ that the duration of this important phase of syphilis is 
of several months or of some years. Tertiary symptoms rarely 
manifest themselyes, in fact^ before the end of the first year, so that 
the period of the secondary symptoms may have a duration of from 
six to eight months, at least in adults^ for, in infants^ the succession 
of these symptoms is more rapid. However, relapses of rubeolous 
or papukr syphilide sometimes show themselves after one^ two^ or 
even three years, counting from the commencement of the disease, 
if no deep-seated gummy lesion has yet appeared. In these cases, 
the secondary period may have a duration of two or three years ; 
but it is not common to see it prolonged much beyond that period 
of time. 

The symptoms which follow, or tertiary symptoms^ do not, in 
general, encroach upon the secondary symptoms, except in certain 
cases of severe syphilis, in which they are seen to appear at the same 
time with the latter. Most frequently there is, between these two 
periods, a time of arrest which may vary between some months and 
several, even ten or twenty years. During this period of repose, the 
diseased organism has gradually undergone, without giving any signs 
of its deterioration, a modification more or less profound, which will 
reveal itself by changes differing greatly from those which preceded 
them. It is then that we must not be too hasty in believing a cure 
which may prove to be fallacious. It is also important to know that 
this latter phase of syphilis advances by jumps only ; one symptom 
succeeds another with an interval generally of perfect health. When 
this suspension of the tertiary localisations of syphilis lasts for several 
years, ten, twenty, or even more, it has been called by some authors 
the la;bent condition of syphilis, a condition in which they generally 
admit that the active principle of the disease slumbers, as it does not 
betray its presence by any apparent sign. We do not know whether 
those authors use the term active principle as synonymous with virus ; 
but we wish to point out that it is precisely in the last period of the 
disease, when the blood and morbid products are no longer inocul- 
able, that we observe these intermissions, too, often deceptive, and 
after which we are astonished to see reappear, from some cause often 
most insignificant, the symptoms of a disease which had appeared to 
be entirely extinct. This singular, insidious course, which is not 
without its analogue in constitutional diseases, and which belongs 
also to hereditary syphilis, has not escaped the attention of the 
greatest physicians. Astruc^ Sanchez, Bosen, Eabre and many other 



120 ACQUntED SYPHILIS. 

observers have recognised it. J. L. Petit said in reference to 
syphilis : " A man may have this disease for twenty years without 
its manifesting itself in such a manner that no doubt can be enter- 
tained as to its existence/'* 

Thus syphilis has not a regularly continuous evolution. Above 
all a chronic disease^ it is sometimes accompanied in its course by 
acute symptoms ; usually intermittent^ it proceeds by stages which 
are sometimes very long^ until some exciting cause intervenes to give 
a fresh impulse to the evil ; it presents this singular phenomenon^ 
one of the most impenetrable mysteries of human pathology^ of ac- 
complishing its evolution by successive periods^ in the intervals of 
which the health continues to be apparently perfect. The overriding 
of its periods is rarely observed. 

Such is the most complete and most usual evolution of the disease* 
But the various phases which have been mentioned do not exist 
always and in all cases. It may happen that one or the other is 
wanting. And if it be doubtfol whether the period of the primary 
lesion has ever failed^ the same does not apply to the period of 
general eruption : the latter not revealing itself by any phenomenon^ 
the patient passes without appreciable transition from the primary 
lesion to tertiary lesions^ sometimes even to visceral affections. If 
it were admissible to rely on this point solely upon the assertions of 
the patients^ such would often be the course of things^ since^ in 
twenty-four cases of visceral syphilis which we have ourselves ob- 
served^ we were unable^ in about ten of them^ to discover the least 
trace of a symptom intervening between the local eruption and the 
lesions of the internal organs* So that^ setting aside all theoretical 
views, there is reason for asking whether the eruptions of the skin 
are not a preservative in reference to ulterior manifestations. Under 
certain circumstances, in fact, it is the last period which fails. The 
general eruption once over, syphilis ceases as if it had completed its 
entire orbit. Comparable in this respect to certain cases of variola 
which never arrive at suppuration, it may justly bear the name of 
syphiloid. In these cases, which are far from being rare, syphilis is 
but an abortive disease ; slight and benignant, it does not leave be- 
hind any troublesome trace of its passage. It is impossible to lay 
too much stress upon this point. At the present day especially. 



• Fabre, he. cit p. 233. 



MODES OF EVOLUTION. 121 

when syphilis still inspires exa^erated fears, it should be known 
that this disease becomes dissipated completely in a great number of 
cases after the cessation of the cutaneous eruptions, and perhaps 
sometimes even with ihQ primary lesion. 

At other times, the course of syphilis is notably accelerated and 
there is no longer any intenral between the symptoms, whidi succeed 
each other without a break, the secondary symptoms superraiing at 
the same time as, or shortly after, the primaiy lesion, and being 
themselves followed immediately by the tertiary manifestations. 
This form of syphilis, which has received the name of galloping or 
acute, is not uncommon in infrnts, by reason, no doubt, of flie 
activity of all the organic functions. It sometimes attracts attention 
by the existence of the three ordera of symptoms, primary, secondary, 
and tertiary ; this has at least been seen by Dr. H. Soger,* in a case 
which he communicated to the Medical Society of the hospitals. 
But it is also observed in adults without the explanation of it being 
easy to seize, as it is not possible to mvoke here, as in the infant, 
the activity of nutrition and the rapidity of the molecular changes. 
A case which we have had the opportunity of observing recently 
under the care of our teacher. Professor GrisoUe, is an instance of 
this rapidity of course. 

Obs. LIII. — ^A young woman of 27, a cook, apparently strong and of 
excellent constitution, contracted syphilis in May, 1864. She had a 
chancre on the inner and upper surface of the left labium majns. She 
soon afterwards felt hissitude, and muscular and articular pains, and had 
an eruption which was probably paptdar. She was ordered purgatives. 
In January, 1865, there appeared two buboes in the left groin, for which 
she was ordered frictions with mercurial ointment, and took one hundred 
pastilles. In February, she had angina and bronchitis, and mucous 
patches on the genital organs. 

In March, an eruption appeared, which commenced at the posterior part 
of the fore-arm, and afterwards became general, invading the hairy scalp, 
the upper part of the neck, the thighs and even the trunk* She had fever, 
with paroxysms in the evening, lassitude, cephalalgia, giddiness, muscular 
and articular pains, anorexia, and dislike to food. 

April 11th, 1865. — On her admission into the Hotel-Dieu, under the 



* Roger, BuH. de la Societi med, de$ h&pUaux de PartM, t iv, fasc. V« 
fol. 429. Compare : Sicard, Qaz. des MpU., 1863, p. 509. Ibid.^ 1857. J, 
F. Heyfelder, Ueber galopirende SyphiUs ((Bfterr. ZeU$ehr\ft f&r prakt, 
Heiik,, No. 3, 1858). 



122 ACQUIRED SYPHILIS. 

care of M. Grisolle, she had a emsty papular emptioii upon the hairy 
scalp, simply papalar at the roots of the hair, of a red colour, resembling 
lean ham ; the papules presented at their base the well-known white ring. 
On the back were several disseminated papnles ; in front of the sternum , 
copper-coloured spots covered with epidermic pellicles; similar spots, 
scarcely prominent, of about one centimeter in extent, upon the upper 
part of the thighs. On the fore-arms were disseminated spots little or 
not at all prominent, of the extent of from several millimeters to one cen- 
timeter and a half, and covered, like the preceding, with a simple layer of 
glittering epidermic lamellae. This eruption showed everywhere the 
greatest analogy to psoriasis guttata, but this analogy was especially 
striking upon the -fore-arms. In the left hand were observed three or 
four papules of the same kind. She had inguinal and cervical adeno- 
pathies, but no lymphangitis of the arms ; the epitrochlean glands were 
indurated and moved under the finger. There was redness of both the 
pillars of the velum palati, and slight ulceration on the surface of the left 
tonsil. She was ordered to take two of Dupuytren's pills every night. 

April 20th. — ^The fever had ceased, but the cephalalgia persisted; it was 
nocturnal and caused insomnia. The eruption was of a dull yellow 
colour ; the appetite was still small ; the redness of the throat had not 
disappeared, but the ulceration of the tonsil was partly cicatrised. Since 
the previous day, the patient complained of slight itching about the papular 
or squamous eruption ; upon one of the labia was a pimple from which 
oozed a serous fluid. The treatment was continued, but nevertheless, 
after a few days, the improvement stopped. Under these circumstances, 
the pills were replaced by others containing proto-iodide of mercury, to 
which were afterwards added iodide of potassium and sulphur baths. The 
patient was at the same time put upon a tonic regimen. No change took 
place, however, except that the eruption became larger and more abundant, 
and that the ulcer of the throat cicatrised. 

June 15th. — M. GrisoUe ordered corrosive sublimate baths, and con- 
tinued the proto-iodide of mercury. 

July Ist. — There was marked improvement, the scales had fallen off 
and the spots were gradually disappearing. On the 10th, the eruption 
had almost vanished. 

July 15th. — The patient complained of pain in the tongue ; on examina- 
tion there were found, at the posterior part of the dorsal surface of that 
organ, three small, firm tumours, of the size and shape of a bean, situated 
superficially and very slightly prominent. She again lost her appetite 
and had a furred state of the primse vise. An emetic was given, and the 
iodide of potassium resumed and continued. A month later, the patient 
no longer presented any syphilitic manifestation ; there remained only, 
in the situation of the gummy tumours of the tongue, an epithelial des- 
quamation in the form of small, elongated, red spots. 

A certain degree of acuteness and still more of irregularity shows 
itself in the course of cases of syphilis occurring in seaport towns 



MODES OF EVOLUTION. 123 

and in cold and damp countries. These are the cases to which the 
name of malignant syphilis is given^ on account of the tendency to 
ulceration or even to suppuration shown by the anatomical lesions 
which characterise them. 

We have hitherto been investigating the course of syphilis inde- 
pendently of any treatment. An important and much contested 
question remains to be examined at this moment. What is the in- 
fluence of therapeutic agents upon the evolution of the symptoms of 
this disease P In the opinion of a certain number of authors^ specific 
treatment has the effect of retarding the appearance of the secondary 
symptoms. But for a long time this was a mere assertion which, to 
pass into the domain of acquired truths, required the sanction of 
facts. Bassereau has studied the problem ; making a comparative 
abstract of a certain number of cases of syphilitic erythema in 
patients who had not been subjected to any general treatment and 
m other patients treated previously, this skilful observer found that 
the treatment had almost always retarded to an appreciable extent 
the development of that syphilide.* Consequently, treatment may 
disturb or at least retard the natural course of the disease, or the 
period of the appearance of the symptoms. Eicord, Bazin, and 
other writers of not less authority partake of Bassereau's views. But 
this question requires to be studied afresh. Side by side with the 
treatment is the hygiene of the patient, which appears capable of in- 
fluencing the course of syphilis ; but this is a circumstance to which 
Bassereau attaches little importance. 

The general duration of syphilis is so variable that it is impossible 
to determine its limits. While this disease, in some cases, completes 
its evolution in a few months and with a course comparatively acute, 
it is seen, under other circumstances, to be prolonged during the life 
of the individual, or even to be transmitted to several generations. 
To endeavour, therefore, to appreciate this duration is extremely 
difficult. This problem calls in question, moreover, the possibility 
of recovery from this disease : let us see what is to be believed on 
this subject. 

Eecovery, death, or a stationary condition, such are the various 
modes of termination which we have to examine. Recovery, and by 
this word we mean the final cessation of the disease and not the mere 
disappearance of such or such a symptom, is, we venture to assert, 

* Traits det affect, de la peau symptomat, de la syphilis y p. 178. 



124 ACQUIRED SYPHILIS. 

the most usual mode of termination of syphilis. This doctrine, how- 
ever^ is not that most widely spread^ and the opposite one has long 
been defended by highly scientific notabilities. Yidus Yidius said 
that syphilis accords truces without ever making peace. " Magis 
indudas fadt quam pacem." Baglivi doubts whether this disease, 
once introduced into the body^ can be entirely expelled from it» 
'^ Lues venerea, semei recepta in corpus, difficiliter postea del^tur ; 
ejus character adhibitis specificis mitesqit, sed non extinguitur. Imo 
post triginta et plures annos sub specie aliorum morborum reviviscit, 
et medicos decipit, causam morbi ordinariam putantes, cum revera 
tamen ab excitato noviter venereo fermento depenijeat.''^ More 
recently, Hunter,t without denying the possibility of recovery from 
syphilis, said that mercipy did not destroy the syphilitic action when 
once it was established. Ca^enave| admits the cure of primary 
syphilis but not of secondary syphilis. From the latter, he says, 
patients do not recover ; they have acquired the syphilitic tempera- 
ment and must live on with it, as others live with the lymphatic 
temperament. Bicord, after having participated in the opinion of 
those who think that the syphilitic diathesis, once estabhshed, never 
becomes extinct, expressed himself later on, on this subject, in 
diflferent terms. " As for me, although having, in my turn, ascer- 
tained this melancholy truth, I do not, however, inf^ the absolute 
incurability of syphilis, as it has been sought to show that I assert. 
I ask myself whether syphilis may not become cured, leaving behind 
it, like small-pox, only a preservative modification.^' With this 
latter hypothesis, the syphilitic impression would persist indefinitely, 
even after the final cessation of any manifestation. 

It would, perhaps, be difficult to meet with partisans of the 
doctrine which admits that syphilis is susceptible of cure, for Eemel, 
A. Par^, and other authors who appear to believe in such cure, mean 
thereby rather the cessation of such or such a manifestation than that 
of the morbid essentiality properly so called. 

It is astonishing that the question which we are discussing should 
have attracted so little attention, and that, in works the most im- 
portant and most complete, it is not even mooted. Latterly, it has 
been propounded. Wishing to show that syphilis may be cured. 



• Praxeos med,, lib, i. p. 95. 

t CEuvres complStes, trad, de Richelot, p. 544. 

X Moniteur des hdpitaux, Aug. 19th, 1865. 



MODES OF EVOLUTION. 125 

Didaj endeavours to prove that this disease is a poisoning and not a 
diathesis ;'^ but before placing amongst poisonings syphilis which 
other authors^ Bicord for instance^ places in the group of diatheses^ 
it would be desirable, first of all, to come to an understanding as to 
the meaning of the terms diathesis and poisoning. This mode of 
procedure would be out of place here ; but we may arrive otherwise 
at recognising that syphilis is susceptible of cure. The observation 
which teaches us that a great number of individuals manifestly 
syphilitic end by enjoying very perfect health> without ever present- 
ing, any more than their descendants, the least taint of syphilis, 
teaches further that this disease reproduces itself, and sometimes be- 
comes double iii the same individual. But, experiment having shown 
that syphilis is no longer inoculable in an infected subject, it must be 
admitted that, in cases of double infection, recovery took place. The 
question of double syphilis was already discussed by the syphilo- 
graphers of the sixteenth century. A. Lecoq f seems to have ad- 
mitted it ; but it is doubtful whether he was speaking of anything 
else than the relapses of secondary or tertiary symptoms. Barth. 
Maggi (1550) believed without hiesitation that an individual may be 
affected with general syphilis by two successive contagions. Brassavole 
regards the case as not uncommon, as he believes that a first infection 
predisposes to a second. Vidus Vidius (1556) appears to believe 
that once cured of the French disease, an individual no longer con- 
tracts the lesions which we call primary. A. Trajan Petronius (1565) 
says that those who have once been cured of the French disease by 
guaiacum are less disposed to take that disease. 

The opinion of Brassavole prevailed for a long time, and it has 
not unfrequently been repeated since then that a first syphilitic in- 
fection predisposes to a second. Bicord justly opposed this view, 
and, never having met with a single case of double infection, has 
denied that such cases can occur. Becent cases have sufficed to 
prove how far this denial was exaggerated. 

Follin quotes three cases of double infection.} A. Boulongne 
gives two fresh cases.§ Diday succeeded in collecting several in* 



• Lemons sur le chancre, p. 227, 2® §dit. 

t De liie hispanica, 1540. 

X Traits depathologie externcy t. i. p. 739. 

§ Hecueil de mim, de mid, et depharm. milit, 3* s^rie, t. ii. 1859, p. 428» 



126 ACQUIRED SYPHILIS. 

stances borrowed £rom various authors.* These cases indicate the 
appearance^ from eleven to thirteen years after a primary infection, 
sometimes of an indurated chancre without enlargement of glands, 
sometimes, which is much more conclusive, of an exanthematous 
syphilide (a case by H. Lee). I am far from wishing to assert that 
all these cases are to be accepted without analysis ; but it is sufficient 
for me that a certain number of them cannot be refused, to admit 
the possibility of the final extinction of syphilis in an infected 
oi^anism, in a word, of its cure. How then did this cure take place, 
and what are the means which enable us to recognise it P 

In reference to the first point, the answer is simple ; syphilis, 
like typhoid fever, variola, scrofula, like all diseases in short, ends 
by yielding to the efforts of nature alone, that is to say, the organism 
frees itself from it at a certain period and in a spontaneous manner, 
treatment, when it intervenes, acting only upon the manifestation 
which it combats and not upon the disease itself. This thesis, which 
we purpose developing further on, already finds support in the re- 
searches of Diday. In fact, eighteen syphilitic subjects treated with- 
out mercury by that author appear to have been completely cured. 
I am quite willing to admit that these cases are not free from 
objection, on account of the short space of time (three years and a 
half to sixteen years) elapsed since the disappearance of the last 
syphilitic symptom; but if this space of time be not absolutely 
sufficient, since tertiary syphilitic manifestations are observed to show 
themselves ten and twenty years after the primary or secondary mani- 
festations, it is none the less incontestable, that as regards its termi- 
nation, syphilis does not differ from any of the diseases the radical 
cure of which belongs to time and hygiene rather by far than to 
therapeutic agents. 

As regards the second point, that of knowing what is the period 
in the evolution of sjrphilis at which the modified organism succeeds 
in re-entering upon its normal and physiological condition of life, I 
admit, and therein I agree with Diday and Sazin, that it is not pos- 
sible to regard an individual as safe from syphilitic affections until 
he has passed through all the phases of the disease. However, as 
cases of typhoid fever are seen to recover at the end of the second 

* Histoire naturelle de la syphilis et Archiv, de mSd., 1862. Dardel 
gives a fresh instance : Des reinfections syphiUtiques, dans Gaz, mid, de 
Lyon, August 16tb^ 1865. 



MODBS OF EVOLUTION. 127 

stage^ and cases of small-pox to become arrested at the end of the 
eruptive period without proceeding to suppuration, so cases of syphilis 
may be met with which terminate immediately after the period of 
secondary symptoms, and perhaps after the primary lesion. Never- 
theless, here as in every other disease, it is always at the end of a 
stage that the evil ceases ; acute or chronic, the disease proceeds 
none the less by periods modelled, so to speak, after the same type. 
These periods are inherent in the organism, which reacts by the con- 
tact of the morbific agent : the quality and mode of action of that 
agent are the causes of the differences observed. 

In reference to a knowledge of the signs which enable us to judge 
of the cessation of the deleterious impression made by syphilis upon 
the organism, let us confess that this is one of the questions which 
interest most the hygienist and clinical teacher, and also one of the 
most difiScxdt problems of general pathology. What criterion do we 
possess for asserting the cure of a disease ? The recognised com- 
pletion of all the phases of that disease. But this does not suffice, 
for, under various circumstances, when a disease has run its whole 
course, the organism, for a longer or shorter period, still feehng the 
blow which it has received, gives evidence of the impression felt by 
its inaptitude to contract afresh the same disease. But, if certain 
forms of poisoning form an exception to this law, syphilis does not 
escape it, and if we would absolutely find the criterion we are seek- 
ing, there would be no other means than to have recourse to inocu- 
lation ; but it is too evident that this means is anything but applic- 
able. Thus, an exact knowledge of the cure of syphilis cannot be 
acquired, the more so as this cure sometimes occurs without the 
disease having passed through all its periods. In this respect, how- 
ever, it is possible to arrive at presumptions. It appears to us that 
the cure of syphilis is to be regarded as probable when, in an indi- 
vidual who has passed through all the phases of that disease, the 
strength has continued at the full for several months, and ct fortiori 
for several years, and no symptom has appeared in spite of the action 
of the most usual provoking causes, such as venereal excesses, hard 
drinking, cold, &c. But even under these circumstances, the phy- 
sician, to avoid compromising his knowledge and reputation, will do 
well to refrain from giving a positive opinion, and so long as the 
slightest indication of cachexia remains, will not promise anything, 
bearing in mind always the frequency of relapses of syphilitic affec- 
tions, even in the tertiary form. Moreover a sign often tardy, but 



128 ACQUIBED SYPHILIS. 

none the less important when it exists^ is furnished by the healthy 
condition of the descendants. It is easy to understand that a 
father or a mother previously affected with syphilis, and whose chil- 
dren enjoy perfect health, may be regarded as being safe from any 
manifestation of that disease. 

Another question presents itself here, which must also not be 
passed over in silence : Is syphilis susceptible of degenerating or of 
becoming metamorphosed into a difi^erent morbid species. On this 
pointy a great number of authors of the last centuries^ and amongst 
others Baillou^ Sauvages, Bosquillon, and J. IVank, have not hesi- 
tated to answer in the affirmative. According to them, syphilis may 
be transformed into rheumatism^ gout^ tuberculosis, or carcinosis ; 
but when we read the account they give of the various metamor- 
phoses^ we soon come to the conclusion that what they regard as 
a transformation of syphiUs is nothing else, in reality, than syphilis 
itself, arrived at the most advanced period of its evolution^ and 
directing its action to the viscera. In a word, most of the cases 
which have served those authors for the formation of their theory of 
the transformations of syphilis may be regarded as cases of visceral 
syphihs. 

However this may be, the vague data and ill-supported opinions 
of the above-named observers must have served the detractors of 
syphilis, who could easily refute assertions generally devoid of any 
anatomical confirmation. It is thus that observations ill interpreted, 
although exact, may have been injurious rather than useful to the 
cause they were intended to support. Hunter * felt called upon to 
discuss the point at issue, and sided with an opinion in which we 
entirely agree. " Syphilis,'^ he says, " never becomes mixed or con- 
fouiLded with other diseases ; it never terminates in any other affection ; 
at least this is extremely rare, although the contrary has been 
asserted.'' And further on he adds : " It is very probable that vene- 
real affections may become the cause of other affections. I have 
seen a chancre act as the immediate cause of an erysipelatous inflamma- 
tion. . . . The chancre here acts solely as an ordinary irritant, 
independently of the specific nature of the disease.'^ More recently, 
Lugelf and Sicord have again maintained, in accordance with 

* Complete Works, trad. fran9. de 6. Ricbelot, Si/ph. constit,, p. 532. 
t RecJierches et observ, sur lea cames des maladies scrqfulenses^ p. 117. 
Paris, 1844. 



MODES OF EVOLUTION. 129 

AstruCy that certain scrofolous lesions may proceed from syphilis, as 
its direct descendents ; but the cases which they give in support of 
this proposition are neither numerous nor conclusive, which has not, 
however, prevented this view from finding credit with a certain 
number of physicians. In reality, it is not rare to meet with, in the 
descendents of syphilitic subjeqts, morbid manifestations having a 
certain analogy with those of scrofulosis ; but, on closer examina- 
tion, we see that they have a still greater resemblance to the mani- 
festations of syphilis. And it is erroneously that certain lesions 
which do not belong to it have been attributed to the strumous 
diathesis, as, for instance, that form of keratitis which the observa- 
tions of Hutchinson have justly connected with hereditary syphilis. 
(See further on.) 

These reflections are applicable to the pretended transformations 
of syphilis into cancerous or tubercular disease. This transforma- 
tion never occurs, and when, in the course of syphilis, tuberculosis 
is seen to develop itself, it can, at the most, be admitted, as we 
shall explain further on, that this latter disease has been occasioned 
by the debilitation which the first has produced in the organism. It 
is important to know that the morbid unities, like the natural species, 
do not become transformed. Syphilis is always itself, and never be- 
comes scrofula or tuberculosis. 

Syphilis which does not become cured may remain m statu quo 
for a period which is sometimes very long, and then it is susceptible 
of becoming progressively weaker in the descendents by the simple 
fact of the multiplicity of the transmissions ; or else it causes the 
death of the individual it has attacked. 

Death, a mode of termination comparatively little frequent in the 
disease of which we are treating, and still more rare at the present 
day than in the fifteenth century, is more common, however, than the 
most skilful syphilographers formerly believed, when syphilitic lesions 
of the viscera were still unrecognised. Exceptional in the earlier 
periods of the disease, it is, so to speak, the exclusive privilege of 
the last ; it has for its immediate cause either variotis visceral lesions 
which interfere with the functions of organs indispensable to life 
and which often end by producing cachexia and marasmus, or 
various intercurrent affections, complications always serious on 
account of the extreme debilitation into which they plunge the 
economy. 

The affections of the hearty the brain^ the liver^ and the kidneys 

i 



130 ACQUIEED SYPHILIS. 

are^ of all the manifestations of syphilis^ those which most frequently 
have a fatal termination, which is easy to understand by reason of 
the functional importance of the organs diseased. Slow in some 
cases, death is at other timek rapid and almost sudden^ chiefly when 
the hearty as seat of the morbid localisation^ is dilated and deprived 
of most of its contractile elements. The deep-seated affections of 
the larynx and trachea also sometimes cause sudden death. The 
lesions of the lungs and those of the liver are, in this respect, less 
dangerous; they produce considerable wasting and generally slow 
death. The direct or indirect lesions of the nervous system vary, in 
the point we are now considering, according to their different seats 
in one or other of the principal centres ; this is a purely physiolo- 
gical fact. With the exception of the visceral lesions, the mani- 
festations of syphilis rarely prove fatal of themselves. 

Of all the intercurrent affections which may complicate syphilis 
and hasten its termination, pneumonia and erysipelas are by far the 
most frequent. This fact, which results from an examination of the 
majority of the known cases of visceral syphilis,* has long attracted 
our attention. As early as 1861, while an epidemic of erysipelas 
prevailed in the Paris hospitals, I observed that a certain number of 
patients who succumbed to that disease in the practice to which I 
was attached were affected with syphilitic lesions of the viscera. 
Since that time, I have remarked that, even in the absence of any 
kind of epidemic, visceral syphilis is frequently complicated with 
erysipelas, and that this always serious disease most frequently carries 
off the patients.f 

It is difficult to explain the appearance of this erysipelatous com- 
plication which is observed in other diseases with cachexia. I can 
here only make known my ignorance. In a study so vast as that 
with which I am occupied, it is always desirable to mention the 
desiderata and the things unknown. 

Pneumonia takes a place by the side of erysipelas as an ultimate 
complication of syphilis ; it is met with, in fact, in a great number 

♦ Compare the observations of Meyer, Ttingel, and ourselves. 

t A patient I had the opportunity of seeing in the practice of Dr. 
Herard is the only one, so far as I know^ who has recovered from ery- 
sipelas supervening under these circumstances. In three cases of my own, 
the erysipelas commenced in the pharynx, the mucous membrane of which 
was ulcerated, and spread thence to the face, sometimes by the ears, 
sometimes by the hasdl fossse. 



MODES OP EVOLUTION. 131 

of cases^ andjalways with characters sufficiently pecuUar to require 
pointing out. Like most of the secondary affections^ it does not 
generally occasion any marked reaction; it develops itself slowly 
and insidiously, and if the patient present some vital resistance, it 
may have a comparatively long duration, and, consequently, differ 
in its course also from most pneumonias. To sum up, syphilis is to 
be regarded as a disease in the course of which secondary erysipelas 
and pneumonia frequently supervene; whence this clinical rule, 
that whenever one or other of those affections presents itself in an 
individual who is debilitated and cachectic, and without any well- 
known cause, the physician should think of the possible existence of 
visceral syphilis. It is not impossible, doubtless, that other lesions 
may put an end to the lives of individuals suffering from tertiary 
syphilis ; but hitherto there have been few instances of any other 
kind of complication. 



k2 



132 HEBEDITABY SYPHILIS. 



HEEEDITARY SYPHILIS. 

Auffter Ferrier, De pudendagra libri duo, Aplirodisiacus, t. ii. p. 906. 
Leyde, 1728. Pierre Huschard, De morbo gallico tractatus, ibid,, p. 930 
Gabriel FaUope, De morbo gallico liber, ibid., p. 769. Matthiole, De 
morbi gallici curatione Dialogus, p. 63. Lugduni, 1536. Paracelse, De 
morbo gallico obirurgia. Strasb., 1605. (?. Rondelet, De morbo gallico, 
Paris, 1573. Ouillemeau, Chirurgie. Paris, 1647. A. Pari, De la grosse 
v§role qui survient aux petits enfants, CEuvr. compl. Lyon, 1652, p. 467. 
Botal, De luis venerese curandse ratione. Parisiis, 1563, in 12°. Out/on 
Dolois, Cours de medecine tb6or. et. prat., par Laz. Meyssonnier, 6® 6dit. 
Lyon, 1673. Harris, De lue venerea; in R. Morton's Oper. med., t. ii. 
p. 83. Lyon, 1737. Musitan, Traite des maladies v§neriennes, trad, par 
Devaux. Gamier, Traite pratique de la v^role. Lyon, 1696. Mauriceau, 
Traits des maladies des femmes grosses et de celles qui sont accouchees. 
Paris, 1712, t. L p. 518. Van Sioieten, Aphor. Boerbaavii, 1773. Fcr- 
celloni, Traite des maladies qui arrive aux parties genitales, et particu- 
liSrement de la maladie venerienne ; trad, par Devaux. Paris, 1730, p. 374. 
Astruc, Edition de Louis, t. iv. 1777. Nils Rosen de JRosenstein, Traite des 
maladies des enfants; trad, de Lefebvre de Villebrune. Paris, 1778, 
p. 537. Levret, Art des accoucbements, 1753, p. 266. Fabre, Traite des 
maladies v^n^riennes. Paris, 1773. Raulin, De la conservation des 
enfants, t. ii. p. 347. Paris, 1777. Nisbett, Essai sur la tbeorie et la 
pratique des maladies v^n^riennes; trad. fr. de Petit- Radel. Paris. 
Swediaur et Bell, D§jk cites. Colornbier, Observations sur la maladie 
venerienne et le millet dont les enfants nouyeau-n^s sont attaqu^s, &c. ; 
m§moire lu le 28 aoiit, 1781, k la Soci§t§ Roy ale de medecine de Paris, 
t. iii., de ses M^moires, p. 181. Faguer, ThSse de Paris, 1783. Doublet, 
Obs. dans le depart, des civils., &c. ; manidre de traiter les enfants malades 
dans rhospice de Vanglrard, &o., Journal de mSdecine, de chirurgie, et de 
pharmacie, Paris, Janvier, 1785, t. Ixiii. pp. 445, 446 et suivantes. Boutan, 
De lue venerea in recens natis, 4 frimaire, an xii. Felletier, Maladies 
syphilitiques des enfans nouveau-n§s. TbSse de Paris, 14 fructidor, an xii. 
F. Leblanc, Maladies veneriennes des nouveau-n6s, et expos§ des moyens 
curatifs. ThSse de Paris, 15 tbermidor, an xi. J» P. Giraud, La verole 
peut-elle se communiquer & Tenfant avant sa naissance ? Tbdse de Paris, 
26 pluviose, an xiii. P. A, O. Mahon, Recberclies importantes sur I'exist- 
ence, la nature, et la communication des maladies syphilitiques dans les 
femmes enceintes, dans les enfans nouveau-n§s, et dans les nourrices, 
par Louis Lamauye. Paris, 1804. Guilliaume God et Ploncquet, Initia 
bibliothecffi medico-practicae et cbirurgicae, t. viii. pp. 392, 399, 400. 
Tubingue, 1804. J. Cqpuron, Apbrodisiographie. Paris, 1807, p. 274. 
Vassal, M6moire sur la transmission du virus vinerien de la mSre k 
Penfant Paris, 1807, Bertin, Traite de la maladie y^n§rienne cbez les 



HEREDITARY SYPHILIS. 133 

enfans nouveau-nes, les femmes enceintes, et les nourrices. PariB, 1810. 
Bourgognet Considerations generales sur la contagion de la maladie 
Yenerienne des enfans trouvgs h. leurs nourrices, suivies de la relatione 
d'une affection syphilitique communique k plusieurs femmes par la suc- 
cion du sein. Lille, 1825. Krauss, Dissertatio de pemphigo neo-natorum. 
Bonn, 1834. HuguieVf Syphilis cbez les femmes enceintes et les nouvelles 
accoucb§es. Gaz, mid,, 1840, p. 62, et Bullet de VAcademie de M^dedne, 
July 13tli, 1840. Robert Lee, De la transmission de la scarlatine, de la 
variole, de la syphilis, et d'autres maladies par vole de Fher^dite. Annal, 
des maladies de lapeau et de la syphilis, 1. 1. p. 317. Paris, 1844. Colles, The 
Dublin Quarterly Journal, 1840, et Ann. des maladies de la peau. Bizzi, 
Sur la syphilis, Gazetta medica di Milano, Apri], 1846, et Gaz, mid., mime 
annee, p. 841. Hertle, Du pemphigus des nouveau-nes et de sa nature. Th^se 
de Strasbourg, 1847. Cazenave, De la contagion apropos de la syphilis 
congenitale. Annales des maladies de la peau et de la syphilis, t. iii. 
pp. 281, 303. Trousseau et Zasigue, De la syphilis constitutionelle des 
enfans du premier age. Archives ginirales de midecine, October, 1847. P. 
Dubois, Du diagnostic de la syphilis consideree comme une des causes de 
la mort du foetus. Gaz, midicale de Paris, 1849. Cullerier, Du traite- 
ment de la syphilis des nouveau-n§s. Bulletin de la therapeutique. May, 
1852, p. 433. De rh6r§dit6 de la syphilis. Mhnoires de la Sociiti de 
Chirurgie, 1854. Bouchut, De la syphilis infantile, Traite pratique des 
maladies des nouveau-nes, &c., 1852. Prieur, Quelques questions sur la 
syphilis. Th^se de Paris, 1851. Depaul, Memoire sur une manifestation 
de la syphilis congenitale consistant dans une alteration lyieciale des 
poumons, pour servir k I'histoire de la syphilis intrauterine. Academic 
de medecine,* July 20tb, 1851 ; et Gazette midicale, 1851, p. 392. 
DevilUers, Recherches sur le traitement antisyhilitique cbez les femmes 
enceintes. Mimoires de VAcademie de midecine, October, 1851. Gubler, 
M§moire sur une nouvelle affection du foie liee a la syphilis hereditairc. 
Mimoires de la SocUti de biologic, 1852, t. iv. Meme sujet. Gazette des 
hopitaux, JsLn. 1848; et Gazette midicale, 1852, p. 262. A, Dugh, De 
Tinnocinte du lait des nourrices atteintes de syphilis pour les enfants 
qu'elles nourrissent. Th^ae de Paris, 1852. Ch, Thierling, Annales et 
bulletins de la Sociiti midicale de Gand, 1852, p. 93. Venot, Journal de 
midecine de Bordeaux, March, 1852. Simon, Memoire sur la syphilis 
congenitale. Journal des connaissances medico-chirurgicales, t, iii. p. 254. 
Ch, Desruelles, Des manifestations de la syphilis congenitale et par- 
ticulierement du pemphigus des nouveau-nes. ThSse de Paris, 1852. 
F, Mayr, Recherches sur la syphilis hereditaire chez les enfans. Zeitzschr. 
fiir GeseUsch. der Aertze zu Wien, traduction d'Axenfeld, 1852. 
Annuaire des maladies de la peau et de la syphilis, Nat, Guillot, 
Le9ons cliniques sur la syphilis des nouveau-nes. Moniteur des 
hopitaux, 1853, p. 394. Maudon, Histoire de la syphilis des nouveau- 
nes et des enfans a la mamelle. Th^se de Paris, 1853. Diday, Traite 
de la syphilis des enfans nouveau-nes et des enfans k la mamelle. Paris, 
1854. Doyon et Dron, Observations sur la syphilis des nouveau-nes 
et des enfans h, la mamelle, Gaz, hebdomad,^ ISH* Putegnat, Histoire 



132 



HEBBDITABY STFHILIS. 



HEREDITAEY SYPHILIS. 



.L . 



Amgier Ferrier^ De pudendagra libri dao, Ap1irodisiacu.>. 
Layde. 1728. Pierre Muschard, De morbo gallico tractatu 
Gabriel Falhpe, De morbo gallico liber, ibid., p. 769. 

»ria gallici caratione Dialogue, p. 63. Lugdani, 15:i«i. 
gallico ehimrgia. Strasb., 1605. G. Bondeht, ' 
Pteia, 1673. QuiUemeau, Chimrgie. Paris, 1647. A . 
verole qui sorrient aox petits enfants, GBavr. compl. 
Botal^ De Inia Teoerese cnrandae ratione. Paris lis, ' 
Ih»i*H*, Coon de m^dedne th^or. et prat, par Laz. . 
Ltod, 1673. Harris, De lae venerea; in R. MorL< 
p. 83. Lyon, 1737. Mueitan, Traits des maladie:^ 
Deranx. Oamier, Traits pratique de la y^role. L, 
Traits des maladies des femmes grosses et de ccll< 
Paris, 1712, tip. 518. Van SwieUn, Aphor. V 
crUoni, Traits des maladies qui arrive aux parti 
li^rement de la maladie T§n^rienne ; trad, par I)k 
Aitruc, Edition de Louis, t. ir. 1777. Nils Hos' 
maladies des enfants; trad, de Lefebvre do ^ 
p. 537. Lerret, Art des accouchements, 175o, ; 
maladies v^n^riennes. Paris, 1773. Rau''! 
enfanta, t iL p. 347. Paris, 1777. NishvU. 
pratique des maladies v^n^riennes; trad. 
Strediawr et BeU, D^jk cit^ Colombter, O' 
Ten^rienne et le millet dont les enfants iior,\ > 
ro^moire In le 28 ao&t, 1781, k la Societe P 
t. iiL, de ses M^moires, p. 181. Fa^ucr, T. 
Obs. dans le depart, des dvils* &c ; nianicr 
dans lliospiee de Ta^giFaid, &c, Jourfvi ^ 
fibanmaeie, Pkiis^ janrier, 1785, t. Ixiii. p:\ 
De hie T caerea in reoens natis, 4 frim r: 
sypbilitiqMsdeacB&BSBonTeau-nes. Tl. 
F. Leblmmc, Maladies vtefriennes des u.\ 
ountifs. Tb^se de Paris, 15 tbermidor, . 
peut-elle se comaraniqner & I'enfant a\ ;i.. 
26 plnrioae, an xiiL JP.^. O, Mabofi. Uc. 
la natore, et la communication dv ^ 
femmes < tcin tes> dans les enfans r. 

Paris, 18<H. ^' 
ei chiruTp, 
180i. J, Cmpwm, Aphr^.i! ? 
la transmission 
r«^teU P^a&1807. BerHn, Ti^iii uM 






HEREDITARY SYPHILIS. 135 

Lancet, January 2iid, 1863. Gozlain, Influence de la syphilis sur le cours 
normal de la grossesse. Thdse de Strasbourg, 1863. F, V. Bdrensprung, 
Die bereditare Syphilis. Berlin, 1864. Henri Roger, Etude clinique sur 
la syphilis infantile. Union mSdicale, 24, 28, January 31st, and February 
4th and 7th, 1865. JBauehutf De la syphilis du nouveau-nes. Gaz. dea 
hSp^., No. 90, August, 1865. 

Hereditary syphilis, although partly recognised by some of the 
syphilographers of early times, has only been really studied since 
the end of the last century. 

Paracelsus (1529) spoke in clear terms of the hereditariness of 
syphilis, but knew little of the disorders which it produces : — " Est 
morbus foedos (morbus gallicus), se ad alios propagans, alios con- 
taminans, et magis hereditariua, quam lepra. — Quiqui luem gallicam 
partu acdpiunty ut infantes, non possunt ab hoc contagio liberari, — 
crescit morbus cum in&nte, et pro miasmitis yirtute modo dtius, 
mode tardius erumpit.'' Augier Ferrier (1653) was not more 
advanced on this point : — " Cum in utero morbus contrahitur, tan- 
quam hereditarium fit malum, et tanquam corruptum elementum una 
cum patemo vel materno semine infunditor ; aut, si mater a die 
conceptionis in morbum inciderit, communicatis foetni vitiosis in- 
fectisque humoribus, primae conformationis facultates, actiones, 
organa corrumpi necesse est.^^ Peter Haschard (1564) recognised 
a double origin of syphilis, contagion and generation, and writes, in 
reference to this latter mode of transmission : — " Per generationem 
vero, quoniam hie morbus humores vitiat et corrumpit ; unde semen 
corruptum qui sic affecti sunt, et ex hoc proles vitiata ac corrupta 
procreatur . . . ." G. Fallopius is more explicit, and says : — 
'^ Preteria videbitis puerulos nascentes ex femina infecta, ut ferant 
peccata parentum, qui videntur semicocti.^^ Although this passage 
was not intended by the author to do more than to make known the 
parts of the body which may be primarily affected, yet, as Diday 
has remarked, the epithet semicocti shows plainly enough that 
already at that time the poison exercised its influence upon the 
child during intra-uterine life. Lastly, we give an observation by 
Bonddet (1560) : — " Ego vidi,'' writes that author, '^ puerum nasci 
totum copertum pustulis morbi gallici." 

Parens opinion upon this subject is easy to interpret, for we read 
in a passage of his book (chap, xxxiii.) : — " Children are often seen 
to leave their mother's womb having this disease, and, soon after, 
having numerous pustules upon their bodies.^^ In the seventeenth 



136 HEBEDITABY STFHIUS. 

centoTY^ L. Goyon Dolois, de Bl^ny, Musitan, and Gamier 
admitted the hereditary transmissioii of syphilis^ and this fact is 
accepted by the principal syphilographers of the eighteenth centory, 
Viijue, Boerhaave^ Van Swieten^ Astmc^ Brnnner^ Banlin, &c. Bat 
in spite of the symptomatic description which Bosen gives of here- 
ditaiy syphihs^ and in spite of the therapeutic indications furnished 
on that point by Levret^ a very distinguished accoucheur, the know- 
ledge acquired was^ no doubt, thanks to the exaggerations of Sanchez^ 
on the point of falling into oblivion^ when, in 1780^ a special hos- 
piial was established at Yaugiraid for pregnant women affected with 
syphilis and for their children. From that moment dates a new 
era in the history of hereditary syphilis. That era^ with which are 
connected the names of Faguer^ Doublet, Pelletier, Leblanc, Bertin, 
Mahon, and Gullerier, has given us a knowledge of the chief external 
manifestations of this disease. For our own day was reserved the 
making known of the more deep-seated or visceral lesions. Trousseau 
and Lasegae, Depaul, Gubler^ P. Dubois, Desruelles, Nat. Guillot^ 
Diday, Putegnat^ &c., have contributed to our knowledge on this 
latter point. 

Pbmod op Appearance. 

Amongst diseases, those which may be called virulent have, more 
than others, perhaps, the privilege of appearing at the moment of 
birth or soon afterwards. 

In the cases in which it has been possible to assume the here- 
ditariness of variola, that disease generally developed itself during 
intrauterine life. In like manner, syphilis most frequently gives 
rise to manifestations connected with the moment of conception or 
of birth. A certain number of children succumb in their mother's 
womb, solely because they are already affected with the disease. 
Deville and Barensprung relate cases of this kind; it has also 
happened to me to see some. 

At other times, the children come into the world with lesions un- 
mistakably syphilitic. Bondelet, Doublet, and Gilbert give such 
cases; Gu^rard, Landmann, A. Cooper, Huguier, CuUerier, and 
many other observers, have seen children leave the womb with a 
syphilitic eruption. 

In the great majority of cases, however, the child who inherits 
syphilis has at first the appearance of health, and some wedcs after- 
wards presents signs which betray the evil transmitted to it from its 



HEREDITARY SYPHILIS. 137 

parents. Usually, as has been shown by Dr. H. Roger, it is from 
the first to the third month of extrauterine life that syphilis mani- 
fests itself in the new-bom child. In fact, as Diday has pointed 
out, the evidence of authorities and that of facts are agreed upon 
this point. 

Nisbett, Doublet, MaMi, Babington, Gilbert, Trousseau and 
Lasegue, Huguier, Bouchut, Bardinet, and Desmarres * assert that 
syphilitic symptoms most commonly supervene, under these circum- 
stances, in from a few days to two or three months ; the last limit, 
but one altogether exceptional, is seven months according to 
Trousseau and Lasagne, and a year according to Cullerier. 

Facts speak no less distinctly. Adding, says Dr. Roger,t to my 
own fourteen observations, in which the date of the first symptoms 
was noted, 158 cases by Diday, twenty-eight by de M^ric in which 
that date was also given, and forty-nine by Mayr, in which the 
period of the outbreak was indicated, I obtained a total of 249 
cases. Amongst these, syphilis showed itself 118 times in the first 
month, 317 times before the end of the third month, and this limit 
of the third month was only exceeded in thirty-two patients ; that is 
to say, that. in almost half the cases, the syphilitic aflFection trans- 
mitted by the parents had appeared before the expiration of the first 
month, and in seven-eighths of the cases, before the end of the third 
month; while in only one-eighth of the cases did it appear after the 
first three months ; whence the inference that, if the physician has 
no information of the source from which thp syphilis was derived, or 
if he doubts the authenticity of his information, he will be able, by 
having recourse to a calculation of probabilities, to decide whether 
infantile syphilis is hereditary or acquired, according as it shall have 
manifested itself before or after the third month of life. 

Such is the general rule ; but it would, no doubt, be an error to 
suppose that hereditaty syphilis never appears after that space of 
time. 

Side by side with the cases of which we have just been speaking, 
there is a certain number of others in which hereditary syphilis, after 
having remained latent for a certain number of years, has ended by 
showing itself, like the constitutional diseases the hereditary mani- 
festations of which are most frequently tardy. As regards the 



* Traits des maladies des yeux, t. i. p. 626. 
t Uni(m mid,, Jan. 31st, 1865, p. 203. 



138 HEREDITABT STPHIUS. 

changes which acquired syphilis undergoes in the course of its evo- 
lution^ it might be asked whether individuals^ the subjects of tardy 
hereditary syphilis^ are not descendants of parents long infected and 
already arrived at the tertiary period at the moment of conception. 
The factsj hitherto incomplete^ do not^ unfortunately^ enable us to 
judge how much of truth there may l9in such a hypothesis ; but 
since the local determinations generally differ accordingly as the 
hereditary syphilis manifests itself in the earlier periods of pregnancy 
or later on, it follows that we must study in two separate chapters 
the precocious and the tardy manifestations. 



PBECOCIOUS OB CONGENITAL. 139 



CHAPTEE I. 

PEECOOIOUS OB CONGENITAL HEEEDITARY SYPHILTS. 

Under this denomination we place the syphilitic symptoms which 
develop themselves in the foetus and those which appear soon after 
hirth. These symptoms^ like those of acquired syphilis, require to 
be studied in each organic apparatus. 



§ 1. Lesions of the external tegument. 

The cutaneous lesions of hereditary syphilis do not differ strik- 
ingly, as regards their form at least, from those which belong to 
acquired syphilis. Erythema, papules, pustules, vesicles, such are 
the elementary anatomical modifications observed. Tubercles are 
rare, but, on the other hand, bullsB are frequent. The eruption pro- 
duced by this latter lesion is known under the name of Pemphigus. 

Roseola is a symptom which has been met with in a few cases 
only. Bassereau* saw break out, on the third day after birth, a 
papular syphilitic erythema which soon became complicated with 
coryza. Spread over almost the whole body, the eruption had com- 
menced on the forehead and cheeks, by patches of a dull red colour, 
which afterwards assumed the coppery tint and became slightly pro- 
minent. In a new-bom child under his care, Cullerier also observed 
the existence of roseola. Gu^rard, quoted by B. Vidal, Landmann,t 
and A. Cooper, J have published the histories of children who pre- 
sented at the moment of birth an eruption of yellow or copper- 
coloured spots. H. Boger relates several cases of the same affection, 
easily recognisable, according to his account, by their characteristic, 
coppery tint. This eruption, as described by Diday, consists of 



* Traits des^affec. de lapeau sympt. de la syphilis, 1852, p. 541. 
t Ann. mid, de la Flandre occidentale, p. 410, March, 1852. 
: The Lancet^ t. iv., 1825. 



140 HEREDITABT STPHIUS. 

patches of a bright red colonr, irr^;ii]arlj rounded^ of variable size 
(most fireqiientljthat of the iiafl). These patches hare their &Toiirite 
seat on the abdomen, the lower part of the chest, the neck, and the 
inner surface of the limbs ; thejr are rarely isolated and are most 
fceqaently accompanied by nlcers of the month and anns. 

Papular , veneular, and supejficial jmstuiar sypAilidef are, like 
roseola, symptoms comparatively little freqnent in the course of the 
syphilis we are now studying; there are as yet, so far as we know, 
few cases to establish, in a very exact manner, the characters of these 
lesions in hereditary syphilis. A distinguished observer. Dr. Boger, 
has given the case of a child three months old, suffering from papu- 
lar syphilis, roseola, and ecthyma ; but there was not in this child 
any other manifestation, and the state of health of the parents was 
not mentioned. I have myself seen a case of papular syphilide in a 
new-bom child. Nevertheless, one circumstance which should be 
remarked here is the rarity of exanthematic eruptions, with the ex- 
ception of mucous patches. 

Mucoui patches are, of all the cutaneous symptoms, that most 
frequently observed in the new-bom child. The reason of this fact 
appears to be in the stracture of the skin at that period of life ; but 
to this anatomical peculiarity may perhaps be added the want of a 
proper attention to cleanliness observed iu the case of so many chil- 
dren. However the case may be, mucous patches usually show them- 
selves in the very first days after birth, but more rarely during intra- 
uterine life ; their favourite seat is the skin in the vicinity of the 
natural openings, and especially about the lips or mouth, the nostrils, 
the external angle of the palpebral commissures, the circumference 
of the arms, and the genital organs in both sexes. They appear 
sometimes and most frequently in the form of small, granular, red 
points, which soon become converted into moist, prominent, whitish, 
foetid patches, surrounded by a mottled areola, sometimes in the 
form of cracks or fissures of greater or less depth and moist, the 
floor of which soon assumes a whitish tint. But whichever of these 
two modes predominates, mucous patches take on, especially around 
the natural orifices, a peculiar arrangement which has caused the 
circumference of the anus to be compared to a kind of serrated 
crown (Trousseau), and which, when fissures of the lips predominate, 
gives to the buccal orifice the appearance of a purse drawn together 
by its string. As in the adult, they consist of the papillae tumefied^ 
injected^ and infiltrated with serum, nuclei, and cells of new forma- 



PKECOCIOUS OR CONGENITAL. 141 

tioD^ and of the sebaceous glands, the activity of whose secretion is 
increased. 

It is evidently unnecessary to return here to the diagnosis of 
mucous patches. The intertrigo and impetigo of young children 
are almost the only affections capable of simulating them. It suffices 
to know that attention to cleanliness and a few emollient poultices 
rapidly remove intertrigo. As regards the yellow, thickened, con- 
fluent, ill-circumscribed crusts of common impetigo, besides differing 
from the whitish and moist surface of mucous patches, they leave 
behind them the dermis simply inflamed and not ulcerated. With 
mucous patches coexist, moreover, patches of a deep red colour which 
may also aid in the diagnosis. 

The deep-seated pustular affections are impetigo and ecthyma. 
These manifestations belong, the latter especially, to a more advanced 
period of the disease than that of the symptoms of which we have 
just been speaking. 

Syphilitic impetigo is generally situated on the face ; but the chest, 
the neck, the ears, and the groins, are parts which do not always 
escape this manifestation. This lesion is characterised by the 
appearance of numerous confluent pustules, which soon burst and 
form, by the rapid evaporation of the liquid portion of the pus, 
thick, yellow, prominent crusts. The skin covered by these crusts, 
which are generally surrounded by a copper-coloured areola, is most 
frequently studded by greyish ulcers of little depth. These ulcers, 
and the copper-coloured areola just mentioned, are signs by the aid 
of which it is possible to distinguish the eruption in question from 
simple impetigo, which, moreover, generally occupies the hairy scalp. 

Syphilitic ecthyma is, in the new-born child as in the adult, a 
serious and troublesome symptom. It shows itself upon the limbs, 
and chiefly upon the legs and buttocks, in the form of mottled 
patches which afterwards become converted into bleeding pustules ; 
these pustules soon become covered with a thick, blackish crust, 
surrounded by a mottled areola, and concealing a deep ulcer with 
perpendicular edges, capable of committing, in a few days, consider- 
able ravages. Although it may sometimes supervene simply as a 
consequence of privations, this affection, nevertheless, almost always 
acknowledges a syphilitic origin. The diagnosis of it is difficult, 
according to Professor Eoger, and it is only by the concomitant 
specific symptoms that it is possible to judge of the true nature of 
this eruption. 



142 HEREDITABY STPHILIS. 

Pemphigus. — The word pempbigas serves to characteiise a cnta- 
neoos lesion consisting of bnOae of a size varying &om that of a pea 
to that of a nat or a walnut. 

This lesion^ which is veiy analogous to that produced upon the 
surface of the skin by the application of cantharides^ is sometimes 
met with in the adult; but it is also observed frequently in children^ 
either at the moment of birth or some days after. While^ in the 
adult^ it is almost always independent of syphilis^ in the child^ on 
the contrary, it most frequently coexists with changes the syphilitic 
origin of which is indisputable^ and on that account it has long 
been believed that a causal relation existed between the pemphigus 
of new-bom children and the venereal disease. 

There is not in the works of the older syphilographers any passage 
which appears to refer directly to pemphigus, unless it be, perhaps^ 
the passage already quoted &om Eondelet. Doublet makes mention 
of isolated, large, prominent pustules, appearing upon the hands and 
feet, and especially upon the fingers of children bom of syphiKtic 
parents. In 1791, Wichmann* not only described this affection 
with precision, but was one of the first to attribute it to syphilitic 
contamination. Shortly afterwards, in 1794, Osiander^t in a special 
treatise, refused to admit this cause. Bertin scarcely mentions pem- 
phigus, and the description given of it by Stan. GHlibert % appears 
to refer, in general, to the simple'form of the affection. Dug^s § 
insists upon the syphilitic origin of pemphigus, but without bring- 
ing forward any conclusive facts in support of his opinion. Lob- 
stein, || Jorg,^ and Krauss,** relate several cases of pemphigus, but 
reject the syphilitic origin of that affection. But, in 1837, Depaul ft 
introduced into a new phase the question at issue, by the connection 
which he established between the pemphigus of new-bom children 
and certain coexisting pulmonary lesions. Valleix J J also studied the 

♦ Beitrdge zur Kenntnks des Pemphigus. £rfart, 1791. 

t Denkwurdigkeiten fur'die Heilkunde und fur die Oeburtshtilfe, 1794, 
t. i. p. 383. 

X Monographic du pemphigus, PariSi 1713, 

§ Recherches sur les maladies les plus importantes et les mttins communes 
des enfans nouveau-nSs. Th^se de Paris, 1821. 

II Journal compliment, des sciences mSd., t. vi. p» 3, 1820* 

IT Handhuch der Kinderkrankheiten, 1826. 

** De pemphigo neo-natorum, Bonn, 1834. 

+f Bulletins de la SociStS anat.^ 1837. 

tt Clinique des fnaladies deS enfans nomeau-hiB* tarisj l838i 



PBECOCIOUS OR CONGENITAL. 143 

pemphigus of new-bom children, but does not appear to have 
observed the form of which we are speaking. Cruveilhier ^ observed 
several cases in which there was at the same time pemphigus and 
lobular pneumonia. In 1847, Stolz, of Strasbourg, asserted that 
the pemphigus of new-bom children is most frequently syphilitic, 
and based his opinion on twenty cases observed by him, and in which 
he succeeded in finding venereal symptoms in the parents. Hertle 
defends this view in his inaugural thesis. 

In 1851, there arose on this subject, at the Academy of Medicine, 
a discussion which remained celebrated. Cazeaux maintained, against 
Paul Dubois, that the plantar and palmar syphilis of new-bora chil- 
dren is not syphilitic ; but the arguments which he made use of in 
denying all causal connection between pemphigus and syphilis could 
not stand against those employed by Professor Dubois, viz., the 
usual existence of syphilis in the parents of children suffering from 
pemphigus, the frequent coexistence of that affection with the lesions 
characteristic of syphilis, and lastly, the possibility of a cure by a 
mercurial treatment. 

Since that time, Desruelles,t revre,J Bamberger, § Olivier and 
Eanvier,|| and H. Boger^ have brought fresh cases in support of the 
doctrine that pemphigus of the extremities is a manifestation of here- 
ditary syphilis. Accepted by Cazenave, Danyau, de Devergie, and 
Huguier, this doctrine, which is advocated by Lebert, Bouchut, 
Maisonneuve and Montanier, and E. Vidal, is that which we our- 
selves have adopted. Men of great merit, however, still hesitate to 
pronounce themselves on this point, or do not partake of the view 



* Anatom, patholog. du corps humain^ 15e livraison* 

t Th^sede Paris, 1852. 

X Du pemphigus des nouveau-nSs, ThSse de Paris, 1855. 

§ Beitrage zur Lehre vom Pemphigus (Wurxhurg, rtiedicin, Zeitschr,, 
torn. i. part 1, 1860). 

II Du pemphigus des nouteau^nes^ dans Mimoire de VAcadimie de 
Midecine, 1863-4, t. xxvi. pp. 554-607. 

^ Union mid,, 1865. Compare : Bulletins de la SociStS anatomiquey 1837, 
1841, 1842, 1851, 1852, 1853, 1854. P. Dubois, Gaz. mSdicale, 1850. 
Cazenave, Diet in 30 vols. Hervieux, Union midicale, 1852. Charrier, 
Oaz, des hSpitaux, 1854. Vauverts, dem. ^dit., ibid., 1861. Bouchat, 
Traits des maladies des enfans nouveau-nes. Paris, dem. §dit., 1862. 
Putegnaty loc. dU Paris, 1864. See also, for further bibliographical 
deiailsi the report of Messrs. Olivier and RanVieri 



144 HEREDITARY SYPHILIS. 

which appears to us to be the most correct one ; some, like Eicord 
and Gubler, regarding the pemphigus of new-bom children as a 
sign, sometimes of hereditary syphilis, sometimes of cachexia ; 
others, with Trousseau and Lasegue, Gibert, Diday, and Bazin, 
recognising in this lesion only the symptomatic expression of 
cachexia in general. 

Active congestion producing a dark red circle, and sometimes a 
genuine papular protuberance, such is the initial modification of that 
portion of the dermis which is about to become the seat of the erup- 
tion in question. The buUse soon appear and are confluent rather 
than discrete, and the skin upon which they rest presents a bluish 
or violet tint which contrasts with tlie pink colour of the other parts. 
Opaline, whitish, or yellowish, according to the quality of the pro- 
duct of secretion, they vary in size and may be one centimeter or 
more in diameter. They contain an albumino-fibrous fluid, in which 
float globules of pus and epidermic cells. The dermis in their 
vicinity is more or less seriously diseased ; sometimes its most super- 
ficial parts alone are affected. 

After a short interval of time, the epidermic pellicle which sur- 
rounds the bulla breaks and the contents escape ; there then remains 
a slight ulceration, followed by a cicatrix, or the contents dry up 
and form yellowish or blackish crusts, which persist for a longer or 
shorter time. It is under such circumstances that the edges of the 
wound, sometimes raised and rounded, give to pemphigus some of 
the appearances of ecthyma. 

Pemphigus may precede birth for a length of time suflBcient, in 
some cases, to enable us to see at once that the child was bom with 
vesicles already burst and empty, side by side with others which are 
beginning to appear and with others which have reached the full 
term of their evolution. But at other times this eruption does not 
develop itself until a certain number of days (eight to fifteen in 
general) after birth, and is observed in children who, until then, had 
appeared to enjoy perfect health; 

The seat of these lesions deserves to be described exactly. The 
soles of the feet and the palms of the hands are favourite seats of 
pemphigus; it rarely spreads to the dorsal surface of these same parts, 
and still more rarely invades other parts of the body. At all events, 
the plantar and palmar regions are the parts first affected, and this 
seat forms, to a certain extent, the characteristic sign of the disease. 
Pemphigus, like most of the syphilitic eruptions, proceeds by sue- 



PBECOCIOUS OR CONGENITAL. 145 

cessive bursts, wliich tends to increase its duration ; but each bulla 
requires a few days only, at most, to complete its evolution. 

Death, the habitual termination of this kind of pemphigus, 
generally results from visceral lesions and from the extreme cachexia 
of which they are the cause. Profuse diarrhoea, vomiting, the 
thrush, and a state of progressive debility, are the precursory sym- 
ptoms of this mode of termination. 

The diagnosis of pemphigus, as an elementary lesion, is generally 
easy. The difiBculty is, to know how to ascertain the origin of this 
manifestation and to discover the link which may connect it with a 
given diathetic condition. Por this purpose, it is important to take 
into account the seat of the aflFection and the epoch of its appearance. 
Thus, the pemphigus which develops itself at the time of birth, or 
some days after, and which is limited to the palms of the hands or 
soles of the feet, is almost certainly syphilitic ; the other varieties of 
pemphigus in new-bom children occupy indiscriminately the various 
parts of the body, and some of them have occasionally appeared to 
assume an epidemic character. A knowledge of the paternal and 
maternal antecedents may also facilitate the diagnosis. Ecthyma, 
which it is sometimes possible to confound with pemphigus, com- 
mences by small indurated papules which suppurate and produce 
deep or even phagedsenic ulcers. 

The prognosis, which is always unfavourable, is the more so in 
proportion as the cachexia is more marked. 

Such is the pemphigus of new-bom children. As regards the 
pemphigus of adults, most authors refuse it a specific origin, and in 
fact this eruption is extremely rare in the course of the evolution of 
syphilis. Bassereau, however, has seen two cases of it under these 
circumstances, and has been led to put it down as a symptom of 
acquired syphilis. In one of the two cases related by that excellent 
observer, the pemphigus, which supervened ten months after the 
appearance of the chancre, coexisted with mucous patches. It ap- 
peared in the palms of the hands and ceased without leaving any 
traces behind it. 

Syphilitic tubercle is another manifestation of hereditary syphilis, 
but comparatively little common. Bertin gives a very vague descrip- 
tion of this lesion. Bassereau relates that three children born of 
syphilitic parents were attacked, only a few days after birth, by large 
sub-cutaneous tubercles or tumours, which soon became softened and 
ulcerated. 

I 



146 HEBEDITABT STPHILIS. 

Pni^nat asserts that new-born cbildieii who inherit syphiEs some- 
times present a cataneons affection characterised by roundedj mam- 
millated tubercles^ which after a certain time soften and ulcerate. 
The ulcers gain in extent and depth, destroying the skin and sub- 
jacent tissue; they become covered with a thick, bhickish, and 
adherent crust, which, every time it falls off, discovers a loss of sub- 
stance more and more extensive and deep. On that account, the 
author gave to this affection the name of syphilitic lupus of new-bom 
children. On the body of a child just bom, Yirchow * saw dissemi- 
nated tubercles from each of which proceeded a lymphatic cord of 
comparatively large size, and on the left arm all these cords ended in 
a gland. Bineckerf has made tubercles of the skin and sub- 
cutaneous cellular tissue in young children the subject of a minute 
description. Those of the sub-cataneous cellular tissue do not 
appear to have escaped the attention of Doublet and Mahon; there 
is, in fact, reason to assume the existence of these tubercles in the 
cases of suppurating tumours mentioned by those observers. 

OnyxU, of which we have already spoken in connection with 
acquired syphilis, sometimes belongs also to hereditary syphilis. 
Doublet, speaking of the isolated pustules on the fingers, adds : — 
'^ Sometimes they are placed in such a manner as to cause the nails 
to fall off. One child lost the nails of one hand and three of one 
foot.'' Albers saw a child which presented, soon after birth, a small 
pustule near the nail of the left thumb. Bertin twice saw the nails 
of the, feet and hands fall off several times, in consequence of sup- 
puration of the matrix of the nail. Gerhardt % gives a very analogous 
instance : in a syphilitic new-bom child, the nails of the feet and 
hands, gradually becoming atrophied, and longer and narrower than 
natural, fell off to make place for sound nails, which soon under- 
went the same change, and this happened three times in succession. 

Bouchut saw a little patient the nails of whose hands and feet 
were attacked by this affection. Here, as in acquired syphilis, the 
falling off of the nail is a phenomenon purely secondary, and always 
subordinate to the condition of the matrix of the nail modified by the 
eraptive affection. 

* OesammeUe Ahhandl.f p. 295. 

f Wurzburff, FerhandL, vol. iii. p. 375. 

XjJ^oumal de Siebold, t. x» § 653. 



PBBCOCIOUS OB CONaENITAL. 147 

§ 2. Lesions of the internal tegumenU 

The most frequent effect of syphilis upon this tegument is the 
mucous patch ; then come erythema and ulcers of greater or less 
depth. Bare upon the tongue and inner surface of the cheeks, 
mucous patches are more common about the isthmus of the throat, 
and upon the velum palati and tonsils^ At these various points, 
where they do not present any notable difference, they are found 
with characters similar, so to speak, to those observed in the adult ; 
the same opaline tint, the same mottled or reddish peripheric circle ; 
they are equally susceptible of ulcerating and of leaving behind them 
slight cicatrices. 

The erythema and the ulcerations do not differ much, as regards 
their anatomical characters, from the same affections observed in the 
adult. The Schneiderian membrane is the most special seat of these 
various lesions, from which the mucous membrane of the larynx and 
pharynx are not, however, always exempt. 

Syphilitic coryza. — It is not always easy to recognise the ele- 
mentary lesion which constitutes this affection ; but there is reason 
to believe, on account of its frequent coincidence with the first mani- 
festations of hereditary syphiUs, that it is caused, either by a simple 
erythema, or by the presence of mucous patches. At all events, the 
orifice of the nose is generally cracked and radiated by fissures or 
small ulcerations which show themselves especially at the angles of 
the alsB nasi, and in a great measure obstructed by crusts through 
which oozes a more or less sanious liquid. The mucous membrane 
is red or whitish, and turgid ; later on, it is sometimes ulcerated, and 
the cartilages may even be eroded. The bones lose their support and 
the nose becomes flattened ; the upper part, already little prominent 
in young children, spreads out still more, which gives a strange 
appearance to the face.* These latter phenomena are, however, 
comparatively rare in congenital syphilis. 

Pharyngitis and laryngitis, manifestations much more rare, have 
scarcely been observed. Laryngitis is doubtless the cause of that 
hoarseness of the cry and of the cough sometimes observed in new- 
bom children. Mayrf has found redness of the mucous membrane 
of the larynx in the post-mortem examinations he has had the oppor- 

* See Trousseau, Clinigue fnid» de tH6teUDieUi t. ii. 
t Ann* dee malad, de lapeau et de la syjtk,, t< iv* p. 288^ 



148 HEREDITAEY SYPHILIS. 

tunity of making. Dr. H. Boger regards as doubtful the case of a 
child whose laiynx presented after death ulceration of the mucous 
membrane with caries of one of the cartilages.^ 

§ 3. Apparatus of locomotion. 

If we look to cases only, we are obliged to confess that lesions 
of the muscles are wanting in hereditary syphilis, as there is not, so 
far as we know at leasts any observation which mentions them ; but 
as little attention is paid generally^ in post-mortem examinations^ to 
the state of the muscular system^ it is at least possible to admits 
by analogy^ that that system is not always exempt from change. 

Although rare^ lesions of the periosteum and the bones have 
several times been observed. Diday has succeeded in collecting six 
cases^ which he found in special authors. But^ in five of these cases^ 
one by Doublet, another by Mahon, a third by Eosen, a fourth by 
Laborie,t and the other by Cruveilhier,J there is question of 
osseous lesions following after suppurating gummy tumours or 
ulcerations of the nasal fossae or of the palatine arch. The change 
in the bone is direct, however, in a case of periostosis furnished by 
Bertin, and in another by Underwood, § in which there is question of 
an exostosis of the cranium developed in a young child. Gullerier|| 
saw, in one case, congenital syphilis attack primarily the bones and 
the cellular tissue. Desmarres^ mentions a child affected with a 
papular syphilide and a mucous discharge, in which two abscesses 
developed on the surface of the cranium did not heal until after the 
elimination of pretty large pieces of bone. Baerensprung** has 
given an illustration of a vast necrosis of the bones of the cranium ; 
and very recently, A. Foumier communicated to the Medical Society 
of the Hospitalsft two cases of tumours, probably hyperostoses, 
developed upon the bones of the fore-arm. Bouchut mentions 
having seen not unfrequently a lesion which consisted in a premature 



* Union mid,, p. 233. 

t Bullet de VAcademie de mSd., July Ist, 1851. 

X Treatise upon the diseases of children, 

f Anatom. patholog., 15 livraison. 

II Bullet, de la Societe de chirurgie. 

If Traits pratique des maladies des f/ettx, 2^ €dit., t. i, p. 626. 

** Die hereditdre Syphilis. Berlin, 1864. 

tt See Union Midicale, No. 84, p. 540, March, 1865. 



PEECOCIOUS OB CONGENITAL. 149 

hardening of the long bones. The tissue of the middle portion of 
those bones was solid^ compact^ and impossible to break or to divide 
with a catting instrument. A lesion somewhat different^ and to 
which may be given the name of separation of the epiphyses^ also 
appears to belong to the domain of hereditary syphilis^ on account of 
its usual coexistence with other syphilitic manifestations. It has for 
its special seat the epiphyseal cartilages. Valleix * was one of the 
first to notice its existence, without suspecting that it might have a 
syphilitic origin. More recently, Bargionif and Eanvier$ have each 
of them published a case of hereditary syphilis with a change in most 
of the epiphyseal cartilages. In Eanvier's case there was a conse- 
quent separation of the epiphyses. Baglioni further points out the 
existence, in the vicinity of the epiphyses, of gummy products which 
are met with again at other points of the osseous system. These 
same lesions have been observed by me in a young child which died 
in the H6tel-Dieu. 



§ 4. GenitO'Urinary apparattis. • 

The lesions of the external genitals not differing from the erup- 
tions described above, there is nothing further to be said about them 
here. The more deep-seated organs are very rarely affected. A 
case of hereditary syphilis with swelling of the testicle has been 
related by North; the same affection was seen by Bryant§ in a child 
six months old. 

Lesions of the kidneys have not, so far as I am aware, been 
pointed out. My esteemed colleague, Dr. Tamier, having had the 
kindness to give me for examination the viscera of a child bom of 
syphilitic parents, I discovered, together with the change in the liver 
so well described by G abler, the existence of a renal lesion charac- 
terised by a thickening of the web of the conjunctive substance, and 
a granulo-fatty change in the epithelial cells of the tubules. The 
kidneys, which were pretty firm, were remarkable for a yellowish tint 



* Separation of several of the epiphyses of the long bones, with ab- 
scesses beneath the periosteum and remarkable long products in a new- 
bom child. Bull, de la Soc» anat, t. ix. p. 169. 

t La Sperimentale, July, 1864. 

X Bull, de la Soc, de Uologie ; and Gaz, mid, de Paris, p. 596, 1864. 

§ Medical Times and Gatette, December, 1863, p. 614. 



150 HEBEDITAET SYPHILIS. 

very similar to the spots which often^ under the same circumstances, 
appear on the surface of the liver. 

§ 6. Ajfparatus of digestion. 

Alimentary canal. — Hereditary syphilis, like acquired syphilis, 
rarely affects the coats of the alimentary canal. Mucous patches or 
erythema of the bucco-pharyngeal tegumentary membrane are the 
chief lesions met with in this apparatus. 

Forster* recently met with fibroid degeneration of Peyer^s glands 
in a syphilitic child which died on the sixth day after birth and 
which, amoDgst other affections, had lobular pneumonia and puru- 
lent bronchitis. In the neighbourhood of Peyer's glands existed 
prominent masses, with a smooth surface, of a greyish pink colour^ 
yellowish at the centre, and consisting chiefly of nuclei, cells, and 
fibres of conjunctive tissue, in place of the glandular elements. A 
case of intestinal syphiUs very analogous to that of Porster has been 
published recently by Professor Eberth, of Zurich {Arciiv fur 
l^atholog. Anat. und Phymlog,, t. 40, p. 826). The case was that 
of a new-born child which presented, at one and the same time, 
gummy nodosities in the thymus, lungs, and intestines. 
. Peritoneum, — A celebrated Edinburgh accoucheur, Simpson,t 
admits without hesitation the existence of hereditary syphilitic peri- 
tonitis. His experience is based upon thirty-one personal observa- 
tions ; but it must be acknowledged that these observations are far 
from being all perfectly conclusive. Some leave in doubt the 
question of hereditariness, others scarcely mention the condition of 
the organs in the abdomen and especially of the liver. Never- 
theless,, the fact pointed out by Simpson appears to be exact. In 
three cases of hereditary syphilis, Wilks found adhesions between 
the Uver and the diaphragm, and in two, general peritonitis. Peri- 
tonitis is also met with, as we already know, in acquired syphilis, 
sometimes localised on the surface of an organ such as the liver, 
sometimes more extensive and general. Gubler has also seen in 
several cases of hepatic syphilis, traces of perihepatitis. Baeren- 
sprungit^ has seen under many circumstances, on the surface of the 

— — ■ — ■ — ■ — — —-^ — ■ 

• Wurzhurg* medicinische Zettschr,, 1863, t. iv. Part I. 
t Edinburgh Med, and Surg, Journal, No. 37 ; and Obstetric Works, 
Obs. v., VI., and VII., t. ii. p. 173. 
I Die Sereditdre SyphiUs, Berlin, 1864. 



PRECOCIOUS OB CONGENITAL. 151 

liver^ the spleen^ or even the intestines^ soft and little consistent^ or 
firm and resistent, as it were ligamentous, pseudo-membranous 
deposits. The characters of this affection are those of adhesive, 
chronic peritonitis, that is to say, of a lesion which does not mani- 
fest itself either by suppuration, by a rapid course, or by acute 
symptoms. 

The pancreas is rarely diseased in the foetus or in the new-bom 
child aflfected with hereditary syphilis. Virchow* observed in one 
case fatty degeneration of that gland, and other authors have some- 
times met with induration of the same organ. As regards the 
salivary glands, we possess no case showing a change in them. 

§ 6. Avparattn of hamopoiesia. 

Liver. — ^The liver is one of the organs which most frequently 
undergo the attacks of hereditary syphilis, and this fact is not sur- 
prising, when we consider the important fanctions of this gland in 
the foetus, and the facility with which it is susceptible of becoming 
changed in the syphilis of adults. Little or not at all known to 
ancient authors, the hepatic lesions connected with hereditary syphilis 
are of two orders, some difiPused, the others circumscribed and very 
analogous to gummy lesions. 

Gubler has the merit of having, for the first time, well described 
the diffused lesions, which are, in reality, the most frequent. 

"The liver, more voluminous than in the normal state, is turgid, 
globular, elastic, hard, and difficult to make an impression upon with 
the finger, which ends by breaking it without leaving any impression 
upon its surface. Changed in its whole extent, or only at certain 
points, it presents a peculiar yellow colour, comparable to certain 
pieces of gun-flint, and in some cases it is studded with small opaque 
white grains having the appearance of grains of semola : oh section, 
its homogeneous tissue shows vascular striae and opaque grains 
irregularly^disseminated, and yellowish patches more or less large and 
extensive. 

" Injection shows tbat the vascular network is almost impermeable. 
On microscopical examination, there are seen in the substance of the 
gland a quantity often considerable, sometimes enormous, of fibro- 
plastic elements, in every degree of evolution, and in the midst of 

* SyphUia conatihUioneUe, trad. fran9. de Picard. Paris, 1B59. 



152 HEREDITABY SYPHILIS. 

which the cells of the enchyma are dispersed and^ as it were^ 
drowned.* This change may occupy only circnmscrlbed parts, be 
limited to one of the lobes, or invade the whole extent of the organ. 
The bile is of a pale yellow colour and very thin; the blood, 
which is ahnost always changed, presents the consistence of currant- 

jelly." 

Most frequently, symptoms the syphilitic origin of which is indis- 
putable coexist with these lesions, which* have been observed by 
Trousseau, Horteloup, Cullerier, Depaul, Lenoir, Lebert, Desruelles, 
Cazenave, and most of the physicians of France and other countries ;t 
so that doubt can no longer be entertained of their connection with 
syphilis. The small whitish grains or nodules disseminated through 
the liver, to which Gubler has given the name of miliary syphiloma, 
differ from gummy tumours properly so called, by the single circum- 
stance that they do not, like the latter, leave appreciable cicatrices 
behind them. It appears allowable to suppose that this difference 
is probably nothing else than the effect of a greater acuteness in the 
course of the disease, the termination of which is almost necessarily 
fatal. CuUerierJ found in a child cured by protoiodide of mercury, 
the surface of the liver covered with a fibrous patch, a kind of 
cicatrix which appeared to him to have followed plastic infiltration. 

Such is the first form of syphilitic change in the liver peculiar to 
the foetus and new-bom child; let us see in what consists the 
second form, which is much more rare than the preceding, and of 
which Testelin,§ Thiry,|| Wedl,ir Zeissl,** and Schott,tt have seen 
examples. 

In cases furnished by Testelin, the liver of a child seven months 
old, which was elastic, brownish-yellow, heavy and voluminous, con- 

* Memoife 8ur une nouvelle affection dufoief&c, Soc, de hiohg,, p. 25, 
t. iv. 1852. 

t Compare : Hecker, Verhandl, der Gesellschaft fur Gehurtsh, Berlin, 
1857, viii. p. 131. Bamberger, Virchow^a Handb, der Path,, t. ii. p. 561. 
Thiry, Gaz. hebdomad,, p. 141, 1859. Howitz, Hospit, Tidende, 1862, 
Nos. 32-35; and Zeitscbr. fiir Kinderkrankb., 1863, p. 365. Testelin, 
Forster, E. Wagner, he. cit. 

X Quoted by Diday, p. 154. 

§ Journ, mSd. de Bruxelles, October, 1858. 

II Presse mid, beige, 1858, No. 22. 

II Grundziige derpatholog, HiBtologie, p. 299. Wien, 1853. 

**'^Lehrbicch der constit. Syphilis, Erlangen, 1864. 

ft Jahrbuch der Kinderheilkunde^ 1861, iv. 



PRECOCIOUS OB CONGENITAL. 153 

tained tumours varying in size from that of a nut to that of a wal- 
nut. The new-born child seen by Wedl was affected with pem- 
phigus, and presented on the convex surface of the liver an oval 
tumour, the size of a bean, of a bright yellow colour at its centre, 
and more resistent than the surrounding hepatic tissue : the mother 
of this child was affected with secondary sypliilis. In a child born 
under similar circumstances, and which succumbed a few days after 
birth, I found a firm, elastic, resistent tumour, of a whitish colour 
on section, situated about the middle of the liver. 

The various lesions in question do not reveal themselves, usually, 
until late, i.e., until they have arrived at an advanced period of their 
evolution. As has been observed by Portal, the children moan, and 
move their legs incessantly in sign of suffering ; they are seized with 
vomiting and, when not constipated, have diarrhoea. The abdomen, 
which is tympanitic, is painful to the touch. The pulse, which is 
accelerated, gradually becomes weaker, the expression of the face 
changes more and more, the skin assumes a yellowish or earthy tint, 
and the emaciation is rapid and progressive : there is a general dete- 
rioration, a true marasmus. Palpation and percussion then reveal a 
more considerable enlargement and even hardness of the liver. 

Icterus is sufficiently rare for Gubler not to have observed it in 
any case ; ascites and oedema of the lower extremities have been 
observed in some cases only, so that it is rather in the general than 
in the local condition that we must here look for symptoms. The 
course of these lesions is slow and chronic ; if cachexia supervene, 
death soon follows. 

The diagnosis rests upon the observation of the above symptoms 
and upon a knowledge of the morbid antecedents of the parents of 
the little patient. The prognosis is the more unfavourable in pro- 
portion as the hepatic lesion is more extensive. 

The spleen, which is frequently affected in the syphilitic new-bom 
child, seldom presents the diffused or circumscribed deposits observed 
in the liver. Pew authors speak of plastic infiltration of this organ; 
but, on the other hand, a greater number agree in admitting, like 
ourselves, that it is often more firm and voluminous (hypertrophy) 
than in the normal condition. 

This hypertrophy of the spleen, of which we here point out the 
frequency, was, in 1867, the subject of an interesting communica- 
tion by Dr. Samuel Gee to the Medico-Chirurgical Society of Lon- 
don. According to that observer, the spleen is augmented in size 



154 HEBEDITAEY SYPHILIS. 

in about one-fonrtli of the cases of hereditary syphilis^ and some- 
times it is accompanied by an analogous enlargement of the liver 
and of the lymphatic glands. If the child do not die^ its spleen 
diminishes in size in proportion to the progress of the recovery. 
Thus the size of this organ may furnish an element of the prognosis 
of infantile syphilis. 

The lymphatic glands^ so frequently diseased in acquired syphilis^ 
are not less liable to the attacks of hereditary syphilis. Hutchin- 
son * saw in a child five months old, most of the bronchial glands 
infiltrated with that form of fibrinous deposits so often met with in 
connection with acquired syphilis. This child, bom of syphilitic 
parents, was the subject of a cutaneous eruption ; it had enjoyed 
good health during the first two months of its ejdstence. The 
enlargement of size and modification of these same glands are 
mentioned in several of the numerous cases given by Baerensprung. 
This modification does not differ here from that observed in the other 
organs, and consists sometimes in a diffused infiltration of new 
elements, sometimes in small circumscribed tumours. The glands 
of the gastro-hepatic epiploon and of the mesentery are its most 
usual seat. 

The supra-renal capsules are remarkable, in a great number of 
the cases of hereditary syphilis, for a very evident increase in size. 
Virchow has ascertained this increase in size in children affected with 
congenital syphilis, and observed, moreover, in one case, complete 
fatty degeneration of these glands. Baerensprung found, under the 
same circumstances, the cortical substance of the supra-renal cap- 
sules invaded by masses of nuclei and young cells of conjunctive 
tissue, a modification very analogous to the diffused lesion of the 
liver. Hypersemic from the first, the supra-renal capsules have 
never presented later on the white miliary points so frequent in the 
liver. 

The thymus, for the very reason of its functional activity during 
intrauterine life, appears already predisposed to undergo the in- 
fluence of hereditary syphilis. It was unknown, however, what that 
influence might be, when, in 1850, Professor P. Dubois,t searching 
carefully for the cause of the deaths of syphilitic new-born children. 



• Medical Times and Gazette, July 17tb, 1858. 

t Gaz, mSd, de Paris, 1850, p. 392. See same journal, 1851. 



PBBC6CI0US OB CONGENITAL, 155 

fonnd in a certain number a change in the thymus which presented 
itself in a form almost always identical, and which was characterised 
by the presence of pus disseminated or collected in cavities in the 
substance of the organ. Since that time, some observations have 
been added to those of the celebrated French accoucheur. Depaul 
has seen once in each of the lobes of the thymus a cavity filled with 
a yellowish and thick grumous matter. "Weber* gives a case of 
abscess in this same gland. C. Hecker,t Desruelles, Braun, Spath, 
and Wedl J met with similar changes. But must it be admitted 
that purulent deposits existed in all these cases, and would it not be 
more plausible to assume the existence of softened gxunmy products, 
metamorphosed and mistaken for abscesses P It is impossible to 
decide this point absolutely, although we lean to the latter hypo- 
thesis, on account of the rariiy of purulent formations in consti- 
tutional syphilis. A case by Lhemann,§ in which the thymus, the 
liver, and the dura mater were the seat of tumours formed of con- 
junctive tissue which had undergone fatty degeneration, would, to a 
certain point, be favourable to the idea that syphilitic lesions of the 
thymus do not suppurate any more than those of the other viscera. 
The description found in the cases furnished by Desruelles appears 
also to refer to a gummy tumour rather than to an abscess. 

For the rest, the syphilitic manifestations of the thymus show 
themselves in the form of deposits or of circumscribed tumours ; 
the diffused lesions which are said to have been found in it may be 
doubted, as many- observers, at least, have not met with them. All 
the more reason, however, for looking for them in future, if they do 
exist. 

Changes in the blood, — ^With these numerous glandular lesions it 
will readily be understood that the blood may become changed ; this 
is, in fact, what happens, as it is easy to convince ourselves by the 
numerous effusions of blood met with after death in the various 
natural cavities or even in the substance of certain parenchymas. 



[ * Beitroffe zur poithohg, Anat, der Neugehomen. Kiel, 1852, vol. ii. 
p. 75. 

f Verhandl, der Berliner Geselhchaft fur Gehurtsh., vol. viii. 
pp, 117-122. 

t Wedl once found in the centre of one of the lobes of the thymus a 
cavity filled with a mixture of pus and serum. 
, f Wtirxburg. med, ZeiUchrifl, 1863, vol. iv. p. 7. 



156 HEREDITA&T STFHILIS. 

This change, althoagh not as yet distinctly pointed out^ is not^ on 
that account, the less frequent. In Hutchinson's case it is stated 
that the pericardium was filled with coagulated blood. A great 
number of the cases given by Baerensprung make mention of effusions 
of blood into the cavity of the pericardium or even into the cavities 
of the pleurae or the meninges. 

Before becoming acquainted with these cases, I had myself already 
seen several examples of hereditary syphilis with visceral lesions and 
multiple effosions of blood. The following observation is not devoid 
of interest in this respect. 

X., a female, aet. 25, was confined in the Hospital la Fiti^ 
(January, 1860) of a child at the full term, and which died six hours 
after. At the post-mortem examination, I discovered beneath the 
pericardium the presence of numerous spots of ecchymosis ; these 
same spots were found less abundantly in the sub-cutaneous cellular 
tissue of the extremities, and on the surface of the lungs and peri- 
cardium, the cavity of which was partly full of a bloody fluid. The 
liver, which was enlarged, and firm and resistent beneath the fingers, 
was of a yellowish colour. The spleen was hard, firm, and large ; 
the kidneys appeared normal. 

The mother of this child informed me that her husband had 
suffered from syphilis ; as for herself, she had never noticed any- 
thing of the kind. 

§ 7. J$paratu8 of the circulation. 

Forster, the only author, so far as we know, who makes mention 
of lesions of this apparatus, states that he met with syphilitic endo* 
carditis in a child six weeks old ; but the proofs which he gives of 
the nature of this affection are not convincing.* There is no case 
on record of arterial lesions supervening in hereditary syphilis, and 
if we sometimes see cases of venous thrombosis in children here- 
ditarily infected, it must be acknowledged that this lesion is rather 
the effect of the cachexia than a modification primarily affecting the 
coats of the veins ; these coats, which are generally tinged with 
the colouring matter of the blood, owe this phenomenon to the 
fluidity thereof, while the white globules are often increased in 
number. 

• Wurthurg, med, Zeitschriji, t. x. p. 29. 



PRECOCIOUS OR CONGENITAL. 157 

§ 8. Apparatus of respiration. 

The respiratory organs, on the contra^, are frequently affected in 
young children who succumb to hereditary syphilis. The changes 
found in them generally occupy the lungs ; they are of two kinds, 
diffused and in the form of lobular pneumonia, or circumscribed and 
in the form of tumours entirely analogous to the gummy tumours of 
adults. 

Diffused lesions ; pneumonia, — Devergie * was one of the first 
observers who spoke of these lesions, but does not occupy himself 
with the link between them and syphilis. 

Two children, well-formed and at the full time, relates that author, 
died immediately after birth. The delivery was an easy one. The 
lungs were very large, compact, fleshy, more dense than natural, very 
heavy, discoloured, and pale ; they sank in water, even when cut into 
small pieces. Their tissue was infiltrated with a colourless serous 
fluid, which it was difficult to press out of the cellular tissue contain- 
ing it. On blowing into them, no air entered. This change did not 
consist either of schirrhus, or of the white induration which precedes 
the suppuration of tubercles ; it was a kind of lardaciform indura* 
tiouy occupying a middle position between the lardaceO'ScAirrhous con^ 
dition and the softness proper to the tissue of the lungs of new-born 
children. 

Ch. Eobin and Lorain f have studied with great care this peculiar 
condition, in a case which presented itself to their notice. C. 
Hecker,t Virchow,§ and F. Weber || have given cases illustrative of 
this change which Howitz^ describes under the name of syphilitic 
infiltration of the lung. Eanvier** has recently presented to the 
Biological Society the various organs of a new-born child whose 
lungs had undergone the same modification. 

The lungs thus affected fill almost the entire cavity of the chest, 

* Annates ^hygiine, April, 1831. 

t Ga%, mSd.f 1855, p. 186 ; and Bull, de la Sociite de hiohgie. 

X Verhandl, der Berliner OeseUsch, Jtir Geburtah,, vol. viiL p. 126. 

§ Gesammte Abhandlungen, p. 595. 

II Beitrage zurpathoL Anat, der Neugebornen,, iL p. 47* 

i Hospital Tidende, 1862, Nos. 10 and 11 ; and Behrend's Syphilidolcg., 
1862, t. iii. p. 601. 

** Gax. mid, d^ Paris, 1864. Comptes rendm des sciences de la SociitS, 
de biologte, 3* s^rie, t. iv. 1863, p. 51. 



158 HEBEDITABT SYPHILIS. 

and often retaia the impression of the ribs ; their smooth and 
marbled surface presents an appearance differing little from that of 
lungs full of air, unless it be by being paler. These organs are firm, 
heavy, denser than water, contain air in some parts only, and cannot 
be inflated like the healthy lungs of a child. The air which penetrates 
them at some points becomes arrested, whence a partial emphysema 
from the rupture of some of the pulmonary vesicles. The changed 
portions of the parenchyma are resistant and admit of being cleanly 
cut; the surface of section is smooth, shining, of a scarcely pink 
white colour (flesh colour), sometimes marbled with white patches 
upon a reddish ground. Compact masses are seen, separated by the 
thickened interlobular septa, and having the consistence of the 
hepatic tissue. It is, in f^ct, a kind of white and very firm hepatisa- 
tion. The fine ramifications of the bronchi and the blood-vessels are 
generally contracted in consequence of the compression. Wagner 
has found the bronchi filled with purulent mucus and a small 
quantity of air. On examination with the microscope, he has found 
the alveoli completely effaced or merely thickened, of an irregularly 
square or hexagonal shape, or divided by septa and elongated ; the 
inter-alveolar conjunctive tissue was thickened, in most of the cases, 
by molecules rich in albumen and fat, amongst which were found 
nuclei and cells of new formation, atrophied and undergoing fatty 
degeneration. 

This pulmonary infiltration, or syphilitic induration of the lungs, 
differs from grey hepatisation, an affection with which it is not 
devoid of some analogy, by the greater hardness of the diseased 
parenchyma, by its resistence to pressure, by its whitish or pink 
coloration, and by the nature of the concomitant manifestations. 

The bronchial glands, simultaneously diseased, are increased in 
size, and present a reddish or yellowish-grey tint. 

The circumscribed jpuhnonary lesions are pointed out by Portal in 
the following case which, in spite of the somewhat late appearance 
of the pulmonary lesion, appears, nevertheless, above all doubt.* 
" In the body of a child born of parents infected with the venereal 
poison, and which died at the age of three years, there were found 
externally true venereal pustules; the glands of the neck were 
swelled, those of the mesentery, the groins, and the axiKse were 

obstructed and fuU of a whitish humour, of the consistence of broth. 

— 

♦ Oh$erv» 8ur la jphtkisie pulmonaire, t. i* p. 530) 180^. 



PRECOCIOUS OB CONGENITAL. 159 

The right lung was almost entirely destroyed by suppuration, there 
were some abscesses in the upper lobe of the left lung, and the 
remaining substance of both lower lobes was hard and resembled 
shrivelled leather. The pulmonary artery and the cavities of the 
right side of the heart were greatly dilated, and the muscular sub- 
stance of the ventricles was singularly softened.^' 

This case had passed unobserved, and in reality the lesions in 
question were not known until the researches of Professor Depaul * 
were published. That author pointed out, as early as 1837, the 
causal connection between them and syphilis, and, later on, com- 
municated to the Academy two cases in which they are perfectly 
described. In one of these cases, a tumour the size of a small nut, 
prominent, of a yellowish tint, and softened at its centre, was the 
only product observed. In the other, the upper lobes of the lungs 
contained an irregular, rounded mass, of the size of a large nut. 
Other smaller masses were disseminated through the other lobes, six 
on the right side and five on the left, the smallest as large as a small 
nut ; these various nuclei, when cut open, were seen to consist of a 
compact tissue of a greyish-yellow colour, and in the centre of each 
of them was found a cavity from which flowed a yellowish, sero- 
purulent fluid, variable in quantity, according to the volume of the 
induration. This same pulmonary lesion was also met with by Ch. 
Desruelles in a foetus the subject of pemphigus and of the well- 
known change in the liver. C. Hecker t has also observed it, and 
Virchow J appears to have seen one example of it. 

On the other hand, Lebert has given a sketch of a gummy tumour 
found in the lung of a child affected with congenital syphilis. § The 
following case, which we saw in the H6tel-Dieu, under the care of 
M. Vigla, does not diS'er from the cases described above. 

A puny new-born child, the subject of pemphigus situated chiefly 
in the palms of the hands and soles of the feet, succumbed a few 
days after birth, at the Hotel-Dieu, in 1863. The mother, who 
denied any kind of specific antecedent, refused to give any informa- 
tion concerning the health of the father. 

* Bulletin de la 8oc. Anat, November, 1837 ; and Mimoire sur une mani- 
testation de la syphUis conginitale {MSm, de VAcad, tmper, de midedne), 
Paris, 1853, t. xvii. 

t VerhandL der Berliner OeselUch. fiir Gehurtsk,, t.viii. p. 126. 

t Gesammt. AbkandLf p. 595. 

§ Anat pathohg* PariS) 1857, pl» clii* figs* 3 and 4). 



160 HEREDITAEY SYPHILIS. 

Post-mortem examination. — ^The brain, the liver, and the kidneys 
appeared intact, but in one of the lungs there existed about its 
centre a rounded tumour of the size of a small nut, of a yellowish 
white colour and pretty firm consistence at the circumference, but 
softer at the centre. This tumour was surrounded by a zone of 
fibrous tissue, and the parenchyma of the lung in its vicinity was 
perfectly healthy. Towards the base, and in the thickness of the 
lower lobe, was found another tumour, having the form of a bean, 
and the hilus of which appeared filled with a greyish and vascular 
tissue ; the surface of this lobe presented a pisiform tumour, smaller, 
but also more firm and greyer than the preceding. The structure of 
these tumours was not altogether identical ; fine fibres of conjunctive 
tissue, between which were interposed numerous elementary granula- 
tions, entered largely into their composition. These elements were 
abundant in the peripheric portions ; but in proportion as the centre 
was approached, there existed only round or elliptical, very granular 
globules ; then, in the central portion, there were found only fatty, 
molecular granulations.* 

Lastly, let us quote the case given by Martineau of a pulmonary 
lesion in a child which died in three days, and of which Comil has 
given very complete micrographical details. But the syphilitic origin 
of the change in the lungs here might seem doubtful, since the child 
showed no trace of pemphigus, and the mother had not contracted 
syphilis until about the fourth month of her pregnancy.t 

To sum up, in the cases which we have just passed in review, the 
pathological product always showed itcelf in the form of tumours 
more or less numerous, of the size of a pea, a nut, or a walnut, and 
these tumours, perfectly circumscribed, firm or softened at their centre, 
and usually of a yellowish colour, do not differ from the gummy 
tumours which, under the influence of acquired syphilis, develop 
themselves in the organs. There are also met with again in them, 
at various stages of development or of change, the elements of con- 
junctive tissue peculiar to diffused infiltration, minus the epithelial 
cells. The zone of fibrous tissue which sometimes envelops them, 
their comparatively small number, and also their microscopical char- 



♦ See Oa%. hebdomad,, ISQi, p. 649. 

t Bull de IS Soe. Anat, 1862, p. 486; and compare : Forster, loe. cit., 
Kobner, KUnische und experimentclle Mittlmlung,, &c., p. 117. Erlangen, 
1864. Baerensprung, Hered, Syphilisj pp. 103, 108, pi. vii. 



PRECOCIOUS OR CONGENITAL. 161 

acters, are so many circumstances which enable us to distinguish 
them from true tubercle of the lung, a very rare affection at this 
period of life. 

To these changes correspond peculiar functional derangements, 
differing little from those observed under similar circumstances in 
adults, but difiScult to detect, as much on account of the weak 
condition as of the rapidity of the death of the children affected. 
Dulness and absence of vesicular murmur are the signs furnished by 
physical examination, when this is possible. The children are most 
frequently bom before the full time, they are sickly, yellowish, 
cachectic, and little developed, and most of them are affected with 
pemphigus, which has for its special seat the palms of the hands and 
soles of the feet. With these affections sometimes coexist visceral 
lesions and especially changes in the liver ; life is seriously compro- 
mised and death generally soon supervenes ; it usually takes place 
in the first or second week after birth. 

A precise diagnosis is difficult, but in the presence, of pemphigus 
of the extremities and of a cachectic condition with dyspnoea, there 
is ground for suspecting the existence of a hereditary syphilitic affec- 
tion of the apparatus of respiration. 

§ 9. Ajtparatus of innervation* 

Less frequently than the liver, the lungs, and the hsemopoietic 
glands, the nervous centres are affected with hereditary syphilis. 
Bobin ascertained the existence of cerebral sclerosis in a child which 
died under the care of Legroux,* and which there was reason to 
believe was the subject of hereditary syphilis. The lesion of the spinal 
marrow met with in one of the two foetuses observed by Potain (see 
Vol. n. p. 84) does not differ from sclerosis, and thus hereditary 
syphilis may produce modifications of the nervous centres very 
analogous to the diffused lesions sometimes observed in adults ; the 
circumscribed or gummy change of these centres is also met with. 
The meningesf and the brainj may equally be the seat of them. 

Virchow has seen syphilitic new-bom children present in the 



* Union mSdicale, June 19tb, 1858. 

t See Howitz, Behrend'a Si/philidologie, 1862, vol. iii. p* 604, and Vol. IL 
p. 41, of this work. 
X Schott, Mayr's Zeitschriftfiir Xmderheilkunde, iv< 4. 



162 HEREDITABY STFHILIS. 

cerebral substance small whitish, or ydlovish deposits, formed of 
masses of fat granules.* In a child two yean old^ snfferii^ bom 
syphilitic paralysis of the oculo-motor nenre, de Graefe found several 
points of cerebral softeniDg,t and, in the case of a child affected 
with an abscess of the arm, which was probably nothing else than a 
suppurating gummy tumour, Hutchinson and Jackscm were of opinion 
that a plastic tumour existed, which compressed the cord and affected 
the roots of the nerves, j: 

Hydrocephalus is another form of change which, according to 
some observera, is occasionally connected with hereditary syphilis. 
Haase§ relates the case of a woman who contracted a diancre in the 
course of the first month of her pregnancy, and whose husband had 
had chancres and syphilitic angina. This woman was delivered 
three times of a dead child at the eighth month. In her fourth 
pregnancy, she gave birth to a hydrocephalic child, which was para- 
lysed on the left side, and presented purple spots disseminated over 
the skiD. This child died at the end of six months. The fifth 
pregnancy furnished a child bom at the full time, whose skin was- 
livid and of a dark red colour. In her sixth pregnancy, she had a 
male child which was affected, in its second year, with scrofulosis 
and serpiginous crusts. 

De Mfericll is equally inclined to admit an influence of syphilis 
upon the production of hydrocephalus ; he has several times observed 
a great development of the head and a peculiar rotatory movement of 
the eyes in the children of syphilitics. We were ourselves formerly 
led to admit this pathogenesis which is corroborated by the imposing 
authority of Dr. Eoger. A provincial friend of oura has told us that, 
surprised at seeing several hydrocephalic children bom of the same 
mother, and wishing to know the cause of this phenomenon, he 
ascertained that her husband had formerly contracted syphilis in 
Paris. 

The symptoms which accompany these various lesions are little 
known, or at least very difficult to study. Insomnia might, ho\^ever, 
be such a symptom and perhaps the chief one. Bertin and, niore 



I hWl 



* Syphilis constitute p. 4. f Arckivfur Ophthalmolog.y i. p. 443. 

X Syphilitic affections of the nervoUB syBtem, in Med, Times and Gazette, 
t. ii. p. 84, 1861. 

§ Allgemen. med. Annal, p. 194, February, 1829, exit, dans Archiv. 
mSd.j l^ s§rie, xxiii. 436, 1860. 
II Lettsomian Lectures on Syphitis, in Zanett, September l8th, 1858. 



PBECOCIOUS OR CONGENITAL. 163 

recently. Dr. Pitschaaft* have remarked that children the offspring 
of syphilitic fathers are often troubled with obstinate insomnia. 
Een6 Vanoyt has corroborated this assertion. To this symptom 
are sometimes added general or partial convulsions, and more rarely 
paralysis with or without coma. 



* Quoted by Bertherand, TraitS dee malad, vinSr., p. 327. 
f Journ, de mid. et de chirurg, praUques, 1849, p. 273. 



»n2 



164 TARDY HEREDITARY SYPUILIS, 



CHAPTER II. 



TARDY HEEEDITAEY SYPHIUS. 



One of the most interesting pathological and clinical questions^ that 
of tardy hereditary syphilis, is variously answered by physicians. 
Side by side with a certain number of authors who admit that here- 
ditary syphilis may, like acquired syphilis, remain latent for years, 
there are others who think that this disease no longer shows itself 
after the first six months of life, that is to say, that it necessarily 
manifests itself in that interval. 

As facts only can have weight in such a matter, let us see what 
they say. 

N. Massa* quotes the case of three children in whom the venereal 
disease developed itself after from three to eleven years. " Tres hoc 
anno curavi ego pueros, unum setate trium annorum, alterum eetate 
sex annorum, et erat puella, tertium undecim annorum; isti non 
sumpserunt lac infectum.'^ These children did not take infected 
milk, says Massa ; but what proof is there that they did not contract 
the disease otherwise than by suckling P None. There is then in 
these cases a desideratum which, let us admit, exists in several of the 
subsequent cases. StoUt relates the remarkable case of two sisters 
aged, the one 10, the other 12, both affected with exostoses and 
catarrh, diseases both of which he suspected of having a venereal 
origin, and which yielded to a mercurial treatment. He also speaks 
of another young girl, who recovered equally well and under similar 
circumstances. HoffinanJ gives the history of a young girl 9 
years old, the subject of epileptic attacks, which did not occur with 
any regularity and were cured by specific treatment. J. Plenck§ saw 
the same symptoms in a child 6 years old. 



• Jphrodinacusj t. i. p. 42. f Ratio medendt, pars iii. pp. 232, 233. 

J Natur<B curiosorum ephcmerid.^ centuria 1 et 2, Franoofurti et Lipsiae, 
1717, Obs. CXXXVI. p 272. 
§ Doctrina de morhie venereis* Tienna, 1779, p. 131. 



TARDY HEBEDITARY SYPHILIS. 165 

Berlin* speaks of a child born of an infected mother, which did 
not present any signs of syphilis until after having been weaned. 
This case may not appear extraordinary; but Ballingf relates 
that he was consulted for a boy of 16, affected with a syphilitic- 
looking ulcer of the throat and caries of the bones of the nose. 
The father stated that about the time when he begat this child, he 
had himself symptoms of constitutional syphilis ; the boy recovered 
under the employment of antisyphilitic remedies. Albers, J who saw 
similar cases, asserts that tardy syphilis prevails chiefly in children 
bom of a syphilitic father and a scrofulous mother. 

Eosen§ mentions having seen a girl of 11, fresh as a rose, in 
whom hereditary venereal disease caused swelling and suppuration 
of the glands of the neck, and of the nose, caries of the palate, and 
corroding ulcers of the face. But, on reading this case, one is led to 
see in it, by reason of the very nature of the lesions (suppuration of 
glands and caries of bone), scrofulous rather than syphilitic mani- 
festations. Baumesll quotes the case of a child which, under the 
influence of hereditary syphilis, was attacked at 4 years of age by 
all the symptoms of commencing syphilis. A nine months* treat- 
ment with general remedies having no reference to the venereal 
nature of the affection, did not at all improve the condition of the 
young patient, who was rapidly lapsing into marasmus. Informa- 
tion given in confidence by the father put BaumSs upon the track. 
The use of the tisane of Vigarous and of fumigations with cinnabar 
was foUowed by rapid improvement ; after being continued for three 
months, this treatment proved perfectly successful. 

Cazenave quotes the cases of two girls, the one 9, the other 
18 years of age, in whom it was impossible to discover any 
trace of a primary lesion, and who, nevertheless, had tubercular and 
serpiginous syphilides. The first was cured by the employment of 
proto-iodide of mercury. 

Trousseau^ saw a young woman who, from the age of 7j had 



• Traits des tnal. vSner, chez les enfane nouveau-nSSf p. 153. 
t Ueber angehorene und erbliche SyphiUs^ p. 129. 
X Ueher JSrkenntniss und Kur der Syphilis. 
§ Maladies des enfans, p. 545. Paris, 1778. 

li De la pMhisie pulmonaire, t. i. p. 428. Paris, 1805. See also, Joum, 
Univ. des Sciences Mid,, t. Iv. p. 100. 
H Gazette des hdpitauXf 1855, p. 497, 



166 TABDY HEBBDITABY SYPHILIS. 

swelling of the legs^ and for nine yean suffered from insomnia and noc- 
turnal osteocopic pains ; at twenty^ she had two exostoses on the arm 
and cicatrices in the pharynx. These symptoms disappeared under 
the influence of an antisyphilitic treatment. A. Foumier, quoted hy 
Davasse/ speaks of two patients, the one aged 18, the other 25, 
who had never had a venereal lesion of any kind, and who both 
presented a gummy tumour of the velum palati ; the first had also a 
tubercle in the pharynx. 

Sperinot saw a young girl of 11 who had ulceration of the 
palate, and commencing cachexia. After unsuccessful attempts at 
syphilisation, iodide of potassium effected a cure. Melchior Bobert j: 
attributes to hereditaiy syphilis tertiary manifestations not preceded 
by primary or secondary symptoms, and which, supervening at an 
advanced age, yield to treatment with preparations of iodine ; but 
this interpretation may appear hazardous. Professor Sigmund, of 
Vienna,^ relates four cases of tardy hereditary syphilis, manifested by 
lesions of the bones and cartilages, tubercles of the sub-cutaneous 
cellular tissue, and ulcers of the back part of the mouth. Zambaco|| 
saw, in a young man of 26, whose brothers and sisters were for the 
most part affected with hereditary syphilis, sudden losses of con- 
sciousness, derangements of vision, loss of memory, &c. 

Bicord quotes the cases of two brothers aged, the one 40, the 
other 44, who both presented a lesion of the palatine vault of 
syphilitic appearance, but who had not had any other venereal 
symptom. He mentions having seen, under similar circumstances, a 
young man of 17, whp was the subject of a naso-palatine osteitis, 
with destruction of the velum palati. This last lesion was also met 
with in a young girl of 14, placed, in 1862, under the care of 
Bouchut.ir In a case of perforation of the palatine vault observed 
in a young woman of 19,** and recently communicated to the 
Medical Society of the hospitals. Dr. H^rard thought it necessary, 
in the presence of an absolute denial of syphilis on the part of the 



• La syphilis, ses formes, son unite, Paris, 1865. 
t La syphilisation, &c. Turin and Paris, 1865. 
J Nouveau traiti des malad, venSr, Paris, 1861,^. 701. 
§ Zeitschr, der Gesellschaft Wiener Aerzte, 1858, No. 5. 
II Affect, nerveuses syphilitiques, p. 207. Paris, 1862. 
H Gaz. des hdpitaux, July lOth, 1862, p. 317. 

•• Bull, de la Soe. med. des hopitaux, et Union mSd., 1861. A rather 
similar case is to be fpuncl in 4rchiv de mid., t. i. p. ?16, 1860, 



TARDY HEREDITARY SYPHILIS. 167 

parents^ to hesitate concerning the nature of the disease ; but though 
in doubt^ this skilful observer inclined rather towards a scrofulous 
origin. Certain forms of lupus have been regarded with reason as 
possibly connected with hereditary syphilis.* 

One of our cases is a good instance of chronic pneumonia pro- 
bably developed under the influence of hereditary syphilis, Tlie 
liver^ in this female patient of 4t2, presented on its surface deep 
cicatrices, lesions of great value for the diagnosis of visceral 
syphilis.! Other organs may certainly become changed under the 
same influence and the same circumstances, and this is a point 
worthy of investigation. 

G. Lagneau lastly mentions epilepsy in children bom of syphilitic 
parents. Idiotcy, according to Critchett,J may be a symptom of 
hereditary syphiHs. It appears easy to me to account for this con- 
nection by the modification sometimes caused by syphilis in the 
development of the bones of the cranium. 

Such are, so far as we are aware, the principal facts known con- 
cerning tardy hereditary syphilis. Two objections may be made to 
the majority of them : the absence of precise information as to the 
health of the parents, and the want of certainty concerning the 
possible existence of acquired syphilis. Despite these gaps, which 
result in a great measure from the difficulty of observation in such a 
matter, are we called upon to reject the tardy manifestations of 
hereditary syphilis, or ought we, after the example of Diday and 
several other distinguished syphilographers, to admit their existence 
without reserve P In my opinion, these manifestations do not admit 
of doubt, especially when we take into consideration, not only the 
cases mentioned above, but also a great number of others more 
recently collected by Hutchinson. § These cases, which throw a new 
light upon the question we are examining, have the great advantage 
of taking into account the local lesion and the general condition ; 
they show that most of the individuals affected with tardy hereditary 

• Veiel, Speciell, Bericht uber die Resultate der Heilanstalt fur Flechten- 
kranke m der Jahren, 1855-61. Schmidt's Jahrhuch, t. cxvii. p. 299. 

t I must not omit to mention the arrest of development in the genital 
organs of this patient ; it appears to me dependent upon the syphilitic 
influence, and thus syphilis may be, in some cases, a cause of malforma- 
tioo. 

X Med. Times and Oftz,, June 9th, 1S60. 

§ Ophthalmic Hoepilal Iteports, t. xi. No. 8, pp. 54-105. 



168 TABDY HEBEDITABY SYPHILIS. 

syphilis have a special stamp, and that other lesions than those of 
which we ha^e just been speaking belong to the tar^ development 
of the inherited disease. Thns the organs of the senses are affected, 
and sometimes, with the disease in the eyes or ears has been seen to 
coincide destmction of the nose, or of the yelnm palati.* 

Heeeditary Syphilitic Qphthauoa. 

Mannsell and Evanson,t Walker, Dixon, and Lawrence, began the 
study of these affections; bnt it is chiefly £rom Hutchinson that we 
borrow the greater part of the following data. 

Iritis. — Iritis is one of the first hereditary manifestations of ocular 
syphilis. In twenty-three cases collected by Hutchinson, the mean 
age of the children, at the commencement of the affection, was five 
months and a half; the oldest was sixteen months, the youngest six 
weeks old (Obs. XXI., XXII.); amongst this number there were 
five male and sixteen female children; in two, the sex was not 
given. In eleven cases only were both eyes affected. The young 
patients suffering from this affection were mostly feeble and cachectic, 
but sometimes also in a pretty good state of health. They presented, 
in most of the cases, symptoms of hereditary syphilis, and, so far as it 
was possible to ascertain, had been conceived soon after the appear- 
ance of the primary lesion in the parents. Infantile syphilitic iritis 
is rarely complicated, and does not present, in general, the symptoms 
of the iritis connected with acquired syphilis ; the neoplasm, how- 
ever, which is usually abundant, renders the danger of occlusion of 
the pupil very great. 

Mercurial treatment, although it does not sufiBce to prevent the 
appearance of this lesion, is none the less the best means for com- 
bating its effects, and the most favourable for the complete absorption 
of the neoplasm. 

Literstitial keratitis, — According to Hutchinson, this affection, 
which is frequently connected with hereditary syphilis, rare in early 
infancy, still more rare in adult age, generally shows itself between 
the eighth and fifteenth years, most frequently about the age of 10. 
It commences by a diffused haziness of the centre of the cornea of 
one eye. At this time no ulceration exists, and the traces of con- 

• See Obs. XXXVIII., XXXIX., XLIL, &c., he. dt, 
t On the diseases of children, Dublin, 18^8. 



TARDY HEREDITARY SYPHILIS. 169 

gestiou in the coats of the eye are extremely slight. The patient, 
nevertheless, almost always complains of a slight irritation in the eye, 
and of dimness of sight; a careful examination shows that the 
opaque patches occupy the thickness of the cornea itself and not 
either of its surfaces ; these patches are separated from each other, 
and resemble so many microscopic masses of fog. In the course of 
a few weeks, sometimes more rapidly, the cornea, with the exception 
of a strip near its margin, becomes opaque from the extension and 
confluence of these interstitial opacities. The opacity is, never- 
theless, greater at certain points, which form, to a certain extent, 
the centres of the disease. At this period, the comparison to ground 
glass is very correct; there almost always exists a zone of sclerotic 
injection, some photophobia, and pain around the orbit. 

In a month or two, the other cornea becomes afifected and passes 
through the same phases, only a little more rapidly ; then comes a 
time when the patient is so far blind as to retain only a simple per- 
ception of light. The eye first affected soon begins to clear and 
generally, in the course of a year or eighteen months, there is a 
marked improvement. In the slighter cases, or under the influence 
of an appropriate treatment, the duration of the disease may be much 
shorter and the re-establishment of transparency complete, but there 
often remain for years, or even for life, patches of haziness which 
interfere more or less with vision. In the more severe cases, the 
surface of the cornea is slightly granular, and has lost its polish ; 
sometimes, in consequence of excessive vascularity, this membrane 
becomes pink or salmon-coloured, and the sight usually continues 
somewhat damaged. 

The usual absence of ulcerations or of pustules on the surface of 
the cornea prevents us from confounding this affection with the 
keratitis which follows the exanthematic fevers and especially small- 
pox. Scrofulous keratitis, with which it was long confounded, is 
accompanied most frequently by an increase in volume of the glands, 
or by tubercles in the lungs. Individuals affected with syphiUtic 
keratitis have a dirty earthy colour of the skin, and the bridge of 
the nose usually broad and depressed, the forehead wrinkled, the 
angles of the mouth occupied by fissures, or by radiating cicatrices, 
and the permanent teeth small and some of them, particularly the 
central upper incisors, notched. Most frequently preceded or 
accompanied by iritis, this affection is modiBed by specific treatment, 
when tonics are of no avail. The prognosis is favourable, but 



170 TARDY HEBEDITARY SYPHILIS. 

recovery is slow and often incomplete; frictions with mercurial oint- 
ment behind the ears^ upon the neck, and in the axillae^ are the most 
appropriate means for combating it. 

Galligo has famished cases confirmative of Hutchinson's re- 
searches. Three children affected with hereditary syphilis and with 
the keratitis in question were subjected to the employment of mer- 
curial preparations internally ; frictions of the same nature were also 
used conjointly with a collyrium of nitrate of silver. Two of them 
recovered completely ; in the third, the albago was divided into two 
patches in the vicinity of the pupil.* I have myself communicated 
to the Biological Society a rather similar case, which will be given 
further on. 

CAoroiditia. — A certain number of cases of hereditary syphilis 
have shown, either on examination with the ophthalmoscope, or to 
the naked eye, a modification of the choroid analogous to hereditary 
or even acquired iritis. This modification consisted in the existence, 
on the surface of that membrane, of whitish deposits in the form of 
patches slightly prominent and covered by vessels of the retina, or 
in cicatrices probably resulting from the absorption of these same 
deposits; the retina was congested and dimmed in consequence of 
inflammation of the membrane of the vitreous humour. In a sym- 
ptomatic point of view, this affection presents several degrees : the 
first degree, characterised by dimness of sight, answers to the exuda- 
tion period ; the retina and vitreous humour are hazy and have lost 
their transparency, but after a certain time, the sight improves, and 
the patches become limited. This is the second degree. Absorption 
constitutes the third. In fourteen cases furnished by Hutchinson, 
choroiditis existed ten times, deposits in the retina twice, inflam- 
matory opacities in the vitreous humour once, and opacities in the 
crystalline lens five times. The period of life at which heredito- 
syphilitic choroiditis and the changes connected with it are observed, 
is generally the same as that at which interstitial keratitis is seen to 
develop itself. In the cases given by Hutchinson, six times out of 
ten the patient was the eldest of the living children in the family. 
The difficulty of obtaining a clear and detailed history of the ante- 
cedents of the patients leads us to base our diagnosis of this affec- 
tion upon the physiognomy and state of the teeth of the individual 
affected. 

* Imparziale ; and Gaz, mid, de Lyon, 1860, p.' 113. 



TABDY HEREDITARY SYPHILIS. 171 

According to Hutchinson^ cataract and inflammation of the vitre- 
ous humour would also appear, to a certain extent, to be connected 
with hereditary syphilis; they accompany choroiditis more frequently 
than keratitis, and develop themselves several years after birth. 
But they are not sufficiently known to enable us with certainty 
to assign to them a syphilitic origin. 

Amaurosis. — ^In addition to the ocular lesions of which we have 
just been speaking, Hutchinson has observed, in several children 
affected with hereditary syphilis,* a change characterised by dis- 
colouration and atrophy of the optic discs (white atrophy) ; the 
sight was lost for a period of from six to eighteen months, and an 
involuntary and often very marked drowsiness in the children left 
little doubt as to the cranial origin of this affection. This amaurosis 
does not differ, therefore, from those which we have studied above. 

Otopathies. — ^Individuals affected with hereditary syphilis are not 
always exempt from deafness, and hearing may be entirely or only 
partially lost in them. 

The morbid lesions which produce these derangements are varied 
and more or less serious. In the cases observed by Hutchinson, 
the function was lost without the appearance of any external 
lesion. The deafness occupied symmetrically both ears, ran rapidly 
through its various degrees of evolution, and became more or less 
complete in the space of six months, despite the absence of pain 
or abundant otorrhoea. This affection, like keratitis, manifests 
itself about the age of puberty, during the course of the five years 
which precede or follow it ; it is, like the hereditary affections of the 
eye, three times more frequent in the female sex. 

The few cases hitherto observed lead to the belief that this variety 
of otopathy depends upon a lesion of the auditory nerve, or that it 
results from a change effected in the inaccessible portions of the ear. 
The symmetry of the change indicates the existence of a central 
cause, and the membrane of the tympanum, without being altogether 
normal, presents no modification in relation with the functional dis- 
turbance ; the Eustachian tubes have always appeared free. Hut- 
chinson, who sees in this affection the analogue of syphilitic retinitis 
and white atrophy of the optic nerves, suspects a modification of the 
auditory nerve or of its ramifications in the labyrinth. The total 



♦ Sec Obs. II., IV., VI., loc. cit. 



172 TAKDY HEREDITARY SYPHILIS. 

loss of hearing, in spite of specific treatment, indicates a prognosis 
little favourable. 

Lesions of the Layers op the Ovum. 

The study of these lesions will serve to complete the subject of 
hereditary syphiUs. The important functions of the membranes 
which envelop the human ovum are well known, and there is reason 
to beUeve that from changes in them result certain cases of early 
abortion in syphilitic women, when the foetus does not present any 
change. There exist, however, few precise observations on this 
point. Lebert* found, between the amnion and the placenta, yellow 
granulations having the structure of tubercle ; but later on,t he did 
not venture to attach importance to this lesion. Simpson j: attributes 
an accessory part only to syphilis in the production of the asphyxia 
of the foetus connected with a change in the placenta. Mackensie§ 
ascertained the presence of a thick fibrino-fatty layer between the 
foetal membranes ; but it is questionable whether syphilis was the 
cause of this deposit. The observations of Wilkinson King, given 
by Wilks,!! suggest the same doubt. All these facts, however, are 
not without value, as they indicate, at least, the frequency of 
placental lesions in syphilitic women. These lesions, according to 
Virchow,1[ affect either the maternal or foetal part of the placenta, 
and if it be doubtful whether the latter may be affected primarily, 
the same does not apply to the former. They present themselves 
under two forms, one diffused, the other circumscribed. The diffused 
form, characterised by thickening with fibrous induration of the 
placenta, generally ends in atrophy of the villosities.** The cir- 
cumscribed form assumes a papular or condylomatous appearance, 
and the excrescences or polypous vegetations which constitute it 



* Compies-rendtis de la Sociite de biohgte, 1852, t. ii. p. 127. 

t Traits d^anatomte patJtolofftque, t. i. p. 242. 

X Obstetric Memoirs and contribut. Edinb., 1856, vol. ii. p. 457. 

§ Association Medical Journal, 1854, No. 97. 

II Guy*s Hospital Reports, ser, iii. vol. ix. p. 60. 

51 Die krankhaften Geschwiilste, t. ii. p. 478. 

** Dr. BrauD, quoted by Wedl {Grundziige depatholog, Histologie,ip, 505. 
Wien, 1853), relates a case of diffused infiltration of the conjunctive 
tissue of new formation, in the chorion of a woman affected with syphilis. 
The consequence of this lesion was atrophy of the chorion and abortion. 



TABDY HEBEDITARY SYPHILIS. 173 

are a macons tissue organised and rich in vessels (Endometritis 
decidiia). 

Sach are the lesions of the placental membranes to which a 
syphilitic origin 'has hitherto been attributed ; it was our duty to 
make them known^ it belongs to the future to pronounce more 
positively concerning them. 



1?4 HEREDITARY SYPHILIS. 



CHAPTEE m. 

MODES OP EVOLUTION. — GENERAL PHYSIOGNOMY. 

Aftee having analysed and described singly the lesions of hereditary 
syphilis, it becomes important to take a general view of this patho- 
logical form, and to follow its course and evolution. Developed 
during intrauterine life, the usual effect of syphilis is, to cause abor- 
tion towards the sixth or seventh month of pregnancy. Although 
doubted by some authors, as de Blegny, Acton, and Huguier, who 
accuse immorality and excesses, when they do not make mercury 
responsible for the evil, this fact is none the less exact, as is estab- 
lished by a great number of cases in which mercury put an end 
to multiple abortions. According to Potton, abortion occurs in 
about one-tenth of the cases of hereditary syphilis. Whitehead 
counted, in two hundred and fifty-six women affected with syphilis, one 
hundred and seventeen abortions; in twenty-six cases examined by 
Porster, three of the children were still-born. Sometimes connected 
with a change in the membranes of the ovum, this death is more 
frequently the consequence of foetal lesions. The foetus, usually in 
a state of maceration more or less advanced, presents, if not always, 
at least in a certain number of cases, appreciable material lesions, 
such as indurated papules of the skin, pemphigus^ diffused or cir- 
cumscribed visceral lesions, or sero-sanguineous effusions into the 
serous cavities. After birth, hereditary syphilis assumes most of the 
forms of acquired syphilis, with the exception of the primary lesion. 
The manifestations called secondary appear first, then come the 
tertiary lesions ; but this rule undergoes numerous exceptions. The 
order of succession which prevails in the development of acquired 
syphilis is far from being equally constant in hereditary syphilis. 
Whether or not the secondary period has had its evolution during 
the course of intrauterine life, only tertiary manifestations are some- 
times observed; at other times, and more frequently perhaps, 
secondary and tertiary manifestations coexist; erythema, papules, 
or pustules are seen side by side with visceral lesions differing little 



MODES OP EVOLUTION. 175 

from those in the adult. This fact is not surprising, for it has its 
reason^ apparently, in the age of the patients; it is sometimes 
observed in children affected with acquired syphihs (Eoger). 

At the moment of birth, and for some days after, the child appears 
to enjoy perfect health. Symptoms soon appear which reveal the 
disease with which it is affected : at first, it is difSculty of breathing 
through the nose, a kind of obstruction which is pretty certain to be 
attributed to cold. Cracks and fissures show themselves in the 
vicinity of the natural orifices, and then appear upon the surface of 
the skin some of the eruptions described above. But, as Bosen has 
already pointed out, these symptoms are not all met with in the 
same subject, one presents more, another less. During this time, 
the general health declines, the child suffers and becomes emaciated, 
it has insomnia, its cry changes, and when to this state of things are 
added visceral lesions, it soon falls into a state of cachexia and 
marasmus. The following is the sketch of this condition drawn 
by one of the most acute observers. *' The face," says Professor 
Trousseau,* ''is of a peculiar sooty tint ; it would appear as if a thin 
layer of coffee-grounds, or of soot mixed with a large quantity of 
water, had been passed over the features ; it is neither pallor, nor 
jaundice, nor the straw-yellow colour of other cachexias. This tint, 
much less deep, scarcely extends to the rest of the body. The eye- 
lashes are not developed or have fallen off; the eyelids are often 
reversed, and at the external angle are sometimes fissures like those 
seen at the lips or openings of the nostrils. In place of eyebrows, 
which have fallen off, is seen a yellowish sooty patch, with a con- 
siderable production of scales, and these same sooty patches, which 
are in fact nothing else than psoriasis, are met with also especially 
upon the chin, around the mouth. • . !^ 

At the same time the child is puny, sickly, emaciated, and 
cachectic. If it was at first robust and well-organised, it becomes 
weak and sad, and is rather puffed than emaciated ; its digestive 
functions are usually deranged, and it has vomiting, frequent and 
obstinate diarrhoea, and sometimes bloody stools; the debility is 
such that death may be the result of syncope, when it is not the 
effect of the marasmus. Erysipelas and pneumonia are frequent and 
always fatal complications. Eecovery is not to be hoped for when 

syphilis develops itself at the very moment of birth, it is rare 

— - — ^_^^.^_^_^___^_^^_^^._^.^^^_^^^_^_.^^_^„.^_______^^___^_^_^^^__ ■ ■ ■ « 

* CUnique midicali de VHoteUDieu, p. 665. Paris, 1862. 



176 HEREDITARY SYPHILIS. 

when the disease supervenes during the first months of life^ hut is 
observed more frequently when it does not appear until after several 
years. 

Such is hereditary syphilis in the first periods of life. Later on, 
this disease reveals itself by symptoms similar to the tertiary sym- 
ptoms of acquired syphilis, for the disorders which show themselves 
in connection with the organ of vision, and which Hutchinson has 
so well studied, appear to us, contrarily to the opinion of that author, 
to belong rather to the group of tertiary than to that of secondary 
manifestations. Like the tertiary manifestations, these ocular lesions 
are characterised by plastic products (conjunctive hyperplasis) very 
analogous to those of the third period of acquired syphilis. When 
they do not occupy the eye, their usual seat is, sometimes the sub- 
cutaneous or sub-mucous cellular tissue, sometimes the osseous sys- 
tem, more frequently, perhaps, the velum palati and pharynx. Thence 
sub-cutaneous gummy tumours with their successive phases of 
evolution, perforations of the velum palati or of the palatine arch, 
exostoses, caries, necroses of the more superficial bones, and more rarely 
visceral lesions (Obs. XLIII.). Chronic arachnitis, with a tendency 
to hydrocephalus, is also met with, according to Hutchinson, in most 
of the children deeply infected. 

These various affections do not, in general, give a very severe 
blow to the organism, and are rarely accompanied by cachexia if the 
principal viscera are intact. Nevertheless, the physiognomy of the 
patient is usually altogether characteristic. The skin presents a 
dirty, pale, or leaden tint, and is thickened, rough, and flaccid. 
More rarely, it presents the beautiful clear colour of scrofulous per- 
sons. Upon the face are seen cicatrices which occupy by preference 
the angles of the mouth, whence they radiate over the cheeks. The 
forehead is generally large and prominent in the region of the frontal 
eminences, and sometimes a large depression exists a little above the 
eyebrows ; the hairs are few, dry, and split at their extremities. The 
bridge of the nose is broad, or even sunken. The permanent teeth 
present an aspect altogether peculiar. The upper central incisors 
are characteristic from their form as well as from their colour and 
dimensions. On coming through the gum, these teeth are generally 
short, narrow from one side to the other, and very thin at their lower 
edge j after a certain time, a portion of this edge, in the form of a 
crescent, breaks off and leaves a broad, deep, vertical notch, which 
continues for several years and disappears from twenty to thirty years 



MODES OP EVOLUTION. 177 

later in consequence of the premature wearing away of the teeth. 
These two incisors sometimes converge and' sometimes are rather 
widely separated from each other. They are traversed by horizontal 
depressions which are by no means constant. 

Sometimes intact and bright^ the eyes present^ at other times^ 
traces of old or recent change, synechise with or without deformation 
of the iris, or chronic interstitial keratitis. The importance of this 
latter lesion is such that many authors incline to regard it as a 
pathognomic sign of syphilitic hereditariness, and as it usually coin- 
cides with the modification of the dental system, it follows that the 
combination of these two circumstances is not without much weight 
in the balance of the diagnosis. To these modifications is sometimes 
added a true arrest of development of the whole individual, or merely 
of one or more organs. These deviations of type, the usual con- 
sequences of material lesions supei-vening either in the course of 
intrauterine life, or later on during the first years of existence, are 
worthy of attention. The following cases, with which we shall close 
this part of our subject, are examples of this ; they inform us, more- 
over, concerning the course of the tardy syphilitic lesions. 

Tardy hereditary syphilis, — Idiotcy, ejpilepsy, smallness of head, 

Obs, LIV. — The woman X., of healthy appearance, was treated by me 
for neuralgic attacks and alopecia. This woman, who believed that her 
husband had had syphilis, did not pretend that she herself had been 
quite free from any symptoms connected with that disease. She bad 
had four children, of which one died at 7, another at 3, and a third at 
2 years of age ; she had had four miscarriages, three at seven months 
and a half, and the fourth at two months. The only child left was 
12 years old and did not look more than 6 or 8 at the most. His head 
was extremely small, and already the bones of the cranium appeared 
firmly united. This child walked when led and was almost completely 
deprived of intelligence and memory. He did not speak, and it was with 
difficulty that he could be made to say oney two. He could not put out 
his tongue, although that organ enjoyed all its mobility. He was obsti- 
nate, had contracted habits of masturbation, and from 2 years of age 
had had epileptiform attacks. The organs of sight and hearing were in- 
tact, the nose rather large and flattened. The two first incisors were 
notched and studded with small depressions, the two other incisors and 
the canines scarcely protruded from their sockets. There was true arrest 
of dental development. On the upper part of the tibia, there was a 
fistulous opening and necrosis of several months* standing. 

Obs. LV.— The woman D., set. 26, entered the Hotel-Dieu in March, 

n 



178 HEREDITARY SYPHILIS. 

1863. This patient had lost her father from chest disease and her mother 
from cancer of the stomach. Healthy until her marriage at 16, she 
perceived, ahout a month afterwards, some pimples upon the genital 
organs, which were soon followed by roseola and angina, for which 
she took pills, Cuisinier's syrup, and sarsaparilla. She had a mis- 
carriage at six months. A second pregnancy took place, and she was 
delivered at nine months of a child now living. This child, which 
was very thin when born, could not be suckled by its mother. It does 
not appear to have presented, during the first years of its life, any 
cutaneous eruption. Later on, it had measles and a hard tumour in the 
neck, which terminated in suppuration. At present 10 years old, he has 
for two years had kerato-conjunctivitis which very notably interferes with 
vision. The cornea is opaque at several points and also ulcerated. The 
eyelids, glued together at both angles, leave an opening which permits of 
seeing, at most, the field of the cornea. The incisor teeth are bicuspid, 
large and short, with transverse striae. The general development is very 
incomplete, the head is yery small, and the child is irascible. 

Madame D. became pregnant a third time, and was delivered of a girl at 
seven months and a half. Now 9 years old and healthy, she has the nose 
flattened at its base and the teeth separated and bifid. 

Since then there have been three fresh pregnancies, of which two were 
at the full time. The children died in two days. The third pregnancy 
terminated at six months. Syphilitic tubercles showed themselves in 
the mother during the course of the latter, in spite of a treatment ordered 
by M. Nonat. 



VABIETIES OF SYPHILIS. 179 



VAEIETIES OF SYPHILIS. 

The preceding study had for its object to make known the numer- 
ous manifestations of syphilis without concerning ourselves about its 
most ordinary types. It becomes necessary to point out the varie- 
ties, now that we are acquainted with the species. Although always 
produced by the same agent, syphilis varies in its form and in its 
intensity. Prom this point of view, we may group under the three 
following heads the differences which it presents : — 

Common syphilis ; 

Benignant syphilis ; 

Malignant syphilis. 

Amongst the numerous historians of syphilis, some have admitted 
more or less severe forms of this disease. Euiz Diaz de Isla points 
out three; but what he means thereby relates much more to the 
periods of syphilis than to the degrees of its intensity. The same 
does not apply to Alex. Trajan Petronius,* who recognises a benig- 
nant syphilis and a malignant syphilis, a distinction which it is still 
possible to find in other authors, and which is worthy of being 
retained. 

1. Common syphilis. — Common syphilis, which we had more par- 
ticularly in view in our Nosography, is the variety most frequently 
observed. Passing through each of the stages which we have pointed 
out, it manifests itself by an entire series of symptoms the danger of 
which consists, above all, in the seat of the morbid localisation. It 
is very susceptible of cure, if care be taken to adopt a suitable treat- 
ment sufficiently early, so as to avoid a change in the functional 
elements proper to the organ diseased, which change, as we know, 
is always secondary. 

2. Benignant syphilis, — This form, which has the closest resem- 
blance to common syphilis^ diJBfers from it only by a less intensity, 
and especially by a shorter duration. It is not necessarily seen to 
pass through all the periods and always to accomplish a complete 
revolution; sometimes, more frequently perhaps than is generally 
beUeved, it reaches the term of its evolution at the end of the second- 



^ AphrodkiacUi, t* ii* p* 1225i 



180 VARIETIES OF SYPHILIS. 

ary lesions. The organism^ for a reason which is not always easy to 
detect, may from that moment regain its normal integrity. Com- 
parable, to a certain pointy to variola which stops short of the suppu- 
ration period, this variety of syphilis might justly receive the title of 
syphiloid; it is, in fact, the analogue of varioloid, that is to say, the 
slightest, the most benignant, and the shortest form of the disease. 
If it is not always easy to say upon what this variety depends, it 
cannot be denied that it is observed chiefly in certain countries 
remarkable for the mildness of their climates. This fact did not 
escape the earlier observers, for Jean de L^on already observed that 
syphilis became cured spontaneously in Lybia.* It will be found 
mentioned elsewhere (see Geographical Distribution), and conse- 
quently we shall not again revert to it. 

8. Malignant syphilis. — Malignant syphilis claims our attention as 
much by its severity as by the differences which separate it from 
common syphilis. This form most frequently reveals itself to the 
observer from its very commencement : the chancre, instead of con- 
fining itself to the more superficial portions of the dermis, graduaUy 
burrows and becomes phagedsenic. Rendered distinct by the inter- 
esting researches of Bassereau, this fact has been thus expressed : — 
''After indurated phagedsenic chancres, supervene severe pustular 
syphilides, more tardy ulcerating affections of the skin, suppurating 
exostoses, necrosis, and caries.'' The observations contained in the 
inaugural thesis of Dubuc do not in any way invalidate this view, 
since, of nine patients affected with severe and malignant syphilides, 
four had phagedsenic chancres at the outset. 

To the primary lesion succeeds a first burst of eruption, remark- 
able for this peculiarity, that it partakes at one and the same time of 
the characters of the exanthematic or precocious syphilides and of the 
deep-seated and tardy syphilides: of the first by its premonitory 
symptoms, its glandular adenopathies, and its generalisation ; of the 
second, by the material lesion which constitutes it and by the cica- 
trices which follow it. Whatever may be the elementary lesion by 
which the eruption commences, pustule or tubercle, its constant 
tendency is to run on to ulceration ; after a time which is generally 
very short, the pimples become covered with crusts which, increasing 
incessantly by a peculiar plastic secretion, stratified and arched at the 
centre, present very much the appearance of oyster-shells. Hence 

* Quoted by Freind, Hist de lamidec»t p. 68, 3e partie. 



VABIBTIES OF SYPHILIS. 181 

the denomination of puslula ostracosa given by the first syphilo- 
graphers to these lesions more frequent in the sixteenth century than 
in our own times. Under these crusts exist ulcers with perpen- 
dicular edges and a greyish, pultaceous floor, surrounded by a pink 
zone. After a longer or shorter duration, the secretion dries up, 
the edges sink down, and the ulcers cicatrise, but sometimes they 
are seen to advance insidiously, and to erode by degrees the adjacent 
parts, or even to gain in depth, to lay bare the sub-cutaneous parts, 
or to cause adjoining cavities to communicate with each other. 

The first eruptive burst does not always behave in this manner : 
the serpiginous or perforating course frequently does not reveal 
itself except at the second eruption ; but, in general, this second 
eruption soon follows the first. The cicatrices which follow have 
the form of ulcers, they are deep and present a dark red tint which 
slowly becomes efiaced from the centre towards the circumference. 
In some cases, instead of the pecuhar evolution which we have just 
described, there appears on the summit of the eruptive pimple, a 
smalTblack eschar, which gradually enlarges and ends by falling off, 
leaving bare an ulcer very analogous to the preceding. The erup- 
tions which during this time show themselves upon the mucous 
membranes have less tendency to burrow and to destroy the tissues, 
and are, moreover, pretty discrete if not altogether wanting (Dubuc). 
The nasal fossse must, however, be excepted, as the mucous mem- 
brane is frequently ulcerated and the septum sometimes perforated. 
With these eruptions, or soon after their disappearance, supervene 
other lesions, and chiefly ocular lesions, exostoses, and more rarely 
lesions of the testicles, or of the abdominal viscera, as was observed 
in a most interesting case furnished by Axenfeld.* These symptoms 
sometimes follow each other with such rapidity that the syphilitic 
testicle may, as was seen by Melchior Robert, coexist with the indu- 
rated chancre, and that there are observed, at the same time and in 
the same individual, the three series of primary, secondary, and 
tertiary lesions. 

A general condition which may be serious serves as an escort to 
these various manifestations. The patients have constant fever with 
exacerbations in the evening ; they become emaciated and pale, and 
lose their strength, they have a bad appetite, with inclination to 
vomit and diarrhoea. They are seized with dyspnoea and palpitation 

»___■_ 

* Axenfeld, Bullet, de la JSoc. anat,, 1863, p. 512. 



182 VAMBTIBS OF SYPHILIS. 

of the hearty have obstinate cephalalgia and insomnia^ and are low- 
spirited and nneasy ; sometimes even the idea of committing suicide 
occars to them. Under these circumstances chiefly^ appear the ordi- 
nary complications of syphilis. Erysipelas and pneumonia sup^vene 
to put an end to the suffering of the patients ; if not, the strength 
gradually returns while the crusts become detached and leave bare 
pink ulcers which soon cicatrise. More rarely, death is the conse- 
quence of the syphilitic lesions themselves, the patients succumbing 
to a kind of marasmus consequent upon the existence of multiple 
lesions of the viscera. When recovery takes place, new eruptive 
bursts sometimes supervene after intervals of time more or less 
remote; like the preceding ones, they manifest a tendency to ulcera- 
tion or to gangrene, and finally to destruction of the tissues. 

Such is the abridged sketch of a form of syphilis still existing, not 
without some analogy to the syphilis of the end of the fifteenth and 
commencement of the sixteenth century, but which, from the nature 
of the local lesions in which it consists, from the characters of the 
general symptoms which accompany it, and from the rapidity of the 
course proper to it, fully deserves the name of malignant syphilis. 
Under what influences is this form of disease seen to develop itself P 
Let us confess that there are a certain number of cases which appear 
unexplained by any rational cause. The cases related by Dubuc 
belong precisely to this class, and that observer, not believing that 
there was reason for invoking a peculiar quality of the virus, found 
himself under the necessity of referring the malignity of the syphUis 
to internal predispositioui Can it be said, however, that the circum- 
stances which favour this peculiar condition always escape our 
notice ? I think not. Early age, which renders syphilis more acute, 
sometimes imparts to it a certain degree of severity or even of malig- 
nity. The influence of race is not perhaps to be neglected in the 
question we are examining ; but hitherto we are without the elements 
necessary for the appreciation of this point; in like manner, the 
opinion that the contamination of one race by another is capable of 
aggravating the disease is by no means proved.* It is easy to under- 
stand that unhealthy conditions may give to this disease a more 
active impulse. Insufficient nourishment, rapid changes of tempera- 
ture, a moist climate, overcrowding, and want of acclimatisation, all 

- — ..^^^^^^ — .^ \ I ■ I — " 

• See Gauthier, Detus annS^s de pratique midicale ^ Canton (Chine), 
Th^se de Paris, 1863, 



VABIETIBS OF SYPHILIS. 183 

circumstances which aggravate syphilis^ may also^ to a certain extent^ 
favour the development of the malignant form. Is the quality of 
the poison itself really without influence P Some authors are in- 
clined to beUeve that syphilis transmitted from the foetus to the 
mother^ like that which results from hereditary lesions^ is generaUy 
more severe ; but this opinion is still without positive proofs. We 
know^ in another field of observation^ that severe small-pox may 
produce benignant small-pox^ and vice versa. But, if external cir- 
cumstances sometimes favour the appearance of malignant syphilis, 
seeing that in many cases it is not possible to attribute the least 
influence to them^ we are naturally led^ until we possess more ample 
information^ to connect this variety of syphiUs with a peculiar pre- 
disposition in the individual affected. 



184 DfFLUENCE OF SYPHILIS 



INFLUENCE OF SYPHILIS UPON OTHEK DISEASES. 

The preceding descriptioii applied to syphilis devetoping itself in 
a healthy organism. Our object now will be to examine this same 
disease in an individual already out of healthy to search for the 
modifications which it is susceptible of undergoing under these cir- 
cumstances^ and for ihose which it may impress npon the diseases 
with which it coexists. Although little studied hitherto^ the subject 
we are about to investigate is none the less important^ inasmuch as 
it is met with at every step in practice. 

If syphilis does not usually supervene in the course of an acute 
disease^ on the other hand it frequently develops itself in individuals 
suffering from chronic disease. To state precisely the possible re- 
action of a given disease upon syphilis is not easy^ considering how 
few elements exist for the purpose ; but the important point to know 
is, that the course of the syftilis is interfered with only when the 
coexisting disease is in a state of activity. Side by side with the 
influence exerted by the disease, however, is another connected with 
the peculiar constitution of the individual affected, and it is no doubt 
to this latter influence that the remark of Spencer WeUs refers when 
he says, in his Practical Observations on Goict, London, 1854, p. 57, 
that syphilis, which is very severe in persons affected with gout, 
readily assumes a scorbutic character. 

There generally exists a reciprocal modification of the two diseases ; 
the one becomes more acute, while the course of the other is retarded. 
A young man affected with Bright's degeneration of the kidney, 
and for several weeks under our observation, was the subject of a 
chancre of two months' standing, not yet cicatrised ; the lesion of 
the kidneys, if the patient's account was to be believed, had advanced, 
in him, with a certain degree of rapidity, since, not having existed 
for more than a few months, it showed itself at the period in question 
by a very copious precipitate of albumen and by the passage of 
numerous fibrinous cylinders into the urine. Another patient, whose 
case we followed for eight months, presented at first, together with 
well-marked tuberculosis, syphilitic rupia and orchitis ; but the pul- 
monary affection was soon seen to predominate, at the expense, in 
some measure, of the syphilitic lesions^ which appeared to be arrested 



UPON OTHER DISEASES. 185 

in their course. It should be added, however^ that for a fortnight 
this patient took fifteen grains of iodide of potassium daily. 

A young woman who was at the same time phthisical and syphilitic^ 
had, during nearly five months that she was under our observation, 
only lesions localised in the genital organs and very slow in their 
development. 

The acute diseases which supervene in the course of syphilis may 
interfere with its evolution. ^' The appearance of an acute disease/' 
says Bassereau, " such as severe fever, inflammation of the lungs, 
&c., supervening soon after the contagion, appears to me, in some 
cases, to have sufiiced to retard the development of erythematous 
syphilides.^'* 

When the syphilitic manifestations exist, the development of an 
acute disease has not, generally, much influence upon their course or 
termination. In an individual suffering from variola and arrived at 
the end of a papular syphilide, I did not observe any appreciable 
modification in the course of the syphilitic eruption. 

We are compeUed to admit, however, that under certain circum- 
stances, syphilis is manifestly influenced by acute diseases. A young 
woman, treated at first by Bazin for a secondary syphilitic eruption 
and a diffused general paralysis, was seized with cholera and trans- 
ferred to the H6tel-Dieu. After the appearance of the choleraic 
attack, the syphilitic eruption became effaced and the paralysis dis- 
appeared. 

A young woman of 23, the subject of syphilitic roseola with an 
eruption of the hairy scalp, had just been subjected by me to a 
specific treatment when she also was seized with cholera which 
caused both these eruptions to disappear. A young man whom I 
saw in the Hospital St. Louis, under the care of Dr. Lailler, was 
rapidly disembarrassed of an indurated chancre by an attack of 
typhoid fever. These various facts distinctly prove, as it appears to 
me, that certain acute diseases, by occasioning great and rapid 
changes of nutrition generally, suffice to combat the manifestations 
of syphilis. Nor is there anything surprising in the fact that these 
diseases have upon nutrition an action to a certain extent ^compar- 
able to that which specific agents exert upon syphilis. 

Such is the description, somewhat brief no doubt, of the part 
which certain diseases may play in reference to syphilis ; the influence 



Traits des affect cutan, symptomat, de la syphilis, Paris, 1852, p. 177. 



186 INTLUBNCB OF STPHIUS 

which the latter exerts upon those diseases calls for more particular 
attention. We shall consider it in cases of traumatism^ in chronic 
diseases^ and lastly^ in acute diseases. 

As regards the influence of syphilis upon traumatism^ it is^ says 
Swediaur,* an opinion accepted by several physicians, that the bones 
of persons affected with syphilis become more brittle, and that the 
patients, consequently, are more subject to fractures. The same 
author afterwards gives the case of a man who broke one of his legs 
and who, after remaining nine weeks in bed, had no consolidation of 
the fracture. It was then suspected that the syphilis of which he 
was the subject might well be the cause of the non-formation of 
callus ; a mercurial treatment was adopted, the fracture united, and 
the padent was completely cured. 

Quite recently, Vemeuil has spoken of the action of syphilis 
upon wounds: — ^'Tou operate,^' says that skilful surgeon, f "for 
fistula of the penis in a syphilitic subject and fail to obtain union by 
the first intention. You adopt an appropriate treatment, you then 
operate again, and this time with success.^* An army surgeon. Dr. 
Guillemin,J has related, in support of the fact established by Ver- 
neuil, the case of a syphilitic patient in whom two small ulcers, 
resulting from excoriations of the fingers, did not heal until prepara- 
tions of iodine had been employed. Delpech writes : — " We see 
venereal ulcers declare themselves upon the occasion of a wound, 
either in the latter itself, or in the neighbourhood of it. This com- 
plication is very rare and only occurs in cases of general infection 
and when the wound has existed for a long time.'' § It must be 
borne in mind that chancres are not meant here, for that lesion, as 
we know, never develops itself in a wound, unless from actual con- 
tact with the venereal poison. 

Amongst chronic diseases, scrofulosis and tuberculosis are those 
upon which syphilis appears to have the most influence. Gout and 
rheumatism are, in general, very little modified by that disease. 
Syphilis, according to Lugol,|| modifies the course of scrofulosis, 
but the cases which that observer gives in support of his assertion 

^_ r ■ " ■ ^ ^^-^ -^ ,^ , — ^ __ , __ — , _ , 

* Loc. cit. p. 183. t Gaz. hebdomad., February, 1863, p. 134. 

X Gaz. hebd., July 17th, 1863, p. 473. Compare : Ambrosoli, De lin- 
Jluence de la syph, consttt sur les plates {Gaz* Lombarde, 44, 1863). 

§ Chirurgie cltmqtte de MontpelUer, t. i. Paris, 1823. 

II Recherches et observations sur les causes des maladies scrojuleuses, 
p. 285. Paris, 1844. 






UPON OTHEB DISEASES. 187 

are not significant, as they refer to individuals simply affected with 
gonorrhoea. Bazin * insists justly upon the property of syphilis to 
evoke manifestations of the scrofulous diathesis and to impart to 
theq[^ a tendency to suppuration ; this is a circumstance which I 
also distinctly observed in a case in which an outbreak of syphilis 
determined the appearance of multiple suppurating adenopathies. 
The influence of syphilis upon pulmonary tuberculisation has more 
particularly occupied the attention of authors. Morton, Morgagni, 
J. Frank, and Graves,t agree in recognising that syphihs is a debili- 
tating cause which, in individuals predisposed to it, favours, accele- 
rates, and aggravates the development of pulmonary phthisis. This 
opinion, which has for its chief supporters Laennec and Andral, is 
based, however, upon a small number of facts only, and, in that 
respect, is nat, perhaps, altogether irreproachable. As for myself, I 
have observed only three cases in which syphilis appeared to me to 
have played the part of exciting cause in reference to the develop- 
ment of tubercles in the lungs. Three individuals debilitated and 
emaciated by syphilis were attacked by tuberculisation rather rapid 
in its course, which ended by carrying them off. Some authors do 
not hesitate to beUeve that syphilis is, of itself, capable of producing 
tuberculosis ; but that is a view which by no means appears justified* 
To prove that syphilis may engender tuberculosis, it would be neces- 
sary, says Gramberini, j^ to establish, by means of clinical facts, that 
individuals placed outside of all the conditions which predispose to 
phthisis, have been attacked by it in consequence of a venereal infec- 
tion* But practical medicine cannot give so explicit an answer, and 
if, amongst the advocates of the opinion which connects tubercles 
with syphilis, there are some who claim to have cured phthisical 
patients by employing mercurial remedies, there is reason to believe, 
with the author quoted above, that they may have been deceived by 
syphilitic laryngo-tracheitis, as appears probable, at least, from the 
dhiort space of time which sufficed for the cure. This, indeed, is 
the manner in which we have felt called upon to interpret elsewhere 
most of the known observations of venereal phthisis. 

The simultaneous existence of syphilis and tuberculosis is, then, 

* Ze^ons sur les syphilidesj 1859. 

t Syphilis and the abuse of mercury, says Graves, are the two causes 
which most favour the development of pulmonary phthisis. 

X Oazetta medica ItaUana Toscana ; 1852, and Ga». mid, de Paris, p. 340, 
1853. 



188 INFLUENCE OF SYPHILIS 

rather rare^ and it may be assumed that there exists between tubercle 
and the syphilitic product an antagonism analogous to that which 
exists between tubercle and cancer. But, the general law of the 
organism, by virtue of which the development of a given pathological 
lesion would arrest or retard the evolution of any process of a dif- 
ferent origin, being true, it is solely by the debilitation of the economy 
which it occasions that syphilis is capable of giving an impulse to 
pulmonary phthisis. The question whether it can modify acute 
diseases is undetermined and has been very little studied. The few 
cases which we have observed are not sufficient to authorise an 
opinion on this point, and if, recently, we saw sink rapidly under 
hemorrhagic small-pox a patient who, a month before, had contracted 
an indurated chancre, this was, no doubt, a mere coincidence. 

To sum up, syphilis may be influenced in its course by the ap- 
pearance of another disease, but is not generally aggravated. The 
manifestations of certain diseases, especidly of scrofulosis and pul- 
monary phthisis, are sometimes evoked by syphilis ; but it is by no 
means proved that they can engender them. With regard to them, 
it is, at the most, an exciting cause. 

The whole influence of syphilis is not confined to this. According 
to certain authors, this disease is to be regarded, in some cases, as a 
preservative against other diseases. Lancisi states that he was in- 
formed by several physicians who had attended plague patients at 
Bome that none of those who had cauteries or venereal buboes in 
a state of suppuration were attacked by the plague.* I remember 
having heard tell that the epidemics of cholera which have raged in 
Paris have never visited the Hopital du Midi (hospital for male 
venereal patients). It is true that this scourge appeared slightly at 
the Lourcine Hospital ; but it is important to know that the patients 
who frequent that hospital are not all syphilitics. This remark ap- 
pears to me the more important since Dr. Espagne has just published 
in the Gazette Hebdomadairey September 15th, 1865, an interesting 
article to show the immunity from cholera in 1849, and in 1854, in 
the venereal and skin disease wards of the hospitals of Montpellier. 
To speak of the Hospital Saint-Eloi only, there were, in 1849, 
twelve deaths from cholera, and in 1854, 118, as well in the medical 
as in the surgical wards, and in neither of those two years did deaths 



* De hoviUa peste, &c. Romae, 1715. See Carr^re, HisUdre de la Soc. 
Roy, de mid., t. iv. p. 219, des m^moires. Paris, 1785. 



UPON OTHER DISEASES. 189 

occur in the wards set apart for syphilis or diseases of the skin. 
Was this the mere effect of chance ? I should not venture to say so. 
Is it to the syphilis, or to the mercury employed in treating it that 
these effects are to be attributed ? Dr. Espagne does not give an 
opinion on this point ; but if I had to decide between these two 
alternatives, I should be inclined to regard the syphilis rather than 
the mercury as a kind of preservative against the cholera. 

Lastly, Chassaignac has reported to the Surgical Society * that, 
out of twenty-five or thirty operations performed by him upon syphi- 
litics, he had never seen one followed by purulent infection, and that 
clever surgeon bases upon those facts an opinion that a kind of 
antagonism exists between constitutional syphilis and purulent infec- 
tion. 

What are we to think of these various observations ? That a real 
antagonism exists between syphilis and some other diseases ? The 
actual data do not authorise us to affirm a fact so important. New 
researches should be made on this subject; but in any case an 
organism under the influence of syphilis appears little disposed to 
undergo the attacks of morbid causes. 

• See Gaz. hehdotn., 18C2, p. 604. 



PART III. 



SEMEIOLOGT. 



§ 1. Diagnosis, 

To study a given sjrmptom in its various modes ; to determine, by 
the aid of this study, the seat and extent of the lesion ; then, these 
two factors being once known, to trace the evil to its source and to 
endeavour to ascertain the nature of it ; such is the method which, 
in a clinical sense, enables us to arrive at an exact diagnosis and at 
really useful indications for treatment. But hitherto we have con- 
fined ourselves to tracing as rigorously as possible the clinical char- 
acters of the numerous syphiUtic affections ; we have now to render 
the data acquired available for the general diagnosis of syphilis, after 
which there will remain the comparison of that disease with those 
which most closely resemble it, and to draw from this comparative 
examination the signs which may enable us to avoid an error too 
often injurious. 

Syphilis being a specific disease, many authors have imagined that 
it must necessarily have characters in relation with its nature and 
entirely distinct. Some of the physicians of the last centuries be- 
lieved that these characters were to be found in the blood, and 
asserted that inspection of that fluid sufficed to insure the diagnosis. 
Jessenius de Jessen, a Hungarian physician, admits, in 1618, that a 
pale or white pellicle on the surface of the blood drawn from a vein 
denotes syphilis when it adheres to the rest of the mass like a tena- 
cious skin; Melchior Friccius, in 1710, and G. D. Coschwitz, in 
1728, uttered this same opinion, which was, moreover, so general 
that Astruc* felt called upon to combat and refute it. 

Quite recently it has been thought that the characteristic sign of 

^ See Astruc> t* iv. |)p« 106 and 107. 



DIAGNOSIS. 191 

syphilis might be furnished by histology ; but the illusion was not 
of long duration. Eobin and Virchow, as we know, do not accord 
any precise histological character to gummy tumours, and we partici- 
pate in this view, despite the opposite opinion of Wagner. It is 
wrong, we think, to ask of the microscope more than it can give ; 
but it would be equally wrong not to avail ourselves of this instru- 
ment, which is a valuable means of examination. The naked eye, 
which judges of the form of the change and its totality, often leads 
us to data quite as positive and perhaps even more certain than the 
microscope, which enables us to see the elements and their reciprocal 
arrangement. And even if we admit with Wagner that there exist 
alveoli peculiar to syphilitic deposits, we cannot grant that this char- 
acter is more important than those which result from the general 
physiognomy presented by an organ affected with syphilis, and espe- 
cially by the consistence, colour, dryness, and peculiar arrangement 
of gummy tumours in the parenchymas. The peculiar colour of 
syphilitic eruptions is no longer a symptom which is always to be 
relied upon, and if it were, would constitute, at the very most, the 
characteristic sign of one period only of the disease with which we 
are occupied. 

Beyond this, we must give up the idea of finding for syphilis a 
sign always certain and really pathognomonic. The physician who 
seeks to arrive at a diagnosis of this disease must take into considera- 
tion all the symptoms, examine them in their different modes, weigh 
and compare them, and seek for their filiation, so as to base his 
judgment, not upon this or that one of them, but upon the totality 
of them. Therein he will only follow the sage precept of the father 
of medicine,* when he says : — " A physician who wishes to form a 
correct prognosis must embrace in his glance all the signs, that he 
may weigh them and judiciously confront them with each other.^* 
But the signs of syphilis are divisible, as Astruc pointed out, into 
demonstrative signs and commemorative signs. 

The demonstrative signs are unequivocal or equivocal, according 
as they belong to syphilis alone or to several diseases. 

The unequivocal signs are few, consisting solely in mucous patches 
and indurated chancre, since pustular and tubercular eruptions are 
not observed in syphilis only. As regards gummy products, they are 
a positive sign only in so far as they are situated superficially and 

^ Hippocratesi PrognoBtic$» 7 



192 SEMEIOLOGY. 

appreciable to sight; but even then it is possible to confound tbem 
\Fitli other lesions and especially with abscesses. 

The equivocal signs, although of less value for diagnosis, must 
nevertheless not be neglected. They frequently offer in their mo- 
dality characters truly pathognomonic : it is thus that behave most 
of the syphilitic eruptions of which the seat, form, and mode of 
grouping indicate pretty certainly, but not absolutely, the existence 
of syphilis ; the same applies to exostoses and to most of the visceral 
lesions appreciable by the senses. 

The commemorative signs are drawn from the information furnished 
by the patients, from the mode of evolution followed by the disease, 
and from the still existing traces of previous syphilitic lesions. The 
cicatrix of the chancre, those left by deep-seated syphilides or gummy 
tumours, the perforation or destruction of the velum palati, the flat- 
tening of the nose, &c., are so many commemorative, one might 
almost say demonstrative signs which, joined to doubtful manifesta- 
tions, will permit of surely diagnosing syphilis. Numerous abor- 
tions without appreciable exciting cause also constitute a sign of 
great value. These latter accidents indicate syphilis in the father or 
mother, if not in both at once. By the aid of these general data, 
let us now proceed to the diagnosis of syphilis in its various periods. 

When no external phenomenon (incubation period) yet reveals 
the existence of syphilis, the diagnosis of it is evidently impossible. 
Later on, the local reaction once set up (period of local eruption), it 
rests, as we know, upon two signs : the peculiar induration of the 
primary lesion with absence of suppuration, and the concomitant 
glandidar adenopathies in the groins, neck, &c., with their characters 
of indolence, hardness, and mobility. The primary lesion having 
disappeared, the glandular lesions and persistent cicatrix are still 
very certain means for the formation of a diagnosis. 

When eruptions have appeared, their dissemination over a large 
extent of surface, their coppery yellow or raw lean-ham colour, the 
absence of itching, and the coexistence of the glandular lesions 
mentioned above, combined with the information obtained concerning 
the primary lesion, are elements sufficient for arriving at an exact 
diagnosis. Let us add that mucous patches, with their peculiar 
characters, are frequently met with at this period. 

These latter manifestations and the adenopathies are, in the absence 
of any cutaneous eruption, certain indications that the evil has not 
yet arrived at its last phase. Li the latter (period of gummy pro- 



DIAGNOSIS. 193 

dacts)^ the diagnostic signs change^ but they are^ at the same time^ 
very different according to the seat of the morbid localisations. 
Upon the skin^ the eruptions, usually of a coppery colour and not 
itching, are limited to a few scattered points, disposed in circles, in 
semicircles, or in a T form ; they complete their evolution slowly 
and leave behind them cicatrices which are most frequently indelible. 
If it is a question of more deep-seated lesions, of muscular or 
osseous lesions, the absence of febrile reaction, the slowness of the 
evolution, the existence of continuous fixed pains with nocturnal ex- 
acerbations, and the presence of tumours firm at first and afterwards 
softening, are so many circumstances which may enable us to suspect, 
if not to recognise, the syphilitic disease. Lastly, when there super- 
vene manifestations less accessible to our means of investigation, 
then the anamnesis and the modes of filiation of the lesions, the 
cachexia and some peculiar symptoms, such as deformity of the liver, 
accompanied or not by albuminuria, are conditions which aid greatly 
in the diagnosis, if they do not completely elucidate it. The simul- 
taneous existence of several of the affections mentioned, or even of 
the traces which they have left behind them (cicatrices, &c.), is a 
useful auxiliary to which may further be added the results furnished 
by specific treatment. It is not our intention to repeat here what 
we have said of the diagnosis of syphilitic lesions considered singly 
in each of the organic apparatuses ; but we must insist upon the 
circumstance that, as a general rule, several of these apparatuses are 
affected simultaneously. Thus cerebral or pulmonary localisations 
are usually accompanied by modifications on the part of the liver 
and of the deep-seated lymphatic glands ; these latter changes, which 
are more common, are sometimes independent of any other visceral 
manifestation. One other point deserves our attention, viz., the 
general physiognomy of the patient, not that this physiognomy has 
in itself any peculiar stamp, for it interests the clinical observer 
rather by negative than by positive signs. The expression of the 
face, the colour of the skin, its elasticity, its suppleness, and the 
epidermis which covers it, if they do not at once put us upon the 
track of the diagnosis of syphilis, lead us, at least, to suspect the 
existence of that disease. By the aid of these various circumstances, 
it is possible, up to a certain point, to arrive by exclusion at the 
diagnosis of syphilis which, in reaUty, occupies an important rank 
in the list of chronic diseases. 
To sum up, the diagnosis with which we are now occupied, what** 





194 SEMEIOLOGY. 

ever may be the period of the disease at which it is looked at^ does 
not rest upon a single sign, but upon a totality of characters con- 
nected with symptoms having an entirely special order of succession. 

Such, at least, is acquired syphilis ; as regards hereditary syphilis, 
which differs from acquired syphilis by the absence of a primary 
local lesion, it differs also by a greater acuteness in its course^ by less 
regularity in its evolution, by a higher rate of mortality, and by the 
period of its appearance during the three or four first months of 
life. 

First of all the tegumentary surface and soon afterwards the 
parenchymas are invaded. To the ordinary eruptions of acquired 
syphilis are here added numerous fissures in the vicinity of the 
natural orifices, pemphigus in the palms of the hands and soles of 
the feet, and coryza. To the appearance of good health which the 
child previously presented succeed a peculiar colour of the skin and 
a gradual wasting away, which give to the httle patient the appear- 
ance of an old man. When it manifests itself at a more advanced 
age, hereditary syphilis is still generally recognisable^ for, on the one 
hand, the lesions which it produces present rather peculiar characters, 
and, on the other hand, the individuals affected with it most frequently 
have a physiognomy which betrays the nature of the disease trans- 
mitted to them. The state of the dental system^ the modification 
undergone by the two central upper incisors, the flattening of the 
nose, and the opacity of the cornea (chronic keratitis), are then 
frequent symptoms which are not devoid of a certain stamp. To 
these symptoms, moreover, are added in many cases smallness of size 
and a certain degree of arrest of development. Combined with the 
preceding analytical description, this synthetical summing up will 
suffice, I hope, to show when syphilis exists in a sick person, and 
whether that syphilis be acquired or hereditary. For greater cer- 
tainty, however, we shall endeavour to give a succinct sketch of the 
analogies and differences between this disease and those which most 
closely resemble it : virulent, toxical, and constitutional diseases will 
be examined, in turn, in relation to syphilis. 

On the first appearance of secondary symptoms, there sometimes 
exists a general reaction in the organism, with cephalalgia, extreme 
lassitude, and prostration of strength, all symptoms which may. 
Suggest the idea of typhoid fever, and that so much the more as 
they are often accompanied by anorexia and epistaxis. But this is 
only a resemblance of short duration^ and a few days suffice to 



DIAGNOSIS. 195 

remove all doubt. A closer analogy and, consequently, a greater 
difficulty for the diagnosis, is met with in reference to syphilis and 
the eruptive fevers, and especially to small-pox. Not only are these 
diseases inoculable^ but they present phases of evolution almost 
identical, to such an extent that the preceding nosographical study 
is, so to speak, copied from the description of inoculated small-pox. 
In each of these diseases, there is a period of incubation, a period 
of local eruption, and a period of general eruption preceded by 
general phenomena (period of invasion). There ceases the analogy 
for common syphilis, the course of which continues by manifestations 
no longer observed in small-pox, but not for galloping or acute 
syphilis, the suppurative eruption of which, like the eruption of 
small-pox, is not always followed by ulterior symptoms. Lastly, 
that which distinguishes these diseases from each other in a clinical 
point of view, is, in addition to the difference in the lesions, the 
greater or less rapidity of their course. While variola and all the 
eruptive fevers require a few weeks only for the completion of their 
evolution, syphilis lasts, in general, several years. The incubation 
period of inoculated small-pox is, as we know, from seven to eight 
days; for the incubation of syphilis a month at least must be 
reckoned upon. The invasion of small-pox is of three days, that 
of syphilis, on the contrary, may be a fortnight ; the same propor- 
tional difference exists in the periods of local eruption and of general 
eruption ; the local lesions which form part of each of these periods 
also have their peculiar modality, and the general reaction which 
accompanies them is very distinct. This reaction, which is, as it 
were, always in relation to the degree of acuteness and the duration 
of the symptoms, is much less strong in syphilis than in small-pox, 
a circumstance important to know in cases of doubtful diagnosis. 

Glanders and farcy resemble syphilis much more than do the 
eruptive fevers, and it is certainly not without some serious grounds 
that Van Helmont attributed syphilis* ^^to the abominable inter- 
course of a man with a mare affected with farcy .^' The opinion that 
syphilis may result from glanders has found advocates in later 
times ;t attempts have been made to base it upon the circumstance, 
which is far from being proved, that glanders appeared at the siege 

* Tumulus pesttSf in article, Peregrina lues nova. 
t See Eicord, Lettres eur la syphilis, 2® ^dit., p. 136* Lettre da Dr. 
Beau. 

02 



196 SEMEIOLOGY. 

of Naples at the same time as syphilis. In 1776, Jalouset,* a 
surgeon at Chatillon-snr-Loing, struck by the analogy between the two 
diseases, endeavoured to apply to them the same treatment ; he sent 
to the Boyal Society of Medicine the case of a horse affected with 
farcy, which, after five months of unsuccessful treatment, ended by 
being cured by the administration of Van Swieten's drops. Of late 
the studies of Kayer and Tardieu in reference to glanders and farcy 
have shown still more clearly the resemblance of syphilis to those 
diseases. " Amongst known affections, there is none to which I 
could better compare syphilis than glanders and farcy,'^ justly remarks 
Virchow, " and that on account of the diversity of the local changes, 
the multiplicity of the organs and tissues attacked, and the succession 
of the manifestations."t I'or.my own part, I know of nothing 
which, to the naked eye as well as to microscopical examination, 
approaches so nearly to syphilis as certain changes occurring in 
farcy. The testicles of a horse affected with chronic glanders pre- 
sented me with what I would almost venture to call a perfect 
analogy to the gummy tumours of the same organ in man. In spite 
of these resemblances, it is very evident that the identity or even 
relationship of syphilis with glanders is by no means demonstrated. 
These two diseases present, in their source, their evolution, and 
some of their manifestations, marked differences. The glanders 
comes to us from the solipedes, in whom it develops itself sponta- 
neously under given conditions ; its incubation, although hitherto 
ill-defined in man, appears shorter, however, than that of syphilis, 
and was of a few days only in a case given by A. B6rard. In both 
diseases, it is true, the prodromata have very ^similar characters. 
" The premonitory pains of chronic farcy,'' says Professor Tardieu, 
" are usually general ; it is a feeling as if the whole body were broken 
up, with shooting-pains which traverse the muscles of the trunk, and 
chiefly of the back and loins.'' But the nocturnal exacerbations of 
syphilis are entirely wanting in glanders. As regards the eruptions, 
they do not present in the latter disease the regularity of course 
observed in syphilis, they are suppurative and invade almost invari- 
ably the Schneiderian membrane, the mucous membrane of the air- 
passages, and the surface of the skin, without even presenting the 
diversity of form of the syphilitic eruptions. The more deep-seated 

* JSist, et Mim de la Soc. royaU de mid. Paris, 1776, p. 241. 
t Virchow, Syphilis constituiionelle, p. 176. 



DIAGNOSIS. 197 

lesions of the joints and mnscles are less circumscribed in glanders 
than in syphilis ; they are also remarkable for a greater tendency to 
suppuration. The evolution is, moreover, always more rapid in the 
former than in the latter of these diseases. 

SpedaUkhedy or the elephantiasis of the Greeks (lepra of the 
Middle Ages), is, like syphilis, a disease with a long incubation 
period, which reveals itself by tubercular lesions of the skin and 
viscera and occasions various derangements. Consisting of so-called 
albuminous exudations, the tubercular lesions of spedalskhed differ 
very little from syphilitic gummy tumours, but they are found more 
frequently perhaps on the internal surface of serous cavities and in 
the sub-peritoneal cellular tissue ; the softening which they undergo 
occupies at once their whole extent. Eruptions of dark patches, 
resembling wine-lees in colour and rounded in shape, combined with 
a feeling of uneasiness, lassitude, and rigors, are the usual premonitory 
symptoms of this disease. The tubercles are small soft tumours, 
reddish or livid, which vary in size from that of a pea to that of a 
walnut ; their shape is very irregular and mammillated. The face 
is their favourite seat. They are generally endowed with sensibility, 
while the spots which precede them are always devoid of it. The 
skin is affected in its whole thickness, of which it is easy to convince 
one's self. Analogous lesions present themselves chiefly in the mucous 
membranes of the mouth, the nose, the larynx and the pharynx, 
whence follow manifestations differing very little from those of 
syphilis. In another form of spedalskhed, the anaesthetic, there 
exist also precursory symptoms, and bullae of pemphigus are seen to- 
appear, filled with turbid, lactescent serum. These bullae, like the 
spots of the preceding period, are reproduced several times ; then 
supervenes the anaesthesia, which is chiefly felt in the interstices of 
the fingers and toes. The hair frequently falls off, the nails become 
affected, the phalanges necrosed, and sensation diminished or 
lost. Lastly supervene paralyses of movement, due apparently to 
exudations upon the rachidian meninges and to sclerosis of the spinal 
cord. 

In spite of a certain degree of resemblance, the two diseases, 
nevertheless, differ notably. That spedalskhed is not contagious like 
syphilis is now placed beyond doubt; neither does it commence, like 
the latter, by a lesion always local, and, further, the spots of syphilis 
are of a coppery red colour, without elevation and without change of 
sensibility, while those of lepra ^re of a dark red^ elevated above tht 



198 SEMEIOLOGT. 

skin, slightly depressed at the centre, shining and as it were oily, and 
lastly, very frequently deprived of sensibility. Syphilitic tubercles, 
flat and copper-coloured, are generally much harder, more developed, 
and more numerous than those of lepra, which are of a dull yellow or 
bronzed colour. Lastly, the ulcerations of the elephantiasis of the 
Greeks, covered with brownish crusts, rest upon a base which is gener- 
ally soft, while the ulcerations of the tubercular syphilide have irregu- 
lar, perpendicular edges, a greyish floor and a ring of induration around 
their base.* The diagnosis of the visceral localisations of spedalskhed 
and of syphilis rests partly upon a knowledge of the commemoratives. 
Leprous alopecia is distinguished from syphilitic alopecia by being 
observed only upon those parts of the head attacked by the disease. 

The diseases which, in the class of poisonings, require to be com- 
pared with syphilis, are mercurialism, iodism, and alcoholism. The 
distinction to be established between these diseases and syphilis is of 
the greatest importance, if we would avoid attributing to the remedies 
or to the hygiene what may belong to the malady, and vice versa. 
Let us add that, in this respect, mistakes have frequently been made. 
Mercurial poisoning, whatever may be the mode of penetration of the 
chemical agent, sometimes produces symptoms which are not without 
analogy to those of secondary syphilis : cutaneous eruptions, ulcera- 
tions of the mouth, tongue, or pharynx, necrosis of the maxillary 
bones, tremblings, and diarrhoea. 

Acute mercurial eruptions, which are generally transient, are 
erythematous or vesicular ; the eruptions of syphilis, more fixed and 
"tenacious, frequently show themselves in the form of pustules or of 
tubercles. The latter are always and necessarily preceded by the 
primary lesion, the former in those cases only in which mercury was 
employed to combat the efiects of the venereal disease. The former 
manifest themselves almost constantly at the same time as a more 
or less considerable salivation of the gums, while the latter never 
present these phenomena. 

The mercurial ulcerations have for their peculiar seat the gums, 
the commissure of the jaws, the free edge of the tongue, the internal 



• Consult : D. C. Danielssen and W. Boeck, TraitS de la spedalskhed ou 
elephantiatis des Grecs, trad. fr. par Colson. Paris, 1848. J. H. Guerault, 
Observ, med, recuHllies pendant^le voyage de son A. J, le Prince Napoleon 
dans les mere du Nord. Thdse de Paris, 1857. Gibert, Traiti des maladies 
ISle la peau et de la syphilUy 3* §dit. t, ii. p. 30. 



DIAGNOSIS. 199 

surface of the cheeks, and rarely the pharynx and genital organs. 
The syphilitic ulcerations occupy, by preference, the velum palati, 
the mucous membranes of the nasal fossse and of the larynx, and 
very frequently the genitals. The former, large and covered with a 
kind of pseudo-membranous pellicle, are accompanied by a peculiar 
and quasi constant foetor of the breath. The latter, more distinctly 
circumscribed, have more analogy with ordinary ulcerations. Certain 
osseous lesions also are symptoms common to the two diseases; but 
while, in syphilis, these lesions are the direct effects of the general 
morbid condition, and may invade various bones, in mercurial poison- 
ing they are phenomena consequent upon the stomatitis and gener- 
ally remain limited to the jaws. Lastly, the cachexia presents dis- 
tinct characters according as it is produced by the mercurial agent 
or by the syphilitic agent; rapid in the first case, it is slow and 
chronic in the second. With mercuriaUsm there is pallor and dis- 
colouration of the integuments, pufl&ness of the face, oedema of the 
extremities, passive effusions into the serous cavities, constant diar- 
rhoea, and sometimes loss of intelligence and trembling. In syphilis, 
the cachexia is always tardy, most frequently connected with visceral 
lesions, a* dry, scaly skin, bronzed rather than pale, emaciation, and 
marasmus. It is unnecessary to revert to the fact that certain 
authors,* even recently, have asserted that most of the tertiary 
symptoms of syphilis are the consequence of a mercurial treatment. 
This opinion must appear altogether unfounded to anyone acquainted 
with syphilis and mercurial poisoning. 

Iodine, and even iodide of potassium, administered injudiciously 
and unreservedly, may be the starting-point of symptoms which are 
not without some analogy with those of syphilis.f While rendering 
the circulation more active, these agents are sometimes capable of 
producing, on the part of the skin, erythematous, papulo-pustular, 
or vesicular eruptions ; on the part of the mucous membranes, an 
intense congestion which becomes localised, by preference, in the 
nasal fossae (coryza), pharynx, and conjunctiva. These various 



• Hermann, Die Behandlung der Syphilis ohne Mercur, Vienna, 1857 ; 
and other authors to be quoted farther on. 

t Consult : Trousseau and Pidoux, TraitS de thSrapeuttque, t. i. 1855. 
Rilliet, De Viodiame constitutionehf in Gaz, hebdom, de mSd. et de chirurgie, 
1860. See the discussion raised at the Academy on the subject of this 
report, Bulletins de PAead, de medecine (same year). 



200 SEMEIOLOGY. 

manifestations^ to which^ in some cases^ are added a cephalalgia 
sometimes intense, palpitation, giddiness, buzzing in the ears, and a 
kind of intoxication, are at least sufficient, under certain circum- 
stances, to lead to error, especially when they are met with in indi- 
viduals affected with syphilis. Let us add that confusion is all the 
more easy, as a certain degree of emaciation and of discolouration of 
the integuments is not rare in such cases. 

Secondary syphilis, at its onset, sometimes shows itself with a 
totality of symptoms very little different : cephalalgia, lassitude, 
insomnia, slight acceleration of the pulse, and erythematous or 
papular eruptions. But, contrary to what occurs in iodism, the 
general condition is here only transient, while the fixed and tena- 
cious eruptions assume characters perfectly well marked. It suffices 
then to be aware of the possibility of the mistake to know how to 
avoid it. 

Chronic alcoholism resembles syphilis in certain points ; like the 
latter, it is characterised anatomically by non-suppurative lesions 
affecting the web of the conjunctive tissue, symptomatically by 
various derangements and a special cachexia.* AlcohoUsm, how- 
ever, never gives rise like syphilis to those circumscribed lesions the 
destruction of which is generally rapid, it always produces diffused 
lesions with a tendency to a definite organisation. In these two 
diseases, moreover, the starting-point of which is so different, the 
symptomatic evolution is also very dissimilar, and the form of the 
symptoms very distinct. It is scarcely possible, in fact, to confound 
alcoholic ansesthesia with that which may result from a syphilitic 
lesion. 

At a certain period of its existence, syphilis presents a great re- 
semblance to constitutional diseases : like those diseases, it is remark- 
able for the dissemination and uniformity of the lesions, and for the 
multiplicity and variety of the symptoms, and it has an uncertain 
duration and progressive course. Scrofulosis, like syphilis, proceeds 
by distinct periods : at its onset, superficial affections of the tegu- 
mentary system ; later on, deep-seated affections which leave behind 
them indelible traces, peculiar adenopathies, then lesions of the 
bones, the joints, the muscles, and the viscera. In both diseases, 
the conjunctive tissue and the lymphatic glands are the parts most 



* See in IHci, encyclopSd. det sciences mid,, Paris^ 1865, t. ii., our article 
" Alcoholism.'* 



DIAGNOSIS. 201 

frequently affected; but^ while suppurative lesions are almost entirely 
wanting in syphilis, they are, on the contrary, frequent in scrofulosis. 
This character, already well marked from the time of the first mani- 
festations, sometimes continues to show itself during the whole 
course of the disease; the impetigo, the ecthyma, the indolent 
abscess, the suppurative osteitis, the fungous masses of the synovial 
membranes in scrofulous subjects, differ notably, in that point of 
view, from the papules, the tubercles, and the syphilitic gummy 
tumours of the skin and sub-cutaneous cellular tissue, as well as from 
the specific modifications of the bones and joints.* Even the 
visceral lesions possess distinct characters in the two diseases; 
amyloid degeneration is much more frequent in scrofulosis than in 
syphilis. Moreover, the seat of the morbid localisations is very 
different, for, to take the osseous lesions only, while those which 
acknowledge a syphilitic origin are situated in the continuity of the 
bones, the others occupy by preference their extremities. The cica- 
trices even are recognisable in these two pathological species : un- 
even, bridled, deep and coloured in scrofulosis, they are generally 
white, smooth, more regular, and more superficial in syphilis, in 
which they sometimes affect the form of a semicircle. Tuberculosis 
differs from syphilis by the seat of its manifestations. The liver is 
to the latter what the lung is to the former. A syphihtic lesion in 
any viscus almost necessarily indicates the existence of an analogous 
lesion in the liver. Several manifestations of rheumatism resemble 
those of syphilis : cutaneous eruptions, tendinous, periosteal, cardiac 
lesions, &c., often differ from syphilitic affections having the same 
seat only by the greater acuteness of the pain which accompanies 
them and by a greater degree of mobility. 

Some of the lesions of rheumatism have even a close analogy of 
structure with the changes of syphilis. Nothing more nearly re- 
sembles a gummy tumour than those cases of partial arteritis the 
product of which is known under the name of atheroma. The chief 
difference lies in the seat of the anatomical localisation ; it is thus 
that the valves of the heart and the arteries, which are frequently 
affected in rheumatism, are, on the contrary, only exceptionally at- 
tacked in syphilis. The cachectic condition peculiar to each of these 
diseases is, moreover, entirely distinct, which is sufficiently explained 
by the causes which produce it. 

* Bazin, Lemons mr la scrofule, Paris, 1863., 



202 SEMEIOLOGY. 

In rheumatism, the cachexia, which is generally the result of a 
cardiac lesion, is chiefly characterised by passive congestions, and by 
serous infiltrations of the sub-cutaneous cellular tissue and serous 
cavities ; in syphilis, this same condition, which is generally con- 
nected with the modifications undergone by the hsemopoietic glands, 
reveals itself by progressive emaciation and marasmus. 

Gout has less resemblance to syphilis than the preceding diseases ; 
but it will not be out of place to quote here the distinctive signs 
which a very trustworthy author has given of the pains of syphilis 
and of gout. " And as to the syphilitic pains called gouty," writes 
A. Par^,* *' they differ from those which are common (gout properly 
so-called), for the common pains have certain periods and paroxysms, 
and those of syphilis are almost continual. Moreover, common 
gout sometimes remains not only five or six years, but also the whole 
lifetime, concealed in the body of a man who lives carefully, without 
his feeling it, and yet his children may be affected with it, which is 
not the case with syphilis. Moreover, the gout which is called 
natural occupies the joints, and causes nodes there, within which is 
found a stony or chalky matter, and syphilis occupies the middle of 
the bones, rendering them carious and rotten. 

The cancerous diathesis does not proceed, like syphilis, by suc- 
cessive periods ; and those of its manifestations which might suggest 
the idea of tertiary syphilitic lesions are never preceded by the affec- 
tions which we have referred to the primary phases of syphilis. 
They generally invade . organisms healthy at least in appearance. 
But further, as we have already shown, cancerous affections differ 
from the localisations of syphilis by their histological characters. 

§ 2, Prognosis. 

In the nosographical part of this work, we made known the 
degree of danger of each of the numerous morbid manifestations of 
syphilis. We were then occupied with the local prognosis only, and 
have now to speak of the prognosis, not of such or such an isolated 
modification, but of the disease considered in its totality. That 
syphilis is a serious disease is an undoubted fact, but why and under 
what circumstances? Lastly, how can its severity be recognised 



• A. Pari, (Eutyres, liv. xix. cb. v. p. 446. Lyon, 1652, et 6dit. 
Malgaigne. 



PROGNOSIS, 203 

beforehand ? Such are the questions which present themselves to 
US for examination. 

The visceral lesions, in consequence of which syphilis sometimes 
ends in death, the cicatrices or deformities which may result from a 
lesion entirely local, the possibility of transmission by contagion or 
inheritance ; such are the circumstances which, for the individual as 
well as for families, or even for society, render syphilis a formidable 
disease. The more deep-seated, extensive, and ancient the visceral 
lesions are, the more fear should syphilis inspire, and this fear should 
be the greater the more the organ affected is essential to life. In 
other words, the syphilitic affections of the air-passages, of the heart, 
and of the brain, are those which most compromise existence, being 
capable, in certain cases, of causing rapid if not sudden death. 
Lesions of the liver, although less formidable, are far from being 
without danger, whether from the ascites which they occasion, or 
from the hsemorrhages and cachexia which accompany them. The 
same may be said of the vascular blood glands, which lead equally 
to cachexia and marasmus, and place the organism in the conditions 
most favourable to the development of the ultimate complications, 
pneumonia and erysipelas. In most cases, in the actual absence of 
any manifestation, syphilis may be regarded as the sword of Damocles, 
which only waits for an opportunity of striking afresh the individual 
it has already wounded. Even after the cure, it leaves behind it 
abnormal adhesions, cicatrices more or less embarrassing, such as 
the attachment of the velum palati to the pharynx, contractions more 
or less considerable of the larynx, trachea, or bronchi, or the face 
may become the seat of repulsive deformities. But this is not all, 
for syphilis is communicable by contact, and frequently an individual 
has been seen to become a kind of epidemic focus. Syphilis gener- 
ally renders the child responsible for the infection contracted by the 
author of its days, and in that respect it is to be considered as one 
of the most formidable of diseases. How many children sickly, 
puny, degenerate, or doomed to certain death from having inherited 
this disease I How many families extinct from not having escaped 
this scourge of reproduction ! 

Hereditary syphilis, a severe form of disease, does not always 
wait for its victim to see the light ; it too often kills the child in its 
mother's womb, or soon after birth, and in any case leaves it ex- 
posed, sooner or later, to serious affections. In this respect, observa- 
tion teaches that the danger is greater in proportion as the infection 



204 SEMEIOLOGY. 

occurs nearer to the moment of conception. The evil effect of the 
poison, therefore, decreases gradually. After delivery at the full 
time, children bom alive have a chance of continuing to live (Ber- 
tin). This rule, however, is far from being absolute ; but in general, 
the sooner syphilis develops itself after the moment of conception, 
the more it is to be dreaded. It scarcely ever spares the foetus ; 
the new-born child may escape from it, and later on it is not incom- 
patible with a long existence, the adult sometimes succeeding in 
overcoming the evil of which his parents had not been able to dis- 
embarrass themselves. In this manner certain hereditary diseases 
are seen to die out when sterility or the death of all the products 
has not led to a complete extinction of the race. The following 
statistics may give some idea of the gravity of hereditary syphilis. 
The mortality from syphilis being, in 1847, 665 for the whole of 
Great Britain, there were amongst that number 265 children less 
than a year old.* At Lyons, Dr. Gay found that out of a total of 
5,327 deaths, nineteen resulted from syphilis, fifteen of which occurred 
in children under 10 years of age.f The syphilis of the father and 
that of the mother react with almost equal intensity upon the pro- 
duct of conception.J Some authors, however, attribute a more 
deleterious influence to syphilis in the mother. This influence, ac- 
cording to Pick,§ is very prejudicial ; in 106 cases of syphilis trans- 
mitted by the mother, seventeen children were born before the full 
time, forty-four at the full time ; eleven out of the seventeen and three 
amongst the latter being still-born. Oat of forty-seven living chil- 
dren, four only lived more than three months, and the fate of two was 
unknown ; as for the others, to the number of forty-one, the mean 

duration of life was twenty-six days, the shortest duration one hour, 
the longest ninety days. 

Thus syphilis diminishes the number of births ; it destroys the 
child at an early age, or, if not, yet does not spare it; later on, the 
disease may still reach it, and in any case modifies more or less its 
mode of being. In fact, there are serious grounds for regarding 
sjphilis as one of the causes of the decrease of strength, the diminu- 
tion in size, and the degeneration of certain families. 

* Hunt, On Syphilitic Eruptions, London, 1854. 

f Quotation from Diday, Exposit, thior. et prat, des nouv. doctr, sur la 
ayphUia. Paris, 1858, p. 381, in 12o. 

t See Baerensprung, Hereditdre Syphilis, Berlin, 1864. 
§ See Schmidt's Jahrb,, t. cxx. p. 194. 



PROGNOSIS. 205 

Age, sex, and hygienic and meteorological influences, are the con- 
ditions which, if they do not suffice to alter our prognosis of syphilis, 
modify it, at least, to a slight extent. At an early age, syphilis, as 
Dr. Roger has pointed out, is always more acute and more serious, 
and sometimes presents the stamp of mahgnity ; sex does not modify 
it much, but unhealthy conditions, insufficient nourishment and want 
of cleanliness, have an evident effect upon its degree of severity. 
Numerous facts prove that sudden changes of temperature and 
humidity may exert the same influence. When it is complicated by 
another disease, syphiUs is evidently more serious and more difficult 
to cure. The same holds good when it has undergone without good 
effect an appropriate treatment. 

The prognosis of syphilis varies, further, according to the form 
which it assumes ; little serious in the benignant form, this disease 
is already more so in the common, and still more so in the malign 
nant form. As regards the periods, the last only is of a nature to 
cause great inquietude, the others, in general, compromising life but 
little. 

Side by side with these prognostic indications, there are others 
drawn from the symptomatic modality, and not less important to 
know. In treating of chancre, we pointed out that the characters 
of that manifestation might aid in the general prognosis of the 
disease. In fact, this lesion presents a different prognostic significa- 
tion according as it is more or less strongly indurated, or is or is not 
phagedaenic or gangrenous, and, without agreeing with the too posi- 
tive opinions of Carmichael and some other syphilographers, it must 
nevertheless be admitted that the peculiar modality of the chancre 
reveals the susceptibility of the organism to the action of the poison. 
With a very indurated chancre, and still more with a phagedsenic or 
gangrenous chancre, serious pustular or ulcerating syphilides are to 
be feared, severe lesions of the mucous membranes, such at least 
would appear to be the legitimate conclusion to be drawn from the 
statistics collated by Bassereau.* In seventy-two cases of pustular 
syphilide, that author found : chancrous erosions, three ; ulcerations 
attacking at least the whole thickness of the tegumentary membrane, 
and varying from the size of a lentil to that of a franc-piece, forty- 



* Bassereau, I^aitS de$ aff%ct d€ la p^au %ympU de la ^yjyAiVw. Paris, 
1852. 



206 SEMEIOLOGY. 

one; phagedsenic chancres, twenty ; serpiginous pliagedaenic clian- 
cres, four. 

The syphilides, according to some observers, may have a pro- 
gnostic value at least equal to that of the chancre. "If we would 
judge beforehand of the severity of a given case of syphihs, and 
foresee the disorders which it is capable of producing ultimately, 
tke first syphilide,^^ writes Diday,* " is the most valuable sign to 
rely upon. In fact, the greater or less intensity of the prodromata 
shows only the greater or less power of resistance in the constitution 
of the subject of them. . . . The syphilide alone, thanks to the 
very variable and very marked form in which it manifests itself, 
suffices to give a just idea what the syphilis will be of which it 
marks the onset. With a roseola pure and simple, continuing as 
such during the whole of its duration, not showing any tendency to 
become papular, and becoming effaced in ten or fifteen days, much 
is to be hoped ; spontaneous cure is almost certain. But the con- 
trary is not less true, and, at the time of my first essays, I remember 
having twice had cause to regret that I had combated with non- 
specific remedies only a case of syphiUs the first outbreak of which 
had been a papular and squamous eruption. Yesicular and pustular 
syphilides also carry with them, of course, an unfavourable prognosis.'' 
We evidently could not pass over in silence these interesting remarks 
of one of the most esteemed syphilographers of our day, and if we 
do not entirely agree with them, under the idea that fresh researches 
are necessary upon so deUcate a point, we none the less feUcitate our 
Lyons colleague upon having been one of the first to enter upon a 
path altogether practical, and which, assuredly, promises to be 
useful. 

A question often discussed is in place here, that of knowing 
whether, since the end of the fifteenth century to our own day, 
syphilis is on the decrease and tending to disappear. Por the pur- 
pose of solving it, let us establish the primary severity of this 
disease. The following is the description given of it by Cataneus in 
1505 : — "Monstruosus morbus foetiditate magna, innumeris pustulis, 
ulceribus per totam faciem universumque corpus, magna etiam ssevitia 
dolorum noctu prsesertim humanum genus affligens laceransque no- 
dositatibus instar lapidum, plerosque debiles et mancos effecit, et 
tahter in humanum genus grassatus est ut quodcumque genus mortis 



* Diday, Histoire nat de la syphilis^ p* 119. Paris^ 1863. 



PBOQNOSIS. 207 

potius eligendam sit." ^igo^ speaking of the pains whicli super- 
vene in syphilitics, wrote: — ^^'Doloribua clamosis laborant/' We 
know Fracastor's account and that^ with most of the authors of the 
sixteenth century, he admitted that there was, even in his day, a 
diminution in the intensity of the evil.* A Par^ agreed in this 
opinion. '^The syphilis of the present day,'' he says, ^'is much less 
cruel and more easy to cure than it was at the time of its commence- 
ment j for it is evidently becoming milder every day."t Astruc 
does not hesitate to partake of this view; and why not believe in 
these authors, worthy, in every respect, of our confidence, and recog- 
nise, with them, that there has been a diminution in the intensity of 
syphilis, especially when certain syphilographers, including Diday, 
admit a decrease in the power of the poison, which they attribute to 
the fact of its successive migration from individual to individual ? 
This is doubtless difficult to judge of, for if the syphilis of our day 
is not comparable to- that of the Naples epidemic, that may depend 
simply upon differences in the hygienic conditions. The severity of 
the endemo-epidemics of syphilis which have raged since the end of 
the fifteenth century is, at the very least, in favour of this view. If, 
in those epidemics, syphilis appeared more intense and more malig- 
nant, it was by virtue of certain accessory causes which presided 
over its extension, and thus it is not proved that syphilis is less 
severe now than it was at the climax of its existence. The inference 
drawn from the weakening of the vaccine poison is without value, 
since this weakening may depend, not upon the repetition of the 
transmissions, but upon the transfer of the virus from one species 
to another. Without wishing to maintain so strongly as BoUet 
that syphilis has not become at all milder since its origin, we think 
that if it has diminished in intensity, it has not done so to an extent 
to justify the hope, entertained by some authors, of seeing the disease 
become extinct spontaneously. On this point we agree with Eeruel, 
who wrote : '' Nisi Deus opt. max. sua dementia ipse extinguat, aut 
effrenem hominum libidinem temperet, nunquam extinctum iri, sed 
fore humano generi comitem et immortalem crediderim." :|: 



* See Historical Notice, vol. i. p. 27 of this work. 

t Par6, CEuvres, t. ii. p. 533, Edition Malgaigne. Paris, 1840, et §dit. 
LyoQ, 1852. 

X Femel, De tuts venerea curatione perfectissima liber, cap. ii. See 
AjphrodisiaciM de Gruneri p* 143. 



PART IV. 



ETIOLOGY. 



CHAPTEE I. : 

BrFIOIBNT OATISB. — THE STPHIUTIC POISON ; ITS ACnOK, ITS MOSES 

OF THANSIOSSIOK. 

Vaeious opinions have been uttered concerning the efficient cause 
of syphilis. The first physicians who described this disease, influ- 
enced by the astrological ideas of their times, did not fail to attribute 
to the stars a share in its genesis. It is thus that P. Pinctor,* 
Qrunbeckjt P« Maynard, &c., ask themselves to what stellar influ- 
ence or to what conjunction of the planets men owed the appear- 
ance of this scourge. Leonicenus attributed it to the inundations of 
1498. Other authors, imbued with the humoral or Galenic theories, 
admit with N. Massa,$ that this evil has its source in a peculiar 
disposition of the liver, a kind of metastasis of bilious matter to the 
genital organs. By degrees, and in proportion as the influence of 
sexual intercourse in the propagation of the disease was recognised, 
these first ideas were abandoned. One of the contemporaries of the 
epidemic of Naples, Al. Benedetti, points out as the principle of 
syphilitic contagion a special cause, a venereal tint, the origin of 
which he places in the change in the humours exhaled by the genital 
organs of the woman. Paracelsus, who was one of the first to adopt 
the denomination lue9 venerea given by Bethencourt, almost divined 



* Pinctor, TracUUus de tnorbo fcsdo et occuUo, his temporibus qffligente, 
1499, cap. iv. 

t Granbeck, Tractatua de peatilentia Scorra nve mala de ^anzos, 1503| 
cap. iv. 

I N. Massa, De morho gaUico libera cap. iv. 



SYPHILITIC VIBUS. 209 

the true nature of syphilis^ when he pointed out the venereal miasm, 
which he regarded as the constituent principle of the disease. Once 
introduced into the economy, this miasm combines with all other 
diseases, modifies them, and gives them a new form ; but its effects 
do not stop there, for Paracelsus, pushing his system to its extreme 
limits, admits that this miasm may produce a number of affections, 
such as phthisis, dropsy, diarrhoea, the exanthems, lupus, cancer, 
&c. 

Whether there be evidence of genius in the views of Paracelsus or 
not, the credit cannot be denied him of having suspected at one and 
the same time both syphilis and most of its numerous effects. 
Femel* points out in a more precise manner the true cause of syphi- 
lis. The cause of the venereal disease, he tells us, is an occult and 
poisonous quality contracted by contagion, inherent in some matter 
or humour, which serves it as a vehicle and carries it into the econ- 
omy.f Thus, according to that great physician, the air and the 
breath cannot communicate this disease, and the contact of some 
matter which contains the poison and serves it as a vehicle is neces- 
sary, j: Under these circumstances, syphilis comes into the class of 
contagious diseases, and Pemel does not fail to compare it to hydro- 
phobia and poisoning by the bites of animals. In this manner, he 
passes judgment upon all the strange opinions which prevailed before 
his time concerning this new disease. After Eemel, the doctrine of 
the virus was, however, not yet adopted. Varendal, taking up again 
the ideas of Massa and Pallopius, makes the liver once more the 
starting-point of the lesions of syphilis. Nicolas de Bl^gny believed 
that the generating or material causo of venereal diseases was due to 
acids. Many other opinions not worth recording have been emitted 
on this subject. 

Physicians of high authority, Astruc, Boerhaave, Van Swieten, 
and several others, declared themselves advocates of the virus theory, 
which, later on, was definitively established by the experiments of 
Hunter. Set aside by Broussais and his school, this theory has again 
been adopted by Bicord, and at present few persons think of dis- 
puting it. But the authors who admit the existence of a syphilitic 



* Feme], De luis venerea curatione perfecttssima liber, cap. iv. 
t Luis venerese virus, non inspiratu, sed humore in quamvis partem 
cutis nudam defixo, sensim prorepit in omne corpus. 
X Loc, cit, cap. 1. 



210 JETIOLOGY. 

virus are not all agreed as to the properties and qualities of this 
morbid principle. Chemical and micrographical researches have not 
taught us anything concerning the essence of it. Numerous hypo- 
theses have been started to explain its nature. Certain authors 
regard it as an acid or alkaline substance^ or even as an acrid 
and corrosive poison ; others as a ferment^ a leaven, or even an 
incorporeal^ invisible principle (Femel, Cazenave). 

Amongst these theories it would be useless to pronounce a decided 
opinion until exact and numerous analyses shall have determined 
clearly the physical and distinctive characters of this agent. These 
researches have still to be made^ but the method by which they 
should be imdertaken is all traced out since the recent experiments 
which have shown that the virulent principle of vaccine lymph 
resides in solid granulations, or rather in living organisms dissemi- 
nated in the clear and transparent liquid which serves for inocula- 
tion. In any case, on the hypothesis that we may succeed in find- 
ing in the syphilitic poison these inferior organisms which play the 
part of ferments, there would still be the difficulty of experimenting 
upon human beings, and of proving that these organisms constitute, 
in reality, the virulent principle. If we may believe Dr. Salisburg 
{American Journal, U.S., cix., p. 17, Jan.), it is an algoid vege- 
tation which produces syphilis ; but before accepting the fact that 
this algoid filament exists as described by that physician, and 
especially before admitting that it may produce syphilis, we must, 
wait for fresh researches. The subject has hitherto been little 
studied, probably on account of the difficulty of procuring the virus 
in a state of simplicity and purity. "What we do know is, that it is a 
fixed and not a volatile principle, contained in a clear, transparent, 
opaline, slightly viscous fluid, to a certain extent analogous to 
vaccine lymph. This is, doubtless, not sufficient to distinguish it 
from any other organic fluid of the same colour and the same 
fluidity; the peculiar character of virulence is not indicated, and 
hitherto is only recognisable by its effects upon the organism; but 
that is enough, nevertheless, to distinguish it from every other prin- 
ciple. Purulence is here opposed to virulence ; for, so soon as 
pus appears, the virulent power diminishes, and contagion is often 
impossible. The liquid which is seen to ooze from the surface of 
the chancrous erosion is the best type which can be given of the 
syphilitic virus ; then, in fact, this virus is not mixed either with 
the detritus proceeding from a chancre much indurated and already 



SYPHILITIC VIRUS. 211 

in a process of retrograde evolution, or with the pus secreted by the 
chancre during the healing process, or with the pustule of ecthyma, 
or any other lesion ; neither is it mixed with numerous epithelial 
cells, or with globules of mucus, as happens when it proceeds from 
mucous patches. 

The product of morbid secretion, this virus is the effect of a disease 
of which it may become the cause, in the same manner that fruit, 
produced from a seed, may, in its turn, under given conditions, pro- 
duce similar fruit. There is nothing extraordinary in this, and let it 
not be said that this virus does not play any other part than that of 
occasional cause. Evidently, to produce syphilis, there is need of a 
predisposed organism, just as the seed requires fitting ground for its 
development. It is useless, then, to continue these speculations. 
This virus communicates its 'properties to the substances with which 
it is brought into contact, and these substances, like the virus itself, 
exert a specific action only on condition of not having undergone any 
change. Certain agents, such as acids, alkalies, chlorine, modify it 
greatly and deprive it of its deleterious qualities, and it appears that 
mortification of the tissues which are the seat of this pathological 
secretion leads to the same result. As regards its absorption, many 
authors have asked themselves how it is effected; but this question ill 
bears discussion : the agents of the absorption of the syphilitic poison 
are those of other substances, viz., the venous capillaries and more 
especially, perhaps, the lymphatic vessels. 

Another point more important in reference to therapeutical ap- 
plications consists in determining whether the absorption of the 
poison is immediate, or whether it only takes place after a certain 
time, and after a kind of multiplication of the morbific agent in the 
vicinity of the part contaminated. We have already stated what is 
to be believed on this subject ;* let us add that removal of the syphi- 
litic chancre does not, any more than cauterisation of it, prevent the 
infection from manifesting itself, as has been proved by carefully- 
made experiments. Evidently, before accepting positively the im- 
mediate absorption of the syphilitic virus, it would be necessary to 
perform the same experiments which have been carried out with the 
vaccine virus, first to inoculate, then to wash the wound, cauterise it, 
apply a cupping-glass to its surface, and if, under such circumstances, 
chancre and its consequences appeared, it is clear that not the least 

* See Davaine^ Compter rendtM de VAeadinik de$ Sciences, 1865. 

#3 



212 -ffiTIOLOGY. 

doubt would exist. But the duty whicli requires that we should not 
risk the health of our fellow-creatures renders such experiments 
impracticable. In reality^ have we much need of this with the infor- 
mation acquired from the vaccine virus^ the great analogy of which 
with the syphilitic virus is known, and is there not great reason to 
believe that, like the vaccine and small-pox poisons, that of syphilis 
becomes disseminated in the various parts of the body, not germi- 
nating in one place, and that the whole economy undergoes at once 
the impression which it is capable of receiving £rom it ? But it 
cannot be admitted that all the principles known, rightly or wrongly, 
under the name of poisons, behave in the same manner. The malig- 
nant pustule exerts, from the first, an action entirely local ; but this 
diflPerence, into the reason of which we shall inquire again, may 
depend upon the special constitution of the contagious matter, which 
contains an abundance of bacteria. The difficulty of absorption of 
these corpuscles may explain, in fact, the local condition which here 
precedes the general condition, and also the non-infection of the 
foetus by the mother in inoculation with the malignant pustule,* as 
shown by M. Davaine. Without insisting further upon the analogy 
or the differences which exist between virulent principles,t let us see 
how we may conceive the mode of action of the syphilitic poison 
upon the tissues and organs. 

Is the poison in the blood ? To this question Hunter answered 
in the negative. According to that author the blood is not inocul- 
able ; but experiments which we shall quote further on prove dis- 
tinctly that that fluid, taken from an individual in the secondary 
period, is capable of communicating syphilis to a healthy individual. 
Thus there can be no doubt that the poison of syphilis, at a given 
moment, exists in the blood. But, this being granted, two hypo- 
theses are admissible. The blood may be virulent because the 
economy, impressed and modified by the contaminating drop, is fitted 
for secreting the virulent matter. This first hypothesis requires that 



* In female rabbits inoculated by him with the malignant pustule, M. 
Davaine was able to ascertain the perfect health of all the progeny, and 
while he found bacteria in the plaoenta, the blood of the foetus was 
entirely free from them. 

t Consult on this subject : Vauthier, Du virus syphUitique et de Bea effeU. 
Th^se de Paris, 1860. Ch. Robin, 8ur les HaU de virulence et deputridite 
de la substance organisie, Comptes rendus des stances et m§m. de la Soc. de 
biologic, t. V, s^rie iii. P^ter, thdse cit^e. Paris, 1863. 



SYPHILITIC VIRUS. 213 

all the humours should be virulent, which is not the case. Or the 
blood may be virulent because the contagious principle has mixed 
with and multiplied itself in it. This latter hypothesis appears more 
probable. Admitted by Astruc, accepted by Eollet, the multiplica- 
tion of the syphilitic poison rests, in reality, upon no proof ; but 
there is also no fact to contradict it. If it be true, however, that 
this poison becomes disseminated by attaching itself to one or other 
of the principles of the blood, we have to ask with which of those 
principles it combines by preference. And then it appears that it is 
to the globules rather than to the serum, since, in the cases of 
inoculation of the blood hitherto performed successfully, the success 
was attained only when blood globules were employed for the opera- 
tion, and the transmission of syphilis from an infected mother in the 
course of pregnancy to the foetus, or from a syphilitic foetus to the 
mother, is a comparatively rare occurrence, which would doubtless 
not be the case if the serum served as a vehicle to the syphilitic 
poison. Thus the syphilitic poison appears to attach itself by pre- 
ference to the blood globules and, carried by those elements, goes to 
modify the tissues. 

B. Bell and the majority of syphilographers believe in a direct 
action of the syphilitic poison upon the blood ; but this opinion 
appears little admissible. By the effects which it produces, this poison 
is, in our opinion, altogether comparable to certain irritant poisons, 
such as alcohol, which acts rather upon the solid than the liquid parts. 
In fact, like alcohol and many other substances, the syphilitic poison 
contained in the blood acts upon the network of the organs, in which 
it occasions, at the same time with hypersemia, the development of 
elements of new formation. 

Such is the period of the disease in which all the lesions which 
furnish a product of secretion are contagious and inoculable. Things 
run this course during a certain time (period of chancre and secondary 
affections). After remaining a longer or shorter time in the economy, 
the virulent agent is eliminated ; it is no longer either in the blood 
or in any of the products of physiological or pathological secretion, 
since the blood and those products have ceased to be inoculable, as 
is proved by experiments made on this subject. The disease, how- 
ever, has not completed all its phases, and the organism continues to 
suffer. The evolution of the malady goes on and fresh manifestations 
supervene, just as we see in a drinker who has long abstained from 
strong liquors, symptoms appear which it is impossible to attribute 



214 JSnOLOGT. 

to anything bat alcoholism. In this state^ which is the really chronic 
period of the disease^ it becomes evident that the organism has under- 
gone a modification and retained a peculiar aptitude for producing at 
▼arioua points of the body derangements which^ anatomically^ are 
characterised by a special hypergenesis of the connective tissues. To 
the simple impression made by the poison has succeeded impregna- 
tion^ and there results from it a modification of the whole organism 
so profound as to disappear with difficulty. The individual affected 
has acquired the syphilitic constitution, he is no longer a normal 
being) but an individual deviating from the type, having undergone 
a kind of degeneration. 

After having spoken of the syphihtic poison, there would be 
reason, doubtless, for asking what is its degree of force at the pre- 
sent time, and of inquiring whether, as certain authors suppose, it 
has diminished in intensity since the end of the fifteenth century. 
This question having been discussed elsewhere, we shall not dwell 
farther upon it. 

§ 1. Contagion. 

After having attributed to syphilis causes more or less imaginary, 
the first syphilographers ended by recognising that this disease was 
the habitual if not constant effect of contagion. At first they 
admitted that the contagion might take place at a distance ; but in 
1512, J. Almenar already spoke ironically of the cases of transmis- 
sion of this nature, which are to be believed religiously, he says, be- 
cause they have been observed in several religious persons. Fracastor 
(1580) declares that syphilis is no longer seen to be transmitted by 
the medium of the air. Vidus Vidius (1550) and Fernel deny that 
this mode of contagion ever existed. From that moment, contagion 
was accepted by most syphilographers, not only in the case of sexual 
intercourse, but in consequence of any kind of contact a little pro- 
longed, direct or indirect, and especially by suckling, by the common 
use of household or other utensils, and by inheritance. 

The error of that period was to admit the transmission of syphilis 
without distinction of periods and by all kinds of humours, patho- 
logical or physiological, especially by the milk, the perspiration, the 
saliva, &c. Nevertheless, the two modes of propagation of syphilis, 
contagion and inheritance, were known. Hunter would not believe 
in the hereditariness of syphilis. A celebrated school has more 
recently denied the contagiosity of secondary lesions. But, to the 



CONTAGION. 215 

numerous observations of ancient authors have been added facts 
which^ at the present daj^ place beyond doubt the mode of propaga- 
tion bj those lesions. 

SoTJECEs OP Contagion. 

Hunter showed without difficulty the small value of the opinion 
which, up to his time, regarded as so many sources of syphilis all 
the humours of persons affected with that disease. The inoculations 
which he practised upon individuals already diseased were, however, 
far from leading him to the truth. Starting from the result of his 
inoculations, he arrived at the conclusion that primary chancre and 
gonorrhoea are the only inoculable lesions. According to him, con- 
stitutional lesions and the blood are not contagious. This must be 
so : since syphilis does not generally become doubled, the lesions 
which Hunter regarded as contagious could not, consequently, be 
syphilitic. Bicord, repeating the experiments of Hunter about 
1836, arrived at the same conclusions; but, like Balfour, Bell, 
Hernandez, &c., and contrary to Hunter, he regarded gonorrhcea as 
a special disease, different and altogether distinct from chancre. 

However, about the same time at which Eicord threw fresh lustre 
over the opinions of Hunter, a singular reaction took place in the 
very country of the latter. In 1835, Wallace proceeded, like 
Hunter, by aid of experiments; but, instead of inoculating the 
patient himself, he took up the idea, little praiseworthy, no doubt, 
in a human point of view, of transferring the contagious principle 
from a diseased to a healthy individual. But the consequences 
which resulted from this mode of experimenting were altogether 
different; secondary lesions, of which Hunter had denied the con- 
tagious character, produced positive results in the hands of Wallace^ 
and from that time a fatal blow was given to the doctrine, a step 
had been made, a new doctrine had sprung up. In fact, the experi- 
ments Wallace repeated showed that the contagious humours are 
furnished by multiple lesions, and that they are generally the effect 
of a pathological, more rarely of a physiological secretion. 

The products of pathological secretion are contagious only on 
condition of their having a specific origin. ^^ The non-specific mor- 
bid secretions of a syphilitic subject (pus, catarrhal matter, serum of 
eczema,'' &c.), writes Diday,* '^ are not contagious. I inoculated 

* Gaz. m6d, de Lyon, February, 1865, p. 47. 



216 ETIOLOGY. 

unsuccessfully a healthy young woman with the matter from a pustule 
of iodic acne taken from a syphilitic patient in the climax of secondary 
eruptions/' The inoculation, by the same experimenter, of the 
serous discharge of eczema was equally unsuccessful. Drs. RoUet 
and Viennois * showed, at the Lyons Medical Congress, that pure 
vaccine matter taken from a syphilitic subject transmits the vaccine 
poison only. The mucous fluid which escapes from the nose of a 
child suffering from syphilitic coryza has, however, been regarded as 
contagious. Chabrely f and H. EogerJ have given cases which 
leave no doubt as to this point; but it may be asked whether this 
secretion was not the product of mucous patches. 

The syphilitic lesions which give birth to the contagious principle 
are those called primary and secondary. 

1st. Primary lesion. — "Whether manifesting itself in the form of 
indurated chancre or chancrous erosion, the primary lesion is emi- 
nently contagious. Two sets of proof support this proposition ; the 
one set are clinical, the other experimental. The clinical facts are 
numerous, and it would be tedious and troublesome to quote them 
here. Dr. Alf. rournier gives several instances of it in his inau- 
gural thesis,§ and adds : " Let it suffice for me to say that, in a 
series of seventy-two observations, indurated chancre has always 
produced (in healthy subjects, of course) a chancre of the same 
nature, and always, under these circumstances, syphilis has followed 
the chancre on both sides.^** 

Experimental facts are no longer rare at the present day, and those 
furnished byRinecker,|| Gibert,ir Eollet,** and Baerenspruugft leave 
no doubt on the mind. The primary lesion or infecting chancre is, 
then, contagious. Mixed or hybrid chancre is also capable of trans- 
mitting syphilis. The same holds good for phagedaenic chancre ; 
the latter is, however, less to be feared in this respect. It has been 
asserted that simple chancre, developed in a syphilitic subject, might 



* See Bouchard, Gaz, hebd, de mid, et de chir,, 1864, p. 700. 
f Journ. de mSd, de BourdeauXf Jan. 1859. 
X Union medicale, 1865. 

§ Alf. Foamier, De la contagion st/philitique, Thdse de Paris, 1860. See 
also Ricord, Zegons aur le chancre, Paris, 1860, p. 252. 
fl See Archives de mSdedne, t. ii. p. 597. 

H Gibert, Traiti des malad, de la peau et de la 8yph, Paris, 1860, 
** Rollet, Recherchea aur la ayphilia, 1861. 
tt Annalen dea Krankenhauaea in Berlin, 



CONTAGION. 217 

have the same property. Five cases bearing upon this point collected 
by Pournier, and three others furnished by Melchior Eobert, seem 
to show the possibility of syphilitic contagion under such circum- 
stances ; but when these cases are examined with care, it is soon 
recognised that they are far from being altogether conclusive. The 
details are wanting as to the characters of the chancre which was the 
source of infection. In one case it is stated (obs. by CuUerier) that 
the chancre was a simple one or soft at the base ; but not all syphi- 
litic chancres, as we know, have a distinctly indurated base, especially 
in women. Moreover, did no secondary lesion exist there ? This is 
a question difficult to answer, but however the case may be, if the 
chancre vrith a soft base in syphilitic subjects may be transmitted in 
the form of an infecting chancre, this contagion, even by Foumier's 
account, must be rare. Again, the pus of a simple chancre, developed 
in a syphilitic subject, was inoculated by Basset and produced only 
a simple chancre. Soft chancre, with perpendicular edges, in an 
individual not affected with syphilis, evidently does not transmit 
syphilis ; we have already stated this opinion,* which we consider 
well founded until further proof against it has been brought forward. 

The question of syphilitic contagion by means of gonorrhoea 
naturally presents itself here ; but further discussion of it is quite 
uncalled-for. It has already been established t that gonorrhoea is 
a disease distinct from syphilis, and that it cannot produce the latter. 
Pure gonorrhoea! mucus taken from a syphilitic subject and inocu- 
lated in the skin, as performed by Basset,$ is not capable, more- 
over, of transmitting syphilis. There is nothing contagious, then, 
in a syphilitic subject, amongst the products of morbid secretion, 
except those which have a specific origin. 

2nd. Secondary lesmia. — The contagion of secondary lesions, like 
those of the primary lesions, rests upon clinical and experimental 
facts. The clinical facts are numerous and go back to a very remote 
period, since G. Torella already speaks of the transmission of syphilis 
between nurses and nurslings. It would be interesting, but much 
too long, to make known all these facts, of which a certain number 
have been collected by Eollet§ and by Alfred Fournier.|| The ex- 

• Vol. i. p. 102 of this work. f Vol. i. p. 92 of this work. 

X See Lettre de fiouohard (Gax. hehdom.j 1864, p. 706). 
§ Bollet, Du chancre produit par la contagion des accidents secondaires 
{Archives de midecine), 

II Foarnieri De la contagion syphiiitique, Thdse de Paris, I860. Com- 



218 AETIOLOGY, 

perimental facts^ whicli are more rare^ carrj with tliem a more abso- 
lute degree of certainty. We need not quote them here, having 
already given an abstract of the majority of them ; a glance at the 
Table at page 69, Yol. I., conveys more information than any descrip- 
tion. That Table not only shows that the majority of secondary lesions 
are contagious, it points out that the degree of contagiosity of those 
lesions is in proportion to the period of their apparition and to the 
abundance of their secretion, or in other words, the sooner they 
show themselves, and the more they secrete, the more apt are they 
to transmit the diseases from which they spring. Thus, mucous 
patches seem to hold the first rank, then come pustular syphilides, 
all manifestations of the period of general eruption. The pustule 
of ecthyma, which served for the inoculation in Vidal de Cassis' 
case, evidently belonged to that period, for only some months, at 
most, had elapsed since the disappearance of the chancre. With 
the exception of roseola and papular syphilide, which do not furnish 
any product of secretion, secondary lesions are, then, transmissible 
by contact ; thus we have been able to advance that one of the 
characters of syphilis at that period is its contagious property. Is 
that characteristic sufficient to distinguish secondary manifestations 
from tertiary manifestations ? That is more than we dare affirm ; 
but what it is possible to say is, that there does not exist at present 
a single case to prove the contagiosity of the affections grouped in 
our last period. 

No experiment, it is true, has been made hitherto concerning the 
contagiosity of the tardy deep-seated syphilides. Diday convinced 
himself by experiments that tertiary lesions are not inoculable. 
Other experimenters have arrived at results equally negative, and in 

pare: Bulletin de VAcad, de mid,, May 24 th and 31st, 1859 ; iUd, t. xxiv. ; 
Giber t, Traiti des maladies de la peau et de la syphilisy t. ii. p. 483, 1860. 
Follini De quelquea doctrines modernea sur la syphilis et la syphilisation 
(Archiv, de mSd., February, 1856). Las^gue, Mime Journal^ May, 1858. 
Guyenot, Qaz. kebd., et Gaz, mid. de Lyon, 1859. Langlebert, Moniteur 
des h6p,. No. 61, 1859. De Gastelnau, TransmissibilitS des accidents second, 
Moniteur des hdp., Nos. 65, 66, 67, 70, 1859). Gabalda, De la contagion des 
accidents second, de la syphilis. Paris, 1859. Joulin, Moniteur des hdpitaux, 
No. 10. Saurel, Transmission de la syphilis second, (Revue tb§rap. da 
Midi, xiii., July and Aug.). Junquet, Syphilis congSnitale contagieuse 
{Montpellier midical., Aug., 1859 ; Gaz, hebd,, 1859, No. 46). Friedberg, 
Kann die Syphilis auch durch andere Secretionen ubertragen werden, als 
durch Schankereiter f (6ehrend*s SyphUidologie, t. ii. part 2). 



CONTAGION. 219 

spite of the numerous punctures whicli I have made in my skin 
whilst making post-mortem examinations of bodies in which gummy 
tumours existed^ I have never contracted anything. All observers 
do not, however, appear to be agreed upon this point, and Dr. 
Craith* admits the contagiosity of certain forms of tertiary syphilis. 
In any case, if it be true that the contagious power may still exist 
in the last period, it is at least much weakened. 

The earlier syphilographers admit freely enough syphilitic conta- 
gion by the physiological secretions, and especially by the milk and 
semen. However, as they do not give any distinct observations on 
this point, the study which we are about to make of it is, so to 
speak, 'quite new. 

The blood. — Hunter did not admit syphilitic contagion by the 
blood; this fluid, according to that observer, has no contagious 
quality. If, he said, the blood could produce syphilitic inflammation 
in a healthy wound, no subject who has venereal matter in circula- 
tion, that is to say who is affected with constitutional syphilis, could, 
under certain circumstances, escape a venereal ulcer; every time he 
was bled, or scratched himself with a pin, the small wounds thus 
produced would be transformed into so many chancres.f Not 
knowing that syphilis cannot become doubled. Hunter reasoned in 
this way; it never struck him that to ascertain whether syphilitic 
blood is contagious, it is necessary to inoculate a healthy person and 
not one syphilised. But what Hunter did not do. Waller, of Prague, 
had the boldness to do. On the 27th of July, 1850, in the presence 
of a great number of physicians and pupils, he inoculated a boy of 
15 with the blood of a woman affected with secondary syphilis. 
On the 31st of the following month, tubercles were observed at the 
points of insertion, which were followed soon afterwards by second- 
ary symptoms. Gibert performed a similar operation with equal 
success.} In 1856, the Secretary of the Medical Society of the 
Palatinate announced to that body that a physician who wished to 
remain incognito had inoculated nine healthy individuals with the 
blood of a person affected with secondary syphilis : of this number 
three only, in whom a large absorbing surface had been rubbed, were 
inoculated successfully. § On the 6th of February, 1862, in pre- 

• On the tertiary forms of syphilis proving contagious {Med. Times and 
Gazette, March 19th, 1859). t Complete Works. 

X Gibert, TraitS des maladies de la peau et dela syphilis. 
§ See Lasdgue, Archives ginir. de mid., t. i. p. 603, 1858. 



220 JETIOLOGT. 

sence of all the physicians of the Florence school, Pellizzari who, in 
I860, had tried two inoculations without result in the persons of 
Drs. Belli and Testi, repeated his attempts upon Drs. Bargioni, 
Bossi, and Passigli, who offered themselves courageously.* Two of 
these inoculations remained without result; but on the 3rd of 
March, Dr. Bargioni saw appear on his left arm, at the point of 
insertion, a papule with a hard base, accompanied by adenopathies 
in the axilla, and followed, later on, by secondary symptoms. 

By adding to these cases four negative inoculations performed by 
Dr. Thiry, and three others furnished by a physician at Albi, Dr. 
Lalagade,t we arrive at a total of twenty-three operations, of which 
six only were followed by a positive result. The following is a 
tabular view of these cases : — 

Inoculatdons. With sttccees. Without success. 

Anonymous &om the Palatinate 9 3 6 

Waller .... 1 1 — 

Gibert 

Pellizzari 

Thiry . 



Lalagade 



11 — 

5 14 

4 — 4 



3 — 3 



23 6 17 



It is clear that the negative facts here cannot annihilate the posi- 
tive facts ; a single one of the latter suffices to make us admit the 
contagiosity of the blood of persons affected with syphiUs. For my 
own part, I do not doubt this contagiosity after Pellizzari's case and 
the details which have been furnished me by the courageous cham- 
pion who was the object of it, my excellent colleague and friend Dr. 
Bargioni, of which the following is the account : — 

The woman whose blood served for the experiment was 25 years old, 
unmarried, and in the sixth month of pregnancy. . . . She presented 
very confluent and very moist mucous papules on the genitals ; one of 
these, situated upon the left labium majus, near the lower commissure, 
where the patient informed us she had had the first manifestation of her 
disease, was larger and more raised than the others, and had a base with 
evident specific induration. This was either the infecting chancre trans- 
formed into a mucous patch, or a mucous patch which had developed itself 



* See Gaz, hebdom. de mid. et de chirurgie, 1863, p. 349. 
t Retme thSrap, mid.'Chirurff., June 25th, 1859. 



CONTAGION. 221 

upon the cicatrix of the primary chancre. There were also seen mucous 
papules around the anus, and greatly enlarged glands, hard and indolent, 
in the groins. There existed, moreover, a confluent erythema, adeno- 
pathies in the back of the neck, and firm pustules on the hairy scalp. No 
treatment had been used ; she was bled from the cephalic vein of the 
right arm; no eruptive manifestation existed at this point, which had 
been washed previously. The surgeon had washed his hands carefully, 
and the tape, the lancet, and the receiving vessel for the blood were all 
new. As soon as the blood was drawn, a pledget of lint was dipped in it 
and applied to the upper and outer part of Dr. Bargioni*s left arm, near 
the insertion of the deltoid, where the epidermis had been removed and 
three transverse incisions made. 

M. Kossi was operated upon in the same way, but with this difference, 
that the epidermis had been removed from the upper and outer part of 
the left fore-arm, and further that the blood applied had already become 
cold. M. Passigli was inoculated in the same region and in the same 
manner as M. Bargioni ; but the blood was almost completely coagulated, 
and for that reason, in addition to the liquid portion, a part of the clot 
was applied to the excoriated surface. The extent of surface destined 
for the inoculation was two centimeters in length by one centimeter in 
breadth. 

The bandage used for M. Bargioni was taken off in twenty-four hours, 
and nothing peculiar was observed, except a slight blackish crust due to 
the drying up of escaped blood. The same day, the bandage was removed 
from the arms of the two other doctors, and nothing remarkable presented 
itself. Four days after, all trace of the inoculation had disappeared. 

On the morning of March the 3rd, during my visit at the hospital, M. 
Bargioni told M. Pellizzari that at the centre of the surface on which the 
blood had been inoculated he had observed a slight projection which 
itched a little. M. Pellizzari examined the arm and saw at the point indi- 
cated a small papule rounded in shape and of a rather deep red colour ; 
no induration was observed at the base of the papule, nor any swelling of 
the axillary glands. M. Bargioni was requested to place upon the papule 
lint smeared with simple cerate to prevent any friction. This papule, 
which was carefully examined every day, increased so much as to attain, 
in a week only, the size of a twenty-centimes piece. 

On the 11th, it was covered with a fine silvery scale, which was closely 
adherent ; on the following days, this scale became thicker, less adherent, 
and began to split at its centre. 

On the 14th, two glands were observed in the axilla of the size of a 
small nut, laovahle and indolent like the papule, the sensibility of which 
latter had^ However, become somewhat increased. 

On the 19th, on pressing the scale which covered the papule, there was 
seen to issue from its periphery a small quantity of purulent serum, and 
pressure occasioned slight pain ; the glands in the axilla had become 
larger and harder, but still remained indolent. No induration was observ- 
able at the base of the papule. 

On the 21 sty the scale had become transformed into a true crust, which 



222 JETIOLOGY. 

at some points of its periphery, began to be detached, leaving plainly 
to be seen beneath it an ulcerated surface, slightly indurated at its base. 

On the 22nd, after the crust had been removed, Afunnel-ahaped chancre 
was seen ; its edges offered a certain elastic resistence, so as to represent 
well-marked annular induration; they were swelled, adherent, and 
obliquely inclined towards the floor of the chancre, which was almost 
dry and covered with a layer which was almost diphtheritic. There was 
scarcely any pain. The sore was dressed with dry lint. 

On the 26th, the chancre was of the size of a half-france piece ; it 
secreted more freely ; its appearance was that of a small funnel reversed. 
The induration had greatly increased. The simple local treatment with 
dry lint was continued. Before commencing any internal treatment. Dr. 
Bargioni wished to wait for general symptoms. Nothing remarkable 
presented itself until April 4th ; the chancre remained stationary, with a 
granular floor ; the glands remained large, hard, and indolent. 

On the 4th of April, there was slight nocturnal cephalalgia, which con- 
tinued for two or three days ; a glandular enlargement at the back of the 
neck was also observed. 

On the 12th, there were seen upon the surface of the body, and espe- 
cially on both sides of the thorax and about the hypochondriac regions, 
spots of an irregular shape and pink colour, unaccompanied by any feeling 
of illness. The glandular enlargement in the neck had become more 
marked. The erythema, more extensive and more confluent on the fol- 
lowing days, left no doubt as to its syphilitic nature. No fever, no 
catarrhal phenomena, no heat or itching of the skin, nothing, in short, 
accompanied this maculated erythema, which went on increasing for a 
week. 

On the 20th, the cervical glands and the sub-epitrochlean glands had 
gained in size and resistence, and the chancre was still in the same state, 
without showing any tendency to cicatrise. 

On the 22nd, the erythema was absolutely copper-coloured and 
studded with lenticular papules. The primary chancre was beginning to 
heal and a mercurial treatment was adopted. 

It is to be remarked that, in these different cases, the lesion \phich 
served for the inoculation belonged to the secondary period ; experi- 
ments performed by Diday with blood taken from individuals affected 
with tertiary symptoms have always given a negative result,* and 
that author thinks that at the period of those symptoms the blood 
has ceased to be inoculable, and I willingly join in his -belief that 
the contagiosity of the blood lasts no longer than that of the 
secondary symptoms of syphilis. 

Some experiments by Melchior Robert would seem to show that 

" ■ .— .1 — ...^.fc^i„„,,|,|^|MM—^««<l ■ I I. - Mi I ■ I ■ M I I ■ I I I II ■ I I III I— 1»»— II ■ ,m 

• Gax. de Paris, 1849. 



CONTAGION. 223 

the blood does not yet possess any contagious property at the com- 
mencement of the period of local eruption (primary lesion), if there 
were not good reasons for believing that that syphilographer had 
confounded true and false syphilis. He remarked, in fact, that the 
blood taken from a wound made in the excision of chancres, whether 
simple or indurated, is not inoculable from one patient to another 
during the first three days which follow the excision, but only as 
soon as suppuration has become established on the surface of the 
wounds, that is to say, about the fourth day. 

To sum up, the blood may be contagious during the continuance 
of the primary lesion, and is no longer so during the tertiary period. 
It is so certainly daring the secondary period, and, in our opinion. 
Dr. Yiennois is right in asserting that that fluid may serve for the 
transmission of the syphilitic poison in vaccination. But vaccina- 
tion is not the only mode of syphilitic contagion by the blood. If 
it be true Ihat an infected mother is capable, in the course of preg- 
nancy, of communicating the disease to her child, or that the latter 
may infect its mother while still in the womb, it must be admitted 
that the blood is the only means of communication between the two 
individuals, unless we assume, which is very improbable, that 
secondary lesions have developed themselves in the interior of the 
womb. 

Transmission of syphilis to tAe/ostus hy a mother infected after the 
moment of conception, — ^Eleven cases collected by Diday,* for the 
purpose of showing that syphilis is transmissible from the mother to 
the foetus, when it is contracted after the fourth week and before the 
seventh month of pregnancy, have not appeared to us to be very 
clear and positive. It is not proved, in fact, that the child infected 
at the moment of its birth or soon after it, was not infected by the 
father, who had not infected the mother until after conception, and 
doubt on this point is at the very least justified by observations due 
to Starck, Depaul, Bertin, and several other authors. Moreover, 
the infection of the child is not always certain : such is a case of 
Bertin's, in which the child presented no other lesions than ulcerated 
pustules on the buttocks ; such again is Baumes' case, in which the 
child, which recovered, presented pustules of syphilitic ecthyma (a 
lesion difficult to specify) upon the buttocks, on the chest, and on 

* Diday, Traiii de la Byphtiis dee nouveau^nSs et des ef\fanU h la mamelle* 
VeLm, 1854, p. 45i 



224 JETIOLOGY. 

the cheeks. The case observed by Diday himself is not more con- 
clusive ; it was that of a woman who took by contagion mucous 
tubercles of the throat, and who afterwards presented most distinct 
signs of constitutional syphilis ; the infection occurred at the com- 
mencement of the seventh month of pregnancy. But mucous 
tubercles are not the primary lesion. How far back, then, did the 
latter dateP Was it not previous to the pregnancy? or did it 
occur after conception? There was nothing to determine this. 
Like Diday, Trousseau believes in the transmission of syphilis under 
similar circumstances, and quotes a case in support of his opinion.''^ 
Putegnat also takes this view. Despite these imposing authorities, 
we believe that facts do not yet sufficiently prove the contagiosity of 
syphilis under such circumstances. Moreover, NataUs Guillot and 
Boys de Loury have seen women affected, at the time of delivery, 
with primary lesions contracted during the latter period of pregnancy 
give birth to children in whom no trace of syphilis manifested itself. 
Mandon, of Limoges, writes that " syphib's contracted by the mother 
during her pregnancy is not transmissible to the foetus."t That 
author, it is true, is content to deny without bringing forward any 
proofs-; but the same does not apply to Baerensprung, who declares 
that a mother contaminated during pregnancy does not infect her 
infant. That author bases his assertion upon fourteen cases in 
which syphih's, contracted at all periods of gestation, even in the fifth 
and sixth month, was not transmitted, since the children were in 
good health eight and ten weeks after birth. Such is the state of 
the question in reference to the contamination of the foetus by a 
mother infected in the course of pregnancy. This cannot yet, in our 
opinion, be definitely settled ; we must avoid drawing too hasty a 
conclusion. A case which presented itself to our notice gives the 
measure of this difficulty. A young woman of 18 was infected two 
months after conception and delivered at the eighth month of a 
still-bom child, which presented no trace of change. Could this 
child be regarded as syphilitic ? The proofs are evidently wanting, 
and this case cannot lead to any really scientific result. 

Transmission of syphilis from the fostus to the mother. — High 



* Cliniqtte mSdicaley t. ii. p. 669. Paris, 1862. 

t La mire peuUelle transmettre au fxtua la diathise acqmse pendant sa 
grossesse f {Journal de mSdecine de Bruxelles, Jan. and Feb., 1856, p. 116, 
et Gaz. held,, 1856). 



CONTAGION. 225 

medical authorities agree in admitting this form of contagion. 
" The husband/' says Eicord^ '' may beget an infected child which 
shall propagate the secondary virus to the mother.'^* Depaulf 
writes : — '* The mother being undoubtedly healthy and the syphilis 
having been transmissible by the father alone^ and that only at the 
moment of conception, the embryo, alone diseased for some time, 
may in its turn, during its sojourn in the womb, infect its mother.'^ 
According to Bazin,:|; the foetus to which syphilis has been trans- 
mitted by its father, may infect its mother during intrauterine life, 
and the lesions which develop themselves in her are then very com- 
municable. S. Cooper, Maisonneuve and Montanier, Hutchinson,§ 
and Balfour || are of the same opinion, which is also shared by 
Lafont-Gouzy If and Putegnat de Lun^ville,'*^ and supported by 
the observations of Semanas ft and Diday. The cases of this kind 
may be grouped under two heads. In the one set, those of Semanas, 
Bazin, J J Beyran,§§ and some of Diday 's, it is a question of second- 
ary manifestations supervening several weeks or several months after 
delivery ; in the other, the syphilis showed itself in the course of the 
pregnancy. The objection to which all the first set of cases is liable 
is, that the contamination may have taken place at the time of 
delivery ; the objection to the second set is, that gestation was the 
occasional and not the efficient cause of the syphilis, the primary 
lesion having passed unperceived, as happened, indeed, in Observa- 
tion IV. of RoUet's report. nil The same objection also applies to 
the three observations of Dr. Balfour, in which the same syphilitic 
lesions were observed to reappear in several successive pregnancies. 
Later on, when we shall point out the influence of pregnancy upon 
secondary syphilitic eruptions, it will be easier to judge of the 

* Diday, Syphilis des nouveau-nis, p. 243. 

t Depaiil, MSmoire lu d VAcadSmie de Medecine, April 9tb, 1851. 
(Bulletins de VAcadSmie,) 

X Lemons sur les syphilides^ 1859, p. 45. 

§ Med, Times and Oaz,, 1856 ; and Gaz, mSd., 1857, p. 646. 

II Edinburgh Med, Journ,, 1856 ; and Ga%, mid., 1857, p. 754. 

^ Lafont-Gouzy, Journ. de mid, de Toulouse, April and May, 1854. 

** Putegnat, Hist, et tMrap, de la syph, des nouveau-nSsy 1854, p. 114. 

ft Semanas, Gaz, mSd, de Paris, 1849, p. 777. 

XX Diday, he, cit, ; et Exposit, des nouv, doctr, sur la syphilis, p. 466. 

§§ Beyran, Transmission de la syphilis dupire an foetus et du fostus d la 
mire ( Union mid,, 1862, t. ii. p. 457). 

1111 Rollet, Recherches sur la syphilis^ 1861, p. ISO. 

2 



226 JETIOLOGY. 

reserve necessary on such a subject. As yet, therefore, we cannot 
admit as certain the infection of the mother by the foetus. 

The milk. — ^Vemois and Becquerel, in some interesting researches 
into the composition of the milk of women in a state of health and 
in a state of disease, have ascertained that in the milk of syphilitic 
women the butter is greatly diminished in quantity, while the salts 
are increased out of proportion and the specific gravity attains an 
extraordinary height. Although this fluid, when examined under 
the microscope, does not present anything peculiar, we cannot help 
asking ourselves whether it may not be contagious. Stahl and most 
of the syphilographers of the last centuries suspected syphilitite infec- 
tion by the milk. Cataneus,* Paracelsus, Ambrose Pard,t and many 
others, firmly believed in it. Astruc, Fabje, Doublet, Bell, Mahon, 
Bertin, and Cooke were of the same opinion. This opinion was 
professed more recently by Lane, Parker, Putegnat de Lun6ville,t 
Melchior Robert, and Eicordi, of Milan. But Hunter, Swediaur, 
and Nisbett deny tb's mode of communication, which Barbantini, 
Dug^s,§ Venot, N. Guillot, Bicord, and Nonat are unwilling to 
place In the list of infecting causes. 

Two opposite opinions are here confronted with each other ; asser- 
tions are not wanting, but few facts are brought forward in proof of 
them. In our opinion, infection by the milk, as it was understood 
by the ancients, cannot be admitted, since everything leads us to see 
in the observations quoted in support of this doctrine, contamination 
by the secondary lesions developed in the breasts of the nurses and 
remaining unobserved. Must we accept with more confidence the 
observations of the modems ? Melchior Bobert gives as perfectly 
conclusive two cases of which the following is an abstract; but. they 
are far from satisfying a strict observer : — 

A uursiDg mother, free from all Venereal disease, was suckling a healthy 

* Lac enim quum ex sanguine generatur, malam sapit qualitatem in 
sanguine prseexistentem. 

t Infants suckled by syphilitic nurses are infected by them, seeing that 
the milk is nothing but whitened blood, which being infected by the vims, 
the child fed with it imbibes the same qualities, &c. {CEuvree completes, 
Lyons, 1652.) 

t Putegnat, EM, et therap, de la ayphiUa dea nouveathnSs. Paris, 1854, 
p. 102. 

§ De Tinnocuiti du lait des nourricea aUeintes de eyphtlie jpaur lee en/ante 
qu'elUs nourrissent Thdse de Paris> 1852> No. d7« 



CONTAGION. 227 

child, when she had connection with her husband, who had contracted 
syphilis a month before. Six weeks later, confluent spots appeared upon 
the body of the child, and the same spots upon the body of the mother, 
accompanied also, in her case, by cephalalgia. The nipples and 
mouth were healthy ; the child had neither sores, nor cicatrices, nor 
enlarged glands. 

D. entrusted her child to a young, fresh-looking nurse, who lost her 
hair and was covered with pimples on the arms and hands. But the nipple, 
which was carefully examined by D., did not present any lesion. Two 
months later this nurse was sent away, and, fifteen or twenty days after, 
the child had six moist pimples about the anus, which were nothing else 
than mucous patches ; it had, further, spots upon" the body, but no 
ulceration or cicatrix of the mouth, and no glandular enlargements in 
the groins or neck. 

Before accepting these cases fully, it would have been necessary 
for them to have been followed out more exactly. Who does not see 
that it was impossible to watch these two children with sufficient care, 
and also that they were observed at much too advanced a period of 
the infection ? 

In support of the opposite opinion, Cullerier read, in 1850, at the 
Academy of Medicine,* five observations of nurses infected with 
syphilis whose nurslings continued healthy; but these cases also 
leave something to be desired, inasmuch as it is not proved that 
these children, despite their good looks, were not syphilitic. 

Duges relates that a woman affected with a tubercular syphilide. 
suckled for nearly five months, at the same time that she was under 
treatment with proto-iodide of mercury, a child which presented no 
trace of syphilitic lesion, but which was merely very weak. This 
case is not perfectly conclusive, and moreover it stands alone. It 
does not, however, deserve the reproach addressed to it by Diday, 
viz., that the child sucked, at one and the same time, both the 
poison and the remedy, for mercury, as we shall see further on, does 
not in any way prevent the lesions of syphilis. 

Such are the facts. The conclusion to be drawn from them is, 
that hitherto the absolute innocuity of the milk of an infected mother 
for a healthy child has not been clearly proved. Thus, it is not 
prudent to allow a child to be suckled by a syphilitic nurse if we 
wish to insure it against all danger. 



* Cullerier, Bulletins de VAcadSmie de Midecine, 1850 ; et Gaz, mid» de 
ParUi tn^me annee> p. 892. 

«2 



228 -ffiTIOLOGY. 

The semen. — ^The old syphilographers attributed a virulent quality 
to the seminal fluid of syphilitic subjects. But since Hunter's time, 
the spermatic fluids like all the products of physiological secretion, 
has ceased to be regarded as contagious. However, in a report pub- 
lished in 1857, Porter* asserts that the semen of an infected man 
may, without the intervention of pregnancy, develop in a healthy 
woman an infection exclusive of any kind of primary lesion. 
Amongst the four cases which serve to support this proposition, two 
are anything but conclusive ; but the other two deserve to be given, 
on account of the difficulty of the subject and its importance. They 
are: — 

A man married, believing himself to be perfectly cured of syphilis ; 
eight months after, his wife had constitutional symptoms, without any 
trace of primary lesion and without being pregnant. The husband had 
uever presented any fresh symptom. 

A man had syphilis three months before marriage ; he had both primary 
and secondary lesions. He was treated with mercury and iodide of potas- 
sium. At the time of his marriage he had no symptoms of syphilis. 
Eight months after, his wife had syphilitic angina with ulceration, 
enlargement of the tonsils and glands, but nothing in the genital organs ; 
later on, she had exostosis. 

Professor Collet, adds Porter in his report, has had very similar 
cases. Langston Parker t also relates three cases of syphilitic in- 
fection which he beUeves to be attributable to the semen. The three 
infected husbands were free from all symptoms. There was neither 
pregnancy nor trace of primary lesion in the women. I will not in- 
sist upon the objections which might be made to these cases. Those 
which present themselves at once to the mind are the following : — 
Is it certain that the asserted infecting husband had not, after his 
marriage, some manifestation which passed unobserved? Was it 
really the semen which was the agent of the transmission P Can we 
believe that no one else had connection with the women ? All these 
points are not stated with sufficient clearness, and deserved to be so 
that they might bear conviction with them. One of our most dis- 



• Porter, Essay on the hist, of syphilis {Dublin Quarterly Journal, May, 
1857; Gaz, mSd., 1858, p. 663). Compare: Vidal, TraitS dea maladies 
venSr»y 1855, p. 75. 

t Langston Parker, On latent syphilis and its effects on healthy females 
and on the foetus in utero (Medical Times and Gazette, July 4th, 1863, p. 6). 



CONTAGION. 229 

tinguished syphilographers, Diday, gives the following explanation of 
the contagion supervening in such cases. '' The semen/' he says, 
** may infect directly, and the spermatozoon, which is the agent for 
the transport of the virulent matter, penetrating as far as the ovary, 
has sufficient power to infect the ovum and the organism of the 
mother to whom it belongs." * I do not know whether any cases 
were quoted in support of this communication made to the Congress 
at Lyons ; but, in my opinion, the question of contagion by the 
semen requires elucidation by the aid of fresh facts before we can 
either accept this mode of contagion or reject it definitely. 

Saliva, perspiration, tears, — Like the milk, the saliva by no means 
escaped suspicion with the earlier syphilographers, and even those 
of the present day still believe that this product of secretion may 
serve for the transmission of syphilis. It is very evident that saliva 
coming from a mouth in which there are mucous patches must be 
infectious ; but apart from this condition, does the saliva transmit 
syphilis ? There is no reason to believe it, after the communication 
made by Diday to the Congress at Lyons, that experimenter having 
been able to inoculate with impunity, in healthy individuals, saliva 
which he had taken from syphilitic subjects. 

The tears, and doubtless also the perspiration, do not behave 
differently, for inoculation with them has not been more successful. 
Let us confess that these failures give little encouragement to the 
belief in the contagiosity of the milk, which is, like the fluids of 
which we have just been speaking, a product of physiological secre- 
tion. 

Modes of Contagion. 

In the following phrase, Paracelsus clearly pointed out the various 
modes of syphilitic contagion : *' Infectio triplici via, videlicet coitu, 
partu, tactu.''f 

Sexual intercourse. — ^Prom the period of the great epidemic of the 
fifteenth century, it has been recognised that sexual intercourse 
between healthy and diseased persons is one of the most frequent 
modes of syphilitic contagion. In 1497, A. Benedictus J proved 



• See Gaz, hebd,, 1864, p. 706 ; et Gaz, mid, de Lyon, February 1st, 
1865, p. 60. 

t Be var. lib. v. c. 1. 

X Novam in mundo pestem, tempestate nostra, concubitu et contact 
haberi animadvertimns. 



230 AETIOLOGY. 

it. In 1498, Aquilanus* showed himself not less positive on this 
point. In 1505, J. Cataneus remarked that coitus was the chief 
cause of the disease, and thence the denomination of lues venerea 
which was afterwards given to it. Daily experience has only too 
thoroughly confirmed since then the truth of the observations of the 
earlier syphilographers, and the fact is so common that we need not 
further insist upon it. I will not dwell upon the contamination 
which may follow, to use an expression of Astruc^s, from the abomin- 
able and unnatural intercourse of persons of the same sex. 

But contagion from sexual intercourse is possible without either 
of the parties being diseased. This fact, which did not escape the 
first syphilographers, has since been studied with care. 

'* There may be a fourth cause of contagion, writes Cataneus>t 
viz., coitus with a healthy woman who, after having recently had 
connection with an infected man, has retained in her vagina some 
of his seminal fluid.'* ■Widemann,t Thierry de H^ry, Femel,§ 
Ambrose Pare, &c., admitted the possibility of this mode of trans- 
mission, which is also found mentioned in formal terms by G. Vella: || 
''I have known healthy women who have had connection with in- 
fected men, and who, not having contracted this kind of disease, 
have nevertheless transmitted it^ to other men who had intercourse 
with them.'' " Some women," says Nicolas de B16gny,^ "who have 
been found to be healthy, have not failed to contaminate men with 
whom they have had connection," &c. 

Astruc, Fabre, and Swediaur also admit mediate contagion. " It 
is believed," says Astruc,** " that a healthy man may contract syphilis 



* Nam fere omnes qui hanc aegritudinem passi sunt, ant illam per 
coitum vel lac sugendo contraxerunt, aut aliquo alio contagioso modo 
(Aphrodisiacus de Gruner, p. 63). 

t Quarta causa poterit esse coitus cum sana cum qua de proximis 
coiverit infectus semiue adhuc in matrice existente. 

t All eesnection with a healthy woman who has had connection a short 
time before with a diseased man must be avoided. Under these latter 
circumstances, experience has shown that there is danger of contagion for 
the man who succeeds the infected paramour. 

§ Fernel, De luis venerecB curatione, c. iv. 

11 Novi mulieres sanas quae coiverunt cum infectis, in quas tale genus 
segritudiuis non transivit, et tamen transivit in viros alios coeuntes cum 
illis. 

% Nicolas de Bl^gny, 12 Art de guerir Us malad, vinSr,, ch. vi. 

*• Loc. cit. t. ii. p. 16. 



CONTAGION. 231 

from a healthy woman, if this woman, after having had connection 
a short time before with a diseased man, allows the other to approach 
her without having first washed herself/^ '^A person/' asserts 
Swediaur,* "whether man or woman, who has syphihtic poison 
lodged in the genitals, may infect another person and communicate 
a gonorrhcea or a syphilitic ulcer, without having the least appear- 
ance of disease, either externally or in the system.'' The theory 
follows. 

In our own days, Cullerier has relied upon facts well observed and 
altogether demonstrative of these views of the earlier writers. Bicord 
relates t a case in which the man and not the woman was the agent 
of the transmission. A young man had connection with a woman 
who had chancre; the same day, he had connection with his usual 
mistress, who was infected with the same disease, without his having 
contracted it. It is to be remarked that this young man had not 
washed himself after the first connection, and that his prepuce was 
very long. Thus, h /ortiori, it cannot be denied that women, after 
having had connection with diseased men, may, by serving as a 
vehicle, have been ^capable of transmitting a disease which they 
themselves did not contract. 

Kisses and other modes of contact. — ^Torella mentions the trans- 
mission of syphilis by Idsses. He attributes the origin of it to 
lesions of the breasts, the face, or the mouth, whether of a nurse 
or of some other person. Por nurses are accustomed to kiss little 
children frequently.^ Femel also speaks of this mode of contagion 
in reference to which Benedictus Victorius wrote in 1581 : — '^ I 
know a young man in perfect health who was in the habit of kissing 
a woman long affected with syphilis; he contracted this disease with- 
out ever having had any other relations with her." || 

Almenar, Brassavole, Fallopius, Leonard Botal, Bernard Tomi- 
tanus, A Par^, Trajan Petronius, Nicolas de Blegny, Astruc, Pabre, 
and many other syphilographers, have not forgotten to mention this 



• Loc, cit, t. ii. p. 98. Paris, 1801. 

t Traits des maladies viniriennes, p. 98. 

X Et hoc accidit propter mammas infectas^ aut faciem, aut os nutricis 
seu alicujus alterius. Solent enim nutrices saepius infantes oscularL 

§ Ego enim experientia edoctos fni juvenem inculpabili sanitate muni- 
tnm, lungo quodem temporis intervi^lo mulierem gallico morbo depra- 
vatam, ore exosculare assuetum, nullo per jovem exercitato coitu, in 
morbum gallicum incidisse {De morbo gaUicOf lib. i. cap. ii.)* 



232 iETIOLOGY, 

kind of contamination. In reference to this subject^ Charles 
Musitan relates the history of the nuns of Sorrento who contracted 
syphilis from kissing a little girl who had been suckled by a syphi- 
litic woman.* A great number of cases of this kind have been 
collected by Rollet.f What I have said suffices, I think, to place 
beyond doubt the mode of transmission in question. The circum* 
stance of lying with an infected person has also been regarded as a 
cause of contagion by several syphilographers, amongst whom are 
Paracelsus and Femel. Guillaume Sondelet wrote on this subject : 
^' Others contract the disease by lying with persons who are infected, 
when it shows itself on the whole skin, chiefly at the points where 
the contact took place.'' J A, F^rier and N. de Blegny § recognise 
this mode of contagion. "To lie with a syphilitic,'* says the latter, 
" and to dbme into direct contact with him while he is sweating, or 
when he has ulcers or pustules on the skin, is a thing which may be 
regarded as dangerous, especially for those whose pores are open.'* 
Swediaur relates the following case : — Two young girls bom of healthy 
parents, the one aged 12, the other 10, had both of them ulcers 
and herpetic eruptions {dartres) upon various parts of the body with- 
out any disease on the genital organs. These two young girls, who 
had never had any venereal affection, sometimes slept with a woman- 
servant who was known to have an unequivocal eruption and a 
corona veneris. Sydenham remarks that he several times observed 
that- children who lay in the same bed with their infected parents 
also became diseased. For my own part I saw in 1858, in the 
practice of M. Bayer, whose house-surgeon I then was, a young 
woman affected with a papular syphilide, who recovered in a few 
days by taking S^dillot's pills. This girl affirmed that she had 
never had sexual intercourse, which was true. When questioned as 
to the origin of her disease, she stated that she had slept for several 
weeks with a friend who had a syphilitic eruption. 

A lady once showed me a son of hers 6 years of age, whose 
skin was covered with a confluent papular syphilide, and who had 
mucous patches in the mouth. The child had contracted the disease 

• Tract de lue venerea^ lib. ii cap. iv. 

f RoUet, Recherches sur la syphilis. 

X Alii cum segrotis dormiendo banc luem contrahunt et tunc in cute 
tota apparet et prsesertim in ea parte qua segrotum tetigerunt [Aphro^ 
disiacus, p. 935). 

§ Nicolas de Bligny, loc, cit, p. 16. 



CONTAGION. 233 

when at nurse. In spite of my repeated warnings^ this mother 
continued to kiss her son, and sometimes had him to sleep by her 
side. Three or four months after, she came to me and showed me 
a most characteristic papular eruption, which soon became modified 
under the influence of mercurial pills. She had not observed any 
pimples on the mouth or face. (See Obs. II. Vol. I. p. 94.) 

Simple contact, consequently, suffices for the contamination, and 
the latter may take place, no matter in what manner the former 
occurred. Thus Vercelloni states that he knew a young man who, 
being afraid to have connection with a syphilitic courtesan, thought 
that he might safely touch her, and whose hand became diseased. 
Side by side with cases of this nature there are others much more 
regrettable, and with which it is important to be acquainted, as the 
teach us the danger of certain professions, and especially of our own. 
Ant. Lecoq states that he knew a midwife who contracted the 
disease by sleeping with a syphiKtic woman.* Femel f and Prosper 
Borgarutius each quote a similar case. The French translator of 
Ch. de Musitan relates, according to Astruc, two similar histories. 
Since then, such cases have been frequent and are now very numer- 
ous. It is evident that the physician is, in such cases, quite as 
much exposed as the midwife, and is more so in all the operations he 
has to perform on syphilitic subjects. The history of Hourmann 
is too well known for it to be necessary for us to allude to it further. 
Not long ago, one of our surgical celebrities contracted a chancre 
on one of his fingers in the practice of his profession. 

Suckling. — G. Torella, of Valence, was the first to point out the 
transmission of syphilis by suckling. In 1498, Seb. Aquilanus, of 
Mantua, wrote that most of the cases of syphilis are due to coitus or 
to suckling. J. Cataneus states : — " We have seen several children 
affected with this disease infect their nurses.^' J G. Vella confirms 
the clinical observations of his predecessors in reference to this mode 
of transmission, but incriminates rather the quality of the milk than 
the act of suckling. In a sacred ode addressed by G. Eeitterius to 
the holy Virgin to beg her to preserve the human race from syphilis, 

• ' 

* Equidem obstetricem novi qu89 dam mulieris inquinatse partum ex- 
ciperet, hoc morbo oorrepta fuit nulla tamen foetus noxa communicata. 
{lAh. de ligno sancto non permiscendoj cap. i.) 

t Aphrodis. "p. 610. 

X Hoc etiam modo vidimus plures infantulos lactantes tali morbo in- 
fectos plures nutrices infecisse. 



234 JBTIOLOGY. 

it is said : '' The child which^ in early life, draws its nourishment 
from the breast of a nurse is no longer in safety. 

Non puer tutus teneris in annis 
Quern 8U8B lactat genetricis uber. 

Benedictus, J. Almenar, Fracastor, and N. Massa mention syphi- i 

litic contagion from suckling. Paracelsus, A. Eerri, and Ant. Lecoq ' 

also speak of this mode of communication, of which, in 1650, A. M. f 

Brassavole relates a very good instance,* at the same time as he < 

points out the means of knowing which of the two, the nurse or the 
nursling, has infected the other. J. B. Montanus and A. Eerrier 
confirm the preceding data. J. Eodrigue, better known by the 
name of Amatus Lusitanus, describes a slight epidemic which had 
for its origin a syphilitic new-born child. This child transmitted 
the disease to its nurse, who communicated it to her husband and 
neighbours. 

O. Fallopius, Femel, and G. Eondelet also admit contagion by 
suckling. Agreeing therein with Brassavole, the latter points out 
that syphilis, in infected nurses, commences with ulcers on the 
breasts. Often also, says A. Pare, a child which has syphilis gives i 

it to the nurse, and in reference to this he relates in his quaint and 
original style the following case : — '^ A rich and respectable woman | 

begged her husband to permit her to nurse her child herself, which 
he did on condition of her taking another nurse to assist her in 
suckling the child. This nurse had syphilis, which she gave to the 
child, the child to its mother, the mother to her husband, and the j 

husband to two little children who usually eat and drank and fre- ^ 

quently slept with him. But the mother, thinking the child did not 
get on well, and was always crying, sent for me to tell her what was 
the matter with it, which it was not difficult to do, seeing that it was 
covered all over with pimples or pustules, and that the breasts of the 
nurse were ulcerated; also those of the mother, who had upon her 
body several pimples ; also the father and the two little children, of 
which one was 3, and the other 4 years old. I told the father and \ 

mother, that they were all aflfected with syphilis, which had proceeded 
from the nurse. I treated them and they all got well, except the 
youngest child, and the nurse was flogged in prison, and would have 



• See this case in AphrodinaciM, p. 668. 



CONTAGION. 235 

been flogged in the public streets, had it not been for fear of dis- 
honouring the family." 

For this father of French surgery there are two modes of trans- 
mission of syphilis by suckling, the sucking of the milk alone^ and 
direct contact between nurse and nursling. Bern. Tomitanus also 
makes known the modes of infection of nurses by their nurslings. 
Leonard Botal, A. Fracanziani, A. Trajan Petronius, P. Borgarutius,* 
N. de B16gny,t Boerhaave, Astruc, Van Swieten, and lastly Fabre, 
are all agreed on the point that syphilis may be contracted by suck- 
ling. I have thought it necessary to expound at length the aiicient 
doctrine on this important point, for the purpose of showing how 
the truth may all at once give place to error when the opinion of a 
single individual comes to be substituted for the truths acquired by 
tradition. 

Hunter, seeking to apply experiment to the study of syphilis, had 
a happy conception, but one which was destined, at the very first, to 
bear bad fruit. Forgetting the history of the past, and relying upon 
artificial inoculation, of which he did not justly appreciate the value, 
he denied the contagiosity of secondary lesions and the transmission 
of syphihs by suckling. And yet the clinical fact did not escape his 
notice ; if his imagination or his system thrust it aside, his spirit of 
observation restored it to the right track. In fact, he relates in his 
treatise two cases of the greatest interest, in which children aflfected 
with hereditary syphilis became the cause of the infection of nurses 
and nursUngs. 

Despite the ingenious experiments of Hunter, the dogma of the 
transmission of syphilis by suckling none the less continued to be 
professed by many observers. Thus Babington, B. Bell, and 
BosquiUon opposed the doctrine of the English surgeon, who found 
partisans, however, in Girtanner, Barbantini, Vacca Berlinghieri, 
Monteggia, Pressavius, Eosen de Rosenstein, and Paletta; but 
Doublet, Swediaur, Bertrandi, Ploucquet, Mahon, Vassal, Bertin, 
Bourgogne, Lagneau, Petit-Badel, Colles, Baumes, Egan, Viani, 
Pietrini, Bertherand, and many others, agreeing with tradition^ 
sought to refute the opinions of the celebrated syphilographer. 

The supporters of Hunter were few in number, then^ when Ricord, 



* For bibliographical indications, see Luisinus, AphrodisiacuSf &c. ; and 
Ricordi, Stfilide da allattamento. Milan, 1865. 
t VArt de guirir Us malad, vSnSr,, 1674. 



236 iETIOLOGY. 

the great and warm partisan of the Hanterian theory, appeared in 
the field. Belying, like his predecessor, upon the results of inocula- 
tion, he fell into the same error. One of his chief pupils, Diday, 
did not fully accept the theory of his master. " It remains estab- 
lished," he wrote as early as 1854, "that the contact of the mouth 
of a nursling with the breast of a syphilitic nurse ought to be care- 
fully avoided.'^ Since that time, he has shown himself a decided 
partisan of the opposite doctrine, which Bardinet, Putegnat, Bou- 
chut,* Valery, EoUet, Eicordi, of Milan, &c., have now rendered 
unattackable. 

The nurse or the nursling may be the agent for the transmission 
of syphilis. The nurse when, under the influence of primary or 
secondary syphilis, she suckles a healthy child ; or if, as may be 
supposed, the milk is not contagious, it is on eondition only that a 
syphilitic lesion becomes developed, and this is what most frequently 
happens, or because a chancre has been carried to the breast of the 
nurse by a stranger who has practised stwtion, of which we find 
numerous instances in science,t or again because there has been con- 
tact of another kind, direct or indirect,^ or again, as was observed 
by Bertin, because an infected child has deposited upon the breast 
of its nurse the virulent matter which shall have served to infect 
another nursling (mediate contagion). But after all, the most fre- 
quent cause of contamination for the nurse is the presence of mucous 

* Bouchut, Transmission de la syphilis des nouveau-nSs aux nourrices 
{Gaz, mid, de Paris, 1850). Compare : Candelon, Modes de la transmission 
de la syphilis chez les nouveau-nes, Th^se de Paris, 1852. 

t Epidemics of syphilis have been seen to supervene in consequence of 
this process. Consult on this subject : A. Everard, Collatio antiqui morbi 
recrudesc, cum gaUico vel indico morh. Mediol., 1661. Albert, Dissertat. 
de osculo fnorhifico et morbifero, Halle, 1726. E. Barry, Account of a 
malignant lues venerea eommunicated hy suction in the City of Cork. Edin- 
burgh, 1728 ; and Medical Essays and Oheerv,, t. iii. No. 21, p. 323 et seq. 
We find here an interesting case given also by Van Swieten, Comment, in 
H. Boerhaavii Aphorism., t. v. p. 348. Ploncquet, Initia hibliothecce medico- 
practiccB et chirurgicce, Tubingen, 1803. Jacob Munniks, Ohservationes 
varied; diss, inaug. GroningsB, 1805 ; et Journ. gin, de mid, de chirurg. et 
de pharm,, 1805, t. x&iv. p. 837; Histoire d'une maladie syphilitique pro- 
pagie par une femme qui faisait mSiier de titer les nouvelles accouchies et 
qui a regni it Groningue en 1804. Bourgogne, Considerat, ginerdles sur la 
contagion de la maladie vinirienne des enfants trouves a leurs nourrices. 
Lille,. 1825. 

X See Ricord, Lettres sur la syphilis, pp. 166, 167, 2« 6dit 



CONTAGION. 237 

patches which, under the influence of sucking, soon develop them- 
selves on the surface or in the neighbourhood of the nipple. 

The nursling is, nevertheless, the most usual agent of transmission. 
The syphilis which it communicates may proceed from three sources. 
It is hereditary, which is the most frequent case ; or it has been con- 
tracted by suckling from a strange nurse ; or it results from some 
contact direct or indirect. If the contact is direct or immediate, it 
is, in general, a foster-child which transmits the disease ; in other 
cases utensils of all kinds, especially linen, or vaccination, may be so 
many causes capable of developing syphilis in children. 

These different modes, into the details of which we cannot enter, 
are easy to understand ; but it is important to accustom ourselves 
to foresee the possibility of them. Neither should it be forgotten 
that under such circumstances, true epidemics of syphiKs have been 
seen to appear. 

We have already made known such of these epidemics as the 
earlier authors have left an account of. We now give a succinct 
history of those which have been observed more recently. Portal 
relates that a kind of scrofulous epidemic prevailed at Montmorency 
amongst the children at nurse. The evil became so great there that 
the Government sent Morand and Lassonne, who ascertained that 
most of the nurses were syphilitic* In March, 1844, Petrini treated 
an illegitimate child, born of a syphilitic mother : this child infected 
two nurses, who communicated the disease to their husbands and to 
their two children.f 

A case which gave rise to a greater extension of syphilis was ob- 
served by Dr. Jolly. J Dr. Facen gives another not less curious. § 
In his excellent work on syphilis from suckling, Ricordi || has fur- 
nished observations not less curious and interesting. In 1863, at 
Cazorezze, a foundling, affected with syphilis, caused the infection of 
twenty-three individuals. In the same year, at Ubolda, a foundling, 
equally suffering from hereditary syphilis, transmitted the disease to 
eighteen individuals. A third epidemic, developed under similar 
circumstances, prevailed in 1864 at Marcalle, where it proved fatal 



* Lugol, Des maladies scrojulenses, Paris, 1844, p. 120. 
t Ilraccofflitore medico, July number, 1850. 

I See Joum, mSd chir. etpharm, de BruxelhSy 1853, p. 92. 
§ Oaz. med, Lombard,, No. 1, May, 1849. 

II Ricordi, StphUide da allaUametUo. Milan, 1865. 



238 -ffiTIOLOGY. 

in sixteen cases. It would be easy to collect a greater number of 
facts of this kind^ but the preceding are sufficient, we think, to render 
intelligible the necessity of a medical police for the purpose of pre- 
venting similar disasters. 

In closing this part of the subject, I must point out, and this is a 
circumstance which is not devoid of a certain practical importance, 
that a nursling which has inherited syphilis does not infect its 
mother any more than the latter infects her nursling. This is again 
the consequence of the law that syphilis does not become doubled. 
CoUes,* in 1837, gives as a constant rule that a new-bom child 
affected with congenital syphilis never produces ulcerations on the 
breasts of its mother, even when it has ulcers in its mouth, while it 
is capable, under the same circumstances, of infecting a strange 
nurse. Baum^s,t in 1840, made the same observation, which was 
afterwards confirmed by the researches of Egan J and by those of 
Cullerier.§ 

Vaccination. — Destined to preserve us from one of the most 
serious diseases, vaccination may also be a mode of contagion of 
syphilis, in which the virus is no longer transmitted by immediate 
contact, but by the medium of some object ; the contagion is then 
called mediate. Suspected to a certain extent by Leroy,|| this 
danger from vaccination appears to have been first pointed out in 
England,ir and afterwards in Italy by Monteggia** and Marcolini.tt 
The latter observed a kind of epidemic analogous to that of which we 
have already spoken in reference to the transmission of syphilis by 
suckUng. A little girl bom of syphilitic parents served for the 
vaccination of ten children, June 16th, 1814 ; on the 80th of the 



* On the venereal disease, 1837, p. 385. 

t PrScis thSorique et pratique des malad. vSnSr., p. 180. 

% The Dublin Quarterly Journal, May, 1846. 

§ Des symptoms consScutifs de la syphilis, considMs dans leurs rapports 
avee Vallaitement. Bulletin gSniral de thSrapeutique, 1850, p. 559. 

II La clef du cabinet des princes, an. x. Obs. XI. and XII. 

% Consult: B. Moseley, A treatise on the Lues bovilla or Cote-pox. 
London, 1805. Dapping, La vaccine eomhattue dans le pays oil eUe a pris 
naissance, Paris, 1807. W. Bowly, Commentaries on the Lues bovilla or 
Cow-pox. London, 1806. 

** Monteggia, M^moire lu, le 17 Fivrier, 1814, k Tlnstitat de Milan. 
See Annali universalidi medicinat di Annibale Omodei. Milano, 1824. 

tt Ibi^* 



CONTAGION. 239 

same month, thirty others were vaccinated, making forty in all ; of 
these several died of confirmed syphilis ; some of the children had 
both syphilis and cow-pox. In a case observed by the same author in 
1822, a child healthy in appearance, but afterwards recognised as 
syphilitic, served by means of the same process for the transmission 
of syphilis to a little girl. 

In 1821, a little girl, healthy in appearance, and in whom vacci- 
nation ran its usual course, served for the vaccination of forty-six 
children; nearly all of them were infected and nineteen died. 
Most of their nurses and mothers contracted syphilis by suckling.* 

In 1841, a child in the neighbourhood of Cremona, bom of syphi- 
litic parents, furnished lymph for sixty-four children, and most of 
these children had symptoms of general syphilis. Neither were the 
mothers or nurses spared. Of the sixty-four vaccinated, fifty-four 
recovered, and eight children and two women died ; the child which 
caused the infection finally died dropsical, after having presented 
various eruptions on the skin and syphilitic ulcers on the genital 
organs and scrotum.f Pitton, in 1844,J and Ceccaldi§ in 1845, 
also observed cases of transmission of syphihs by vaccination ; but 
these cases may leave matter for doubt, and we are inclined to ask 
ourselves, after reading them, whether syphilis was the efficient 
cause or simply the occasion of the development of the syphilis in 
the new-bom child. A more positive case is related by Viani. A 
child which had already infected four nurses, one of whom commu- 
nicated syphilis to another nursling, served for the revaccination of 
its uncle and aunt, whom it also infected. The vaccinator, Dr. 
Viani himself, was ignorant of the child's antecedents. || 

Cases little different and in which there is every reason to assume 
the transmission of syphilis by vaccination, are also given by 
Mounell and other observers.^ Since that time the attention of the 



* Cerioli, Del contagio venerea j &c., 1821 ; and AnnaL untv. de medicina 
di Omodei, t. xix. ; Revue mid,, t. iii. p. 51. 

t Cerioli, in Oazetta medica di Milano, October 14tb, 1843, t. ii. No. 4. 

X Joum, des cannaissances med, chir.y 1844. 

§ Revue mid, chirurg. Paris, 1853, t. xiii. p. 121. 

II Gaxetta medica Lomharda, 1849 ; et Gaz, mid. de Paris, 1849, p. 847. ' 

% NeU) York Med. Times, 1864. James Whitehead, Third Report on the 
Clinical Hospiiah Manchester, 1859. J. Lecoq, Oaz. des h6pitaux, 1859, 
p. 508 ; et Guyenot, De Nnoculation de la syph. const. Thdse de Paris 
1859. 



240 JETIOLOGY. 

medical world has been directed to this mode of transmission^ to 
which two actions brought in Germany, one against veterinary- 
surgeon B , the other against Dr. Hubner, suddenly gave great 

publicity. 

Ten families were revaccinated, and in consequence of the opera- 
tion nineteen persons out of twenty-four contracted syphilis. The 

veterinary-surgeon B , the author of these revaccinations, was 

proceeded against and condemned to two years' imprisonment and 
a fine of fifty dollars.* On the 16th of June, 1852, thirteen children 
of one village were vaccinated on the same day and with the same 
lymph, which was taken from a child said to be syphilitic ; ulcers 
soon developed themselves at the points of vaccination in eight of 
them, and about three months later syphilitic eruptions appeared ; 
no abnormal symptom was observed in the five others.f 

In spite of these numerous and much to be regretted facts, the 
possibility of the transmission of syphilis by vaccination was not yet 
generally admitted when the interesting work of Dr. Viennois, of 
Lyons, appeared in ISGO.J After having examined the cases on 
record, that author came to the conclusion that it is the blood and 
not the virus which is the agent of the transmission of syphilis. 
In a paper published about the same time, Rollet§ arrived at 
the same conclusion. Since then, cases have been numerous. 
"Recently," wrote Dr. Galligo, in August, 1860,|| "there was 
" observed in the neighbourhood of Florence, at Rufina, the trans- 
mission of syphilis to fourteen children vaccinated with lymph 
taken from a child which, although apparently in perfect health, was 
stated to be the issue of parents who, a short time before, had been 
suflTering from severe secondary affections.'' 

Towards the end of May, 1861, a child at Rivalta, eleven months 



• See Wegeler, Medtzinische Zeitung, April 3rd, 1850. 
^ f See S6e, Gaz. hebd, de med. et de chir*, March 9t1i, 1855. Broca, 
SociStS de chirurg.f t. v. Consult also : Pauli de Landau, Ueher Contagio- 
sitat und JErblichkeit der Syphilisy &c. Mannheim, 1859. Friedenger, 
Erfahrungen uher Vaccine und syph. Krankh.j &c. Vienna, 1855. J. 
Heine, Beitrdge zur Lehre von der SgphiHs in ihrer Verhindung mit Vaccine 
und diphtheritis. Wurzburg, 1854. 

X Viennois, De la transmission de la syphilis par la vaccination {Arch, 
gin. de med., June and Sept., 1860). 

$ RoUet, Hecfierches sur la syphilis, Paris et Lyon, 1861, p. 372 et suiv, 

II Gaz, held, de med, et de chirurg,, No. 31, p. 519; 1860. 



CONTAGIOK. 241 

old and in perfect healthy was vaccinated with lymph from a tube 
furnished by the public officer of Acqui.* Ten days after, on the 
7th of June, lymph was taken from the pustules of this child and 
used to vaccinate at one sitting forty-six children, who were all 
perfectly healthy. On the 12th of the same month, seventeen other 
children were vaccinated with lymph taken from one of the forty-six 
of the first series. The whole number of those vaccinated was thus 
raised to sixty-three, of which number forty-six became infected ; 
thirty-nine out of the forty-six of the first series and seven out of the 
seventeen of the second series presented traces of syphilis. On the 
7 th of October, out of twenty-three of these children, six had died 
without treatment, fourteen were recovering, and three were still in 
danger ; the twenty-three others were dispersed in various communes. 
Twenty mothers or nurses were infected.t 

A very similar case, though rather more open to objection, has 
been given by Dr. Glutter. In a village of 650 inhabitants, thirty- 
four individuals of different ages and of both sexes were affected with 
syphilitic lesions of the mouth and throat after vaccination; but it 
was not possible to ascertain positively who had been the medium of 
transmission. 

In 1856, at Lupara, in the kingdom of Naples, Dr. Marone 
vaccinated in the early part of November, a certain number of 
children with lymph from a tube which came from Campo-Basso, 
and which was coloured by a Uttle blood, although clear and trans- 
parent as usual. One child was vaccinated first, and then served for 
the vaccination of the others ; twenty-three of the children, including 
the one vaccinated first, forming nearly the whole number vacci- 
nated, although bom of parents healthy and free from any sym- 
ptoms of syphilis, were attacked by that disease after being so vacci- 
nated. The mothers of these children contracted the disease in 
their turns. In a second series of vaccinations, performed with 



* Dr. Pacchiotti has since ascertained that this child might have con- 
tracted syphilis from a nurse. Pacchiotti, SifiUde trasmessa per mezzo 
della vaccinazione in Hivalta presso Acqui, Turin, 1862. And H. Lee, On 
the inoculation of syphilis, 

t See Gazetta medica italiana, 'Sov. 4th, 1861; and Gaz. hebd,, 1861. 
Pacchiotti, /oc. cit. Consult also Jaccoud, in Gaz, held., 1861, Amed^e 
Latour, Cerise, Lach^se, dans V Union medicale, IS61. Yenot, in Journ, 
de Bordeaux, March, 1862, p. 117. W. Acton, Brit, Med. JoUrn,, Feb. 
22nd, 1862. 

r 



242 AETIOLOGY. 

lymph taken from those vaccinated first, eleven other children had 
syphilis and, like the former, infected their mothers ; these again 
infected eleven nurslings, and some of them communicated the 
disease to their husbands. Some very young girls were also 
infected by contact with the nurslings or with the children vacci- 
nated.* 

A case not without interest presented itself in Professor Trousseau's 
clinical practice, in the course of the vnnter session of 1861-62. 
A young woman of 18, who had not had any symptom of syphilis, 
was vaccinated with lymph taken from regular vaccination pustules. 
The result was almost null, which caused no surprise, as she had 
been vaccinated abeady. But a month after, two ecthymatous pus- 
tules appeared upon the arms, and soon afterwards, syphilitic roseola. 
In four children who had been vaccinated at the same time every- 
thing passed off normally. 

Auzias Turenne has also given several cases of vaccinal syphilis.f 

ChassaignacJ presented to the Surgical Society a child in which 
there was no reason to suspect hereditary syphilis, and which was 
nevertheless affected with syphilis some time after having been vacci- 
nated. Devergieg and H^rard have each communicated a case of 
the same kind to the Academy of Medicine. Dr. Viennois || has 
made known to the same society two cases observed by Dr. A. 
Adelasio, of Bergamo.lf My friend Dr. Millard has given another 
case very recently to the Medical Society of the hospitals {Bull, de 
cette SocietSy 1865). 

Laroyenne** Eodet, of Lyons, ft and Bouvier J$ have also furnished 
analogous cases. Such is, though still incomplete> the long series 
of observations which prove, at the present day, in a manner satis- 
factory to the majority of physicians, the transmission of syphilis by 



* L'ImparziaU, No. of March 1st, 1862, p. 142. Pacchiotti, he, ciU 
p. 99. H. Lee, he, cit p. 76 ; and Zaneet, 1862, t. i. p. 567. Consult also 
Strieker, in Virehoto'a Archiv, t. xxii, pp. 285-312, 1861. 

•f See Courrter midiealf 1863. 

X Bulht. de la Soc. de ehirurff., meeting of August 26th, 1863* 

§ Bullet de VAcad. de mid, Paris, 1862-63, t. xxviii. p. 664. 

11 Ibid, p. 1189. 

^ Bull, de VAcad, de mSd,, 1564-65, t. xxx. p. 20. 

*♦ Gaz. mSd. de Lyon, June 16th, 1864. ff Ibid, 1866, p. 35. 

tX Bull, de VAcad, de mid,, meeting of February 28th, 1865. See also 
Uazk deh hdpitausi, October 22nd» 1864* 



CONTAGION. 



243 



vaccination. These observations are compared with each other in 
the following Table: — 

Vaccinated. 

46 



Cases by Cerioli 
Tassani 



9> 
» 
M 

» 

>y 
ft 
>} 
}} 
f> 
>t 
» 
fy 
» 



Surgeon B. 

Hiibner . 

Monell . 

Marcolini 

Viani 

Lecoq 

Galligo . 
at Bivalta . 
by Bidard . 
„ Mountain 
„ Schreier . 
,, Trousseau 
„ Marone . 
„ Devergie. 

Ghassaignac 

H6rard . 

Adelasio . 



99 



99 



99 



I am well aware that negat 



64 
24 
13 

1 
40 

2 

2 
14 
63 

6 
30 

5 
34 
1 
1 
1 
2 



Infected. 

40 
46 
19 

8 

1 
40 

I 

2 

2 
14 
46 



Healthy. 

6 

18 
5 
5 



1 
34 
1 
1 
1 
2 



17 
6 

30 
2 

4 



tive facts exist ; but these facts, sup- 
posing always that the very rational interpretation of Viennois is not 
always applicable to them, prove nothing in presence of the many 
positive facts given above. In a recent and celebrated discussion at 
the Academy of Medicine, opinions were divided ; but at last most 
if not all the members ended by recognising that it was not possible 
to deny this mode of syphilitic contagion, which had for its advo- 
cates Depaul, Trousseau, and Bouvier. Thus nothing remains to 
be done at present except to find the nieans of preventing this con- 
tagion. Fiirthei' on, we shall inquire what those means may be. 

Various operations, — Cupping, tattooing, catheterism, 8fc. — ^Vacci- 
nation is not the only operation by means of which syphilis may be 
transmitted. In 1677 there was observed, as we already know, at 
Briinn, in Moravia, an epidemic of syphilis the origin of which was 
at last found out to be the cupping undergone by several persons at 
the hands of the bath-man of the town.* Cases of the same kind 



* See Historical Notice^ p. 29. 



r^ 



244 -ETIOLOGY. 

have been given by G. Horst and observed at Bamberg^ in 1602, by 
Sigismund Snizer, at Ulm, in 1662, by Horst himself, and at Winds- 
helm, in 1624, by Marc Widemann, in more than seventy persons. 
The disease in all these cases had been caused by the use of cupping- 
glasses.* More certainly still than in vaccination, the blood is here 
the agent of transmission. 

The operation of tattooing also appears to have sometimes been a 
means for the propagation of syphilis.f A circumstance more re- 
grettable, but one which cannot be denied, is, that operations per- 
formed without sufficient care by physicians or surgeons have, in 
some instances, given rise to syphilitic contamination. It is thus 
that, within the last few years, there have been seen in Paris itself cases 
of syphilis which appeared not to have had any other origin than 
catheterism of the Eustachian tube. At the meeting of the Medical 
Society of the Hospitals, September 28th, 1861,J a female patient 
who had been infected in that way was presented by LaUier, and at 
the following meeting, October 12th, thirteen cases of communica- 
tion in the same manner were quoted by various members. It is 
true, however, according to Dr. Roger, that some of these cases might 
tell in two ways. 

In 1863, my friend Dr. Maurice Eaynaud showed me at the 
Saint-Louis Hospital a victim of this operation, under the care of 
Hardy. In this very year, a case which deserves to be added to 
the preceding was published in the Gazette hebdomadaire. Fortu- 
nately for the honour of the medical profession in Paris, it must be 
added that all the patients in question were treated by the same 
specialist. § Another point to be remarked is, that in a great 
number of these cases the syphilis assumed a severe form. 

It is evident that catheterism of the bladder is liable to the same 
objection. If there is not as yet any case showing this mode of con- 
tagion, is it not on account of the seat of the evil ? A speculum or 
syringe has also been known to transmit the poison of chancre. || 

* See Astruc, De morhts venereie, 1740. 

t See Petry, Uehertragung der secunddren Syphilis durck daa Tattowiren 
(Allgem, Wien. med, Zeitung, No. 14, 1859). 

X See Union mSdicale, October llth, 1864. 

§ A fresh case has just occurred »(see Gaz, mid, de Jjyon, March Ist, 
1866). 

(I Tardieu, Etude midico^Ugale 8ur lee maladies accidenteUement et in- 
volontairement produites par imprudence, nSgligence, ou transmission con" 



CONTAGION. 245 

Thus both surgeon and physician ought to pay the greatest atten- 
tion to cleanliness in the exercise of their profession. There is a 
surgical operation now out of use and in which syphilis appears 
sometimes to have been transmitted, viz., transplantation of teeth. 
Some cases quoted by Hunter in reference to this subject appear 
to leave little doubt, despite the contrary opinion of that surgeon 
himself. 

Occupations. — ^It is clearly proved at present that certain occupa- 
tions have sometimes served to propagate syphilis. Several instances 
of the propagation of that disease amongst glass-blowers have been 
observed by the physicians of Rive-de-Gier, where there is a manu- 
factory of glass. Dr. Niobis, a physician in that locality, has seen 
about ten cases of this kind, and EoUet,* who was able to verify 
them, has justly appealed to them as proofs of the contagiosity of 
secondary lesions. The fact is, that mucous patches, always so 
frequent about the mouth, are, under such circumstances especially, 
much more frequently the source of the contamination than chancre. 
Moreover, nothing is more favourable to the morbid transmission 
than the obligation of a workman to take immediately and to press 
between his lips the iron tube which one of his fellow-workmen, 
affected with buccal lesions, has just had in his mouth-f The know- 
ledge of this source of contagion has sufficed for the extinction of it, 
Diday proposed that the workmen should be examined once a fort- 
night, and that none should be admitted to the works except with a 
certificate of health from a medical man. Chassagny, for fear this 
expedient might appear vexatious to the workmen, advised them to 
make use of a mouthpiece into which to introduce the tube. Each 
workman, having his own mouthpiece, necessarily ceases to be ex- 



tagieuse comprenant Vhiatoire mSdico-Ugdle de la syphilis {Ann, d'hygi^ne et 
de med,'lSgale. 2* serie, t. xxi. p. 371). 

* Arch, de mid,, 1859. Gaz. mSd, de Lyon, Nov. 16tli, and Dec. 1st, 
1862. 

t The propagation of syphilis in the practice of glass-hlowing has not 
only excited the attention of medical men, but it may be said that the 
reality of this mode of transmission has been legally established. To the 
cases already known may be added those which presented themselves at 
the glass-works of Montlu9on, where a single workman who had syphilid 
contaminated twelve others. A kind of slight epidemic resulted there- 
from, of which Dr. Dechaux has given an interesting account in the Oaz, 
mid. de Lyon, Nos, 1$ and 16, 1867. 



246 JBTIOLOGT. • 

posed to the danger. This very applicable means was also iec(»n- 
mended by Yiennois at the Congress at Bouen.^ 

Various objecU, — Kitclen utensils, linens clothes^ ^(?.— Leonard 
Botal relates that an intimate fri^d of his^ a truthfnl and respectable 
man, was veiy severely affected with syphilis^ and that he always pro- 
tested most vehemently that he did not know how he had contracted 
the disease unless it was from drinking out of the same glass with a 
man with whom he was living on familiar terms and who was then 
suffering greatly from fche disease.f 

In Rollers interesting report^:^ we find the case of a young woman 
of irreproachable morals who contracted syphilis^ the first manifesta- 
tion of which was a chancre upon the lip. After questioning this 
patient in the prei^ence of her mother and husband, BoUet came to 
the conclusion that the disease had been communicated by the cook. 
The latter, who had been ill for eight or ten months, had the isthmus 
of the throat occupied by an eruption of confluent mucous patches, 
and the young lady was in the habit of tasting all the dishes prepared 
by her servant, with the same spoon and immediately after her. The 
tobacco-pipe, so common an object and one so easily and so willingly 
lent to a friend, must also be regarded as frequently serving to com- 
municate syphilis : this mode of transmission, of which certain facts 
leave little doubt, has been observed by us in the case of a friend. 

The use of linen belonging to diseased persons is another cause 
of the propagation of syphilis, which, if we may believe ancient 
authors, is not very rare. Nicolas Massa § asserts that he cured 
one of his friends, who had contracted the disease from having slept 
for a single night in the sheets which had served for a man affected 
with a venereal ulcer on the leg. Fabricius de Hilden relates |J that 
a young girl of 15, being in carnival amongst a party of genflemen, 
and having changed clothes with a young man, contracted venereal 
pustules and ulcers on the genitals by mere contact with his drawers, 
which were infected. These two cases and another by Ant. Fracan- 
ziani,ir who relates that he saw a young girl of 7 who got the 

* See Gazette hehdomadaire, p. 666, 1863. 
t Lib, de luis venereee curandcB raiioney cap. iv. 

X Rollet, Itecherches cliniq, et expSriment 8ur la syphilis, Paris, 1861, 
Obs. XXVI. and XXIX. 
§ Nicolas Massa, Lib. de morbo gaUico, tract, i. cap. ii. 
II Fabr. de Hilden, Obs, chir, et mSd,, 1716, centur. i. Obs. C. 
^ Quoted by Astruc, t. ii. p. 10. 



CONTAGION. 247 

disease from having worn a leather garment which had been used by 
a syphilitic woman^ would doubtless not have much weight at the 
present day if a distinguished observer of our own time, H. Clerc, 
had not seen a very similar instance. An old man of more than 
70, who for many years had not had sexual intercourse, had an 
infecting chancre of the glans which, to all appearance, proceeded 
from the rubbing of the organ against a pair of trowsers of very 
suspicious origin which he had worn for about two months.* 
Gabriel Fallopius f states that he talked with an old man who had 
in his house two syphilitic subjects who had numerous ulcers about 
the posteriors, and who asserted that he had contracted the disease 
from making use of the same privies. It is impossible to believe 
such a case ; but I have pointed out this and* the preceding cases 
because I am anxious to call attention to the circumstance that the 
mediate contagion of syphilis is more frequent than is commonly 
supposed. 

Conditions and Immediate Eesult op the Contagion. 

Whatever may be the product of secretion which contains the 
virus, and the manner in which this morbid agent is conveyed, it is 
necessary, to render contagion possible, that this seed should fall 
upon some ground, and to enable it to germinate, it is further 
necessary that it should penetrate, without which it dries up and 
remains sterile. We know that an individual already under the 
influence of syphilis is incapable of contracting the disease afresh, 
and that infected nurses do not suffer from suckling a syphilitic 
child. But, independently of these cases, it is a fact that certain 
individuals are refractory to syphilis without its being possible to 
know why such is the case. It is unknown whether this is the 
effect of a general disposition or of a purely local condition. Either 
state of things may exist. We know Uttle of the general disposi- 
tiona in reference to this immunity. As regards the local condition, 
it is very probable that the. introduction of the virus is difficult, if 
not impossible, without a cutaneous or epidermic erosion. Fabre 
believes absorption to be possible without any kind of wound, but 
admits that it is easier when the virus is deposited upon a mucous 



• See A. Martin, Mse citie, p. 44. 

t G. Fallopius, De morho gallico iractatuSf cap. xxii. 



248 JETIOLOGY, 

membrane covered with a thin epithelium. Bicord/ on the con- 
trary^ thinks with the majority of modern syphilographers that the 
presence of an excoriation is necessary. After having given some 
cases in support of this view, he adds : — "These cases, which I could 
multiply, prove that the physiological conditions of the act of coitus 
have no share in the contagion of syphilis/' The numerous cases 
of contagion which we have given above do not leave the least 
doubt in this respect. Are not the regions most frequently contami- 
nated, such as the lips and breasts, remarkable for their tendency to 
crack ? The cases already quoted of women infecting individuals j 

after an impure connection, and themselves remaining healthy, ■ 

appear to furnish a strong argument in favour of the necessity of 
an excoriation for the absorption of the syphilitic poison. 

Bicord has said that chancre is the necessary exordium of acquired 
syphilis. This law has since been confirmed by numerous researches, 
and particularly by those of Alf. Fournier, who found that, in 1,046 
male patients, the existence of chancre was ascertained 1,033 times, 
either from information furnished by the patients, or from the result 
of a personal investigation. Thirteen times only out of that number 
was chancre not made out in a positive manner to be the origin of 
the disease, which is evidently no proof that it was really wanting. 
When the contagiosity of the primary lesion only was admitted, the 
law established by Bicord could not appear extraordinary; but when 
the contagiosity of secondary lesions was proved, there were grounds 
for asking whether this law always held good. Observations were 
not long wanting, and a discussion as to priority soon arose ; but 
on this point, as on so many others, there already existed important 
data which it would have been well to bring forward at the very 
first. 

Brassavole in 1550 1 and EondeletJ in 1574, wrote that in 
infected niurses the syphilis commences by ulcers of the breasts. A. 
Trajan Petronius used very similar language. § "The first part to 



• Lettres sur la syphilis, 3« 6dit. Paris, 1863, p. 183. 

t De marho galUco tract, cap. xxii. See further on, in the Medico-Legal 
part, the precise quotation of Brassavole. J Aphrodisiacus, p. 935. 

§ Videmus infantes ulcere in labiis primum or to in luem gallicam in- 
cidere, nutrices in papillis, viros in pene, meretrices in vulva. . . . Primi 
affectus sunt velut ulcera in pene, in vulva, in ano, quae coitu contra- 
huntur, in labiisque turn suctu, turn osculo, in maxillisque nutricibus in-, 
quinatos infantes lactantibus evenire solent. Aphrodis,, p. 1167, 



CONTAGION. 249 

be affected (in nurses)/' say Fabre,* "is the nipple, because the 
child's mouth impregnates it with infected saliva. There supervene 
then, in this spot, first painful phlogosis and afterwards small 
pimples which become converted into ulcers or chancres ; very often, 
the glands in the axilla, or those of the neck, become enlarged at 
the same time, also those in the groins, where buboes supervene 
when the chancres occupy the genital organs. After these primary 
symptoms, the nurse experiences others characteristic of confirmed 

syphilis, &c '' 

Bosquillon is not less explicit in his translation of Bell,t when he 
says : — " Hereditary syphilis is communicated with extreme facility. 
If a child thus infected be given to a healthy nurse, the nipple of 
the latter is soon observed to swell and become red, the inflammation 
reaches the areola and in a few days small vesicles appear and become 
transformed into ulcers having all the characters of venereal ulcers ; 
the axillary glands become swelled and the disease long resists 
specific treatment." According to Petit- Eadel,J chancre of the 
breast, common enough in nurses who take children infected with 
ulcers of the mouth, always manifests itself at the outset in the 
form of a small red pimple which itches very much ; this pimple 
soon comes to a head, becomes inflamed and excoriated, spreads, and, 
occupying the whole nipple, discharges a viscous whitish matter. 
We read again in Delpech's (of Montpellier) Clinical Surgery :§ — 
" It happens not unfrequently that kisses upon the mouth, given by 
persons infected and having some of the symptoms of syphilis in 
the throat or mouth, give rise to an infection occurring at the free 
edges of the lips. There s^re then generally seen one or more ulcera- 
tions, usually followed by inflammatory swelUng of the correspond- 
ing lymphatic glands, those of the jugular or sub-maxillary regions. 
This consequence is so common, that the concomitant or rapidly 
supervening swelling of the glands may serve to distinguish primary 
or chancrous ulcerations from secondary ulcerations proceeding from 
old syphilis, and which never occasion similar lesions. Chancre and 
bubo are then the exclusive symptoms of syphilitic infection com- 
municated by the mouth." After these quotations, long commen- 



• Fabre, TraiU des malad, vSnSr. Paris, p. 15, 1773. 

t Bell, Treatise on venereal diseases, &c. 

} Cours des maladies syphil,, t. i. 1812, p. 361. 

§ Chirurg, clinique de Montpellier, t. i. 1823, p. 326. 



250 -ETIOLOGY. 

taries are needless to show that a certain number of physicians of 
past centuries and of the beginning of the present one were led by 
clinical observation to regard as the analogue of infecting chancre 
the lesion which results from the contagion of secondary affections. 
But these facts were forgotten when, on the 14th of November, 
1855, Auzias Turenne asserted, before the Medical Society of the 
Pantheon,* that |there is no induration more strongly marked than 
that which occupies the spot contaminated by the communication of 
syphilis by means of secondary lesions. 

At the meeting of the 13th of the following February, Langlebert 
expressed for the first time the idea which he afterwards developed,t 
viz., that secondary syphilis, in its transmission, reproduces priniary 
syphilis, i.e.y chancre. This proposition, then based upon a small 
number of facts only, was soon accepted, developed, and propagated 
by EoUet, of Lyons,t and his two chief pupils, Guyenot§ and 
Viennois-fi Appealing to experimental facts and collecting a great 
number of clinical observations, Bollet succeeded in raising to the 
position of a principle, a pathological law, a dogma, the fact that 
syphilis, whatever may be its source, always commences by a primary 
chancre. But is this dogma as absolute as the Lyons syphilographer 
is inclined to consider it P^ Such is not the opinion of Dr. Eicordi, 
of Milan, who brings forward cases to oppose it in which the first 
effect of contamination by secondary affections is not a chancre, but 
a simple papule. These cases, which were not yet published when 
the first part of this work was printed, are too important and too 
much in accordance with the division we have established concerning 
the forms of the primary lesion (see Vol. I. p. 79), to be omitted 
here. We give them as briefly as possible. 

A woman contracted an ulcerated chancre on the breast irom having 
suckled her neighbour's, child, which had syphilitic lesions of the mouth. 
This woman continued to suckle her own child under these circumstances. 
Eicordi observed in the latter, a little to the right of the tip of the tongue, 

* Bxtrait des proces-verhaux de la Soc, mid, du Paniheonf p. 6. Paris, 
1865. 

f Moniteur dea hSpitauoBf Dec., 1858. Du chancre produit par la conta^ 
gion des accidents secondaires de la syphilis, 1862. 

J Gaz. m^d, de Lyon, January, 1859; et Arch, gen, de m^d., 1859. 

S Guyenot. Th^sede Paris, 1859. || Viennois. Thdse de Paris, 1860. 

f Rollet, Recherches sy.r la syphilis^ 1861, p. 237 et suiv, Cullerier, 
Rapport h la Sociiti de chirurg-, 1862. 



CONTAGION. 251 

an opaline papule scarcely raised at all, which [rapidly increased in size 
and formed, at the end of four days, a small patch of the size of a lentil, 
harder than the tissue of the tongue, painless, with corresponding swell- 
ing of two sub-maxillary glands. There finally remained a small livid 
spot ; but during its existence, the papule never became ulcerated. (Obs, 
XLI. by Ricordi.) 

In an observation by Pellizzari, it is a question also of a primary 
papule of the breast which had been produced by a mucous patch in the 
mouth. (Obs. XLI I. by Ricordi.) 

A woman named Angela contracted the disease from her child, which 
had been suckled four or five times by a neighbour afiected with ulcera- 
tion of the nipple from having nurse.d a foundling in the Hospital Saint- 
Catherine. Three weeks after, this neighbour presented two ulcers at 
the angles of the lips and a purulo- sanguineous discharge from the nose ; 
also ulcerated mucous papules in the fold of the neck and on the buttocks. 
These symptoms still existed when the child entered the hospital with its 
mother. The latter was not then infected ; the breasts, axillse, and vulva 
were all healthy. She continued to suckle her child. Four days after 
her admission, she presented at the outer side of the areola of the left 
breast, a reddish spot slightly elevated, of the size of a small lentil, dry, pain- 
less, and without induration. On the following days, this spot gradually 
became raised and was accompanied by induration of four corresponding 
aocillary glands. Sixteen days after the first manifestation of the papule 
on the breast, her child was cured of the lesions of the mouth, and the 
papule itself was beginning to throw off its crust. Under the detached 
scales of the epidermis was seen a protuberance of the size of a small pea, 
soft, red, and free from ulceration. This small tumour disappeared after 
cauterisation with nitrate of silver. 

A young woman, eet. 22, saw appear under very similar circumstances 
to those of the preceding case, on the outer part of the areola, a small 
red spot, such as is observed in measles. In five days, this spot increased 
to double the size and began to be raised ; some of the glands in the corre- 
sponding axilla then became affected and soon presented types of specific 
bubo. The mammary papule soon attained the size of a lentil and assumed 
a dark red colour, but it always remained dry and perfectly intact. Later 
on, secondary symptoms supervened, and especially a papular syphilide. 
(Obs. XXXIX. by Ricordi.) 

We have here four cases la which the initial form of the syphilis 
was a papule which did not hecome ulcerated, and thus, says Dr. 
Bicordi, the law propounded by Eollet is not exact, since, according 
to that observer, or at least according to the school which he repre- 
sents, it remains to be proved that indurated chancre may exist, even 
exceptionally, without ulceration.* It appears to us that these cases 

♦ L. Nodet, Etudes eliniques et expirtment, sur les diverses especes de 
chancre, &c. Paris, 1864, p. 17. 



252 JETIOLOGY. 

do not invalidate the principle laid down by EoUet, but simply prove 
that that distinguished physician has not recognised all the initial 
forms of the primary lesion ; at the same time, they justify the descrip- 
tion which we have given above (Vol. I. p. 80). In fact, it is a 
primary lesion and not a secondary manifestation which is the origin 
of the syphilis in the cases given by Eicordi, and the proof of this 
is, as Bicordi himself remarks, the incubation of the lesion and the 
existence of concomitant adenopathies, circumstances which do not 
belong to secondary affections. 

K To know what relation exists between the contaminating lesion 
and the initial manifestation of syphilis is a point which we have 
already discussed, and upon which the observations of Eicordi have 
served to throw more light, since they show that dry papules and 
chancrous erosions are frequent consequences of the contagion of 
secondary affections. But are we to understand that these affec- 
tions never give rise to indurated chancre. By no means. The 
projecting, red, papular or tubercular, initial point often becomes 
covered with a crust, and later on, when this disappears, there 
remains an ulcer with an indurated base and looking more or less as 
if scooped out, in fact, a typical indurated chancre. On the other 
hand, it is more than probable that indurated chancre does not always 
engender a similar lesion; it may give rise to one of the other two 
varieties, and especially to chancrous erosion. Thus the initial form 
of syphilis would appear to depend partly upon the constitution of 
the individual affected. 

Such are, to sum up, the various points included in the study of 
syphilitic contagion. The great practical interest of this question, 
the difBculties connected with it, and the numerous vicissitudes it 
has undergone, are so many circumstances which have induced us to 
discuss it somewhat at length, but which it is possible to condense 
into a smaU number of aphorisms : — 

1. Syphilis is not contagious for an individual who is already 
under the influence of the infection ; in other words, it does not 
become doubled. 

2. This disease is transmitted with certainty by the primary lesion 
and by secondary affections of a secreting nature. It is not proved 
that it is transmissible by mean? of tertiary affections; but the con- 
tagious properties of the blood in the primary period, or at the 
very least in the course of the secondary period, cannot be denied. 

8. Whatever may be the source from which it proceeds, syphilis 



HEREDITABINESS. 253 

always commences by one of the varieties of the primary lesion. 
Although no absolute relation exists between the contagious lesion 
and the primary manifestation, it may nevertheless be aifirmed that 
the dry papule and the chancrous erosion are, more frequently than 
indurated chancre, the sad consequence of the product of secretion 
furnished by secondary affections. 

§ 2. Hereditariness. 

It was in 1536 that Paracelsus, the great innovator of the period, 
clearly pointed out for the first time the transmission of syphilis by 
inheritance : — " Tandem fit morbus hereditarius et transit a patre 
ad filium, ab infecto ad alium. . . . Est morbus foedus, magis 
hereditarius quam lepra.^' 

Brassavole, in 1550, observed a case of hereditary syphilis in a 
child which infected its nurse. Amatus Lusitanus, in 1554, related 
one of the first observations of inherited syphilis. Fallopius wrote, 
in 1535 : — '^Prseterea videbitis puerulos nascentes ex femina infecta, 
ut ferant peccata parentum, qui videntur semicocti." 

Since that time, the hereditariness of syphilis has been admitted 
by the generality of syphilographers : A. Ferrier, P. Haschard, V. 
Rondelet, B. Tomitanus, A. Par6, A. de Bl^gny, Astruc, Fabre, 
&c.* Hunter, as we know, denied the hereditariness of syphilis, 
which did not prevent him from relating two most conclusive cases 
of congenital syphilis. 

The successors of Hunter do not all share his opinion, and some 
have sought to prove by special treatises the transmission of syphilis 
by inheritance; such are, in particular. Doublet, Mahon, and Bertin. 
Kicord, who accepted most of Hunter^s views, could not refuse to 
admit hereditariness; the same holds good for Diday, his pupil. 
This mode of transmission is, indeed, now one of the most firmly 
established. The father and the mother are the factors whose single 
or joint influence requires to be investigated. 

Infection by the father. — ^Astruc recognised the exclusive influence 
of the father in hereditary transmission, but he regarded it as much 
less frequent and less certain than that of the mother. Swediaur f 
relates that a dragoon affected with a syphilitic ulcer of the throat had 



• See vol. ii. pp. 136 and 137, of this work, 
t Traits des malady verier,, t. ii. p. 177. 



254 .ETIOLOGY. 

a child which presented the same symptom without the mother's ever 
having suffered from any syphilitic affection. Bertin quotes a very 
similar case.* Haase,t V. Gerhardt^J Boehr,§ Derschjold,|| 
Campbell,ir Bertherand, Cazenave, Diday,** Martinez and Sanchez, 
Trousseau, and Beyran,tt tave given cases which leave little doubt 
of syphilis transmitted by the father. Three of these cases, given in 
the thesis of Dr. E. Vidal, appear clearly to establish the hereditary 
influence of the father. They refer to three physicians who, in spite 
of previous syphilitic affections, believed they might venture to 
marry, and whose children presented, a few days after birth, evident 
traces of syphilitic infection, their mothers never having manifested 
any suspicious lesion. 

This collection of facts furnished by men well informed and placed 
in conditions of observation often very different from each other, can- 
not leave any doubt, as it appears to us, as to the exclusive action of 
the father in the inheritance of syphilis. But some distinguished 
observers do not share this opinion. Bouchut hesitates to declare 
himself on this delicate subject, but has finished nevertheless by 
admitting, in the last edition of his work (1862), that he considers 
this mode of transmission possible. 

Vassal,$$ Cullerier,§§ Notta,|||| and CliarrierT[ir deny syphilitic in- 
fection by the father. They base their opinion upon cases, amountmg 



* Traits des malad, nSnSr, chez les enfanU nouveau-nSSf p. 163, Obs. XIII. 

t AUgem. medizin, Annal, February, 1829, p. 194. 

t Journ. de Siebold, t. x. § 553. 

§ Journ, derprakt, HeUkundey 1836. 

II Quoted by Tronchin, De Vextinction de la malad. vSnSr,, p. 50. 

^ The London and Edinh, Monthly Journ, j 1844, p. 514. 

** Train de la Syphilis des nouveau-nes et des enfants d la mamelle, 
Paris, 1854. Most of the cases given above are found in this excellent 
work. 

tt Transmission de la syphilis du pire au fxtus et du fcstus d la m^re 
( Union mid., t. ii. p. 457, 1862). 

XX Vassal, Mimoiressur la transmission du virus vSnSrien de la mire d> 
Verdant. Paris, 1807. 

S§ Cullerier, De VhiridUS de la syphilis {MSmoires de la Soc. de ehir., 
1857, t. iv. p. 230. 

II II Notta, Mim, sur VhereditS de la syphilis {Archiv, de fnSd,^ &• s6rie, 
t. XV. p. 272, 1860). 

Ut Charrier, De PherSditS syphU, (Archiv. de mSd.^ 6« s^rie, t. xx. p. 334, 
1862). 



HEBBDITARINESS. 255 

to twenty-six in number, in which syphilitic fathers begot one or 
more healthy children. I will not attempt to poiiit out what might 
be thought doubtful features in some of the observations given by 
those authors : most of them leave little to be desired ; but, in such 
a question, what can negative facts prove against positive facts P 
Nothing, except that an infected father does not necessarily transmit 
the disease from which he is suffering. More than this : we see 
children born and grow up healthy, both of whose parents are or have 
been syphilitic. 

In a recent work in which Baerensprung makes known his long 
experience in reference to the subject we are now examining, we find 
forty cases of hereditary transmission by the father infected at the 
moment of procreation ; the mothers manifested symptoms in the 
course of their pregnancy only. If most of these cases leave nothing 
to be desired, there are some of them, however, which are not per- 
fectly conclusive, on account of the doubt which exists as to the 
exact moment of the syphilitic infection in the woman. I have my- 
self twice observed congenital syphilis in children whose mothers had 
never presented anything, and a medical friend of mine, practising 
in the country, has often told me that having to attend a woman in 
perfect health, all of whose children died soon after birth, he learnt 
from the husband that he had had syphilis before marriage ; as for 
the woman, she never showed any symptom of the disease. Thus 
the fact of the transmission of syphihs by the father cannot be 
denied. 

But under what circumstances, and during what period of time, is 
this transmission possible ? Several of the cases mentioned above 
teach us that this mode of transmission exists so long as the father 
is the subject of primary and secondary symptoms. But what occurs 
when he is exempt from these? Diday quotes several instances 
of syphilitic transmission in this state. Baerensprung has given 
fourteen cases in which, despite the latent condition of the syphilis 
in the father at the moment of procreation, both child and mother 
were infected. Consequently, a father healthy, or at least exempt 
from any manifestation of syphilis, is nevertheless capable of infecting 
the child which he begets. 

The Berlin professor has sought to push his analysis further, and 
asks himself whether, in these cases, the degree of severity for the 
fcBtus is the same. Then, comparing sixteen cases of a first series of 
observationsi in which the father had symptoms of syphilis at the 



256 JETIOLOGY. 

moment of procreation, with fourteen cases of a second series, in 
which the father was exempt from anj manifestation, he has come to 
the conclusion that abortion is less frequent in this latter series, 
which appears to indicate a diminution in the power of transmission. 
In a third series of cases collected by the same author, in which the 
syphilis in the father is always in the secondary period, but weakened 
by time and previous treatment, the foetus was still infected ; here 
the mothers, who were infected in the other cases, continued healthy. 
Lastly, in a fourth series of observations, containing eight cases of 
tertiary syphilis in the father, neither the mother nor the child was 
infected with the disease. 

From the comparative examination of the numerous cases col- 
lected by Baerensprung and from those observed previously, it 
follows, that syphilis in the father is transmissible during the 
primary and secondary periods ; but that it is no longer so in the 
tertiary period ; or if it be so still, it is so in a much slighter degree. 

Infection by the mother. — The influence of the mother in the 
hereditary transmission of syphilis is less disputed than that of the 
father; but, in our opinion, it is doubtful whether it be more power- 
ful. Numerous cases too long to be given here prove this influence 
in a peremptory manner.* In ten observations of mothers infected 
while the fathers continued healthy, Baerensprung generally saw 
frequent abortions, or delivery before the full term. The effects were 
as severe as in the cases of infection by the father. But when the 
syphilis in the mother had been weakened by time, or by previous 
treatment, the abortions were rare, the children were mostly bom 
at the full term and alive, a certain number of them were curable, 
and the hereditary transmission showed itself less intense, as in- 
dicated by eleven cases related by the author. In six cases in 
which the mother was affected with tertiary lesions, there was no 
hereditary transmission. The effects of syphilis proceeding from the 
mother do not differ notably from those produced by syphilis in the 
father. 



* Diday, TraitS dela syphilis des nouveau^nSs, 1854| has collected several 
observations which prove the truth of this assertion. The nurses infected 
by strange nurslings furnish on this point irrefutable facts. See Berth er* 
and, PrScis des tnalad, vSnir., 1852. Ij^hitehead, Transm, de la syphilis des 
parents atuc enfants {Arch, de med., 1857, t. ii., p. 371). Bardinet, De la 
syph, hirSdit. et de sa transmissibiliti. Mimoire prSsente h VAcad, de mid., 
December 28th, 1852. 



HEB£DITABIN£SS. 257 

Infection by the father and mother. — The transmission of syphilis 
under these circumstances is the logical consequence of what has 
already been said ; it is proved by numerous observations in which 
it has been seen to give rise to very serious consequences. Abor- 
tions then succeed each other in the same family and only cease 
under the influence of time and of the good effects which may result 
from a specific treatment. It would be wrong, however, to suppose 
that the children are always doomed to certain death. " Two children 
were bom healthy in the first years of a marriage. After that time, 
the mother was infected by her husband; both of them, affected with 
secondary syphilis, were treated with Zittmann's decoction and mer- 
cury. A year afterwards the woman again became pregnant ; the 
child was bom at the full term and remained healthy for five years, 
when it had eczema. Three children born since that time have con- 
tinued healthy.'^* 

After the above, it is unnecessary to insist further upon the phy- 
siological mechanism of syphilitic hereditariness. If the father 
alone be infected, it is clear and patent that the transmission occurs 
by the semen ; but if the mother alone be infected, does the same 
thing still hold good ? This is a disputed question, and while cer- 
tain observers, as Gusco and Peter,f assert that the blood is the 
chief agent of infection, there are others who attribute to the ovum 
alone the power of this transmission. We can bring no direct 
proof in support of either opinion; but, considering the difficulty 
of inoculation of the blood, and above all the great analogy in pro- 
perties and characters between the secretion of the testicles and that 
of the ovaries, there is reason to believe in the influence of the 
ovum rather than in the action of the blood. The hereditariness of 
syphilis appears to us to be effected more especially by the modified 
and vitiated germ. What, in fact, is the germ but an anatomical 
element, a cdl which, like all the cells of the infected economy, has 
undergone the impregnation of the poison ? j: A microcosm of the 

* Baerensprung, Die heredttdre syphilis, Berlin, 1864| p. 149. 

t Peter, Des maladies virulentes. Th^se de concours pour Tagr^gation 
en m§decine. Paris, 1863. Compare : Lays, JDes malad. hSrid, ThSse 
de concours. Paris, 1863. 

X See on this subject an interesting communication made to the 
Academy of Sciences by one of its members, M. Coste, from which it 
results tiiiat the colouring matter peculiar to the flesh of certain species of 
the family Salmonides exists in the contents of the ovum, and i:i the 

9 



258 -ETIOLOGY. 

diseased being, the germ can only reproduoe an organism similar to 
that from which it proceeds ; otherwise it would be necessary to 
renounce the experience of every day and the most general laws of 
natural science. What has always surprised me is to see physicians^ 
agreeing therein with people in general^ invoke the action of the 
blood to explain the mechanism of hereditariness. This error 
evidently cannot be perpetuated^ at all events amongst medical 
men. 

embryou ; but if, placed under special conditions, these specimens lose 
this colour, the ova lose it also, and the flesh of the products is no. longer 
coloured. 



DETERMINING CAUSES* 259 



CHAPTEE n. 

PREDISPOSING AND DETERMINING CAUSES. 

After having pointed out the efficient cause of syphilis and made 
known its various modes of propagation, it remains for us to study 
the action of external influences and individual conditions in refer- 
ence to the appearance, the form, the course, and the evolution of 
syphilis. These circumstances, which are in reahty to be regarded 
as the predisposing or determining causes of the disease, are numer- 
ous and varied. We shall pass successively in review the physical 
and climacteric influences, the hygienic influences, and then the 
physiological and pathological influences. 

Physical and Hygienic Influences. 

Without any action upon the genesis of syphilis, physical agents 
play a certain part in the development of its manifestations. This 
influence did not escape the notice of Hunter, who had a certain 
tendency to exaggerate it. " It is certain," he wrote, '* that cold 
has a very powerful action upon the animal economy. It appears, 
at least, to have a great influence in predisposing the human body 
to receive the venereal irritation, and to manifest its morbid pheno- 
mena more rapidly.'* * 

The fact is exact ; but it cannot give, as Hunter would have had 
it do, the explanation of the course of syphilis from the superficial 
parts towards the deep-seated parts. 

Traumatism is one of the causes which chiefly serve to fix the 
seat of the anatomical determination of syphilis. Duverney f attri- 
butes the greater frequency of exostoses upon the bones situated 
superficially to the circumstance that those bones are, more than 
the others, exposed to the action of the air, to contusions, and to 
various kinds of injury. Virchow points out this determining cause 

^ Hunter, Treatise on venereal diseases 

t Duveruey^ Maladies des os» Paris, 1751) t ii. pp. 477-479. 

e2 



260 -ETIOLOGY. 

ia the production of affections of the liver. The fact is, that we 
cannot doubt this influence, which is mentioned in several of our 
observations in reference to the lesions of the liver and other 
viscera. 

Side by side with the action exerted by traumatic agents is to be 
placed the influence of cold and of heat. ^^ Heat/^ says Martius,* 
^' favours the appearance of syphilides more than cold ; the influence 
of a temperature low for our climates, such as 3° above (cen- 
tigrade), as a mean, is almost as energetic as that of a mean heat of 
+ 16°, since the number of syphiUdes produced by these two causes 
are to each other as 3 to 4. A mean temperature of + 6°, 4 ap- 
pears more fitted to prevent their appearance. The influence of 
temperature makes itself felt in a very short time, and artificial cold 
and heat have the same influence as the natural temperature of the 
atmosphere." 

Thus the warmest and the coldest seasons equally predispose to 
syphilides. It is evidently by their degree of temperature that 
vapour baths or common baths exert a provocative action upon these 
manifestations ; violent exercise no doubt acts in the same way. 
Climates too warm or too cold, and all those which expose per- 
sons to rapid changes of temperature, are conditions little favour- 
able to syphilis. Thus Daniell speaks of syphilis being severe and 
malignant on the east coast of Africa. Vieit and Brocchi have 
observed it to possess the same characters in Sennaar, and Petit in 
the interior of Abyssinia, Purnari, Deleau, Armand, and Daga have 
made known its degree of intensity in Africa, Porter in the Sierra- 
Madre of Saltillo in Mexico, Hunter in the Antilles, and Bernhard 
in central America. Sigaud and Bibra have seen this disease com- 
mit considerable ravages in Brazil and Chili. Lesson has described 
its intensity in the Moluccas and in several of the South Sea Islands. 
Schanks, MacGregor, Leslie, and Heymann, equally complain of 
its malignity in India and in the Indian Archipelago. Monat 
declares that in the Bengal Presidency it presents the same appear- 
ances as in Europe. 

We know, from other sources, the severity of syphilis in the 
north of Europe, and especially upon the coasts of Sweden and 
Norway, and in the north of Germany and Russia, Let us add 



* Martius, Memoire sur les causes gSnsrahs des syphiUdes, Th^se de 
Paris, 1838, p. 73. 



DETERMINING CAUSES. 261 

that this disease is not less severe in North America. Consequently, 
cold climates are not more favourable in this respect than hot ones. 
The temperate regions, and particularly those whose climate varies 
little, are much more favourable, as shown by the data furnished by 
various authors and especially by Thiery for the Spanish province of 
Estremadura, by M^nis for Brescia, by Quitzman, Eoser, and Olym- 
pias for Greece, by Hennen for the Ionian Islands, by Barasch and 
Oppenheim for Turkey, by Eobertson for Syria, by Polak for 
Persia, by Aubert-Eoche for the coasts of Abyssinia, and by Pruner 
for the interior of Egypt. 

It would be wrong, however, to believe that in these latter regions 
syphilis will always present itself in a benignant or little severe 
form; other conditions than climate may impart to it a different 
character. It is seen to assume severer forms in certain seaport 
towns apparently the best situated in respect to climate, such as 
Barcelona (Cuynat), Marseilles, Naples, &c., and that doubtless on 
account of greater excesses, overcrowding, want of cleanliness, and 
misery in those localities than in the neighbouring towns. To sum 
up, a climate which varies little, and of which the temperature is 
moderate and scarcely different from that of the place in which 
the disease was contracted, is that which, according to Sydenham, 
should be chosen by preference by persons affected with syphilis. 
'^ Syphilis showing itself for the first time in any climate," says 
Swediaur,^ " is very violent in its effects ; but it is much more so 
when it is imported from a warm country into a cold climate.^' 
The severity of the epidemic of the fifteenth century appears to 
support this view. 

As regards the nature of the modifications produced in syphilis by 
a given climate, observation teaches us that primary and secondary 
lesions predominate in warm climates, such as Italy, Sicily, Greece, 
Turkey, Persia, India, &c., while deep-seated, tubercular or osseous 
affections are comparatively more frequent in cold countries, such as 
Russia and Sweden. This explains, to a certain extent, the fre- 
quency of epidemics of syphilis in certain countries, such as Italy, or 
the locality of syphilitic contagion in certain other countries, e. gr, 
in the East (Poyet) and in Africa (Daga). 

Of all the hygienic influences, poverty and want of cleanliness are, 
perhaps, those which contribute most powerfully to the aggravation 

* Traits des maladies syphUiiiquea^ t. ii. p. 67. 



262 -ETIOLOGY. 

of syphilis. It is, in fact, to the combination of these two causes 
that we may attribute the malignity and the extension of scherlievo 
on the borders of the Adriatic and in the Tyrol, and of radesyge in 
Sweden. Density of population, which does not fail, in general, to 
cause immorality, is.another condition not less deleterious, and there 
is every reason to beHeve that the overcrowding of the workmen 
amongst whom the so-called " Ditmarsch disease ^^ developed itself 
was not without influence upon the severity of its form. Starting 
from these data, it is easy to explain the appearance of the great 
epidemics of syphilis consequent upon wars, in which most of these 
unfavourable conditions are found combined. Food insufficient in 
quantity, or bad in quality, is also, as Bassereau has pointed out, a 
powerful cause of the aggravation of syphilitic symptoms. To sum 
up, the crowding together of a great number of persons, the immo- 
rality resulting therefrom, and food often disproportionate to the 
fatigue undergone, are so many causes which may serve to explain 
the extension and the severity which syphilis sometimes assumes. 

The abuse of spirituous liquors is another kind of occasional cause 
. pointed out by some authors. Excesses in wine or spirits, says 
Boerhaave, are unfavourable to syphilitic subjects. Observation, 
writes Sicord, has shown what occurs from the abuse of spirituous 
liquors, especially in warm seasons. The simplest chancres, under 
their influence, rapidly become inflammatory, and in certain regions, 
especially in the genital organs, the cellular tissue of which easily 
becomes cedematous, the inflammation soon produces gangrene.* 
Bassereauf also points out the deleterious influence of spirituous 
liquors, to which he attributes, in certain cases, the precocity of 
syphilides. We have had several opportunities of observing this 
influence; the following case is a good instance of it : — 

A male patient who had been under our care for a year, for vis- 
ceral syphilis (liver, spleen, and glands), feehng better and believing 
himself to be permanently cured, thought he might without danger 
relax somewhat the severity of the diet we had prescribed for him. 
But after a rather prolonged drinking bout, there supervened an 
exostosis on the forehead. Appropriate treatment (iodide of potas- 
sium) soon caused it to disappear. Some time after, the patient 



• Ricord, Lettre^ sur la syphilis, 3« edit. Paris, 1863, p. 255. 
t Bassereau, loc, cit, p. 306. 



DETERMINING CAUSES. 263 

again believed himself thoroughly oured^ and had another drinking 
bout^ but had a fresh exostosis in the same region. 

Phtsioloqical Inplubncbs. 

These influences^ which are numerous, depend upon the age, the 
sex, and the great physiological changes which take place in the 
organism in the course of our existence. 

Age. — ^No age is exempt from syphilis; from his birth to the 
most advanced old age, man shows an unfortunate aptitude to con- 
tract that disease. There are ages, however, at which syphilis is 
more common. It is during the first days after birth that hereditary 
syphilis shows itself, and youth is the period in which acquired 
syphilis is most frequent, because it is the period during which man 
exposes himsdf most to contagion* 

In 158 patients examined in reference to this question, Cazenave* 
found— 

From birth to 10 years, 1 case (hereditary syphilis). 



IVom 


10 


to 20 


ii 


2 


From 


20 


to 80 


» 


67 


From 


80 


to 40 


»J 


48 


From 


40 


to 60 


J9 


27 


From 


60 


to 60 


a 


11 


From 


60 


to 70 


jj 


2 






The influence of sex is also ntlll. "Whatever certain observers 
may have said on this subject, men and women are equally liable to 
contract syphilis, and if fewer women are affected with it than 
men, it is, as Bassereau has shown, because the number of women 
who give themselves up to debauchery is infinitely less than that of 
men. 

Constitution and temperament also do not predispose to syphilis, 
any more thau they modify its effects in a notable manner ; such, 
at least, is the result of the observations of Martius and Bassereau. 
No temperament, no constitution, says this latter author, can be 
regarded as disposing particularly to the generalisation of syphilitic 
symptoms. The infiuence of temperament manifests itself really 
only in the form of the symptoms, and in their course, dura- 
tion, and greater or less tendency to yield to, or to resist treatment. 

* A, Cazenave, Traite des syphilides, p. 521. 



264 JETIOLOGY. 

What is tte influence of races upon the development of syphilis ? 
A first point to establish is^ that no race is exempt from that 
disease. In fact if, as Schleissner points out, syphilis has never 
been able to become implanted in Ireland, this immunity in no way 
depends upon the race of the inhabitants of that country. The 
same applies to the immunity observed in certain tribes of the 
central part of Africa, where the race, according to Livingstone, has 
never been crossed, since this immunity does not extend to the whole 
negro race, and since, on the contrary, syphilis commits dreadful 
ravages amongst the blacks of the west coast of Africa and in the 
countries situated to the east of Soudan. There is, moreover, 
nothing strange in this when we know that privileged individuals 
may expose themselves to contagion with impunity. This fact has 
long been known, since it was already mentioned at a period in which 
syphilis raged with intensity. In fact, J. Cataneus writes : — " Vidi 
tamen complures concubitus immundarum non recusantes, et in 
sordes venereas sese preecipitantes qui tamen nullamindeinfectionem 
hauserunt.^'* As regards the influence of race upon the form or 
severity of the disease, we are taught by observation that in the 
countries in which the races live intermixed, and especially in the 
tropical regions of Asia and America, there is not any notable 
difference in this respect ; but nevertheless it follows from the facts 
observed in Turkey by Kigler, that the destruction of the pharynx 
is more frequent amongst the coloured races. Pruner points out 
that in the countries of the East, and particularly in Egypt and 
Arabia, the tendency to erythematous, vesicular, and squamous 
eruptions is in proportion to the fineness and whiteness of the skin. 
On the other hand, serpiginous and warty eruptions and nodes are 
rather forms peculiar to individuals whose skin is thick, like the 
Egyptians and Abyssinians. Amongst the latter, the syphihdes 
have a great resemblance to pian. The spots and cicatrices are^ 
moreover, darker coloured or blacker in individuals whose skin is 
blackest. 

I should have nothing further to add concerning the influence of 
race if the idea had not recently been started that syphilis may 
become aggravated by transmission from one race to another : — " If 
we renew the poison," says G. Gauthier,t *^ by drawing it at distant 

I III . - — — — — — - — ■ — • — " — ■ — ^ 

* De morho gaUico tractattusj 150^. 

t G. Gauthier, Deiix annSes de pratique mSdicaie d Canton (Chine). 
ThSse de Paris, 1863. 



DETERMINING CAUSES. 265 

sources from subjects of a different race, inhabiting a different 
climate, and submitted to a different hygiene, we shall immediately 
see the disease assume a surprising intensity, and lesions the most 
insignificant become very serious." This proposition is based upon 
the fact that in the seaport towns of China, and perhaps also in some 
others, syphilis is more common and more intense in the sailors 
and soldiers who put in there. It is not my intention to contest 
this opinion, after what has already been said of the severity of 
syphilis in seaport towns. But is not this a complex problem? 
Are there not, apart from the question of races, peculiar conditions 
capable of contributing to the aggravation of the disease? The 
passing from one locality to another, the temperature of which is 
not the same, the want of acclimatisation, and frequently intem- 
perance also, appear to us to be so many circumstances the influ- 
ence of which is, perhaps, much more considerable than the circum- 
stance of the transmission of the poison between individuals of 
different races. 

The age of puberty in both sexes, pregnancy, and the cessation of 
menstruation in women, are circumstances which here, as in the 
generality of diseases, frequently play the part of occasional causes. 
Puberty is a period at which cases of tardy inherited syphilis do not 
fail to manifest themselves. Pregnancy, on the other hand, is a 
period in which secondary affections rarely fail to appear in women 
recently infected. One female patient seen by us, and who was 
infected a short time before becoming pregnant for the first time, had 
six pregnancies, and in each of the first four she saw appear mucous 
patches or syphilides, and sometimes both these forms of lesion. Pacts 
of this kind are numerous, and to become convinced of this it is only 
necessary to read the observations furnished by authors ; we see in 
them that most of the women infected before pregnancy do not fail 
to manifest, during that period, the signs of syphilis. Like phthisis^ 
syphilis awakes under this influence. At all events, if pregnancy is 
not, in general, more than a determining cause, delivery may become 
an aggravating cause, and it is possible that it may impart to syphilis 
more marked and more serious features. According to CuUerier, 
jun.,* the symptoms of syphilis are generally less severe during the 
period of gestation, the infection which may take place at the same 
time as conception sometimes remaining concealed during the whole 



* Joum, gSnSr. de mSd,, de chirurg,, et depharm,, t Ix. p. 343, 1817. 



266 MTIOLOQY. 

of the pregnancy, and not showing itself openly until after delivery. 
However this may be. Hunter, Nisbett, Protean, Swediaur, Biett, 
Cazenave, Gibert, Eayer, Alibert, and Martins, assert that syphilis, 
which has been latent for a longer or shorter time, suddenly declares 
itself in the form of an eruption on the occasion of pregnancy, de- 
livery, the menstrual period, or the cessation of menstruation. Thus 
menstruation, and still more the cessation" of it, appears to act in the 
same way as pregnancy and delivery, and, like these two states, to 
favour the appearance of syphilitic lesions. The venereal disease, 
says Cullerier,* often shows itself at the turn of life, after having 
lain dormant for many years, sometimes even for the first time. It 
has been observed to be then very obstinate, appearing most com- 
monly in the shape of ulcers in the throat and nasal fossae ; affections 
of the skin and bones are also seen to appear. 

Pathological Iotluences. 

According to Hunter, the least derangement in the constitution is 
a sufficient cause for the manifestation of syphilis. And in reference 
to a patient who had had secondary symptoms for the first time in 
August, 1781, and had a recurrence of them in June, 1782, in con- 
sequence of a disease called injhenzay he asserts that the interval 
would certainly have been longer if the fever had not determined this 
second outbreak. Freteau and Swediaur, and Biett and Alibert, all 
agree in recognising the influence of acute diseases upon the develop- 
ment of syphilitic affections, and Martins has come to the same con- 
clusion. Bassereau, however, has not entirely verified this result ; 
the cases which he has analysed have taught him that intercurrent 
diseases which may have weakened the organism at a period little 
removed from that of the contagion cannot be considered as determin- 
ing causes of the generalisation of syphilitic lesions in the economy. 
It is difficult, however, to deny to the eruptive fevers, especially to 
small-pox and cow-pox, the power of calling forth the manifestations 
of syphilis. Bamberger f gives two cases in which the influence of 
an attack of small-pox upon the appearance of syphilitic symptoms 
appears little doubtful. Friedenger and Viennois % have observed 
janalogous cases in reference to cow-pox, and the latter author has 

• hoc, dt t See Gaz. hehd, de med, et de chir., 1858, p. 390. 

X Dela trammission de la sypTi, par 2a vaccination (Arch, med.y June, 
1860, p. 647) '^^tDela ayphiUa vaccinak. Paris, 1865, p. 227. 



DETEBMINING CAUSES. 267 

carefully pointed out their great value in reference to the diagnosis 
of vaccinal syphilis. Moreover, it is not in syphilis only that the 
eruptive fevers have the sad privilege of acting as occasional causes ; 
there are other diseases, and especially scrofula and tuberculosis, in' 
which they behave in the same manner. 

Like the physical, physiological, and pathological derangements, 
moral derangements sometimes elicit the determinations of syphiUs 
which had previously remained in a latent state. To this kind of 
influence may be added the necessity in which a great number of 
individuals find themselves of marrying at an akeady advanced age. 
Military conscription, which leads to this result, is certainly not 
without its disadvantages in this respect. Lastly, let us add that 
idleness amongst soldiers, and amongst a great number of young 
men in general, is also to be regarded as a predisposing cause of 
syphilis, and, for that very reason, as a cause of degeneration of the 
species. 



PAET V. 



TREATMENT. 



To cure is the duty of the physician, to prevent disease is his highest 
aim. SyphiUs, like all diseases, has necessarily its preventive means 
and its curative means : let us see what these are. 



PUBLIC HYGIENE. 269 



CHAPTER I. 



PROPHYLAXIS. 

« 

§ 1. Public hygiene, 

G'ar^^nn^^, Traltement des maladies y^n^ennes. Paris, 1770. Bourru^ 
Moyens les plus propres k §teindre le mal y^n^rien. Paris, 1771. Reatif 
de la Bretonnef Le Pornographe. Marc, Dictionnaire des sciences mldi- 
cales, art. Copulation. FodSrS, ibid., art Maison. F. S. Hatier, Police 
medicale contre la propagation de la syphilis (Annales d'hygidne publ. et 
de m6d. legale, 1836, t. xyi. p. 262). Parent-Duchalelet, De la prostitu- 
tion dans la ville de Paris. Paris, 2« 6dit, 1 837 ; 3« ^dit., 1857. VTeminckx, 
Des mesures adoptees et realisees en Belgique contre la propagation des 
affections veneriennes. See Gaz, mid. de Paris, p. 1, 1846. Diday, Gaz. 
mSd de Paris, 1847, 1849, 1850 ; et Exposition critique et pratique des 
nouvelles doctrines sur la syphilis. Paris, 1858, pp. 501-555. W, Acton, 
Prostitution considered in its moral, social, and sanitary aspects. London, 
1857. Sandouvillef Des mesures administratives k prendre dans le but 
d'empecher la propagation des maladies y^neriennes (Annales d'hygidne 
et de m^decine legale, t. xlvi. 1851, p. 72). Davila, De la prophylaxie de 
la syphilis. Th^se de Paris, 1853. JBottchut, Trait6 des maladies des 
nouyeau-n6s, 1855, p. 820. Hutchinson, De Tinfluence qu'a la circoncision 
de preserver de la syphilis {Med, Times and Gax,, 1856; et Gaz. mSd, 
1856, p. 589). Richelot, De la prostitution en Angleterre et en Ecosse, in 
Precis hygienique, statistique et administratif sur la prostitution dans les 
principales yilles de I'Europe. Paris, 1857. Gustave Lagneau, MSmoire 
sur les mesures hygi^niques propres k pr^yenir la propagation des 
maladies yineriennes (Annales d'hygidne et de mid. legale, 2^ sirie, 1855^ 
t. iv. p. 317; 1856, t. y. pp. 21 et 241). A, Fournier, De la contagion 
syphilitique. Thdse de Paris, 1860. F, Jeannel, M^moire sur la prosti- 
tution publique, &c., l^' Idit., Paris, 1862 ; 2*" 6dit., 1865. Amil Micordi, 
Sifilide da allattamento, &c., Milano, p. 173. Goulhot de Saint- Germain et 
Dupin, Discours au SInat. Paris, 1865. Hitet, Sur les r6glements de la 
prostitution en Hollande (Nederl. Tijdschr., June, 1865). 

Peom the veiy earliest times^ legislators *and physicians have under- 
stood the necessity of interfering for the mitigation of the ravages 
committed by venereal diseases. For a long time also^ attempts have 
been made to regulate prostitution. 



270 TREATMENT. 

The only idea in thia respect during the earUer periods was to 
watch over the cleanliness and the dress of prostitates, and over the 
luxurious and comfortable fitting up of the privileged houses. In 
the midst of the unbridled libertinism of the empire^ Borne did not 
seek otherwise to prevent the effects of debauchery. But in the 
reigns of Constantine, the two Theodosius, and Justinian, severe 
laws were established for the restriction of prostitution. These laws 
were prohibitory and ordered confiscation of farniture, clothes, and 
houses ; they decreed whipping, banishment, &c. Everything, in 
this Draconic legislation, says Parent-Duchatelet, announced good 
intentions, but a complete ignorance of the manners, habits, and 
management of prostitutes. The capitularies of Charlemagne pre- 
sent, in our country, the first instance of this excessive severity; 
but, during the four following centuries, all measures were aban- 
doned despite the greatest immorality. On his return from Pales- 
tine, Saint Louis endeavoured to apply a remedy to such a state 
of things by means of a prohibitory law; but perceiving after- 
wards that he had only aggravated the evil, he ended by tolerating 
prostitution, which experience had taught him could not be abolished^ 
and sought to regulate it for the purpose of diminishing the scandal 
and attenuating the evils of which it is the cause. Since that 
time, special neighbourhoods have been allotted to prostitutes. 
Avignon, Toulouse, and many other towns had, like Paris, Venice, 
and London, their prostitution districts and special laws in reference 
to prostitutes. 

At the time of the epidemic of the fifteenth century, it was 
sought to separate from all communication with others, even lepers, 
the individuals convicted of being the subjects of syphilis. The 
sequestration of syphilitics was the law of that period. The rich 
were compelled to remain in their houses, the poor were driven 
away and threatened with death, and abandoned even by the physi- 
cians, who felt themselves unable to combat the disease : — " Pauperes 
hoc morbo laborantes expellebantur ab hominum conversatione, 
tanquam purulentum cadaver ; derelicti a medicis (qui se nolebant 
intromittere in curam) habitabant in areis et silvis." * A rigorous 
measure, adopted first at Strasburg in 1495, and which received, on 
the 6th of March, 1496, the sanction of the Parliament of Paris, 
was as follows : — '-^ Premierement sera fait cry publique d'aprds le 



♦ L* Phrisius, D$ morho galUco Uber, Aphrodi$,, t* i. p« 846. 



PUBLIC HYGIENE. 271 

roy, que tous les malades de cette maladie de grosse v^role Strangers 

iant hommes que femmes^ qui n'estoient^ &c partent hors 

de cette ville de Paris ^s pays et lieux dont ils sont natifs^ ou 1& 
oil ils faisoient leur residence quand cette maladie les a pris, on 
ailleurs oil bon leur semblera, sur peine de la hart ^^ &c. 

A law of James lY. of Scotland, of September 22nd, 1497, 
also obliged persons affected with the grand gor to leave Edinburgh, 
on pain of being marked on the cheek with a red-hot iron, so that 
they might be recognised in future. 

Voyer d'Argenson in 1714, and Berrier in 1747, both lieutenants 
of police, were the first persons in Paris who sought to subject 
prostitutes to sanitary visitation. In 1762, Aulas required that the 
persons who kept tolerated houses should be made responsible for 
the sanitary condition of their women, and that all, without excep« 
tion, should be subjected to constant visits made by surgeons attached 
to the police and under the direction of a head-surgeon. Gardane 
in 1770, and Bourru in 1771, each expressed a wish for the estab- 
lishment of public offices, or of special hospitals, for the treatment 
of venereal diseases. 

In 1778, appeared the celebrated order of the lieutenant of 
police, Lenoir, an order to which the present administration still has 
recourse whenever energetic measures become necessary. Never- 
theless, in spite of its severity, this order, which was badly carried 
out moreover, did not improve the state of things. Under the 
Bepublic, the want of a distinct organisation made itself more and 
more evident, and anxiety was felt especially about the means to be 
opposed to contagion ; it was then that a Paris surgeon proposed to 
establish (1800) in each arrondissement a place to which all women 
of that class should be bound to come to be examined twice a 
week, and where those should be retained who, having been ascer- 
tained to be diseased, were afterwards to be sent to the hospitals. 
In 1802, a health dispensary was established for this purpose in 
Paris. In 1811, it was organised with more care, and the benefits 
of this measure were soon recognised. Before long, in fact, similar 
institutions were seen to be established in the great centres of popula- 
tion, and thus there became organised in Prance a system of prophy- 
laxis which is every day becoming more complete. These measures 
did not,* however, appear sufficient to all medical men; some de- 
manded the application of sanitary visits to men also. Eatier ex- 
pressed the wish to see these visits made in the barracks of large 



272 TBSATMENT. 

towns, and to render more frequent the inspection of women. 
Belgium took the initiative in this respect. The inspection of 
prostitutes, of servant-women, and of matrons, was made there 
twice a week and entrusted to a controlling inspector for the pur- 
pose of preventing the propagation of syphilis in the army. More- 
over. Dr. Yleminckx recommended that no soldier should be treated 
in the barracks, and demanded that each one should be required to 
point out the woman who had infected him. The measures which 
this eminent inspector caused to be adopted had such results that, 
in 1846, only one soldier in 190 was syphilitic, while at Strasburg 
the proportion, according to Bertherand, was one in thirty-three, and 
at Lyons, according to Sandouville, one in forty, and even this 
figure was below the reality, since a great number of soldiers were 
treated privately. 

Such has been the progress made in reference to the prophylaxis 
of syphilis. But the measures to be taken must be considered in 
respect to men, to women, especially to prostitutes, and lastly to 
nurses and nurslings. 

Measures relative to Men. 

The general prophylaxis will not be complete, says Aug. Tidal,* 
until the prevention of the propagation of the evil by men shall be 
effected. Restif de la Bretonne, Marc, Batier, Diday, Acton, San- 
douville, Davila, and G. Lagneau, regard it as desirable to subject 
soldiers and sailors to sanitary visits. According to Marc, in times 
of peace, only men previously ascertained to be healthy should be 
chosen for cantonments in country districts ; no furloagh should be 
granted without first taking the same precaution, and, in case of 
venereal disease, not until a complete cure had been effected. 
Davila is of opinion that no national or foreign sailor should be 
permitted to disembark until after he had been examined. " The 
importance of examining sailors,^' says G. Lagneau, '' is not doubt- 
ful, and its execution not, perhaps, altogether impossible, since 
quarantine is enforced for individuals coming from countries where 
the plague exists.^' As regards soldiers, we have already pointed 
out the advantages obtained in Belgium from the regulations to 
which they are submitted, and France, no doubt, might derive the 
same advantage from the application of the same regulations. 

* Aug. Vidal, Traiti des malady vSnSr, Paris, 1855; p. 573. 



PUBLIC HYGIENE. 273 

These precautionary measures are more difficult of execution for 
workmen, even for those employed in the Government establish- 
ments. In Germany, however, according to Davila,* the workmen 
in some of the large manufactories are examined every month by a 
physician who certifies that they are free from any contagious 
disease. We have already said that the men employed in the glass- 
works in the neighbourhood of Lyons have, of their own accord, 
asked to be examined for the purpose of protecting themselves from 
a contagion to which they are liable. Strictly speaking, then, it 
would be but a slight infringement of the liberty of the individual 
to subject to examination the numerous workmen employed in mines ; 
these examinations and many others would, at the very least, be 
useful for the generality. But, according to some physicians, the 
measures to be taken in reference to men should not stop here. 

As early as 1430, ancient regulationsf were in force that persons 
keeping licensed houses in London should cause to be examined not 
only the prostitutes therein, but also the men who frequented them, 
and since then some syphilographers have thought that the best 
means of reaching the sources of syphilis would be to examine the 
men who have connection with prostitutes. Diday, who has paid 
great attention to everything which concerns the prophylaxis of 
syphilis, asks for a police regulation obliging the keepers of licensed 
houses to examine the men presenting themselves there, and not to 
admit them until they have been ascertained to be healthy. This 
measure, long carried out in Hamburg,]: in spite of the difficulties 
of its application, appears to furnish good results. 

Bourru, almost a century ago, asked that those who did not 
scruple to communicate syphilis and to infect a multitude of persons, 
should be severely punished. Punishment is therefore regarded as 
justly due. If considerable indemnities are sometimes, and with good 
reason, granted to nurses contaminated by syphilitic children, why 
should not a fine be imposed upon the individual who voluntarily 
transmits the disease with which he is affected P I admit that such 
a measure might occasion false accusations, but these would be easily 
detected, and there would be nothing to prevent the punishment 
from falling back upon the accuser. Sanitary visits and punishment 



* Loe, ctt. p. 23. t Lagneau, he. cU, p. 62. 

X See Parent-Dachatelet, De la prosHftUion dans la viUe de Paris, 3* 
§dit. Paris, 1857. 

i 



274 



TREATMENT. 



are^ then^ the means which an intelligent administration might 
oppose to syphilitic contagion by men. 



Measuees eblative to Prostitutes and other Women. 

^^ To mitigate for the present the ravages of syphilis and ta make 
it disappear, probably, in the end/' writes Parent-Dnchatelet, *'the 
first and most indispensable condition is, to watch over the h^ih 
of the individuals placed under the circumstances most favourable to 
its propagation ; these individuals are evidently prostitutes.^' Pros- 
titution is the great source of syphilis. Erom statistics by Puche 
and Poumier^ we learn that out of 873 cases of transmission of 
syphilis there are — 



Public prostitutes 

Clandestine prostitutes 

Kept women, actresses, &c. 

Workwomen 

Servant women . 

Married women, wives of syphilitics 



625^ 
46 
52 

100 
26 
24 

873 



Although the figures in reference to prostitutes are here probably 
somewhat high on account of particular conditions, since it is a 
question of observations made in special hospitals in which public 
women abound, prostitution is none the less one . of the most 
irequent causes of syphilis; it is also one of those for which it 
is possible to find a remedy. 

In France, the manner in which the examinations are made is not 
the same in all the towns. In Paris, the women in licensed houses 
are seen every, week, those living in their own rooms twice a month, 
the speculum being used every other time. In Bordeaux, the exa- 
minations take place once a fortnight, and the use of the speculum 
is exceptional; at Marseilles and at Bheims the examinations are 
weekly. Daily observation shows that want of strict- legislation and 
insufBcient visits are the weak points of this organisation. In fact, 
we are forced to admit that, in this respect, Brussels and Hamburg 
are in advance of Paris. In both those towns the public women 



* Alf. Foumier> JD« la contagion syphiU Thdse de Paris> 1860. 



PUBLIC HYGIENE. 275 

are examined twice a week^ and the use of the speculum is always 
obligatory. 

Moreover^ the too great number of women to be examined^ and 
the little time which it is possible to devote to each of them, are dis- 
advantages which tend to render our sanitary measures to a great 
extent illusory^ Let us add that as the examination takes place 
shortly after the arrival of the women at the dispensaries, they do 
not fail always to remove by washing and astringent injections 
the product of secretion indicative of the contagious lesion. Under 
these circumstances, only a comparatively slight security is ever 
obtained. 

Numerous reforms havje been proposed, one of the chief of which 
is an increased number of medical visits. Bicord, Batier, Sandou- 
ville, and Davila, are of opinion that these visits ought to take 
place every three or four days ; but this interval of time is, doubt- 
less, still too long, if we would combat the disease vigorously and 
strive to make it disappear entirely. Multiplying the visits is iK)t 
enough ; it is important to prevent deception and to avoid every- 
thing which may render difficult the medical diagnosis, which pur- 
pose can only be effected by keeping the women for some hours in a 
place devoted to that object. An essential point, and one upon 
which Guichard and Davila have already insisted, is, to examine not 
only the genital organs, but also the skin, the mouth, the throat, 
the anus, &c. Since it has been admitted that secondary lesions are 
contagious and that they produce infection more frequently perhaps 
than the primary lesion, this examination has become indispensable. 
In like manner, in hospitals, an important point is not to leave 
prostitutes free immediately after the disappearance of the primary 
lesion, since, when the period of secondary affections supervenes, 
these women become a fresh source of contagion. What is to be 
done here ? " Two methods present themselves,'^ says A. Foumier, 
"either to keep in hospital and treat every syphilitic prostitute 
during a time sufficiently long to ensure a cure within the limits of 
possibility, or, after a longer or shorter time, to place her at liberty, 
but to keep her under special observation. This second means, 
which is the easier to effect, would necessitate the attendance of the 
woman every second or third day at a dispensary, after which, if 
she was found to be again affected, she would be sent into hospital 
again.'* 

Similar measures are applicable to women licensed in their own 

t2 



276 TREATMENT. 

rooms. As regards workwomen and married women^ there are great 
difficulties ; but it suffices to meet the evil at its source, that is to 
say, in the houses of prostitution. Moreover, punishment of the 
man who willingly transmits syphilis to a poor workwoman, would 
be a powerful adjuvant. Thus, to watch closely prostitutes in 
licensed houses and in their own rooms, to oblige them to undergo, 
every two days at least, a strict examination, to detain all such as are 
suspect and not to set them at liberty, in case of undoubted syphilis, 
until they have passed the period of secondary affections, are the 
measures indispensable for diminishing the frequency of syphiUs, if 
not for putting an end to its existence. What it is important to 
bear in mind is, that syphilis will not cease definitely to exist until 
prostitution shall everywhere be subjected to regulations sufficiently 
strict.* 

MeASXJEES EELATIVE TO NxJBSES AND NUESLINGS. 

The great development given above to the contagion of syphilis 
in suckUng shows the whole importance of the hygienic question at 

* Works on prostitution have increased in number to a surprising extent. 
The following have appeared in France since the publication of this work : 
— Didiot, Etttdes statistiques de la syphilis dans la garnison de Marseille. 
Marseille, 1866. Garin, De la police sanitaire et de F assistance publiqtie 
dans les rapports avec F extinction des maladies veniriennes, (Oaz. mSd de 
Lyon, Lyon, I®' juin, 1866.) Lefort, Critique du travail precedent dans, 
6az, held, de mid. et de chir, Paris, 1866, p. 433. Bergeret, De 
la prostitution et des maladies venSriennes dans les petites locaUtSs. 
Ann. d'hygiSne publ. et med. legale, 2^ serie, t. xxv. p. 348. Lecour, 
De la prostitution et des mesures de police dont elle est Vohjet d Paris, 
au point de vue de Vinfection syphilitique. Arch, de mid., 1867, t. ii. 
pp. 711, 736. Jeannet, De la prostitution dans les grandes villes au xix'. 
si^clcy et de V extinction des malad, vSner, Paris, 1868. These various 
treatises prove clearly the great social interest attached to the prophylaxis 
of venereal diseases, and especially to their extinction. It is a good sign 
that this question was brought before the Medical Congress held at Paris 
in 1867, and that a commission has been formed to communicate with the 
various European governments for the purpose of enforcing for these dis- 
eases regulations stricter than those at present in force in too many countries. 
What will this commission do, and what will the result of its efforts be ? 
We do not know, but though convinced of the possibility of the extinction 
of syphilis, we believe that the existence of this disease, like that of many 
others, will be little compromised until scientific principles shall form the 
basis of the government of nations. (Note sent for English translation, 
July, 1868.— .Transl.) 



PUBLIC HYGIENE. 277 

issue. In this point of view, a doable supervision is necessary, as 
has been pointed out by Cullerier and Bard,* for if the mouth of a 
child may infect a nurse, the breast of a nurse may also infect the 
child. 

The nurse requires a very close examination. Not only the 
breasts, the mouth, the pharynx, the cervical glands, but also the 
genital organs must be examined. Bosen gives the sage advice of 
examining also any child previously suckled. An exact and careful 
observer, he was aware that syphilis transmitted by the nurse is 
most frequently due to a former nursling aflfected with hereditary 
syphiHs. The physician, who cannot be too much upon his guard 
against deception, must also not forget that a nurse whose interest 
it may be to deceive, may very well present a nursling not her own. 

For the purpose of preventing this mode of contagion, it has been 
proposed to establish offices for nurses.f But these offices would 
require supervision. Lagneau asks for the establishment of special 
offices, at which it would be forbidden to present a woman if she 
had not previously been subjected to a close examination, as shown 
by a medical certificate. In these establishments, thus placed under 
sanitary supervision, suspicious children could be rejected, says 
Bouchut, to prevent the infection of mercenary nurses. In this 
way, healthy nurses, as well as the parents of children recognised as 
healthy, would have an interest in presenting themselves. 

The necessity of examining children about to be sent out to nurse 
is nothing new. In 1776, the Faculty of Medicine of Paris proposed 
to impose upon accoucheurs and midwives the obligation to signalise 
syphilitic children, and to fasten to their arms, before giving them 
up to the nurses, a ticket which would show their condition as well 
as that of their parents.]: Farent-Duchatelet § advised that the state 
of health of soldiers' children should be ascertained before they were 
put out to nurse. Lagneau asked whether it would not also be 
possible to subject new-bom children to medical examination, either 
at the time of registering the birth, or two or three months later. 

* Cullerier et Bard, DicHonn, des sciences mid, Paris, 1821, t. liv., art. 
Syphilis, p. 144. 

t See Marc, Dictionn. des sciences mid. Paris, 1813, t. vi. p. 305, art. 
Copulation, 

X Marc, he, cit. p. 303 ; et Lagaean, p. 269. 

5 See also Joum. de Mideeine^ de CMrurgie, et de Pharmacie, &c., t. Ixxvi. 
p. 494, 1788. 



278 TREATMENT. 

The family^ under these circumstances, would receive from the 
phjsdcian a certificate which every director of an establishment for 
nurses would be obliged to ask for before presenting a woman to 
suckle the child. Lastly, the director would require also supervision 
by the physician of the locality into which the child was sent. In 
this latter respect, Bicordi* expres^s the wish for a regulation 
which I cannot do otherwise than approve : to give instructions to 
the physicians to eitamine twice a week all nurslings sent into their 
diidtricts, and to establish a sanitary line to prevent the propagation 
of the contagion whenever it shotdd develop itself in one of the 
children. Lastly, the arrival of a nursling to be notified to the 
mayor, who would inform the physician thereof. What would then 
become of those unfortunate beings affected with a disease of which 
their parents are the authors P If it were ascertained that the 
mother was syphilitic, there would be no reason, her health per- 
mitting, why she should not suckle her child. In the opposite case, 
the child ought to be brought up by hand, as is done, according to 
Diday, by the women to whom syphilitic children are entrusted from 
the hospitals, either with ordinary feediiig-bottles, or with Professor 
Wiirzer's nipple-caps. With the aid of the latter, the child sucks 
the milk in proportion as the nurse draws it by means of a tube with 
which the instrument is furnished.f 

In any case, the nurses ought to be informed of the danger which 
may accrue to them, as well as to their children and to the persons 
who associate with them. It is important that their nipples should 
be cauterised whenever they become excoriated, all contact with an 
ulcerated part of a nursling presenting any manifestation of syphilis 
should be carefully avoided. 

Lastly, a question of the highest interest, and to which every 
physician will probably have to give an answer at least once in his 
life, presents itself. An individual who has had syphilis, and who 
wishes to marry, asks whether or not he is in danger of begetting 
diseased children. The answer to such' a question is, as will easily 
be understood, most delicate, for if, on the one hand, it is a question 
of preventing the procreation of a degenerate race, it is important, 
on the other hand, to avoid interfering with an arrangement which 
may form the happiness of a whole life. According to Diday, every 



* S^fUide da aUaUamento, Milan, 1865. 

t ^ee Lagneau, Ann, d^hyg, publ et de mid. Ugale^ 2* sSrie, t. ▼. p. 274. 



PRIVATE HTGIENB. 279 

individaal affected with primaiy or constitutional syphilis, if he has 
not undergone any general treatment^ ought to be declared unfit to 
marry. " In my opinion,^' says that physician,* '' this is a matter 
of conscience which admits neither of infraction nor concession.'^ 
Now that he knows that syphUis may be cured without treatment, 
the great Lyons syphilographer would not hold, I imagine, a language 
so absolute ; the truth is that, in such cases, there are distinctions to 
be made. It is certainly the duty of a physician to forbid marriage 
whenever the primary lesion or secondary affections exist ; but, if 
several years, have elapsed since the cessation of these symptoms, 
and if the patient, thoroughly recovered, is in the enjoyment of 
perfect health, although it may not always be prudent to advise 
marriage, we are not called upon to forbid it absolutely, for the 
chances of cure are more numerous after multiple lesions than if 
theire had been nothing but an indurated chancre. In the case of 
tertiary manifestations, the physician ought first to treat the patient, 
reserving the right to authorise miirriage afterwards, if the cure 
appear to him to be complete. 

Eor> the rest, a physician cannot exercise too much prudence under 
such circumstances, in which, in the absence of certain signs, the 
guarantee of the cure is always impossible. 

§ 2. Private hygiene. 

Private hygiene of venereal diseases, equally with public hygiene,' 
has long occupied the attention of legblators and physicians. There 
are few medical treatises which do not say a few words at least on 
this subject* Cdsus speaks of it at great length. Lanfranc (1290) 
advises washing the penis with vinegar and water as a prophylactic 
measure against the affections occasioned by connection with dirty 
or diseased women. Armand de Yilleneuve, Guillaume de Salicet, 
and Nicholas Massa propose the same me9sure:t I'racastor, in his 

■ ■M^— — ^— ^— MM ■ ■ — ^ ■ ■ I ■ I ■ ■» ■ ■ » ^ ■ »■ p ■ ^■^■■■ ■ » ■■ I ^^1 I, I ■ m i b^ ■ ■ i. ■■ ■ ■■ ■ ■ — — i— » i 

I . . • * 

* Traiti de la syphilis des nouveau-nSs, &c», 1855, p. 330. 

t " Si vero quia cum infecta muliere coire voluerit, quod fatuum est, 
lavetor ytdva cam yino aut aceto, et membrum virile cum aceto. . . . ." 
This washing was to take place before the act ; the process to be adopted 
after the act was: <<Quod si forte quis cum muliere iiifecta ooiverit, 
layentor partes illse post coitum cum vino albo calido, vel cum aceto, quod 
mihi magis placet, ut fiat confortatio membri et prohibitio coruptionis ad 
illam matain quahtatem, et sic stet in suo robore membrum confortatum.'' 
Nic. Massa, De tnorho gaUico (Aphrodts.y t. i. p. 52). 



280 TREATMENT. 

poeniy praises lemon-jnice^ then frequently used. O. Fallopius speaks 
highly of lotions with vulnerary fluids, mercury^ and guiacum. 
Aromatic and alcoholic decoctions were also employed by some 
physicians. In 1690^ Ettmuller advised washing with a mixture of 
turpentine and wine. Later on^ Mahon recommended for the same 
purpose a solution of alum. Waren suggested^ after the act^ the 
application of an astringent ointment^ followed by washing and in- 
jection with an alkaline solution. Qardanne (1772) proposed a pre- 
servative consisting of lime-water^ alcohol, and corrosive sublimate. 
Peyrilhe, Hunter, Tordyce, &c., recommended, like Waren, alkaline 
solutions. According to Langlebert, Luna Calderon* discovered a 
preservative the composition of which unfortunately remained un- 
known. In 18&8, Coster advised the employment of chlorine and 
its preparations. Ricord recommends most of the substances men- 
tioned above, and even chlorinated lotions ; acids, alkalies, water, 
alcohol, wine, and solutions of sulphate of zinc and of lead have aU 
appeared to him to be of some use, but on condition that the virulent 
pus has not yet entered into the tissues. Langlebert recommends a 
fluid which is a kind of compound of the preceding; it is a mixture 
of soft soap, potash, and rectified spirits of wine, with the addition 
of essence of lemons. A fluid very similar, but more caustic, has 
been proposed by Eodet, of Lyons ; it contains perchloride of iron, 
chlorohydric add, and citric acid. Other substances have also been 
recommended, and especially oils and fats. In reference to their 
physiological action, these various substances may be ranged in 
three classes. One class modifies the circulation of the part to 
which it is applied and tends to prevent absorption ; these are the 
alcoholic and astringent lotions, such as vinegar and water, solu- 
tions of tannin, alum, &c. Another, like fats, protects the organs, 
in the shape of a coating, and thus prevents absorption. The third 
class, more energetic, consists of substances intended to destroy the 
poison, some of which, at least, are active enough to serve as 
caustics, as, for instance, the preparation recommended by Bodet, of 
Lyons. 

What is to be said of these substances, except that there is not 
one of them which can be regarded as an absolute preservative. 
Each of them has, however, peculiar advantages, a relative utility. 



* Luna CalderoD, Demomtration de la prophyUwie €(e h 9^fhiU$, Pari8| 
1815. 



PEIVATE HYGIBNB. 281 

and special indications. Thus fatty substances^ which keep up the 
suppleness of the parts and tend to prevent absorption^ will be used 
with good effect by the male before the act, and by nurses before 
giving the breast. Alcoholic solutions, acids or alkalies, and espe- 
cially Bully's preparation of alcohol and vinegar, which are most 
commonly used, may be employed at any time, and if a solution of 
continuity be observed, caustics should be applied. In the absence 
of those which we have pointed out, a stick of nitrate of silver might 
be used. Advantageous so long as absorption has not taken place, 
these various substances are evidently useless when a chancre exists. 
Let us mention, lastly, pheiiic acid, an agent which, according to one 
of our greatest scientific authorities,* appears capable of neutralising 
a certain number of poisons, and especially the poison of syphilis ; 
but no case has yet been brought forward in confirmation of this 
opinion. 

The question up to what moment it is possible to neutralise the 
poison of syphilis in situ appears soluble by analogy, if it be admitted 
that this poison does not behave otherwise than the poison of hydro- 
phobia, glanders, cow-pox, or even animal poisons, such as that of 
the viper. Renault d'Alfort, having cauterised the inoculation 
wound some hours, and even one hour after the insertion of the 
virulent matter of glanders or of clavel^e, did not prevent the de- 
velopment of those diseases. Bosquet and E. Eousseau have made 
analogous observations; the former in reference to cow-pox, the 
latter by inoculation with the poison of the viper. There is reason 
to believe, therefore, that the efBcacy of therapeutic agents destined 
to neutralise in situ the poison of syphilis is necessarily propor- 
tionate to the rapidity of their application, for the absorption of the 
morbid principle is prompt, and once effected, such agents are 
inefficient. 

Such are the means which everyone may employ for the purpose 
of defending himself against syphilis. These means, as we have 
already stated, are in nowise certain preservatives, and have no 
other action than that of diminishing the chances of infection in an 
individual who exposes himself to the danger of contracting syphilis. 

Certain other measures which it is scarcely necessary to mention 
have also been pointed out, I mean syphilitic inoculation and pre- 



* Chevrexil, Comtderattons sur Vhistoire de la partie de la mSdedne qui 
conceme laprescnption des remade*. Paris, 1865. 



282 TREATMENT. 

ventive sjphilisatioB. The former of these methods^ which consists 
in inoculating the Uood taken from the neighbourhood of tertiaiy 
lesions^ was formerly proposed bj Diday ; but it has since been 
given up by that author himself^ and no one^ so far as I know^ has 
ever thought of putting it in practice. Neither has preventive syphi- 
lisation found more favour. We shall speak^ further on^ of curative 
syphilisation. 



METHODS OF TBEATMENT. 283 



CHAPTEE n. 

TEEATMENT. 

§ 1. Of the variom methods of treatment employed tip to the present 

time. 

Eational oe Methodical Treatment. 

The first manifestations of the syphilitic epidemic of the fifteenth 
century^ having been a complete surprise for the physicians of that 
period^ were not treated at all. It was considered disgraceful 
for a practitioner to occupy himself with such a disease. But^ 
let us add^ the omission had its more especial cause in the com- 
plete ignorance of a new disease, unknown to Hippocrates, to 
Galen, or to Avicenna. '^The learned,*' relates Gaspard Torella, 
^' avoided treating this disease, being persuaded that they knew 
nothing about it. . . . Por,*' adds the same author, " since this 
strange disease had never been seen up to our time, no one, 
however clever, however experienced he might be, could treat it 
according to the rules of art. ... It is for this reason that drug- 
gists, herbalists, and impostors of all kinds, still boast of curing 
syphilis completely .''* Under these circumstances, remedies as 
dangerous as they were singular were employed ; the abuses were so 
great, the disease going on increasing meanwhile, that physicians at 
last became ashamed of neglecting their duty, and thus, says Astruc, 
shame rather than the hope of success made them undertake the 
treatment of this scourge. Guided by the theoretical ideas of the 
period,t they instituted a treatment at once rational and methodical. 
Strict diet and a very healthy regimen, consisting of food easy of 

• See Aphrodis,, t. i. Compare : Wendelin Hock, Tract, de morho gaUico, 
cap. i. Jean Almenar, De lue venerea, Pavia, 1516. Ulrioli de Hutten, 
De curatione morhi ffallici per administrat, ligni guiaci, caps. i. et ii., 1519. 

f Consult, in Aphrodis, Luisini, the treatises by Nicol. Leonicenus, 
Conradi Gilinus, G. Torella, Seb. Aquilanus, Jac. Catanee, Wendel, Hock, 
Bened. Victorius, See also the treatise quoted by Astruc, t. ii. p. 78. 



284 TREATMENT. 

digestion^ fonned tte Hygienic treatment. Bleeding * according to 
tlie age, strength^ and temperament of the patient ; leeches or cup- 
ping, laxatives or mild purgatives, cataplasms with the purified juice 
of wild chicory, bugloss, &c. ; syrups composed of the same juices, 
together with baths and various kinds of ointments, were the means 
employed in the treatment of syphUis. Let us add to these means, 
when the disease was obstinate, sweating in stoves or even in a 
moderately warm oven, a means to which Gaspard Torella gave the 
preference when it was a question of curing pains and pustules. 
Some physicians, few in number it is true, made use of decoction or 
infusion of vipers, others, lastly, frequently had recourse to the 
application of a cautery to the head, arm, or leg. 

From that period, however, began the use of a medicine which 
has become celebrated in the history of syphilis, I mean mercury. 
Introduced into therapeutics by the Arabs (Rhazes, Avicenna, 
Mesne, &c.), this agent was employed against lice, the itch, impetigo, 
the malum mortuum (Theodoric), a kind of lepra, and other cuta- 
neous eruptions.f Analogy naturally led to the employment of it 
for syphilitic eruptions. Encouraged by earlier writers, the first 
syphilographers followed therein the precepts of Celsus, who recom- 
mended, in case of the appearance of an unknown disease, to observe 
what disease it most resembled and to try remedies similar to those 
which had several times cured the latter. It is thus that Conrad 
Gilinus (1497), J. Widmann,J Torella, Sebastianus Aquilanus, Ant. 
Benivenius, Wend. Hock, J. Cataneus, Angelus Bologninus, and 
others, were induced to propose various mercurial ointments. Bd- 
ranger de Carpi and Jean de Vigo were, nevertheless, the two great 
supporters of treatment with mercury. At the very first the effects 
of this agent were dreaded, and the doses given small : there was 
scarcely one-fortieth part of mercury in the ointment used by Gas- 



• * On this point oonsult : Antonii Benevenii, De morho gaUico tractattu, 
&o. {Aphrod., t. L p. 401). Leonardi Botalli, Aitensis, medici regit, Luis 
venerea curanda ratio {Aphrodisiacus, t, ii. p. 865). 

4- It was from the Arabs, in fact, that came the saracene ointment, the 
formula of which is to be found in Guy de Chauliac {Chirurg. rnagn^e 

Tract., doct i. o. 3). 

X Widmann dictus Meichinger, Tractatus de pustulis qtue vulgato 
nomine dicuntur Mai de Frantzoi. Argentorati, 1497. See, for other 
authors, Aphrodi&iactu de Luisinus. 



METHODS OF TREATMENT. 285 

pard Torella.* The ointments used by other physicians of that 
period contained one-fourteenth or even one-eighth of the same 
substance. The empirics also had recourse to mercury ; but, less 
restrained by the fear of causing injury, they contributed gradually, 
by their excesses, to bring that drug into discredit. In fact, the 
•patients, worn out by strong and repeated frictions, sometimes 
perished from the action of the remedy,t and those who had 
suflBcient strength or good fortune to resist its violence remained 
exhausted by salivation, diarrhoea, ulcers of the mouth, &c., or only 
recovered their health after a long time and great and continued 
sufferings. The remedy soon became worse than the disease, and 
the method of treatment fell into discredit, to which the discovery 
of a new medicine, guiacum, in 1517, further contributed. Prom 
that time dates, in fact, the famous discussion concerning the 
advantages and disadvantages of mercurial preparations, which has 
continued to our own time, and which has very recently received a 
fresh impulse. In the sixteenth century, as in our own days, people 
were not content to point out the dangers of mercury ; they sometimes 
accused that agent of causing the severest manifestations of syphilis, 
or regarded it as capable of doing so. *' Occasiones tumor um pro- 
veniunt a visceribus affectis,'' wrote Fallopius, J '' sed, ut in pluribus, 

post inunctionem hydrargyri, qui non sanarit segros Gum 

inungantur partes illse, imbecilles redduntur, et morbus petit loca 
iUa.'^ 

The following passage from Ulrich de Hutten shows plainly 
enough the abuse made of the drug in question. " The ointment," 
he says, " caused such profuse salivation, that the patients were in 
danger of losing their teeth unless care was taken to prevent that 
result. The throat, the palate, and the tongue became ulcerated ; 



* Gaspard Torella, although an advocate of mercury, attributed the 
deaths of Ceesar Borgia and that of his brother to the abuse of that 
medicine (Aphrodia., t. ii. p. 528). 

t Fumigations with cinnabar, which were also employed at that period, 
were not without danger, as appeared from the following passage in Jean 
Benedict : Suadeo ut caveas ab empiricorum suffimigiis, in quibus ponitur 
cinuabaris, tanquam a preesentissimo veneno, et cujus ego fumo vidi 
periisse quemdam nobilissimum pictorem Bononiee et mulierem devenisse 
ad apoplexiam. (De morho gaUico Ubellw, cap. iv. ; De cura morhi gallici, 
p. 182). 

X De morho gaUico {Ajthrodmacue, p. 826). 



286 TREATMENT, 

the gams swelled^ the teeth became loose^ and there flowed inces- 
santlj from the mouth a very stinking secretion/^ Babelais was no 
less explicit in a similar sense. 

In the sixteenth century^ then^ the mercurial and anti-mercurial 
doctrines abeady prevailed. At that period syphilis was also treated 
by the ordinary methods of treatment of other diseases and^ to some 
extent, on the expectant principle and by diet : that is to say, we 
find, in the germ at least, the various therapeutic measures of which 
we shall have to speak further on. 

Treatment with Sudobipic Woods, Vegetable Treatment. 

The treatment with sudorific woods marks a period of pause and 
salutary reaction from the excesses and deleterious consequences of 
treatment with mercury. Ulrich de Hutten relates how it followed 
the discovery of guiacum, the most celebrated of all the sudorific 
woods used for the cure of syphilis. ^'A Spanish gentleman, 
treasurer of the province of Hispaniola, suffering greatly from 
syphiHs, heard from an inhabitant of the country of a remedy which 
he would do well to employ, and was the first who imported it, 
though he feared that it would not have the same virtues as in that 
island.'^ This version appears to allude to Gonzalo Eernandez de 
Oviedo y Valdez ; but, nevertheless, there are great difierences of 
opinion concerning the name of him to whom we owe the importa- 
tion of guiacum and the date of that importation. '. I shall not 
attempt to clear up this point in the history of guiacum.* What 
is certain is, that guiacum, known in Spain as early as 1508, accord- 
ing to Delgado, reached Italy and Germany only about the years 
1517 and 1518.t 



* On this subject may be consulted with advantage 6osqaillon*s notes 
to the translation of the TraitS de la gonorrhSe virulente et de [la maladie 
vinerienne, by Benj. Bell, t. ii. p. 395. Paris, 1802. Those of Potton, in 
his translation of the work of Chevalier Ulrich de Hutten on the French 
disease. Paris, 1865. And lastly, an interesting paper by J. M, Guardia, 
in No. 49, p. 741, of the Gazette Midicale de Parts, 1865. 

t On this subject and on the treatment with guiacum, consult: Delgado, 
Del modo di adoperare il Ugno santo d* India occidentaie, owero delmodo cJie 
si guariace il mal francese, ed ogni male ineurabile, Venice, 1529, in 4to. 
Nic. Poll, De cura morbi gallici per lignum guyacanum, in Aphrodisiaeus, 
t. i. p. 242. L^on Schmaufis, De morho gaUico tractatue* Salisburgee, 



METHODS OF TREATMENT. 287 

Few remedies have become so rapidly popular. It was sobn pro- 
claimed throughout Europe that the mal de Naples could be cured 
bj means of a drug furnished by America, and from that time the 
people^ who make strange mistakes in their chronicles^ became per- 
suaded that the remedy and the disease had both had their origin in 
the same country, which, no doubt, contributed to confirm the idea 
of the importation of syphilis from America. Numerous cures, 
guaranteed by the physicians of that period, occurred to justify 
the favour in which guiacum was held. Ulrich de Hutten and his 
friend Erasmus were indebted to it, according to Oviedo, for a cure 
which mercurial inunction had not been able to effect. The former 
aided greatly in the propagation of this remedy by the pubUcation 
of a special treatise. Musa, Brassavole, Nic. Massa, Eracastor, and 
Fernel,* in the sixteenth century ; Valsalva, Morgagni, and Boer- 
haave, in the eighteenth^ assert that they had opportunities of observ- 
ing its good effects. 

Before being administered, guiacum underwent various kinds of 
preparation. " The most usual manner, formerly, of preparing the 
decoction of guiacum,^' says Astruc,t '^ was to iniPuse for twenty-four 
hours, in a new earthen pot, and in eight, ten, or twelve pints of 
water, one pound of this wood, cut small or well rasped ; having 
well closed the vessel, it was kept at a steady heat until one-fourth, 
one-third, or one-half was evaporated, according to the strength and 
temperament of the patient and the violence of the disease. After 
cooling, the decoction was strained and kept in well-corked glass 
bottles. Erom the same wood a second decoction was made, called 
' Bocket.' The first decoction was used as a remedy, the second as 
an ordinary drink. • . . When the decoction was ready, and the 
patient had been gently purged and kept on light food for some days. 



1518, and Aphrod., t. i. p. 383. Ulrich de Hutten, De morbi gallici cura- 
Hone per administrationem ligni guajacif in ApKrod,, t. i. p. 275. Trad. fr. 
par Potton. Paris, 1865. Gonzalo Fernandez de Oviedo y Valdez, Del 
palo guyacan, o del pah santo, 1552, taken from Natural y general historia 
de las Indiai. Seville, trad. lat. in Aprod., t. i. p. 352. 

• Ant. Musa Brassavole, De morho galMco liber (Aphrod., t. i. p. 658). 
Nicolas Massa, De morho gallico liber, Venetiis, 1563 ; et Aphrod,, t. i. 
p. 39. Hier.-Fracastor, De morho galUco poematum lib. Hi. {Aphrod, ft, i. 
p. 183). Jean Femel, De lue venerea dialogs {Aphrod,, p. 610). Ant. 
Gallus, De Ugno sancto non permiscendo opus {Aphrod,^ i, i. p. 455). 

t Astruc) t. ii. p* 95, Sdit, de Louis. Paris, 1777. 






288 TREATMENT* 

he was placed in a wann room and took^ early in the mornings eight 
or ten ounces of the first decoction warm^ in bed^ and having been 
well covered up^ was made to sweat for two or three hours; .having 
been wiped drj^ four hours at least after taking the decoction^ he 
took some biscuits or other light food^ and drank abundantly of the 
second decoction; four hours after this^ the same process was 
repeated. K the patient was too deUcate^ too emaciated^ or too 
weak to bear such a rigorous diet, he was allowed some bread and 
chicken-broth and even^ after some days^ the quarter or half of a 
chicken roasted or boiled^ without salt. This method was employed 
for about a fortnight^ during which time, if the bowels did not act 
freely, emollient injections were given every two or three days. 
After a short interval, the same treatment was repeated until the 
thirtieth or fortieth day. After this, he was ordered to return very 
gradually to his ordinary mode of life, not taking any wine for a 
month, or much food, and using the second decoction as ordinary 
drink." 

Such was the mode of employing guiacum. It appears to us that 
the preparation to which the patient was subjected, and the strict 
diet, contributed, at least as much as the remedy, to effect the cure. 
Eor the rest, the different form in which guiacum is administered at 
the present day sufficiently explains the diversity of its action. 

Another wood, which equally came from India, but, according to 
Astruc, differed from the preceding, was employed at the same time. 
In France, where this wood, known under the name of holy wood^ 
enjoyed a great reputation, both patients and physicians spoke of it 
only with pious admiration. '' Oh, holy wood ! " said, in one of his 
prayers, a patient who felt himself relieved, if not cured, by the 
effects of this remedy ; *' Oh, holy wood, art thou not the blessed 
wood of the cross ? " As these woods were dear, there were gradu- 
ally substituted for them, but without success, ebony, hazel, box, 
and especially juniper woods, &c.* 

The most pompous praises and the recommendation of the two 
greatest sovereigns of the period, did not suffice to maintain the 
reign of guiacum. As early as 1546, Fracastor, writing his prose 
treatise on contagious diseases, asserted that the decoction ought to 
be given in stronger doses and for a longer period. Matthiolus 
held much the same opinion. Guiacum finally fell into discredit. 

* See Brassavole, Jean de LeoDf and Scaliger. 



METHODS Ot TREATMENT. 289 

About this time (1536 or 1537) cinchona was introduced into 
Europe and used by the Emperor Charles the Eifth, as related by 
Vesalius.* It gradually took the place of guiacum. Then came 
sarsaparilla and sassafras^ and it was soon found that all these plants 
possessed analogous virtues, and they were finally administered under 
the name of decoction of sudorific woods. The strict method of giving 
them at first appearing unfitted for patients of feeble constitution, 
more food was given and less sweating practised, but the curative 
virtues of the remedy were lessened. Guiacum and the other woods 
soon lost their reputation. In 1564, Eracanziani candidly admits 
that, the disease having become obstinate and difficult to cure, many 
very clever physicians had been obliged again to have recourse to 
mercurial inunction. In the seventeenth century, guiacum was 
still in use, but the physicians of the eighteenth century, with few 
exceptions, abandoned it almost completely, and had recourse to 
mercury. Astruc declared, like many others, that the sudorific 
woods were incapable of curing any but local and commencing 
venereal diseases. Mercury again came into favour. Before 
speaking of the mercurial treatment, I shall say a few words on the 
vegetable remedies employed for the cure of syphilis. 

Since Eracastor's time, physicians who took into account the 
vigour of their patients did not always employ the most energetic 
remedies ; feeble persons were put upon the use of certain vegetables. 
Eesins, incense, cannella bark, &c., were used. Later on, saponarius 
was praised by Sennert, Bartholin, and Stahl. Bittersweet, ger- 
mander, hyssop, white dittany, and many other plants received more 
or less merited commendation. Kalm and Bertram extolled the 
root of the lobelia syphilitica, Bussell and CuUerier the daphne 
mezereum, Cirillo attributed great advantages to citron, already 
praised by Eracastor.f He asserted that he saw numerous cures 
efi^ected by lemons and oranges, fruits which he recommended to be 
taken in large quantities. It is impossible, certainly, to deny the 
value of these various substances ; but they appear to us, after all, 
to be only feeble adjuvants. 

• De radice chinee, EptstohB^ 1556 (Aphrod., t. i. p. 586). 
t Sed neque carminibus neglecta silibere nostris 

Hesperidnm decus, et Medarum gloria citre 

Sylvarum 

Ergo ubi nitendum est csecis te opponere morbi 

Seminibus, vi mira arbor Cythercda praestat 



290 TREATMENT. 



Treatment with Opium and Oxygbnisbd Substances. 

In a work written in 1661 Simon Pauli gives an account of the 
cure of a case of syphilis by means of opium ; but this case was 
forgotten, and it was towards the end of the eighteenth century 
only that opium acquired, all at once, a certain celebrity in the treat- 
ment of syphilis. In 1779, Grant and Michaelis, physicians in the 
English armies in America, mention having obtained great results 
from the employment of that remedy* Several English,t Swedish, J 
and ^German § physicians soon began to employ it under similar 
circumstances, and appeared equally satisfied with its therapeutic 
effects. 

Convinced that the properties of opium had previously remained 
unknown because it had been administered too timidly, the advo- 
cates of that medicine began, in general, by giving about four 
grains daily, which dose was gradually increased in the course of 
three or four months, until it reached forty grains in the twenty-four 
hours. Under these circumstances, sleep was prolonged, and a 
drowsiness came on sometimes, from which, however, it was easy to 
rouse the patients ; the bowels generally continued to act, but there 
most frequently supervened an abundant foetid perspiration, and a 
considerable flow of mucous urine. Gherardini,|| Richter, J. Pasta,ir 
and many other celebrated practitioners did not recognise any bene- 
ficial effects from the use of opium, except that of relieving certain 
pains which resisted mercury ; consequently, the exclusive employ- 
ment of it was abandoned. 

Towards the end of the last century, oxygenised substances, and 
especially nitric acid, were used for the treatment of syphilis. 
Struck with the fact that mercury had no effect except in the form 



* See Medical Communications, 

t See CuUen, Materia med,, t. ii. p. 354. Pearson, Observ, on the effect 
of various articles of the materia med, in the cure of the lues venerea. 
London, 1800, p. 57. 

X A. Tode, Mint, de la Soc, de mSd de Copenhague, t. i. p. 424. 

§ Tuissinck, De opii usu in syphilids observatio prohato. Ley den, 1785 
Franck's transl. of Weikard on Brownian theory. 

I) Gherardini, Appendix to Jhis Italian translation of Fabre's TraitS des 
maladies vSneriennes, 

^ Pasta, Nuove Bicerche della facolth delV oppio nelle mallatie venerea, 
iSergamo, 1788> in 8^ 



METHODS OF TKEATilENT. 291 

of oxide^ Girtanner imagined that the properties of that metal 
resulted from its great facility of giving up its oxygen to animal 
substances. Starting from this idea^ Scott^ of Bombay^ and Alyon, 
of Paris, then Rollo and Cruikshank,* English military surgeons, 
thought that they could not do better than to treat syphilis with 
oxygenised substances, which they employed externally as well as 
internally. 

Despite its transient reputation, the treatment with oxygenised 
substances does not appear always to have been unsuccessful. It 
seems really to have contributed to the cure of some cases of 
advanced syphilis. ^Further on we shall make known the indications 
proper to it. Nevertheless, it was soon observed that these sub- 
stances possessed only a slight advantage, and the theory by virtue 
of which they were prescribed was not well founded. Undergoing 
the fate of many other remedial agents, they fell into oblivion, but 
not, however, into complete oblivion, for we see them reappear from 
time to time, and we shall state further on what benefit may be 
derived from acids, and especially from nitric acid, in the treatment 
of certain lesions of the viscera. 

Tkesatment with Meecuby. 

Begarded as a poison and at first excluded from therapeutics, 
mercury was in use amongst the Arabs and ndost of the physicians of 
the Middle Ages. Employed in the treatment of cutaneous affec- 
tions, it was, as we have already stated, about the year 1497 1 that 
it was applied to the cure of syphilis. Later on, when it fell into 
discredit, it was not entirely given up, since J. Bethencourt em- 
ployed it in the epidemic of syphilis at Eouen, and Thierry de 
H^ry, Nicholas Massa, and several contemporary physicians con- 
tinued to prescribe it. In 1538, Alp. Eerri J asserted that it was 
necessary to have recourse to mercurial inunction, after having used 
holy wood without success. Eallopius § related that a young man, 
whose syphilis had resisted all the foreign remedies, had, at last, been 

♦ Compare : Th. Beddoes, On the effects of the nitrous acid in venereal 
diseases, 1797. A. Schmidt, Beitrdge xu den ResuUaten der Versuche mit 
der Salpeter-Sdure bei syphilit, Krankkeiten, Vienna, 1802. 
. f In a satirical poem by G. Summarissa, of Verona, mention is made of 
the employment of mercury in 1496. 

X Alp. Ferri, De ligno sancto liher, Aphrodis., t. i. p. 404. 

S Fallopius> Lib* de morho GaUico*, cap. 67* 



292 TREATMENT. 

cured by an empiric, and adds : " I make use of mjercurj in obstinate 
and desperate cases^ especially when I have already tried other 
means/^ 

Thus the advantage of mercury over vegetable preparations 
became recognised. This agent was at first used externally only. 
There were, says Astruc, four ways of using it, viz., as a plaister or 
cerate, as a wash, as an ointment or hniment (inunction) and in 
perfumes (fumigations). 

Proposed by Angelus Bologninus, the celebrated plaisters of J. 
de Vigo rapidly fell into disuse on account of the cutaneous irrita- 
tion which inevitably followed the employment of them. Mercurial 
washes were composed, according to Augier Terrier, one of the first 
who mentions them, of desiccating drugs and corrosive sublimate 
dissolved in distilled water. The sublimate was also used for wash- 
ing and rubbing in a warm place all parts of the body except the 
chest, the head, the stomach, and the armpits, and that two or 
three times a day for ten days, according to the strength of the 
patient and other circumstances. Like the plaisters, the washes soon 
came to be regarded as dangerous and were banished from thera- 
peutics. 

Fumigations, used at the same period, produced similar ill effects 
in unskilful hands ; but it must be stated that they were approved of 
by Massa, Eondelet, &c. They were of two kinds (Astruc), benig- 
nant or malignant, according to the quality of the drugs of which 
they were composed. The former contained fatty and resinous 
matters and balms. The latter were made of the same substances 
with the addition of arsenic or preparations of mercury, such as 
cinnabar, red precipitate, turbith mineral, or even corrosive subli- 
mate. The patient about to undergo fumigation was first bled and 
purged, and then put into a kind of well-warmed tent. At his feet 
was placed a pan of charcoal, and through a hole made for the pur- 
pose the substances intended for the fumigation were thrown at 
intervals, so that the patient remained exposed from head to foot to 
the smoke which was thrown off, until he perspired freely. If, by 
chance, the patient was observed to be near fainting, he was allowed 
to apply his mouth to a hole made for that purpose, or to breathe 
fresh air through a tube. He was kept in the tent a longer 
or shorter time, according to the severity of the disease and his 
strength. The fumigation lasted half-an-hour, three-quarters, or a 
whole hour, according as the patient could bear it. He was then 



METHODS OF TREATMENT, 293 

placed in a warmed bed and well covered to make him perspire freely 
for an hour or two ; after which, having been well wiped, a glass of 
wine was given him, and two hours later he had a meal. These 
fumigations were employed daily or only every three or four days, 
according to the severity of the disease and the strength of the 
patient. They were repeated six, seven, eight, or nine times, until 
saKvation or purging occurred, or the symptoms entirely disap- 
peared. 

Not until about the year 1585 did P. A. Matthiolus first venture 
to give mercury internally. He administered it in the form of red 
precipitate. This agent was soon used in the form of crude mercury 
and became the basis of the famous pills of Barbarossa, which 
Prancis I. is said to have been one of the first to use in Erance 
(1540) ; then, with the discoveries in chemistry, were seen in suc- 
cession, sweet mercury (aquila alba, calomelas, protochloride of 
mercury), athiopa mineral (black sulphuret of mercury), white 
precipitate (nitrate of mercury), &c., &c. This time also, physicians, 
and especially empirics, committed regrettable excesses ; convinced 
that salivation was necessary, the price of health, the only means of 
eliminatiug the poison, they sought, above all things, to produce it. 

It was not until 1718, says Yvaren,* i.e., two hundred and 
eighty-four years after the appearance of syphilis, that Chicoyneau, 
Chancellor of the University of Montpellier, strove to demonstrate 
the inutility of salivation and to substitute for it, in the complete 
cure of the disease, the method called that by extinction. This 
salutary reform did not triumph at Paris until long after, and sixty 
years have scarcely elapsed since it became the common rule. How- 
ever, despite the use of more moderate doses, mercurial treatment 
was not yet safe from all reaction. The mercurialists Vigo, Fra- 
castor, Brassavole, Massa, Botal, Bondelet, &c., and the anti-mer- 
curialists Torella, Montanus, Fernel, Pallopius, Tomitanus, &c., 
reappeared under new names. The therapeutic uncertainties of the 
sixteenth century are represented in the nineteenth as if to prove our 
ignorance and slow progress. 

The interesting observations of some English physicians, the 
passionate attacks of Broussais against the morbid specificity of 



* La Syphilis, by Jerome Fracastor, trad. fr. Paris, 1847. See for 
history of the use of meroury against syphilis, Virchow, Zur Oe$ehiehU 
der Qttecksilber^Behandlunff in der Syphilis (Archiv, t zix. p. 238). 



294 TREATMENT. 

syphilis^ and somewhat exaggerated fears of mercurial preparations^ 
served all at once^ at the commencement of the present century, to 
call forth again the question of the treatment of sjrphiUs without 
mercury and to throw doubt upon the good effects of mercurial 
preparations. 

Teeatment without Meectjet. 

The treatment without mercury was a kind of revolution in the 
history of syphilis^ and in this respect deserves attention. It was 
the period in which the ideas of Balfour^ Hunter^ Adams^ and 
Carmichael concerning the plurality of poisons began to take root in 
England. Prance was at war with Spain ; Dr. Pergusson, surgeon 
in the English army in Portugal, having opportunities of observation 
in the large hospitals of that country^ remarked that the mercurial 
ixeatment was very little in use for syphilitics. Primary ulcers 
were combated by local means alone, and it was only in private pracr 
tice that decoctions of roots and other similar means of treatment 
were added to the topical remedies. Affections of the throat were 
treated with stimulating gargles only, and frequently disappeared as 
qnickly as the chancres. Recourse was not had to mercury except 
for affections of the bones ; but these were very rare, and generally 
so slight that they were regarded as rheumatic, and cured with small 
doses of calomel^ Dover's powder, guiacum, warm baths, &c. The 
disease, however, showed more intensity amongst the English, to 
which appeared to contribute above all a febrile condition caused by 
the unaccustomed heat of the climate, debauchery, and excesses of 
all kinds. The disease, in the latter, almost always assumed a 
phagedenic character, commencing with violent inflammation and 
fever, and requiring an active and especially antiphlogistic treatment. 
These various circumstances observed by Pergu^son led him to 
suppose, either that vegetables have more marked antisyphilitic 
properties in warm climates, or that the disease itself is so mild 
in Portugal that it may wear out of itself, after having accom- 
plished a certain evolution. Moreover he asserted that he had 
observed the ^ame benignity in Portugal in reference to small-pox. 
Although convinced of the curability of syphilis without mercury, 
Pergusson * did not imagine that what took place in Portugal would 



* FergussoD^ Ohserv, on t?ie venereal diseases in Portugal (MedtcthChirur" 
ffical Transactions, 1813, t. iv.}. 



\ 



METHODS OF TREATMENT, 295 

be applicable to England; but bis observations gave birth to an ijea 
which already had a tendency to develop itself. Several surgeons 
set to work, and in a short time the researches of Thomson,* Eose^t 
and Guthrie:!^ demonstrated the possibility of the success of a non- 
mercurial treatment. Thomson treated all the patients placed under 
his car6, as well in hospital as in private practice, by antiphlogistics 
and soothing topical applications, and remarked that one-tenth only 
of those who were subjected to his treatment presented secondary 
symptoms. Bose observed constitutional symptoms in one-third 
only of his patients treated without mercury. He never saw caries 
supervene. The observations of Guthrie agree, in the main, with 
those of Bose ; the proportion of constitutional symptoms appeared 
to him to be still less ; but he admits that he was not able to 
observe the patients long after they went out. 

Further, in 417 cases of syphilis treated without mercury, Hennen 
observed secondary symptoms forty-six times only. A medical 
report on the English army by J. McGregor and W. Franklin is 
still more decisive ; it teaches us that, from the month of December, 
1816, to the month of December, 1818, 1,940 individuals were 
treated for primary ulcers of the penis. In this number were 
included, not only simple ulcers, but also the syphilitic chancres of 
Hunter. But, of these 1,940 patients, ninety-six only had secondary 
symptoms, and further, of these ninety-six, twelve patients had taken 
mercury for special reasons stated in the report. Amongst these 
1,940 individuals, affected with primary ulcers, sixty-five were sub- 
jected to mercurial treatment. Consequently, if we deduct from the 
total the numbers sixty-five and twelve, there remain 1,863 cases in 
which there was a perfect cure without mercury. The mean dura- 
tion of the treatment was twenty-one days for the patients who had 



* ThomsQii, Obs. on the treatment of syphilis without mercury, Edin- 
burgh, 1817, m 8°. 

t Thomas Rose, Ohs» on the treatment of syphilis, with an account of 
several cases of that disease in which a cure was effected by the use' of 
mercury {Medico- Chirurgical Transactions, 1817, t. viii.),- 

X G. Gntfarie, Obs, on the treatment of the venereal diseases without 
mercury, Med,- Ch, Trans,, t. viii. Ccunpare: J. Bartlet, Dissert, med, 
inaug, de syphilidis tractatione sine hydrargyro, Edinb., in 8^ J. Hennen, 
Principles of military surgery, comprising observations of the arrangement, 
police, and practice of ?iospitals, and of the history, treatment, and anomalies 
of Variola and Syphilis, 2nd edit. Edinburgh, 1810, in 8% 



296 TREATMENT. 

iio.buboes^ and forty-five days for those who had. During the two 
same years^ 2^827 patients affected with ulcers on the penis were 
treated with mercury; the mean time required for the cure was 
thirty-three days when there were no buboes, and fifty days when 
there were ; fifty-one of these patients had secondary symptoms. 

While this revolution was taking place in England, in America 
Harris^ Stevens^ and others repeated the same experiments and 
arrived at the same results. In Prance, wh«re the physiological 
doctrine began to be established, the idea of treating syphilis with- 
out mercury was necessarily well received. Jourdan, Broussais, 
Eichond des Brus, Dubled, Bobillier, Desruelles, and the elder 
Devergie appeared as its chief defenders. The publications advo- 
cating the simple treatment were numerous ; but the statistics given 
in them are, in general, less complete than those of the English 
physicians. As in England, the treatment was as follows : rest, 
emollient applications, cleanliness, diluent drinks and a diet rather 
lowering than tonic. In Germany, the non-mercurial treatment, 
first employed by Briinninghausen, of Wiirzburg, was afterwards 
carried out on a larger scale by Dr. Pricke, of Hamburg, After 
having successively tried both methods, that physician declared that 
the symptoms were more severe and the duration of the treatment 
longer when mercury was used. 

Like the English physicians. Dr. Pricke kept his patients in bed ; 
each of them received daily two ounces of bread, forty-four ounces 
of water-gruel, and six spoonsful of cooked vegetables.* Por women, 
this diet was continued through the whole duration of the disease • 
for men, at the end of a fortnight or three weeks, the quantity of 
food was slightly increased, in proportion as the symptoms dimi- 
nished in intensity. General bleeding was rarely ordered, but a 
solution of magnesia in fennel water was given daily. This treat- 
ment was employed against primary and secondary lesions, by Dr. 
Pricke, who, far from repudiating the use of mercury completely, 
considered it, on the contrary, a valuable and powerful remedy. He 
also prescribed, however, in secondary syphilis the decoction of the 
sudorific woods and nitric acid. 

Handschuh and several other German physicians also tried the 
treatment without mercury and obtained analogous results. These 
experiments were imitated in Italy, Denmark, and Sweden, and it 

f See Graves, Lectt*re$ on clinical medicine. 



METHODS OF TREATMENT. 297 

was asserted everywhere that the employment of the new method 
rendered syphilitic affections more benignant and less numerous. 
Let us add, however, that the value of mercury given in small doses 
and combined with a light diet was never completely denied. 

Prom all these statistics, which were not perhaps always made 
with complete impartiality or took into account sufficiently the 
nature of the primary lesion, there nevertheless resulted a useful and 
fruitful revolution in the treatment of syphilis. Up to that time, 
in fact, there had been an abuse of mercurial preparations in all 
primary lesions and even in gonorrhoea, which was regarded as one 
of these. Often, instead of being cured, the disease was aggravated, 
it being too readily believed that those symptoms were always 
followed by constitutional syphilis. The method described by the 
English physicians proved that, in the absence of a mercurial treat- 
ment, syphilitic chancres themselves are less frequently complicated 
with phagedeena, without being on that account more frequently 
followed by secondary symptoms.* This method further taught us 
the valuable lesson that a great number of syphilitic lesions, espe- 
cially amongst the secondary manifestations, may yield to diet alone, 
and that mercury is thus by no means a specific, but a simple 
adjuvant which, under certain given conditions, favours the return 
to health. In fact, Bennet, taking into account all that had been 
published on the subject, was able to write : — '^ The number of 
experiments which had for their result the undeniable proof that 
syphiUs is cured more quickly, and with less danger of secondary 
affections, when it is treated simply than when recourse is had to 
mercurial preparations, now amounts to more than 8,000.''t Quite 
recently. Dr. Drysdale has published a work on the cure of syphilis 
without mercury to which we refer the reader.J 

Gradually, however, syphilis again came to be treated with mer- 
curial preparations ; syphilisation, a new mode of treatment which 
sprang up some years before, alone continued the non-mercurial 
plan. * But the attacks made upon the employment of mercury were 
not to cease so soon. The paradoxes maintained by the Broussais 
school, completely abandoned in France, have been resuscitated a 

* See Oauthier, JBxamen historique et critique des nouvelles doctrine$ 
mSdicales sur le traitement de la ayphilia, Lyons, 1843. 

t CUnical Lectures on the Principles and Practice of Medicine, Edin- 
burgh, 1859, p. 59. 

I Drysdale, Tretttment of syphilis without mercury. 



298 TREATMENT. 

short time ago in Germany, where Jos. Hermann,* Lorinser,t and 
some other physicians maintained that there is no such thing as 
secondary symptoms, and that all the morbid forms usually described 
under that name are the more or less remote consequences of the 
mercurial treatment. It is not my intention to enter into the 
numerous discussions raised by this new war against mercury ; let 
it suffice to say that, thanks to the works of Singer, j: Waller, § 
Overbeck,|| and A. Kussmaul,^ mercury was this time also found 
innocent of the crimes imputed to it.** From this discussion, how- 
ever, resulted a more profound knowledge of the manner in which 
that agent behaves in the economy and of its eUmination. 

Treatment with Silver, Brass and Platinum. 

Fracastor and some physicians of his time make mention of gold 
as a means of combating syphilis. A. Lecoq, Gervais, U9ay, 
Pitcaim, and other authors, have proposed or employed the prepara- 
tions of gold against syphilis. It. is nevertheless to Dr. Chrestien, 
of Montpellier, that belongs the having made known, and at the 
same time made popular, the employment of that agent in the treat- 
ment of syphilis. Gold finely divided, oxide of gold, purple of 
Cassius, perchloride of gold and sodium, were the preparations tried 
by that physician. No season, no temperament interfered with the 
use of those remedies, and the treatment, which was combined with 
a simple diet, rarely required to be continued more than two months. 
Let us add that the experiments made in France and elsewhere did 



♦ Medicintsche Studien. Vienna, 1855. Die Behandlung der Syphilis 
ohne Mercur, Vienna, 1856-1857. Studien iiber Krankheitsformen in 
Idria (Wiener med. Wochenschrift, 1859, Nos. 19, 20, 21). 

t Mercur und Syphilis (Wiener med Wochenschr,^ 1859, Nos. 14, 15, 18, 
20, 26). Compare : J. Keller, Ueher die Erkrankungen in den Spiegelfa^ 
hriken zu ScphienhiUte, Friedrichsthaly &c. (Wien, med, Wochenschr,, 1860, 
No. 38). 

t Wochenhlatt der Zeitschr, der Wiener Aerzte, No. 11. 

§ Beitrdge zur Losung einiger Streitfragen in der Sgphilidologie (Prager 
Fiertelfahrschr,, t. xvL 1860). 

II Mercur und Syphilis. Berlin, 1861. 

^ ^Uhtersuchungen iiber den constitutionellen MercuriaUsmus undsein Ver- 
haUniss zur eonstit. Syphilis, Wurzburg, 1861. 

** See Follin, Mercurialisme et Syphilis, critical analysis in Archiv, de 
med,f October, 1861. 



METHODS OP TREATMENT. 299 

not serve to confirm the favourable opinion formed by Percy con- 
cerning that method and expressed by him in a report to the 
Academy of Science. 

Dr. Legrand, of Amiens,* also wrote a volume in favour of gold 
and its preparations. Mercury, he "says, does not cure venereal 
diseases, but gold does ; gold is, therefore, the specific for syphilis. 
This is evidently exaggerating the effects and misrepresenting the 
mode of action of the remedy. However the case may be, we find 
in that work some histories of patients which would seem to bear 
witness to the utility of preparations of gold for primary or even 
secondary lesions, if, in reality, such lesions did not frequently 
become cured spontaneously. There is good reason for believing, 
however, that gold, like all disturbing means, is not devoid of utilitv 
in the treatment of syphilis. 

The example once given, a wish soon arose to try all the precious 
metals. Serres, of Montpellier, proposed the salts of silver and 
pure silver, from which he stated that he had obtained good results.f 
In 1840, Dr. P. HoeferJ recommended for the treatment of syphilis 
the king of metals, platinum, from which, however, he obtained only 
doubtful results. Independently of the uncertainty of their action, 
the various metals of which we have just been speaking are too 
high in price for it to be possible to use them on a large scale in 
therapeutics. 

Treatment with Aesenic, Iodine, and Iodide op Potassium. 

We have already said that arsenic formerly served for the treat- 
ment of syphilis, in which it was associated with mercurial prepara- 
tions either in washes or fumigations. Plater,§ as we know, was 
not even content with dissolving corrosive sublimate in a very small 
quantity of water, bat also added arsenic. That agent did not 
cease, however, to be regarded as a poison and, as such, was never 
fairly classed with the remedies for syphilis. Quite recently, it has 



* Legrand, De Vor et de son emploi dans le traitement de la syphilis, 
Paris, 1836. 

t >MSmoire sur VempUd des prSparations.d'argent dans le traitement des 
maladies venhiennes. Paris, 1836. 

X Hoefer, Gaz, mid. de Paris, Nov. 25th, 1840. 

§ See vol. iii. of his Pratiqtte, livr. i. chap. xiv. Astruc, he, cit. t. ii. 



300 TREATMENT. 

been highly spoken of in certain cases. We shall revert to this 
point later on. 

Iodine and its compounds had not long entered the domain of 
therapeutics when they were employed for the cure of syphilis. 
Inspired by the practice of Girtanner, who gave burnt sponge for 
venereal ulcers of the throat. Martini, of Lubeck,* conceived, in 
1821, the idea of substituting iodine for the sponge, and obtained 
good effects from it. He quotes several cases of patients affected 
with venereal ulcers of the throat, and who, after having undergone 
without success various methods of treatment, rapidly recovered 
from their ulcers and from the concomitant cachexia. In the course 
of the same year, Biett, at the Hospital Saint-Louis, employed 
iodine combined with mercury successfully against syphilides. In 
1824, Eichond des Brus employed tincture of iodine internally, in 
doses of from twenty to forty drops, and externally, in frictions, 
against gonorrhoea and buboes. In 1831, Lugol published cases 
of tertiary affections cured by preparations of iodine alone. Thus 
was the way prepared for a new antisyphilitic agent. 

Wallace, of Dublin, has the merit of having been the first to 
employ iodide of potassium, to fix the doses of it, and to point out 
the indications for it, whereby he definitively introduced iodine into 
the therapeutics of syphilis and placed it almost on a level with 
mercury. He began his experiments in 1832, and gave the results 
of them in the form of lectures four years later.f 139 patients 
were observed, of whom six were affected with iritis, six with affec- 
tions of the testicle, ten with various diseases of the bones and joints, 
ninety-seven with cutaneous syphilides, and twenty with lesions of 
the mucous membrane of the mouth, nose, and throat ; lastly, three 
pregnant women were also subjected to the same treatment for the 
purpose of preserving the foetus from syphilitic contagion. The 
preparation employed, mixtura iydriodalis jpotassa, contained eight 
parts of iodide of potassium to 250 parts of distilled water. Adults 
took a tablespoonful of this mixture four times a day, i.e., about 
thirty grains of iodide of potassium. 

The success achieved by Wallace soon excited the attention 



* Hufeland'a Journal, April, 1833. Co'indet had already proposed (1820) 
iodide of meroary for combating venereal affections complioated "with 
scrofula. 

t See Lancet, March, 1836. 



METHODS OF TREATMENT. 301 

of medical men. In England, Judd,* A. Saville,t Winslow^J 
Ballock,§ and R. Williams ;|| in France, Trousseau,^! Ricord,** 
Payan,tt Gautliier,Jt Boys de Loury, and Costilhes ; in Italy,§§ 
Brera, Sperino, Riberi and Gasca,|||| and Pellizzari;^^ in Germany, 
Gasman,*** tried iodide of potassium and testified to its good effects. 
Ricord observed that tertiary lesions were more favourably influenced 
by this agent than secondary lesions. Deep-seated aflections of the 
skin and mucous membranes, gummy tumours of the cellular tissue, 
and lesions of the bones, were the manifestations which appeared to 
him to yield most readily to iodide of potassium. This fact, which 
was accepted by Trousseau, Sperino, Payan, Gauthier, and several 
other experimenters, was taught by Bazin ; we ourselves have also 
been led to admit it. It was further ascertained that, by increasing 
them gradually, larger doses than those used at first by Wallace could 
be given with safety. By degrees, from fifteen to sixty and even 
ninety grains of this medicine were given daily ; the dose was still 



* Judd, A Pract, Treatise on Urethritis and Syphilis, 1836, in 8°. 

t A. Saville, London Med, Gaz,, August, 1835. 

X Winslow, London Med, Gaz., December, 1835. 

§ Bullock, Edinh, Med. and Surg. Journal, January, 1837. 

II Williams, in Behrend's Syphilidologiej t, ii. pp. 316, 331. 

If Trousseau and Pidoux, Traiti de therapeutique et de mati^re mSdicaUf 
t. i. p. 267, 5« 6dit. Paris. 

•♦ Ricord, BuU, gSner, de therapeutique ^ t. xii., 1837, p. 241 ; and Gaz, 
des hopitaux, 1839. 

ft Essai thSrapeutique sur I'iode, ou Application de la mSdec. iodee ou 
iodurSe, Bruxelles, 1850 ; et De Vemphi de Viodure de potassium, &c. 
Paris, 1847. , 

XX Observ, pratiques sur le traitement des maladies syphil.par Viodure de 
potassium. Lyons, 1845. 

§§ Des differents agents thSrap. employSes a Saint-Lazare contre les malad, 
syphil. et de leur appreciation (Gaz. mSd, de Paris, 1847, p. 418). 

II II See Giornale delle scienze mediche, 1847. 

HV Gazzetta toscana delle scienze medico^iche, 1845. 

*♦* Medicin, Jahrb, des (Esterr, Staates, 1843. Compare: Ebera (of 
Breslau) Medecin. Zeitung, 1836. Hanck and Kluge, joum. V Experience, 
July, 1844. Oct. Hocken, De la valeur comparative des prSparations de 
mercure et d^iode dans le traitement de la syphilis {Ann. des malad, de la 
peau, t. i. p. 344; and Gaz, med, de Paris, July 27th, 1844). Esparb^s, De 
Vemphi de Viodure de potassium contre la syphilis, Tbdse de Strasbourg, 
1859. Evrain, De Viodure de potassium dans tons les ages de la syphilis, 
Tbdse de Paris, 1861. 



302 TEEATMENT, 

further increased^ but without a proportionate augmentation of its 
therapeutic influence. 

Despite attacks occasioned most frequently by changes of doc* 
trine, an experience of three centuries has confirmed, as we know, 
the value of mercury in the treatment of syphilis, while most of 
the other methods employed for combating that disease have, in their 
turns, fallen into complete oblivion. Iodide of potassium, the use 
of which is very recent, has not had to undergo the same vicissi- 
tudes; its good efiPects are so generally recognised that it is now 
impossible to refuse it a place by the side of mercury in the treat- 
ment of syphilis. Thus two substances, iodine and mercury, are 
incontestably the chief agents which we are now able to oppose to 
the ravages of syphilis. 

It would be superfluous to insist further upon the methods of 
treatment hitherto employed for combating syphilis ; what we have 
already said appears more than sufScient to give a glimpse of the 
multiplicity of remedies and various phases through which the 
therapeutics of syphilis have passed. I shall remark, in conclusion^ 
that the spirit of system has always had the most deleterious influ- 
ence upon the manner of treating syphilis, and that at the present 
day, it is important to recognise that this disease, like all those 
which attack the human race, calls for expectation or action 
according to the indications which present themselves. It now 
remains for us to search out these indications in acquired syphilis 
and in inherited syphilis. 

§ 2. Treatment of acquired sypAilis. 

Syphilis is curable, because it yields to a well-directed treatment ; 
but it is also capable of becoming cured of itself, sponte sua, that is 
to say, without medicines and with the aid of simple hygienic 
measures. Under our conditions of observation, it is rare to meet 
with cases of the spontaneous cure of syphilis, for if our patients 
do not treat themselves, they ask to be treated, and we physicians 
do not like to take upon ourselves the responsibility of leaving to 
itself a disease which, after all, is not without danger. But there 
are countries in which things run a different course, and to become 
well acquainted with the natural course of syphilis, the best plan is 
to study it amongst uncivilised people. In fact, the author of "the 
general history of Pirates (Johnson) wrote in 1726 in reference to 



ACQUIRED SYPHILIS. 303 

the Brazilians : — " Most individuals (men and women) are affected 
with venereal diseases, but they do not have recourse to any medicines 
to palliate these affections. The only man who occupies himself 
with looking after them is an Irish priest, who has no other remedies 
than a few simples. It is with these plants, the action of which is 
assisted by the salubrity of the air and a light diet, that the inhabit- 
ants conquer the disease, and if there are few who escape the annoy- 
ance of a discharge or an eruption, there is not one, at least, who 
becomes precipitated into the abyss of evils into which mercury has 
already plunged so many victims.''^ Livingstone, as we have 
already stated,t teaches us that, in the centre of Southern Africa, 
syphilis becomes cured spontaneously. Lesscti relates that syphilis 
does not commit any ravages in the Society Islands and especially 
at Taiti. The essentially light diet of the inhabitants, who live upon 
fruits only, and drink nothing but emulsions of the cocoa-nut; the 
frequent baths, the high temperature, the indolence which makes 
them avoid fatigue, and the use of the ava root, which intoxicates 
them and causes them to perspire freely, are, says that author, the 
most active and efficacious remedies for that disease. In Egypt, 
syphilis also very easily becomes cured under the influence of a some- 
what strict diet, or by very simple remedies, as affirmed by Sonnini 
and Bruce, t According to Leo Africanus, the same was formerly 
the case in Numidia. It is unnecessary to dwell upon proofs of 
this kind ; there is another not less important one furnished by the 
history of the therapeutic methods employed for combating syphilis. 
The numerous patients treated with sudorific woods, opium, &c., and 
recovering, evidently owe their cure as much to the efforts of nature 
as to the influence of the treatment, which, at the very most, played 
the part of an adjuvant; and although there is reason to believe that 
most of the cures attributed by the English physicians to non-mer- 
curial treatment had reference to soft chancres, rather than to hard 
chancres and constitutional syphilis, it is at least quite admissible 
that true syphilis was not foreign to all those cases. Thus the 
natural course of syphilis in certain countries, the methods of treat- 
ment formerly employed, and daily observation, § show that syphilis 



* Graves, Clinical Medicine, f See vol. 1. p. 54 of this work. 

X See vol. i. p. 55 of this work ; and Gaz. mSd. de Paris, 1839, p. 394, 
Sur le traitement de la syphilis en E^ypt, by Clot-Bey. 
\ Diday, Histoire naturelle de la syphilis, 1863, p. 394, gives eighteen 



304; TREATMENT. 

is capable of {spontaneous core, so that an organism modified by the 
poison of syphilis may, in time, return to its primitive and normal 
type, without the necessary intervention of active treatment or 
specific agents. Syphilis, in this respect, does not differ either from 
small-pox, typhoid fever, rheumatism, or any other disease, and the 
duty of the physician called upon to treat it consists solely in aiding 
nature's efforts and favouring the tendency to recovery. Under these 
circumstances, it is clear that the general treatment of syphilis 
ought to be expectant : that is to say, the physician must not act 
upon any theoretical ideas, but only when formal indications exist. 
How to attain this end, is the point which it now remains for us to 
examine. For this pirpose, let us follow syphilis in its various 
phases and in its various seats ; this is the only way of meeting all 
the indications which this so long continuing and so multiform 
disease presents. 

Period op Incubation and op Local Eruption. 

The physician, as will easily be conceived, is rarely called upon to 
treat syphilis during the period of incubation ; but yet it may be 
asked whether even then, in doubtful cases, something might not be 
done. The satisfactory results at which Professor Sigmund* has 
arrived are, in this respect, most encouraging. In fact, out of a 
total of fifty-seven cases of probable syphilitic contagion in indivi- 
duals who had placed an excoriated part in contact with syphilitic 
matter, and who, for the most part, were physicians, accoucheurs, 
nurses, &c., thirty-five were treated by cauterisation of the point 
contaminated, and twenty-two were left to themselves. Of the thirty- 
five cauterised from the first to the tenth day, ten became syphilitic, 
i.e., about twenty-two per cent. Of the twenty-two left to them- 
selves, eleven were attacked by syphilis, i.e., fifty per cent. This 
diflerence is still more significant if we take into account only the 
cases in which cauterisation was performed early. Of the thirty- 
five individuals of the first set, twenty- four were cauterised from the 
first to the third day, and syphilis developed itself in three only of 
these, Le., twelve per cent. ; while of the eleven others who were 

cases of syphilis cured without mercury, without relapse, after three years 
and a half and more. 

• Ueher die Behandlung der ersten Merkmale und Erscheinungen der 
Syphilis {Wiener med. Wochenschrift, May 29th, and June 1st, 1867). 



ACQUIRED SYMILIS. S05 

cauterised from the fifth to the tenth day, seven became syphilitic^ 
i.e., sixty-three per cent. Thus it would appear to result from these 
statistics that cauterisation ceases^ so to speak^ to be of use when 
the contamination dates further back than the fourth day, and that, on 
the other hand, it may offer great advantages when practised before 
that time has elapsed. Hence the conclusion that the poison of 
syphilis is probably not absorbed instantaneously, and that, before 
producing general infection of the organism, it remains for some 
time enclosed locally in a circle more or less confined. This is, 
moreover, to a certain extent proved by the success of the inocula- 
tions performed by Wallace, Puche, Lindwurm, and Belhomme. 
The syphilitic virus being regarded as a poison, some authors have 
believed in the possibility of combating it directly in the blood. For 
my part, says Swediaur,* I think it probable that mercurial remedies 
enter into the mass of the humours, become mixed with the poison, 
and exercise upon it a direct chemical action, by which its nature 
and effects are destroyed. This theory, for a long time accepted, 
still reigned at no remote period,t and even at the present day has 
some partisans. We everywhere hear it repeated that mercury 
neutralises the poison of syphilis, and the counter-poison of syphilis 
is sought for like that of cholera and many others. This would 
appear to be the result of a false medical education. I think, with 
Graves, j: that syphilis and mercury are not, like an acid and an 
alkali, two opposed forces the simultaneous existence of which is 
impossible. It evidently cannot be denied that a poisonous sub- 
stance, whatever it may be, is capable of being neutralised in situ ; 
but once absorbed, it also cannot be denied that there is only one 
means of combating its effects or of preventing the manifestation of 
them, viz., to produce physiological effects capable of re-establishing 
the function primarily deranged. But mercury, regarded as a 
ispecific agent by the partisans of the neutrahsation of poisons, is as 
incapable of modifying or annihilating the poison of syphilis during 
the incubation period as it is, later on, of preventing secondary or 
tertiary affections. § We must, therefore, have no hesitation in 



* Traits 9ompL des malatL vSnSr,, p. 79* 

t Consult: Joum. de la section de mid, de la SociStS d9 la Loire^ 
Infirieure: and Gaz. mSd,, 1836, p. 87. 
, X Graces, Clinical Medicine, 2nd edit. 

i Crousillard (These de Strasbourg, 1863) quotes from several authors^ 

X 



306 TBEATMBNT. 

abstaining entirely from treatment daring the course of the incuba- 
tion of syphilis, consequently no general preventiye measures are 
indicated. When the primary lesion has appeared and syphilis un- 
doubtedly exists,* are we already called upon to commence a general 
treatment? Or must we defer this treatment until constitutional 
symptoms present themselves P For my part, answers Ricord,t a 
well-marked induration suffices to cause me to prescribe a general 
treatment, and from the first day on which I can discover it, I attack 
the diathesis point blank. Against indurated or Hunterian chancre, 
writes Diday,J give mercury (the proto-iodide by preference) ; 
against chancriform erosion do not employ any internal treatment. 
Baerensprung,§ on the contrary, formally repudiates mercurial pre- 
parations, and recommends against chancre derivatives and sudorifics, 
especially Russian baths. Under these circumstances, the cure of 
chancres is tedious and relapses are more frequent ; but they occur 
only in the first months after the infection, up to the fourth month 
at latest, and are confined to certain superficial syphilides of the 
skin and mucous membranes. The Berlin syphilographer has never 
observed tertiary syphilis in patients who had been treated by him 
and had abstained &om usuig mercurial preparations. 

These authorities suffice ; but in presence of this divergence of 
opinions, what are we to do P And first of all, what is to be 
expected from mercurial treatment at this period P Will it prevent 
secondary afiections P By no means. Martins, Bassereau, Leudet^ 
H. Lee, Bazin, and Gibert, all agree in admitting, after strict^obser- 
vation, that mercurial preparations employed for the cure of primary 
lesions do not prevent secondary manifestations, and serve, at the 
most, to retard their appearance. Numerous cases famished by 
Diday in his last work, also bear witness to the impotence of mercury 

cases of secondary sypliilis supervening despite the use of so-called 
specific therapeutic agents. 

* In cases in which a positive diagnosis cannot be [formed, it is clear 
that every conscientious physician should abstain from a general treat- 
ment. If the least doubt is left in your mindi says Ricordi I coigure you 
to defer all specific treatment and to wait. 

t Lemons sur le chancre, par A. Foumier, 2^ §dit. p. 298. 
I i Mistotre naturelle de la eyphUis. Paris, 1863, p. 189. 
~ f SxposS de la doctrine de M» leprqfeseeur F". Baerensprung (de BerUn) 
relattvement ^ Porigine et au traitement de la syphilis, par J. F. Van der 
Donckt (Archiv, med, beiges, analyse dans Oa»* mid, de Paris^ 1855| 
p* 587}« 



ACQUIRED SYPHILIS. 207 

for the prevention of general symptoms. A first point, therefore^ 
maybe regarded as established: mercury in no way prevents the 
manifestation of secondary affections, conseqaently, it does' not 
attack the diathesis as Eicord asserts, and, in this respect, is useless, 
if not ddeterious. Bat in reference to the primary lesion, what is 
its action P Baerensprong observed that the duration of the chancre 
is longer when recourse is not had to merctirial preparations ; but 
the facts upon which he bases his opinion, at the same time that 
they show that mercury shortens the duration of the chancfre, sug- 
gest the idea that it facilitates the absorption of the induration. 
Consequently, mercurial treatment is little suited to the period 
of local eruption, and is only indicated when a very indurated 
chancre is slow in being absorbed : mercury may then play the part 
of a useful adjuvant and be the more necessary the more the 
lymphatic glandular system is deeply affected. Apart from these 
conditions, attention to cleanliness most frequently suffices for the 
treatment of infecting chancre. Thus the ulcer may be washed 
with spirit and water or tincture of Guaco* and afterwards dressed 
with a calomel ointment,t or simply with dry lint. 

Eicord, as we know, always performs cauterisation on the appear- 
ance of the chancre ; but from the moment at which it is proved 
that this lesion is the first phenomenal expression of the modification 
of the organism, it becomes clear that the abortive method is of no 
value. If this method has been able to exhibit some success, it 
was, as PoUin very judiciously remarked, because it was employed 
indifferently against soffc chancre and infecting chancre at a period 
when the distinction between these two forms was Hot yet known. 

Moreover, experience has spoken on this point. J. L. Petit, who 
at the commencement of his practice excised indurated chancres of 
the prepuce, afterwards renounced this operation, which he con- 
sidered useless. Diday{ did not succeed in preventing constitutional 
infection in spite of the destruction, by means of carbo-sulphuri^ or 
chloride of zinc paste, of chancres of less than three days' or even 



* See Pascal, Du guaco et de sea effeU curatifs dans diverses formes du 
mat vSnSrien. Paris, 1860. 

t In such cases, Ricord prescribes the following ointment : 

Opiate Cerate. • • .30 parts. ' 

' Calomel . . • . 1 „ 
Mix and apply three times a day. 
X See Ga», mSd* de Lyons \ and OaZk mid, de Paris, i860, p.d3^i 

i it 



308 TREATBflENT. 

onlj twentj-four hoars' standing. On this point there is no dbnbt: 
the abortive method employed against the primary syphilitic lesion is^ 
at the very leasts useless. 

. Ferruginous preparations, tonics, and even the water treatment 
are the means usually indicated by the general condition of the 
patient, and rendered indispensable by certain complications, such as 
phagedaena, which is the sign of an unfortunate tendency of the 
disease which the ancients called malignity. Here, however, local 
treatment becomes necessary; cauterisation is the most certain 
barrier to oppose to phagedsena. For this purpose, Eicord gives the 
preference to the carbo-sulphuric paste, and in cases of very large 
chancres, he advises the use of chloroform to alleviate the pain of the 
operation. Bollet prefers cautery at a white heat or chloride of 
zinc paste, with the precautions which we shall point out further on. 

In certain cases, however, simple dressing with a solution of the 
potassio-tartrate of iron* and the same salt taken internally are 
means which suffice to combat the evil. 

In case of inflammatory complication, rest, baths, and emollient 
poultices will be required. These means will also serve to relieve 
phymosis and paraphymosis ; but if the prepuce or a portion of the 
glans threaten to become sphacelous, it will easily be understood 
that we must not hesitate to perform an operation which has not 
here, as in the case of soft chancre, the disadvantage of reinoculat- 
ing the venereal lesion. Nothing is more simple, in fact, than to 
remove the extremity of the prepuce and the chancre which has 
formed there. 

Soft or simple chancre (pseudo-syphilis), the action of which 
is entirely local, requires only local treatment ; but that treatment is 
of the greatest importance on account of the frequent complications 
of this lesion and of its unfortunate tendency to spread and multiply 
itself. Hunter clearly understood what is required in this respect. 
'^ The most simple method of treating a chancre,'^ t says he, ^' consists 
in destroying or extirpating it. In this manner it is reduced to the 

* Ricord prescribes the following solution : 

Distilled water .... 250 parts. 
Potassio-tartrate of iron . . . 90 „ 
Three tablespooDsful to be taken daily. The sore to be dressed three 
times a day with lint dipped in this solution. 

t Hunter does not make any distinction here between soft chancre and 
syphilitic chaDcre. 



ACQUIBED SYPHILIS. 309 

condition of a simple ulcer or wound and becomes cicatrised like all 
ulcers or wounds of that nature/' To reduce a specific ulcer to the 
condition of a simple ulcer, to transform a wound possessing a 
special maintaining cause into a wound devoid of any such cause, 
appears to Sicord to be the proper object of the treatment. Cau- 
terisation, if sufficiently deep, thoroughly fulfils this purpose. It is 
performed with various substances, such as caustic potash, nitric 
acid, and by preference carbo-sulphuric paste (Bicord), or chloride 
of zinc paste (EoUet, Diday*). After having washed the diseased 
parts, BoUet applies to their surface discs of the caustic, so as to 
cover them exactly without going beyond them. These discs are 
retained in their places with lint, strips of diachylon plaister, or 
bandages, according to the region ; they are kept on for one or 
several hours, according to the depth of the lesions and the effect to 
be produced. The eschar almost always becomes detached on the 
third day, and the wound left behind is usually covered with a 
pseudo- membranous layer which might give the idea that it is still 
virulent, if a careful examination did not show that the edges are on 
a level with the floor, and that the whole surface is becoming raised 
and healing instead of burrowing by ulceration. The advantage of 
chloride of zinc as a caustic is that it does not cause such intense 
pain and is not liable to cause haemorrhage. 

While a general treatment suffices for combating the adenopathies 
of syphilitic chancre, which rarely suppurate, local treatment is 
almost always necessary for the buboes of soft chancre. This treat- 
ment varies, however, according to the period in the evolution 
of these lesions. At the commencement, so long as no suppuration 
exists, rest, emollient poultices, baths, and rubbing with mercurial 
or iodine ointment are the means indicated. The application of 
tincture of iodine has the disadvantage of causing severe pain. 
Blisters, employed as abortive means, have sometimes succeeded ; 
leeches, applied for the same purpose, have the great disadvantage, 
when the suppurating bubo is opened, of serving for its inoculation, 
if the punctures they produced are not yet cicatrised. Premature 
incisions, employed for the purpose of preventing peeling off of the 
skin, are generally hurtful ; but when suppuration has taken place 

* Consult : Bollet, Oa%, mid, de Lyon, December 15th, 1857. Diday, 
same journal, 1858, Nos. 2 and 4. Dron, De la miihode destructive dee 
chancres (Annates de la syphiUsj 1858). Pebauge, Thdse de Paris, 1858. 



310 TRBATMBOT. 

and the bubo threatens to bursty we most not hesitate to give an 
issue to the pus. A single incision by means of a bistouiy^ is 
preferable to canstic. The use of a thread seton^ as recommended 
by Bonnafont^ is not to be rejected. Let us add that these methods 
of treatment have the advantage of being suitable for virulent bubo 
as well an for sympathetic bubo^ the diagnosis of which^ as we have 
already stated^ is always surrounded with great difficulties. 

After the incision, the bubo, ulcerated and transformed into a 
virulent wound^ requires the same treatment as a soft chancre.^ 

Period of Geiosbal Eruption and of Secondaet 

Affections. 

. The chief therapeutic agent to oppose to the manifestations of 
this period is mercury. But the local determinations^ although 
imminent, have not yet shown themselves ; the patient is not yet 
beyond the prodromata, he is suffering from violent headache, he 
feels a general lassitude, vague pains, and a moral prostration which 
indicate the speedy irruption of the disease. Should mercurial 
treatment be commenced? By no means, answers Diday, with 
whom we agree on this point. Bather suspend all treatment with 
mercury, if already going on, and, paying but little attention to the 
Bpecifi/D CQjadition, suit your r^edies to the chief symptoms. . 

Give, a nuld purg^tiyei if the tongue be furred, and then give pre- 
parations of iron if there be evident chloro^ansQmia. Combined with 
rest, baths, and small doses of opiuin, these means will most generally 
succeed in alleviating, if not in combating the disease. Otherwise, 
aQeording to-Diday, recourse must be had to iodide of potassium or 
sodium to the e:Ktent of from fifteen to thirty grains daily. 
. Diday writes further: — "With roseola — wait. With a vesicular, 
squamous, or pustular syphilide — rgive mercury. With a papular 
syphilide — ^wait, but watoh.^' To us> who are advocates of the 
expectant plan in reference to syphilis, this mode of proceeding 



H i* » 



* 'Consult: Bonnafont, Mem.de mSd, et de chir. miliL, 1854, 2* s^iie, 
t.xiii.) p.' 337. "Reboxil, Des udinites vifiSrtennes. I Tbdse'de Paris* 1857- 
Eiber, Behandlung eiternder Buhonen nach Leb'ert ( Wten. med, 
Wbchenschr., No. 38, 1860). Schmidt's Jahrb,, t. cxiv. p. 199. Weisflog, 
Ueber die Brocha*sche Behandlung der eiternden Buhonen {Schtoetz, 
Monatechr,, No. 12, 1860). A Guerin and P. Picard, JSur le. traitemetU dee 
buhon9 (Btdletin g6nir. de, therapetdiqtte, t. Iv, June, 1861). 



ACQUIRED SYPHILIS. 31 1 

is very seductive. Bat since it is not clearly proved that rubeolons 
and papular syphilides are always the indication of a really benignant 
form^ and as^ moreover^ in the absence of specific treatment, these 
manifestations may endure for a very long time, we are led 
to admit that every exanthem distinctly syphilitic ^calls for the 
employment of mercury. In like manner, exanthematic eruptions, 
secondary affections of the eyes, joints, &c., require to be com* 
bated by mercurial preparations. Consequently,, the presence of a 
secondary lesiofi would indicate the use of mercury, except in certain 
rare cases which will be spoken of further on. 

In the absence of these lesions, no indication, no treatment, the 
preparations of mercury being incapable, as we know, of preventing 
ulterior affections. But, the indication being recognised, what 
method Is to be preferred P Should the mercury be used internally 
or externally. 

External treatment. — We have made known above the method 
with mercurial Iqtions and fumigations. We cannot dwell upon 
these methods, now justly fallen into disuse. The same does not 
apply to inunction, which has not ceased to be in vogue in Germany, 
and which undoubtedly deserves the preference when to the syphilis 
are added derangements of the primse visB which render the internal 
use of mercurial preparations impossible. 

Differing already in the composition and quantity of the ointment 
employed, the method by inunction varies also according to the region 
in which it is applied. Feyrilhe caused it to be performed upon the 
surface of the ghns, and Cirillo on the soles of the feet. Clare had 
minute quantities of calomel rubbed several times a day into the 
inner surface of the cheeks, in the vicinity of Stenon's duct. 
Baerensprung* and Sigmund^ the two chief Qerman syphilographers 
who give to mercurial inunction the pre-eminence over all other 
methods of treatment by mercury, adopt a nearly similar process. 

As applied by Sigmund,t this method includes three stages : the 
preparation of the patients, the inunction, and the treatment after 
the inunction. The preparation of the patient lasts &om six to ten 
days. It is sought to regulate the diet, to remove or modify 
various affections, such as fevers, diarrhoea, and especially affections 
of the gums. The skin is rendered more supple by baths, the tem« 
.. — _ — I I ..■■... ,.■■■■ ■ .. ■ - ■ III 

* AnnaUn des CharitS-KrankenhauseSy 1858, vol. vii. p. 2. 

t Die Einreihungen mit grauer SaUbe hei SyphiUsformen, Vienna, 1859. 



312 TREATMENT, 

perature of which varies from 86^ to 92° Fahr. The innnction is 
made on both legs^ both thighs^ the anterior surface of the chest and 
abdomen^ the arms, and the back. It lasts at least twenty minutes 
each time. It should be performed at night, before the patient goes 
to bed, and die parts rubbed are afterwards enveloped in linen or 
cotton cloths. The linen must be changed after each nibbing. The 
quantity of mercurial ointment used exceeds fifteen grains daily. The 
inunction is performed from twenty to thirty times. The patients 
are kept in bed for eighteen hours at a time and allowed but little 
food, but regard must be had to the anaemic complications which 
may contra-indicate low diet. At the same time, gargles of corrosive 
sublimate, alum, or tincture of iodine are to be used according as 
there is or is not ulceration of the buccal or pharyngeal mucous 
membrane. The inunction is suspended during the menstrual 
period ; the same thing is not done during pregnancy, however, and 
Sigmund thinks that if performed early, it may prevent infection of 
the foetus. In women recently delivered, two pr three weeks are 
allowed to elapse before commencing the inunction, that the anaemia 
which generally follows delivery may have time to disappear. In- 
unction practised upon nurses does not seem to have any influence 
upon the syphilis of the children they are suckling ; it is, therefore, 
applied also to the children themselves. The cicatrisation of wounds 
of any kind is not retarded by this mode of treatment. Internal 
remedies may be employed simultaneously with inunction : Zittmann's 
or PoUini's decoction, diuretics, narcotics, various preparations of 
iodine or iron, bitters, or cod-liver oil. The season most favourable 
for this mode of treatment is the spring or first half of summer. 

After the last inunction, the patients take a hot soap-and-water 
bath (88° to 92° Fahr.) for half an hour. They are still kept some 
days in bed and made to sweat. They are allowed rather better diet. 
This treatment is not entirely free from ill effects ; cutaneous inflam- 
mations are observed and eczema, which is rarely severe enough to 
necessitate its suspension. Salivation is a more serious result and 
one by no means to be sought for as was formerly done. Yery 
rarely, however, is this salivation so considerable as to require the 
cessation of the inunction. Sigmund has several times been obliged 
to suspend this treatment on account of the existence of profuse 
perspirations, obstinate diarrhoea, cerebral or pulmonary congestion, 
haemorrhages from the nasal fossae, anus, or uterus, epileptic attaokS| 
and persistent insomnia. 



ACQUIRED SYPHILIS. 313 

Baths containing mercury in solution always constitute a very 
unreliable mode of treatment^ on account of the difficulty of knowings 
even approximately, the dose of the remedy absorbed. As a general 
remedy, therefore, mercurial baths are to be rejected ; but recourse 
may be had to them when it is desired to produce a local effect, as 
in the case of obstinate syphilides. The bichloride of mercury is 
the salt to be preferred ; it is used in various proportions and first 
dissolved in alcohol or ether. Under the same circumstances, fumi- 
gations, as already described, may be of use. For these, cinnabar is 
usually employed. The temperature is gradually increased, but 
should never exceed 122° to 131® Fahr. The fumigation should be 
continued for fifteen or twenty minutes and be repeated daily. Such 
are tlie external methods employed at the present time;* these 
methods, it must be borne in mind, have indications and contra- 
indications with which it is necessary to be acquainted. They are 
generally suitable for cases of obstinate syphilis which have resisted 
internal treatment. 

Internal treatment. — This treatment is that which is preferred and 
generally employed in France, except under the peculiar circumstances 
pointed out above. Numerous preparations are in use, but we shall 
content ourselves with making known the chief amongst them. 

Despite the favour in which it formerly stood, metallic mercury is 
now given up. Belloste's pillsf and blue pillsf after having enjoyed 
great celebrity, are almost entirely forgotten. S^dillot's pills are 



* Calomel employed in Bub-cutaneous injections after M. Scarenzio's 
plan {Annali universali di medicinal 1864), appears to have fumislied 
good results to Dr. Ambrosoli (see Giornale italiano delle malattie veneree)* 

•)• BeUoste's pills : 
Take 
Metallic mercury . 
Aloes . 
Rhubarb 
Scammony . 

Black pepper 
For one pill. 
X Blue pills : 

Take 

Metallic mercury . gr« 0*75 

Confection of roses . -- ) ^ 1.5 
Powdered liquorice . j ^ ' 
For one pill. _ 



aa j gr. 0-75 

aa I gr. 0'30 
gr. 0*15 



S14 TBEATMENT. 

more generally advised : I have several times seen their good effects 
in the hands of mj teacher^ M. Bayer^ and I have often had the 
opportunity of employing them with success.* 

To be of use^ metallic mercury requires to be given in rather large 
doses. Eor the purpose of avoiding this inconvenience^ the idea 
occurred long ago of having recourse to its compounds. That one 
of its compounds which has had the greatest reputation^ as much on 
account of the good effects which it has produced as of the great 
authority which dictated it^ in a manner^ to a whole medical genera- 
tion^ is the bichloride of mercury^ or corrosive sublimate. Becom- 
mended in the treatment of syphilis by E. Blancard^ Melch. Friccids^ 
Hoffinann^ and Boerhaave^ this remedy was definitely accepted by 
physicians as a powerful anti-syphilitic since Yan Swieten^s time^f 
who regulated the employment of it according to a formula sent to 
him from Bussia by the celebrated Sanchez. The formula prescribed 
by the Yienna physician has been modified for the purpose of pre- 
venting the sometimes deleterious action of the sublimate upon the 

Btomach4 
Mialhe§ combines albumen with the sublimate and has been 



* Sedillot*s pills : 

Take _ 

Strong mercurial ointment . gr* 1*5 

Medicinal soap . . . • -- \ 
Powdered marsh mallow . . ^ / S^* ^'^ 
For one pill. 

f Van Swieten's drops) 
Take 
Bichloride of mercury . . . 12 parts. 

Com spirit 1,000 „ 

A tablespoonful to be taken morning and evening. 
X The following is the new formula : 
Take 

Bichloride of merciury ... 1 part. 
Distilled water • . • . . . 900 „ 

Rectified alcohol 100 „ 

§ Mialhe has given the following formula : 
Take 
Bichloride of mercury . . .15 grains. 
Chlorohydrate of ammonia . . 75 ,, 
The whites of two eggs. 

Distilled water . . . .30 ounces. 
From one to three tablespoon sfol to be taken daily. 



ACQUIRED SYPHILIS, 315 

imitated therein by Baerenspmng and Michaelis. But it is not 
only in solution that the sublimate is administered^ it is also given 
in the form of pills for the purpose of avoiding the disagreeable taste 
which it produces and of facilitating secrecy in the treatment. 

It is thus that it serves as the base of Cullerier's* and Dupuytren's 
pills.t 

The proto-chloride of mercury, or calomel, formerly much in 
use, is now much less frequently employed for the treatment of 
syphilitic affections. The large doses necessary for obtaining its 
curative effects having the disadvantage of producing salivation 
or of irritating the bowels, it is now seldom used except as a 
purgative. Introduced into therapeutics by Biett, the iodides 
of mercury soon attained a high rank in the treatment of 
syphilis. After having tried the bin-iodide, Biett ended by giving 
the preference to the proto-iodide. Later on, PucheJ and 

* Gullerier's pills : 

Take 

Bichloride of mercury ... 1 part. 

Wheat flour 15 „ 

Powdered gum . . . . 2 „ 

Distilled water sufficient to make into a mass, of which gr. 

2^ to be taken morning and evening. 

t Dupuytren's pills : 

Take _ 

Bichloride of mercury . . • gr. 0'18 

£xtract of opium ....,, 0*22 

Extract of guiacum . . ^ „ 0*75 

For one pill, two of which td be takeil daily. 

For children, to whom syrilpy inedioines are more easily administered, 

Larrey's syrup may be given : 

Take 

Coisinier's syrup . . . 500 parts. 

Chlorohydrate of ammonia \ 

Bichloride of mercury . aa | 0-25 to 0*30 parts. 

Extract of opium • . • . ) 

From one to six tablespoonsful to be taken daily. 

I Fuche combines the bin-iodide of mercury with iodide of potassium 

as follows : 

lodo-hydrargyrate of potash . . 1 part. 

Iodine . .> » ^ . • . 1 >} 

Iodide of potassium . . . 20 „ 

Syrup of wild poppies . . . 473 „ 

This syrup is well suited for persons of lymphatic constitution, who have 

reached the end of the secondary period. 



318 TREATMENT. 

Gibert* recurred to the bin-iodide^ which they combined mth iodide 
of potassium in the treatment of deep-seated syphilides. 

Cazenave^t Bicord^ Bazin^ and a great number of other physicians 
make choice of the proto-iodide of mercury for the treatment of 
superficial syphilides and their contemporary afiections. The 
cyanide of mercury, lauded by Biett and Parent-Duchatelet, is 
generally very little used in spite of the advantage attributed to it 
by the latter of not producing pain at the epigastrium, like the 
bichloride. 

Such are the various methods and the preparations generally 
employed in secondary syphilis. To sum up, the employment of 
mercury internally constitutes a simple and not dangerous method. 
The bichloride and proto-chloride of mercury are the two com- 
pounds to be chosen ; but the bichloride is, without doubt^ the one 
which deserves the preference, if it be true that all the prepara- 
tions of mercury^ once absorbed, are first of all transformed into 
that salt. 

However this may be, experience has taught us that it is some- 
times necessary, for the purpose of obtaining a more rapid cure, to 
vary the preparations. I have seen, says Bazin,§ syphilides, favour- 
ably modified at first by the proto-iodide, become stationary all at 
once, although the treatment was continued strictly, and only pre- 



* Gibert recommends the syrup of the iodurated bin-iodide of mercury 
(Boutigny), every 25 parts of which contain : 

Bin-iodide of mercury • • .0*1 centigramme. 
Iodide of potassium • ... 50 „ 

f Cazenave gives^ in the twenty-four hours, from gr. f to gri uj of 
proto-iodide of mercury, or from one to foor or ^more of the following 
pills: 

Take ^ 

Proto-iodide of mercury • . • 7} grains. 
Extract of lettuce .... 22| „ 
For twenty pills. 
X Bicord prefers the following formula : 
Take 
Proto-iodide of mercury . • --"I 
Extract of lettuce . . . aaj 45 grams. 

Extract of opium . . • . 15 „ 
Confection of roses . . . . 90 „ 
For sixty pills, one, two, or three to be taken daily. 
§ Le^onB sur lea sf^hUidea, Paris, 1859. 



ACQUIRED SYPHILIS. $17 

sent a fresh tendency to resolution when another compound of 
mercury was substituted for the proto-iodide, such as Van Swieten^s 
drops or Dupuytren^s pills. The same author begins the treatment 
of the syphilides with a pill containing gr. i of the proto-iodide, and 
asserts that it is useless to give more than gr. |^ seeing that no 
advantage is obtained from larger doses. 

An important question, and one variously answered, is that of 
knowing during what length of time the internal employment of 
mercury is to be continued. Hunter gave a quantity of mercury 
proportioned to the number of the ulcerated surfaces and the 
violence of the disease. Dupuytren continued the treatment up 
to the complete extinction of the symptoms, plus a period equal to 
that required for the cure. '' Six months of mercurial treatment, 
plus three months of treatment with preparations of iodine,'^ says 
Bicord, ''is the method which furnishes the most permanent cures, 
and which succeeds, in an enormous majority of cases, in really 
neutralising the poisonous influence, I may say in curing the syphilis, 
at least in the generahty of its manifestations." This method, how- 
ever, is not that of all practitioners, and is not that either of Diday 
or of Bazin. For the physician of the Hospital Saint-Louis, when 
a resolutive syphilide has completely disappeared, it is important to 
suspend the use of mercurial preparations, to be returned to if a 
fresh eruption supervene. 

No serious reason existing to justify the continuation of the mer- 
curial treatment after the cessation of the local determination, I, 
for my part, give the preference to Bazin's method. In fact, it is 
to hygiene much more than to therapeutics that recourse should be 
had to prevent relapses, to eradicate the disease, and to restore to 
the organism its normal characters. A special remedy for secondary 
syphiUs, mercury does not on that account suit all cases. A bad 
condition of the primse vise, debility of the organism, and a certain 
degree of chloro-ansemia, are so many contra-indications which 
should be taken into account. In persons of a delicate constitution, 
affected with scrofula, predisposed to phthisis and to other diseases 
of the same class, mercury should not be given, says Sir Benj. 
Brodie,* until it has been ascertained to be indispensable. But, 
adds the same observer, I believe that scrofulous subjects who have 
a well-marked syphilitic affection are treated with more advantage 

t ' ~ - 

* See Ann, dee malad. de lajpeau et dela syphilis, 1. 11. p. 90. 



318 TREATMENT. 

by the aid of this medicine, for if the mercury be deleterious for 
them^ the syphilis is still more so. Individuals who have all the 
appearances of vigorous health are not always those who best support 
the preparations of mercury. Those who are in the habit of drink- 
ing much wine and who lead an irregular life, place their constitu- 
tions in a condition little favourable for the employment of those 
preparations ; with them, it is better to defer the use of mercury 
until the constitution has been improved, so as to avoid having to 
combat, later on, mercurial and syphilitic affections. Sometimes, for 
reasons which could not be foreseen, mercury acts as a poison ; for 
this reason we must carefully watch all those to whom we administer 
this drug, if they have not taken it before. In short, far from 
exerting a favourable action, and effecting the cure of secondary 
affections, mercury may disturb the general health and aggravate the 
manifestations of the disease, in proportion to the quantity in which 
it is given. Under these circumstances, the use of it must be sus- 
pended. The patient will soon improve, and later on it will often 
be possible again to have recourse to this remedy, and this time with 
more success. In like manner, mercury ought not to be continued 
when, after the period necessary for its action, it does not manifest 
any therapeutic effect, A suitable hygiene, combined with tonics, 
then becomes useful, as also the employment of certain mineral 
waters and the water cure. 

If the phenomena of chloro-anaemia be added to the syphilis, 
preparations of iron, exercise in the open air, sea air, and salt-water 
baths, are so many excellent adjuvants. All abuse of spirituous 
liquors, too stimulating food, or great fatigue, should be most care- 
folly avoided. To place the organism in suitable hygienic conditions 
is the best mode of preparing it for the successful employment of 
remedial agents. In case of a furred condition of the alimentary 
canal, patients derive benefit from emetics, which enable them better 
to support mercurial preparations. Amongst the local applications 
capable of aiding the general treatment are alkaline, sulphur, or 
corrosive sublimate baths, astringent, tonic, and antiseptic lotions, 
and cauterisations, if ulcers more or less deep exist. Mucous 
patches, relapses of which are so frequent, readily yield to slight 
cauterisation with nitrate of silver, chlorine lotions, or the application 
of calomel in powder. 

Let us point out also the use of certain well-known drinks, to 
which however we must take care not to attach too much import* 



ACQUIRED SYPHILIS, 319 

ance : such are the decoction* of Vigarous, Zittmann, Pollini, and 
Pdtz.* The latter, recommended by Bayer, appears to me mord 
suitable for the tertiary period, on account of the small quantity of 
arsenic which it contains. 

Peeiod of Gummy Peoducts or of Tbrtiaby Affections. 

While the secondary manifestations of syphilis rarely require any 
other than a general treatment, the tertiary lesions, more deep-seated 
and more persistent, generally require further the employment of ft 
local treatment. The hand of the surgeon may be called in to com* 
bat them or at least to remedy the functional derangements which 
they occasion or which they leave behind them. We shall have to 
take into account these various circumstances. Iodine is here 
the basis of our treatment, as was mercury in secondary syphilis. 
Administered first of all by Martini, of Liibeck, and by Lugol, the 
tincture of iodine has recently been lauded afresh by Dr. J. Guille* 
min,f who recognises in it> amongst other advantages, that of being 
moderate in price, almost incapable of adulteration, and little or not 
at all dangerous in its use. The doses of it are very small com* 
pared to the usual doses of compounds of iodide ; that employed 
by Dr. Guillemin is the following : — 

Tincture of iodine . • .5 parts. 

Common water . . . 1,000 „ 

Two or three spoonsful of this solution before each of the tWd 
chief meals of the day suffice in general, according to that author, 
to combat not only tertiary, but even secondary affections. 

Iodine, nevertheless, is seldom given uncombined; recourse is 
most frequently had to one of its salts, and then the preference is 
given to the iodides of potassium and sodium. But if the iodides 
are not dangerous to the organism, except in large doses, the same 
does not apply to the iodates, and consequently we must avoid the 



* These various drinks are decoctions of sudorific woods and sarsaparillat 
Those of ^Vigarous and Pollini contain sulphuret of antimony, that of 
ZittmanD, calomel, that of Feltz, sarsaparilla, isinglass, and sulphuret of 
antimony. 

t On the adwmtages of the euhstttution of iodine for iodide of potassium 
in the treatment of syphilitie diseases (Gaz» hehdom, de midedne et d4 
ehirurgie, Parisi 1866, p» 134 et seq.). 



320 TREATMENT- 

production of those salts in the administration of the iodide of 
potassium or sodium. But the recent researches of V^e (see Bul^ 
letin ginirale de therapeutiqiie, t. Ixxi. p. 405) show that chlorate 
of potash, ahsorbed simultaneously with iodide of potassium^ may 
yield to it its oxygen and convert it into iodate^ a poisonous agent. 
Experiments by Melseus prove the possibility of such poisonings and 
therefore we must avoid giving chlorate of potash to a patient who 
is taking iodide of potassium. 

The doses in which iodide of potassium is given vary from seven 
and a half and fifteen grains to forty-five, sixty, and seventy- 
five and ninety grains in twenty-four hours. Some practitioners 
carry the dose to 150^ 180, and 225 grains, or even more, but with- 
out advantage to the patients, for, with iodide of potassium as with 
all medicinal agents, the organism cannot utilise more than a given 
quantity. Moreover, experience has shown that, under these cir- 
cumstances, the therapeutic influence of the remedy is never in pro- 
portion to the doses taken^ and that the pathogenic effects alone are 
increased. The object of the physician in such cases is, therefore, 
to arrive gradually at a dose which produces therapeutic effects with- 
out producing pathogenic effects injurious to the patient. This salt 
is taken in solution, or in syrup, but very rarely in pills, on account 
of its deliquescence. The best mode of administering it is, to in- 
corporate it, once dissolved, with tonic or depurating syrups, such 
as syrup of gentian, saponaria, quassia, sarsaparUla, &c.^ Ricord'^ 
gives this remedy in the following form : 
Take 

Syrup of gentian • • .500 parts. 

Iodide of potassium . • 30 „ 

Three tablespoonsful to be taken daily. 

Melchior Eobert substitutes syrup of sarsaparilla for the syrup of 
gentian. The larger doses of iodide of potassium are indicated in 
the case of advanced and deep-seated lesions, such as changes in the 
bones, or visceral localisations which may place the life of the 
patient in danger. But if the affection does not extend beyond the 
external or internal tegument, and especially if the patient finds 
himself in that stage of the disease to which certain authors have 
given the name of transition period, the mixed treatment^ as em- 



* Le^oM iur U chancre, 2 ^dit. 



ACQITIRED SYPfllLIS. 321 

ployed by Gibert and Bazin,* is the best means of removing these 
symptoms. The bin-iodide of mercury, combined with iodide of 
potassium, or syrup of the iodurated bin-iodide of mercury (Bou- 
tigny, Gibert), is the preparation to be employed with most advan- 
tage against deep-seated, tuberculo-ulcerative and puro-vesicular 
syphilides, affections for the most part very obstinate. Like mer- 
cury, the iodide of potassium destroys the manifestation, but does 
not prevent relapses, and consequently does not affect the diathesis. 
The space of time during which it is desirable to continue the use 
of this medicine is, for some authors, from two to three months ; 
but those authors too readily forget that no absolute rule can exist 
on this point, and that the constitution of the patient, his general 
state of health, and the greater or less tenacity of the manifestation, 
are then the only guides. It is evident that, when the local morbid 
determination yields readily, it is not necessary to continue the use 
of the remedy long ; in the opposite case, the use of it must be 
continued until the general health is restored, especially when the 
lesion is a deep-seated one, a circumstance which renders it difiBlcult 
to seize the exact moment of its complete disappearance. 

The iodide of iron in pills, or still better in syrup, will be sub- 
stituted with advantage, in debilitated persons, for the iodide of 
potassium ; we shall return to this subject further on, when speaking 
of the treatment of hereditary syphilis. Like the mercurial pre- 
parations, the preparations of iodine require to be assisted in their 
action, whenever the patients present a certain degree of cachexia, 
or of simple anaemia. Bitter drinks, infusions of cinchona, Bor- 
deaux wine, the juice of meat, roast meats, and even preparations 
of iron f become, under these circumstances, more or less necessary. 

* We have already giyen Gibert*8 formula. The following is that to 
which £. Bazin gives the preference : 
Take 
Bin-iodide of mercary • . . 0*15 parts. 
Iodide of potassium . . .10 „ 
Syrup of saponaria . . . 500 ,» 
Two tablespoonsful of this syrup are given daily at first and afterwards 
increased to four. * 

t The preparations of iron have not been regarded as adjuvants only* 
H. Behrend (of Liverpool) has advised the internal use of potassio-tartrate 
of iron (Lancet, December, 1&56), from which he asserts that he has 
obtained complete success. Side by side with those who give the pre- 
parations of iron are found others, like Marsden, who content themselves 



322 TREATMENT. 

The deranged digestive fanctioiis sometimes require to be treated 
separately ; but it is important to know that one of the chief means 
to be opposed to intestinal derangement^ especially if dependent upon 
a material lesion of the heemopoietic glands^ is treatment with pre- 
parations of iodine. In short, the contra-indications for this treat- 
ment are comparatively rare. 

Under circumstances which experience alone suffices to determine, 
iodide of potassium, even in large doses, remains without effect upon 
tertiary affections. I have then often had occasion to congratulate 
myself upon the results of the use of calomel in minute doses, espe- 
cially in a robust and still young man, who, in less than twenty-five 
days, was cured of hemiplegia, and in a woman of 29 years old, 
suffering from intense cephalalgia with transient aphasia, which 
manifestations had been treated unsuccessfully with iodide of potas- 
sium. 

If it should happen that the cachectic condition was kept up by 
amyloid degeneration of viscera such as the liver and spleen, we 
might, as has been recommended by Dr. Budd,* make use of a 
nitric acid drink. Administered for a certain time, nitric add 
possesses, according to that physician, a remarkable tendency to 
cause absorption of the morbid deposit to which the enlargement of 
the organs is due, to restore their normal texture, and to produce an 
improvement of the general condition. When it is well borne, this 
remedy, to which we have several times had recourse, is given for 
months together, without deranging the stomach and without pro- 
ducing excessive acidity of the urine. 

The local indications, comparatively frequent in the course of the 
tertiary period, vary with the seat and degree of intensity of the 
lesions. They present themselves when ulcers more or less deep 
follow syphilitic neoplasms, and leave behind them losses of sub- 
stance, contractions of canals, or other derangements capable of 
involving important functions. Ill-conditioned ulcers, indisposed 
to cicatrise, developed upon the surface of the skin or mucous mem- 

ivith administering stomachic and tonic remedies and a strengthening 
diet {Lancet, July 27tb, 1657, p. 650). It is by no means astonishing that 
such treatment should succeed under many circumstances, after what we 
know of the spontaneous cure of syphilitic manifestations. It is generally 
because we do not know the natural course of diseases that properties are 
attributed to certain means which they do not really possess. 
* See DulHn Medical Press, September 16th^ 1863» 



ACQUIRED SYPHILIS. 323 

branes, are favourably influenced bj the application of glycerine, 
alcohol, or tincture of iodine ; when these lesions take on the serpi- 
ginous form, the means in question are not always sufficient, and it 
becomes necessary to have recourse to cauterisation with nitrate of 
silver or perchloride of iron, more rarely with the acid nitrate of 
mercury or corrosive sublimate. 

Gauthier recommends touching ulcers of the throat with a pencil 
of lint dipped in a weak aqueous solution of tincture of iodine con- 
taining a minute quantity of iodide of potassium. Introduced into 
the nasal fossse in cases of ozoena, this solution corrects the foetor of 
which those cavities are the seat. 

It is very evident that every kind of inflammatory complication 
supervening under these circumstances will require the employment 
of sedatives and emollients. Local treatment is not less useful in 
the syphilitic affections of the apparatus of locomotion. I have been 
able, on several occasions, to verify the good effects of blisters for 
syphilitic arthropathies, osteocopic pains, and osteo-periostitis. In 
the case of obstinate exostoses, Melchior Bobert recommends dress- 
ing the blisters with tincture of iodine or strong mercurial ointment 
and then covering them with emollient poultices. These means may 
also be used against muscular contractions. Ulcerating gummy 
tumours of the muscles require the same management as deep-seated 
cutaneous ulcers. Mercurial ointment, or Vigors plaister, assists 
the resolution of tertiary syphilitic lesions seated superficially. 

Certain lesions may necessitate recourse to a surgical operation, 
and these are chiefly those affecting the palatine vault, the pharynx, 
and the air-passages. When perforations of the palatine vault or of 
the velum palati refuse to cicatrise, staphyloraphy should be tried, if 
it be applicable ; if not, it is still possible to remedy these lesions 
with the aid of well-made obturators.^ Another circumstance fitted 
to justify a surgical operation is, when adhesions have become formed 
in consequence of the ulcers, between the posterior surface of the 
velum palati and the upper part of the pharynx. We know that 
these adhesions most frequently have a syphilitic origin,t which is 

* Gabriel Fallopius already tried to remedy, by means of an instrument 
of this kind, syphilitic perforation of the palatine vault. (See Aphrodis., 
p. 829.) 

t This ori^ is met with twenty-six times in thirty cases given in the 
report by Dr. Paul, of Breslau^ recently translated by Dr. Vemeuil. (See 
Archives de mSdecine, October, IS66, p* 422.) 



324 TRfiATBfENT. 

explained by the fact that syphilitic ulcers are the most freqaent of 
all those observed in those regions. 

Lesions of the air-passages canse, in some cases^ derangements of 
respiration so considerable that it becomes necessary to perform 
tracheotomy.* Useful when the laiynx alone is affected^ this opera- 
tion is often withoat result in lesions of the^ trachea^ the usual seat 
of which, as we have already stated^ is the lower portion of the 
trachea. 

§ S. Trea^f/ient of hereditary eypkilie. 

Before treating hereditary syphilis, we should endeavour to pre- 
vent it so far as lies in our power. It is for this reason that a con- 
scientious physician should never sanction the marriage of any person 
who is the subject of a syphilitic affection. But when there are no 
longer any symptoms^ then permit the marriage, says Yidal de Cassis, 
if the treatment has been complete and six months have elapsed 
without any manifestation. For my own part, I should not venture to 
go so far ; I should, at least, require of the patient that he should first 
pass a season in one of the thermal establishments to be spoken of 
further on, and then only should I give an opinion. Marriage once 
completed, a physician ascertaining the existence of syphilitic affec- 
tions on either side has no alternative except that of forbidding all 
sexual intercourse for the time being, which measure may be less 
rigorously enforced in proportion as the manifestations belong to a 
more advanced period of the disease. 

Transmitted hereditarily, syphilis calls for treatment in the foetus, 
in the new-bom child, and at a more advanced period of life. 

1. In the foetus, syphilis is, as we know, one of the most frequent 
causes of abortion. But, to combat the disease in the foetus, it 
becomes necessary to act upon the mother. The question whether 
syphilis should be treated during pregnancy has been answered in 
various ways. The majority of the older physicians were inclined to 
abstain, and this view, which is shared by Doublet, has been adopted, 
some years ago, by Dr. Huguier, who believes that mercurial treat- 
ment adopted in the course of pregnancy predisposes the woman to 
more serious after-consequences of delivery than those observed after 
simple treatment. Some physicians, going farther in this direction, 
have accused the mercury of causing the abortion. This opinion, 

* See Demarquay, Union MSdicale, 1864. 



HEREDITARY SYPHILIS. 325 

which Coulson's observations concerning the mode of action of mer- 
cury upon the functions of the uterus have contributed not a little 
to accredit, is evidently exaggerated. Neither the duration of the 
treatment nor the doses of the medicine appear capable of producing 
such a result ; observation, moreover, is by no means in favour of 
this view. 

Amongst the numerous physicians who recommend specific treat- 
ment for pregnant women, must be mentioned N. Massa, Gamier, 
de BMgny, Astruc, Petit, Fabre, Levret, Rosen, Underwood, 
Swediaur, Bell, Bertin, S. Cooper, Lagneau, Vannoni,* Gibert, 
Cazenave, Cullerier, Eicord, Devilliers, &c. But, according to all 
those physicians, mercury, properly administered, is almost always 
opposed to abortion, while this accident is common in the absence of 
all treatment. Pick,t who has made numerous researches on this 
subject, has arrived at very similar results. Thus he points out the 
value of the adoption of specific treatment in women affected with 
syphilis during pregnancy, and does not hesitate to have recourse to 
this treatment, the mother being exempt even from any manifestation, 
when the health of the father and previous miscarriages give rise to a 
suspicion of infection of the foetus. In a discussion at the Academy, 
which caused great sensation. Professor Moreau quoted the case of 
a woman who, after several successive pregnancies, all followed by 
delivery before the time and by the death of the foetus, was sub- 
jected, as a last resource, to antisyphilitic treatment, and whose fresh 
pregnancies ran on to the full time. J 

Mercury, the drug to which most of the physicians in repute agree 
in giving the preference, may be administered internally, but on con- 
dition that the digestive functions, already predisposed to become 
deranged by the pregnancy, are not notably out of order. The 
derangement of those functions necessitates the employment of 
inunction, which should be made daily with strong mercurial 
ointment. 

2. In the syphilitic new-born child, Guyon-Dolois and Gardanne 

• 11 Raccoglitore medico, August, 1842. Consult; E. Bertin, Gazette 
hehdom., 1858, p. 862. 

t See Schmidt 8 Jdhrh., t. cxx. p. 194. 

X Cazeaux, Maisonneuve, and Montanier are against treatment when 
the parents appear healthy ; but Dubois, Depaul, Moreau, Vidal de Cassis, 
and Putegnat de Lun§villeare of the opposite opinion, if the parents have 
bad syphilitic children. 



326 TBEATMBNT. 

believed it necessary to wait for a certain time after birth, before 
beginning the treatment. Bnt, if we take into consideration the 
serious natnre of syphilis and the danger incurred by young children 
affected with it^ we cannot adopt this mode of proceeding, which is 
based upon no data. In my opinion, the treatment should commence 
as soon as syphilis manifests itself; in the absence of any symptom 
we must wait. This opinion^ which differs from that of Diday, of 
Lyons, who advises treating all children both of whose parents are 
known to be syphilitic, appears to me to be justified by the fact that 
mercury no more prevents the appearance of the manifestations of 
hereditary syphilis than it does that of the manifestations of acquired 
syphilis. It is proved, moreover, says Vidal de Cassis, that infected 
parents have produced very viable children, who have never presented 
the least symptom of syphilis. Thus we must always treat when 
manifestations exist, unless complications superadded to the syphilis 
contra-indicate specific treatment. 

Mercury and iodide of iron are the two chief agents for the 
treatment of hereditary syphilis, and, accordingly as these agents are 
administered to the child or to its nurse, the treatment is called 
direct or indirect. The direct treatment was employed at first. N. 
Massa (1586), Pare (1553), Botal (1563) Augier-Ferrier, Guyon- 
Dolois, de BMgny, and Astruc, were advocates of it; they employed 
frictions and fumigations, that is to say, a direct external treatment. 
Bivi^re, Yercelloni, Bruimer, Sanchez, Underwood, Nisbett, and 
Bell advised mercury internally, that is to say, the direct internal 
treatment. 

The idea of treating. a diseased child by giving remedies to the 
mother is to be found already in Hippocrates. * Pierre Gamier, of 
Lyons, in 1699, proposed to administer mercury to the child in its 
mother's milk. Levret, Burfcon (1775), Bosen de Bosenstein, 
Colombier, Doublet, Faguer, Swediaur, &c., soon adopted this mode 
of treatment. For the same purpose, the milk of a goat or an ass 
previously rubbed with mercurial ointment was employed. At first 
some success appeared to be obtained, but this was not confirmed by 
after observation. Since that time Bertin, Lagneau, Philippe 
Boyer, S. Cooper, Gibert, and Cazenave, had recourse to a mixed 
treatment, and more recently, Cullerier, Bassereau, Natalis Guillot, 



* Lactantium cura posita est tota ia medicatione uutricum. JEpist., 
liY. m. 



HEREDITARY SYPHILIS. 327 

Putegnat, and Vidal de Cassis have returned to the direct treatment. 
This treatment is, in fact, the only efficacious one, for the doubts 
expressed at first as to the insufficiency of the indirect treatment 
have become certainties since strict chemical analyses have shown 
that mercury passes little or not at all into the milk of the nurses. 

P^Ugot* could not discover mercury in the milk of an ass which 
took five grains of corrosive subUmate daily, nor in that of a goat 
which took as much as twelve grains. Cullerier, E^veil, and Lutz, 
were equally unsuccessful in the analyses which they made of the 
milk of women who had taken preparations of mercury. But Per- 
sonne, employing another process, succeeded in finding mercury 
in very small quantity in the milk of a woman who took, for two 
months, three-quarters of a grain of the proto-iodide daily.f Thus 
were explained the failures of the indirect treatment and the 
necessity which existed of reverting to the direct treatment, either 
external or internal. 

The direct external treatment consists in the employment of in- 
unction and baths. The inunction is made with calomel or mercurial 
ointment. Cazenave advises rubbing the gums with calomel mixed 
with honey. Massa, Botal, Doublet, and Bertin employed frictions 
with mercurial ointment. Lagneau and Putegnat de Lun^viile use 
them at present, and Cullerier made them the basis of liis treatment 
at the Lourcine Hospital. " After having bathed the child in water 
several times for the purpose of alleviating any inflammation which 
may exist, and also of predisposing the skin to absorb more readily, I 
cause to be made,^' says that observer, " upon the sides of the chest 
and towards the axilla, inunction with fifteen grains of Neapolitan 
ointment, on one side one day and on the opposite side the next day. 
This inunction should be made gently, so as not to irritate the skin, 
and may be prolonged for several minutes. Twice a week I suspend 
the inunction and give the child a tepid bath to which I cause to 
be added from thirty to sixty grains of corrosive sublimate. For 
children more than a year old, the dose may be increased (thirty 
grains of the ointment and ninety grains of corrosive sublimate). 
These frictions very rarely produce local symptoms such as erythema 
or vesicular eruptions. When the genital organs and anr.s are the 



♦ Journ, des connaiasancea mid.-chir., November, 1836. 
f See Cullerier, BuU. de therapeutique, October, 1852. Compare : Ch 
Ilavin, Bu traitement de la syphilis congenitale, Th^se de Paris, 1857. 



328 TREATMENT, 

seat of mucous patches or of ulcers with an abundant secretion^ I 
touch them occasionally with a solution of nitrate of silver (four^ 
six^ eight parts to thirty of water) ; but^ if the secretion be 
moderate^ or dry tubercles only exist, I content myself with vege- 
table lotions ; but I always powder the surfaces with starch, flour, or 
lycopodium, and isolate them as much as possible with dry linen 
or lint. When it is the skin of the face which is attacked, as 
is often the case in veiy young children, the same lotions should be 
employed^ but, moreover, as the parts are here exposed to the air, 
and desiccation very readily occurs, which produces cracks and 
fissures which are very painful when the child cries or sucks, they 
should be covered, as often as possible, with some mild cerate, such 
as simple, opiate, or calomel cerate/' For my own part, I willingly 
subscribe to this mode of treatment, for I have several times had the 
opportunity of observing its good effects. 

The direct internal treatment, more commonly employed in 
England,* requires certain precautions, on account of the great irri- 
tability of the bowels in young children. The bichloride of mercury 
(corrosive sublimate), recommended by Bertin and Lamauve, is the 
preparation generally selected ; it is given in minute doses in milk, 
honey, broth, syrup, &c. Pure calomel, as administered by Riviere, 
Yercelloni, and Brunner, or combined with chalk, as is customary 
in England, is always less easily borne on account of its purgative 
properties. 

The sudorific preparations, recommended by Ferrier, Harris, 
Brunner, &c., are means for the most part unreliable and deserving, 
at the most, to be added to the mercurial treatment. The nurse's 
milk is the best food which a syphilitic child can take. The diges- 
tive functions require to be watched carefully. 

To sum up, the direct treatment is the only really efficacious one. 
It consists in the internal use of mercury and better still, in frictions 
with mercurial ointment and baths with corrosive sublimatcf The 
mixed treatment (direct and indirect at the same time) is indicated 
when both nurse and child are affect-ed. But these different treat- 
ments are not always sufficient, and it often becomes necessary to 

• S. Cooper, TraitS ilem. depath, chirurg, Paris, 1841. 

f An English surgeon, Dunn, states that be bas several times treated 
infantile syphilis successfully with chlorate of potash. (CommuDica- 
tion to the Royal Medico-Chirurg. Society.) These cu^e^ hfive b^ea 
contested. 



EFFECTS OP PREPARATIONS OF MERCURY AND IODINE. 329 

add local means. Fatty substances^ cucumber pomade, fresh lard, 
&c.^ are indicated in most of the cutaneous eruptions. Gibert 
recommends an ointment with calomel or proto-iodide for tubercles 
and pustules. We know that Cullerier uses a solution of nitrate 
of silver for mucous patches and ulcers of the genital organs and 
anus. 

Such is the treatment of the more superficial manifestations of 
hereditary syphilis. When these manifestations involve important 
viscera, and especially when they are accompanied by cachexia, the 
preparations of iodine are to be preferred. In affections of the liver, 
Gubler recommends iodide of potassium to the extent of one grain 
and a half daily, while Cullerier states that he has obtained good 
results from proto-iodide of mercury. Bouchut gives several cases 
of syphilitic coryza cured with iodide of potassium. For my own 
part, I cannot too strongly recommend the iodide of iron in young 
children. I have had frequent opportunities of witnessing the good 
effects of this remedy in visceral lesions with cachexia. It is given 
in the form of a syrup. 

3. The treatment of tardy hereditary syphilis does not differ 
notably from the treatment of acquired syphilis : preparations of 
iodine are still suitable ; and lastly, it is perhaps more to hygiene 
and to nutritive agents (cod-liver oil, &c.) than to therapeutic agents 
that recourse should be had. 

§ 4. Physiological and pathogenic effects of mercury and iodide of 

potassium. 

m 

Experience having shown the good effects of mercury and of iodide 
of potassium in the treatment of syphilis, it is not without interest 
to ask of theory the mode of action of these substances and to seek 
in clinical observation for the pathogenic effects to which the patients 
who make use of these therapeutic agents are exposed. 

Our knowledge of the physiological action of mercury is, as yet, 
very incomplete. Used externally or internally, the mercury is 
absorbed ; then, according to several authors (Mialhe, Voit, &c.), it 
is transformed into bichloride,* probably at the expense of the 
chloride of sodium contained in the blood ; whence the preference 

* Hunter thought that all the preparations of mercury must be trans- 
formed into the same compound, since they produce only one and the 
same effect upon the constitution. 



EFFECTS OF PREPARATIONS OF MERCURY AND IODINE. 331 

scarcely increase in weighty and that, in adult age, they may lose 
bulk. 

I shall not dwell longer upon these physiological effects; the 
pathogenic effects differ little from them. If the change in the 
blood become well marked, the lips grow pale, the eyes become 
hollow, the emaciation increases, the nervous and muscular functions 
are weakened, the tissues are flabby, the breathing is difficult, and 
sometimes heemorrhages occur at various points of the body, but 
especially from the gums and mouth. This condition, to which the 
name of mercurial cachexia has been given, is, however, but rarely 
observed, at least at the present time, in individuals treated for 
syphilis ; but there are other symptoms which are more frequently 
met with. Mercurial fever, characterised by marked uneasiness, an 
easily appreciable acceleration of the pulse, and depression rather 
than increase of power, is most frequently combined with a bad state 
of the digestive functions and with salivation. Sweating, erythema, 
and eczema, symptoms pointed out by Pearson, in 1783, have since 
been carefully studied by Alley.* Erythema, which is devoid of 
analogy with roseola, is rather rare ; the vesicular eruption is more 
frequent and consists in a quantity of small acuminated vesicles 
resting upon a red base. Ulcers of the mouth and pharynx, already 
well described by Bell,t also possess peculiar characters upon which 
we have dwelt already (see Vol. I. p. 170). A symptom much 
more frequent is mercurial stomatitis ; the swelled and painful gums 
are covered with whitish pellicles ; the breath is foetid and the patient 
complains of a metallic taste in his mouth ; the tongue, covered with 
a mucous layer, is thickened ; and saliva flows abundantly from the 
mouth. It is for the purpose of preventing the latter occurrence 
that the employment of various means, and especially of chlorate of 
potash, has been recommended, but without constant success. This 
salt may also be employed with advantage against buccal lesions 
developed under the influence of mercury. Velpeau recommends 
that the gums should be rubbed three or four times a day with 
powdered alum, which the patient takes upon his finger. A great 
number of other means have been pointed out since the time of 
Matthiolus ; but none of them, according to Astruc and Swediaur, 



* Observations on the Hydrargyria or that vesiculotts disease arising from 
the exhibition of mercury, LondoD, 1810. 
t Zoc, cit, t. ii. p. 147. 



332 TREATMENT. 

suffice to prevent salivation. Dyspepsia is another bad result of 
mercurial preparations ; the appetite falls off, digestion is difficult, 
and there is a feeling of weight in the epigastric region. Under 
these circumstances, the patient sometimes becomes emaciated, and 
is irascible and impetuous. These various symptoms, for which it is 
not always easy to provide a remedy, indicate, at the least, a suspen- 
sion of the mercurial treatment. 

Certain derangements of the nervous functions appear also to 
depend upon the use of mercurial preparations. Cases furnished by 
Colson * and Diday show that tremor may be one of the effects of 
the employment of mercury, and it is not impossible that certain 
forms of madness (hypochondria, idiotcy) also acknowledge the same 
origin. 

Iodide of potassium f is easily absorbed. The first effects of its 
physiological action, according to Professor Euss,:^ of Strasbourg, 
show themselves in the alimentary canal, where it acts by contact 
before it acts by absorption. A sensation of dryness and thirst is 
felt in the pharynx, which, if the doses are rather large, becomes 
red and swelled at the same time with the tonsils, without much 
difficulty in swallowing. An increased secretion of mucous or iodic 
ptyalism succeeds this condition. The saliva is viscous while neither 
the gums nor teeth present any pathological change. After using 
the iodide for some time in increasing doses, the tongue becomes 
covered with a uniform, greyish layer, easily recognisable when it has 
once been seen. This layer, which usually precedes the iodic erup- 
tion, is the indication of the maximum therapeutic effect, and thus 
its absence or its presence may be a source of valuable hints for the 
augmentation of the doses. 



* Colson, Essai sur le tremhlementohservi a la suite du traitement mercuriel* 
(Arch, gSn. de mid., 1827, 1'® s§rie, t. xv. p. 338.) 

t Iodide of potassium, according to Mosler ( Virchoul's Archiv, t. xiii.) 
is rapidly eliminated by the bile, while calomel passes with difficulty into 
that product of secretion, and thus the former of these agents would 
appear to deserve the preference in the treatment of syphilitic aflfectioxis 
of the liver. 

X Gaz mid, de Strasbourg, November, 1865. For the effects of iodide 
of potassium and iodide of sodium, consult Trousseau and Pidoux, £l€m» 
de therap,, p. 245, 5® §dit. Titon, Th^ae de Paris, 1856. Lomet, Action 
de iodure de potassium sur les differents appareils. TL^se de Strasbourg 
1863. Gamberini, Bollet delle Scienze mediche, Bologna, April, 1852. 



EFFECTS OF PREPARATIONS OF MERCURY AND IODINE. 333 

In the respiratory apparatus a staffing up of the nasal fosssB is 
frequently observed, from exaggeration of the secretion of the 
pituitary membrane, a true coryza, in a word. The bronchi share 
this process. There is a dry cough, but little marked, with frothy, 
but never thick or purulent expectoration. 

On the part of the circulation, there is first of all acceleration and 
fullness of the pulse ; then, at the expiration of a period of time 
varjring with the individual, the pulse becomes depressed and finally 
resumes its first condition. This, according to the Professor quoted, 
explains the contradictions of experimenters. Hence also the con- 
clusion that persons whose pulse is naturally quick are less easily 
acted upon than those whose pulse is more moderate. The salt of 
iodine is met with in the blood with all its chemical qualities ; its 
action, consequently, is entirely catalytic, and it does not modify the 
blood globules either in form or in number. Its pathogenic influence 
is almost null if we know how to graduate the doses of it and dilute 
it with a sufficient quantity of fluid. Wallace nevertheless points 
out as consequences of the use of this drug, constipation, profuse 
perspirations, and more rarely salivation. Its special action upon 
the skin manifests itself in the form of iodic acne, the more or less 
discrete pustules of which have, at first, for their favourite seat, 
according to Kiiss, the regions nearest to the syphilitic lesion. The 
appearance of this eruption may safely be predicted when the greyish 
coat appears upon the tongue which announces the saturation of the 
economy. The Strasburg Professor mentions also a limited infiltra- 
tion of the sub-cutaneous connective tissue of all the regions of the 
body, affecting by preference the vicinity of the parts affected. 
Cephalalgia, tremor, vertigo, and neuralgia are the further derange- 
ments which may result from the use of iodide of potassium. 

This agent appears, moreover, according to Overbeck, to possess 
the property of acting upon the albumen of the blood, for in indi- 
viduals poisoned with lead, or in those who have taken preparations 
of mercury, it is sometimes seen to determine the passage of albumen 
and of a larger quantity of lead or of mercury into the urine. Like 
mercury, iodine would thus exert a modifying, solvent action upon 
the albumen, and to this action are due, according to that observer, 
the therapeutic effects of the preparations of iodine in syphilis. 
But this is a view which, in my opinion, is altogether hypothetical. 
Nevertheless, I shall abstain from forming for myself a theory which 
would be as uncertain as all those abeady propounded on this sub- 



334 TREATMENT. 

ject.''^ I shall content myself with pointing out that mercniy and 
iodine do not produce any real action except upon the anatomical 
determination^ and that they remain without effect so long as that 
determination does not exist. It is a fact that those agents do not 
in any way modify the derangement of nutrition which presides over 
the formation of the syphilitic product, since they are incapable of 
preventing its appearance. Their action is exerted solely upon 
that product^ or rather upon the elements which constitute it ; it 
consists^ in fact^ in favouring the retrograde or fatty metamorphosis 
of those elements and their absorption. If this be so, it cannot be 
said that these remedies are specifics in the sense of neutralising the 
cause^ or syphilitic virus ; f they can only be considered as such 
because they exert a special action^ in some sort elective, upon the 
connective dement, and very especially upon the local determinations 
of syphilitic origin. These preparations, as we know, are without 
effect against lesions such as pulmonary tubercle, the resemblance of 
which to gummy tumours is very striking. 

To sum up, mercury and iodide of potassium do not attack the 
essence of syphilis itself but its manifestations. As in aU diseases, 
the syphilitic diathesis is not cured by the efforts of therapeutics, 
but by the forces of the organism alone. This is a principle of 
which no physician should be ignorant. There are, then, two 
indications : to combat material lesions capable of compromising 
existence, and to place the patient in circumstances the most favour- 
able for enabling him to triumph over his disease. Herein lies the 
whole secret of the treatment of syphilis, which secret may be 
expressed in two words ; if there be any lesion, act; if there be no 
lesion, wait. 

One fact worthy of remark is that, far from arresting the 
symptoms of syphilis, mercury and iodide of potassium sometimes 



* It is evidently umiecessary to examine here the various theories 
which, since Fracastor's time, have been propounded concerning the mode 
of action of mercury in the cure of syphilis. Let us state that these 
theories, a succinct analysis of which will be found in the French transla- 
tion of Fracastor's poem, by Yvaren (Paris, 1847, p. 287), have necessarily 
varied with the medical doctrines, and that there is not one of them 
which would appear reasonable at the present day. 

f Cullerier denies the therapeutic specificity of mercury in syphilis. 
See Itecherches pratiques sur la thSrapeutique de la syphilis, &c., by Dr. 
L« Champonni^re {Oaz, tnSd», 1836, p. 623). 



EFFECTS OP PREPARATIONS OP MERCURY AND IODINE. 335 

impress upon them a certain degree 'of acuteness.* It would not even 
be impossible for them to contribute to the calling forth of fresh 
symptoms. Bazin t observed that, under their influence, groups of 
tubercles sometimes disappear in one region to reappear in another, 
and that it is not rare to see mercurial treatment determine fresh 
outbreaks when the affection had already for a long time been 
stationary.} Hutchinson has met with similar cases, for he states 
that he has seen syphilitic iritis declare itself with great intensity, 
or even invade the eye of the opposite side, after the employment of 
a mercurial treatment, even when that treatment had produced saliva- 
tion. I have observed the same thing for syphilitic lesions of the 
viscera, and, amongst the cases given in this work, there are some 
in which the most serious and most intense symptoms showed them- 
selves only a few days after the employment of a specific treatment. 
In a case related by Paurds, treatment with iodide of potassium had 
just been commenced, when convulsions, followed by hemiplegia, 
supervened. In a patient of Legroux's, I saw hemichorea follow 
hemiplegia a few days after the use of calomel. § I also have had 
the opportunity, under similar circumstances, of observing the 
decrease of hemiplegia at the same time that paralysis showed itself 
on the opposite side. At this very time, I have under my observa- 
tion a young woman of 22 who, after taking iodide of potassium for 
three days for osteo-periostitis of the ascending portion of the 
inferior maxillary bone, saw an exostosis appear on the forehead. 
Such cases cannot cause serious alarm, or cause us to suspend our 
treatment; but they necessitate a more careful watching of that 
treatment. 

§ 5. Mineral waters. — Water cure, — Diet. 
The therapeutic means of whi6h we are about to speak generally 

* The property of rendering more acute certain manifestations of 
syphilis does not belong to mercury and iodide of potassiun^ only. It 
sometimes happens, say Trousseau and Pidoux (t. i. p. 337)) that, under 
the influence of the preparations of gold, all the local lesions of syphilis 
become more intense, and even that fresh ones make their appearance. 

t Lemons 8ur les syphtlideSf p. 174. 

X Medical Times and Oastette, July 14th, 1860 ; and Qaz. hehdom., 1860, 
p. 620. 

§ For the observations by Faurds and Legroux, see L. Qros «and 
Lancereauxi Affections nerveuses syphUUigueSi p. 199* 



336 TREATMEOT. 

suffice for the care of mild syphilis^ and^ in case of severe syphilis, 
they are powerful auxiliaries of mercury and iodide of potassium, 
from their tendency to direct the diseased organism back to its 
natural type. 

Mineral Waters. 

Th. SardeUf Reoherches sar les maladies cbroniques, 1775, p. 294. 
Patistier, Manuel des eanx mm6rales de la France. Paris, 1818. Gibertj 
Traite des maladies de la peau et Manuel des maladies Teneriennes. 
Paris, 1840. Anglada, Traits des eaox minerales, 1833. Dupctsquier, 
£aux, d'Allevard, &c. C. Define, Manuel de r§tranger aux bains 
d'Aix en Savoie, 1850. Fontin, Bulletin de I'Academie de M§decine, 
1845, et RechercheB sur les eaux minerales des Pyr6n§es, &c. Paris, 1853, 
p. 380. CoTutantin James ^ Goide pratique, &c. Paris, 1854. Vidal, Essai 
sur les eaux d'Aix en Savoie, 1851. Fngelmann, Sor I'usage des eaux de 
Kreuznacb dans le traitement des affections syphilitiques. Frankfort, 1849. 
Dossier, De Temploi des eaux sulfureuses, &c. Journal de medecine de 
TotUouse, 1851. Marc Piffot, Essai clinique sur Taction des eaux thermales 
Sulfureuses de Bagn^res-de-Luchon dans le traitement de la syphilis. 
Paris et Toulouse, 1854. Helfft, Handbuch der Balneetberapie. Wetzlar^ 
Traits pratique des propri6tes curatives des eaux sulfureuses d'Aix-la- 
Chapelle, 1856. JBaizeau, Memoire sur Tinfluence des eaux minerales 
sulfureuses sur la syphilis. Gazette midicale de Paris, 1856. Lamhron, 
Annales de la Society d'hydrologie midicale de Paris, t. iii. p. 168. 
Durand'Fardel, Traits th§rapeutique des eaux min§rales. Paris, 1857. 
Petrequin et Socquet, Traits gSn^ral pratique des eaux minerales, &c. 
Lyon, 1859. Reumont, Neue Beobachtungen und Erfahrungen ilber die 
Wirknng der Aachener Scbwefelthermen bei Syphilis. Deutsche Klinik, 
1 862. Ludwig Diemer, Die Aachener Scbwefelthermen in constitutioneller 
Syphilis und Quecksilber-krankheiten. Aachen., 1862. Pidotix, Sur le 
traitement par les eaux minerales. Union mSdicale, 1863, p. 387. Martin 
Lanzer, Des eaux thermales de Luxenil contre le virus syphilitique, &c. 
Retyue de thSrapeutiqtie, et Gaz, hebdomad,, 1863, p. 341. 

It is not in the present day only that mineral waters have been 
employed in the treatment of syphilis. Fracastor,* in his celebrated 
poem, alludes to. the properties of sulphur waters. Nevertheless, 
thermal waters were little employed by the first syphilographers, 
who, for the most part, regarded them as deleterious, no doubt on 
account of the property which they possess of developing manifesta- 
tions which had previously remained latent.t Borden was one of the 

* Ilia ego, quae venas per montis hiantes 
Callirhoe, baud ignota tuse, fumantia mitto 
Sulftira. 
t See Benedietus Victorius, De morho galUco, in Aphrodiiiacus, p. 638, 



MINERAL WATERS. 337 

flfst to foresee all the benefit to be obtained from the influence of 
thermal sulphur waters in the treatment of syphilitic diseases, and 
numerous observations have shown the just appreciation of that 
learned physician. Mineral waters having assumed a greater im- 
portance every day in therapeutics, their action upon syphilis was 
soon studied, as well as upon most other diseases. In reference to 
the subject with which we are occupied, Durand-Pardel has summed 
up the state of our knowledge in an excellent work from which we 
shall borrow on several occasions. 

A well-ascertained fact is, that thermal waters do not constitute 
a specific treatment for syphilis. Eicord,* Sigmund,t and many 
other observers have seen syphilitic aflfections reappear after the 
employment of them. If, in some cases, the use of them has been 
followed by the final cessation of the syphilitic manifestations, this 
effect, says Larabron, has been produced in subjects who, previously 
to the thermal treatment, had taken for a long time, with a certain 
degree of regularity, mercurial preparations in considerable quantity. 
Marc P^got J equally believes that the cures which it is possible to 
attribute to sulphur waters have been made in individuals saturated 
with preparations of mercury. Therefore, according to Lambron, 
the curative effects are only produced because the thermal waters 
give to the albumino-hydrargyrous compounds arrested in the web of 
the organs the fluidity necessary for the completion of the cure. C. 
James gives, from Pag^s, two instances of salivation and stomatitis, 
apparently mercurial, supervening under the influence of the 
Barege waters, in individuals who had not taken mercury for four- 
teen and eighteen months respectively. But, at all events, setting 
aside theory, it is important to know that mineral waters exert upon 
the most obstinate secondary and tertiary affections an action 
favourable to the employment of a specific treatment. Thus it 
is under certain circumstances, and especially in cases of obstinate 
syphilis with cachexia, that the use of thermal waters is indicated. 

The numerous cases given by Dassier, P^got, Despine, and others, 

place beyond doubt the good effects of mineral waters combined 

with preparations of mercury or iodine. Not only does the thermal 

treatment combat successfully syphilitic affections by imparting 
to mercury and iodine properties they no longer possessed, but 

• Quoted by Durand-Fardel. f Quoted by Helfft, p. 507. 

I Loc, cit, p. 170. 



338 ^TREATMENT. 

it also stimulates the organism, restores langnisliing fanctions, espe- 
cially of nutrition, and is one of the chief remedies to be opposed to 
syphilitic cachexia.* Another effect of the treatment with mineral 
waters is the almost constant absence of salivation, in spite of large 
doses of mercury,t or, as observed by Lambron, the rapid dis- 
appearance of that symptom, if it has already shown itself. 

Thermal waters having, like most of the exciting agents^ the pro- 
perty of causing to*appear manifestations which had remained latent, 
find their indication and their utility whenever it is desirable to 
ascertain whether an individual who has been affected with syphilis 
is atill under the influence of that disease or not. In this respect, 
M. Pegot, C. James, and Lambron regard the sulphurous mineral 
waters as the touchstone of syphilis. But the infallibility of this 
means of verification is far from being recognised by all authors. 
Eicord, Gerdy, Helfft, and Durand-Pardel cannot make up their 
minds to admit the action of sulphur waters as an absolute criterion 
for the diagnosis of syphilis in all obscure or doubtful cases. More- 
over, it is not only sulphur waters which would appear to have the 
property of unmasking the hidden effects of syphilis: Durand- 
Fardel has seen the waters of Plombieres and those of Yichy act in 
this manner, and, according to Pleckles, the baths of Carlsbad have 
several times brought to light again old syphilitic affections. 

Warm sulphur waters take precedence, however, of all the other 
classes of mineral waters when it is a question of assisting the cure 
of syphilis, or of reproducing its manifestations. The thermal soda 
sulphur waters of Bareges, Bagneres-de-Luchon, Gauterets, Aix*en- 
Savoie, Allevard, Aix-la-Chapelle, Weilbach, Schinznach, Acqui, 
Viterbo, &c., are indicated by preference. In Germany chiefly, 
recourse has. also been had to the chlorurated soda waters. Thus 
Dr. Feez praises the waters of Wiesbaden as useful in the cure of 
syphilides, and Botureau informs us that the waters of Naulieim 
may constitute a very powerful adjuvant in combating secondary and 
still more tertiary manifestations.^: In like manner, Sngebnann 
prescribes with advantage the waters of Kreuznach, whenever the 
syphilis is accompanied by scrofulosis, in which case it is generally 
obstinate. 



See P^got, loc» cit, p. 64. f C. Despine^ loccU.jp, 217« 

X £!tude9 eur let eaux de Nauheitn, 1856, p. 120. 



MINERAL WATEBS. 339 

Watee Cube. 

Applied to the treatment of syphilis^ the water cure is simply a 
usefal adjuvant ; like mineral waters, it is unfitted to form a special 
method of treatment. Schedel erroneously believed that no other 
remedy cured with more certainty primary lesions ; but L. Pleury 
jastly points out the fact that Desruelles and the opponents of mer- 
cury have shown that chancres become cured in patients subjected to 
a simple treatment, and that in two or three weeks, that is to say, in 
a space of time not longer than that required with cold water. Does 
the water cure prevent consecutive aflFections ? Has it any marked 
advantages over mercury and iodide of potassium ? In a word, does 
it check, better than any other treatment, the progress of the 
syphilitic diathesis ? Such are the questions which it is important 
to solve. But a case of secondary syphilis has been treated without 
success by Priessnitz (Scoutetten). Schedel gives three cases of 
secondary or tertiary syphilis against which the water treatment was 
also unsuccessfnl. Lubanski does not mention syphilis in his work. 
Bidart points out some cases of tertiary syphilis cured with cold 
water. Baldou gives eleven observations of patients cured, but most 
of them incomplete and very inconclusive, so that the cure of syphilis 
by the water treatment is by no means proved. 

L. Pleury, not wishing to treat by the water cure alone patients 
afiFected with syphilis, has recourse at the same time to specifics, 
with which he combines sweating and general cold douche baths. 
" Under these circumstances,'' says that author,* " the water treatment 
has appeared to me to be a valuable adjuvant of specific treatment ; 
it is very useful for combating the chloro-ansemia so often met with 
in patients affected with constitutional syphih's j it has also appeared 
to me to exercise a very favourable influence on the course of 
the disease^ and chiefly on that of the secondary and tertiary mani- 
festations; this influence has shown itself especially in feeble, 
lymphatic individuals, with a tendency to scrofula.'' In short, the 
good efiects of the water treatment in the last periods of syphilis 
cannot be denied ; it is only to be regretted that this mode of treat- 
ment has hitherto been too little tried. I believe that it deserves to 
be employed at the same time with hygienic measures after the use of 
mercury and of iodide of potassium, and that it is an excellent 
means for completing the cure of syphilis. 

* Traits pratique et raisonnS de VhydrotMrapie, FariSi 1856, p. 392. 

e2 



340 TREATMENT. 

Dietetics. 

Diet has from the earliest times been regarded as a powerfal 
adjuvant in the treatment of syphilis. The ancient syphilographers 
attached more importance to it than modern writers do^ and often 
exaggerated its effects. "In the first years after the' appearance of 
syphilis/' says Fracastor, "the patient was forbidden to leave his 
bed for a whole month ; but since then this rule has been somewhat 
less strictly enforced. At that time he was also allowed only just 
sufficient nourishment to sustain life (three or at most four ounces of 
breads two ounces of chicken, and one ounce of raisins). He had 
to abstain from wine, and take, as his only drink, the second decoc- 
tion of guiacum alone or with the addition of honey. At present, 
physicians are less strict; the patient is allowed to go out and 
to take more food. But the physician who employs the most 
rigorous measures cures his patients most certainly and most 
radically.''* The management of syphilitics was not, however, 
confined to this ; for we see the same Fracastor, in Book II. of his 
celebrated poem, recommend exercise in the open air, the pure air of 
the hills,t the pleasures of the chase, the tillage of the land, the 
exercises of wrestling, leaping, tennis, riding, &c. 

Fallopius writes on the same subject : — " Ego vidi aliquos curatos 
ligno fagi, qui conjecti in triremes, atque instituta victus ratione 
tenuissima, laborantes, ex toto liberantur; sed iste non est usus 
medicus." Brassavole has given a good instance of the effects of 
gymnastic exercises in the history of the man who cured himself of 
nocturnal pains by going often to pull the rope of the great bell of 

* De tnorbis contagiosts, Aphrodisiacus, 
t Protenti potius campi mihi liber et agri 

Tractus et apricis placeant in coUibus aurae, 

Molles zephiri pulsusque aquilonibus aer. 

Hie, jubeo, tibi nulla qoies, nulla otia sunto ; 

Rumpe moras, agita assiduis venatibus apros, 

Impiger, assiduis agita venatibus ursos. 

Nee tibi sit labor aerii cursu ardu^ montis 

Vincenti, rapidum in values deflectere cervum, 

£t longa lustrare altos indagine saltus. 

Vidi ego ssepe, malum qui jam sudoribus omne 

Finisset, sylvisque luem liquisset in altis, &c., &c. 
The whole of the first part of the second book of Fracastor is devoted to 
dietetics. 



DIETETICS. 341 

Ferrara.* At a period much nearer our own, Van Swieten insisted 
upon the importance of dietetics : — '' Vidi ipse memorabilem casum, 
qui me docuit, quid constans segri animus, ctim victupenittia mad" 
lento, ac vahdorum laborum tolerantia, efficere possit in lue venerea 
inveterata, et vix non desperata/' He also gives the followiDg 
case: — A young man had been treated four times by mercurial 
salivation and three times with decoction of guiacum, and each time 
the disease, after having apparently been removed, manifested itself 
by new symptoms. Deprived of everything and abandoned by his 
family, this young man addressed himself to Van Swieten, who con- 
soled him and promised to relieve him. He advised him to put on 
the dress of a peasant, and placed him, at the beginning of April, 
as servant with a farmer, who subjected him, for his board only, to 
the hardest work. He had nothing to eat except bread, parsnips, 
carrots, potatoes, and some kinds of fruit, and nothing to drink 
but whey ; he abstained from meat, fish, eggs, milk, butter, and 
cheese. In the following October he was perfectly cured. Van 
Swieten saw him afterwards, when he was the father of several fine 
children. 

As we have already said, it was by the aid of diet that patients, 
in the sixteenth century, sometimes succeeded in escaping the 
disastrous consequences of both the evil and its remedy, mer- 
cury, which was given them so lavishly. To diet also are to be 
attributed a great number of the cures which have been placed 
to the account .of the sudorific woods. In like manner, it is by 
diet pushed to its extreme Umits that the inhabitants of Abys- 
sinia,'!' the fellahs of Egypt, and most barbarous nations extin- 
guish their venereal affections. Diet also radically cured several 
hundred soldiers reduced, for several months, to eat nothing but 
biscuits and vegetables.} Lastly, it is diet which aided in the cure 
of those thousands of patients to whom, at a certain period, the 
benefits of a well-directed mercurial treatment were denied. Diet 
is, therefore, all-powerful in reference to syphilis, and, in reality, is 
quite as important in' the chronic as in acute affections; for it is one 

* See the treatises of Fallopius and Brassavole in Aphrodisiacus. 
Consult, in the same collection, the treatise of N. Massa, in which is to 
be found the observation of Broila Montanus. 

t See Combes and Tamisier, Voyage in Abyssinie, t. i. p. 279. 

I Clot- Bey, Sur le traitem^nf de la syphilis in Egypte, Ga%, mid, de 
J^ariSf 1839, p. 394. 



342 TREATMENT. 

of the principal modifiers of the organism. This great power at the 
disposd of the physician is nevertheless generally neglected, and is 
scarcely employed at all in the present day. Vidal de Cassis and 
Payan have, it is true, drawn the attention of physicians to the 
successes obtained, in the Hospitals of Marseilles and Aix, by means 
of dry diet or the Arabian treatment j but the cases to which this 
mode of treatment, which has received the name, of cura /amis, is 
suited have not been sufficiently specified. Applied without distinc- 
tion of cases, this method may be dangerous in enfeebled individuals, 
with a tendency to scrofula. Low diet, says Eicord, sometimes 
aggravates the disease, while a reparatory and tonic diet constitutes 
the condition of a successful treatment. 

It follows from *this that rules and indications exist in dietetics. 
The food should be little changed, for the habits of the patient 
should be respected. Butchers' meat in small quantity, vegetables, 
a little wine, but rarely spirits, unless the patient has been accus- 
tomed to their use, should make up the diet. Eresh air also, that 
second form of food, should not be neglected. '' Bemember,'' 
writes Diday, " that the air and sun bath, which is never a useless 
supplement, sometimes becomes a succour which is indispensable for 
those subjects in whom vital action languishes." Exercise in the 
open air is certainly indicated. Not only is fresh air useful, but it 
ought to possess certain properties. We know that rapid changes of 
temperature are not always advantageous and that it is not a matter 
of indifference in what medium we live. A warm and dry set of rooms, 
with a good exposure, is not to be neglected on the part of the 
individual who is seeking to become cured of syphilis. In such 
cases, inaction is a very bad thing ; without requiring so much as 
Fracastor did, the patient should continue his usual occupations ; 
and if he wishes to be cured definitely, he will do well to give him* 
self up to a kind of training. Fencing, gymnastics, riding, all in 
the open air, and with suJB&cient nourishment, are, iu our opinion, 
the best means of effecting that renovation of the organism without 
which the cure can never be complete. 

But, at the same time, it is necessary to avoid fatigue and to 
endeavour to obtain good rest at night. Sleep is one of the most 
imperative requirements of the age atwhich syphilis is most frequently 
contracted ; it ought to be taken at night and from nine or ten in 
the evening. Continence is another hygienic measure to be observed 
by the patient ; he should avgid the pleasures of the flesh as well as 



8YPHILISATI0N. 343 

the pleasures of the table, and enjoy with the greatest moderation 
women as well as wine. How many times haverwe not seen the 
abuse of spirituous liquors become the occasioning cause of symptoms 
which would otherwise, perhaps, never have manifested themselves ! 
How many times especially have we not seen such excesses change 
the character of the disease, and convert a mild form into a malig- 
nant one ! Tobacco, and above all that which is smoked in pipes, 
such a frequent provoking cause of mucous patches of the mouth, 
should be carefully avoided. The moral condition, equally with the 
physical condition, call for the careful observation of the physician. 
The earlier syphilographers were not ignorant of this : N. Massa 
did not forget moral hygiene in the great men of his day who were 
aflfected with that disease,* neither should we forget it in reference 
to our patients ; be they great men or artisans, we should seek to 
alleviate their moral condition, which is often depressed and restless, 
as has been described already. All these considerations, upon which 
I cannot dwell longer at the present moment, have their value in the 
treatment of syphilis. Par be it from me to pretend to say all that 
is to be said on this point ; but let the physician not forget that the 
future of his patient depends, almost invariably, upon his observa- 
tion or neglect of a rigorous system of diet. 

§ 6. Syphilisation and vaccinatum. 
Syphilisation. 

AtmaS'Turennet De la syphilisation ou vaccination syphilitique 
(Archives de medecine, 1851, 4e sene, t. xxvi.) ; De la syphilisation et de 
la contagion des accidents secondaires, &o., in S**. Paris, 1853 ; Corre- 
spondance syphLLographique. Paris, 1860. Sperinot La syphilisation 
§tudiee comme xn§thode curatiye et comme moyen prophylactique des 
maladies veneriennes ; traduit de I'italien par Tr§sal. Paris, 1855. In 
this interesting work is to be found a detailed historical notice of the 
question before us, and several papers by Drs..Mottini, Zelaschi, Galligo, 
Gamberini, and Calderini. TF*. Boeck, Syphilisationem studeret ved 
Sygesengen. Christiania, 1854; Recherches cliniques sur la syphilisa- 

• The following is a summing up of his precepts : — " Laetentur igitur 
et sunt jocundi, fugiant plorantes et loca tristia ; sint in jocis, cantilenis 
et fabulis, quae sint delectabiles et jocundse. Audiant sonos et voces 
suaves. £t stent in vindariis et cam caris amicis ; et, si sunt studiosi, 
iieque multum studeant, maxima materiae difficiii. Nic. Massa (De morbo 
^allico tractatm^ cap. xv.), 



344 TREATMENT. 

tion (Hevue MSdico-Chirurgicale de ParU, September, 1854) ; De la sypbi- 
lisation appliqu^e aux eiifants, traduit en fran9ai8 par Hagen, 1857 ; De 
la syphilisation, 6tat actuel et statistiqne. Christiania, 1860 (en fran9ais) ; 
et encore Bulletins de I'Academie de m§decine, 1851, 1852. All these 
works are published in one volume under the title : De la syphilisation, 
&c., 1853. Hagen, De la syphilisation (Thdse de Strasbourg, 1855). 
Follin, De quelques doctrines modernes sur la syphilis et la syphilisation. 
Archives de med., January, 1856. J, JJ. GuSrauU, Observ. m6dic. 
receuillies pendant le voyage du prince Napoleon dans les mers du Nord 
(Thdse de Paris, 1857). Melchtor Robert, Bulletin de la Soci§te imp^riale 
de m^decine de Marseille, No. 4, 1859 ; et Nouveau Traitg des malad. 
ven§r., 1861, p. 750. Boeck, Note sur la theorie de la syphilisation. 
Gazette hebd,, No. 19, 1859. Sigmund, Syphilisationen bei syphilitischen 
Krankheitsformen. Wien. med. Wochenschr., Nos. 17 und 19, 1859. 
Hehra, Ueber Syphilisation. Wien. med. Wochenschr., No. 12, 1859. 
Hermann, Zur Frage der Syphilisation. Wien. med. Wochenschr., No3. 
5, 6, 7, 1859. Lindwurm, InteUigenz-Blatt, No. 13, 1860. Diday, Gazette 
mSdicale de Lyon, I860. Auziaa-Turenne, Correspondance Sypbilogra« 
phique. Paris, 1860. Boeck, Note sur la syphilisation. Gaz, des 
hopitaux, No. 83, 1861. Wildhagen, Ueber Syphilisation. Norsk Mag- 
azin, vol. xiv., 1860 ; and Behrend*s Syphilidologie, neue Reihe, vol. iii-, 
1861. Martin Lanzer, La syphilisation devant la Soci^t^ ro^dicale du 
Pantheon. Journal dee connaieeancee niidico^chirurgicalee, September, 
1861. Auziaa-Turenne, Discours sur la syphilisation k la Soci^te m§d. du 
Pantheon. Paris, 1861. Boecker, Die Syphilisation vom Sanitatspoli- 
zeilchen Standpunkte. Vierteljahrschrift fiir gerichtliche Med., t. xx. 
p. 37. Mansouroff, Note sur le traitemeut de la syphilis constitution ell e 
par les inoculations r^p^t^es du virus chancreux. Gaz. hehd., p. 8, 1861. 
Faye, Nogle Bemarkninger om Syphilisation eller curativ Chancker- 
inoculation. Christiania, 1861. SociStS MSdicale de Clermont-Ferrand, 
Rapport et discussion sur la syphilisation. Clermont, 1865. D, J, 
Simpson, Remarks on Syphilisation or a cure for constitutional syphi- 
lis. JSdinb, Med, and Surg, Journal, December, 1864. Boeck, Con- 
ference sur I'historique, la theorie, et la pratique de la syphilisation. 
Medical Times and Gazette, Jane 10th, 1865, and France midicale, 
Paris, 1865. 

Syphilisation had its birth in France. While studying the eflfects 
of the syphilitic viras upon animals, Auzias-Turenne ascertained 
that after a certain number of inoculations, the animal inoculated 
becomes refractory to the chancrous virus, without having at all lost 
its good health and without having shown the least trace of the 
disease of which the first sign had been given it to satiety. It is to 
this immunity, or rather to the peculiar state of the organism thus 
modified, that Auzias-Turenne gave the name of syphilisation. A 
letter bearing date November 10th, 1850^ announced this result to 



SYPHILISATION. 345 

the Academy of Sciences. Auzias-Turenne did not stop at this 
point, but thought it would not be impossible to reproduce in man 
what he had observed in animals. But how could the human race 
benefit by the discovery ? Some persons relieved the experimenter 
from his embarrassment by offering themselves spontaneously for 
inoculation. A complete immunity having been obtained in thetn, 
it was soon sought to transport into the domain of therapeutics ihe 
theoretical ideas first of all propounded by Auzias-Turenne. At 
Turin, Sperino attempted to treat by syphilisation the prostitutes of 
his venereal hospital, and, about the same period, Boeck introduced 
syphilisation at Ghristiania. Since that time, several well-known 
physicians have put this method into practice, as well in Sweden as 
in Germany. In France, the author of a thesis presented to the 
Faculty of Medicine of Strasbourg, in 1855, making use of the 
results obtained by Sperino and Boeck, sought to re-establish 
syphilisation, already greatly fallen into discredit. In 1857, H. 
Guerault published the observations he had made on syphilisation 
during a voyage in Norway. Towards the end of the same year, 
Melchior Robert communicated to the Society of Medicine of 
Marseilles some experiments performed relative to syphilisation, and 
from which it follows that, under the influence of a certain number 
of inoculations of chancre, not exceeding thirty-six, indurated 
chancres may be made to undergo resolution easily enough, 
secondary and tertiary affections healed, and such a modification 
effected in the economy that lesions which resisted the employment 
of specifics afterwards become very amenable even to small doses 
of those remedies. That physician, however, reserves this means 
for exceptional cases, and prefers mercurial treatment to it. Diday, 
in an interesting critical study, inserted in the Gazette Medicate de 
LyoUy asserts that syphilisation is suitable to certain cases of obsti- 
nate syphilis only. Gibert and Bazin are of a very similar opinion ; 
but many other distinguished physicians reject this mode of treat- 
ment. Quite recently, the Medical Society of Clermont-Ferrand 
manifested a tendency of this kind in the general conclusions which 
terminated a remarkable discussion on that subject. Nevertheless, 
it uttered the wish that liberty of experimenting should be granted 
in France to physicians who believed themselves to be sufficiently 
enlightened. 

Syphilisation may be considered as a preventive means or as a 
curative means. Preventive syphilisation, now completely given up. 



346 TREATMENT. 

cannot arrest onr attention ; curative syphilisation alone requires to 
be examined with care. 

The conditions of success for curative syphilisation^ as practised 
in the hospitals of Christiania, for instance^ refer to the application 
of the method soon after the appearance of constitutional symptoms 
and in individuals who have never been subjected to any so-called 
specific treatment. As regards the mode of its application^ the 
following is that described by Professor Boeck: — "I take the 
poison of a chancre contracted by coitus^ or of an artificial postnle 
or ulcer in persons already under treatment by syphilisation. I 
make the first inoculations on the sides^ and I make three such on 
each side. After three days^ I make three other inoculations on 
each side^ taking the matter from the pustules produced by the 
previous inoculation. I continue to inoculate every three days on 
the sides^ always making use of the matter of the last preceding 
pustules, until I obtain an absolutely negative result. I then begin 
to inoculate both arms and proceed in the same manner as on the 
sides, until the matter again ceases to produce any result. Having 
arrived at this point, I take matter from another individual, and 
inoculate it upon the sides or arms^ or even upon both places at 
once, and continue with the fresh matter in the same manner as 
with the first, until it no longer acts. When there exists immunity 
also for the second matter on the sides and arms, I begin the inocu- 
lations upon the thighs, and continue in the same manner as upon 
the places already named, until immunity is attained. Upon the 
three places mentioned, I again inoculate with matter taken from 
other patients, until no matter which I can obtain has any effect.^' 
The result of the inoculations soon manifests itself. At the end of 
twenty-four hours, the point of inoculation is swollen and isur- 
rounded by a small areola of a pale red colour ; on the third day, 
the pustule is generally well-marked, and, when it bursts, a small 
round ulcer, with perpendicular edges and a greyish, lardaceous 
floor, is left. 

Such is the mode of proceeding and its immediate result. The 
first question which presents itself here is : What is the nature of the 
inoculated lesion ? To judge from the preceding description, it is 
clear that it is not the true syphilitic chancre which is transmitted 
under such circumstances, but simply soft chancre (pseudo-sypMlis). 
The absence of an incubation period and the characters of the lesion 
would already leave no doubt on this point, even if we did not know 



SYPHILISATION. 347 

further that the initial phenomenon of constitutional syphilis is not 
reinoculable. Consequently, the pretended immunity sought to be 
attributed to syphilisation is the result of the inoculation of simple 
chancre, and, in this respect, the legitimacy of the term syphilisation 
might be contested. Moreover, this immunity is but temporary, 
even according to the chief advocates of syphiUsation, since refractory 
individuals have been capable of being reinoculated later on, and a 
certain number of relapses have been recorded. 

But physicians whose skill and merits cannot be contested assert 
that syphilis may be cured by chancrous inoculation; there are 
some even who prefer this mode of treatment to all the others. 
Thus a second question presents itself: What is the therapeutid 
value of syphilisation P Let us admit that the facts are, in such a 
case, difficult of interpretation. IVom the moment when the possi- 
bility of a spontaneous cure of syphilis can no longer be denied, it 
becomes necessary to inquire whether the cases of cure attributed to 
syphilisation are not the consequence of the natural course of the 
disease. But, to decide under such circumstances, it would be 
necessary to have an exact norm for comparison, such as a precise! 
knowledge what, if left to themselves, would become of a certain 
number of cases similar to those treated by syphilisation. Then 
only would it, in my opinion, be permissible to form a definite 
opinion concerning syphilisation. Without the norm for comparison 
of which I have just spoken, statistics cannot prove anything abso- 
lutely. Of seventy-six individuals suflfering from syphilis and cured 
by syphilisation, forty-five, we are told, were affected with vague 
symptoms only, and therefore left out ; of the remaining thirty-one, 
five cases were treated unsuccessfully by syphilisation, and in twenty- 
six the- symptoms disappeared. Such a result is evidently favour- 
able ; but it appears to me anything but conclusive and, to convince 
ourselves of this, it will suffice to glance at the statistics furnished us 
by the English physicians in reference to the non-mercurial treat- 
ment. Even if we accept the therapeutic efficacy of syphilisation, 
this method is far from rendering the patients exempt from relapses, 
and consequently we cannot attribute to it, as it has been sought to 
do, the property of modifying the whole economy. " I have treated 
420 individuals in all,^^ very recently stated Professor Boeck, of 
Christiania, ^'of whom forty-five have had relapses ; but as it may 
be assumed that some of those treated last year are still liable to 
relapses, I may, perhaps, fix the number of these at 12 — 13 per 



348 TBEATMBKT. 

cent. So far as I can remember at this moment, thirteen of them 
were treated afresh by syphilisation and two with iodide of 
potassium, and three of them had^ farther, tertiary affections. The 
results obtained from syphilisation in children affected with here- 
ditary syphilis have not been brilliant, adds that physician. Of 
forty-two children, twenty-two died ; but I treated all the cases I 
coold meet with^ and everybody knows that, in such children, 
affections of internal organs exist which it is not in oar power to 
care." 

To sam up, the therapeutic efficacy of syphilisation is as yet 
devoid of proofs sufficiently conclusive, and if this mode of treatment 
be useful, it is in certain given cases only, and without its being 
posable to guarantee the success of it. After this, there will never 
be reason to prefer syphilisation to the various modes of Ireatment 
pointed out above. It is very probable, moreover, that the thera- 
peutic effects of syphilisation consist in a revulsive action entirely 
local. 

Cullerier sought to convince himself of the fact by treating a 
certain number of syphilitics with blisters. He caused to be applied 
daily from four to six flying blisters, of the size of a half-franc piece, 
on the anterior surface of the chest; in exceptional cases, he had 
large blisters applied, and refrained, for one set of patients at least, 
from all mercurial or iodine treatment. One of the pupils of that 
teacher, Parisot, has given in his inaugural thesis * the results of 
this mode of treatment. Amongst twenty-two patients affected with 
primary, secondary, and tertiary syphilis, a certain number of cases 
of cure in which this treatment did not appear without effect might 
be counted. Thus this treatment caused to disappear papular, 
pustular, and squamous syphilides, mucous patches, &c. ; but it was 
unsuccessful against the more deep-seated lesions of the mouth and 
throat. It is upon the cutaneous manifestations of syphilis, upon 
papular syphilides properly so-called, that it has most effect. Cut 
these superficial manifestations are precisely those against whicli 
syphilisation is most successful, as is easily seen by casting a glance 
upon the comparative summing up by Professor Boeck. Xiike 
syphilisation, blisters frequently fail against primary and tertiary 
lesions, and neither of the methods prevents relapses. But the 
method by means of blisters ought only to be employed when mer- 

* Etudes sur un nouveau traitement de la syphilis experiments d rhSpit€tl 
du midi, en 1857. 



VACdlNATIOi^. 349 

curial treatment remains without effect and the severity of the sym- 
ptoms calls for the adoption of energetic measures. The surfaces 
subjected to the action of blisters usually assume an aspect in keep- 
ing with the temperament of the patient; in lymphatic subjects, 
they become the seat of inflammatory accessions and are soon covered 
with impetiginous crusts. The cicatrices generally present a more 
or less deep sooty tint, to which th5 syphilis is not, perhaps, entirely 
foreign. 

Another process by revulsion (tartar emetic plaister), tried by 
Dr. Hjort * at the instigation of Boeck, of Christiania, has equally 
been followed by good results, according to the report of the latter.f 
And despite the opposite opinion of the majority of the advocates 
of syphilisation, we are inclined to recognise in it nothing else than 
the result of an action analogous to that which may be produced by 
other revulsive means of equal power, but we believe that this mode 
of treatment is applicable in particular cases only which have resisted 
the ordinary means of treatment, such as mercury, iodide of potas- 
sium, preparations of iron, and even mineral waters. This opinion 
is, moreover, that of very experienced practitioners, such as Gibert, 
Bazin, Diday, &c. 

Vaccination. 

With syphilisation I compare vaccination, another mode of treat- 
ment of syphilis, which had its origin in Bussia, and which consists 
in treating that disease by multiple inoculations of vaccine virus. 
Imported into Prance by its inventor, Justin Lukomski, a captain 
in the Bussian service, this method did not appear worthy of fixing 
the attention of the surgeons in whose presence it was tried. In 
Kussia, however, it was carried out for a time, and at first some 
success was attributed to it. Numerous observations given by 
Yeltzinski % and by Kreyser § make known the good results obtained 
by this means^ namely, the more rapid disappearance of the primary, 
secondary, or tertiary lesions. But in these cases, as in those having 
reference to syphilisation, it does not appear that any allowance has 

^. * See MagaxinfoT Z€effevidenskaben, t. xv., liv. ill. 

f Recherches sur la syphilis, &c. Christiania, 1862, p. 473. 

X Madieale Heihmg der Syphilis vermitteht Kuhpochen-vaccination, 
X»eipzig, 1860. 

§ Die Vaccination aU Heilmittel gegen SgphiHs {Medic, CerUral-Zeitung, 
1860, t. xix. p. 49). 



350 TREATBIENT. 

been made for the coarse of syphilis left to itself^ or at least not 
sabjected to the action of any specific remedy. The considerations 
upon which we entered a short time ago apply, a fortiori, here, and 
if vaccination be really of some use, it is owing to the revulsion 
which results from the artificial production of a greater or less 
number of pustules. Moreover, this method, brought, towards the 
end of the year 1860, before the Physico-Medical Society of 
Moscow, and warmly discussed, was condemned with certain reser- 
vations.* 

Such are, amongst the various therapeutic methods employed for 
combating syphilis, those which have attracted most attention. Far 
be it from me to pretend to have said all that is to be said upon a 
subject so vast ; but I console myself for it, convinced that what is 
required by the physician is not so much the knowledge of thera- 
peutic measures more or less eccentric as a sure and certain rule for 
doing no harm and for knowing how to render himself useful. But 
if, as I have laboured to prove, syphilis, like all the diseases to 
which man is liable, has a natural tendency to spontaneous recoveiy, 
it is clear that the duty of the physician {interprea natura et 
minister) is to facilitate this tendency. The important thing to do 
then is, to place the patient in the circumstances most fitted to 
bring about this recoveryi and thus the first precept refers to 
hygiene ; but since hygiene no longer suffices wh^ lesions mani- 
fest themselves and compromise existence, therapeutic agents are 
then indicated. Amongst these agents, mercury and iodide of 
potassium, as we have already said, deserve the preference; but let 
us take care not to make of them, as we too often see done, a 
universal panacea applicable to every obscure case, for even when 
the syphilis is well marked those agents have their special indica- 
tions. 

If hygienic measures suffice in the period of the primary lesion^ 
mercury is the therapeutic agent of the secondary period, that is to 
say, of the hypersemic or phlegmaseous lesions disseminated on the 

• See Gaz, held, de mid, et de chirur,, V^ Bene, t. i. p. 567, 1864« 
Compare : Behrend, Die Vaccination als HeUmittel der Syphilis (Behrend's 
Syphilidologiey t. iii. part 2, 1861). Schuberg, Versuche »ur Heilung der 
Syphilis mitteUt der Vaccination (Badisch. Mittheil., No. 11, 1861). 
Sabborky, Ueher die SeUung der Syphilis durch Blattereinimpfung (Aferf. 
Mittheil. Nos. 17, 18, 19, 1861 ; and SainUPetershourg Med. Zeitschr., t. i. 
p; 335, 1861). , , 






VACCINATION. 351 

cataneoas and mucous surfaces. The bichloride and proto-iodide of 
mercury are the preparations to be preferred. The bin-iodide is 
more generally employed for the deep-seated syphilides. The iodide 
of potassium is better suited for combating the slow and chronic 
lesions which invade, in the last periods, the parenchymas. The 
duration of the use of these agents is necessarily variable, and it will 
easily be understood that no absolute rule can be given in this 
respect. As a general rule, so long as their influence upon the 
economy is beneficial and not debilitating, there is nothing to fear ; 
but so soon as they produce anaemia, the employment of them must 
be suspended. A remedy is never an indifierent thing ; it is either 
useful or deleterious, and it is the duty of the physician to ascertain 
which is the case. The therapeutic effect once obtained, we have 
only to wait and hygiene and time will complete the cure. Daily 
exercise short of fatigue, gymnastics, cutaneous frictions, baths, and 
the water cure will, in their turn, serve to restore the organism, 
which tends naturally to return to its normal primary condition. 



PART VI. 



LEGAL MEDICINE. 



Fabre, Traite dea maladies v^n^riennes, p. 15. Paris, 1773. Boucha- 
court. Consultation m^dico-l^gale sur un cas de syphilis communiquee de 
I'enfant k sa nourrice par rallaitement. Revue Medicale, 1840 ; et Gaz, 
Med. de Farts, 1841, p. 534. Diday, Trait§ de la syphilis des nouveau- 
iies, &c. Paris, 1854. Ditterich, Neue mediciDisch-chirurgische Zeitung, 
1859; et Gaz, Med. de Farts, 1865. Cazenave^ De la transmission de la 
syphilis de Teufant ^ sa nourrice, sous le rapport m§dico-l§gal. Ann. des 
maladies de la peau et de la syphilis, t. iv. p. 85. Viennois, De la syphilis 
transmise par la vaccination. Archives gen. de medecine, June, I860, and 
following months. RoUet, De la transmission de la syphilis entre 
nourrissons et nourrices, an point de vue de la medecine legale, dans 
Gazette hebdomad, de mid, et de chirurgie, 1861, p. 589. A. Tardteu, 
Etude sur les maladies provoqu^es ou communiquees, dans Annates 
d'hygi^ae publique et de medecine legale, 2* serie, t. xxi., 1864, p. 104 et 
suiv. Am, Ricordi, SifiUde da allattamento. Milano, 1865, p. 157 et 
suiv. Chahalter, Rapport sur un travail de M. le Docteur Viennois, ayant 
pour titre : Etude mSdico-Ugale sur un cas de syphilis infantile, Gaz, tned 
de Lyon, July 16th, 1865. 

Syphilis, by its nature even, and especially by the mode of its 
propagation, cannot fail to give rise to a great number of judicial 
actions and debates. Since the sixteenth century, the medico-legal 
question has been propounded, and it is of physicians that the in- 
formation necessary for elucidating and solving it is demanded. 
The well-known story given by A. Par^ of a nurse who infected her 
nursling, who transmitted the disease to its mother and the lattec 
to her husband and other children, could no longer provoke a judicial 
discussion; but "the nurse was flogged privately, and would liave 
been flogged publicly, had it not been for the fear of dishonouring 
tlie family." Documents relating to the medico-legal stady oi 
syphilis are rare, it is true, amongst the writings of the earlier 
syphilographers ; but important materials already exist, however^ on 



LEGAL MEDICINE. 353 

the subject. Thus, as regards the transmission of syphib's by suck- 
Kng, Brassavole estimates very correctly the two heads of the medico- 
legal question : — " Si infaus lac exsugeos/^ he says, " circa os pus- 
tulas contrahat, quae extranei coloris sint, nee curari facile valeant, 
judica hunc morbi gallici contagium a nutrice recepisse. E con- 
trario, si infans a berophotrophio receptus, pustulas per corpus 
habeat, sitque prave affectus, et nutrix in mammis, ac papillis, pus- 
tulas incidat quse facile curari non possint, judica nutricem banc ab 
infante recepisse contagium.'^ 

Later on, in a treatise upon venereal diseases which is not without 
value, Fabre writes : —" We know that fathers and mothers affected 
with syphilis have ruinous and dishonouring actions brought against 
them by nurses who have been infected by their nurslings. Under 
such circumstances, the judges can only decide from the evidence of 
the physicians and surgeons; it is important, therefore, that they 
should know how to determine when the child has really communi- 
cated disease to its nurse, and when the nurse has contracted the 
disease from another source. ... To give an opinion in such a 
case, then, it is necessary to investigate the condition, not only of 
the child, but also of its mother ; if it be proved that the latter had, 
during her pregnancy, either chancres, or virulent gonorrhoea, or 
some other well-marked symptoms of syphilis, there is reason to be- 
lieve that the disease which has manifested itself in the nurse, since she 
began to suckle the child, has proceeded from the latter. But besides 
this circumstance, which is essential, it is also necessary to know the 
effects and the course of the virus in a nurse who has contracted it by 
suckling. The first part to be affected is the nipple, . . There super- 
venes in this part, first a painful phlogosis and then pimples which be- 
come converted into ulcers or chancres; the glands in the axilla or those 
of the neck very often become swelled at the same time, like those 
in the groins, where buboes appear when the chancres occupy the 
genital organs. After these initial symptoms, the nurse has others 
characteristic of confirmed syphilis, such as ulcers of the throat, 
pustules, ulcers upon the genital organs, which may be mistaken for 
disease contracted in those parts,^^ &c. 

It appears to us difScult to be more precise and more exact on this 
difS-cult subject, and at the present day, in spite of the recent acqui- 
sitions of science, we must still often be guided, with slight modifi- 
cation, by the sound observation of Fabre. 

Hunter, Bell, and Swediaur altogether neglect the medico-legal 

aa 



354 SYPHILIS. 

points of view in their otherwise so remarkable treatises. Neither 
has this point of view received more attention from Ricord^ whose 
anticontagionist doctrines concerning secondaiy syphilis^ and espedally 
concerning transmission by nurslings to their nurses, have not always 
met with the approbation of magistrates. It is to be remarked, in 
fact, that under many circumstances the tribunals have pronounced 
condemnations in such cases, and that at the very time when the 
doctrines of the Hospital du Midi were in the highest repute. 

Since the transmission of secondary affections has been proved, 
the medico-legal study of syphilis has entered into a new phase, 
thanks especially to the important works of the Lyons school and 
to those of M. Tardieu. That professor has collected numerous 
documents on this subject, and has summed up the various points 
with great clearness in an important work, which may be consulted 
with advantage. 

M. Tardieu has taken for the basis of the division of his work the 
conditions of the transmission of syphilis. For one who looks at 
the subject in a medico-legal point of view only, nothing, certainly, 
could be better ; but in a general work, in which the great divisions 
rest upon the evolution of the symptoms, it appears to me desirable 
for the unity of the subject to take this evolution into account in 
the exposition of the medico-legal portion. For that reason, I shall 
examine successively and, first of all, the conditions for the medico- 
legal decision to which each of the phases of the disease we are 
studying may give rise. 

Primary lesion. — ^This lesion being, to make use of an expres- 
sion already employed by Eollet, as it were the pivot upon which all 
the medico-legal bearings of syphilis must turn, it is in the highest 
degree necessary to have its characters clearly defined; let us, 
therefore, briefly recapitulate its principal features. 

Chancre, the first effect of the contagion, appears at the point 
contaminated, after an incubation period, the duration of whicli 
varies from eighteen to thirty-five days, or even more. Usually 
single, it shows itself multiple in exceptional cases only. It is at 
first a small, reddish or brownish, painless pimple, sometimes covered 
with an epidermic pellicle, and which soon becomes ulcerated. The 
ulceration may nevertheless be wanting; it is, therefore, neitlier 
characteristic nor essential. The ulcer, when it exists, is more- 
over dry rather than moist, giving off, at first, only a kind of sero- 
granular emulsion, and not secreting true pus until the period of repair 



LEGAL MEDICINE. 355 

has arrived. It varies considerably in form : sometimes it is a slight 
aad almost superficial erosion (chancrous erosion), sometimes more 
extensive and deeper, cup-shaped, with a smooth surface and shining 
edges, of a whitish colour, with a dark-coloured and afterwards 
grey and lardaceous floor. The base (a most important item) is 
manifestly indarated, sometimes elliptical, anfractuous, irregular, 
sometimes having a well-defined and regular outline, sometimes 
resembling parchment. To the chancre is added, almost constantly, 
another lesion, that of the neighbouring glands, which become 
involved and form small ovoid tumours, independent, movable, and 
collected in groups. 

Such are the general characters of the primary lesion ; they may 
be modified somewhat according to the various regions, but they 
always retain a physiognomy which renders them recognisable every- 
where. 

Prom the mere fact of the presence of this lesion at any point of 
the economy necessarily result the following conclusions : — There 
is syphilis, — syphilis acquired and not hereditary, — syphilis com- 
municated at the very point actually diseased. 

This last conclusion, which is of the greatest importance, neces- 
sitates a more detailed examination, for, according to the seat of the 
primary lesion, a logical deduction will frequently suggest a different 
mode of contagion, and, in many cases, the true origin of the 
disease. Let us, then, examine rapidly the various cases which may 
present themselves. 

On the genital organs, the primary lesion is most usually the 
effect of sexual intercourse. Such is its origin, but, to make it the 
object of medico-legal investigation, there must be either an indecent 
assault, violation, or the wish of a husband or wife to obtain a 
divorce on the plea of a serious injury (venereal infection). 

At the anus, chancre indicates unnatural intercourse, voluntary 
or forced. 

Around the nipple, or on the surface of the breast, it most fre- 
quently results from suckling and is traceable to the nursling as its 
original source. This is a fact now well established, and only too 
frequent, of which the physician may convince himself easily enough 
in spite of certain difficulties which we shall attempt to make known 
further on. 

About the mouth, chancre betrays, either contagion by means of 
dirty objects : glassblowers' tubes, drinking-glasses, spoons, mouth- 

a a 2 



356 SYPHILIS. 

pieces of instrnments^ children's toys, &c. ; or direct infection from 
mouth to month, by kisses or other still more direct modes of con- 
tact ; or mediate transmission, as in the case of a nurse who com- 
municates to her own child the lesion which a strange nursling has 
produced upon her breast. 

On the nose, or on the pharynx, the primary lesion has hitherto 
been observed only as a consequence of certain operations, such 
as catheterism of the Eustachian-tube. 

On the fingers and at other points of the body, chancre reveals 
clearly enough the manner of its importation ; thus it has been seen 
to appear upon the hand of an accoucheur, after obstetric operations, 
or even from a simple examination per vaginam: on the arm 
of certain subjects after the inoculation of suspicious lymph; lastly, 
on other parts of the body after surgioal operations. 

Under all these circumstances, and under many others which 
might arise, the physician has always in the end the same duties to 
perform : 1st, to establish the reality of the disease ; 2nd, to seek 
for the relation which may exist between the lesions presented by the 
various parties. 

But we have made known the characters upon which is based the 
diagnosis of the primary lesion* It remains for us to point out the 
means of discovering the link which connects this lesion with that of 
the person accused. It is evident that this object cannot be attained 
except by comparing the lesions on both sides ; but since, in civil 
cases, personal examination can never be insisted upon, it follows 
that, in a certain number of cases, one of the elements of his 
opinion being absent, the physician will find himself incompetent. 
Under such circumstances, moreover, it is very rarely that judicial 
authority dictates direct inquiries. When such inquiries are 
authorised, it is by relying upon the characters which enable him to 
recognise the standing of the primary lesion that the medical jurist 
will be able to determine the origin of the disease and, by that very 
means, to convince himself whether any connection is possible 
between the lesions he is called upon to investigate. It is, therefore^ 
important to know that chancre has, like most of the manifestations 
of syphilis, a peculiar evolution, and that it passes through succes- 
sive phases. In this respect, we may recognise three phases in it ; 
a first phase of short duration, the papular period; a second of 
ulceration or destruction, and a third of reparation and of cicatrisci^ 
tion. In each of these phases, the primary manifestation presents a. 



LEGAL MEDICINE. 357 

different aspect. Without speaking of the papular period, which is 
still disputed by some authors, and which is really, perhaps, not 
constant, let us bear in mind that the physiognomy of ulcerated 
chancre, with its greyish, uneven, graniJar floor, is very difierent 
from the physiognomy of chancre in the process of repair and the 
surface of which is seen to be covered with fleshy granulations 
having a purulent exudation^ and, a fortiori, from that of cicatrised 
chancre. 

It is evident that the oldest chancre must be the original chancre ; 
but we must refrain from being too positive on this point, especially 
when the lesions which are the object of comparison are at periods 
little remote from each other. Syphilitic chancre has, in fact, a 
course more or less rapid according to the age and the individual ; 
but, its incubation period being variable, it becomes necessary, 
to establish a connection between two lesions of this nature, that 
there should exist between them a certain difference of age. It will 
easily be understood, however, that the circumstances in which the 
physician is placed do not furnish him, in this respect, with anything 
more than probabilities, for he can never render himself responsible 
for coincidences. But if we cannot lay it down as a principle that 
the first infected has certainly contaminated the other, we may at 
least afiBrm very positively that the latter cannot have transmitted 
the disease to the former. When secondary symptoms are met with 
on the one side, the task of the medical jurist is rendered more easy. 
In fact, it is clear that the subject of the primary lesion has not 
infected the other, and a connection is certainly possible between the 
affections in the two parties- It is thus that a nurse having a 
primary lesion on the breast cannot be accused of having transmitted 
syphilis to a child which has mucous patches of the mouth, and 
vice versa. Mucous patches on the nipple of the nurse cannot 
be attributed to a chancre in the mouth of the child. The inverse 
propositions belong to the domain of the possible, let us even say 
that they are frequently the expression of the truth. 

Secondary lesions. — ^These lesions, when not the effect of here- 
ditary syphilis, are preceded by the primary lesion, and do not 
appear, in general, until six or eight weeks after the first appearance 
of the chancre. They occupy the skin and mucous membranes, and 
consist in eruptions which are generally extensive or disseminated, 
but superficial and arranged in patches or in small points. It is 
unnecessary to repeat here the various characters of syphilides and 



358 SYPHILIS. 

mucous patches, which have been spokea of abeadj. Let us 
observe^ however, that these manifestations are frequently accom- 
panied by glandular adenopathies^ the multiple seats of which are the 
groins, the posterior region of the neck, immediately beneath the 
roots of the hair^ and sometimes the glands of the arms or of the 
lower part of the neck. 

Like the primary lesion^ the secondary manifestations bear witness 
to the reality of the syphilis; but, to ascertain their starting-point, 
we must look for the initial lesion> and this, as we know, sometimes 
persists in the form of a cicatrix for a very long time. But if the 
most careful examination do not enable us to discover anything, 
since this lesion must necessarily have existed in the case of acquired 
syphilis, we must demand of the individual affected information as 
to the time of its appearance, its characters, its duration, and its 
seat, so as to be able to determine on both sides the filiation of the 
morbid manifestations and to show the relation which may exist 
between them. Lastly, if there should no longer be any trace of the 
primary lesion, we must bear in mind that the outbreaks of secondary 
syphilis generally present a certain regularity in their evolution, 
fioseola and mucous patches are amongst the earliest; but nothing 
absolute can result from these data, l^e physician informed on 
this point will refrain from speaking in the affirmative when doubt 
exists ; what is required of him is, in my opinion, evidence com- 
patible with the actual state of our knowledge, and nothing else. 

In a case in which secondary symptoms are observed on one side, 
while tertiary symptoms exist on the other side, it is very evident 
that it is the individual whose symptoms are those of the least 
advanced period who may have been infected by the other. 

Tertiary lesions. — These lesions, which are characterised by 
peculiar gummy deposits and deep ulcers, do not usually supervene 
in less than a year from the commencement of the syphilis, and, 
iu general, are much too remote from the moment of the contagion 
for it to be possible to determine their filiation and to pronounce 
upon the source from which they spring. Consequently, if the 
diseased individuals have both reached the tertiary period, the 
physician must content himself with pointing out the reality of the 
syphilis. The same would not be the case if tertiary symptoms 
were met with in one of the two parties at the same time with 
primary or secondary manifestations in the other. Then, evidently, 
the latter could not be accused of having transmitted the disease. 



LEGAL MEDICINE. 359 

Such are the data which a medical jurist may obtain from the 
knowledge of syphilitic affections and from their course. Let 
US now consider from another point of view the medico-legal study 
of syphilis^ and examine that disease in reference to the modes and 
conditions of its transmission. If the syphilis has been com- 
municated by sexual intercourse, the question for the physician, 
in case of an action for divorce, consists in recognising the existence 
of syphilitic aflfections in the parties, in determining the origin 
of them, and in connecting them one with another by means of con- 
tagion, for, says Professor Tardieu, if it too often happens to us, in 
the practice of our profession, to meet with such cases as unfor- 
tunately cannot leave any doubt in our minds, how much more 
difficult and uncommon is it for us to be in a position to apply 
to these cases all the rigour of a medico-legal demonstration. And, 
adds the same author, I do not hesitate to lay down as a general 
precept the duty of abstaining, reserving, of course, those excep- 
tional cases which the conscience of each physician will always know 
how to discriminate. 

In the transmission of syphilis by suckling, numerous instances 
of which will be found in the remarkable report quoted above, it is 
to be remarked that the cases brought into court have most frequently 
been on the part of the nurse, much more rarely on the part of the 
parents. In the first case, as M. Tardieu points out, the complaint 
is generally made late, whence arise peculiar practical difficulties, and 
especially the impossibility of confronting, in a common inquiry, the 
nurse and the nursling, which will sometimes have died. In the 
second case, the parents only briug a defensive action, for the pur- 
pose of freeing themselves from the responsibility imputed to them. 
The duty of the physician then consists in establishing the reality of 
the disease and the successive transmission according to the date, 
the seat, and the form of the specific lesions ; 1st, by the examina- 
tion of the child and the appreciation of the facts which concern it; 
2nd, by the examination of the nurse, either directly, or indirectly. 
It is with this indirect information, often very useful, that must 
be ranged whatever refers to the children and husband of the nurse 
suspected, as well as to other nurses who may have taken part in the 
suckling of the diseased nursling. 

As regards the examination of the child, we must bear in mind 
what has been established above, viz. : that it is between the second 
and third^ month that the first signs of congenital syphilis usually 



o60 SYPHILIS. 

show themselves; that the most contagious and characteristic 
element is the macoos patchy which has for its most frequent seat 
the opening of the mouthy the nasal orifices, the circumference of 
the anus, and the genital organs; and then that there supervene 
eruptions of vesicular, pustular, or bullous form, lesions of the 
nails, interdigital ulcerations, and a persistent and obstinate corjza. 
These various lesions are followed in general, as we already know, 
bj a state of cachexia more or less marked. 

As regards the nurse, we must endeavour to ascertain, as far as 
possible, what was the state of her health before she began to suckle 
the suspected child ; but what it is important to establish is that 
the appearance of the symptoms which she presents was posterior to 
that of the disease in the child. We have already stated the data 
upon which a physician should found his opinion in such a case : 
let us repeat that the first symptom which presents itself in the 
nurse, in the by no means uncommon case of transmission by a 
nursling affected with hereditary syphilis, consists in an indurated 
pimple at the extremity or at the base of the nipple. This pimple 
ulcerates, becomes enlarged, and is soon accompanied by axillary 
adenopathies;* later on supervene syphilides, alopecia^ and adeno- 
pathies of the cervical glands. No lesion exists at the very first 
about the genital organs, but only later on in. the course of the erup- 
tions of the secondary period. *^ The children of the nurse,'^ justly 
remarks Professor Tardieu, ".are, as it were, a very certain and very 
delicate test which the expert should interrogate carefully. Seversd 
eventualities may arise. The children which the nurse has had before 
taking charge of the infected nursling may continue healthy during the 
whole period of the disease in the mother. Or, healthy at first, 
they may become diseased in their turn, not by suckling, but in 
consequence of repeated contact and the many ways presented for 
contagion. If the last born child, as frequently happens, shares 
the breast with the strange nursling, it runs every chance of con- 
tracting the disease at its source. There is one peculiarity of the 
greatest importance which, when it presents itself, is truly significant. 
This woman, before taking charge of the diseased child, shall have 



* See the excellent inaugural thesis of Dr. Viennois, Recherches sur le 
chancre primitif et lea accidents conaecutifs produtts par la contagion de la 
syphilis secondairCf Paris^ 1860, in which there is a very minute descrip- 
tion of chancre of the breast. 



LEGAL MEDICINE. 361 

had several children and not lost one of them ; since that period^ 
she miscarries or her children die at an early age/' As regards the 
husband^ inquiry should be made into the state of his health and a 
personal examination of him made; but we must bear in mind the 
fact of a possible coincidence. 

Another circumstance, the recognition of which would throw the 
greatest light upon the inquiry and clear up the expert's doubts, is 
the case in which several persons, having frequented a suspected 
child, shall have presented the symptoms of syphilitic infection. 
Thus a nursling may have infected several nurses to whom it has 
been given in succession, members of the family who have made use 
of objects belonging to it, or even strangers who have approached, 
touched, and kissed it. 

Examples of this have been quoted by Stark, Bardinet, Diday, 
and other authors. It will easily be understood how important it is 
to examine, as carefully as possible, in such cases, the nurses and all 
those who have been in more or less direct relation with the child. 

After this examination, the difficulties will not be great. To 
establish the connection, we must rely upon the circumstance that 
the syphilis in the nurse commenced in the breast at a time when 
her genital organs were intact. The important point, according to 
Professor Tardieu, is to ascertain exactly, at one and the same time, 
the state of the breast and that of the genital organs. In fact, 
even if the examinatioa of these organs be made late, it may still 
enlighten the expert concerning the point at which the disease has 
commenced and the course which it has run. 

The different evolution of syphilis, accordingly as it is acquired 
or hereditary, is another point which is not without importance, and 
upon which BoUet has very justly insisted. It is that, if the nurse 
contract syphilis otherwise than from her nursling, the contagion 
produced in the latter will manifest itself by the primary lesion, and 
not by mucous patches, as usually happens in congenital syphilis, 
in which the primary lesion is always wanting. 

As mention has been made elsewhere (iBtiology) of the various 
modes of contact capable of transmitting syphilis, I shall merely 
recapitulate here the facts^ always very complicated, resulting either 
from contact with a part or object contaminated, or from inocula- 
tions caused accidentally by circumcision, by tattooing, by vaccina- 
tion, by the carelessness of some operators in using contaminated 
instruments, or even practised voluntarily for an experimental or 



362 SYPHILIS. 

therapentic purpose. In all these cases^ of which a careful study 
will be found in the excellent report of Professor Tardieu^ the duty 
of the expert is always the same ; it consists in establishing the 
reality of the syphilis and in determining the possibility of a con- 
nection between the lesions presented by the two parties. There 
ends the task of the physician; that of the magistrate is to determine 
the rights of each person. 



APPENDIX. 



ON SUPPOSED SYPHILITIC AFFECTIONS IN ANIICALS. 

Boerhaave, Traite de la malad. vener., trad. fr. Paris, 1753, p. 16. 
HunteTf Complete Works. Stoediaur, Traite des malad. v^n^r., t. i. p. 7. 
Paris, 1801. AuziiM'Turennef Transmission de la syphilis aux animaux. 
Gaz. medic de Paris, 1844, pp. 709, 726. Helot, de Castelnau, and Jules 
Davasse, Nouvelles experiences sur Finoculation de la syphilis aux 
animaux. Gazette des hdpitaux, No. 27, 1849. CuUerier, Archives 
g^nerales de medecine, 4« serie, tome viii. p. 50, 1854. Robert de WeUz, 
Deux r^ponses k deux lettres de M. le Docteur Ricord sur I'inoculation de 
la syphilis aux animau^. Wiirzburg and Paris, 1850. Diday, Trans- 
mission de la syphilis de Thomme aux animaux. Gaz, med, de Paris, 
1851. Sperino, Traite de la syphilisation. Manoury (de Chartres), dans 
Gazette hehdom. de mSd. et de chir., 1855. Follin, Maladie du co'it chez les 
chevaux 'et syphilis, dans Archives g6n^r. de m6d., 1859, t. i. p. 332, 
Revue critique. Lafosse, Maladie v6n6rienne des solipddes. Journal des 
vStSrinaires du Midi, Nov. et Dec. 1860. Analyse dans Gaz. hebd., 
p. 108, 1861. 

To know whether syphilis is a disease confined to the human race is 
a question which has long fixed the attention of observers, and 
which, in my opinion, has its place marked out in this work. This 
question is a double one ; firstly, does there exist in certain animal 
species * a disease comparable to, or identical with, syphilis in man ; 
secondly, is syphilis transmissible to animals ? 

* I relate here, as a mere curiosity, that one of the earliest syphilo- 
graphers, Ruiz Diaz de Isla, makes mention of syphilis in cahbages. *^ At 
Baize, my native place,'* he says, ^* I have observed cabbages affected with 
syphilis. This disease is communicated to them by stagnant waters in 
which the linen of syphilitics has been washed, and which has then been 
used to water them. The excrescences on these plants so closely resemble 
the pustules of the French disease that children cut them off with scissors 
and put them on their faces to imitate that disease. Moreover, other 
pot-herbs also suffer from that disease, no less than a great number of 
animals. 



364 APFBNDIX. 

Obsenration teaches us that there are^ in the horse^ affections 
of the genital organs transmissible, as in man, by coitus; and, 
which is curious, side by side with certain forms which infect 
the economy, and in which the disease becomes generalised as in 
syphiUs, there are others which never occasion in the individual 
more than a simple local derangement.* Here, therefore, the 
dualistic doctrine reappears. In Germany, Bodloff admits, in this 
respect, two distinct diseases: the one an unimportant exanthem 
which does not generally extend beyond the external organs of 
generation ; the other a malignant affection which alone deserves the 
name of disease from coUiotu 

But like the physicians, veterinary surgeons are not agreed as to 
the nature of these diseases. Contrarily to Rodloff, Hertwig f is of 
opinion that only one disease from coitus exists, and that it appears 
in two forms, the one benignant, the other malignant. Characterised 
at its onset by the appearance, on the external genital organs, of 
buUsB, ulcerations, spots, &c., this disease may either become 
arrested spontaneously or compUcated with^ general derangements 
and nervous phenomena and be transmitted in one or other of these 
two forms. 

The disease from coitus has prevailed in Russia and in Prussia 
since the end of the last century. Observed in 1796 and 1799 in 
the district of Trackene, it persisted there until 1801. In 1815, it 
was observed to appear at Witthowo, near Bamberg; it showed 
itself from 1816 to 1820 in Hanover, and in 1817 and 1818 in 
Lithuania. 

It was found in 1821 in various parts of Northern Germany, in 
1826 in Silesia, from 1827 to 1880 in Bohemia and in the canton 
of Berne. It was observed for the first time in France, in the 
course of the year 1 880, by Lautour, J who described it under the 
name of contagious disease of the genital organs of the stallion and 



• These same affections would appear to be met with also in the bovine 

race. All the cows put to a bull upon whose penis was a condyloma the 

size of a nut, were affected with a mucous discharge which continued 

several weeks, and required, in some cases, the employment of astringent 

i njections (Archives de mSd., 1840, p; 358). 

t See Maladie de VHalon, in Magasin de mSdectne vStSrinaire, 1842. 
Analysed by Delafond, Receuil de mSd, vStir., 1852, p. 897. 

X See Receuil de mid. vMr., 1834, p. 118; Journal tf^Sorique et pratique, 
1832, p. 258. 



I • 



SYPHILIS IN ANIMALS. 365 

iAe mare. In 1840^ it broke out in Fomerania^ and it is then that 
it was observed by Eodloff, inspector of the breeding places of 
Posen.* About the same time it prevailed in France, where it was 
described by Dayot under the name of contagious eczema.t Balar- 
dini observed it in the Lombard©- Venetian kingdom.} While 
England has hitherto been preserved from this disease^ the North of 
Africa has long been subject to its attacks. The disease from 
coitus has been observed by Signol § in the province of Constantine, 
and General Daumas has seen it prevail amongst Arab horses in the 
same province, where the natives give it the name of el dourine. || 
Fixed since the year 1857 in the department of the Upper Pyrenees, 
this disease has been the object of interesting researches and 
experiments on the part of the veterinary surgeons of the Toulouse 
school. Prince and Lafosse ^ have studied it carefully, at least in 
reference to contagion. We shall speak successively of its two 
forms, the coital exanthema and the diseas& from coitus properly 
so-called. 

At its commencement, the coital exanthema shows itself in the 
stallion in the form of oedema more or less marked, a£Pecting the. 
penis and sheath so as sometimes to produce paraphymosis. After a 
few days, the oedema decreases and towards the end of the first 
week, phlyctensB appear on the lateral and inferior surfaces of 
the penis or on the glans. On the third day, in general, these 
phlycteuffi dry up ; but they sometimes leave behind them ulcers 
surrounded by a red areola, the edges of which are sometimes smooth 
and continuous, sometimes broken and wrinkled, and having a 
whitish or lardaceous floor. These ulcers heal in six or eight days, 
leaving behind them a smooth, white cicatrix. The general 
symptoms, such as fever, loss of appetite, ^c, are scarcely ap- 
preciable; erection and coition are painful. A day or two after 



* See JReceuil de mid, vStSr., 1855, p. 241. 

t MSm. de la 8oc, impSr, et centr. cTctgricuUuref 1847-1848. Beceuil de 
mid. vitir., 1850, p. 92. 

X Observ, de syphilis ehez lis chevaux. Gazette medica Lonibarda, 1849. 

§ See Comptes rendus de la 8oc, impir, et centr, de mid, vitir,, 1853 ; et 
JReceuil de mid. vitir,, 1854, p. 127. 

|] See ReceuU de mid, vitir., 1855, p. 476 ; et Comptes rendus de la 8oe, 
impir, et centr. de mid, vitir, 

f See Journal des vitirinaires du Midi, 1853, p. 145 ; 1855, p. 1 ; 1860, 
Nov. et Decemb. 



366 APPENDIX. 

having been covered, the mare presents uneasiness and a certain 
d^ree of agitation. The vnlva becoi^es swelled generally or 
partially ; from the vagina and external surface of the labia majora 
Sows a whitiah viscons fluid, theu oedema supervenee which occupies 
the perineum and descends as far as the teats. About the third or 
fourth day there appear upon the genital organs yellowish buUte con- 
taining an acrid serous fluid, lesions which finally terminBte in white 
dcatrices. Attention to cleanliness suffices, in general, for the cure 
of this disease, which is entirely distinct from the disease from 
coitus, but which is, to a certain extent, comparable to the local 
lesions of the genital organs in man. 

The disease from coitus proceeds, like the coital exanthema, 
by local determinations which it is possible to compare to the 
spedfic indurations of syphilis. The horse's sheath, and sometimes 
the scrotum, are swelled, hot, and painful. The swelled mucous 
membrane of the urethra forms an impediment to micturition, and 
the urine is retained in the bladder. Lastly, the vesicles of coital 
exanthema or slight erosions are observed. In the mare, the 
cedema which shows itself in the perinenm and on the abdomen 
becomes transformed into a lardaceous indnration, which soon 
disappears. A yellowish white fluid flows from the vulva ; later on, 
the mucoas membrane becomes swelled and assumes a grey or 
marbled tint. The clitoris becomes puffy and the matter secreted is 
of a greenish yellow colour. Lastly, small vesicles appear upon the 
mucous membranes, and Hertwig states that he has twice seen 
rounded ulcers involving the entire thickness of the vaginal mucous 
membrane. 

To these symptoms, which are purely local and comparable to the 
primary lesion of syphilis, succeed symptoms nf a difi'ercnt kind, 
secondary symptoms which show the general infection of the 
organism. It is about four or six weeks after the first appearance 
of the disease that these new symptoms show themselves. The coat 
becomes tough, the skin exhales a bad odour and the eye grows 
dull; then cutaneous tumours, having their seat in the thickness of 
the skin, show themselves first upon the croup and spread to the 
costal regions, chest, and thighs; they are comparable to the lumps 
produced by the stings of insects, assume a circular form surrounded 
by a distinct border, and have a diameter which varies &om one to 
three centimeters. Contrarily to other observers, Hertwig asserts 
that there sometimes proceeds from the centre of these patches 



SYPHILIS IN ANIMALS. 367 

a yellowish serum which agglutinates the hairs (see Arch, m4d,, 
loc. cit.). It is to be observed that allusion is made here to 
cutaneous patches^ and not to sub-cutaneous tumours as is seen 
in farcy and glanders ; moreover, the lymphatic cords and multiple 
abscesses peculiar to farcy are wanting. 

The mucous membranes may take part in the disease; those 
of the nose, the bronchi, and even of the eyes may be injected from 
the commencement of the disease; the inguinal and sub-glossal 
glands are sometimes swelled and indurated. Later on appear fresh 
manifestations, arthritis, paralysis of motion, partial or general 
atrophy, erythematous or pseudo-farcinous eruptions of pimples; 
and, lastly, as exceptional phenomena, coxo-femoral luxation and 
spontaneous fractures have been observed (Lafosse). The hind- 
quarters are the most frequent seat of paralysis, which is generally 
connected with an affection of the spinal cord as yet little under- 
stood. This disease has a duration varying from two months to 
three years, is rarely cured, and the animals generally sink under a 
horrible marasmus. It rages for two or three years in a locality, 
and usually leaves it after that time to reappear in places more or 
less distant. 

The disease from coitus is contagious ; this is a point upon which 
almost all veterinary surgeons are agreed, and which is now beyond 
all doubt since the performance of conclusive experiments at Tou- 
louse. Fifteen perfectly healthy mares were put to stallions affected 
with the disease from coitus and brought from Tarbes. Of this 
number, five presented in a slight form the symptoms of the disease 
and recovered spontaneously ; five were severely affected, of which 
one was cured and the other four died. Of the two stallions which 
covered these mares, one died of the disease from coitus, the other 
presented slight symptoms only. These cases evidently require no 
commentary, but it appears that contagion by inoculation takes 
place with difficulty ; many experimenters, including Lafosse, have 
failed to inoculate the disease by puncture, or even by frictions upon 
the genital organs. Hertwig asserts, however, that he has sometimes 
succeeded in transmitting the disease by means of friction made in 
the vagina with the virulent matter. 

Such is, in animals, this disease, which presents a sufficiently 
close analogy with syphilis to have led certain observers to think 
that it may have resulted therefrom. The opinion which consists in 
recognising a causal connection between the two diseases is not, it 



368 



APPENDIX. 



must be admitted, generally accepted. Most veterinary surgeons 
regard the disease from coitos as entirely distinct from syphilis. 
Lafosse, who shares this opinion, bases his views upon the circum- 
stance that no one has yet pointed out in the disease from coitus the 
corroding ulcers or indurated chancres of the genital organs, the 
cervical and axillary buboes, the moist pustules of the margin of the 
anus, the periostoses, the exostoses, &c. These considerations are 
not without value, and I think, with the Toulouse professor, that 
all that can be done is to institute a comparison between the 
diseases in question. But a case recently given by Professor H. 
Bouley* would tend to suggest the idea that doury (disease from 
coitus) may, after all, proceed from syphilis in man. An individual, 
yielding to a vulgar notion, and desirous of curing himself of a 
syphilitic affection of the penis, introduced that organ into the 
vagina of a female ass, which afterwards communicated the disease 
from coitus to a male ass which, in its turn, gave it to other 
females. Let us add, however, that in spite of this case, M. 
Bouley does not believe in the identity of the disease from coitus 
with syphilis. 

To sum up, there exists in animals, and especially in horses and 
asses,t a disease transmissible by sexual intercourse ; but notwith- 
standing many points of contact, that disease differs from syphilis in 
man. Moreover, it is not proved that syphilis can be transmitted 
from the human race to animals. 

Gontrarily to Van Helmont, whose opinions as to the first origin 
of syphilis we have already made known, Hunter $ maintained that 
the syphihtic poison had its birth in the human species, and that no 
other animal but man was known which could be infected with it. 



* Bull, de VAcademie de mSdecine, Sept. 20tb, 1864. 

t See Vidaly Gaz. mSd, de VAlgerie, 1863. P. Gamier, Union mSdicale, 
1863. 

X Hunter, Treatise on the venereal disease, Boerhaave {TraitS de la 
maladie vSnSr, trad, fr., Paris, 1753) quotes from the Ephimiridea des 
curieux de la nature, that a dog perished on the spot from having 
swallowed the saliva of a person under treatment for syphilis. Swediaur 
{Traits des malad. syph,, Paris, 1801, p. 7) states that he has seen dogs 
affected with gonorrhoBa and ulcers on the penis, as well as stallions ; but 
there is nothing to prove that these affections were syphilitic. From the 
experiments he has performed, Tumbull concluded that neither dogs nor 
rabbits were susceptible of being affected by the syphilitic virus by 
inoculation. 



SYPHILIS IN ANIMALS. 369 

Turnbnll, Babington^ Ricord, de Castelnau,* and other observers 
have in vain sought to inoculate syphilis in animals. The question 
appeared finally settled when, in 1844, Auzias-Turenne succeeded 
in transmitting to a young ape ten or twelve perfectly well-marked 

chancres.f 

Let us take note of this case and let us observe that the number 
of chancres inoculated by no means proves that there was any trans- 
mission of constitutional syphilis. Experiments performed in 1845 
by Cullerier J led to the recognition of the fact that syphilis could 
not be transmitted to animals. Aurias-Tureune did not, however, 
consider himself defeated. It became necessary tp inquire whether 
the lesions asserted to have been transmitted from man to the ape 
were susceptible of being grafted afresh upon man. But, in 1850, 
Robert de Weltz § tried the experin^ent upon himself with pus taken 
from a sore developed upon an ape and upon a cat in consequence of 
inoculation from a human chancre. He made four inoculations 
upon his arms and prqduced chancres which developed themselves 
for some days and were then cauterised. In the following year, 
Diday || also inoculated successfully in a man the pusi proceeding 
from a chancre existing in a cat ; the results of these inoculations 
were soft chancres. Since that time, several experimeiiters have in 
vain attempted the iuQCulatipn of syphilis in animals, having been 
able to produce in them local lesions only. * Melchior Robert, 
having undertaken experiments in reference to this subject, never 
obtained constitutional manifestations. Maunoury,1[ whp intro- 
duced into the cellular tissue of rabbits fragments of indurated 
chancres taken from patients, did not succeed, any more tl^an 
Sigmund, of Vienna, in producing other thj^n local lesions. Bassej;, 
in more recent experiments, has arrived at the same results.*'^ 

* De Casteloau, Itecherches sur Vinoculation. Paris, 1841, p. 479. 

t CommunioatioDS to the Academy of Sciences and to the Acadei^y of 
Medicine. See Bulletin de VAcadimie de mSdecine. Paris, 1844, i. x. ^. 212. 

X Arch, ginir, de tii^rf., 4* 8§rie, t. viii. p. 54, 1845. Jules Davasse, 
Nouvelles experiences sur Vinoculation de la syphilis aux animaux {Ga%, 
des hdpitauXf March 6th, 1845). 

$ Ricord, Letters xv. and xvi. in, LeUres sur la syphilis^ Union mSd.t 
1850. Robert de Weltz, Deux rSponses d deux lettres de M, Ricord, &c* 
Paris, 1850. See also Gazette medicalef 1850, p. 544. Auzias-Turenne» 
ibid. p. 841. 

II Oaz, mSd. de Paris, 1851, p. 809. f Oaz. hebdomad., 1855, p. 548- 

** See RoUet, Recherches sur la syphilis, p. 11, 1861. 

bb 



370 APPENDIX. 

Do not these facts suffice to settle the question? It is allowable 
to think so. Since it was not possible, in any of the cases quoted^ 
to ascertain in the animals the existence of syphilitic manifestations^ 
there is naturally reason to believe that constitutional syphilis is not 
transmissible to them. But fresh researches appear necessary. One 
of my colleagues of the Biological Society, Dr. Legroes, has recently 
devoted himself to these researches. He failed entirely with two 
dogs and four rats which he inoculated with syphilitic chancres, but 
succeeded, on the contrary, with two guinea-pigs. One of these 
animals was devoured, after a short time, by a dog. As for the 
other, it died from the consequences of the infection produced by 
the operation which it had undergone. The following is its history : 
On the 1st of November, 1867, this animal received under the skin 
of the thigh a fragment of an indurated chancre taken from a 
patient three hours before the inoculation. During the iSrst few 
days nothing remarkable occurred. A fortnight later, there appeared 
an ulcer covered with a dry bluish crust which spread gradually. 
At the same time there was a fulness rather than induration of the 
base of the ulcer, and some of the glands in the groin were enlarged. 
On the 7th of December, this animal was presented to the Biological 
Society, where my colleagues and I recognised these various facts. 
The ulcer, covered with a dry, black crust, was almost as large as a 
two-franc piece. Two months after the inoculation, it certainly 
presented that diameter, and it was only a fortnight later when it 
began to cicatrise. But at that time the animal was emaciated and 
weak ; the hair began to fall off, the feet were the seat of small 
superficial erosions, which were not without analogy with those 
observed in pemphigus, and in the region of the groins were 
observed not only several small ulcers but also several cutaneous 
nodules and glandular tumours. These latter tumours were equally 
common wherever lymphatic glands existed. It was under these 
circumstances and after progressive wasting away that death took 
place spontaneously on the 17th of April, 1868. The animal was 
then sent to me and I made the post-mortem examination very care- 
fully. The appearances found were as follows : — The hair was com- 
paratively scanty; in the left flank, at the point of insertion of the 
hairs, was a deep round ulcer, involving the skin and even a part of 
the subjacent cellular tissue. The ulcer on the thigh was not 
entirely cicatrised ; on the feet were slight erosions. Most of the 
lymphatic glands of both groins presented important modifications. 



SYPHILIS IN ANIMALS. 371 

They were larger than natural and at the same time very hard^ and 
connected with each other by unchanged conjunctive tissue. They 
formed on each side an elongated chaplet from four to five centi- 
meters in length ; their substance was dry, whitish, of firm consist- 
ence, and homogeneoas. The lumbar glands, those surrounding 
the trunk of the coeliac artery especially, formed, by their accumula- 
tion, very resistent masses ; nevertheless, they presented the charac- 
ters of the inguinal glands, that is to say, extreme hardness and a 
slight increase of volume. The lymphatic glands of the posterior 
cervical region were also changed, as were several of the sub- 
maxillary and axillary glands. Microscopical examination revealed 
an abundant proliferation of the qonjunctive elements of these 
glands. In the thickened web were found small groups or masses 
of nuclear and cellular elements of new formation ; the lymphatic 
elements had partly disappeared. In the flanks, near the anus, were 
seen three small rounded tumours, of the size of a cherry-stone, 
situated in the deeper layers of the dermis and in the adipose cellular 
tissue. These tumours were greyish, firm at their circumference, 
but softened at their centres. They bore a striking resemblance to 
the gummy tumours observed in man. The muscles and the bones 
were, like the articulations, intact, On the surface of the left tunica 
vaginalis were seen six or eight white, miliary patches. In the globus 
major and testicle there existed a rounded tumour of the size of a large 
pea, very firm and of a greyish colour ; at the centre of this tumour 
was found a point of softening, consisting in a white, lactescent 
fluid formed of molecular granules, fatty granulations, and granular 
cells, while the hard portion presented nuclei and small round cells 
in a thin web of connective tissue. At the sternal extremity of one 
of the ribs an enlargement having at its centre a small, white, dry, 
and granular mass. The kidneys and supra^renal capsules were 
mottled and injected, without any other appreciable change. The 
hard and greatly enlarged bronchial glands compressed the trachea 
at its termination. The lungs were everywhere congested, had a 
fleshy appearance, and presented on their surface several small, 
whitish protuberances. On section they appeared mottled, with 
disseminated greyish nuclei, as is the case in the form of pneumonia 
peculiar to syphilitic new-bom children. The heart did not present 
anything special. On the middle portion of the spleen was a slight 
transverse depression, in the vicinity of which were seen small 
infarctus of blood. In the lower third of the organ was an elon- 

662 



372 APPENDIX, 

gatedj yellowish infarctus. The glands situated in the course of the 
hepatic vessels were indurated and enlarged. The liver also was enlarged 
and presented^ on its concave surface, and towards the left lobe, three 
slight depressions, each of which was about a centimeter in length ; 
the convex surface of this organ was uneven, knobby, and as it were 
puffy at some points. At these same points there was a yellow 
colour and evident indaration ; on section, there was seen a yellow 
tissue studded with greyish points, upon a yellow and mottled floor. 
Thin shoes of the organ examined under the microscope showed the 
existence at the periphery of some of the lobules, of small islets or 
masses of round nuclei and of young cells. The bladder contained 
a compact, white substance, placed upon a pedicle, which was pro- 
longed into the canal of the ureter. Under the microscope, this 
substance was seen to be composed of greyish, molecular granula- 
tions endowed with motion. 

The importance of this case will be evident to every one. The 
infection is positive, and doubt can exist only as to its syphilitic 
character. An absolute certainty on this point cannot be attained 
unless, by the aid of the morbid products furnished by the animal 
infected, syphilis were transmitted to man. The responsibility of 
such an attempt is so evident that it will easily be understood that 
neither Dr. Legroes nor I were willing to assume it. Nevertheless, 
in its actual state, this case, by reason of its peculiar evolution and 
of the lesions discovered at the post-mortem examination^ appears 
to me fitted to shake the conviction of those who assert that syphilis 
is not transmissible to animals. For my own part, I am inclined to 
believe in this transmissibility, at least in certain species of animals. 

Although better proved, the communication of soft chancre to 
animals has also not yet been sufficiently studied. In fact, experi- 
menters have succeeded, in some cases, in inoculating non-specific 
pus and in producing lesions analogous to those produced in animals 
by chancrous inoculation. Lichtenstein"^ affirms that lymph taken 
from the pustules produced by frictions with tartarised antimony is 
inoculable, and Dr. A. Bienzi asserts that he succeeded in inocu- 
lating simple ecthyma and the pus of leech-bites. But, after these 
experiments, we ask ourselves whether any pus might not produce 
the same effects, and it is allowable to retain some doubt as to the 
reaUty of the transmission of soft chancres from man to animals. 

■- - ■ — — ■ - — 

* Journal de Huf eland. 



SYPHILIS IN ANIMALS. 373 

In a recent discussion, which took place before the Academy of 
Medicine, the question of syphilis in animals was discussed. Dr. 
Vernois * quoted a case tending to establish the transmissibility of 
syphilis from man to animals. A cat which was accustomed to eat 
lint impregnated with sanious and purulent matter of chancres, 
mucous patches, and venereal ulcers of patients in the Hospital du 
Midi, sank under syphilitic cachexia, after having for a long time 
presented on its lips and in its throat characteristic ulcers. At the 
post-mortem examination several of the bones were found to be 
affected with periostosis, exostosis, and caries. But, not only is this 
case single, it is not even entirely irreproachable, as Ricord and 
Velpeau have not failed to show.f In reference to this subject, 
moreover, the eminent surgeon of the Hospital de la Charity reminds 
us that he had in vain attempted with Bretonneau, in 1817 and 181 8, 
to inoculate all the purulent matters produced by syphilitic lesions 
in dogs, sheep, and rabbits. M. Leblanc, for his part, points out 
that he watched for years animals he had inoculated with syphilis 
without the least vestige of a manifestation having shown itself* M. 
Depaul, however, announced that he had seen cases of transmission 
of syphilis from man to the ape, and even to animals of other species. 
The question is not settled ; but it cannot be doubted that animals 
are a soil very ill adapted to the development of syphilis ; and if it 
be true that this disease may germinate in their organisms, it soon 
dies out in situ. True syphilis, that which we have been following 
through all its phases, is then, to sum up, the melancholy appanage 
of humanity. 

* See Bulletin de VAcad, de mid., Sept. 14tli, 1864. 
t Transmission de la syphilis de Vhomme attx animaux. Bulletin de 
VAcad, de mid,, Sept. 20th, 1864. 



INDEX. 



1. 



- i. 295, 

- i. 153, 
247, i. 344, 



Adenopathies, secondary - 
iBtiology of syphilis - 
Africa, syphilis in 
Albuminuria 
Alibebt, syphiUde 
AlopsDcia - 
Amaurosis 
Amboyna pimple 
America, syphilis in - 
Angina - - - - 
Animals, syphilis in - 
Aphasia . - . . 
Arsenic, use of - 
Arsenite of copper, ulcers from 
Arteries, affections of 
Asia, syphilis in - - 



i. 180 

ii. 208 

i. 53 

ii. 77 

i. 136 

i. 217 

ii. 109 

i. 38 

i. 57 

i. 161 

ii. 363 

ii. 45 

ii. 299 

i. 119 

i. 400 

i. 49 



Badeb, choroiditis - - - i. 200 
Bello8tb*8 pills - - - ii. 313 
BiBTT, syphilides - - - i; 136 
Blood, changes in (acquired) i. 17, i. 380 

changes in (hereditary) - ii. 165 

contagion of, in syphilis - ii. 230 

BoBCK, on syphilisation - - ii. 346 
Bones, affections of - - i. 188, i. 233 
Brass, use of - - - - ii. 298 
Brain, afiections of, cases of i. 344, ii. 67 
■ affection of, case of - - i. 344 

affections of, albuminuria in ii. 77 

affections of, diabdtes in 

gummy tumours of - 

inflammation of - 

membranes of, affections of 

Breast, affections of - 
Bribtowb, case of cyst of brain 



■ • 

II. 

• • 

u. 

« • 

11. 

• « 

11. 



Bronchitis 

ulcerative - 

Brvnn, epidemic 
Bubo 



72 
52 
48 
38 
i. 227 
ii. 57 
-i. 161,ii. 12 

- ii. 12 

- i. 29 

- i. 108 



Carotid artery, obliteration of - ii. 39 



Cauterisation in period of incubation 

ii. 304 
Cazenaye, pills of - - - ii. 316 

on diseases of nails -^ - i. 159 

incubation of syphilis - i. 68 

Cephalalgia, localised - - ii. 45 
Cerebellum, affections of, symptoms of 

ii. 71 

membranes of, gummy tumour of 

ii. 44 
Cerebral softening . . - 
Chancre, absence of - 
diphtheritic condition of 

— diy papule form of 

extra genital, frequency of - 

frequency of (relative) 

from secondary syphilis 

gangrene of - - - 

indurated (Bibliography) - 

indurated, results of irritation of 

in medico-legal aspect 

larvated - - - - 

not self 'inoculable 

— phagadsBuic - - - 

— and rupia - - - - 

significance of - 

simulated by other affections 

soft ----- 

followed by syphilis - 

treatment of - - - 

uretheral - - - - 

varieties of - - - 

Chancrous erosion ... 
China, syphilis in - - • 
Chorea following hemiplegia 
Choroiditis in acquired syphilis - 

in hereditary syphilis 

Cirrhosis of liver . - - 
Condylomata in acquired disease- 
in hereditary disease - 



« • 

11. 


49 




93 




102 




81 




87 




99 


ii. 


250 




101 




74 


I of 


s 


• 

1. 


89 


• • 

11. 


355 


• 

1. 


86 


• 

1. 


86 


• 

1. 


101 


• 

1. 


212 


• 

1. 


73 


• 

1. 


119 


• 

1. 


95 


• 

1. 


103 


• • 

11. 


304 


« 

1. 


86 


i. 


79 


• 

1. 


82 


i. 


8 


• • 

11. 


67 


• 

1. 


200 


ii. 


170 


• 

I. 


332 


i. 


172 


• • 

u. 


140 



376 



INDEX. 



Congenital («m Hereditary) 

Connectiye tiMoe, affsciions of - i. 219 

Contagion, modes of - - - ii. 229 

sommary of foots of - - ii. 252 

Copper, anenite of, nloers from - i. 119 

Cornea, lesions of - - - ii. 109 

Coryza in hereditary syphilis - ii. 147 

Cullbbisb's pills - - - ii. 315 

CuBLiNO on orchitis, &o, - • i. 273 

Cysts, probably g^ummy tomonrs ii. 66 

Day A88B, muooas patches - - i. 174 
Deafness - - ii, 27, ii. Ill, ii, 171 
Deyelopment, arrest of, with hereditary 
syphilis (case) - - - ii. 27 
Dbtillb, mucous patches - - i. 174 

Diabetes ..-.-' "• 72 

DiDAT, incubation of syphilis - L 72 

— change of voice - - - i. 166 
Diet in syphilis - - ii. 335, 340 

Diphtheritic condition of chancres i. 102 

Duality of syphilis - - - i. 103 

Dufuttbbn's pills - * - ii. 315 

Dura mater, lesions of - » ii. 38 

Ear affections of • - - ii. Ill 

Ecthyma i. 210 

EncephalitiB - - - - ii. 41 
Epidemics - - - i. 25, 29 

Epilepsy^ syphilitic, distinct from true 

ii. 46 
Epileptic oonvulsionB with tumour of 

dura mater - - - - ii. 39 
Eruption, local, of syphilis - i. 74 
Erythematous syphilides - - i. 139 
Europe, distribution of syphilis in i. 45 
Exophthalmos, case of - - ii. 101 
Exostosis of sphenoid, &c., causing 

amaurosis - - - - i. 247 
Eye, afEisctions of (acquired) - i. 195 

— in hereditary disease 

ii. 27, ii. 168 
Eyeball, protrusion of - - ii. 101 
Eyelids, lesions of - - - ii. 107 

Face, paralysis of, {tee Nerve) 

Fever, syphiUtic - - - i. 125 

Fingers, affections of - - - i. 271 

Fracture, spontaneous - - i. 243 

Framboesia- - - - - i. 30 

French disease, the - - - i. 21 

Fumigations, use of - -. - ii. 311 

Gangrene with chancre - - i. 91 
Oeb, spleen in hereditary syphilis ii. 153 



Gibbbt*b syrup - - - ii. 316 
Glanders, afiiactions of trachea in ii. 15 
Gland, thymus affections of - ii. 154 

thyroid affections of - i. 377, ii. 76 

Glands, bronchial, affection of in here- 
ditary syphilis - - - ii. 164 

— cervical posterior - - i. 180 

intestinal - - - -1.321 

•^— gruphatic, changes in - - i. 378 
■ ■ ■■ salivary • - - - i. 322 
Gonorrhoea - - - - i. 92 
Greeks, syphilis among the - i. 10 
Growth, airest of, in hereditary syphilis 

ii. 29 
Guaiacum, use of - - - ii. 286 
GuBLEB, affections of liver in here- 
ditary syphilis - - - ii. 151 
Gummous tumours - - - i. 220 

of bones - - - - i. 237 

of brain - - - - ii. 52 

of dura mater - - - i. 39 

of fingers - - - - i. 271 

of joints - - - - i. 251 

in muscles of larynx - - ii. 2 

of liver - - - - i. 338 

• of lungs - - - - ii. 19 

— of muscles - - - - i. 265 

of testis - - - - i. 274 

— ^ of tongue - • - - L 306 

Heart, affections of - - i. 335, 385 
Hemiplegia - « - ii. 55, 60 
Hereditariness of syphilis, physiology 

of ii. 263 

Hereditary syphilis, authors on - ii. 132 

cases of - - - 

affections of eyes in - 

affections of liver in - 

affections of lungs in - 

affections of nerves in 

affections of skin in - 

affections of testis in • 

— arrest of development in 

effusion of blood in - 

-~~- period of appearance - 
■ symptoms of - - 

■ treatment of - - 
Herpes syphiliticus - 
HuNTEB, inoculation with gonorrhceal 

pus i. 92 

phases of syphilis - - i. 66 

HuTcuiNsoK, affection of bronchial 
glands in hereditary syphilis - ii. 154 

hereditary syphilitic ophthalmia 

ii. 168 



- ii. 177 

- ii. 168 
ii. 84, 151 

- u. 167 

- ii. 162 

- U. 139 

- ii. 149 

- ii. 27 

- ii. 166 

- ii. 136 

- ii. 174 

- ii. 324 

- i. 147 



INDEX. 



377 



Hutchinson, tnmour of spinal cord 

ii. 162 

pericardinm filled with blood ii. 156 

Hydrocephalus in hereditary syphilis 

ii. 162 

Hygiene, authors on, list of - ii. 269 

Icterus - - - - i. 182, 361 
Impetigo ----- i. 210 
Incubation of syphilis - - i. 68 

case of prolonged - - 1. 71 

cauterisation in period of - ii. 304 

India, syphilis in - - - i. 8 

Infection, cases of double - - ii. 125 

Inoculation, absence of pustule of, in 

small-pox - - - - i. 94 

— from child (case) - * ii. 26 

— with gonorrhoeal pus - - i. 92 
Intestines, affections of - i. 164, dl4 
Inunction of mercury, use of - ii. 311 
Iodine, use of - - - - ii. 299 

in tertiary affections - - ii. 319 

Iritis i.i96 

appearance of, while patient under 

influence of mercury - - ii. 335 
in hereditary syphilis - ii. 168 



Jaundice - - - 
Jews, syphilis among the 
Joints, lesions of 



i. 361, i. 182 

- i. 10 

- i. 251 



Keratites, hereditary syphilitic 

ii. 109, 168 
Kidneys, affections of - i. 294, ii. 77 

Lachrymal ducts, lesions of - ii. 105 
Labbet's syrup - - - ii. 315 
Larynx, affections of - i. 166, I7I9 248 

character of changes in - ii. 8 

conglomata in - - - i. 177 

list of authors on - - ii. 1 

Latent syphilis - - - - ii. 119 
Lee (H.), inoculation with pus from 

indurated chancre - - - i. 89 

inoculation of chancres - i. 105 

inoculation of syphilitic subject with 

common pus - - - - i. 106 
Legal medidne - - - - ii. 352 
Lepra, confounded with syphilis - i. 20 
Leprosy and syphilis - - - ii. 197 
Liver, affections of (acquired) i. 253, 278 

302, 327, 330, 335, 397 

affections of, in hereditary syphilis 

ii. 29, 76, 84, 151 
-'— acute yellow atrophy of - i. 358 



Liver, amyloid condition of - i. 357 
Lungs, affections of, authors on - ii. 16 

cicatrices of - - - ii. 20 

gummy tumours of - - ii. 19 

affections of, in hereditary syphilis 

ii. 157 

Mamma,, affections of - - i. 227 
Menstruation, arrest of, with hereditary 

ii. 27 
ii. 291 
ii. 316 
ii. 329 
ii. 306 
ii. 327 
ii. 310 
ii. 322 



syphilis - - . . 

Mercury, use of - 

iodide of, administration of 

physiological effects of 

— '— in treatment of chancre 
— r- in hereditary syphilis - 

in period of eruptions - 

— =— in tertiary affections - 
Microcephalism in hereditary syphilis 

ii. 177 

Milk, contagion by the - - ii. 236 

' nature of in syphilis - - ii. 226 

Mineral waters, use of - - ii. 336 
Mucous membranes, affections of i. 161 
Mucous patches (acquired) - - i. L72 
■■ hereditary - - - - ii. 140 



Muscles, affdctions of 
Myelitis, case of 



- i. 188, i. 263 
- u. 90 



Nails, diseases of (acquired) - i. 157 
affections of, in hereditary syphilis 

ii. 146 
Nerve auditory, affections of - ii. 116 

facial affections of - i. 195 

fifth, affections of - ii. 92, ii. 98 

— '— fourth, affections of - - ii. 94 
' glosso-pharyngeal, affections 

ii. 97 

ninth, affections of - - ii. 97 

olfactory, affections of - ii. 92 

optic, affections of - ii. 92, ii. 109 

— ^ pneumogastrio affections of ii. 97 

seventh, affections of - - ii. 96 

sixth, affections of - - ii. 95 

splanchial, affections of - ii. 102 

third, affections of - ii. 92, 93 

Nerves, affections of, in hereditary syphilis 

ii. 162 

spinal, affections of - - ii. 99 

Nervous system, affections of, authors 
on - - - - - - ii. 36 

Neuralgia - - - ii. 100 i. 193 

Nodes, of bones - - - i. 233 

of cranium (internal) - ii. 38 

in cellular tissue - - i. 220 



Oceania, syphilis in - 



i. 62 



378 



INDEX. 



(Etophagat, aflbetioni of - - i. 311 
Olhciory apparatus, ohasgea in ii. 102 
OnTzia acquired - - i. 167 i. 218 
-^— hereditary - - - - ii. 146 
Ophthalmia syphilitio - - i. 195 
Opium, use of - . - . ii. 290 
Optio neryes, leaioDB of - - ii. 109 

Orchitis i. 273 

Ovariea, affections of - ii. 20, i. 282 

Ovum, lesions of layers of - - ii. 172 
Ozosna - - - - - iL 102 

Palate, affections of - - i. 215, 304 

Panaris L 271 

Pancreas, affections of - - i. 324 
Papular syphilide . . . L 142 
Paralysis, general - - - ii. 64 
-^— of nerves (see Nerves) 
Pabb Ambrose, syphilitic fever - i. 135 
Paronychia syphilitica - - i. 159 
Pemphigus, hereditary - - ii. 143 
Pericardium, affBotions of 1. 384, ii. 156 
Peritoneum, affections of (acquired) i. 325 

affections of inherited syphilis ii. 150 

Phagedsamio chancre - - - i. 91 
Pharynx, ulcers of - - - i. 169 
Phthisis, influence of syphilis in producing 

iL187 
Pian . . . . i. 30,38 

Pituitary body, affections of - i. 376 
Pityriasis ----- i. 156 
Platinum, use of - - - iL 298 
Plica Polonica - - - - i. 217 
Pneumonia, syphilitio, cases of ii, 18, 25 
Pons Varolii, softening of - - ii. 50 
Potassium, iodide of, use of ii. 66, 61, 299 

in long affections - •» ii. 33 

in neuralgia - - - i. 193 

•— ^ in tertiary affections - - ii. 319 
— physiological effects of - ii. 329 
Pregnancy, specific treatment during 

ii. 325 
Prevention of syphilis - - ii. 269 
Prophylaxis - - - - ii. 269 
Psoriasis - - . - 1. 151 

PucHE's synip - - - - ii. 315 
Pustular syphilide - - > i. 145 

Badestoe - - - - i. 134 
Bayer, ulcerating tubercles - i. 214 
Betina, lesions of - i. 202, ii. 109 

Bhinitis ii. 202 

BicoBD, inoculation of gonorrhoea! pus 

i. 92 
phases of syphilis - - i. 66 



BiooBD, pills of ... ii. 816 
BoBBBT (Melchiob), ou chancro i. 102 

Bomans, syphilis among the - i. 10 

Boseola, Mercurial - . - - i. 142 

syphilitic - - - - i. 139 

in hereditary syphilis - ii. 139 

Bupia i. 210 

Saint Euphemia, disease of - i. 138 
Saint Paul's Bay, disease of - i. 40 
Salivary glands, affections of - i. 322 
Sedillot's pills - - - ii. 314 
Semen, syphilitic ^ - - ii. 228 
SiBBEys - - - - - i. 34 
SUva, use of - - - * - ii. 298 
Small-pox, absence of pustule of inocula- 
tion in - - - i. ' 94 
Spedalsked - - - - i. 36 
Skin, affections of - - - ii. 139 

hereditary - - - ii. 139 

Spinal cord, affections of - - ii. 83 
-- — tumour of, in inherited syphilis 

ii. 162 

Spleen, affections of - - - i. 377 

hereditary syphilis - - ii. 153 

Squamous syphilides - - - i. 149 

Stomach, affections of- - - L 314 

Struma and syphilis - - - ii. 129 

Suckling, contagion by - - ii. 235 

Supra-renal capsules, affection of i. 377 

— hereditary syphilis in - ii. 164 

SwEDiAUB, syphilitic fever - i. 126 

Swieten'b (Van) drops - - ii. 314 
Synonyms of syphilis - i. page iii 
Syphilides - - - - i. 209 

bibliography of - - - i. 134 

Syphilisation, authors on - - ii. 343 

Syphilis, in animals - - - ii. 363 

determining causes of - ii. 259 

definition of - - - i. 64 

duality of - - - - ii. 103 

gruptive stage of - - i. 135 

evolution of - - - ii. 119 

false, local - - - i. 96 

general diagnosis of - - ii. 191 

— — geographical distribution of i. '45 

hereditary (see Hereditary) 

history of - - - - i. 1 

incubation - - - i. 69 

infiuence of on other diseases ii. 184 

infiuence of treatment on - ii. 123 

latent condition of - - ii. 119 

medico-legal aspect of ' ii. 362 

poison of, on the - - ii. 208 

•^— prevention of - - - ii. 1269 



INDEX. 



379 



SyphiliB, primary, conditions simnlating 

i. 119 

prognosis of - - - ii. 203 

stages of - . - - - i. 66 

synonyms of - - i. page iii 

tertiary - - - - i. 206 

transmission of - - ii. 223, 250 

treatment of - - - ii. 283 

treatment of, period of eruption 

ii. 310 
^— > treatment of, period of incubation 

ii. 304 
•— — treatment of tertiary affections ii. 319 

unity of - - - - i. 103 

varieties of - - - ii. 179 

— — without chancre - - i^ 193 

Tabdibu, affections of trachea in glan- 
ders - - - - - iii 15 
Testis, affiBctions of i. 192, 273, 349, ii. 149 
Thymus gland, in hereditary syphilis 

ii. 154 
Thyroid, affections of - ii. 76, i; 377 

changes in - - - ii. 76 

Tongue, gummy tumours of - i 306 
Trachea, affections of, authors on ii. 8 

affections of, in glanders - ii. 15 

Treatment ^ - - - - ii. 283 

hereditary syphilis - - ii. 324 

— - new-bom child - - ii. 325 

— of period of eruption - - ii. 310 



Treatment, of pregnant women - ii. 325 

of tertiary affections - - ii. 319 

■ summary as to - - - ii. 350 
Tubercular syphilide - i. 142, 212 

Tubercles in hereditary syphilis - ii. 145 
Tumours, gummous (see Gummous) 

TuBOK, affections of lamyx - ii. 5 

"Ulcers, superficial, of larynx - i. 169 

Unity of syphiUs . - - i. 103 

Urethra, affections of - - i. 293 

Urine, albumen in - - - ii. 77 

increase in quantity - - ii. 74 

sugar in - - • - ii. 72 

Uterus, affections of - - - i. 389 
case of inherited syphilis - ii. 29 



Vaccination^ contagion by - 
—. — influence of - - 
Veins, affections of - 
Vesicular, syphilide - 
ViRCHOW, gummous tumours 
-: — stages of syphilis 
Vitreous, affections of 
Voice, change of 



ii. 238 

ii. 349 

i. 404 

i. 147 

i. 221 

- i. 66 

- i. 200 
- i. 166, i. 177 



Warts - - - - - 1.179 
Water cure - - - ii. 335, 339 
WiLKfl, case of paraplegia - ii. 85 

syphilitic tumours of larynx ii. 4 

idBfections of trachea - - ii. 10 



WiTBON fr Ha£eli., Printers, London and Aylesbnrjr. 



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