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other vegetables, our observations have notyet led to certainty, or to such generallaws as may serve to us as guides on alloccasions.

CLINICAL

LECTURES AND REMARKS,DELIVERED ON

DISEASES OF THE SKIN, VENEREALDISEASES, AND

SURGICAL CASES,AT THE

SKIN INFIRMARY, AND AT THE JERVIS-STREET HOSPITAL, DUBLIN.

BY DR. WALLACE,SURGEON TO THOSE INSTITUTIONS.

Experiments with the venereal poison, contimt-ed.—Statement of objects to be consideredin the present lectures.—Experiments withthe matter of the primary pustule.—FIRSTEXPERIMENT :-C. D. inoculated with thematter of a primary pustular sore.-Resultsand Remarks.—SECOND EXPERIMENT:—JI. M. inoculated with the matter of a pri-mary pustule.—The nitrate of silrer applied.-Results, local and constitutional.-Re-marks.—Experiments with the matter of thepustular bubo.—FIRST EXPERIMENT:—J. F.inoculated with the matter contained in abubo.-Further trials with "the nitrate ofsilver.—Results, local and constitutional.-SECOND EXPERIMENT:—L. M. inoculatedwith the matter of an ulceruted bubo.—Fur-ther trials with the nitrate of silvei.—Re-sults.-Rerna-rks. —Experiments with thematter of the constitutional pustule.—FIRSTEXPERIMENT :-P. M. inoculated with thematter of a constitutional pustule. Localand constitutional effects.—SECOND EXPE-RIMENT :-J. M. inoculated with the matterof a constitutional pustule.—Results, localand genéral.—Conclusion, with a surrunaryof seve1’al important points.

(LECTURE XXIII., ON SYPHILIS.)CwrNTLFMEN :-In my last lecture on the

venereal disease I made you acquaintedwith the details of certain experimentswhich demonstrate that the secretions of theexanthematic form of syphilis are infectious,and that the disease which they induce isexanthematic. This morning I propose tomake you acquainted with other experi-ments from which you will observe we areauthorized to conclude :-

1st. That the secretions of the primarysyphilitic pustule are infectious, and propa-gate a similar pustule.

2nd. That the secretions of a bubo, which

accompanies or immediately follows the pri-mary syphilitic pustule, are infectious, andpropagate a similar pustule.

3rd. That the secretions of the constitu-tional syphilitic pustule are infectious, andpropagate the exanthematic form of syphilis.As time will not permit me to review more

than two experiments under each of theseheads, I must premise that, although theyare sufficient to demonstrate the truth of thepositions just stated, they are only a smallproportion of those made by me during theinvestigation of those important points. Ishall now read you the reports of the

FIRST EXPERIMENT WITH THE SECRETIONS OF

THE PRIMARY PUSTULE.

" January 17, 1834. Tlzree punctureswere made in a perpendicular line, at alittle distance from each other, on the frontand inner part of the thigh of C. D., a heal-thy man, aged 22 years. Each puncture wasthen touched with matter taken from a pri-mary pustular sore. (The sore which furnish-ed the matter was seated on the inner surfaceof the prepuce of a man otherwise healthy,had existed about twelve days, and was gra-nulating in its centre, but ulcerating at itscircumference.)

" January 18. The punctured spots seem alittle inflamed, and seem tumid under theend of the finger.

" JoKMary 20. The spots are more inflaan-ed, and in the centre of each there is a blackraised point surrounded by a whitish line,and this by an areola; hence each spotforms a distinct pustule, but their areolee areso close that they nearly coalesce. (Here isa drawing which represents these appear-atices.)" January 22. He says that the inoculat.

ed spots are very painful. Their areolas aremore extended. The top has been rubbedoff the upper pustule, and a cupped ulcer,the size of a small pea, is exposed. The

tops of the other pustules are more flat thanthey were, and are covered with a thin yel-low scab." January 23. The ulcer is now covered

with a thick but depressed crust, and theother crusts are larger than they were yes-terday.

" January 24. The spots are not so sore,but the discharge secreted by them is in suchquantity as to soften their crusts, and parti-ally to detach them. The cuticle is sepa-rated from the margins of their areola, andlies white and collapsed, like the cuticle atthe circumference of a ruptured bulla." JaHMary 25. The extent of the spots

has increased. The cuticle of the areola ofone of them is desquamating; and that ofthe areolar margins of the others still lies

collapsed. The crusts are depressed, of adark colour, and irregular form." January 27. The crusts are still darker

in colour, irregularly depressed in their

616

middle, yet, on the whole, raised above thesurrounding skin. The areolae of all aredesquamating, and appear more tumid orraised, and more diffuse. There is a littlehardness felt on grasping the base of eachspot, and they are all less sore than theywere.

January 29. The spots have the same

general appearance, but their crusts are

larger, and their desquamatiom more marked." February 1. The areolæ are more livid.

Their desquamation is not so obvious, andthe crusts are depressed below the level ofthe areolar margins.

" February 4. The spots are nearly un-covered ulcers ; for their discharge is so

copious that the formation of crusts is pre-vented. The colour of their areolæ is stillmore livid. To be covered with simpledressing.

" February 5. The crusts have been re-moved by the application of the simpledressing, and the spots are-easier than be-fore it was applied. The surfaces exposedare excavated, but very irregular, and tu-bercular-shaped granulations are rising fromthe upper one ; the margins of all are morewhite than their middle parts ; their edgesare red, and their areolæ very tumid. (Hereis a drawing which represents all these cha-racters.)

11 Febi-?tctry 8. The appearance of thespots is the same as on the 5th, with the ex-ception of a slight increase of tumidity oftheir areolar margins.

" February 10. The surfaces of all theulcers are nearly on a level with the soundskin, although not so high as the margins oftheir areolæ to which the surrounding tumi-dity is nearly confined. The granulations,which have filled up the ulcers, are large,or of a tubercular form, and of a dirty ordingy-white colour. (See these drawings.)

" February 11. The edge of the upperulcer seems a little undermined, and thetumidity of the areolar margins of them allis increased.

" February 15. The ulcers are but littlealtered since the last report. Their granula-tions are, however, rather more red; their iareolar margins more tumid, and still higherthan their surfaces, although these latter arefully as high as the surrounding skin." February 17. The ulcers are less regu-

larly rounded, and lage or tuberculatedgranulations cover their surfaces, which arestill whitish at their circumference.

" February 19. The tubercular form of Ithe granulations on the surfaces of theulcers, and the elevation of their areolarmargins, are still more marked.

"February 2;5. The tumidity of the basis Iof the ulcers is greatly increased, and hencethey appear larger or fuller ; their surfaces, as well as their areolar margins, are consider-ably raised above the level of the surround- , ing skin; the two superior sores seem to be .

closing in, but their granulations are still ofa tubercular form.

" March 2. The uppermost of the ulcersis nearly healed, and the cicatrix which ithas formed is raised and tubercular-looking;the tumidity surrounding the two lowerulcers has disappeared, except immediatelyoutside their edge, or under their areolarmargins ; hence this point rises so abruptlyas to form a ring almost a quarter of an inchhigher than the level of the skin; their sm-faces, which are also raised considerablyabove the surrounding skin, are contractingfrom their circumference to their centre." March 4. The cicatrix of the healed

ulcer is still raised and tubercular-looking ;the two other ulcers are contracting andshining, but their surfaces and areolar mar.gins are greatly raised.

" March 6. The middle ulcer is healed,but its cicatrix is raised and irregular; thecicatrix of the superior ulcer has sunkalmost to a level with the surrounding skin ;the inferior ulcer is covered by a dark crust.

" March 10. All the ulcers are healed."Remarks.—From the 17th of January,

when the inoculation was performed, to thel0th of March, when the ulcers were healed,both days inclusive, are 53 days. This ismore than the average time required by theprimary syphilitic pustule to run its courseand cicatrize. Neverthess, such of you asare acquainted with the characters of thispustule, as laid down by me in a formerlecture (see LAKCET, No. 673), will at oncedetect their delineation in the reports whichI have just read. The erythematous, orpapular spot; the fully-formed pustule ; theexcavated or cupped ulcer ; the tumid mar-gin ; the fungous surface, and the subsequentcicatrix, all of which characterise the origin,progress, and termination of this pustule,are accurately described, and leave no doubtof the nature of the disease which supervenedon the inoculation, although that diseasewas not followed by constitutional symp-toms. I shall now read you the reports ofthe

SECOND EXPERIMENT WITH THE MATTER OF

THE PRIMARY PUSTULE.

" August 6, 1831. I made two punctureson the anterior and inner part of the thigh ofM. M., a healthy man, aged 22 years, andinserted into them matter taken from a pri-mary pustular sore. The individual whofurnished this matter had a plurality of

pustular sores, some seated on the glanspenis, and some on the inner surface of theprepuce. The oldest had been a month inexistence, but the one from which the matterwas taken was in its first stage, and wasseated on the inner surface of the prepuce.The man was otherwise healthy."August 8. The punctures have caused

inflammation; the middle of each inflamedspot is raised and yellow, or purulent-

617

looking, with a dark point in its centre, cor-responding to the point punctured ; in fact,each spot forms a pustule, with a deep base.On removing the top of one of these pustules,a small cupped yellowish white ulcer, witha sharp edge, is exposed. The nitrate of

silver was applied to this ulcer so as to causeits surface to assume a dingy ash, and itsedge a black colour. (Here is a drawing ofthese appearances.)

" August 10. The spot to which the iii-trate of silver was applied, seems to havedied away. The other is covered with a

brown crust, slightly depressed in its niid-

dle, yellow at its circumference, and sur-rounded by an inflamed areola. On remov.ing this crust an ulcer is exposed, having thesame characters as the one to which thenitrate of silver was applied. This sore wasnow covered with adhesive plaster.

" August 12. The sore, to which the nitrateof silver was applied, is nearly healed. Thereis neither hardness of base nor of areola:but the one which was covered with adhe-sive plaster is whitish niid flat, its borderperpendicular, and whiter than its generalsurface. Its edge is sharp, and very slightlypunctulated, its base tumid, and its areolarmargin somewhat rounded." August 14. The sore, to which the ni-

trate of silver was applied, is quite well.The areolar margin of the other is more

tumid ; the extent of its surface is increas-ed ; and there is a faint appearance of in-

cipient granulation." August 16. The surface of the sore con-

tinues flat, but its areolar margin is moreraised."August 21. The areolar margin is still

more raised, and is of a brown-red colour.The surrounding redness does not extendbeyond this margin. The surface of theulcer is above the level of the sound skin,and is of a whitish-yellow colour, brokennp by reddish points, rounded and raisedhigher than the yellow ground. In some

parts this surface seems to pass under theedge and areolar margin. There is an ap-pearance of incipient desquamation of theareola." August 28. The surface of the ulcer is

covered by large granulations, but it hasnot risen to a level with its areolar margin.Its edge has still a white and nibbled as-pect. Its areolar margin is of a deep red-brown colour, and dies off into the surround-ing parts.

" September 4. The sore is healed. Thecicatrix is raised, irregular, scruffy, andlivid, and its middle is not so high as its cir-cumference." October 28. He complains of pain iu his

throat, and when asked where the uneasi-ness is seated, he points to the region of theright sub-maxiliary gland. On examina-tion, the mucous membrane of the isthmus ofhis fauces appears red and tumid, and his

tonsils enlarged. There is an eruptionpretty much confined to his forehead, arms,thighs, and hips. The spots which composeit have, for the most part, white sphericaltops, or centres, containing matter, and sur-rounded by a diffused areola. There are,also, red spots slightly raised in their cen-tres, and others without elevation. Lastly,there are some spots of a more purplishcolour, which present in their centre a flat,or sunk, little crust. He has no pains, norhas he had any. Habeat pil. cal. c., tart.em. ij. ter die.

‘ September 14. His mouth has beenslightly affected for a week; the small pus-tules have shrunk ; no fresh ones have ap-peared. He has neither sore throat norpains. The cicatrixes of the inoculatedspots remain slightly hard, but haveshrunk."

Remarks,—Mercurial action was kept upfor nearly three weeks after this report,and all hardness of cicatrix had then sub- -sided.Of the two pustules produced by inocu.

‘

lation in this case, one was treated with thenitrate of silver, and the other permitted topursue an undisturbed course. The formerwell illustrated the remarkable power whichthis salt possesses, when applied as anescharotic, and at an early stage, of arrest-ing the progress of the primary syphiliticpustule. In the reports of the other pus-tule you find all the characters of this formof primary venereal disease well delineated.Observe, that the period which it occupiedin running its course was much shorter thanthat occupied by the pustules in the case ofC. D., and the secondary symptoms whichfollowed, although mild, were clearly pus-ttilar.The experiments, of which I have now

read you the reports, are quite suflicient toestablish the infectious quality of the secre-tions of the primary pustule.

I shall next read to you the reports ofthe

FIRST EXPERIMENT WITH THE SECRETIONS OF

THE PUSTULAR BUBO.

" March 3, 1825. I made three punctureson the anterior and inner part of the rightthigh of J. F., a healthy man, aged twenty-five years, and applied to them matter dis-charged at the moment of opening a bubo,which existed in a person who had severalwell-marked primary pustular ulcers on hispenis, and, among the rest, one which hadperforated the frenum.

" March 5. Each of the punctures has pro-duced inflammation.

" iliai-ch 6. The inflammation is increased.Each inflamed patch feels tumid, and itscentre presents a black point, surroundedby a yellow line, and this is surrounded bya brown-red areola, not quite circular in itsoutline,

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" March 7. The punctured spots are of the ulcer, does’ not form a ring, butscarcely more inflamed than yesterday ; two appears as if its central half had been re-of them have formed crusts, one of which is moved by the action’ of the caustic. Thesunk, or depressed, granulations on the surface of this ulcer are" March 8. All the characters of the in- smaller, and of a more healthy red colour

flamed spots are better developed ; - they are than those of the other two ulcers.more extensive; their crusts are thickerand " March 20. The reparation of the ulcerlarger, and their bases more tumid. to which the caustic was applied, is evi-" llTarcla 9. The extent of each inflamed’ dently more advanced than that of either of

spot is increased ; the areolae of two of the others.them have coalesced. By pressure on the " lllarch 22. The ulcer to which the ui-crusts, purulent matter can be expressed trate of silver in substance was applied isfrom under them. He says they pain him almost healed. The one to which the solu-as if they were coming to a head.’ Sup- tion of this salt was applied is farther ad-purating. vanced than the third, the surface of which’

" March 10. The spots are increased in is composed of several large granulations,size, and appear as if they were very turgid and seems to extend under the areolarwithmatter. He says they have discharged margin, which is rounded and much ele-a quantity of matter. A poultice to be ap- vated.

plied. " March 25. The ulcer to which the solid" March 12. The three crusts have been nitrate of silver was applied, is healed. The

removed, and as many ulcers exposed; centre of the cicatrix and the areolar mar-these are all-similar in character ; they are gin are higher than the intermediate portionexcavated, and of a yellowish or dingy- of the cicatrix, and hence there is formed awhite colour. Their borders are oblique sort of groove. All the ulcer to which thefrom without inwards, and whiter than their solution of the nit. argent, was applied iscentral parts. Their edges are serrated, or healed, except its upper part; the one tonibbled, and slightly punctulated; their which adhesive plaster alone was applied,areolar margins tumid and rounded, and the is not nearly healed, and its areolar margincuticle lies loose on them. When these is very much elevated.ulcers are examined with a lens, their sur- " March 28. The ulcer to which the solut.faces appear to pass under their edges. nit. argent, was applied is on the point ofTheir areolæ still exist, but are less marked, being healed. The one to which the ad-and more of a purplish red. hesive plaster alone was applied is healing" To one of these ulcers the solid nitrate with an elevated surface, the granulations

of silver was applied, so as to act as an of which are tuberculated, and the newescharotic; another was washed with a cuticle covering them, Is of a white or pearlystrong solution of the nitrate of silver; and colour. The areolar margin of this ulcer isthe third was left alone, still raised."MarcA 13. The slough has separated "March 30. The ulcer to which the solut.

from the sore to which the solid nitrate of nit. argent. was applied is healed. Thesilver was applied. The appearance of the other is nearly healed, but presents the sameother two is not altered. general characters noted on the 28th." March 14. The slough has separated " April 1. The unhealed sore is covered

from the ulcer to which the solid nitrate of with a crust. Its areolar margin is still asilver was applied, and the appearances of little elevated.this ulcer is now very different from that of

" April 5. All the ulcers are healed. Thethe others. Its surface is more red, and cicatrix of the one to which no caustic wasmore sunk, and of the shape of the end of a applied, is raised at the part last healed.thimble. Its edge is neither serrated nor The areolar margins of all the cicatrixes arepunctulated ; its areolar margin is less of a dark or slate colour, and the cicatrixesbroad, yet still tumid. The other two themselves are depressed.ulcers are not altered in appearance from

" lJ’lay 8. He complains of soreness of hiswhat they were on the 12th, with the excep- throat. Says lie feels as if he had caughttion that their -surfaces are more irregular, cold ; and the isthmus of his fauces appearand not so deep. It may, also, perhaps be inflamed. The cicatrix of the ulcer to whichsaid; that their areolar margins are more no caustic was applied seems disposed totumid. re-ulcerate." ftIa1’ch 16. The areolar margins of the" May 10. Complains of pain and swell-

ulcers not acted on by the solid nitrate of ing of the upper bone of the sternum, and ofsilver, have, by their elevation, formed a weakness of his limbs. Says the pain is ofring) and the granulations of their surfaces a stinging kind, or as if there. was’ glassare large, semi-transparent, and of a whitish- inside his breast.’ Has sore throat, and anred colour. The areolar margin of the ulcer eruption of about twenty psydraceous pus-to which the solid nitrate of silver was ap- tules on his face and arms.plied, is much narrower and less elevated, " May 13. Complains very much of painsand not being depressed towards the surface in his breast, forearm, elbow, and left ankle.

619

These are most severe at night. Sweatsmuch. His throat is sore to his feeling, andappears red. The orifice of his nose at theleft side seems swelled. The eruption con-tinues nearly as it was. Pulse small andweak. Habeat. mist. hyd. pot." May 16. Says he is better, that his throat

is not so sore ; he has more power over hisarms ; his breast is also better, and he canshift in bed with more ease. The eruptionis very much faded.

" May 19. Eruption gone; pains muchbetter; complains of soreness in his lefthypochondrium. The hyd. of pot. to be

omitted, and to have a purge." llTay 25. To resume the hyd. pot." This

he continued for twenty days longer; that isfor nearly a fortnight after all symptomshad disappeared.

I shall defer the remarks which I have tomake on this case until I have read you thereports of the .

SECOND EXPERIMENT WITH THE SECRETIONS

OF THE PUSTULAR BUBO.

" October 31, 1835. I inoculated L. M., ahealthy man, aged 30 years, in three pointsof the anterior and inner part of his thigh,with matter taken from a bubo which hadbeen some days opened. The ulcer whichthe bubo formed, was about half an inchlong, its edge and margin white, the dis-charge clear, the base hard, and the sur-

rounding skin of a dark red colour." November 1. The punctured parts ex-

hibit a black point, and round this a whiteline surrounded by a diffuse areola." November 5. The middle of each inocu-

lated spot is covered with a crust and thisis surrounded by an areola. Adhesive plas-ter to be applied." November 6. The crusts have been re-

moved, and three rounded ulcers exposed.Each of these is about the size of a split pea,its surface white, its edge sharp, and sur-rounded by a diffuse areola. Upon remov-ing the secretions with which the cup ofeach ulcer is filled, its bottom appears flat, ofa dusky or dirty colour, more white at itscircumference, which seems to pass underits edge. The nitrate of silver applied toone of these ulcers so as to blacken its edge,and cause its surface to assume a dark ashcolour, or, in other words, so as to act as anescharotic." November 7. The ulcers which were not

cauterized are again covered with crusts,and their areolar margins are very tumid.The cauterized ulcer is covered by a slough.

11 November 18. Each ulcer is now coveredby a crust. The one to which the nitrate ofsilver was applied is smaller and drier, andthe parts surrounding it are flat and scarcelyred. There is no pain nor uneasiness pro.duced on pressing the crust of this ulcer,and he says it is quite well."The skin surrounding the two other ulcers

is red, their areolar margins tumid and des-quamating. The crusts coveting them areraised up, as if supported by matter, andpain is produced when they are pressed.Adhesive plaster applied to all tlte spots.

" November c Noi-embe)- 19. The crusts have beenremoved from the sores to which the nitrateof silver had not been applied: but thatcovering the other remains adherent. Thesurfaces of the exposed sores are irregularand tuberculated, and raised above the sur-rounding sound skin, though depressedbelow their areolar margins. Dressed with,adhesive plaster." Norembe7’ 21. The crust of that ulcer to

which the nitrate of silver had been appliedis removed ; and the skin under it is healed,livid, and-pitted; and the edge or line whichseparates the cicatrix from the surroundingskin is clearly defined. The other ulcers,have, from the degree of elevation of theirmargins and surfaces, somewhat the ap-pearance of condylomata. The rednesswhich surrounds them, or their areolse,have become very narrow.

" November 23. One of the two ulcers notacted on by the nitrate of silver, is nearlyhealed, yet its areolar margin is red, and,as well as the surface of the cicatrix, raisedhigher than the surrounding skin. Thehealed surface is irregular. The other ulceris contracting.

" November 26. The areolar margins, andthe surfaces of the ulcers, have shrunk nearlyto a level with the sound skin. The sur-faces present a wart-like appearance."

Remarks.—The two experiments, the re-ports of which I have now read, leave nodoubt of the infectious nature of the matterof bubo, and that the disease which it in-duces, is precisely the same as that whichresults from inoculation with the matter ofthe primary pustule itself. It is now seve-ral years since I first published the resultsof my experiments upon this subject, and itis gratifying to find that they have beenconfirmed by those of M. RICORD, sincemade at the Venereal Hospital in Paris. Ithus distinctly claim that I was the firstwho experimentally demonstrated that thematter of bubo is infectious, and producesthe primary pustule. Previously, the ques-tion was sub-judicio.

I wish to remark, in a particular manner,that otie of the experiments, the reportsof which I have just read, was made withmatter contained in the cavity of a bubo.Now, the inoculation with this kind ofmatter, that is; of matter contained in theabscess of a bubo, very seldom indeed pro-duces a specific effect. I had fruitlesslymade a great number of inoculations withit, and had almost concluded, in my ownmind, that the matter secreted by bubo wasnot infectious, when, on one occasion, I suc-ceeded in producing by it the characteristicpustule. Subsequently, however, I used

620

the matter of such buboes as had formedulcer5, or had been discharging for somedays; and ever since, I seldom failed ofproducing, by inoculation with this matter,the specific pustule. These truths couldhave been ascertained only by experiment,for it would be natural to expect that thereverse would occur, or, that the matter

pent up for some time in a bubo, and fullymatured, would be more likely to cause aspecific disease, than that which escapes, assoon as formed, from an open or ulceratedbubo. A knowledge of such facts shouldmake us very cautious in drawing conclu-sions from experiments followed by negativeresults.

I need scarcely observe that the two lastexperiments confirm the remarks alreadymade this morning, on the power of thenitrate of silver to control, or cut short, theprogress of the primary syphilitic pustule.Indeed, this is a truth which you almostdaily witness. I need not, however, nowenlarge on a subject which I have so fullydiscussed in former lectures.*

I shall now read to you the reports of the

FIRST EXPERIMENT WITH THE Matter OF THE

CONSTITUTIONAL PUSTULE.

" A*oceM6fr 15,1835. Three punctures weremade with a lancet on the anterior andinner part of both thighs of 1’. 1B1., a healthyman, aged 27 years, and matter taken fromthe pustules of J. K. was applied to eachpuncture. (J. K. laboured under a large- crop of psydraceous venereal pustules, andthe eruption had been in existence aboutfourteen days.)

11 Noveitber 22. The punctures have notinflamed. ’" Novenaber 2-1. Punctures have not in- I

flamed. He is told that he need not returnunless the punctures inllame." December 14. He says lie has returned

in consequence of the inoculated spotshaving inflamed. Small, raised, red-brown,large-sized papulae, or small tubercles,have formed on all the punctured parts ofthe right thigh, and on two of those of theleft. The surfaces of these tubercles are

slightly scaly. The scale covering one ofthem, is so thick as to appear like a scab,and, on its removal, a small superficial ulceris exposed. He says it is a few days sincehe noticed these spots commencing." I didnot now think of telling him to return, and,in consequence, he absented himself untillie found it necessary to apply on accountof the soreness of the inoculated spots. "..".

11 Januai-y 11. There are, on his rightthigh, on the parts inoculated, three green-ish-yellow scabs, each the size of a farthing,and surrounded by desquamating areoleeof a purplish-red, or crimson colour. The

* Sac Dr. Wallace’s Lecturen on this subject in’THE LANCET, Nos. 541, 46, 52, 53.—Eu.L.

"

areolac have met, or joined, at the corre-sponding parts of their circumferences, sothat they form a continuous red surface.There are, on the left thigh, two of thesame kind of scabs, but not being so

closely placed, their areolae do not meet.Upon pressing these scabs, a quantity ofthick, dirty brown matter exudes fromunder their edge. The glands at the upperpart of both thighs, and in both groins,but particularly at the right side, are

swelled, and the skin covering some of themis red. A poultice to be applied tj thecrusts on the right thigh, but those on theleft to remain without any application. Tolie in bed.

11 Taititcti,y 13. The crusts to which thepoultice was applied have been removed,and three ulcers exposed, which resembleeach other very much. Their figure is circu-lar, and their surfaces depressed a little be-low the level of the surrounding skin. Theircolour is a dirty or dingy white, not unlikethat of condylomatous sores. The circum-ferences of their surfaces are smoother thantheir middles, owing, apparently, to incipi-ent cicatrization. The areolas round theseulcers, as well as those round the crusts onhis left thigh, are less strongly marked thanthey were. The swelling of the glands inthe groin, and redness of the integuments, aredecreased.

Januaiy 21. The colour of the ulcers isredder, but verges 011 a nut-brown ; theirsurfaces, which are somewhat glassy, or

semi-transparent-tooking, are disposed tobleed. He complains of pain shooting fromhis shoulders down his arms, and from hiships down his legs. He also complains ofheadach, and of pain in his ear and side ofhis jaw ; all these pains are more severe atnight. He says he has soreness in histhroat, and that there are spots among hishair. On examination, I find that he hasgot the rubeoliform rash, particularly onhis trunk, aud that the isthmus of his faucesis red." Juuttury 28. His pains are less trortble-

some, but the rash is more strongly marked,and there are several small, round, white,and superficial spots on the surface of hissoft palate and uvula."

It is unnecessary to occupy time with afarther detail of the reports ; stillice it to

say, that he was subsequently submitted tomercurial treatment, and all the symptomsrapidly disappeared. I have lately seenthis man, that is, more than a year afterie experiment; he was, apparently, veryhealthy; the cicatrixes left by the sores

were, however, visible, and rather remark-able in their appearance; they were raisedand smooth, and the skin forming thentseemed to be deprived of capilluli, and ofthe orifices of the epidermoid glands. Ishall now read to you the notes of the

621

SECOND EXPERIMENT WITH THE MATTER OF THE

CONSTITUTIONAL PUSTULE.

° June 1, 1835. Matter taken from the

pustules of J. S., inserted by puncture,witlla lancet, into the common skin of the penisof J. M., a healthy man, aged 23 years.(The pustules of J. S. were psydraceoussyphilitic pustules. His eruption had beenabout four weeks in existence, and severalof the pustules were then forming smallcrusts.)" June 6. The inoculation has not pro-

duced any perceptible effect." June 28. There is a crust covering the

inoculated surface; this crust is of a dirty-yellow colour, surrounded by an areola.The glands in both groins are slightly en-larged, but not painful. Some adhesive Iplaster applied to the crust. ,

" June 29. Upon removing the dressingthe crust came away, and exposed a flat,brownish-red surface, the size and shape ofa silver sixpence, surrounded by a raised ortumid areolar margin. This ulcer is so

very superficial, that it is little more than anexcoriation. He says that several crustshad formed, from time to time, on the in-

oculated surface, and that he had takenthem off." July 14. He has had, for some days, a

pain in his right shoulder, but has neithersore throat nor eruption. The sore on hispenis was dressed with adhesive plaster.

" July 24. The surface of the ulcer on hispenis is a little more raised, but scarcelyaltered in other respects. His body is nowcovered by a rash, consisting of spotsclosely set together, and slightly raised androunded, but not quite circular in their out-line. He complains of soreness in his scalp,and of slight pain in his shoulder. (I maypass over some of the reports.) August 20. The skin surrounding the

anus, to the extent of two inches, is of ared-brown colour, and sprinkled, as it were,with a number of elevated spots; some ofthem are not larger than a grain of shot, andothers are as large as the end of a finger;the smaller ones are red, and the larger oneswhite, and parboiled-looking; there aretwo, large and elongated, and the portions ofthem near the anus are red, while their outerparts are whitish. The raphe of the peri-neum is red, and very tumid. He says thatthere is a great discharge from the partswhen he walks. On the scrotum there aretwo tubercles, like those near the anus ;and on the dorsum of his tongue there is anelevated spot, or tubercle, which presents onits surface a number of red points. On histonsils there are white patches, surroundedby a preternatural redness, and there isscattered over his body a number of reddish-brown, slightly scaly discolourations.He was now submitted to mercurial

action, and in less than fourteen days all

the symptoms had disappeared; mercurywas continued, however, for three weekslonger."

Remarks.—The several experiments, withthe details of which I have now made youacquainted, are to he considered as demon-strating only general facts ; these facts are,however, of great importance ; they, toge-ther with those demonstratect in my lastlec-ture on syphilis, open to view a new andextensive field ; they lay the foundation fora satisfactory explanation of the proteancharacters of the venereal disease, and for ascientific classification of its varieties. Tofill up the outline now sketched, the assist-ance of many observers will be required. Ihave myself still to communicate to you anumber of subordinate facts counected withthe subjects of this and the last lecture;some derived from experiment, and somefrom the history of the symptoms presentedby the disease under varied circumstances.These will demonstrate how far the formsof both primary and constitutional syphilisare inHuenced,—1st. By the age at whichthe poison, whether it be pustular or exan-thematic, contaminates the system ; 2ndly.Ly the treatment adopted, as well previousas subsequent to the occurrence of constitu-tional symptoms ; and, 3rdly. By the natu-ral organization, and habits of living of thepatient. With these details you shall bemade acquainted, in the only way in whichit is possible without great repetition, thatis, as the cases which illustrate them arebrought under your review. I shall nowconelude this morning’s lecture by givingyou

A SUMMARY OF SEVERAL INTERESTING

CONCLUSIONS,

at which the experiments already detail-ed authorize us to arrive, in addition to themore general inferences stated in my lastlecture, and at the commencement of thepresent.

1st. The local specific effects which resultfrom inoculation with the matter of the pri-mary pustule, and of the pustular bubo,commence almost immediately. In all theexperiments which I have detailed, specificinflammation was produced within thesecond day, and in three or four days thecharacteristic pustule was fully developed.

2nd. The local specific effects which re-sult from inoculation with the matter of

secondary pustule, as well as with the mat-ter of the difl’erent varieties of exanthematicsyphilis, do not occur for some weeks afterinoculation. In none of the experiments, ofwhich I have read you the reports, was thelocal specific effect produced in a shortertime than three weeks. This accords withthe statement already made to you on moreoccasions than one, that when an individualis exposed in the ordinary way to venerealinfection, the exanthematic primary sore

622

does not take ’place as soon after exposureas the pustular.

3rd. The sore which follows inoculationwith the matter of the primary pustularsore, or pustular bubo, is generally healedsome weeks before constitutional symptomsappear. Thus, the primary sores whichwere followed, in two of the cases detailed,by constitutional symptoms, were healedbefore the constitutional symptoms com-

menced,4th. The sore which follows inoculation

with the matter of the secondary pustule,and of the exanthematic forms of syphilis,persist, in general, until constitutionalsymp-toms appear. Thus, in all the experimentsadduced, with these secretions,:constitutionalsymptoms occurred before the local specificeffects had subsided. Hence it is, that in

practice, particularly among the lowerclasses, we very often find the primary andconstitutional symptoms of exanthematicsyphilis co-existing.

5th. Inoculation with the matter of the

primary pustule, and of the ulcerated pustu-lar bubo, seldom, if ever, fails to producethe characteristic primary pustule.

6th. Inoculation with the matter of theconstitutional pustule, and of the exanthe-matic forms of syphilis, very often fails toproduce any specific effect. I should hereremark, that inoculations with this matterwill succeed much more frequently if appliedto a surface than if introduced by puncture.Hence it is that I have generally preferredthe former mode of inoculation with this

matter. It is well known that scabies is

propagated by contact, and cannot be pro-pagated by puncture; and that vaccina can-not be propagated by contact, although soeasily propagated by puncture. Is not the

fact which I have ascertained respectingthe propagation of the syphilitic virus,analogous to those already known respectingscabies and vaccina ?

7th. The primary pustule, whether pro-ducer by inoculation with the matter of a

similar pustule, or of a pustular bubo, is

not followed in the majority of cases by con-stitutional symptoms. Of the four cases

which I have related this morning, onlytwo were followed by constitutional symp-toms.

Stli. The primary exantheme, whether pro-duced by the matter of the constitutional I

pustule, or by the matter of any of the ex-anthematic forms of syphilis, is, in a vast

majority of cases, followed by constitu-tional symptoms. Thus, all the five cases

which I have related in the last lecture on

syphilis, and in this morning’s lecture, werefollowed by constitutional symptoms.

ACCOUNT OF THE EPIDEMIC

WHICH ATTACKED THE

BRITISH AUXILIARY LEGION

IN THE WINTER OF 1835-36,AT VITTORIA IN SPAIN.

By WILLIAM LARDNER, Esq., Surgeon to the1st, or Reyna Isabel, Regt. of Lancers.

As no account (at least to my knowledge)of the epidemic which committed sechhavoc in the Auxiliary Legion, has yet beenpublished, a few remarks, founded on sadand ample experience, may contain interestenough to find a place for them in the pagesof THE LANCET. This disease was firstnoticed in the regimental hospital of the 1stlancers, in Santander. I do not attempt to*’investigate the cause, or causes, of it, nordid I ever see an instance of its being pro-pagated by contagion. Suffice it to say,that, like cholera, it attacked all classes of

persons ; but more frequently those whoseconstitutions had suffered from bad living,or previous disease, fell victims to it. Inthe month of November, 1835, it extended itsravages to the Convent de Corban, distinct cabout a mile and a half from Santander.Staff-surgeon Davies, who was appointed to take charge of that building, which wasdestined for recruits from England, appearsto have considered the cause of the diseaseto have originated within the walls of thebarrack. We find in his first report to headquarters the following :—" As to the origiii-7 of this disease, which has assumed, in a.very short period after its attack, the markedcharacter of typhus, it! is involved in someobscurity, but I cannot help being impressedwith the conviction that the generatingcauses may be fairly attributed to the dirty, ,:crowded state of this convent for someweeks past, a want of proper attention tocleanliness and ventilation, and a succes-sion of rainy weather for some days previousto its breaking out, in connection with aclose state of the atmosphere. The state of the atmosphere here alluded

to was noticed by many at this period. Itis a singular fact that the same state of theatmosphere was remarked in Portugal atthe invasion of cholera. Even vegetationdrooped beneath its withering influence. I

saw, myself, whole groves of olives blasted.The faculty of Warsaw, when I was there,in 1831, were so puzzled about the cause ofcholera, and struck with the appearance ofthe atmosphere, that they frequently analyzedit, and made several experiments with it,but failed in discovering anything. Theymight as well have analyzed the brain witha hope of finding the soul, or the thinkingquality. The cause of cholera, typhus, andother serious epidemics, has baffled the in.