Lectures ON CERTAIN POINTS IN THE CLINICAL EXAMINATION OF THE URINE
507 the breasts being clearly traced.) In the children we find a persistent indolent action leaving a copper-coloured stain, and often an indurated cicatrix, accompanied by multiple chronic enlargement of the corresponding lymphatic glands; followed by mucous tubercles, ulceration of the throat, loss of hair, and various forms of eruption which the Commission appointed for the purpose of investigating the disease pronounced to be syphilitic. In the mothers we have a persistent indolent form of
... dhesive inflammation on the breast leaving an indurated cicatrix, accompanied by chronic multiple enlargement of the axillary glands, and followed by mucous tubercles, ulcerations of the throat, loss of hair, and various forms of eruption on the skin, which the medical men who formed the Commission, and others who did not, pronounced to be syphilitic. It would seem superfluous to reiterate the question " Was this the same disease ?" were it not for the enormous amount of prejudice which the dogma of Ricord, which long held the minds of men in subjection, still exercises upon public opinion. The great master had said that no secondary symptom could be communicated ; therefore it was formerly argued, and is still argued by some, that such cases as those above related could not be syphilitic because there was no communication between any primary disease in the children and the breasts of the mother. Here we may again refer to Swadiaur's opinion, as quoted in the first of this series of lectures, where he talks of those who " by an illfounded theory suffer the syphilitic virus to be communicated, and the disorder propagated through whole families." It must, however, in justice to the great luminary of this branch of medioal science to whom reference has been made, be stated that his mind has at all times been open to conviction and to proof, and that he has now materially modified his opinions, which for so long a period exercised such an extensive sway. But there are still lesser luminaries which for a time shone with borrowed light, who are not so easily convinced. It is therefore necessary to multiply examples. In October, 1858, a Commission was appointed, composed of MM. Velpeau, Ricord, Devergie, Depaul, and Gibert, to give an official answer to Government upon the question of the inoculability of secondary syphilis, and whether the inoculability 0f that disease was different in the child and in the adult. The following cases were officially reported :-1. A patient, affected with lupus on the face, was inoculated on the left arm with some secretion from secondary mucous tubercles. The patient from whom the secretion was taken had a number of flat tubercles around the anus, which had existed for about a fortnight. These had followed a chancre on the penis fifteen months previously, the cicatrix of which was still apparent. Eighteen days after the inoculation, a prominent copper coloured papule appeared on the inoculated spot. At the expiration of twenty two days, the papule had enlarged, and discharged a moisture from its surface. On the twentyninth day, an enlarged gland existed on the corresponding armpit. On the thirty-second day, a scab having become detached, left exposed an excoriation srill very superficial. On the fiftyfifth day, there was an ulceration, still superficial, in the centre of the former papule, which, having become larger and more indurated, now constituted a weil-furmed tubercle ; some spots and red pimples shortly showed themselves on the body, and were followed by a gene'-a.! syphilitic eruption. Three mouths and a half after the inoculation, and after six weeks of mercurial treatment, a white superficial and slightly depressed scar was left on the arm; the enlargement of the axillary glands continued, and the general syphilitic eruption was fading. 2. A patient, affected with inveterate lupus, was inoculated in the same way as in the preceding case. At the expiration of twenty-five days, some redness showed itself upon two of the inoculated points. Upon each of these spots a papule developed itself. This was at first dry, but subsequently discharged a fluid, and became excoriated, covered by a crust, and indurated. An enlarged gland, the size of a nut, developed itself at the same time in the axilla. The thirty seventh day after the inoculation, roseola developed itself upon the skin. The two preceding cases were inoculated by Dr. Auzias-Turenne ; the two following were inoculated by M. Gibert. 3. This case was very analogous to the two already mentioned ; but the papule produced by the inoculation was much smaller; the induration which followed was less marked ; the ulceration which succeeded was superficial, round, and fungous; roseola following in this as in the other cases. 4. The patient who furnished the secretion in this case had been under the care of M. Puche, in the Hôpital du Midi. He had had an indurated chancre on the external surface of the prepuce, and this had left an indurated cicatrix, with slight indolent enlargement of the inguinal glands. Secondary mucous tubercles had formed on the scrotum, around the anus, between the thighs, and in other parts. A large, squamous papule existed on the forehead, of a coppery-red colour, quite dry, and of the size of a half-franc. On the 9th of February the point of a lancet was passed into the circumference of this papule, and was charged with some blood and serum. This was immediately inoculated on the upper and anterior part of the right arm near the elbow, in a, patient affected like the preceding with lupus of the face. Fifty days after this inoculation, a prominent, red, irregular papule was seen upon the inoculated point. This had, he said, existed for fifteen days. It became the size of a half-franc, and was covered by a slight scab. It was, therefore, very similar in appearance to the affection from which the inoculated matter had been taken. During the whole of its course it did not become excoriated, and secreted no fluid. It therefore presented a well marked instance of the second form of syphilitic infection noticed in a previous lecture (No. II.) Around this papule were seen some copper-coloured and slightly raised spots; subsequently a squamous syphilitic eruption, and a variety of other syphilitic symptoms, appeared on other parts of the body.* It would be obviously improper, under any circumstances, to multiply the number of cases of artiticial inoculation with this infecting variety of the disease ; but other cases of the same kind are not wanting. The above have been selected as those recorded by a Commission, of which M. Ricord was himself a member ; and there is, therefore, the best possible assurance that if these cases had in any respect been unsatisfactory, the weak points would have immediately been brought to light. Those who still oppose themselves to the idea of secondary syphilis being communicable, often ask for the same demonstration of the fact as Riccrd afforded with regard to the inoculability of the suppurating sore. But they who have requested this evidence can scarcely have seriously considered what they are asking, They ask, for the sake of satisfying their minds, and in order to correct their preconceived ideas, that a disease which necessarily produces its constitutional effect should be inoculated upon a patient who had not previously had that disease-a proceeding which, if it were carried out for their satisfaction, they would probably be the first to condemn ; nor, in truth, are any further experiments upon this point either necessary or justifiable. The cases recorded in the present lecture show that secondary syphilis, under certain circumstances, is readily communicable, and that that communication, when due precautions are not observed, may take place in the act of vaccination. In the ntxt lecture some further illustrations of this great fact will be given, and some of the peculiar svmptoms observed in the children at Rivalta will be more fully comidérect. The source whence, in these cases, the original syphilis was derived GENTLEMEN,-The detection of sugar in the urine, and the estimation of its quantity, are questions of such importance to medical practitioners that I make no apology for occupying your time in this and the succeeding lecture with their consideration. Let me at once draw a broad distinction between the existence of sugar in the urine in proportions sensible to direct testing, and its existence in such minute quantity that elaborate analytical processes are required for its detec ion. It is highly probable that traces of sugar, as of all other substances dia-* This case may be compared with that of the boy related in Lecture II.