Sept. 1, 1866.] ORIGINAL COMMUNICATIONS. [British Medical Journal.

I found the left ventricle quite empty and firmlycontracted, just as it has been found in cases of cho-lera. The right was occupied by a largish fibrinousclot extending up into the pulmonary artery. It didnot appear of ante mortem origin. The lungs werecongested. The absence of abdominal pain is notan argument against this view; as we know, from ob-servation of epilepsy, that an unfelt irritation maygive rise to very severe symptoms. Cases of thisnature would be more amenable to treatment thanothers; inasmuch as the intestinal irritation mightbe removed by appropriate remedies, as calomel andopium, castor-oil, etc. It is to be feared, however,that, in many cases, the heart, kidneys, and otherorgans, are too severely stricken in their vital powersto carry on their necessary functions, even when theirritation of the intestinal nervous structures is re-moved.In conclusion, I may say that I regard cholera as

by no means a single and uniform morbid process, but-one which consists of several varying elements.These may be enumerated as cardiac paralysis, con-striction of arteries, alterations in the blood and ca-pillaries, intestinal irritation. They may be variously,developed in different instances, some may be moremarked in one case, others in another, and remedialmeans should be varied accordingly.

REMARKS ON SYPHILISATION.By GEORGE GASKoIN, Esq., Surgeon, Chevalier of

the Order of Christ, Portugal; Surgeon to theArtists' Benevolent Fund; formerly House-Sur-geon and House-Pupil, St. George's Hospital.

[Continued from page 41.)IN the continuation of his second lecture, Mr. Leesays that the immunity obtained in animals throughrepeated inoculations was attributed by M. Auzias tosaturation of the system with the syphilitic virus;-and then ho goes on to say that "the early theoryformed of the process was embraced by the wordgiven to it; but that theory has perished, thoughthe term has been maintained. Syphilisation is amisnomer. For, let us allow that we can make anindefinite number- of ulcers on the person of a syphi-litic by repeated inoculations of the pus of an in-,lurated chancre, there is here no analogy to the pro-cess by which animal poisons are carried into theconstitution-to vaccination, for example." Here wehave it implied that Auzias Turenne has fled fromthe principles with which the public were first de-luded and amused; he has experienced a defeat, wemust suppose (for has he not shifted his ground ?); aloathsome mode of treatment is maintained, thoughthe plea for its introduction is found to be ground-less and untenable; "the theory embraced by theword given to it" is utterly destroyed; while, inobedience to necessity, the venue now is changed,and a source of professional notoriety is supported onsome other ground of conclusion equally false andsubvertible.But why, oh! Henry Lee, do you persist in laying

your readers on a wrong scent by suggesting inothers the existence of untenable and varyingOpinions, for which there is only the very faintestfoundation in truth? Why range yourself with theoppressors of a great discoverer, as if it were notplain to every eye that his tardily and meanlyacknowledged merits are a reproach to the age inwhich we exist, even more than the false glitter ofreputations which flourish by his side. Was it not

uly; said by the wicked lawyers of James's reign,Give us a line of writing from a man's hand; it shall

be enough for us to hang him straightway? and youhave got now this unfaithful record of a dream, yourake up this word " saturation", which, in conjunc-tion with syphilis, expresses so revolting an idea.The intention and legitimate aim of the discovererto regulate and destroy the action of the virus bymeans of the same virus, and thus to rescue thepatient's health from destruction, is kept out ofsight altogether; and we have this " saturation" pre-sented to our notice, which is asserted to have beenM. Auzias-Turenne's original conception in proposinga new treatment of syphilis; and, "therefore", sayyou, "this process was naturally termed syphilisa-tion-this theory has perished, while the term has beenretained". But did this theory ever exist ?"

See we not rather here revived the prejudicesof the previous century, when to give a man thesmall-pox, or matter from out of the body of acow, was called flying in the face of Providence,and marring God's likeness in his creatures, just asnow we are accused of piling syphilis on syphilis?What is your ground of warranty for this assertion?No greater than what we shall see to follow. In theearliest physiological communication made by M.Auzias-Turenne to any learned society, November1850, in the brief summary of his crude ideas on sy-philitic vaccination, or syphilisation, as he then com-menced to call it, one phrase, or short section of anintroductory character, runs simply thus. No. 3." The noun-substantive syphilisation (the correspond-ing verb being syphilise) may be used to denote asort of saturation of the living organs, or better acondition of immunity obtained by successive chan-cres"; and by and bye he says, in so many words,that the virus offers itself to us as the best means ofcontending with the difficulties of the disease.Could anything be more modestly expressed by a

youthful aspirant ?, But, just as any stick mayserve to beat a dog, we see here how unfashion-able talent may cry out in vain for protectionagainst the imputation of absurdity; nay, evenwhen one of the cleverest men and one of the bestphysiologists of the time is in question. If he benot buoyed up by a clique, he must go to the wall;and abroad, out of his own country, where his per-sonal qualities and antecedents are unknown, hemust be content to rank with a Hahnemann and aParacelsus, or with smaller fry. You threaten thepublic with an accumulated syphilis; and ask, byimplication at least, if Auzias-Turenne and the restare to be allowed to fill up human creatures likebeer-barrels, or swell them out like sponges, with sy.-philitic poison.What can give a more sad idea of the times in

which we live than to see favoured and diligent menlike Ricord and Henry Lee, representative men of theday, putting themselves so entirely in the wrongwith regard to the degree of merit to be found intheir contemporaries? What a picture is thus af-forded of the condition of science amongst us,when all sorts of forced interpretations, imperfectapprehensions, and explanations ill understood,weary out the thread of life and exhaust all philo-sophic patience! Such experience might seem tomake a return to the middle ages desirable whenghostly charity attempered a material persecution,altogether not more terribly felt perhaps than thiscrushing prejudice from the regions of fashion, whilethe very organs of public liberty are made to swellthe chorus of dispraise.In what way, we ask, is syphilisation a misnomer P

With a thorough-paced dualist, it is liable to suchan interpretation, because he looks on the wholething as a sham. Yet with no reason on his part.For these wise men of Lyons l ve lately decided

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ORIGINAL CXMMUNWATIONS.

that vaccinia is a wholly different disease from thesmall-pox. To use their hackneyed expression, it is"antagonistic" to it. Still none of them, thatwe have heard, affirm that the poison of vacciniadoes not control small-pox. But Mr. Lee is notopenly a dualist-as to difference of species, atleast; he does not deny expressly to the matterof soft chancre the name of syphilitic matter;but if the cure is done with syphilitic matter,surely the patient is syphilised. The idea ofmaking an indefinite number of ulcers is altogetherassumed by Mr. Lee; it is on the definite limitationof the inoculations that the whole rationale is sup-ported. The number of inoculations in a series andin the aggregate, though it may vary much, isnecessarily limited; till, at last, when the final limitis reached, the most erosive virus no more affectsthe frame than a drop of water laid upon the skin.What does the writer know about the process by whichanimal poisons are carried into the human system ?Does he know more than the rest of the medicalworld? Has he any particular theory to support?Is there one path, one process for them all? Weknow little enough about these things as yet.As regards vaccinia, then, the poison does enter the

constitution; we should scarce have expected such aconfession from Mr. Lee; we should have thoughthe would have declared the operation of the vaccinevesicle to be "localised", "its history terminatingwith its cicatrisation." What proof to the contrary,if we omit its protective power? In the soft chancre,beside other proofs, there is a curative power as re-gards syphilitic disease. This is one of the reasonswhy we believe it affects the constitution, and isnot a purely local or "localised" sore, the sphere ofwhose operation, according to the Lyons school, isconfined, " like a spine in the tissues," to the neigh-bourhood of its site; and we also believe its secretionto be of a syphilitic nature and origin, so that,whether matter from soft chancre or hard chancrebe used, syphilisation is not a misnomer.

But, forasmuch as no imputation can be moreserious than that of thrusting back science and im-peding the freedom of its career, we may say that weagree with that admirable writer, Bassereau, as tothe existence of a simple ulcer of the genitals beforethe advent or cataclasm of syphilis in Europe; but itis not this Venerola which we have to deal with inthe present day, but a soft chancre, which is a pro-duct of syphilis, and which is syphilis in a modifiedor fluctuating form, just as it falls under observationwhen we inoculate, and such as is signified, appa-rently, in the pages of Guicciardini, where thiswriter says that in the course of his not very lengthyexperience, which dated from the very beginning ofthe French disease in Italy; it had become mitigated," having divided spontaneously into more than one sortdiffering from what it was at first"; and too muchweight cannot be given to his words. Although thehistory of the soft sore is the most obscure problemin the study of syphilis, this is what we are inclinedto believe concerning it: we think ourselves justifiedin considering it to be part and parcel of the dis-ease; and we believe that Bassereau's view of thesubject is a partial one, for he has not taken all thefacts into consideration.As to the thrust of the indefinite number of

hard chancres, we may say that the sophism is ofParis importation. It is repeated, as regards thesoft sore, in all new French treatises, as well asin the books which are copied from them. It is atruth which cannot be denied, that of all man-kind the Parisians are the most gullible; for, if theLondoner enjoy a standing testimonial of his cre-dulity, having acquired the name of cockney, yet

the Parisian, as far more sanguine, unballasted, fedon silly vanities, goes very far beyond him in thisrespect, so as indeed to have merited a more signifi2cant epithet which it will not be necessary to men-tion.Now, Lindman, the young German physician, who

was one of the first to try multiple inoculations onhimself for syphilis, when his fellows at the Aca-demie de Chirurgie, fresh fiom their masters' teach-ing, came round him pitying his condition, andbeseeching him to desist, told them people wouldnever believe that syphilisation was so bad as intruth it was, until some worthy and excellent manhad died of it, and therefore he had determined togo on. His subsequently improving health andflourishing appearance being the subject of generalremark, defeated their anticipations of his decease.He still went on inoculating; and he appears to havetold some one who questioned him or bothered him(for he would have nought to do with the Aca-demy after their first behaviour to him), that hehad inoculated himself with 2200 chancres, andafter that he had ceased to count. He seems to havetaken a pretty exact measure of their credulity,and to have reproved with a just sarcasm theirpretentious scepticism. It is necessary to say thatthe fact of so many inoculations is perfectly absurd.The greatest number got by Boeck out of a largecollection of cases treated by him was not a third ofthe number mentioned. How few of them are ulcers,it is not necessary to describe. The exaggeration ofthe French shows how far their wishes extend be.yond their proofs in propping up their artificial sys-tems.

This story is on a par with that still current inthe Quartier Latin, of a student, J-, killed by sy-philisation, a piece of tragedy retailed to a friend ofours, some time since, by a medical booksellerof the Quartier, with the true accent de la vrit&.The tale occurs in the celebrated Lettres suer la Syphi-lis. The more correct version is as follows. Aboutfifteen years gone by, a young student, in very dis-tressed and unfortunate circumstances, adding toilto dissipation, died of contagious erysipelas, thenraging in the house and quarter, at a time when thefew inoculations that had been made on him were(as we have it on the evidence of M. Auzias-Turenne)wholly cicatrised.M. Ricord, in a book characterised rather by " hu-

morous anecdotes" and "situations" than by any-thing like fair argument, applies to this event hisfavourite word " deplorable" less in pity than in cen-sure; and the case is still quoted as a warning to allwho dare, even in thought, oppose themselves tothose who hold the reins of power in the schools ofscience; and, since the action of animal poisons Isin question, this would seem the best opportunity ofreferring to that argument which Mr. Henry Lee hasput forward in his last lecture, as to the immunitywhich is attained after bites of fleas and mosquitoes,either constantly reiterated or multiplied at shortintervals of time. Whether an effort of candourprompted our objector to a confession which hemakes so entirely for us, or whether, as we ratherbelieve, he brings it in to support a theory of deriva-tion which we entirely reject, it would still appear torange itself under the head of those stories to whichwe have referred above. Such a tale seems to wantconfirmation from popular experience. We hTeainquired of great travellers and others who havebeen much among those things, and they have an-swered us with smiles, or with laughter not unaccom-panied with tears. But if he have persuaded him-self of this matter, we may surely be permitted togive attention to what we have heard concerning

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ORIGINAL OOMMUNIOATIONS. [iit Modis Jouxf1.immunity obtained by repeated inoculation of thepoison of serpents, a far more important fact, butwhich, as far as we are concerned, needs further elu-cidation, though the sources from which we heard ofit are more than respectable.M. Ricord may proffer and publish the belief that

syphilis is a degraded glanders, M. Diday expectto find in vaccine matter the materials for a cure;'English syphilographers may depend on chlorate ofpotash, and give sulphite of soda a fair and lengthytrial; but when a method of treatment offers itself,which is in accordance with pathology, and an orderof ideas are produced which rest on instruction, ob-servation, and experiment, it is decried as baselessand absurd, and its advocates, too, are treated withslight respect, if not with scorn and inattention.

So far from there being no analogy between syphi-lisation and the operation of animal poisons, it is byanalogy that we are guided throughout. Withoutthis guide to the practitioner, we think it scarcelyright and hardly possible to expect much success.The attention of modern physicians has been far lessdirected to the class of virulent diseases than for-merly. Of late, pneumonia, carditis, diabetes,pymemia, rheumatism, and other complaints, have ex-cluded fevers and virulent diseases from much notice.Only fitfully and exceptionally have they engagedattention. It was far otherwise in the middle of theeighteenth century. When inoculation for small-poxarrived in England in the year 1721, although its in-ventor was lost to view, it came soon to be consideredone of the noblest efforts of the human mind. Weknow the difficulties opposed to it; and that thirty orforty years had passed away before its merit was wellrecognised. From that time onward, every one's headwas working in one direction. Inoculation was theorder of the day; for the cure of syphilis, it was firsttried in the year 1778. This idea with regard to syphi-lis obtruded itself on many minds. The circumstanceof the disease running itself out, and of its being aneruptive disorder, made the analogy too obvious notto occur to many. The chief objection to the treat-ment lay in the chronic character of the disease, so dif.ferent from small-pox and other exanthems, whichpervade the tissues rapidly.

Before the discovery made by Auzias-Turenne, inthe middle of our century, the medical mind of Parishad been deeply stirred by discussions on the occur-rence ofglanders in man. It required the stubborn per-severance and earnest soul of Bayer to prevent thispathological fact being consigned to the grave ofthe Capulets. The evidence of cases went fornothing against an opposition of the most bitterkind. All the questions which relate to the conta-gion and course of virulent diseases came under re-view and consideration at that hour; and it wasunder the impulsion of ideas which had becomefamiliar through discussion, that Auzias-Turenneavailed himself of opportunities he then possessedto attempt the inoculation of animals with syphilis.Being fresh from anatomical study, a delicate anddexterous manipulator, and withal earnest in thework, he succeeded, where Hunter, Ricord, Cullerier,with a less degree of earnestness, had failed. WhenM. Auzias-Turenne had discovered a natural limitto the number and extent of the inoculations, thepath was traced out to that point of success whichwas uppermost in his mind, but which had equallysuggested itself to others. Immunity was found atlength to be attainable. Mankind were now suffi-ciently well informed to put the plan in execution;and, as it appears to us, it has been followed by acertain measure of success.That Dr. Boeck inoculated, or caused to be in-

ocuated, the hard chancre on the bearer during

his stay in England, admits not of a doubt; thatthe same has been done since his departure can-not be denied. Mr. Lee believes he can inoculateand get a soft sore with an unwashed lancet wipedwith dry lint, such as is commonly done by Dr.Boeck in his clinical practice. This, however on thefirst blush it may appear plausible, has not been putto the test by the objector.In writing of the inoculable pus obtained from

stimulated chancres, Mr. Lee expresses himself thus:" Whether," he says, ",such matter be a product oftrue syphilis, or whether it depends on some dynaini-cal change in the action of the part, it is essentiallydifferent from that which pertains to an infectingsore." This secretion, whether theoretically we sup-pose it to have its origin in syphilis or not, is practi-cally not that which produces syphilis. In thechange of action which has taken place during itsproduction, it has lost its sting so far as its power ofproducing an indurated chancre is concerned, and ithas also lost, so far as present evidence goes, itspower of affecting the patient's constitution." Ourforegoing argument will give us the key to sucherrors as these. He holds to the false belief, thatan inoculation on a syphilitic soil carries no principleof infection; and he is then driven into a corner tofind what can have happened in the sore. "It ischanged," "it is essentially different," it is " practi-cally different," "'it has lost its sting-the stingwhich it has in the parent sore." An unicist wouldlook on this with calmness; but to a dualist of theadvanced school it is very perplexing.Of the disappearance of the virus Mr. Lee is fully

convinced. The theories of Langlebert are so flat-teringin their application; the girls from the cliniqueof Bidenkap shut out all else from view. But what ifthere be no change after all ? What if such sores doinfect ?* This, truly, is what Mr. Lee will be the lastman to allow, because it gives a shock to his system;for he has spent many years in constructing an " edi-fice", and never was there a more ingenious artificerthan our friend. His edifice, however fairly built, willhave to share the fate of many modern constructions.The keystone of this fair building is " adhesive in-flammation", as distinguished from "suppurative ac-tion"-a secretion of sero-epithelial debris, in anti-thesis to pus. But is not the distinction betweenlymph-globule and pyoid globule too subtle whereonto establish a difference in kind, or, let us say, inspecies? In fact, the difference between them isroundly denied by the French, with whom the chan-crous secretion, in all its forms, is pus. Fibro-plastic globules and fibres have been somewherecalled, we believe, heteromorphous; and the pyoidglobule, homoiomorphous; but the line was nevercut so sharp between them as we find it in thisartificial theory before us. Nor, indeed, is a pus-globule, according to our ideas, exactly a pathologicalentity. To Henry Lee, who identifies the infectingsore with adhesive inflammation, the passage, whetherby artificial or other means, to a suppurating sore, isall-important; it is an " artificially induced" action,manifested in the pus, and conveyed by the pus. Thesore has lost its sting; it has S"lost its infecting prin-ciple; and it has gained a contagious principle, as a re-sult of this action. Whatdoes all thismean? It conveysthe idea that there has been produced a soft sore, acontagious non-infecting sore and mark, not in situwhere the "action" has been "induced" by irritsa-

* See case of Melchior Robert's pupil, quoted in previous paper.Ricord has stated that, if chancrous pus be inoculated on a syphi-litic person, the sore produced is never an indurated ulcer; but,notwithstanding, if the pus from it be transplanted to a uon-syphi-ilitic, a hard chancre is the result, and also consecutive syphilis.So also Bumstead On Venereal Diseases, 184, Intro4ustion, p. 46.

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British Medical Jornal.] LRADING ARTIOLES. (Spt. 1, 18688

tion of some sort, but manifested in the spot of ino.culation, where the infecting power is lost, " as faras present evidence goes," and the contagious poweris retained; so that from this sore you can inoculateright on in a series, although it be no longer pox.Vrong in fact, wrong in theory. The case of the

pupil of Robert, who, as we have seen, was infectedthrough one of these inoculations, shows that it hasnot necessarily "lost its sting"-i. e., its infectingpower. But let us follow Lee in his argument, inwhich he so nicely distinguishes contagious from in-fecting power. It needs explanation truly, and onerequires to be behind the scenes. Let us consult hisFrench prototypes. According to their purely ar-tificial distinction, contagion is local, infection ge-neral in its effects. A small quantity of blen-norrhagic pus deposited on a mucous surface, fol-lowed, as often is the case, by the disease, marksblennorrhagia as having a contagious principle.The same term, then, applies to the simple or softvenereal sore, which is with the French a local,contagious, non-infecting disorder. We now un-derstand what he means by its losing its infecting,and gaining a contagious power. He means, totidem-verbis, it has ceased to be an infecting, and has be-come a soft or simple chancre. There has takenplace a change of species; that is what he insinuates.This is the theory of the dualists and of Langlebert,undisguised. But how does this change occur, andwhen? At what point? During its flight to theinoculated part; at the moment of departure or ofarrival. One disease goes out, and the other comesin, like two sentinels relieving one another, ornight-nurses taking their turn about. But thiscontagious sore, whence comes it? Not out of thesavine powder or the dry lint of the manufactory?Does it come e nubibus, for ex nihilo nihil fit ? It isthe result, the author says, of " action"; it is "1 ac-tion" which is at the bottom of the change, andwhich produces a sore which is not a common ulcer,but which can be inoculated right on in a series.The passage from adhesive inflammation to suppura-tive inflammation, is it so extraordinary that itmakes quite a change of disease? The action doesnot only break down the syphilitic principle com-pletely, but it manufactures out of it an entirelynew article, a most definite non-syphilitic malady,which, if we may believe the dualists, had a pre-existence to syphilis among European populations.But perhaps Mr. Lee may say it is not a disease atall which is begotten; it is an "action" which is" induced". Does not common sense revolt at that?Suppose now you were to say to a man, " Sir, excuseme, you have not a disease hanging about you; youhave an action." Might he not answer, " Sir, Inever had%an action in all my life ? I have reallysomething that ails me." Would it not be a scene deHoliire? No, that argument will not do. Would ithold good in pneumonia, phlegmon, or any disease?Does leprosy begin only in a tubercle, and not alsoin an ulcer or a scale ? Are we then so pre.cise? We have heard something of polymorphismlately, and the term has been applied with a some-what lavish hand to affections which are tolerablyregular in their course; but syphilis, has it notalways been esteemed polymorphic par excellence-the polymorphic disease ? Be, therefore, less exact-ing as to its elementary forms and primary devia-tiQns, we beseech you.

It renains for us to add, that a strong corro-borative proof is given of the infecting characterof the inoculations in the occurrence of the mul-tiple glandular swellings which occur "like a chap-let" on the edge of the pectoral muscle, as describedby Boeck and Bidenkap; and the same may be sa4d

of those skin-manifestations so convincing to themind of the operator that the inoculated virus reallyhas what M. Rollet and others have been pleased todeny to the simple sore-an " echo" in the economy,

[To be continued.]

We are requested to remind members of the Asso-ciation that the Annual Subscriptions becamedue on the 1st of January. They can be paideither to the Secretaries of the Branches; or tothe General Secretary, T. Watkin WilliamswEsq., 13, Newhall Street, Birmingham.

It'isk RetbraI s}furnal.SATURDAY, SEPTEMBER 1ST, 1866.

APHASIA.A GREAT deal of very good work has recently beendone, chiefly in France, in the attempt to fix theseat of the faculty of language or of articulate lan-guage. We believe, for our part, that it is not wellto speak of language as being a distinct faculty-atall events, in the sense of its being so distinct fromthe rest of mind and its outward doings as to have aseparate seat in a small part of the brain Therehas been much discussion on the subject; but, to ourthinking, the work which will last will be that whichM. Broca and others have done in collecting facts toshew where the Nervous System is most often da-maged in cases where power of speech is lostor disordered. It may seem at first glance to be atiresome refining of words to speak as if it were set-tled-although we do not say that we admit eventhis-that damage within a limited region of thenervous system disorders or destroys speech, whilstwe will not admit that language has a seat. Withinthe limits of this short article, we have no intentionwhatever to discuss the subject of language; nor, inspeaking briefly, must we be understood to wish todogmatise on points which are very much disputed.Our object is rather to contribute what we can togreater width and precision of investigation, andespecially to point out that the distinction we havejust indicated is an intelligible one.

In many published cases of loss of speech, thedamage to the nervous system has been of convolu-tions in the region of the corpus striatum; and, ac-

cording to M. Broca, it has generally involved partof the third left frontal convolution. It nearly al-ways involves the corpus striatum too, and henceloss or defect of speech is almost invariably attendedby hemiplegia. Speaking of those cases in which thedamage is the result of embolism, a writer in a con-

temporary (Lancet, Nov. 26th, 1864) says:-In some, the supply of blood is cut off from so

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