than in Norway and Guiana, but in no other respect does it change one jot. The sweating sickness of 1517 was more fatal and rapid than that of 1485, but, I suppose, no one ever doubted their identity in nature. The cholera of 1854 was more deadly than that of 1849, yet cholera has not altered in one essential characteristic since it first issued from the jungle. Many other instances of these mutations of severity might be cited, but not one of them points to a fundamental change like that which we must admit if we are to accept the unity of syphilis. It seems to be in the order of things, that old opinions, however well founded, must, for some reason or other, yield to those which possess the charm of novelty-that the generation of to-day must overlook or reject something which a previous age had received with general assent. Thus it proved with respect to syphilis. By the time that the pathology of the disease had begun to assume completeness of outline under the hands of Paracelsus, 1527, and Fernelius, 1556,-that the dependence of the constitutional symptoms upon a specific primary affection, itself produced by a poison acting at the point of contact, had come to be recognised, although still encumbered with much that was erroneous as regards the nature of this lesion,-the old historical landmarks had almost been lost sight of, and very soon after the time of even the first of these two writers the epoch of confusion had fairly set in. As this is the turning-point in the history of our subject, I propose to examine it rather fully. MM. Bassereau and Chabalier date the change in men's opinions as to the quality of syphilis from the account of this disease given in 1508 by Vella. If so, his readers were very easily convinced, for, I think, a piece of worse reasoning could scarcely be found; and if he can be supposed to have proved anything, it is that he has utterly confuted himself. He saw the disease both before and after the outbreak of the morbus gallicus, and expresses his surprise at finding it from that date followed by constitutional symptoms, because the initial lesions seemed to him identical. "The way in which these patients are infected," he says, "is the same as that in which the virile members were infected before this disease (the morbus gallicus) existed-that is to say, by the act of coition, by the same organ, and, so far as the power of sight enables one to judge, by the same pustules. For which reason, those skilled in the art (of medicine) not being able to see any distinction between the one and the other, proceeded in the old way with the treatment of the new disease." Unless this means that chancroid not only existed, but was fairly common before the assumed date of the coming of syphilis, I am utterly at a loss to know what it does mean. If the fact of an author, writing on the spot, treating one disease as new and never alluding to the other in any such way, be not evidence of the pre-existence of that other, pray, of what is it evidence? what does it go to prove? Here, too, we see scattered to the winds all the arguing about the soft sores of the thirteenth and fourteenth centuries being common ulcers, for Vella tells us that he could not distinguish them from sores which were clearly the first lesions of syphilis. Therefore, if the older sores were not chancroids, chancroid has never existed at all, and must be treated as a myth. Of course, Vella's mistake was that he converted an occasional resemblance into a rule. The occasional resemblance we know to be an established fact, seeing that some of the best observers, even M. Ricord himself, have not hesitated to confess that they could not always make out the nature of a sore from its visible signs. Here, then, we see that the confusion between the two forms of syphilis, soon afterwards to be openly taught, is fairly hinted at on authority, and had already begun to disturb men's opinions; but for all this, I consider that both Bassereau and Chabalier have erred in ascribing the beginning of the belief in the unity of syphilis to the weight of any arguments employed by Vella, for I am inclined to think that he never had influence enough, either with his contemporaries or with later writers, to gain currency for his views. He seems to have scarcely ever been mentioned by either class of authors, and his practical knowledge of the disease to have been in rather a crude state, for he was evidently not acquainted with the Hunterian sore, common, according to what de Vigo says, after the invasion of Italy, seeing that he could not very well have mistaken it in a developed state for one of the old soft chancres. It is not true, too, that those skilled in medicine treated both kinds of primary sore-that is to say, the lesion seen before, and that first noticed after, 1494-in the same way; not a passage can be produced from any standard writer on syphilis to such effect. The purely local method pursued by the practitioners of the fourteenth and fifteenth centuries is as distinct as can well be from the constitutional means employed almost at the first appearance of syphilis, especially as regards the use of mercury, recommended as early as 1495; and for my part I cannot understand any person maintaining the identity of the two systems. Vella's evidence, therefore, in support of the unity of syphilis, which he is trying to enforce, must, I contend, be rejected, and, as well as I can make out, was rejected for long after. It was not even a novelty on his part to trace a likeness between the old sores and the primary lesions of syphilis. Six years previously Almenar had described the new disease as beginning with a corrosion on the penis like the caroli. But I must totally dissent from the sweeping statement of a modern writer, that when syphilis first broke out the authors of that day, Marcellus of Como, Leonicenus, Beniveni, Cataneus, de Vigo, Vella, and Fracastoro, found no difference between the old caroli pudendorum and the pus sores on the genitals, which they described as an accidental symptom preceding syphilis! Fracastoro is not entitled to a hearing, as he could only have learned about the matter from others. With Vella I have already dealt, and de Vigo must be eliminated, for his classical description of hard sore is the earliest thing of its kind; no such portrait of Hunter's chancre exists before his time. As regards three of the first four names I can say nothing; the author in question does not quote his references, and I have searched in vain for a single passage to which such an interpretation could be given. The evidence of Cumanus I must read the other way, for though he saw the two diseases side by side, he does not seem to have thought of confounding them; and his description of sores the size of a millet seed, whether it refer to itch or to follicular chancre, would be as difficult to find in any author before his era as would that by de Vigo. But, indeed, the question is one, not of resemblance, for that with some reservation may be admitted, but of identity. On the latter point the evidence of the earlier writers after 1494 is decisive; they saw no identity. And as I understand Vella, some of his contemporaries were anything but convinced that the two affections were one and the same, for in substance they were asking the question, "Why, if this be old, did we never see such results till now?" And the reason why is, according to him, a new state of the atmosphere. The mystification was not long to be delayed, and the task fell into the hands of two of the most incompetent and blundering observers of that or any other age, Massa and Bragsavolus; the first effectually began, and the other thoroughly completed the work of confusion. Massa, a person of narrow, superstitious views, who in an age of inquiry had not advanced a step beyond the crude opinions of the earliest observers, added, 1532, chancrous bubo to the body corporate. Bragsavolus, 1551, joined to the two forms of syphilis, now fused into one, gonorrhoea, recognised as a local complaint at least as far back as the time of John Arden. They carried the day. Though they were opposed by men like Fracastoro, Scaliger, and Fallopius, the tidal wave of obscurity which they had raised buried for a time at least all dissent, and has made itself felt often enough in the present century. Such men, having adopted an idea, seem incapable of any further impression from either arguments or facts, and adhere to the first conviction in much the same way as the bivalve clings to the rock on which it has anchored itself. It will be unnecessary to reproduce the opinions of Fernelius, Fallopius, and others. They effected no particular change in the general belief. It will suffice to say that the reign of chaos, having fairly set in, went on with unvarying monotony, reaching, perhaps, its lowest depths in the pages of Sydenham, who wrote, I should say, the worst description of syphilis in the whole world,— the catastrophe in which, according to him, this disease naturally closes being a picture utterly untrue to nature, though quite in keeping with the rest of his account. "The limbs," he says, "rot away piecemeal, and the mangled carcase, having at length grown hateful to the living, is buried in the earth." The views of Turner and others who followed Sydenham need not detain us, as they go for nothing in this question, the first real step towards the solution of which was reserved for Hunter, with whom history ends and pathology begins. VIII. REPORT OF CASES ADMITTED TO WARDS X., XI., Reported by W. SCOTT LANG. THE number of cases admitted, exclusive of those in the Wards at 1st May 1885, was as follows: : To Ward No. X., 139 males. There were 14 deaths-equal to a mortality of rather under 4 per cent. The principal cases may be classified as follows: The fatal cases of fractured pelvis, fractured skull, and fracture of spine and sternum, were all caused by falls from great heights, and in each case death occurred within a few hours of admission. In the case of fractured pelvis, it was found at the autopsy that the head of the femur had been driven through the acetabulum, and was lying in the pelvic cavity. The bladder was ruptured, and death occurred in a few hours from shock. The case of compound dislocation of ankle occurred in a very stout man, aged 63. There was no rise of temperature, and he was apparently doing well; but he died suddenly on the fifteenth day, from failure of a fatty heart and coagulation of blood in the great vessels. |