CHAPTER X.

THE ALTERATIVE CURE OF SYPHILIS.

PERHAPS the most famous of alterative cures is the cure of syphilis by mercury. Assuming, as we have good reason to do, that the alterative action of a drug is a habit-breaking or memory-effacing action, we are met by the question, How can the process of syphilitic infection be represented as an affair of morbid habit in the tissues, and of what is it a memory? The answer to that question is not so forced or far-fetched as it may seem at first sight. The key to the problem is the irregular or protracted healing of sores in certain situations; or, in other words, syphilis is the tradition or idea of bad healing, or of granulations gone wrong.

There is first of all a doctrinal obstacle to be cleared away. It will be admitted by everyone who keeps his eye on the facts that the attempt to make an absolute separation between two kinds of venereal sores has been an ill-judged one. There are cases within the knowledge of many practitioners where a common sore, developed within a few days of exposure to infection, having an encroaching or spreading tendency, and no

obvious induration, has been followed by symptoms of constitutional infection.*

No surgeon now confidently acts upon the doctrine that sores indurated from the outset are the only "true" or "syphilitic" sores. The belief on that point which held sway for a number of years has silently been given up, and we are practically back at the old stand-point. The surgeon who is asked by his patient whether the sore will be followed by secondaries, prudently answers, if it be a common ulcer, that he cannot be sure. Meanwhile, to cover the failure of the dogmatism about "true" sores, a very characteristic kind of fallacy or poor logic has been resorted to. If the common or soft or spreading or suppurating ulcer should happen to be followed by constitutional infection, we become wise after the event; we allege that the "true" syphilitic virus had been communicated at the same time as the "spurious," that the one was implicitly present along with the other, although there was nothing to betray its presence; otherwise, how could the constitutional infection have arisen? This is so transparent a begging of the question that it is hardly necessary to argue it.

*I lately saw, in the tertiary stage, a case where a large sore of that kind had developed on the mucous surface of the foreskin five days after the exposure to which the patient confidently traced it. The entire prepuce had been at once cut away; but in due course there occurred the symptoms in the throat and on the skin, and, within a year or two, periosteal nodes followed by intra-cranial symptoms, which at one time seemed to warrant the very worst prognosis.

The absolute separation of indurated or syphilitic from non-indurated or simple sores should never have been made; if there were to be any useful contrast at all, it would have been much nearer the mark to set off a certain degree of circumscription and induration' against a certain degree of phagedæna; and it will probably be found to hold good that local destructiveness diminishes, pro tanto, the chances of metastatic infection. But in these matters of venereal sores we are far removed from the rigidity of species; it is now abundantly evident that the specific tests of a "true" sore, which were discovered in one of the sanguine moments of medical progress, are constantly failing us and landing us in confusion and mistake. The best evidence of the uselessness of the test is that surgeons of high repute thought it safer to put the patient on a mild course of mercury even when the sore was a soft one.

If all sores on the sexual parts of men and women had followed the natural course of repair, we may be sure that they would never have been known by their distinctively venereal characters and consequences. Hunter makes the obvious remark that, unless the sores had been on the genitals, they would never have been communicated from person to person. We may go farther, and say that unless in the course of these transmissions and retransmissions, and amidst the general circumstances of lewdness and personal neglect, the natural healing of sores, or the normal process of repair, had been seriously interfered

with, venereal sores would never have acquired their distinctive and inbred character among the sores of the body, the same being, according to Hunter, "a small disposition to heal.”

It is, indeed, conceivable that a particular type of granulation-tissue might have been bred by the mere contagious reproduction of sores in that particular region through a long succession from sex to sex, and without the factor of neglect or indifference to the healing process coming in. But there is no need to make allowance in real life for such a possibility of evolution as that. Neglect of healing, or indifference to the existence of sores, has not only been the grand cause of their spreading from person to person, but it has also been the cause of their distinctive syphilitic characters. The class of men and women with whom syphilis is mostly associated are characterised not merely by the absence of moral restraint; there is also a frequent want of care of the person, or an indifference to the cure of their ailments. All the virulent epidemics of syphilis in recent times in obscure parts of Europe have had that sort of physical neglect as their principal factor, although it has been more often due to the unsophisticated nature of the people than to their degradation; and those recent epidemics, as Professor Hirsch points out,* are a good analogy for the great fifteenth-century epidemic, which, although not by any means the beginning of syphilis among

*Geographical and Historical Pathology,' English translation, ii, 1885, 90, 97.

mankind, was the fountain-head of much of the syphilis now extant.

We have to put into the foreground then, two obvious and common-sense considerations: first, that (as Hunter says) the sores would never have passed from sex to sex unless they had been on the sexual parts; and second, that their other distinctive character of "small disposition to heal" is one that has been acquired, bred and intensified in various ways, and is constantly being acquired, bred and intensified afresh, under circumstances which are well known although not much discussed or written about.

Let us take, then, the case of a neglected sore in some recess or fold of the labia, from the irritation of acrid discharges, or from herpes, or from a contusion, laceration or other injury; or let us take Hunter's statement of fact that "the penis is liable to ulcers like other parts of the body, and from some circumstances, rather more so than other parts; for if attention be not paid to cleanliness, we have often excoriations or superficial ulcers from that cause. Since, then, this part is not exempted from the common diseases of the body, and as every disease in this part is suspected to be venereal, great attention is to be paid in forming our judgment of ulcers there." Let us take such a case in either sex, and make the further warrantable assumption that the presence of ulceration, recognised or unsuspected, had not been permitted to bar sexual intercourse; then we may infer that the ulcerous process would be inoculated on the sound party, just as an intense urethral