catarrh is frequently set up in the male from a catarrhal or other excited state of the mucous membrane of the female.

It may seem that we are assuming too much here, when it is kept in mind that, according to Ricord's experiments, no pus other than chancrous pus was able to induce a chancre on the skin. But it is at the same time clear that no experiment can possibly reproduce the natural circumstances of the case; and we have the clear analogy of gonorrhoea acquired where there is no gonorrhoea, but some much simpler exciting condition, in the woman. It would be hard to exclude the possibility that sores on the pudenda, which are no other than sores of common origin, may be transmitted by contact or contactual inoculation.

Now, in the inoculated person, such a sore might or might not reproduce the characters of the original sore; according to the temperament or constitution of the individual, it would reproduce them perchance in a more rapid sequence, and it might reproduce something more. In particular, the small beginnings of phagedæna, which may be found in every ulceration, would have a chance, at least, of extending. It is observed by Pearson, and after him by Brodie, that the degree of phagedæna as often depends on a bad state of constitution in the infected party as on anything specially phagedænic in the sore from which the infection came. It is amidst such differences between the man and woman, or again between the woman and

man, that ordinary ulcerations-always assuming that they are transmissible-may become ulcerations of a peculiar type. In some such way a slight phagedænic tendency, such as any ulceration has, may be cultivated from time to time into a fixed character of venereal ulceration, that character which, as Hunter says, distinguishes venereal sores above all other sores, namely, their small disposition to heal.

The circumstances under which a sore on the genitals, of common origin, may be cultivated into a sore of a special type and with a special inveteracy, are not confined to the general differences of sex always in operation, including occasional instances of marked personal idiosyncrasy. We find them on a much larger scale in differences of race and habits, and in changes of climate. The almost inexplicable outbreak of syphilis in Tahiti and New Zealand after the arrival of Cook's and De Bougainville's ships in the last century, probably depended for its small beginnings on de novo causes in concert with racial differences. A remarkable instance of the effect of change of climate on the type of venereal diseases is given by Larrey.* The French Army of the East (1801), of which he was surgeon-in-chief, contracted a very mild kind of venereal sore from the Alexandrian women, which healed in about three weeks and left no bad consequences. But Larrey remarked that in several persons who returned to France with sores unhealed, the type of the process became peculiarly inveterate. Larrey does

* Relation historique et Chirurgicale,' &c., Paris, 1803.

not say that the inveteracy amounted to constitutional infection; and in all probability it was simply an exaggerated indisposition of the primary sores to heal. But there are cases occurring in everyday practice where the same kind of inveterate soreness, from blundering attempts at self-treatment or the like, is followed by roseolar rash and sore throat.

It will be admitted that Hunter's definition of a venereal sore, as one that has little natural disposition to heal, suffices for the sort of ulcer that enlarges its borders, eats away the sound margin of tissue, starts the ulceration at new centres, or shows the phagedænic tendency in one degree or another. But it will occur to everyone that the kind of sore which is always most to be feared, namely, the indurated sore, cannot be accused of an indisposition to heal. The definition does not apply to such cases literally; but it applies to them with quite peculiar force if we have regard to the kind of healing. It is not ordinary healing by granulations; it is healing by a kind of "granulomatous" tissue, which approximates to tumour tissue. The phagedænic tendency is one kind of indisposition to heal, and the granulomatous or indurated tendency is a peculiar modification of the same indisposition. In both cases we miss the selflimitation of normal repair: in the one case, quite obviously in the more or less marked phagedæna ; in the other case less obviously but not less really in the tumour-like characters of the new growth of repair.

Something has determined the ulcerous process along the one devious road or along the other; and it will probably be found that the decision has rested more with the infected individual's constitution, temperament, idiosyncrasy or diathesis than with anything fixed, inherent or certain to breed true, in the infecting matter. I have already quoted the opinion of Pearson and Brodie that the degree of phagedæna in venereal infection is apt to depend on the constitution of the person infected; and if communicated sores with a long history or tradition or memory of bad healing take the phagedænic direction in some persons, they take the granulomatous or callous direction in others.

It is not in venereal sores only that those differences in the healing process are observed. Some persons heal badly wherever the injury is; and although the bad healing of a wound or sore is often set down to a syphilitic taint in the constitution, the hypothesis is a very arbitrary one and often wrong. Thus, in a case where the whole circumstances were known to me intimately, the healing which followed the loss of a piece of skin in front of the forearm (down to the deep fascia) took so irregular a course, that a wellknown surgeon was led to suspect syphilitic infection; and he would have doubtless been strengthened in his suspicions if he had seen the tumour-like thickening of the scar (of almond shape), which remained for weeks after. But there was not a particle of evidence of syphilis; it was simply one of those cases of bad healing, where the reparative process takes the

direction of granulomatous rather than of granulationtissue; and there were some things to account for it (although I do not go into them) in the situation, manner of production, and subsequent exposure of the wound, and in the constitution of the individual. Surgeons with large experience of the healing of wounds and sores have probably seen many such

cases.

The differences among individuals as regards healing will always have many opportunities of asserting themselves in the constant transmission and retransmission of sores on the sexual parts, all the more so that those parts are peculiar in their innervation and vascularity. Who can find his way through that labyrinth of pathology? Those who affect to believe that the types of venereal sore have existed ab aeterno, and that they always breed true, need never enter it. For others it remains to make the attempt, following what clues they may.

We have good reason to think that the degree of phagedæna does not by any means depend on the eating character of the sore from which the infection came; and conversely we may take it that induration and all its consequences may follow infection from a sore of a different kind. Even if we could always know the kind of venereal ulceration from which the sore was caught, it would be impossible to predict the result in the infected person, just as it is impossible to say whether a non-indurated sore may not be constitutional. What we do know is that a venereal ulcer is always