Secale 169. Spontaneous Appearance of Venereal products.
Considered from a purely theoretical standpoint, such a spontaneous manifestation may not be impossible per se; for there is no reason why that which, at one time, originated spontaneously, should not again originate in a similar manner. If, at the present day, we behold only infusoria starting into life spontaneously, yet no one would dare to assert that at some future period we may not witness the spontaneous birth, from a conjuncture of adequate circumstances, not only of cattle, elephants, and rhinoceroses, but even of human races. Why should not new diseases develop themselves so much more readily? May we not say that cholera is a spontaneously developed disease? Do we not see cases of sporadic cholera manifest themselves, day after day, which though they have nothing in common with epidemic cholera as a specifically idiopathic disease, yet seem to suggest by their very name, the possibility that epidemic cholera may develop itself as a spontaneous plague? Why, then, not syphilitic phenomena? A spontaneous manifestation of these phenomena may not be impossible; but it is not probable, more specially as regards the syphilitic phenomena of which we are writing, and which have not only the name, but the essence in common with those to which we have applied the name of specifically venereal. For, on surveying the whole history of creation, we indeed see whole genera and species of plants, animals, and diseases, start into existence under the influence of adequate circumstances; but from the moment that a whole race is born, its single individuals are afterwards perpetuated by the act of generation, but no longer by the original circumstances that gave birth to the race. If, therefore, the assertion is to be insisted upon, that, in order to contract a venereal disease, it is not necessary to have intercourse with an infected individual, but that so-called venereal symptoms may arise from intercourse with the healthiest woman, in consequence of the irritation produced by acrid menstrual blood or an acrid leucorrhoea discharge, or even by a want of cleanliness on the part of the woman, or by too much ardor during the act of coition: we shall insist, in the first place, upon evidence that the phenomena occasioned by the aforesaid causes, are identical with those which pathologists designate as venereal, and that the woman herself had no previous sign of contagion on her person. On looking over the history of the cases which the advocates of this theory adduce as proofs of its correctness, we find, however, that they have taken it for granted, without making any further examination, that the assertions of the women regarding all freedom from infectious symptoms, were true, and that they never imagined that the infected individual might have had connection ten, twenty, thirty, or even forty days ago, with some diseased woman, who communicated to him infectious germs that did not begin to sprout until some time after he had cohabited with her successor. What is apt to occasion an additional amount of confusion is that, the opponents of the infection theory resort to the most deadening uniformity in classifying the different phenomena in the sexual sphere; be they simple or complex, the most harmless and accidental ulcer, as well as the most malignant chancre, are arranged by them under the vague appellation of venereal. Under cover of such a vague terminology, we may not only make the assertion that venereal phenomena may be superinduced by the most harmless, or perhaps by a somewhat heating act of coition, but that a number of such phenomena may disappear spontaneously without any interference on the part of art. In trying to apply this theory to specific venereal diseases, such as chancre, figwarts, etc., the aspect of case changes, and any one who chooses, may convince himself that Fernelius was right, when, in the year 1542, he wrote of syphilis: “Hoec lues nulli adnascitur, nisi contagio qui se polluerit.”
Secale 170. Pseudo-venereal Phenomena.
We do not mean to deny that any one of the above-mentioned causes such as an acrid leucorrhoea, uncleanliness of the female parts, unusual order during the act of coition, etc., may cause a variety of abnormal phenomena in the sexual sphere, not only discharges, but even ulcers of a greater or less extent, which, under certain circumstances, in consequence, of an herpetic, scorbutic, or scrofulous diathesis, may even become very obstinate, and, through a purely consensual continuation of the irritation, may even cause a swelling of the inguinal glands. This, however, would not justify the inference that even the healthiest woman may communicate during the act of coition gonorrhoea, chancre, buboes; between these venereal products and the former harmless consequence of ordinary intercourse there may exist an analogy of form, but not by any means an identity of essence. An ordinary discharge is no more like a specifically contagious gonorrhoea than a syphilitic chancre is like a common, non-contagious ulcer, or a syphilitic bubo like an ordinary swelling of the inguinal glands. Even inflammation of the prepuce and glans, with or without balanorrhoea, phimosis, or paraphimosis, may take place without being syphilitic, and will run an entirely different course from the latter. If we regarded nothing but the general name which all these phenomena have in common, we might indeed start the doctrine that there is no syphilitic product which might not be equally caused by a non- contagious principle of communication. A due regard for the pathological essence of these products will soon convince us of the impossibility of such an occurrence. Nothing seems more absurd than the statement still to be found in pathological and therapeutic manuals: that a prostitute, having cancer of the womb, had communicated to one of her lovers a most malignant chancre and to another a virulent gonorrhoea. No more than a patient with variola can infect others with measles or scarlatina; can a circinomatous patient communicate syphilis, or vice versa, can a syphilitic patient communicate carcinoma? Specific causes can only have corresponding specific effects. If the cancerous girl in question had real cancer, she may have infected her lovers with cancerous, but not syphilitic ulcers; if these ulcers were really syphilitic in one, taking the form of chancre on the penis, in another that of a malignant ulcer in the urethra, the supposed cancer of womb must have been a syphilitic sore. By means of a number of experimental investigations which Ricord has instituted for the last few years with unparalled industry and sagacity he has demonstrated beyond all possibility of cavil that the principle of the producing only its like is so true that special syphilitic products can only reproduce products of a like kind; that a chancre, for instance, can never produce primary mucous tubercles or primary condylomata, but will always produce chancre, and vice versa, that tubercles and fig-warts can only produce their like, but no chancre. The same thing might be said of gonorrhoea; this, however, would lead us to the subject of unity or plurality of the venereal contagium, to which we shall devote a special chapter.
II. DIFFERENT VENEREAL CONTAGIA.
Secale 171. Venereal Views.
Although we have discussed this subject when treating of gonorrhoea, as much as the special therapeutics of this disease rendered necessary, yet we have to refer to it again in the present place in order to explain our views concerning it as completely as possible in connection with the whole range of venereal phenomena. Beside the question of the specific character of venereal diseases, the question of the unity or plurality of the venereal contagium has led to endless disputes and distressing confusion. Ricord’s experimental discoveries, regarding the products which different primary phenomena are capable of producing as primary, protopathic results, might have satisfied the disputants that, where different seeds bear different kinds of fruit, the different seeds may have been analogous, but cannot have been identical; they all may belong to one family, but each seed must possess its own, independent properties. Systematic prejudices or other causes interfered: some, who were a priori advocated of the specific character of miasmatic diseases, were not satisfied with merely distinguishing the contagium of gonorrhoea from that of chancre, but went so far as to claim even as specific miasm for fig-warts. Hahnemann belongs to this number. Others, again, who did not relish the idea of having to acknowledge at least one specific disease, mixed up gonorrhoea, chancre, and fig-warts, as accidental manifestations of one and the same pathological activity. Experiments and observations were not wanting; but inasmuch as, in making these examinations, experimenters frequently confounded with each other analogous, form that had not been sufficiently discriminated hitherto, and hence ascribed to all of them results that perhaps only belonged to one of them exclusively, it follows as a necessary consequences that these observations, despite the care with which they were made, must have been more or less contradictory. In addition to this, it frequently happened, that among individuals who has already been infected several times, the last infection was charged with consequences that really were manifestations of a previously-existing constitutional syphilis. A multitude of, in themselves, invaluable observations, instituted by Ricord, Hernandez, Cazenave, Baumes, Bell, Sawray, and other French and English authors, may be referred to as evidences of the illogical conclusions drawn from them; nor can we have any difficulty, by carefully examining their observations and discriminating the different forms of venereal diseases of the same name, in deducing the truth from the contradictory conclusions of observers. In this respect, it seems so much more necessary to subject the statements of French and English practitioners to a rigid examination, since most of our German manuals seem to be based upon them, and many erroneous propositions, by Ricord, Cazenave, Sawray, and others, are copied even by Schoenlein with so little critical acumen, and with so much dogmatism of style, that it seems as though the Professors had only intended to say to their students: “It is so, write this down among your notes!” Let us examine the different doctrines bearing on this subject.
