Secale 175. Secondary Products of the same kind.
Let us leave all these hypothetical statements to those who are anxious to hunt after shadows instead of grasping realities, and let us consider by what more palpable reasons the identity of the venereal contagia has been sought to be proved, namely, that gonorrhoea has been known to produce the same secondary phenomena as chancre. Authors, however, go too far if they mention dolores osteocopi, strictures of the urethra, and priapism, as such phenomena. We say nothing against the dolores osteocopi; but strictures of the urethra after chancre! Is it not an established fact, that these strictures sometimes occur twenty years after the disappearance of gonorrhoea? It would be wrong to charge a stricture upon a chancre, for no better reason than because chancre happen to be the last infectious product. Or are we to understand by chancres the accidental oedema of the urethral lining membrane which often occurs simultaneously with chancre in the urethra, and then disappears again together with the cure of the chancre? Or, perhaps, the spasmodic contractions of the urethra, which, as well as priapism, may take place during every somewhat intense inflammation of the penis or urethra, as a purely consensual phenomenon? In such a case, we should have to consider the poison of Cantharides as absolutely identical with that of gonorrhoea and chancre. The case is different in regard to the truly secondary and constitutional symptoms of syphilis, such as the dolores osteocopi, and various syphilidae, even chancres in the throat, which have not only been known to occur after chancres, but likewise after gonorrhoea, although very rarely after the latter, as is even admitted by Doctor Cazenave, the most zealous advocate of this theory. We might have added, that most of these rare cases occur among females. In my own practice, I have only seen consequences of this kind occur tolerably frequently after the gonorrhoea of females, but never among males, Putting together: (1) the experimental inoculations (No. 173) and observations instituted by the advocates of the plurality of venereal contagia; (2) my own cases of masked chancres in the anterior portion of the urethra; (3) the ease with which such masked chancres may remain unnoticed in the case of women it is evident that the few cases mentioned by the advocates of unity of the venereal contagium, cannot be reckoned among the cases of gonorrhoea with hidden chancres and mucous tubercles, unless the facts of the case should render this arrangement compulsory. Why should so few cases of gonorrhoea be succeeded by secondary syphilitic phenomena, whereas the majority of cases of gonorrhoea, even when merely suppressed by local agents, have no such result? Is it not because in those few cases the gonorrhoeal discharge was associated with another principle not by any means essential to the nature of the former, hence no essentially pathognomonic sign of gonorrhoea? Now, if the essential signs of simple gonorrhoea are distinct from those of the syphilitic chancre, the contagia producing the one and the other must be so likewise; and the advocates of the unity of the venereal contagium, who admit that the cases where gonorrhoea has produced the same secondary products as the syphilitic chancre are but rare, might content themselves with the above inferences, if there did not exist other valid reasons in favor of the plurality of the venereal contagia.
Secale 176. Reasons for the Plurality of the Venereal Contagia.
After having seen, in the preceding paragraphs, that the facts adduced by the advocates of the identity of the venereal contagia are rather against them that in their favor, let us now examine the facts alleged by the advocates of the plurality of these contagia, in support of their own theories. Here these gentlemen begin the controversy by putting forward the undeniable fact, that a chancre never gets well without the interference of art, but that gonorrhoea admits of a spontaneous cure. This fact is denied by the opposing party only in so far as this, that there are likewise many cases of gonorrhoea that do not get well of themselves, and that, on the other hand, there are many chancres that get well without the interferences of art; all of which is undeniably true. If we inquire further what kinds of gonorrhoea do not get well without the interference of art, and what kinds of chancre, on the contrary, do get well spontaneously, we answer: “A chancre that will never get well without the use of specifically-appropriate agents, and which, if left to itself, would, after cicatrization, run into other and different forms, is the Hunterian chancre; and a gonorrhoea that will never get well without artificial means, is one that arises from the presence of a masked Hunterian chancre, or of mucous tubercles, unless we choose to regard as a cure the metastatic changes which the latter might occasion.” Whether among the other chancres there are some that are capable of a spontaneous cure, we will not stop to inquire; nor will we stop to inquire; nor will we stop to inquire whether there are other kinds of gonorrhoea that do not get well without treatment; one thing is certain, that a gonorrhoea which heals spontaneously, in no case originates in a Hunterian chancre or in mucous tubercles. This ground is sufficient for further argument. For if the fact is established that the Hunterian chancre cannot heal of itself, without passing into other forms, or breaking out in other localities, it is evident that every gonorrhoea which gets well without exhibiting any of the symptoms of a metamorphosed syphilitic product, is one that has no sort of affinity to chancre, and, therefore, must owe its existence to some other totally different virus. Reviewing in our minds what we have said in No. 155-166 of the syphilis of the ancients, of the great European epidemic, and of the transformation of the venereal diseases occurring subsequently to this epidemic, we find: (1) that as far back as the Greeks and Romans, not only ulcers but gonorrhoeal discharges were known which had this peculiarity, that their disappearance was not followed by general constitutional affections; (2) that either during, or, at any rate, shortly after that epidemic, according to the uniform testimony of all contemporary writers, a new and hitherto-unknown form of the venereal disease made its appearance, which De Vigo (No. 160) describes as distinguished by lardaceous ulcers, with hard and callous, livid (copper-brown red) edges, and Fernelius (No. 164) as a disease pervading the whole organism, and afterwards breaking out in cutaneous pustules and other (secondary) phenomena, by which the disease, he says, was distinguished from any other formerly existing plague. In No. 166, we have seen that, soon after that period, a new form of gonorrhoea broke out together with this syphilitic plague, which was denominated blennorrhagia gallica, and of which Bargarucci says that, in contradistinction to the hitherto known gonorrhoea, it was neither curable by local treatment nor without treatment. This gonorrhoea was nothing else than the modern contagious “blennorrhagia” of the French, associated with syphilitic chancre, a disease that, even at this day, is much more frequent in France than in any other country.
Secale 177. Sycosis, fig-wart Disease.
A discriminating examination of the facts before us, of an apparently contradictory nature, a superficial apprehension of which might lead to the most erroneous conclusions, together with a knowledge of the historical development of the venereal diseases, show that, at the present time, we are acquainted with at least two venereal contagia: (1) an ancient contagium producing a gonorrhoea, that, after passing through its inflammatory period, runs its course to a spontaneous cure; and (2) a new contagium producing the chronic, copper-colored syphilitic chancre, or chancre-syphilis, with all its general consequences; this disease never gets well without proper treatment, and is likewise capable of producing a symptomatic gonorrhoea, very different from the ancient, idiopathic gonorrhoeal discharges. In the first division of this work, we have state (No. 16) that this symptomatic gonorrhoea is distinguished from the idiopathic (simple) gonorrhoea by its more torpid form, or its less marked symptoms of inflammation; to which we add an observation by Cazenave, “that it is not always the most acute gonorrhoea that superinduce secondary symptoms of a constitutional syphilis, but that this result sometimes follows the mildest forms of gonorrhoea.” Hahnemann likewise appears to have considered his so-called fig-wart-gonorrhoea, which he evidently regarded as a purely symptomatic phenomenon, as not very inflammatory; the question now simply is, whether this Hahnemannian fig-wart-gonorrhoea is identical with our presently described symptomatic syphilitic gonorrhoea, or, as is Hahnemann’s opinion, belongs to a third so-called sycosic contagium. Looking, with a view of solving this much-disputed question, at the historical and pathological facts that might be interpreted in favor of a third contagium, we find (1) that fig- warts seem to have existed already about the time of Juvenal and Martialis, at any rate, long before the great epidemic and the appearance of the syphilitic chancre, and that hence they could not have depended upon the latter; (2) that fig-warts, even if they break out as primary or protopathic symptoms, yet, according to the testimony of Ricord and his disciples, never produce a chancre; but that (3) according to the observations of Baumes, of Lyons, and several other physicians, they are infectious, and capable of reproducing their like, or a gonorrhoea, with which they are very frequently associated. These undeniable facts are, on the other hand, met by other observations that are equally undeniable, according to which the chancre, in its fungoid stage, has not only passed into evidently cock’s-comb shaped excrescences and other condylomata, but likewise into humid tubercles, which most German physicians confound with fig-warts, and which have first been definitely demonstrated by Lagneau of Paris, some 30 or 40 years ago. There are few physicians, having opportunities for observation, that have not witnessed similar transformations. Moreover, mucous tubercles, even if their contagium never produces chancres, but always their like, are, like chancre, capable of superinducing all the signs of secondary syphilis. If we would assert that the equality of form existing between the idiopathic fig-warts, and the consecutive fig-warts breaking out subsequently to chancre, does not argue in favor of their essential identity, the previously-mentioned secondary results would demonstrate this essential identity of the chancre and fig-warts in an irrefutable manner. Furthermore, inasmuch as, according to the observations of Reynaud and other French physicians, a chancre, after having passed into its fungoid stage, every often ceases to reproduce chancres, but, when transmitting its contagium, produces mucous tubercles, it follows that our modern fig-wart-contagium, despite its apparent idiopathic character, appears to be really nothing more than a syphilitic contagium, altered in form, but not changed in essence.
