Atlas of venereal diseases / by A. Cullerier ; translated from the French, with notes and additions, by Freeman J. Bumstead.
- Bumstead Freeman J. (Freeman Josiah), 1826-1879.
- Date:
- 1868
Licence: Public Domain Mark
Credit: Atlas of venereal diseases / by A. Cullerier ; translated from the French, with notes and additions, by Freeman J. Bumstead. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![of general syphilis. M. G then sliowed me a certificate of general constitutional syphilis given by the physician who attended the child. But all cases are not as simple as the one quoted from M. Olerc; and in those of a more difficult charac- ter, such as the transmission of chancres of different forms, few physicians, it is to be hoped, would assume the responsibility of a decision which had no other base than mere theory. [We mean by the term confrontation simply ex- amination of the symptoms presented by the person from whom the disease was derived, for the purpose of throwing light upon the nature of the disease in the recipient. This method was resorted to by Bassereau to estab- lish the existence of two diseases in what had passed before his day under the common title of Syphilis. Since M. Cullerier does not believe in this distinction, it was not to be supposed that he would regard this method of diagnosis with much favor. When practi- cable, however, it is of the greatest value. Unfortu- nately, it is often the case that the responsible party cannot be induced to submit to an examination ; and it is true, as M. Cullerier says, that this method can only be resorted to in recent cases, but it is chiefly in recent cases that we require this aid. In those of older date, we have other available means. If a man contracted a sore in sexual intercourse six months ago, in all probability the fact is now estab- lished beyond question by his subsequent symptoms whether this sore was a true chancre or not; but if the sore made its appearance six days ago, and if its character be doubtful, the diagnosis can be made by no means so well as by examination of the woman from whom the disease was derived and in whom it has had time to mature. If she present the characteristic symptoms of syphilis, your patient in all probability has a true chancre. On the other hand, if her disease has been confined to the genital organs after the lapse of sufficient time for the evolution of general symptoms, if such were to occur, your patient's sore is also local. For obvious reasons, in cases of communication of syphilis from a nurse to a nursling, or vice versd, con- frontation taken in connection with the history of the case is the only means of settling the responsibility of the contagion.— F, J. .B.] The study of venereal diseases has also been pursued experimentally, and for this purpose recourse has been had to inoculation. I say has been, for although for twenty years the school of M. Ricord, following the example of Hunter, made inoculation the criterion of its doctrine, this method is now almost entirely aban- doned both because it has no longer anything to teach, and because the errors to which it may lead have been detected. Inoculation consists in taking the product of any secretion whatever, and introducing it into the skin, either of the patient himself (auto-inoculation), or of a healthy subject. It is practised, like vaccination, with the lancet, by scarification, by denudation of the epi- dermis by means of a blister, or by maintaining for some length of time the diseased in contact Avith a healthy tissue. The latter, the more difficult and more painful mode, has been resorted to but rarely. M. Eicord always tried auto-inoculation. It is this also which led Hunter to deny the virulence of consti- tutional symptoms, and to consider the primary lesion alone contagious. A deeper knowledge of the varieties of chancre has shown how far Hunter was wrong in this opinion. Inoculations of the patient himself have been performed by the thousands. I shall speak of them again when treating of gonorrhoea, for they have been frequently employed in this disease, and we shall see that they have been almost valueless. If the results of this method of experiment have not been as great as were expected, let us at least acknowl- edge that it does not deserve the anathemas that have been hurled against it; with the exception of a few unfortunate cases of phagedena, which were the con- sequence of chancrous inoculations, the only reproach which we have a right to cast upon it is, that it has been useless. [I cannot allow M. Cullerier's estimate of the value of inoculation to pass unchallenged. It is not true that it has been useless, that it is now almost en- tirely abandoned, nor that it has no longer anything to teach. It is still extensively employed by the modern school of venereal pathologists, as an invaluable and justifiable means in doubtful cases, for distinguish- ing between the true chancre and the chancroid; the latter being auto-inoculable, the former not. Far more just is the following appreciation of this method by M.](https://iiif.wellcomecollection.org/image/b21691630_0020.jp2/full/800%2C/0/default.jpg)
