True Cowpox a Manifestation of Syphilis.

W. B. Clarke, M. D., Indianapolis, Ind.

The first writer to explicitly point out the fact that true cowpox is a manifestation of syphilis was Auzias-Turenne, in a paper entitled "Smallpox and Cowpox," communicated to the French Academy of Medicine, September 5, 1865, which was reprinted in La Syphilization, and is reproduced in Prof. Crookshank's "History and Pathology of Vaccination" (London, 1889). This classically-presented paper was a critical analysis of the report of the Lyons commission on vaccination, and the words he uses to which I desire to call your special attention, are: "May not syphilis, the type of virulent maladies, present itself under forms sufficiently varied and dissimilar to embarrass the diagnosis of an accomplished physician? Between syphilis and cowpox the analogy may be a long way followed up. The inoculation of cowpox-a malady with a fixed virus sufficiently well named pox of the cow (verole de vache)-may, for example, give rise to polymorphic vaccinides, and sometimes to disseminated pathognomonic vesico pustules, just as the contagion of the mucous patch, symptom of a malady with an equally fixed virus, gives rise to various secondary eruptions, and sometimes to the appearance of disseminated nucous patches." And the next year he contributed another masterly paper, showing that cowpox and smallpox were not similar, his resume of the appearances of cowpox making the resemblance manifestly to syphilis.

But Dr. Charles Creighton has done more to illuminate this subject that any other writer. He is a London hospital surgeon (St. George and Charing Cross), demonstrator of anatomy at Cambridge University, and wrote the articles on "Pathology" and Vaccination" in the newer Encyclopedia Britannica, and the books "Jenner and Vaccination," 1889, and "Cowpox and Vaccinal Syphilis," 1887. But before taking up Creighton's work in connection with our subject, let me read you Jenner's description of the primary pox in the cow's teats:

"It appears on the nipples of the cows in the form of irregu

lar pustules. At their first appearance they are commonly of a palish blue, or rather of a color somewhat approaching to livid, and are surrounded by an inflammation. These pustules, unless a timely remedy be applied, frequently degenerate into phagedenic ulcers, which prove exceedingly troublesome."

Let me also read what Jenner says about cowpox communicated to milkers:

"Inflamed spots now begin to appear on different parts of the hands of the domestics employed in milking, and sometimes on the wrists, which quickly run on to suppuration, first assuming the appearance of the small vesications produced by a burn. Most commonly they appear about the joints of the fingers, and at their extremities; but whatever parts are affected, if the situation will admit, the superficial suppurations put on a circular form, with their edges more elevated than their center, and of a color distinctly approaching to blue. Absorption takes place, and tumors appear in each axilla. The symptoms become affected, the pulse is quickened; shivering, succeeded by heat, general lassitude, and pains about the loins and limbs, with vomiting, come on. The head is painful, and the patient is now and then affected with delirium. These symptoms, varying in their degrees of violence, generally continue from one day to three or four, leaving ulcerated sores about the hands, which, from the sensibility of the parts, are very troublesome, and commonly heal slowly, frequently becoming phagedenic, like those from whence they sprung."

These are Jenner's words; do you want a better description of a chancre?

But to return to Creighton. He says, "Jenner and Vaccination," p. 34: "We know now, since the experiments of Ricord, Henry Lee and others, that a sore of the pox proper, or of syphilis, when inoculated on the skin, begins in the same kind of whitish vesicle as the milker's cowpox, and that the classical pox and the cowpox are in that, as in other respects, closely parallel." He describes some of Ricord's syphilis inoculating experiments, and Crookshank, in his "History and Pathology of Vaccination," gives Ricord's plates and compares them with those of cowpox

and horse-pox, which I have exhibited. Dr. M. R. Leverson, of Brooklyn, N. Y., has had these reproduced and enlarged by artist Weyprecht, of New York, and the collection is the finest of the kind. As Creighton says, "the full meaning of the deep scar of cowpox is a loss of substance through the whole thickness of the corium ;" and Jenner says "the sores ate into the flesh," and it may surprise you to know that he advised a thorough caustic when the sore was well under way, so as to cut short its effect and heal it up. John Hunter's broad characterization of syphilitic sores was "a small disposition to heal," and I presume most of you are familiar with so-called vaccinal sores with a similar disposition, though I will let Bohn, in his Handbuch der Vaccination, describe the vaccinal ulcer of ordinary practice: "The destruction of the corium extends both to the breadth and to the depth, and a crater-like sore mostly results, with a hard base, and indurated edges, which, at first glance may frighten the practitioner by its likeness to syphilis. The sore is of a sluggish nature, having little innate disposition to heal. Ofter there springs from its floor a growth of spongy tissue, in which case we have weeping ulcera elevata, with still less of spontaneous disposition to heal."

Crookshank, in his "History and Pathology of Vaccination," speaking of cowpox, says, "It is the course which the malady runs, which brings it so closely into relation with syphilis; many cases which are attributed to syphilis are unquestionably the full effects of the cowpox virus, and nothing could more clearly point to the analogy between the two diseases than the difficulty in diagnosing the exact nature of these vaccinal accidents. * * *

The results of the artificial inoculation of syphilis were unknown to Jenner, but if they had been known he would scarcely have failed to have observed the likeness between them. So striking, indeed, are the appearances that it is possible that by judicious selection a strain of syphilitic lymph might be cultivated which would produce in time all the physical characters of the 'vaccine 'vesicle." And Crookshank, I wish you to remember, is professor of bacteriology and comparative pathology in

King's College. London. And Creighton, in his “Jenner and Vaccination, published the same year (1889) as Crookshank's "History and Pathology of Vaccination," makes Crookshank's closing words, as above, plainer, thus: "Mr. Henry Lee carried his [syphilitic] inoculations through several removes, and in a number of instances got the whole process to end with the scab, just as it does in ordinary inoculation with the pox of the cow's teats,"

In fact, it is because we do not in these later days use true cowpox, fresh from the cow, in all its natural savageness when taken from an old vesiclle or sore, but rather a nondescript, "managed," reduced, attenuated, cultivated, modified, many-timesremoved, humanized, glycerinated, commercially-prepared, article, that we do not have serious trouble whenever we vaccinate.

As Creighton says (p. 127, “Cowpox and Vaccinal Syphilis,) "Not only in isolated cases, but even in groups of cases, where the syphilis befell a number of infants vaccinated from a common source, doubts have been thrown upon the authenticity of the facts just because that common source could not be shown to have been tainted with the virus of syphilis," and he declares that the phenomena are "due to the inherent, though mostly dormant, natral history characters of cowpox itself." He continues, "As a matter of fact, there are many authenticated cases, some of them fatal, belonging either to epidemics or occurring singly, where rashes, mucous tubercles, marasmus, and the like, have followed primary vaccinal sores, though no complication of veneral syphilis, either actually proved or hypothetically intelligible, but simply because the cowpox, in respect to its original although mostly latent characters, runs on all fours with the veneral pox itself." He then closes his volume thus: "The real affinity of cowpox is not to the smallpox, but to the great pox. The vaccinal roseola is not only like the syphilitic roseola, but it means the same sort of thing. The vaccinal ulcer of every-day practice is, to all intents and purposes, a chancre; it is apt to be an indurated sore when excavated under the scab; when the scab does not adhere, it often shows an unmistakable tendency to phagedena. There are doubtless many cases of it where constitutional symptoms

are either in abeyance or too slight to attract notice. But in other instances, to judge from the groups of cases to which inquiry has been mostly directed, the degeneration of the vesicle to an indurated or phagedenic sore has been followed by roseola, or by scaly and even pemphigoid eruptions, by iritis, by raised patches or sores on the tonsils and other parts of the mouth or throat. and by condylomata (mucuos tubercles) elsewhere. * * * A careful and unbiased survey of the facts has convinced me of the fact that cowpox sores must be credited with a power of producing secondary symptoms, not because they have the contamination of venereal pox in them, but because their nature is the same as, or parallel with, that of the venereal pox itself."-Medical Advance.

FROM THE SAME ADDRRESS.

The verified cases in which syphilis has been inoculated, via the practice of vaccination for the prevention of small-pox, are innumerable. One of the latest notable published cases of this kind, in which a family of eight persons were thus afflicted, is reported by Dr. W. S. Gottheil, the New York syphilologist and cancer expert.

I now hold in my hand a manuscript from Dr. Hubert Boens, of Brussels, Belgium, government physician, superintending physician of the prison of Charleroi, the second sentence of which begins thus: "I have collected, both in the prison of Charleroi as well as among my patients outside, in sixteen years, a considerable number of cases, more or less grave, of a syphilitic character, exclusively due to the inoculation of the Jennerian vaccine. To the ,700 minute observations of this kind which I have in my notes, some of which I have published in different pamphlets, I must now add two recent ones."

The testimony before the British Royal Vaccination Commission, recounted disasters from vaccination, some syphilitic notably the Motte aux Bois, France, of 1889, in which fortythree children were syphilized, and the Morbihan, France, of 1886, in which more than thirty were so affected; these being part of four hundred and fifty cases testified to before the commission. Dr. Jonathan Hutchinson's cases, of England, are also cited. In