THE ETIOLOGY OF CONGENITAL SYPHILIS, HISTOLOGICALLY CONSIDERED. BY JL E. atkiysoy; m. d., PHYSICIAN TO THE BALTIMORE SPECIAL DISPENSARY. [.REPRINTED FROM THE NEWYORK MEDICAL JOURNAL, JAN, 1875.] NEWYORK: D. APPLETON & COMPANY, 549 & 551 BROADWAY. 1875. APPLETONS’ JOURNAL, FOR 1875. Appletons’ Journal will sustain, during the ensuing year, its reputation for general excellence. The publishers will endeavor, more strenuously than ever, to furnish a pe- riodical of a high class, one which shall embrace a wide scope of topics, and afford the reader, in addition to an abundance of entertaining popular literature, a thorough sur- vey of the progress of thought, the advance of the arts, and the doings in all branches of intellectual effort. As the design is to make a superior literary journal, engravings will be employed only when they serve to illustrate the text, and never merely as pic- tures. 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D., PHYSICIAN TO THE BALTIMORE SPECIAL DISPENSARY. [REPRINTED FROM THE NEWYORK MEDICAL JOURNAL, JAN, 1875.] D. APPLETON & COMPANY, NTEW YORK: 54 9 & 551 BROADWAY. 1875. THE ETIOLOGY OF CONGENITAL SYPHILIS, HISTOLOGICALLY CONSIDERED.1 Congenital syphilis is described by the various writers upon tbe subject as having its origin in three possible modes. These are : 1. Through the male element of impregnation ; 2. Through the female element of impregnation; and, 3. Through the circulation from the mother, consequent upon the nutritive processes of utero-gestation. There is, however, by no means a unanimity of opinion among these authors as to the relative frequency of these modes, and there are not wanting those who utterly deny the validity of one or the other of them. The theory of infection through the maternal circulation manifestly lays claim to a greater facility of demonstration than either of the other two; thus, all its requirements would he fulfilled by cases such as the following hypothetical one: A woman, never having had a previous syphilitic lesion, at some time subsequent to her impregnation acquires the initial ulcer; her child, born alive, subsequently exhibits symptoms that are undoubtedly syphilitic. Simple and plain as these requirements seem to he, the number of cases reported in favor of this theory of foetal con- 1 Eead before tbe Baltimore Pathological Society, November 13, 1874. 4 ETIOLOGY OE CONGENITAL SYPHILIS. taraination is astonishingly few. Diday gives details of cases (“ Syphilis in Infants,” Hew Sydenham Society’s Trans- lation, pages 29-31), two of which, only, it seems to me, are unobjectionable; these are as follows : “Mr. P , after having had a primary sore for some days, had connection with his wife, when she was in the seventh month of preg- nancy, and gave her a similar sore. Baumes treated them both with Yan Swieten’s drops and sndorifics. The mother had, nevertheless, copper-colored papulae on' her forehead and ulceration of her tonsils. She was delivered of a child, ap- parently healthy, wdiich was given to nurse to a young woman, in whom, when examined most minutely by Baumes, no dis- ease was discovered. At the end of thirteen days the child had pustules of syphilitic ecthyma on the buttocks, chest, and cheeks. It was cured by mercurial treatment.” “ P. Dubois has published the case of a young woman, aged nineteen, who contracted, at the fifth month of pregnancy, a primary sore on the lower lip, which was soon followed by general symptoms. She was delivered of a child, which died on the eighth day with pemphigus and sanguineous infiltra- tion of the lungs.” Lancereaux, however, does not hesitate to reject even these cases, and will not allow this mode of contamination ; and the very paucity of instances recorded in its favor would certainly seem to give him some justification for his opinion. The potency of the germ-cell or ovum as the carrier of the contagious element has certainly been assumed upon entirely insufficient grounds; for, admitting the liability to foetal in- fection through the circulation of the mother, it becomes im- possible to decide, upon any amount of inductive evidence whatsoever, whether or not an instance of congenital syphilis, derived from the mother, can be ascribed to any other source of contagion. In a word, no number of accumulated facts, relative to the transmissibility of syphilis to the foetus, by a mother, herself the subject of the disease prior to impregna- tion, can, in the smallest degree, enlighten us as to whether her disease was transmitted through the ovum or through the circulation. The male element of reproduction, however, it has been ETIOLOGY OF CONGENITAL SYPHILIS. claimed, maybe proved to be tbe direct vehicle of syphilis to the embryo, and that by the assistance of two lines of evi- dence, as follows: 1. A father having syphilis, either mani- festing itself or existing potentially, yet latent at the moment of impregnation, may, through his semen, convey the virus of the disease to the embryo, the final result being the extrusion of a syphilitic child, the mother remaining healthy, although never having previously suffered from syphilis. 2. A mother, never having had syphilis, in due time after her impregnation by a syphilitic father, exhibits, without the previous occur- rence of an initial lesion, symptoms of constitutional disease, derived from her foetus. Bow, could either of these lines of evidence be proved, there would no longer remain any doubt about the question : we should be obliged to accept, as established, the theory of direct paternal transmissibility of syphilis. But what are the facts 1 Concerning the recorded cases adduced as settling the first proposition, by some of the very first syphilographers, such as Hutchinson, Diday, Yidal (de Cassis), Lancereaux, Bi- cord, Langston Parker, and others, most of their weight is due, not to their own intrinsic value, but to the eminent celeb- rity of their foster-parents; for, when we come to an exami- nation of these evidences, supposed to be conclusive, we must be overwhelmed with the sense of their insufficiency. Thus, although symptoms of constitutional syphilis in the mother have not obtruded themselves upon the notice of the observers, certainly sufficient care was not taken to establish her free- dom from the disease; furthermore, most of the cases, even as reported, justify the gravest suspicions as to the physical condi- tion of the mothers, who either had certain lesions which were not regarded as specific, or else whose histories are lamenta- bly deficient: the great majority of cases being so obviously devoid of definiteness of detail and scientific exactness of ob- servation that they cannot for a moment be entitled to serious consideration. Even those cases which have been worked up with care and elaboration are singularly incomplete and un- convincing. As, however, the object of this paper is not to disprove the theory of the transmissibility of syphilis through either the 6 ETIOLOGY OF CONGENITAL SYPHILIS. sperm or germ cells, but rather to cast discredit upon the evi- dences heretofore considered sufficient proof, and to offer other and more philosophical reasons for believing that such trans- missibility is both possible and probable, I do not at this time propose to discuss in detail the cases supposed to be corrobo- rative. For this purpose, I cannot do better than to refer the inquirer to a paper contributed by Dr. F. A. Sturgis to the New York Medical Journal for July, 1873, entitled “ The Etiology of Congenital Syphilis.” In it, in denying the pos- sibility of transmission through the sperm-cell, and in review- ing the records upholding the theory, the author remarks: “In selecting cases for criticism, I have copied from those whom I believe to be the best and most trustworthy defenders of this doctrine, from such men as Hutchinson, of London ; Langston Parker, of Birmingham; Diday, of Lyons, and others of equal weight. The result of this critical examination of cases is, it seems to me, the successful demonstration of their untrust- worthiness.” My own researches lead me to the conclusion that there are no instances to be found which will bear the close scrutiny required by the importance of the subject. The reporters have been, for the most part, content with the asser- tions of the woman or her friends, or there is no mention of more than a single examination having been made, or those important inquiries as to the immunity afforded the woman by a former attack of the disease, or as to its latency, are lack- ing, or else the subsequent history is not noted. That these objections are not captious must appear when we consider the great obscurity of symptoms occasionally experienced in syphi- lis, especially in women, or their insignificance, so that their evolution may have escaped attention, or the occasional inactivity of the disease; for, if a term of years may inter- vene between outbreaks of the malady (and this has been noted in cases in which the father was claimed to be the sole source of foetal infection, when years had elapsed since the last manifestations in his own person),1 then may we not be undoubtedly justified in demanding the strictest attention to 1 See Diday, “Infantile Syphilis,” New Sydenham Society’s Transla- tions, pp. 17, 18; also Lancereaux, New Sydenham Society’s Translation, vol. ii., p. 225. ETIOLOGY OF CONGENITAL SYPHILIS. 7 every possible detail of research ; and may we not be allowed, at least, to suspect an existence of syphilis, potentially, in the system of the mother, who to all external appearances has been, and continues at the time of observation, a healthy woman ? So long ago as 1837, Colies, of Dublin, observed a fact which will go far toward destroying the credibility of those cases in which mothers are said to have given birth to syphi- litic children, themselves remaining unaffected. This obser- vation is as follows: There has never occurred a single in- stance in which a congenitally syphilitic child infected its own mother (extra-utero); per contra, very many nurses have ac- quired chancres of the IreoM and consequently constitutional syphilis from contact with the specific sores of their nurs- lings. So far as I have been able to ascertain, there is to this day no mention of a single exception to this rule. Surely, if the mothers who themselves nurse their offspring affected with constitutional syphilis (and, doubtless, they nurse them far more frequently than they allow them to be nursed by others), are not protected from contagion by the previous or actual existence of the poison in their own systems, wTe would have a fearful array of such instances. This fact must surely tend to throw the greatest doubt over the evidence afforded us by many recorded but imperfectly-observed phenomena. Let it be remembered, howTever, that Colles’s observation has no bearing upon the question of paternal transmissibility. It merely casts great discredit upon that evidence, supposed to favor the theory, which would persuade us that a syphilitic child may be born of a healthy mother. Aside from the strong negative evidence afforded by such observations as those of Colles, and the great want of accuracy and trust- worthiness in the recorded'cases of claimed direct paternal transmission (mother escaping), it must appear extremely im- probable, in view of the intimate connection between the mother and child during gestation, that a woman can carry an embryo to full term, indued with syphilis by the male element of impregnation, herself escaping infection. There remains to be considered the second series of proofs of direct paternal transmission of syphilis to the foetus; that 8 ETIOLOGY OF CONGENITAL SYPHILIS. is, the instances in which women are said to become syphilitic only subsequent to their impregnation by a spermatozoid syphilitically infected. The difficulties attending the ascer- tainment of the existence of syphilitic lesions of the female genitals are notoriously great, and it is a fact familiar to every one in the habit of treating syphilitic persons, that in a large proportion of cases all knowledge of symptoms, preceding the constitutional ones, is honestly disclaimed by both males and females. Moreover, the symptoms of constitutional syphilis, especially the early ones, are very frequently overlooked or misunderstood. It is not claimed that such modes of infection do not occur, but only that the uncertainty and obscurity that necessarily involve them debar their being accepted as au- thentic and conclusive, or as more than corroborative of more exact data. Granting the unreliability of the evidence usually adduced and accepted as proving the syphilis-carrying qualities of either ovum or spermatozoid, there remains no direct proof determining whether the disease may be communicated to the embryo by means of either reproductive element, or exclu- sively during the process of nutrition, subsequent to impreg- nation; nevertheless, believing that a foetus may become contaminated by any one of the asserted modes of infection, it is necessary that I should state my reasons for entertain- ing this view. Abandoning the method of searching for light by the routes that have been so frequently and unsatisfactorily trav- eled, it seems to me that the promise of success is frcjn the considei’ation of—l. The histology of the elements essential to reproduction and the nutrition of the foetus. 2. The nature of the specific jmison or virus of syphilis. 3. The mode in which this virus produces its peculiar morbid action upon the tissues. The consideration of the first subject of inquiry offers us a field that has been tolerably well worked; and incorporated with the results of the laborers therein, is a good deal that seems certain, more that seems probable. In the first place, it has been ascertained as a fact that the reproductive cells, both male and female, are the product of epithelium; that they are, in fact, epithelial cells. 9 ETIOLOGY OF CONGENITAL SYPHILIS. In the lower orders of the animal kingdom this is espe- cially apparent. Waldeyer states (“ Strieker’s Manual,” Hew Sydenham Society’s Translation, vol. ih, page 188) that the ova of ascaridse proceed from the epithelial cells of the ovarian tube; that (id., p. 189) from the hermaphrodite glands of certain mollusca, even in the same follicles, both ova and seminal corpuscles are found, which proceed from the epi- thelial cells lining the glandular follicles. At page 190 of the same volume is presented a diagram of the ovarian tube of Yanessa urtica, in which the various stages of development of epithelial cells, and the selection of certain of their number, and their further elaboration into ova, are represented. “In the common polyp, sperm-cells and germ-cells are developed in the same layer of indifferent tissue;” and in one of the sponges, Huxley observes that they are mingled together in the general parenchyma (Herbert Spencer, “Principles of Biology,” vol. i., page 222, American edition). Waldeyer, in the monograph already referred to, also demonstrates by text and diagram, in the foetal vertebrate, the evolution of Graafian follicles and ova from the epithelium of the ovary; and his general conclusion regarding the origin of the ova is as follows; “In all classes of animals they seem to be more highly-developed epithelial cells of the ovary, that have un- dergone some peculiar modification, so that the follicular epithelium and the egg-cells stand in direct genetic relation.” From what has already been said, the same generalization may be inferred to hold good concerning the sperm-cells. (“ Strieker’s Manual,” vol. ii., p. 155) supplies us with valuable evidence upon this point. Fie observed in the testes of the Salmonidas the development, from the cells of the epithelium, of the young spermatozoids. La Yalette St. George, not denying and not affirming that these cells are epithelial, declares them to be uni-and multi-nucleated cells. There need be, however, no further adduction of proofs in this paper bearing upon the epithelial origin of the repro- ductive cells, since biologists are generally agreed upon the subject. The next question that arises is, To what extent are these cells differentiated, or more highly developed than ordinary 10 ETIOLOGY OF CONGENITAL SYPHILIS. epithelium cells? Although Waldeyer has just been quoted as expressing the opinion that they are “ more highly-devel- oped epithelial cells,” other investigators, of no less authority, do not hesitate to declare their conviction that the sperm and germ cells have no special “ elaboration fundamentally differ- ent from all other cells.” Space will not allow such an inves- tigation of this subject as its interest might demand; but I think I certainly can, in this place, do no better than refer to the remarks of Mr. Herbert Spencer, concerning this question, and quote somewhat extensively some of them occurring at page 221, vol. i., “Principles of Biology,” American edition. His words are: “ If, by way of demurrer to this view, it is asked, why other epithelium-cells do not exhibit like prop- erties, there are two replies: The first is, that other epi- thelium-cells are usually so far changed to fit them to their special functions, that they are unfitted for assuming the reproductive function. The second reply is, that in some cases, where the epithelium-cells are but very little specialized, they do exhibit the like properties; not, indeed, by uniting with other epithelium-cells to produce new germs, but by producing new germs without such union. I learn from Dr. Hooker that the Begoniaphyllomaniese&c habitually develops young plants from the scales of its stem and leaves—nay, that many young plants are developed by a single scale. The epithelium-cells comprising one of these scales swell here and there into large globular cells; from chlorophyll in their interiors, shoot out rudimentary axes; and then, by sponta- neous constrictions, they cut themselves off, drop to the ground, and grow into Begonias. . . . Thus, there is no warrant for the assumption that sperm-cells and germ-cells possess powers fundamentally unlike those of other cells. The inference to which the facts point is, that they differ from the rest mainly in not having undergone modifications such as those by which the rest are adapted to particular functions. They are cells that have departed but little from the original type. Or, in the words suggested by a friend, it is not that they are pe- culiarly specialized, but rather that they are unspecialized; such specializations as some of them exhibit in the shape of locomotive appliances, etc., being interpretable not as intrin- ETIOLOGY OF CONGENITAL SYPHILIS. 11 sic but as extrinsic modifications, tliat have reference to noth- ing beyond certain mechanical requirements.” From all these considerations it must be seen that, from the essential similarity of origin and history of the reproduc- tive cells, whatever susceptibilities to impressions from with- out are possessed by one, the other must be capable of. This proposition cannot be invalidated by the asserted fact that these reproductive cells, in man, are stated with much ap- pearance of probability (the germ-cell especially) to be formed during an early period of embryonic life, and only then ; for, this is true, in the first instance, of the germ-cell, only in so far as is meant the primordial ovum, consisting of a nucleus or germinal vesicle embedded in the surrounding mass of proto- plasm : the zona pellucida, or vitelline membrane, forming with its contents what may be termed the mature ovarian ovum (Waldeyer), being a product of the follicular epithelium, either directly, or from the cell-nutrition resulting in the formed material of Beale, and not existing until the ovum is about to be set free by the functional activity of the surround- ing parts. So, too, it may be said of the spermatozoid, that its condition, however inactive, was, prior to its assuming the form recognizecFUs the mature male element of repro- duction, that of an epithelial cell ; these changes being of course consequent upon nutrition, are accompanied by addi- tions to and subtractions from the preexisting mass ; so that it appears that, notwithstanding the early date of formation of these cells, they must remain, during their entire existence, subject to impulses from without. Having indicated the origin of the reproductive cell in the epithelium-cell, for the purpose of ascertaining the virus-car- rying capacity of either of these, it becomes necessary to dis- cover whether or not there be any histological community of nature between them and those particles which, in the organ- ism, are the carriers and distributors of the virus of syphilis. Our knowledge of histology, as it exists to-day, does not justify a positive assertion of the possibility of tracing the relationship ; for we lack definite information as to the most vital point of the argument, viz., the precise characteristics of the virus itself; so, also, is it not universally admitted that 12 ETIOLOGY OF CONGENITAL SYPHILIS. the genealogy of the epithelium-cell can be traced out. But enough is known to entitle one to the confident belief that such relationship will be proved to the satisfaction of all in- vestigators as completely as it is now to the few who claim to have established it. The consideration of this question will consist in the citation of the facts and observations (that have been available) in favor of the theory of the derivation of the epithelium, and consequently the reproductive cell, from the wandering cell, the white blood-corpuscle and lymph-cell. On page 39, of volume i., New Sydenham Society’s Translation of “ Strieker’s Manual of Histology,” the editor (Strieker) thus states the conviction of great histologists re- garding the nature of epithelium-cells : “ The development of epithelia from the cells of the connective tissue has already been maintained by many, by Burckhardt, by Yirchow, and by Forster. Yery recently Pagenstecher has stated that they proceed from exudation-corpuscles; and Biesiadecki says spe- cifically that they come from the colorless blood-corpuscles; ” and, at page 38 of the same volume, he so far gives in his adhesion to the theory as to say: “It is even conceiv- able that the colorless blood:corpuscles are destined for the regeneration of the tissues of the animal body. Nor can any solid objection to this view be raised from the stand-point gained by a knowledge of the history of development. The blood proceeds, indeed, from a different germinal lamina to the epithelia, for example; but primarily all cells proceed from the segmentation spheres, and these again from the fer- tilized ovum. Lastly, who can determine what influences must be in operation to cause a segmentation spheroid to become an epithelial cell, and whether similar influences may not also act on young cells in the post-embryonal period ? ” According to Biesiadecki the wandering cells exist nor- mally in the rete mucosura, becoming more numerous in path- ological conditions (pointed condylomata, eczema, etc.), and Pagenstecher claims that he can demonstrate transition forms from these ambulant to epithelial cells, and concludes that, therefore, the migrating cells become epithelial cells.—Neu- mann, “Handbook of Skin Diseases” American edition, p. 171. 13 ETIOLOGY OF CONGENITAL SYPHILIS. As already stated, this theory of the development of the wandering cell into the epithelial cell has by no means met with universal acceptation ; but sufficient facts are available to justify its adoption, provisionally, trusting to time and ex- tended observation to definitely establish it. At all events, the various stages from the leucocyte to the wandering cell, and from the epithelium to the reproductive cell, have been pretty satisfactorily determined. (Also may we safely believe the statement of Recklinghausen, to the effect that the leucocyte is also the progenitor of the red blood-corpuscle.) Passing by for the moment the discussion of the carriers of the syphilitic virus, it may be well to appropriately ascertain what may be the nature of the thing carried, that is, the virus itself. According to Mr. Hutchinson, syphilis must be re- garded as one of the zymotic fevers ; and this view, probable as it is, has met, on the part of syphilographers, with a strong disposition to its acceptance ; certainly with no very decided opposition. How, although the virus of syphilis has not been demonstrated to the eye or other senses (Lostorfeo’s claim of discovery of syphilitic corpuscles in the blood having proved not well founded), there exists great reason to consider it as consisting of solid particles. Successful inoculations have only been obtained through the use of virus containing solid or corpuscular elements. But, although no actual demonstration of the virus of syphilis has, as yet, been attained, we have more positive information regarding that of other specific diseases: thus, the active principle of the vaccine disease has been recognized and separated from the mass of fluid; like- wise the poisonous principle of glanders, of farcy, and of small-pox. These discoveries are for the most part due to the investigations of M. Chauveau, of Lyons, of Dr. Burdon-San- derson, and of Dr. Beale. This recognition of the active agents in the causation of zymotic diseases has been followed by very decided differences of opinion as to their essence: whether they are organisms, independent in their life and continuing their like by simple growth and reproduction, or merely “ detached particles of a living organism ” (Ross), or, in other words, detached portions of cells. Do they induce disease by a multiplication of them- 14 ETIOLOGY OF CONGENITAL SYPHILIS. selves at the expense of the organism, or do they impress with, their own morbid molecular motion those parts of the body similar in nature to themselves and with which they unite ? Whatever may be the nature of these bodies containing the active principles of zymotic diseases, investigators are pretty well agreed that it is through the corpuscular elements of the organism that they perform their offices; that in the blood and lymph tracts the leucocytes and lymph-cells (of which Recklinghausen says, “ The lymph-corpuscles are now uni- versally admitted to be identical in all their characters with the colorless corpuscles of the blood ”), and their descendants in the tissues, are either used up as the pabulum of these “ in- dependent organisms,” or, as is ably and convincingly argued by Dr. James Ross, in his work upon the “ Graft Theory of Disease,” they must unite with the “ detached portions of a living organism,” after the manner of the reproductive cells, and acquire from them a perverted molecular motion, which evidences itself by the resulting symptoms of the special zy- motic disease. Assuming the accuracy of these conclusions of different writers concerning the origin of both germ and sperm cell in the epithelium-cell, and of this latter in the leucocyte, which is declared to be the contagium-bearer of the human blood (and, in the present state of science, evidences are daily accu- mulating in support of them), the following deductions may legitimately be drawn. 1. A syphilitic mother may primarily infect an ovum, which may subsequently become impregnated : 2. She may, the ovum escaping, subsequently infect the embryo through the bioplastic elements of her own blood, during the process of nutrition. 3. A syphilitic father may also, through the sperm-cell, infect the germ-cell impregnated by it, the result being a syphilitic embryo. These results appear to me far more satisfactory than those heretofore reached, clinically; for, as already remarked in this jpaper, by sucli methods it cannot h*4lio tirot phme-be a syphilitic father may primarily infect the embryo, since definite proof of the mother’s immunity cannot, or rather has not been had. ETIOLOGY OF CONGENITAL SYPHILIS. 15 2. It is, and must always remain, impossible to decide when the mother has had syphilis previous to conception, whether the foetal infection takes place through the ovum, primarily, or the subsequent circulation between herself and the child. 3. Positive proof of infection is alone capable of demon- stration in those cases where syphilis has been acquired by the mother at some period during her pregnancy. There remains to be noted the following point in the con- sideration of syphilis transmitted to the foetus, and in it is also involved the whole subject of the pathology of specific diseases; it is this : why is it that a person, being syphilitic at the very time of impregnation, may become the parent of a healthy offspring % That such persons do beget healthy chil- dren sometimes is a fact of which almost all writers upon syphilis are cognizant, and which has appeared to be utterly inexplicable. The discovery, however, of the solid character of certain contagia, with the strong probability that that of syphilis is of the same nature, turns a flood of light upon this vexed question. If the blood were universally pervaded with the poison- bearing principle, it would be impossible for any moist tissue in the organism to escape contamination; bones,• cartilage, muscle, connective tissues, nervous system, viscera, all would be involved in the common calamity, in proportion to their moisture. That such a condition does not exist, we know, since, in their subjective and objective symptoms, not only syphilis, but all the zymotic diseases, express themselves by the selection of certain parts and certain individuals of those parts, for their special morbid manifestations. This must of necessity be so ; for the universal involvement of these tissues, the various combinations of whose functions result in life, in a common and simultaneous perverted molecular motion, would be incompatible with its continuance, a fact which forces itself upon the attention in the treatment and etiology of the spe- cific fevers; for, invariably, the powers of life succumb in these diseases in direct proportion to the intensity of the morbid action; in other words, that patient dies most certain-l ly whose system is most intensely pervaded by the contagious 16 ETIOLOGY OF CONGENITAL SYPHILIS. principle. Now, contemplating this question, assisted by the light thrown upon it by recent investigations, we begin to apprehend that, the contagion not being a gaseous or liquid substance, a solution of the mystery is attainable. The solid virus is able to effect its object only when brought into actual contact with other solid particles, which, in their turn, must meet still other solid particles; thus, the conta- gium, not being all-peiwading, cannot be brought into con- tact with all the tissues capable of being infected, at least at one time. Now, when we reflect that there exist strong indis- positions for the parts of many individuals to assume certain morbid actions, or to be strenuously affected by such actions ; considering, in particular, the sluggishness of the syphilitic virus, completing its phases in months and years, where other contagious disorders perform their changes in hours and days ; it becomes easily conceivable how certain lymph-cells and leucocytes, and the descendants of these, the epithelial cells, and consequently reproductive cells, may escape the fate that has befallen their brethren; so that a single seminal dis- charge may consist of sperm-cells both healthy and morbid, while the Graaflan follicles may contain ova of like differ- ences. MEDICAL WORKS PUBLISHED BY D. APPLETON & 00. Anstie on Neuralgia. 1 vol.. 12mo. Cloth, $2.50. Bartholow’s Treatise on Therapeutics. (In press.) Barker on Puerperal Diseases. 1 vol. Cloth, $5.00. Barker on Sea-Sickness. I vol.. 16mo. Cloth, 75 cents. 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