Lues Venerea 
HENRY ALFRED ROBBINS, M. D. 
Professor of Dermatology and Syphilology in the Medical Department of 
Howard University, Washington, D. C. 
A few days ago, I had the honor of receiving a formal invita- 
tion from my friend, Dr. Thomas C. Smith, the Chairman of your 
Commitee on Essays, to address the society, at some time in the 
near future, on the subject of Syphilis. 
At first the request would seem easy enough to comply with, 
as it is a subject that every drug clerk and medical student think 
they fully understand. 
Dr. Smith, in his letter of invitation, states: “The several ques- 
tions relating to Syphilis are generally regarded as fully an- 
swered and settled; and yet put a well-qualified practitioner on 
the stand, and it is lamentable to witness his display of ignor- 
ance on the subject.” 
The cause of this lack of knowledge may be readily understood 
when you call memory to your aid, and look back on your own 
student days. The subject has been and is still ignored by near- 
ly every medical school. 
Dr. Charles W. Allen, of New York City, states: “The amount 
of time and attention given this all important subject in all 
medical schools of this country is farcical. Men are sent out 
into the world, and are expected to diagnosticate syphilis, when 
the training the college authorities have vouchsafed them in 
this branch is entirely out of proportion to its importance. I am 
continually seeing victims of this disease who are no less the 
victims of this lack of proper clinical instruction and require- 
ments on the part of the medical schools. I say it in a spirit of 
shame, rather than one of captiousness, that practitioners from 
a lack of knowledge permit patients to marry, and to cohabit 
w'hile still sources of danger exist, and to go about freely with 
contagious lesions in the mouth or throat, without giving them 
warning of the facility with wrhich they can transmit the disease 
to others.” 
* Read before the Medical Society af the-District of-Columbia. Revised. In an article published in the Virginia Medical Monthly on 
“Unmerited Syphilis,” I gave illustrations of how innocent 
people acquire this disease, and in its most malignant form. 
Dr. L. Duncan Bulkley states: “Non-venereal chancres have 
been mistaken for epitlieliomata, and operations for their re- 
moval have been even performed.” 
I have known one case of tubercular syphiloderm of the upper 
lip, to be diagnosed to be lupus by one surgeon, and epthelioma 
by another. 
Gummy tumors have been diagnosed to be sarcoma, and the 
ever ready knife of the surgeon ordered into use, but where the 
happy administration of the proper treatment has caused them to 
melt away like snow under the mid-day sun. 
Maisonneuve gives the case of a patient who underwent a se- 
rious operation for a supposed encephaloid cancer of the 
pharynx. After six months the tumor began to grow again, and 
grow so rapidly that the patient was given up in despair, and 
sent to the hospital to die. When examined upon his entrance, 
an enormous tumor was found occupying the left lateral region 
of the neck and the entire parotid region. It projected into the 
pharynx, obliterating the velum palati and threatened the pa- 
tient with death by asphyxia. The true nature of the tumor was 
eventually suspected, and the patient put upon specific treat- 
ment. The tumor vanished without leaving a vestige. 
. Syphilitic testicles have been pronounced to be cancer, and 
surgeons have castrated the victims, causing bloody mutilations. 
A correct diagnosis and knowledge as to the treatment would 
have rendered castration unnecessary. 
Professor Von Esmarch states that he was once consulted by 
an American, who had been operated upon by some of our Cali- 
fornia colleagues. “They had cut away his penis, and scrotum 
as well as a large piece of his abdominal skin.” Our surgeons 
of the Pacific slope had regarded the case as carcinoma, and had 
made as good a eunuch of him as you can find in Constantinople. 
After castrating him, they fixed him so that the only way he 
could be re-infected by syphilis was in a non-venereal manner. 
Von Esmarch states that they “failed to see unmistakable evi- 
dences of syphilis.” 
The other day, I was looking over Part III of the Pictorial 
Atlas of Skin Diseases, and Syphilitic Affections—taken from 
photo-lithocromes of the models in the Museum of the Saint 
Louis Hospital, Paris. It contained, among other superb illus- 
trations a colored photo-lithocrome of a broken-down ulcerative 
syphilitic gumma of the thigh. This patient was a man thirty- 
nine years of age. 
The patient went to a hospital and was admitted to a surgical 
ward. He stated that the surgeon thought of operating on him, 
and even auscultated the thigh “to hear pulsations;” so it seems 
possible, that an aneurism was suspected. However, after two 
surgeons had consulted together, the operation was abandoned, and he was discharged, with means of treatment directed mainly 
toward his pains (opiates internally, belladonna plaster on the 
thigh). 
In one month he returned to the hospital in a worse condition. 
“A different surgeon from the one who first saw him now at- 
tended him. The thigh was now massive and hard, but the skin 
was purple, the ecchymoses having partially disappeared. Prob- 
ably the new surgeon diagnosed malignant tumor—likely enough 
an osteo-sarcoma—for he proposed to the patient the amputa- 
tion of his leg at the hip joint.” 
“A few weeks afterwards, the poor fellow was sent to the 
Saint Louis Hospital. The appearance of the lesions, as we have 
already described them, left no room for doubt as to their nature. 
Despite the lack of evidence of antecedent syphilis, and denials 
of the patient, the diagnosis of syphilis was made, and specific 
treatment instituted. 
“The disease which had lasted for two years was cured in two 
months.” 
John Hunter said that the two great obstacles to the study of 
venereal disease were ignorance and falsehood. Ignorance on 
the part of the surgeon, and falsehood on the part of the patient. 
I have prepared and published more than thirty articles on the 
subject under consideration, and I feel as if I had barely touched, 
or rather skimmed over, the horrors and ramifications caused 
by this hydra-headed monster. Hercules, of fabulous history, 
destroyed his by cutting off its heads and applying fire-brands. 
The arrows he dipped into its poisonous blood were fatal to those 
he wounded. 
Thus with the monster of Syphilis, the poisonous virus is in 
the blood of its victims, and proves too often worse than death. 
We may cut out the wounds, but the virus remains there still. 
This evening I can only call your attention to a few important 
and I trust interesting facts, which I have arranged under the 
titles of Lues Venerea. 
It is the most far-reaching and diabolical scourge that afflicts 
mankind. 
Volumes have been written to prove that Lues Venerea was of 
American origin, and was brought to Europe by the crews of 
Christopher Columbus, and that this fair land was the cradle of 
the disease. 
Our Aborigines were not the imparters, but the imparted. 
Captain Dabry, in an article, entitled “La Medicine Chez les 
Chinois,” published in 1863, quotes from another author named 
Hoanty, who lived two thousand six hundred and thirty-seven 
years before the Christian era. This Chinese author gives an 
unmistakable account of cases of lues venerea, and his descrip- 
tions surpass those of many modern writers. 
In a surgical work compiled by Theodoric, a Dominican monk, 
in 1250, a chapter is devoted to the malum mortuum, and a treat- ment by means of mercurial inunctions is recommended. This, 
from the description was undoubtedly syphilis, and if the an- 
cients knew how to use mercury by inunction, we can not boast 
of much progress. * 
Lanfranc, of Milan, in his treatise on surgery, composed in 
1296; has a chapter on “Chancre and Ulcer of the Penis in 
Man.” Guillaume de Salicet and Gerard, in their works on 
surgery, written during the same century, also describe a disease 
which could be no other than syphilis. 
In my article, already referred to, I endeavored to prove that 
the brute creation was entirely exempt from this affliction. Al- 
most every variety of animal has been inoculated with the virus 
of syphilis, and with negative results. Since writing that ar- 
ticle, I find that Klebs states that he has been successful in inocu- 
latinig a monkey with the virus of lues venerea. This will be 
reassuring to the disciples of Darwin, and for their gratification 
I will state tfiat the poor little ancestor, six weeks after the 
inoculation, or rather cruel implantation, exhibited general and 
febrile symptoms, attended by a papular eruption of the fore- 
head and face, and five months later, on the necroscopic exami- 
nation, Klebs found syphilitic lesions in the skull and lungs. 
The idea of living organisms being the cause of syphilis was 
expressed in a rude form as early as the seventeenth century. 
Professor Senn, in his “Surgical Bacteriology,” states: “It is 
interesting and profitable to know what has been done during the 
last few years in the bacteriological study of syphilitic lesions, 
although the claims which have been made are in all probability 
unfounded.” 
The germ of syphilis, sooner or later, will be discovered, and 
the name of the micromrganisim detective will rival that of 
Robert Koch. 
Perhaps no word grates on the ear more than that of chancre. 
It is always associated with the name of the great pathologist 
John Hunter, for it is generally believed that he was the first to 
describe graphically the indurated chancre. Hunter believed in 
the identity of gonorrhoea and syphilis. He was chief of the 
identists, and continued to believe in his theory up to the time 
of his death. 
To prove his theory, he experimented on himself. I will make 
use of his own language (taken from his book, which was pub- 
lished in London in 1788, in old English type. A copy of this 
book was presented to me by my friend Dr. Thomas C. Smith), 
as it will give you an excellent idea of the evolution of syphilis, 
and how the first eruption is suppressed by the administration 
of mercury, resulting in doubt as to diagnosis, until the disease 
has taken a firm hold on the constitution. 
Hunter wrote as follows, viz.: “To ascertain several facts 
relative to the venereal disease, the following experiments were 
made. They were begun in May, 17G7: “Two punctures were made in the penis with a lancet dipped in 
venereal matter from a gonorrhoea; one puncture was on the 
glands, the other on the prepuce. This was on a Friday. On 
the Sunday following there was a teasing itching in those parts 
which lasted till the Tuesday following. In the meantime, these 
parts being often examined, there seemed to be a greater red- 
ness and moisture than usual, which was imputed to the parts 
being rubbed. Upon the Tuesday morning, the parts of the 
prepuce where the puncture had been made were redder, thick- 
ened and had formed a speck; by the Tuesday following the 
speck had increased and discharged some matter and there 
seemed to be a little pouting of the lips of urethra, also a sensa- 
tion in it of making water, so that a discharge was expected 
from it. The speck was now touched with lunar caustic and 
afterwards dressed with calomel ointment. On Saturday morn- 
ing the slough came off and it was again touched and another 
slough came off on the Monday following. The preceding night 
the glands had itched a good deal and on Tuesday a white speck 
was observed where the puncture had been made; this speck, 
when examined, was found to be a pimple full of yellowish mat- 
ter. This was now touched with the caustic and dressed as the 
former. On Wednesday the sore on the prepuce was yellow, 
and therefore was again touched witlf caustic. On Friday both 
sloughs came off and the sore on the prepuce looked red and its 
basis not so hard, but on Saturday it did not look quite so well 
and was touched again, and when that went off it was allowed 
to heal, as also the other, which left a dent in the glands. This 
dent on the glands was filled up in some months, but for a con- 
siderable time it had a bluish cast. Four months afterwards the 
chancre on the prepuce broke out again and very stimulating ap- 
plications were tried, but these seemed not to agree with it and 
not being applied it healed up. This it did several times after- 
wards, but always healed up without any application to it. That 
on the glands never did break out and herein also it differed from 
the other. While the sore remained on the prepuce and glands, 
a swelling took place in one of the glands of the right groin. I 
had for some time conceived an idea that the most effectual way 
to put back a bubo was to rub in mercury on that leg and thigh, 
that thus a current of mercury would pass through the inflamed 
gland. There was a good opportunity of making the experiment. 
I had often succeeded in this way, but now wanted to put it more 
critically to the test. (The practice in 1767 was to apply a mer- 
curial plaster on the part, or to rub in mercurial ointment on the 
part, which would hardly act by any other power than sym- 
pathy.) The sores upon the penis were healed before the reduc- 
tion of the bubo was attempted. A few days after beginning 
the mercury in this method the gland subsided considerably. It 
was then left off; for the intention was not to cure completely 
at present. The gland some time after began to swell again 
and as much mercury was rubbed in as appeared to be sufficient 
for the entire reduction of the gland, but it was meant to do no more than to cure the gland locally, without giving enough to 
prevent the constitution from being contaminated. 
About two months after the last attack of the bubo, a little 
sharp, pricking pain was felt in one of the tonsils in swallowing 
anything, and, on inspection, a small ulcer was found which was 
allowed to go on until the nature of it was ascertained and then 
recourse was had to mercury. The mercury was thrown in by 
the same leg and thigh as before, to secure'the gland more ef- 
fectually, although that was not now probably necessary. As 
soon as the ulcer was skinned over, the mercury was left off, it 
not being intended to destroy the poison, but to observe what 
parts it would next affect. About three months after, copper- 
colored blotches broke out on the skin and the former ulcer 
returned in the tonsil. Mercury was now applied the second 
time for those effects of the poison from the constitution, but 
still only with a view to palliate. It was left off a second time 
and attention was given to mark where it would break out next, 
but it returned again in the same parts. It not appearing that 
any further knowledge was to be procured by only palliating the 
disease, a fourth time in the tonsil, and a third time in the 
skin, mercury was now taken in a sufficient quantity and for a 
proper time, to complete the cure. The time the experiments 
took up, from the first insertion to the complete cure, was about 
three years.” 
Hunter speaking of the mercurial treatment says: “It shows 
that parts may be contaminated and may have the poison kept 
dormant in them while under a course of mercury for other symp- 
toms, but break out afterwards.” 
The experiment of trying to inoculate syphilis with gonor- 
rhoeal pus had since been tried in vain. There is not the shadow 
of a doubt but that the great anatomist had the misfortune of 
finding a patient who had an urethral chancre, and the pus from 
that infecting source was commingled with the gonorrhoeal 
discharge. Or the patient was suffering from constitutional 
syphilis at the time he had gonorrhoea. 
John Hunter was born in February 13, 1728, and died on 
October 16th, 1792, in the sixty-fifth year of his age. As 
anatomist, naturalist, physiologist and surgeon combined, he 
stands unrivaled in the annals of medicine. Early in 1786 he 
published his Treatise on the Venereal Disease. Although cer- 
tain views expressed regarding syphilis have been proven to be 
erroneous, the work is a valuable compendium of observation of 
cases. 
I believe that I am the first to attribute the death of this great 
man to lues venerea—a disease inflicted on himself. Unwilling 
to endanger the life of another he experimented on himself. His 
former pupil and devoted friend Edward Jenner—the discoverer 
of vaccination as a preventive of small-pox—diagnosed Hunter's 
trouble to be angina pectoris, and so it was, but back of this 
stood the liydra-lieaded monster, syphilis. I will describe the tragic death scene and comment on the post 
mortem appearances. 
While attendinig a board meeting at St. George’s Hospital, 
Hunter had an acrimonious discussion with a colleague; sud- 
denly he ceased speaking and hurried into an adjoining room, 
where he instantly fell lifeless into the arms of Dr. Robertson, 
ilis body was examined to ascertain the cause of death. 
“The carotid arteries and their branches within the skull were 
thickened and ossified.” Similar to the changes which have in 
later years been described by Heubner as characteristic of syph- 
ilis. “The coronary arteries and tricuspid and mitral valves 
were much ossified. The aortal valves were also thickened and 
rigid.” These arterial changes were in my opinion of syphilitic 
origin. 
Sir Astley Cooper, the prince of surgeons, is more than any one 
else responsible for the profound ignorance regarding the effects 
of syphilis existing at the present time. In an article on 
syphilis of the internal organs called “Organic Syphilis,” pub- 
lished in the Virginia Medical Monthly of July, 1893 (not Aug- 
ust, 1894), I quoted as follows from the teachings of this re- 
nowned surgeon: 
“Sir Astley Cooper, in his lectures on surgery, taught that 
some parts of the body are incapable of being acted upon by the 
venereal poison, such as the brain, the heart, and the abdominal 
viscera.” Indeed, he writes: “This poison does not appear to be 
capable of exercising its destructive influence on the vital 
organs, or those parts most essential to the welfare and con- 
tinuance of life.” 
Judging from the above, you would think Sir Astley had en- 
joyed about the same advantages in studying the effects of 
syphilis as the majority of our medical students have. 
The late Dr. F. J. Eumstead once told me that the professor 
of surgery in a leading medical college was teaching his students 
that gonorrhoea was apt to be followed by secondary symptoms, 
and should be treated with mercury. 
Do you wonder that the late Dr. Tilbury Fox said and wrote: 
“Dermatology has been much retarded by having been viewed 
too much from the surgical, as it will be advanced from consid- 
ering it in the future, from the purely medical point of view, in 
connection with the recent advances in pathological observa- 
tion.” 
In marked contrast to the teaching of surgical professors 
stands Hoan-ty, the Chinaman, who lived more than two cen- 
turies and a half before the Christian epoch. “Hoan-ty” de- 
scribes chancres, of which he noticed two kinds, one which sup- 
purates freely, the other emits only a serous matter; he noticied 
also the accompanying tumors. He would appear to have been 
very well acquainted with the intra-urethral chancre, which he 
says is easy to detect by the nature of the pus, which it produces, 
and which is not the same as that of gonorrhoea, and also by the pain felt at a fixed and hard point of the canal.” (Captain 
Dabny—La Medicine Chez les Chinois.) 
It was not until men like Virchow of Berlin, the greatest 
pathologist of the age, and Ricord, and Fournier of France, 
Jonathan Hutchinson, Wilkes and Moxon of England, Bumstead, 
Sturgis and Taylor of this country, and other men now of inter- 
national fame, began their investigations, and not until then, 
that the great discoveries were made. 
Abrose Pare, born in 1590, stated, “If there is an ulcer on the 
penis, and the part is hardened, it will be an infallible test that 
the patient is affected with constitutional syphilis.” 
What is now known as the Hunterian chancre was described 
by Pare more than a century before the birth of Hunter. In- 
duration at the base, and surrounding the sore, is the most char- 
acteristic sign of true chancre, but it is not infallible. It may be 
a subsequent, as well as an early symptom, and it may not be 
noticeable on the female organs of generation. Then, again, 
cauterizations with lunar caustic will produce a hardness not 
distinguishable from induration. Generally, it is noticed at the 
close of the second week, but it may appear later. It is slight at 
first, but when at its height, is well marked, circular, resembling 
a pea, and it surrounds and extends over the limits of the sore. 
It seldom leaves a cicatrix. It usually lasts two or three weeks, 
but may continue for as many months. Under treatment, its 
duration is decidedly shortened. 
As a rule, a chancre comes solitary and alone, and this is a 
very important point in diagnosis. Four times out of five a 
true chancre is single; if multiple, it is so from the first, and 
comes from simultaneous innoculation at various points. Of 
450 chancres observed by Ricord in 1856, 341 were single, and 
115 were multiple. (Lecons sur le chancre, 1857.) Clere found 
in 207 men suffering from constitutional syphilis, the chancre 
single in 224 and multiple in 43, or four-fifths. 
Fournier gives the following statistics relating, however, to 
women only: Of 203 patients observed, 134 had a single chancre; 
52 had 2; 9 had 3; 4 had 4; 5 had 5; and 1 had 0 chancres. He 
also gives as extraordinary, 1 case where 19, and another where 
23 chancres occurred simultaneously. 
Fournier innoculated the discharge of 99 chancres upon the 
patients themselves, and succeeded in but one instance, in which 
the experiment was performed within a very short time after 
infection. 
Poisson obtained like results in 52 cases, and Luvoyenne was 
unsuccessful in every one of 19. 
Chancres occur wherever the virus has been deposited on an 
absorbing surface; 95 per cent occur on the organs of generation, 
and those parts most likely to excoriation, and where the specific 
virus can find a resting place, as the cervix penis and mucous 
surface of the prepuce in the male, and the labia in the female. In my article on unmerited syphilis, I called attention to a 
great variety of chancres, which occurred on all parts of the 
body, from the eyelids to the toes. Extra-genital chancres occur 
in men in the proportion of 0 per cent of all kinds. In women, 
the proportion of extra-genital chancres is much greater, amount 
ing to 15 per cent., an important clinical fact. The usual site of 
extra-genital chancres is about the mouth of both sexes, and in 
women about the anus and on the breasts. Chancres of other 
extra-genital localities are much less frequent. 
Sir Samuel Wilks-Baronet and lately President of the Royal 
College of Physicians, London—pathologist, and physician par 
excellence, my former instructor at Guy’s Hospital, expresses in 
terse and admirable language the symptoms and ills which occur 
after the inoculation or absorption of the syphilitic virus, as 
follows: 
“From one week to one month, after the local development of 
the virus, the glands which receive directly the lymphatics of 
the part primarily affected, become symmetrically enlarged and 
indurated as in chancres of the penis, and vulva, the superior 
chain of inguinal glands. Acute or suppurative adenitis is not 
common. The lymphatics may become enlarged and tender, but 
angeioleucitis is rare. When induration of the base of the true 
chancre exists, it is by many, and probably rightly, regarded as 
the first of the constitutional symptoms. The prelude of the 
diathesis and the local reaction of the general poisoning.” 
Not infrequently after the local sore has lasted two or three 
weeks, rheumatic pains, headache, weariness, etc.,—according 
to Fournier, the third act of the drama of syphilis—are com- 
plained of. These are early and sure tokens of systemic in- 
fection. They are very commonly followed in the course of four 
weeks to two months, by symmetrical exanthems on the skin, 
and mucous membranes, and symmetrical affections of the nails, 
hair, eyes, and later unsymmetrical ulcerations in the mouth, 
throat, and skin, tending to spread widely, and deeply, with 
fibre-plastic exudation of the periosteum, connective tissue, 
muscles, fascia, nerves, viscera, not usually symmetrical, chronic 
in progress, and attended often with ulceration, or even a slough- 
ing disposition, with tendency to relapse; for when the virus has 
entered the system, there is scarcely a tissue that may not be 
implicated and that always in a specific and characteristic man- 
ner, by the exudation of fibro-albumenoid material, modified to 
some extent by the organ in which it happens; in the solid organs 
as circumscribed masses, whilst on free surfaces it is seen on 
the base and border of ulcerous sores, the same as in the primary 
local lesion. There is quite often entire freedom from any symp- 
toms, lasting for months and even years, as if the virus had been 
exterminated, but usually certain reminders, in the form of scat- 
tered scaly patches on the skin, as so-called psoriasis palmaris— 
sores on the tongue, lips, etc., appear from time to time. So 
long as this tendency or state exists, it is evidence of the presence 
of virus in the system, communicable by direct or indirect means. Either from the prolonged effects of the special toxic agent upon 
the constitution, or from concomitant causes, a cachetic condi- 
tion may come on at a later period, varying from a few months to 
twenty years, with a tendency to fatty degeneration of the 
various structures of the body, and perhaps to those known as 
waxy or lardareous. These are the so-called tertiary symptoms, 
but are more properly the sequelae of syphilis. True chancre 
gives a relative and not absolute protection against subsequent 
attacks of the malady. 
In my article on “Organic Syphilis,” already referred to, I gave 
illustrations of grave mistakes in diagnosis; I closed the subject 
as follows: “The cases reported above show that organic syphilis 
is not detected in many cases by the physician, and it will never 
be known how many have died, or may die, where the cause of 
death is certified as resulting from morbus Brightii, disease of 
the heart, apoplexy, phthisis pulmonalis, marasmus, etc., but 
where in the dim back-ground stands the grim monster 
Syphilis.” 
“They also show that where a proper diagnosis is made, what 
brilliant results follow the proper treatment.” 
The immortal Shakespeare thus describes the effects of Lues 
Venerea, in his “Timon of Athens,” Act IV, Scene III, in an ad- 
dress to Phrynia and Timandra: 
“Give them diseases; . . . bring down rose-cheek’d youth 
To the tub-fast, and the diet. . . . Consumption sow 
In hollow bones of man; strike their sharp shins, 
And mar men’s spurring. Crack the lawyer’s voice, 
That he may never more false title plead, 
Nor sound his quillet’s shrilly; hoar-the flamen, 
That scolds against the quality of flesh, 
And not believes himself; down with the nose, 
Down with it flat; take the bridge quite away 
Of him that, his particular to foresee, 
Smells from the general weal: make curled pate ruffians bald 
And let the unscarred braggarts of the war 
Derive some pain from you; plague all, 
That your activity may defeat and quell 
The source of all erection.”