THIRD CHAPTER GENERAL DEVELOPMENT, COURSE, AND TERMINATION OF SYPHILIS.
I. DEVELOPMENT OF SYPHILIS
Secale190.-Period of Germination.
EVERY unprejudiced observer must admit that between the moment of the infectious contact and the appearance of the first protopathic phenomena, a longer or shorter interval elapses during which absorbed poison prepares the subsequent manifestation of the diseases; this interval has been designated as the period of incubation or germination. It is true that some physician-even Ricord of Paris, relying upon his experiments in Inoculation,-deny this period of incubation, and maintain that, so far from being absorbed by the organism, the contagium, on the contrary, remains adhering to the locality where it is applied, and where, as it first effect, it produces an ulcer, which is only when fully developed succeeded by the absorption and diffusion of the poison in the organism. In order to give still more weight to this view, he alleges, as a proof of its correctness, the fact, that in all cases where a chancre produced by inoculation is cauterized a few days after its first appearance, or at any rate previous to the setting in of the characteristic induration of its base, the inoculated individual remains perfectly free from all subsequent secondary phenomena, even if no internal treatment had been pursued, and that secondary affections only manifest themselves in case the cauterization takes place after the base has already become indurated. Although facts cannot be contradicted, yet the conclusions drawn from these facts may differ, according as the import of the facts is viewed in a different light by one party or the other; and this is likewise the case in regard to the conclusions which Ricord has drawn from his experiments of inoculation. In the first place, his experiments, which he always instituted on patients who were already attacked with syphilis, do not prove anything regarding the cases where healthy persons become infected; for, if it be at all true that a certain interval has to elapse between the initial infection and the production of the first primary or protopathic symptom of the disease, this interval was not whom the protopathic manifestation of the disease might, therefore, have taken place much more speedily, Indeed, in Ricord’s cases, it usually takes place in one or two days. Most generally the primary symptom was developed on or before the third day. the conclusion which he draws from the speedy appearance of chancre, that a chancre can be removed by cauterizing without the least danger, as long as the poison has not yet been absorbed by the organism, is likewise erroneous. This conclusion is likewise based upon an equally incorrect application of he observed facts to conditions much as occur in he natural course of syphilis. If he had operated on healthy persons, and, while they remained under his supervision, had not seen cauterization followed by buboes, mucous tubercles, or other consecutive phenomena, how could he know that a genial infection, which had already begun previous to the appearance of the primary product of inoculation, would not sooner or later manifest its existence by secondary phenomena: Operating as he did upon individuals who, on account of other syphilitic affections, were subjected to internal treatment, how could he know that the non-appearance of secondary phenomena, even for a period of years, was not owing to this internal treatment, instead of attributing it to the innocuousness of the inoculation sore that was only four or five say old.? Be this, however, as it may, Ricord’s assertion is contrary to daily observation, according to which a period of six days, or two or three weeks, has to relapse from the moment that the infection is first communicated to the period when the first primary product of the syphilitic disease manifests itself upon the sexual organs.
See.191.-Pathological Processes during the Period of Germination.
This period of incubation being once admitted as a fact, the question then occurs, what changes the locally-applied contagium effects in. the organism in order to predispose it for the development of such an exceedingly chronic disease that never again becomes extinct of itself? This subject has been a bone of contention absorbed; but whither it travels, or when it finally becomes located, whether in. the liver, the bile, the fact, as was asserted by tea partisans of Galen, or weather in the fluids, the blood, or even in the lymphatic glands-nobody is prepared to indicative, with positive certainty, any more than weather it is conducted any where in particular; or whether according to Ricord and his adherents, it does not rather, like a grain of seed planted in. the soil remain hidden under the epithelium of the mucous membrane or under the subjacent cellular tissue, until the germ succeeds in piercing its coverings. This last mode of explanation however acceptable it may appear to Berzelius, Liebig, and the chemists generally, who do not understand any thing of the living processes of the organism, might perhaps seem more tenable than it really is, if we could be made to understand why the organism, which so readily absorb through its epidermis semi-liquid substances, such so readily absorbs through it epidermis semi-liquid substances, such so readily absorbs through its epidermis semi-liquid substances, such as mercurial ointments, should desist from its laws of absorption in favor of the syphilitic contagium, and should decline to absorb this favor of the syphilitic contagium, and should decline to absorb this favor of the syphilitic contagium, and should decline to absorb this totally fluid substance through the mucous membrane, s which are possessed of an extraordinary degree of absorptive power. No, indeed, the poison is absorbed; and that it attacks the whole organism and disharmonizes the unity of it vital processes, even before a trace of the primary syphilitic products is perceptible, is not only shown by the excited feelings with which sensitive patients even shows by the excited feelings with which sensitive3 patients, even shown by the excited feelings with which sensitive patients, even without being aware of the least sign of infection, and sometimes without being aware of the least sign of infection, are sometimes troubled from the moment that the infection makes place, to the very period when primary symptoms are on the point of breaking very period when primary symptoms are not the point of breaking out-this mental excitement being mauve associated with a feeling of malaise, and thou general languor and weariness,-but, is likewise shown by the febrile motions which sometimes precede the braking out of primary symptoms, a nd are either overlooked by the patient, or attributed to some other cause. Castelnau, in this annals of the cutaneous diseases relates two very remarkable instances of this kind. The first case was that of a journey man mason, in whom this fever was attends with malaise, violent pains in. the small of the back, and loss attended with malaise, violent pains in the small of the back, and loss of appetite, and became so violent that he had to leave off work and go to bed; three days after which, a small swelling showed itself in go to bed; three days after which, a small swelling showed itself in the left groin, which increased in. the following days to the size of a pigeon’s egg, the fever, together with the other ailments abating all the while, until the bubo remained without any other symptoms. the other case was that of a prostitute, who was attacked with a small chancre at the inferior commissure, nd at the same time with fever; this chancre was first succeeded by buboes, afterwards the abscesses on the cheeks and neck, during which the fever continued with equal violence until the abscesses had healed. By dint of making inquiries whenever I had chancre, I have found out, in spite of the great carelessness of most patients, who never apply to a physician until the are compelled to do so, that this fever is not at all uncommon, but consists, in most cases, in a certain characteristic feeling of languor with weariness, attended with more or less chilliness, which in some individuals increases to a shaking chill, and it frequently felt only on the day before the primary product breaks out. Whether the contagium is absorbed rapidly or slowly the fact is, that it is absorbed just as surely as the organism perceives signs of a general disturbance previous to the breaking out of the local symptoms.
Secale192.-Breaking out of the Local Symptoms.
It is well known that, in most cases, the first symptoms generally make their appearance at the spot where the infection has been communicated. This fact is so generally recognized, that those who regard chancres, protopathic buboes, etc., as purely local symptoms, rely more particularly upon this circumstance to prove the correctness of their theory. But the case here is the same as in many other contagious disease, where the general organic reaction against he poison that had bean force upon the tissues first embodies itself in a visible form at the very spot whence the shock first emanated. In hydrophobia, for instance, where, at the moment when, after sometimes of considerably protracted period of incubation, the general disease breaks out, the wound which the animal had inflicted with its teeth, and which had become cicatrized a long time previous, breaks open anew, becomes aggravated, and finally inflames. The same process takes place in inoculation of the small-pox, when the pustules prefer the spot where the matter had been originally inserted, for their first appearance, but, as Blache and Aubry relate, may likewise show themselves over he whole body. This circumstance may likewise occur when the syphilitic contagium is introduced in open wounds, as is shown in the case No. 99, of the second division of this work, where a chancres eruption over the whole body emanated from much a cause. Who knows whether many of the pustules syphilitic exanthems, that have been regarded as secondary phenomena heretofore, do not constitute protopathic primary symptoms, spreading all over at once, in consequence of a renewed symptoms, spreading all over at once, in consequence of a renewed infection show themselves immediately at the original spot of communication: I cannot imagine upon that grounds certain German writers base their assertion, that the first local symptoms generally break out forty-eight hours to four days after the infection had first been communicated. This I a theory which, lie the fable of the “crystalline vesicle.” that is acid to be always present toad only to remain unnoticed occasionally may be accepted and believed by those how only know of funereal diseases from books; but any one who has seen a sufficient number of cephalic cases, is aware that, in most cases of natural chancres that had not been produced by inoculation, t he first germs never show themselves forty-eight hours, inoculation, t he first germs never show themselves forty-eight hours, or four days, after infection; but usually from the seventh to the fourteenth day, a nd frequently not until three or four weeks have elapsed. No less incorrect is the assertion, that in the first twenty-four hours after infection signs of a general reaction becomes apparent such ask; considerable determination of the blood, turgescence, increased turgor vitalis, increased redness, and alteration of the secretary activity. The fact is that, during the whole period, from the moment of infection to period of the braking our of the disease, which breaking out is generally completed without twenty-four hours, absolutely nothing is noticed is most cases at the spot of communication, whether the braking out takes place severe or twenty eight days, or even later subsequent to the infection taking place. It is difficult to determine why, in one case, the disease should brake out sooner, in another case later. This period may even vary in the same individual that had caught the infection several times. In spite of the greatest excesses that may be committed during this period, it may last longer than if the patients remains perfectly free from physical or normal excitement. All that can be asserted in regard to the various typical or fundamental forms in which the venereal disease may appear. we have observed from the earliest period to the present time: (1) Idiopathic gonorrhea; (2) the various forms of chancre; (3) Condylomata (mucous tubercles and fig-warts). Whether the syphilitic contagium, as some assert, can remain latent in the body for years, without showing any manifest signs of the distance, after the fashion of the hydrophobic virus, is a question that it may be very difficult to decide. If a person is bitten by a mad dog, the whole town knows of it; and very body can state the time, how long it will take for the disease to break out. But, if a man gets bitten by a rapid girl, he is not apt to publish it to the world; and, if the thing should become known, nobody can tell whether the trouble originated in an old offense for in a recent trespass.
