Secale 193.-Development of the Various Forms.
If Cazenave and other French physician assert that the form in which the venereal disease may manifest itself, after the infection has taken place, depends exclusively upon the individual disposition of the patient, and upon other accidental circumstance, a statement of this kind is undoubtedly correct, into far as a certain form of chancre, for instance need not necessarily produce a like form, but may bring forth s simple. Hunterian, or phagedaenic chancre, no matter what the original chancre form may have been. But, if these authors go so far as to assert that, no matter what sort of venereal contagium may have originated the disease, this disease may assume any imaginable form, chancre, mucous tubercle, or protopathic bubo, and that these diversified results are altogether determined by the constitutional individuality of the patient and by the various influences tow high he may be exposed, the falsity of such and assertion must be apparent, even from what we have said in No. 176, 177, concerning the plurality of the venereal contagia, and can only be accounted for by assuming a want of a correctly discriminating diagnostic acumen. We might as well take it for granted that cherry, pear, or peach trees can grows out of an apple-seed, and that a result of this kind depends altogether upon the nurture foe tea soil in which the seed is plated, and upon the circumblent influences under which the unfolding and growth of the seed take place. In as much, however as out definitions might become mixed up, and consequently might be opposed by apparent facts, we will here again present a cursory view of the conditions wonder which the different venereal typical forms can accomplish and complete their growth, and ultimate shaped and realization.
(1) Chance forms-These can at all times, and under any circumstances, only grow from chancre, not even from condylomata and their accompanying sycosic gonorrhea, for the reason that condylomatous forms that have acquired an independent extends, although born of chancre, yet constitute a lower degrees nd inferior variety of the chancre-form, in so far as they belong to a modified or altered state of the growth of chancre, and hence cannot possibly reproduce their prototype of a higher order.
(2) Condylomata.-These growths, which may assume the form of mucous tubercles (tubercular mucosa seu humida), and that of fig- warts (condylomata, excrescentiae), may, in accordance with their different nature, spring from two different modes of contagion:
(a) by direct infection, with existent mucous tubercles or fig- warts, and the symptomatic gonorrhea accompanying these forms; and.
(b) by infection from chancre in its fungoid, condylomatous stage, but never by infection from a chancre in it first, ulcerous stage.
(5) Gonorrhoea.-According as it is either the symptomatic or idiopathic, it may proceed from one, or from several different modes of infection, namely:
(a) The simple idiopathic or local gonorrhoea, depending upon contagium of it sown, can neither comes from chancrous nor condylomatous infection but can only be cause by its own specific virus.
(b) Symptomatic gonorrhoea.-This form of gonorrhoea, which is always associated with mucous tubercles, fig-warts, or latent chancres, can never be developed from truly idiopathic gonorrhoea, but may readily result from an infection caused by any of the other forms-chancres, mucous tubercles, or fig-warts, in which ask it will never appear alone, but always in company with one of the above mentioned phenomena.
(4) Protopathic bubo.-This may succeed an infection by the virus of chancre, as well as by that of mucous tubercle or fit-warts, but never an infection by simple gonorrhoeal, virus which can only produce a consensual swelling of the inguinal glands.
(5) Secondary phenomena may not only appear after chancres, mucous tubercles, and fig-warts, but likewise in consequence of symptomatic, but never as a consequence of purely Idiopathic gonorrhoea.
What special form each particular chancre, mucous tubercle, and secondary anthem, may assume with respect to its malignant nature, further spread, or other differences, depends upon the individual disposition of the infected person, as well as upon accidental circumstances that may either promote or impede the further development of the infection, and concerning which we shall make all needful remarks, after having previously considered the general course of syphilis.
II. COURSE AND PERIODS OF SYPHILIS.
Secale 194.-the Different Periods generally.
We have already stated more than once in other places, that it is not by its symptoms, each considered by itself, but by the connection for these symptoms among themselves, that syphilis constitutes a unitary, progressively-unfolding chronic malady, that does not get well spontaneously, and the phenomena of which, as they appear from time to time in the organism, constitute symptomatic manifestations. At the same time, we have distinguished among these symptoms such products as belong to the initial appearance of his malady, from those that only manifest themselves after the disappearance of these initial symptoms, and constitute, as it were, a new phase in the course of the disease However, after having described in the first and second divisions of this work the different primary and secondary phenomena, each with as much careful detail as possible, were still have to consider the internal connection of these symptoms, and of their successive development, in a regular series, from the unfolding of the first form to the most perfect pervasion of the whole organism with constitutional syphilis. Let us now examine, with more particular care, how this polypus monster takes root in the organism from the first moment of its existence, and in what order, and through what metamorphosis, it continues to spread and ramify, until it has dipped its thousand stings into every fibre of the organic tissues. We have seen that even the frequently mentioned mucous tubercles and fig- warts notwithstanding their apparent idiopathicity and inherent capacity for reproduction, are nothing else than sprouts of the chancre from which the syphilitic disease generally emanates, so that we may commence our subject with a consideration of the chancre as the true and sole root of all syphilitic mischief, so much more as the idiopathic gonorrhoea that has been so often unjustly charged with the sign of its malicious neighbor, after all, only does a small amount of mischief in the organism, and need not occupy our attention in this place. It must have been seen, from what we have stated in previous chapters, that the first thing the chancre seeks to accomplish immediately after its initial localization, is to create a mode or less oedematous, swollen base of cartilaginous hardness, where it forms a cup-shaped excavation surrounded by callous edges, the hence it can not only spread its devastating disorganizations but likewise throw out roots for new vegetations. This is the first destructive period of chancre, which, however, does not last long, so that, unless it should have become converted into a phagedaenic sore, and chancre takes root after the fourth, or at the latest, after the sixth week, so far as to expand into a fungoid growth, with manifold ramifications. In this second or fungoid stage, it only passes from its destructive form in to that of a condylomatous expanse, but even throws out at the same time new sprouts in the neighboring tissues, which, in the shape of mucous tubercles and fig-warts even after the extinction or cicatrization of the original form, continue infectious, and capable of reproducing in healthy individuals, if not the original type, at least the fungoid form of chancre. This state of development likewise passes by, and another period sets in when these infectious forms cease to make their appearance, but the fully-developed polypus sprouts in every direction through the various tissues of the organism, This third period initiates a second epoch in the life of syphilis, essentially distinct from that of the chancrous period, when we no longer speak of chancre or its primary products, but of constitutional syphilis, the chancre or its primary products, but of constitutional syphilis, the of spring of the former. it is to these two epochs of the unfolded and the involved general syphilis, to which the name of primary and secondary has been applied, each one of which we shall now proceed to consider more particularly with reference to their special characteristics.
Secale 195.-Special Characteristics of Primary Syphilis.
What constitutes the pathological distinction between the primary and secondary periods of syphilis, is the circumstances that in. the former there still exists a struggle between the polypous monster and the organism that has become disharmonizes, but not yet overwhelmed by its pestiferous breath. In this struggle, the monster, on the one hand, seeks to extend it influence, and, on the other hand, the organism, incapable of overwhelming the hostile thing, seeks to limit its activity as much as possible to the locality where the infection had first been perceived, or, at any rate, to keep the hostile effort within local bounds. For this reason it is that the first primary symptoms always make their appearance at the original spot of communication. If this should not be the case, as, for instance, when protopathic buboes break out, the primary symptoms still remain local symptoms, and never appear very far from the original spot of communication. What these primary local manifestations of the syphilitic disease are we know from the proceeding paragraphs: (1) the different forms of chancres: (2) mucous tubercles and fig-warts; (3) the symptomatic gonorrhoea depending to on these products; and (4) the bubo, which according to circumstances, may either be a primary (protopathic) for a consecutive (deuteropathic) manifestation. These are the forms that belong exclusively to primary syphilis; if they show themselves any where else than on the sexual organs for instance, the chancres and mucous tubercles on the lips, in the mouth and throat, and the corners of the mouth, or around the anus, we might safely conclude that they result from a desert insertion of the virus in these parts, if we had not to take into consideration another circumstance that not only can, but frequently and unfortunately does, exercise a mortifying influence upon the natural course of primary syphilis. This influence is the hand of man, which often interferes with the natural course of the disease in the most criminal and reckless manner, and, instead of destroying the hydra itself, contents itself, whenever this monster shows one of its heads, with chopping it off not considering that, where one head is chopped off, several others at once grow up in its place. This is true as regards the chancres, mucous tubercles, or buboes; if they are only removed from their local site by external means, instead of being met by specific internal antidotes the same primary symptoms usually are not slow to break out in an analogous form, like chancres or mucous tubercles, in some other locality, more particularly on the mucous membrane of the throat or mouth, or around the anus, on the scrotum, etc. These phenomena, which have been termed “Secondary chancre,” “Secondary mucous tubercles,” are, however, far from being symptoms of secondary syphilis, but, by their pathological nature, belong no less than the consecutive bubo to the primary epoch of syphilis, during which the reacting organism still endeavors to localize the syphilitic disease. In proof of this, these products, whenever they appear in this manner, are always the almost immediate consequence of chancre of mucous tubercles that had been removed by cauterization; as such, they are consecutive, not secondary products of syphilis, and and just as capable of communicating the disease as their suppressed primary prototypes. Hence, we have two kinds of primary symptoms, that are not only essentially distinct from each other, but have likewise to be carefully distinguished from he really secondary phenomena (a) the primary local symptoms that always make their appearance at the original spot of communication; and (b) the suppressed consecutive phenomenon breaking out in other localities after the primary symptoms had been cypress by improper management, and still constituting to some extent purely local symptoms. In this respect, we say, that cancer, buboes, mucous tubercles, fig- warts and gonorrhoea, whether they appear as primary or consecutive phenomenon at the original spot of communication or in some other locality, still appertain to the primary epoch of syphilis, where the disease had not yet become constitutional; although some of them,. for instance some kinds of fig-warts, if they have once broken out, continue in. the secondary period for years;l but in this period can never break out anew, unless a new infection has taken place.
