Secale 196.-Special Symptoms of Secondary Syphilis.
As regards this period in. the ulterior course of syphilis, its chief signs is the appearance of new phenomenon that never show themselves as primary symptoms after infection, either on the skin, or on the mucous membranes, in he osseous system or in other tissues,. In this period of the disease, the syphilitic products no longer appear single and localized, as is still the case with the consecutive phenomena, but they either show themselves like exanthems, on various portions of the skin, or likewise in to the tissue in company with other syphilitic products, thus evidencing a general overpowering of the organism by the syphilitic disease. That this period begins, as some assert, after the chancre has disappearance of the primary phenomena, must necessarily constitute a secondary manifestations. What alone distinguishes and separates these two periods from each other, is the isolated, absolutely local reappearance of the phenomena in one, and the simultaneous, more or less general appearance of diversified phenomena in. The other period, or the consecutive buboes, chance in. the throat, mucous tubercles, etc., of which we have spoken in the preceding paragraph, break out ever so remotely after the complete disappearance of the primary products, and let them continue for years in a condition of fungoid growth; nevertheless, if no other symptoms supervene on the skin, or in to other tissues, the primary period continues until such symptoms occur. The reverse of this is likewise true, if such symptoms break out while the chancre is still existing in its integrity at the original spot of communication. let this chancre be ever so recent, and ever so recent, a never so remote from the stage of fungoid growth; from the moment that these other symptoms show themselves simultaneously with the chancre upon the skin, on the mucous membrane or in he osseous system, syphilis enters upon he secondary period of its existence. Moreover, in as much, as we have stated at the beginning of the paragraph, as the essential characteristic of this secondary period not only consists in manifesting itself by more general phenomena, but more particularly in this, that being a true metamorphosis of the disease, it no longer occasions, after the fashion of the primary period of syphilis, local transpositions of the primary syphilis, local transpositions of the primary symptoms, But manifests itself by new forms that had not been existing hitherto, and never appear as the immediate results of infection, we in conclude that whenever such a form, even isolated, man rests itself upon the skin, the mucous membranes, or in other tissues, it is a sure sign that secondary syphilis has set in. This altered form, deviating more or less form the fundamental typhus of the primary period, is, in the end, the only permanently mental types of the primary period is, in the end, the only permanently mental types of the primary period is, in the end, the only permanently remaining characteristic of secondary syphilis; for although, during the evolution of this period the universality of secondary syphilis action throughout the whole organism is distinctly recognized either by the simultaneous appearance of several of these form, or by the supervention of these forms during the existence of primary phenomena; nevertheless, in the further course of this period, a moment of time arrives then the first tumult of syphilitic action appears diminished; the primary symptoms, which till existed at the commencement of this period have either been removed by the hand of art, or have remained stationary stunted remnants of the disease, and the continual presence of syphilis in organisms not longer manifested by the prevalence of general products, but by the development of local phenomena which, like the cornea veueries or the psoriasis either continue unchanged for years as the sole visible sign of the disease, or only appear from time to time, generally s local symptoms. It is to this involution period of secondary syphilis that the term constitutional syphilis has been more particularly and not improperly applied, and about which, on account of the importance which attaches to it in the history of syphilis, we shall offer a few additional remarks.
Secale 197.-Constitutional Syphilis.
As we have shown, the course of syphilis, from the moment of its first appearance to the moment when it seems to have concluded, as it were, a treaty of peace with the organism presents two essential distinct phases in the first of which the disease, after having committed certain primary destructions, changes to a fungoid body, which, in the second period, after having acquired its full growth and characteristic shape, penetrates the whole organism, with its ramifications, in. the shape of herpes, pustules, and tubercles of every sort, and, from the epidermis to the marrow of the bones, does not leave a single tissue free from its pestilential taint. In in second division of this work, we have more fully considered the products of the fully which each of these forms, on serves in its course we cannot fall to notice that a certain systems of mutuality or reciprocation seems to exist between incipient condylomatous growths and their ulcerative destruction so that, whenever the destruction has taken place, cicatrization follows without the assistance of art, by the sole power of Nature. This however, does not prevent the syphilitic disease from at once reproducing new pustules and tubercles in the place of those that had become cicatrized, and to continue the same system of destruction and restoration with these new formations as with the former. This seems to indicate a continual struggle between the organism and the parasitical growth of syphilis, which the organism is unable to arrest, and can only keep in a state of temporary subjugation, during which the slumbering disease does not become roused as fresh its existence, either by occasionally renewed outbreaks, or by an obstinate preservation of the already existing products. the symptoms of syphilis hat manifests themselves during this period, and are much less intense then the symptoms of the period periods, have been termed by some, among whom we may mentioned Ricord, of Paris, tertiary syphilis. This, however, is incorrect; for in the whole course of syphilis there are only two reproductive periods (1) the period of conception and development of the original cardinal or typical forms, and (2) the period of the metamorphosed primary of fundamental typical forms, together with all the phenomena in the different tissues of he organism belonging to he province of this metamorphosis. These last-mentioned phenomena are all of them, included in the stage of evolution of secondary syphilis, and a constitutional syphilis is nothing else than a syphilis that has become stationary and does not untold any new phenomena, but rather enters upon a new stage of involution. a syphilis of this kind, so far from producing another series of new stage of involution. a syphilis of this kind, so far from producing another series of new creations or metamorphosis, only develops such symptoms as are inherent in the development of secondary syphilis,, there cannot be any tertiary symptoms, and all those apparently tertiary symptoms that might possibly occur during the new process of involution, on the part of the constitutional syphilis, must of necessity belong to secondary syphilis. We might indeed talk, in some respects, if not or tertiary syphilis and tertiary syphilis would belong to the secondary period, and to no other syphilitic evolution, as may be readily seen from the following list of the different stages which this disease runs.
FIRST PERIOD
Primary Syphilis, with local symptoms: PRIMARY PRODUCTS.
Ist STAGE: Ulcerous condition of the Primary Ulcers: Primary phenomena.
2ND STAGE; Condylomatous or Fungoid Growths, and consecutive local phenomena, in the pulse of the primary ulcers transferred by art from he original spot of communication to other localities; Consecutive phenomena.
SECOND PERIOD.
Secondary Syphilis, with general, new phenomenal; SECONDARY PRODUCTS.
Ist STAGE: Evolution and appearance of a variety of new forms, being signs of a true metamorphosis of the primary disease:GENERAL SYPHILIS.
2nd stage: Completed evolution of these phenomena, and retrogression of the general phenomena towards a localization of the same forms: CONSTITUTIONAL SYPHILIS.
This we may establish four different kinds of phenomena, (1) primary (2) consecutive, (3) secondary and (4) constitutional, an arrangement that excludes for the present tertiary and quaternary products, until a new metamorphosis or evolution of syphilis, succeeding the secondary period, shall have been demonstrated.
Secale 198.-Remarks on the symptoms of the Four Stages of Syphilis.
The distinction of the above- mentioned four stages of syphilis is of importance in other respects. The dispute concerning the contagious or non-contagious character of the products of secondary syphilis, that has been raging for a long time, is well known; as far as we ourselves are concerned, d it is out opinion (sec No. 184) that no truly secondary product is contagious. Here, too, we adhere to this opinion, but at the same time reiterate the advice the consecutive phenomena, which still appertain to the primary period of chancre, should not be confounded with secondary phenomena originating in a metamorphosis of the chancre. A misapprehension of this kind unfortunately occurs quite frequently, even in “Rueckert’s Klinischen Erfahrungen.” What has had its being previous to this metamorphosis and has originated in a purely metastatic transfer of the chancre or mucous tubercles to together parts of n the skin, mucous membrane s o lymphatic glands in other parts on the skin, mucous membranes or lymphatic glands- in other words, all truly primary (primitive as well as consecutive prototypical) forms, all chancre, s mucous tubercles, fig warts, and buboes, transmit the infection at all times and without fall, not matter whether chancres are seated on the sexual organs of in the throat, or whether the latter are located in the inguinal region or in the axilla, or any where else. This distinction is of particular importance as regards the phenomena appearing in. the throat and around the anus, which hitherto, unless they had originated in a direct contact with the infectious matter, have always been numbered among he secondary phenomena, may of which may be nothing but consecutive primary phenomenon, transferred to those localities by virtue of a process of metastasis. In order, therefore, to render all misapprehension absolutely impossible, even for those who don’t know what is, and what is not, primary or secondary syphilis; and inasmuch, a s, after what has been said, we can express ourselves more definitely, we will here condense the statement we have enunciated in No. 184, in he following two general propositions:
