(a) All fundamental or prototypical forms, products of the primary action of syphilis-hence all chancres mucous tubercles, figwarts, and gonorrhoea; in general, all products that can be shown to be immediate result of infection, -transmit the contagion absolutely and all the times, no matter where they are located, and whether they have made their appearance as primitive or consecutive phenomena.
(b) All products that owe their origin to the secondary action of syphilis subsequent to a previous metamorphosis of the prototypical forms-hence all tetters, rhagades, pustules, tubercles, and other ulcerations, and in general, all products that cannot be shown to be the immediate results of infection, and can only be produced by a process of metamorphosis, are incapable of transmitting the infection to healthy persons.
Yet, although the products of secondary syphilis have evidently lost their power of reproduction, yet they still possess the power to perpetuate themselves in the affected organism, by putting forth new sprouts; as well as the power to transmit hereditary syphilis which power they seem to retain even during the period of involution of constitutional syphilis, since the facts so far known, and those that we have mentioned No. 186-188, satisfactorily show that syphilis may be transmitted to the offspring even by parents in whom every vestige of a former constitutional syphilis had disappeared from the sphere of phenomenal observation. It is, however, remarkable that during an involution of this character the syphilitic disease will sometimes reappear again in one of its prototypical forms, most frequently under the form of mucous syphilitic disease to the offspring becomes extinct in an individual afflicted with constitutional syphilis or whether this power ever ceases; we do not even know anything positively certain regarding he duration of this last-named period.
III. TERMINATION OF SYPHILIS
Secale 199-Termination in Recovery
If many Old-school authors continue to assert, even to his day, that syphilis can get well spontaneously, without the assistance of art, they either mean by such a spontaneous cure the momentary disappearance of a view isolated forms of the disease, or else they blindly copy one from the other, or assert that which they know to be false. It is not only possible but an established fact, that several syphilitic exanthems, and certain primary ulcers, called “fugitive chancres” disappear of themselves after a certain period; even the Hunterian chancre, after having passed from the stage of ulceration into that of fungoid growth, may finally dry up and cicatrize without leaving any thing else behind than a hard, globular, copper-colored elevation at the place where it had been located. But to call this cure, not only of the chancre, but of the syphilis itself, either implies ignorance of what is to be understood by during, or ignorance of the syphilis itself. That after such a disappearance of cicatrization is isolated products, the whole syphilitic process is not extirpated, is not only shown by the fact, after a shorter or longer period of time subsequent to this disappearance, other forms of the disease break out; but likewise by this other fact that, after a chance is removed from the sexual organs by cauterization, it soon breaks out again in the throat or win other localities. It would be desirable to determine by experiments-on criminals. for instance, who being condemned to death, might be pardoned for such a purpose-what becomes of syphilis, if it passes through at its stags without any interference whatsoever; for, in, order to decides the question whether syphilis, after having reached its constitutional form finally becomes extinct of itself, the clinical observations that have been made so far, are not sufficient, since in all cases sheer the disease seems to have been thoroughly eradicated, the resources of art have been more less instrumental in accomplishing this object. But even if the natural, spontaneous decrease of the signs of syphilis of their final reduction to a latent form, should be a demonstrated fact, the question would still remain open whether syphilis indeed dies dies not entirely, or whether it root, even after every outward sign is vanished, still remains alive, like a perennial plant, to the very end of organic life, and, under certain circumstances for instance, after violent emotions, acute fevers, severe injuries, and such like causes-may sprout forth again years after it had left the sphere of phenomenal manifestations: so that it would be nonsense to talk of the disease having terminated in health. Indeed whenever a radical, rational treatment has not been pursued with a view the thoroughness of the apparent cure must continue to prevail. Even in cases when a cure with specific antidotes seems to have been achieved, a rest of disease often remains hat might be mistaken for syphilis, but very frequently is nothing more than some organic malformations, such as a cicatrix after large wounds, or badly healed fractures etc., which had remained after the removal of the syphilitic disorganizations for the reason that he affected organ had so far deviated from its normal condition that it was found impossible to restore it. In this class belong some indolent swellings of bone remaining subsequent to syphilitic caries, or sycosic malformations of the mucous membrane on the prepuce, etc.; or mercurial ulcers may remain in consequence of the treatment that had been pursued, which are no longer syphilitic.
Secale 200.-Termination in Fatal Cachexia.
The termination of syphilis in death, which was quite common about the time when the disease first made its appearance on the stage of human ailments occur but seldom at the present time, at least not directly, as is the cure with typhus, small-pox or other diseases which having reached the highest degree of intensity, whether destroy life by playing the central organs of vital action, or, even after the disease is removed open leave the patient so weak that he has not got strength enough left to live. Nevertheless, several authors talk even to this day of a general syphilitic cachexia. Although, in most cases that are related of such cachexia. Mercury seems to have played a much more conspicuous apart than syphilitic, yet Cazenave, of Paris, relates a case the disease had progressed so far, that the patient was not only covered all over with syphilis pustules, tubercles, and ulcers, and had sunk into a state of extreme marasmus, with a withering and sallow skin, but was likewise seized with such a violent, colliquative diarrhoea, that death seemed inevitable, and was other authors it happens, even it its day, that patients, after protracted sufferings, and covered with syphilitic exanthems, deprived of their speech, hearing, smell, and even vision, sink into a state of extreme emaciation, with a lax, dry, sallow skin, and with a peculiar fetor emanating from their bodies, until they are attacked with incurable diarrhoea nd hectic fever, that puts an end to their fluids. Even if death from, syphilis does not always result in this direct manner, in consequence of a general progress of the disease, yet it may result in another indirect manner. Such fatal terminations may take place, if the existing ulcers, by corroding large vessels, give rise to haemorrhages that cannot be arrested. Death may likewise be super induced by the pressure of exostoses on the under wall of the skull bones upon he brain, whose functional activity is thereby paralyzed; own of my patients die din Baden- baden of the consequence of such an exostoses. The sane thing may result, if the skull-bones become perforated by syphilis caries, and the brain itself is injured by the ulcerative process. Cases where syphilitic ulcerations of the larynx can super induce a fatal ulceration of this organ, as well s cases where death may take place from destruction of he surgical vertebra, in consequence of chancres ulcers of in the fauces, are well known known, and have been mentioned by us in other parts of this work. Less frequent are cases of a fatal destruction of the uterus, caused by ulcers on the neck of this organ. What authors relate of the transformation of syphilis into carcinoma of the womb, may be correct in so far as the syphilitic disease may rouse a cancerous diathesis into activity; nevertheless, syphilis cannot be transformed into cancer; if death should result in such a case, it is caused by cancer, not syphilis. Beside these cases, syphilis, even if it should not attain a high degree of development, may destroy life in consequence of sleep being prevented by agonizing sufferings, or in consequence of extensive suppurations or hectic fever; or, finally, in consequence of the gummata in lungs, liver, heart, and stomach, of which Virchow has given us a description; all such causes may lead to such vast disturbances in the vital functions, that death must necessarily ensue unless help should still be possible.
