Secondary Forms


Secondary phenomena are the remote sequelae of an infection caused by a specific virus, continue to infect everyone who comes in contact….


FIRST CHAPTER

OF SECONDARY SYPHILIS GENERALLY

1. GENERAL DEFINITION OF SECONDARY PHENOMENA.

Secale 79. Various Definitions.

ON persuing the works of those who have written on the treatment and nature of venereal diseases; and upon examining the expressions of which most practitioners make use in designating the nature of single cases, we cannot help being amazed at the confusion which prevails, even to this day, in regard to the terms: general constitutional, and secondary phenomena, etc. Not a few regard all these terms as synonymous; according to them, secondary syphilis begins at the moment when, after the appearance of the primary protopathic symptom (gonorrhoea, chancre, or figwart), some other consecutive phenomenon is superinduced as a pathological consequence of the former: whereas others maintain that the consecutive phenomena do not always, by any means, belong to the secondary period, since even general constitutional symptoms may really and truly constitute a primary malady. Hence the dispute what symptoms constitute primary, and what secondary; some even contending that not one syphilitic phenomenon is in truth either primary or secondary, but that everything depends upon the chronological order in which the symptoms appear, whether protopathically or consecutively, so that we may not only have secondary buboes, mucous tubercles, and figwarts, but likewise secondary chancres and gonorrhoea. This theoretic confusion may not deserve any consideration at the hands of homoeopathic physicians, who are never guided in the selection of remedies by speculative categories, but by the totality of the existing symptoms; but since, in many cases, where the outlines of the symptoms are not delineated with sufficient clearness, we have to consider the cause in which an existing malady originates; and since all previous experience shows that one of us will reject remedies for secondary syphilis which another praises for the same malady; it is evidently of the utmost importance, that we should, in the first place, clearly define our understanding of the term secondary phenomena. Hence, before we enumerate and describe secondary phenomena, we will endeavor to furnish a precise definition of this term, in order that out readers may be enabled to distinguish between symptoms that really deserve the appellation of secondary, and such are improperly classed in the category.

Secale 80. Truly Secondary Phenomena.

If we survey the phenomena which, during the course of the gradually unfolding and progressing malady, may manifest themselves as consequences of the primary manifestation, from the first protopathic symptom (chancre, gonorrhoea, figwarts) to the remotest affections of bones, which sometimes do not break out till year after the first appearance of the disease; an attentive observer must become aware that, no matter at what period the secondary symptoms follow this first manifestation of the syphilitic disease, they can be ranged in two classes which, in a nosological point of view, are essentially distinct from each other. For while many of these symptoms show themselves already a few days after the suppression, or even during the presence of a chancre, or of some other protopathic product, without, however, being able to transmit themselves by infection or inoculation to other individuals; on the other hand, there are other symptoms belonging to this order, which, in spite of their apparently much more retarded appearance, still possess the faculty of transmitting their own virus, in an extraordinary degree, such as: consecutive buboes, mucous tubercles, and figwarts, which are just as contagious as protopathic products of the same kind. From these facts it is furthermore evident that during the unfolding of the consequences of a protopathic symptom, a period must necessarily arise when the virus undergoes an essential modification in the organism, passing, as it does, from its original primary condition into a subsequent modified condition, which, occurring subsequently to the former, may be justly regarded as secondary. It is not only with regard to single phenomena (such as ulcerated and fungoid chancres, etc.), but likewise with regard to the course of the whole syphilitic disease, that we distinguish a first or primary, and a second or secondary stage, whose respective phenomena, the products of two essentially distinct modes of action of the infectious virus, must not be confounded with each other. If, in accordance with what a rigorous scientific logic would seem to demand, we limit the term “secondary phenomena” to these sequelae of the original symptom which appertain exclusively to the second of those two periods; and if, from a similar reason, we designate as “primary” phenomena, those that exhibit the characteristic signs of the former of those periods; it is evident that a phenomenon may be consecutive, without being on that account secondary, and that these two series of phenomena may differ from each other in all their essential properties. For this reason, and in order to avoid all confusion of ideas, all deep-thinking, and logically- discriminating physician have limited the term “consecutive” phenomena to the designation of products which, although occurring subsequently to the protoplastic manifestations of the syphilitic disease, yet continue to show all the diagnostic signs of the primary period of this disease. In the third division of this work, where we shall enter upon a survey of the whole course of syphilis, we shall see that this division is founded in the nature of things, and rigorously justifiable from a scientific point of view; for the present it may suffice, that we should declare our adhesion to this general classification into primary and secondary phenomena, and that, by “secondary,” we never understand the simply consecutive symptoms of the primary period, but always the phenomena of the second period, which are no longer capable, owing to some essential modification of the nature of the contagium, of transmitting the syphilitic disease by direct infection of the individual.

Secale 81. Boundaries of the Secondary Phenomena.

When asking the question what constitute more particularly secondary phenomena, it is at once evident that buboes, mucous, tubercles, and sycosic condylomata, being still endowed with the faculty of communicating the primary disease, cannot be classed among secondary phenomena. This point being conceded, another no less important question arises for our consideration; by what specific signs do we recognize the secondary character of a syphilitic product, and its consequent inability to transmit the disease, independently of all sexual connection and experiments by inoculation? Some have sought to determine this question by the greater or less extent of the simultaneous manifestations of syphilitic phenomena, and, for this reason, have been secondary syphilis wherever these phenomena did no longer show themselves at the original site of the malady, but appeared more or less diffused in other localities, in consequence of which the terms “general” and “secondary” were considered synonymous. That they are not always synonymous, is evident from the fact that among the syphilitic phenomena, more particularly among the mucous tubercles and figwarts, many of them, even when protopathic manifestations, show themselves in localities more or less remote from the original site of infection, without having caused, on that account, to be any thing else than products of the primary period of syphilis, and without having lost their power of transmitting the original disease. It is true that such general phenomena, appertaining as they do to the second stage of the primary period, constitute a sort of transition stage to the secondary morbid process, where the virus no longer produces chancres, but transition forms; but inasmuch as these forms, more specially buboes, tubercles, and figwarts are still capable of perpetuating themselves by the act of coition, they cannot, even if scattered over the whole surface of the body, properly be considered as secondary, and hence the terms “general” and “secondary” syphilis cannot be considered as synonymous. The fact, however, is that where there are secondary phenomena the affection is always general; but not the reverse, that, where the affection is general, there are always secondary phenomena. A similar, only opposite difference take place with reference to constitutional syphilis. Where the syphilis is constitutional, secondary phenomena will always be present; but the first manifestations of secondary phenomena is not necessarily always accompanied by a complete infection of the whole constitution with the syphilitic disease. Thus it is that secondary phenomena are not only distinguished from the simple consecutive phenomena of the second stage of the primary period, but likewise, to a certain extent, from those which constitute the general and constitutional syphilis; hence again, we class among secondary phenomena those that NEVER OCCUR as primary PROTOPATHIC symptoms after an infectious connection, and, for this reason, do not communicate the disease, but always manifest themselves as remote consequences of previously-existing primary syphilitic products.

George Heinrich Gottlieb Jahr
Dr. George Heinrich Gottlieb Jahr 1800-1875. Protégé of Hahnemann. His chief work, " The Symptomen Codex" and its abridgments, has been translated into every European language. He also published several smaller works for daily use, ''Clinical Advice" "Clinical Guide," and "Pharmacopoeia", as well as his "Forty Years' Practice”. Also "Manual of the Chief Indications for the Use of all known Homoeopathic Remedies in their General and Special Effect, according to Clinical Experience, with a systematic and Alphabetic Repertory."