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Syphilis

according to Dr. Farr, a disease belonging to the enthetic order of zymotic diseases. It may be defined as a specific disease produced by the contagion of the same disease in another person, (1) in its primary form by the appearance on the part inoculated of one of two different kinds of a sore or chancre, and (2) in its secondary or constitutional form by various eruptions on the skin, by sore throat, affections of the eye, the glands, the bones, and almost every other tissue of the body. The contagion may be conveyed by direct inoculation during sexual intercourse; accidentally, in other forms of personal contact, and purposely, by inoculation for medical or experimental purposes. There are two kinds of chancre, and in one the disease is merely local, never affecting the constitution; but in the other the constitution is affected, and the disease may break out after long intervals of health, and may be transmitted from one generation to another through the blood of the mother or the semen of the father.

The local form of syphilis appears in three principal varieties (1) The common soft chancre unaccompanied by bubo; or suppurative syphilitic inflammation. Three or four days after inoculation the sore appears and begins to suppurate at once. The sore has a punched-out appearance, its edges are slightly undermined, and its base is thickened by inflammation of the parts underneath it. The sore heals with no remaining induration in three or four weeks. (2) The sore with suppurating bubo; or ulcerative syphilitic inflammation. The sore is ragged and has worm-eaten appearance, a the glands and the absorbents are affected, and specific abscesses may form in the course of the latter, but no part of the body beyond the gland is affected.

In these two forms the treatments consist in keeping the part clean, applying a mercurial wash, poulticing the bubo and opening it as soon as it suppurates. (3) Sloughing and gangrenous sores. In this form the sore may slough and be- SYPHILIS come gangrenous as soon as it is formed, or a previously formed sore may take on a sloughing action. The absorbents are not affected, nor is it followed by secondary symptoms, but the sloughing may proceed with great rapidity, and may prove fatal from exhaustion hæmorrhage. or The constitutional form of syphilis is distinguished by the appearance on the part affected of a sore called the hard or Hunterian chancre, and by a chronic engorgement of the lymphatic glands forming a bunch of hard knobs under the skin. The sore may appear in from three to five days after exposure to contagion, and it may vary as the disease is derived from a primary or a secondary sore.

The general opinion of the medical profession is that the constitutional form of syphilis can be treated efficiently by mercury only, and that the treatment should commence as soon as the disease declares itself. Much has been written in praise of salvarsan "606," as a cure in the earlier stages, but it has been demonstrated that relapses were more frequent than when mercury was used. are The secondary symptoms of constitutional syphilis do not usually appear till after the primary sore has healed; but the period is quite uncertain, though, in the majority of cases, it is under half a year. The secondary symptoms sometimes ushered in by what is termed the syphilitic fever; but they are generally in the throat, the sore throat being due to an eruption on the mucous membrane of the mouth or fauces; or in the skin, being usually either roseola, lichen, acne, mucous tubercle, pityriasis, psoriasis or lepra. These eruptions are distinguished from other eruptions which are not specific, partly by their coppery color and by their circular or horseshoe form, and by their tendency to disappear at the center and spread from their edges. The eye and the larynx are affected in the latter secondary stage. Periostitis or nodes are also seen at this period.

Other secondary symptoms are the development of mucous tubercles-flat, raised, oval patches, generally situated at or near the junction of the skin and mucous membrane and yielding a contagious secretion, probably a fertile source of inoculation. The mucous tubercle generally disappears rapidly under the local application of calomel. Syphilitic vegetations and condylomata are also contagious. In the treatment of secondary syphilis it is now generally admitted that the administration of mercury is necessary for the complete eradication of the syphilitic diathesis. SYPHILIS The tertiary stage of syphilis is distinguished from the secondary by the occurrence of an interval of health of longer or shorter duration-days, months or even years and is characterized by a reproductive process. The affections of the skin are of the suppurative and ulcerative type, such as rupia and ecthyma. The tissues of the bones rapidly soften, and become carious or necrosed.

The glands are also deeply affected, even the great secreting and blood glands-the liver, spleen, thyroid, etc.

The nervous system is also affected by tertiary deposits in the nerve-structures or their membranes leading to irritation or paralysis. The treatment of the tertiary stage must be conducted on the same principles as that of the secondary stage.

Infantile or congenital syphilis is transmitted to the fœtus in utero, either through the blood of the mother or the semen of the father, or both, and is a form of secondary syphilis, differing from it only in that the primary sore has occurred on the body of the parent instead of the infant itself. The disease is characterized by a persistent coryza, a reddish or copper eruption-roseola or lichen-especially on the genitals and on the palms and soles. Crescentic patches of mucous tubercle are common on the interior of the mouth, the lips, and anus, and there is a peculiar yellowish complexion.