ON LUES VENEREA, OR SECONDARY SYMPTOMS.
Secondarysymptoms are those changes which occur in consequence of the admission of the venereal poison into the system, or common circulation at large. The introduction to the disease of bubo explains the mode of inlet. Like gonorrhœa and primary syphilis, it is often a very complicated complaint. Secondary symptoms are admitted to occur without being preceded by any primary form, as, for instance, by immediate absorption unattended with the irritation which accompanies chancre, or attendant upon bubo; but where one secondary affection arises without the primary, at least many hundred arise subsequent to it; and unless, in the latter instance, treatment, and vigilant too, is adopted, not one in a hundred escapes them.
Lues venerea(a synonymous term with syphilis) is supposed to be imbibed from a very sensitive glans penis, a simple abrasion of the skin of that organ, an ordinary ulcer, or it may be transferred by inoculation. The late John Hunter is certainly the most eminent authority—thevade mecumof professional men. In these matters he was a man of indefatigable perseverance and untiring observation. Few new lights have been thrown on syphilis since his time, except on the treatment, which has become wonderfully simplified.
In thus again adverting to Mr. Hunter’s name, it ischiefly to observe, that the basis of my own thoughts and practice has been built upon his writings; and therefore, in being thus explicit in describing syphilis and its multitudinous varieties, the reader is assured that what is here written is, at all events, well founded, and not compounded of the many new adventurising propositions of the day. Mr. Hunter considered that contamination took place about the beginning of the local complaints; that no person was safe from lues while the original sore was present, and not under treatment; but that, if the seeds of lues were not already implanted in the constitution, the consequences might be averted by treatment. Children are born infected with lues, which they derive from their parents; for instance, a man laboring under secondary, or primary symptoms, cohabits with a healthy female, the femalemayescape both diseases, but the child may inherit them.
Instances have been known of children so infected, conveying the disease to the wet nurse, to whose care they may be removed; and, like other infectious disorders, the complaint may be diffusedad infinitum. There is an impression abroad, that, like consumption, healthy persons are obnoxious to the breath and perspiration of the afflicted; but, as in many other conjectures, corroboration is wanted to prove the fact.
Syphilis is divided into primary and secondary; but modern pathologists add a third stage, called tertiary symptoms. Hunter used to divide lues into two orders; the first was the most frequent form of the complaint, after chancre and bubo; the second, the remaining symptoms. The former consisted of the affections of the skin, throat, nose, mouth, and tongue; the latter, the bones and their coverings, called the periosteum and the fasciæ of muscles, as explained in the preliminary part of this publication. Lues does not always exhibit itself according to this arrangement; which circumstance explains that the occurrence is more owing to conditions of health, and peculiar tendencies of the structures involved to receive the contamination, than to any properties of the animal poison.
He considers, also, that the development of the disease depends much upon the state of weather, and the care the patient may bestow upon himself; cold being a formidable predisposer to the extension of secondary symptoms, andthat the parts least protected are generally the first to become diseased. Hence the throat usually exhibits a morbid action before the skin, furthermore, upon the cure of the more superficial parts of the body; and, therefore, suddenly suspending treatment, the symptoms manifest themselves in the deeper seated. The deduction from this statement is, a necessity for especial care in the clothing of the body, and the continuance of the treatment some little while after all external evidences of the complaint have disappeared.
Mr. Hunter considered that the disease may be engrafted in the constitution, and remain dormant for a considerable period, through the parts not being brought into action by any of the aforementioned causes. Ordinary illness, simple fever, excess, fatigue, and a host of other occasions, may excite a particular structure into a morbid condition, when the hitherto dormant disease will sprout out. His arguments are supported by numerous cases whereinseveral yearselapsed between the primary and secondary symptoms, although no new infection was contracted in the intermediate time.
Mercury was Mr. Hunter’s sheet-anchor; his faith in it was to the effect that it would cure every stage of the disease, but that one course of it, although it might cure chancre, would not prevent secondary symptoms. They might not occur, because the poison may not have been carried into the circulation; and in like manner the second stage of the disease need not be followed by a third. But he considered that, when the several forms of the disease betrayed themselves, their origin must be traced to a general contamination of the system at the same time.