Glands become inflamed from other causes than syphilis; a scratch, a bruise, or any local irritation, will occasion an enlargement of the nearest set of glands, or at least one of them. Scrofula is a specific cause. As the venereal poison carries with it its morbid nature wherever it happens to be conveyed, the glands become infected with it; and hence it is the more readily transferred to the system at large. Very frequently and fortunately the disease terminates in the glands; that is to say, does not extend to the circulation at large. The time that intervenes after absorption has taken place, before bubo manifests itself, is as uncertain as that of chancre appearing after connexion; but generally the party is safe a fortnight after the entire disappearance of the chancre. Where it is otherwise, some trace of irritation on the glans or prepuce is discoverable upon close investigation, or it will follow great fatigue, venereal excesses, &c. If the disease extend to the constitution, it rarely affects other glands than those primarily attacked; and hence it is rare that more than one gland becomes inflamed. Having given the received notions of the cause, the symptoms should next be described.
No person can be unaware of the approach of a bubo. There is seldom much advance of a swelling without pain, which latter may be said to attract the patient’s attention to the part, when a tumor, possibly the size only of a horse-bean, is discovered. If the swelling be venereal, it rapidly increases in size. It is at first moveable, but soon feels as though firmly fixed. There is next experienced inconvenience in walking. If the disease proceed to suppuration, a continued throbbing is felt in the part, which also swells, assumes a diffused redness, and at last an evident sense of fluctuation is perceived. It may be ushered in with a shivering fit. The skin becomes thin and tender, and a conical point protrudes, which, unless punctured, bursts and emits its contents. It is astonishing what immense destruction of parts takes place in large buboes. The theory how solids become converted into fluids—how muscle, fat, and cellular membrane, become absorbed, and a thick purulent secretion deposited, is fitter for a work addressed exclusively to medical men than to the public; and it therefore must suffice that such happen, and few persons are ignorant of the fact; but the modus operandi may at best be but the subject of conjecture.
The artist’s graver has pencilled a faithful picture (see next page) of the appearance of the disease in question. On the right side is represented a bubo that has broken, or discharged its contents, and which is in a state of healing; on the left side a bubo ready to burst; and, by way of economising space, the left testicle is exhibited in a state of varicocele, by no means an unfrequent accompaniment to the previously narrated condition, but at the same time by no means a necessary attendant, it being a totally distinct affection. Buboes present more varieties in their size, and duration, and consequences, than they do on their initiation. Cases in corroboration will be found in their proper place.
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ON LUES VENEREA, OR SECONDARY SYMPTOMS.
Secondary symptoms 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—the vade mecum of 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 is chiefly 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 female may escape both diseases, but the child may inherit them.