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 diffused ad 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, and that 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 wherein several years elapsed 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.
OF THE SYMPTOMS OF THE FIRST STAGE OF LUES.
Six weeks is the time usually allowed to elapse between primary and secondary symptoms; but it is not invariably the case, instances having occurred where the disease has embraced, and most severely, both stages in a fortnight, and others between which a much longer time has existed. The first symptoms of lues consist either of a sore throat or a spotted skin. When the skin is the seat, a red spot, not unlike a flea-bite, is perceived; the color soon dies into a brownish or copper-colored hue. Occasionally, at the outset, a small pimple is observed, which breaks and scurfs; the coppery-colored spot next feels rough, and a kind of scurf will exude that after a few days falls off to make way for more. The disease being more usually slow than rapid in its progress, weeks may be consumed before ulceration occurs, and merely a discoloration of the skin is seen in spots seldom exceeding the size of a sixpenny or fourpenny piece. Some of these spots will nearly disappear, leaving a faint scar, and new ones will spring up. The entire body may be covered with them, but usually those parts nearer the centre of circulation generally possess the most—such as the chest, neck, shoulders, arms, wrists, hands, and head. As the disease progresses, the scurf on the spots accumulates, falls off, re-forms, getting thicker each time, when upon being detached, for they cling now more closely, a sore and moist state of the skin is observable. This may be covered with a new crust, or may at once proceed to suppuration.
When an ulcer is formed, it will sometimes spread rapidly, and embrace a patch the size of a crown-piece, when the process of ulceration will assume the vigor of disease.
