SYPHILIS, is according to Dr. Farr's system of nosologica] classification, to be regarded as belonging to the enthetic order of zymotic diseases (see NOSOLOGY and ZYMOTIC DISEASES). belonging diseases have the common property of being developed in the system after the introduction by inoculation or implantation of specific poisons. The poisons which produce diseases of this order may be introduced through any abraded cutaneous surface, or through mucous membranes, especially if any solution of continuity occurs. A morbid poison thus introduced into the system produces a specific effect both on the tissue at the place of insertion and on the blood, as soon as the poison begins to be become absorbed; or, in other words, it produces both a constitutional and a local change. The absorbed virus seems to undergo the following changes in the liv ing and infected body—viz. (1) Increase, (2) Transformation, and (3) Separation or excretion. Taking our illustrations from the disease to which this article is specially devoted, the increase is shown by the fact, that the pus from a single syphilitic sore may by inoculation be made to spread the disease a thousand-fold. The transformation is indicated by the successive phenomena which supervene during the course of the disease. For example, syphilis is followed, as we shall presently show, by a series of secondary and tertiary phenomena, which follow a tolerably uniform course in different patients. The separation or excretion of the poison may be accomplished in several ways. While in some of the more intense poisons—such as those of certain serpents—the whole mass of the blood seems rapidly affected, in others, as syphilis, " a double process of the zymotic-like action seems to take place before the full effects which the poison is cap able of producing are completed. The multiplication of the venereal poison, and its effects upon the system, seem to become developed during the existence of the harden ing process which surrounds the infecting venereal sore. This is the first zymotic-like process, and is attended with a local papule, and perhaps an ulcer. From this local sore the system becomes contaminated, and in the blood a second process (of zymosis?) appears to be completed, by which the original poison becomes intensified, its pernicious influence more complete, and its specific, secondary, and tertiary effects are more fully developed."—Aitken's Science and Practice of Medicine, 3d ed., vol. i. p. 666.
From this brief sketch of the nature of enthetic diseases, we turn to the considera tion of the special disorder known as word whose origin is unknown. The terrible ravages of this disease among our soldiers and sailors, to say nothing of the fearful misery which it occasions in private life, afford more than sufficient apology for our introducing into these pages some of the most important details regarding this repulsive form of disease.* It is almost unnecessary to observe that syphilis is a con tagious disease usually propagated by impure sexual intercourse. The following is a brief history of the course of the disease, if its progress is not checked by proper remedial agents. At an uncertain period, varying from three to ten days, after expo sure to the infection, one or more venereal ulcers (commonly known as chancres) appear upon the generative organs. These ulcers present many varieties, which have been variously classified. The following arrangement, by Mr. Henry Lee, surgeon to the Lock hospital, is an eminently practical one—viz. (1) The Hunterian or indurated or infecting chancre; (2) The non-indurated or suppurative chancre; (3) The ulcerative chancre; and (4) The sloughing chancre. These local affections are so different in their characters, and in their action on the constitution, that each must have a brief separate notice. (1) The indurated, or, as it is frequently termed, the Hunterian chancre, from its having been first accurately described by John Hunter, is the only one of these local affections that can be associated with constitutional syphilis Its natural course is thus described by Mr. Lee. "At an uncertain period, but generally from three to four days
after exposure to infection, attention may be drawn to the part by a slight itching. On examination, a red spot, surrounded by a little induration, will perhaps present itself, or a vesicle about the size of a millet-seed will not unfrequently form upon the infected part. The cuticle covering this vesicle is so thin that it usually gives way at a very early period; and this commonly happens before the disease has been carefully exam ined. The base of the vesicle then becomes indurated, and the induration (whether preceded or accompanied by a pimple or a vesicle, or independent of either of these) assumes a circular form, extending equally in every direction, and terminating quite abruptly in apparently healthy parts. A sore generally follows; this is excavated, with out granulations, sometimes glazed, at other times having some adhesive matter on its surface. The color of the chancre will depend often upon the amount and character of the substance which adheres to it, and will frequently present a fawn hue, or different shades of brown and red. When this adventitious matter is removed, the sore will usually again assume its original smooth and red glazed appearance."—" Syphilis" in Holmes's System of Surgery, vol. i. p. 400. This variety of sore frequently gives rise to a chronic enlargement of one of the glands of the groin (forming what is termed a bubo), which does not involve the skin or the cellular membrane. It is followed by certain constitutional symptoms known as secondary symptoms, and requires, both in its primary and secondary forms, mercurial treatment. (2) The suppurating chancre usually begins as an abrasion, which when fully developed, often presents the same appearance as if a piece of skin had been removed by a circular punch. The sore is covered with ill formed granulations, and extending equally in all directions, maintains its circular form. After continuing three or four weeks, it generally heals, without leaving the hardness which is so characteristic of the Hunterian, infecting or indurated sore. An other important diagnostic difference is furnished by the mycroscopico-chemical exam ination of the fluid secreted by the sore. In this suppurating sore the secretion consists of pus, which, on the addition of acetic acid, exhibits the characteristic compound nuclei; while in the infecting sore the secretion resembles turbid serum, presenting none of the characters of the pus. It does not give rise to bubo, nor is it followed by second ary symptoms. (3) The ulcerative chancre is a ragged worm-eaten ulceration; secreting an ill-formed pus, and presenting an irritable surface. Soon after the appearance of this sore, one of the glands of the groin will become enlarged and painful. This may be preceded by a shivering fit, more or less marked. The enlarged gland or bubo becomes very tender to pressure, and as the swelling increases, the skin becomes red, especially-at the center, and the general symptoms of suppuration present themselves. Great relief is afforded by the discharge of the pus. It is never followed by secondary symptoms, and, like the preceding form, requires only local treatment. (4) The slough ing chancre is fortunately rare in this country, but in many foreign ports, in warm and hot countries, this form of syphilis commits great ravages among our sailors, who have given to it certain characteristic names, such as the black pox, the black lion, etc. It does not affect the inguinal glands, and is not followed by constitutional symptoms, and requires only local treatment.