§ 2. Animal Virus.
a. 4ophs7is arid GonorrIrrea.—Both of these, as local disorders, are con sidered to belong wholly to the province of surgery, and therefore no attempt will be made to give any details on the 'subject, or even to indicate the prin ciples of their diagnosis. They can only be incidentally mentioned when their existence tends to obscure other phenomena, or their features present any similarity to disease of a wholly different origin.
They are separated from each other by a very broad line of demarcation, the one being merely a, local malady, while the other tends to become consti tutional; the one can, and the other cannot, infect the system at large. It is this power of the syphilitic poison to pass into the blood, and to manifest itself in various tissues and organs, which sometimes brings it within the cog nizance of the physician ; and it will be more convenient to consider any special characters which it presents, when treating of the various organs in which its ,symptoms usually show themselves, remembering only the unity which comprises all these separate manifestations, the syphilitic impregnation. It is often difficult, and yet not unimportant in practice, to be able to deter mine that, where primary syphilis has existed at some previous period, the system has not become impregnated ; and also, that this poisoning of the body has taken place where the existence of the primary malady is denied.
The decision rests chiefly upon the mutual dependence and connection of the whole group of the symptoms ; the peculiar ulcemtion of the fauces and perhaps the larynx ; the specific chamcters of the cutaneous eruptions ; the very frequent falling of the hair, and the presence of periosteal thicken ings; in severe cases, caries of the bones of the nose is also present. The more complete the picture is as a whole, the more confidence we feel in the dis" trnosis: the specific characters of each may, singly, deceive us. The patient's habits and mode of life are very likely to throw light on the ques tion, when a suspicion of syphilis is denied ; and we may form some estimate of the probability from the course of the primary sore, where its previous existence is admitted ; as a geneml rule, we are informed by writers on this subject, that a sloughing or phagedienic sore, or one followed by a suppurating babe, less likely to be followed by secondary symptoms than an indurated chancre,.
The only question we shall have to consider with reference to gonorrhau, is how we may discriminate it from leucorrhcea and vaginitis ; the discussion of which must be reserved to the chapter devoted to the diseases of the female organs of generation.
b. nature of this disease is so little known, and the opportunities which each observer has of studying it are so few, that its diag nosis is, in fact, nothing else than a knowledge of its whole history. We have
here no test to apply to the disordered functions, by 'which we can measure the information they convey, and there is no other condition which really simulates it, or ought to be mistaken for it. Cases are indeed recorded, in which persons entertaining a delusion that they had been bitten by's mad dog, have seemed to labor under a similar disease; if the symptoms were really analogous, it is impossible to say wherein this differed from hydropho bia, except that the bite of a rabid animal was wanting, and that the disease terminated in recovery when the delusion had been successfully removed. We know only the category of symptoms, and we know absolutely nothing more. • Sometimes the bite is difficult to cure, is inflamed and irritable; most com monly it seems to heal kindly, and only inflames at a later period ; bat it does not appear that either condition is necessary to the issue. Then, again, in ordinary cases, the dangerous symptoms appear about six weeks after the bite ; but the period that may elapse is, so far as we know, unlimited. When they have once begun, they go on most rapidly to a fatal termination. First, there is a general feeling of malaise, a convulsive constriction of the throat in attempting to swallow liquids, and slight acceleration of the pulse ; then comes an instinctive shudder at the sight or sound of any fluid, followed by a remarkable erethism of the nervous system, which produces spasmodic con tractions of the muscles, especially about the throat and larynx, and convul sive paroxysms at the least jarring noise or sudden movement. In this con dition the patient is especially excited by currents of air on any part of the body ; and the spasms may be thus renewed even after death. At last, the unhappy victim of this frightful malady becomes violently delirious, and rapidly exhausted ; and he either expires in the recurrence of convulsions, or more frequently becomes tranquil before death, and sinks pubieless and haunted. A peculiarity which attends most cases of hydrophobia, the con stant hawking and spitting up of adhesive mucus and saliva, was, at one time, fancifully interpreted into an imitation of the bark of a dog ; it simply depends upon the inability to swallow and the irritation in the throat, the act being performed in a peculiar manner in consequence of delirium: as in insanity, the patient bespatters indifferently the bedclothes and the floor, or even the attendants, with his expectoration. The inclination to bite seems purely mythical.