CHRONIC INFECTIOUS DISEASES. 



appearance of the other symptoms of constitutional syphilis. There 

 is considerable regularity in the succession of these symptoms, re- 

 minding us of the course of the acute exanthemata. There may 

 even be premonitory fever and enlargement of the spleen. The 

 so-called " secondary " symptoms affect the skin and mucous mem- 

 branes ; in the " tertiary " stage there are changes in the subcu- 

 taneous and submucous connective tissue, the bones, fibrous and 

 serous membranes, and internal organs. This division into stages is 

 not always accurate, as they may extend into each other ; but usu- 

 ally they are separated by an interval of latency more or less long. 



Chancroid sometimes occurs in the anus and rectum from un- 

 natural coitus, or from the pus of a neighboring chancre. A care- 

 less physician may mistake syphilitic ulcerations of the anus for 

 haemorrhoids ; they may cause stricture of the rectum. If syphilitic 

 iritis be accompanied by much dimness of vision, this may be due 

 to cloudiness of the vitreous or to retinitis. 



When the periosteum and bones are diseased, the joints may 

 become affected from the same cause ; but other joint-affections 

 may occur incidentally, and be called syphilitic rheumatism. Even 

 in these cases, iodide of potassium is very useful. 



All authors do not agree that treatment of the primary sore is 

 useless ; but some claim that where it is recent and favorably situ- 

 ated (on the prepuce, etc.), it may be excised and sequelae be thus 

 prevented. Fournier says, in treating syphilis, he gives one or two 

 grains of iodide of mercury daily for two months, then discontinues 

 for one month ; a second treatment for two months is followed by 

 an interval of three months, and a third treatment for one or two 

 months. This treatment with increasing intervals is continued for 

 two years. The second year iodide of potash is combined with the 

 mercurial.] 



After inoculation of a suitable subject with syphilitic virus, whether 

 accidental or intentional, that is to say, of a subject who is not syphi- 

 litic, and who has never been so, and after expiration of the term of in- 

 cubation, there arises, not a vesicle nor pustule which breaks, leaving 

 a sore as occurs after infection from the chancre but a hard papule, 

 or nodule of variable size and thickness. The smaller syphilitic indu- 

 rations are of the size of a lentil or pea, the larger attain the size of a 

 bean, or of a small hazel-nut. Microscopic research shows the indura- 

 tion to be the product of profuse proliferation of cells and nuclei, which 

 have no characteristic peculiarities, and which lie embedded between 

 the normal elements of the parts, in the scanty connective tissue. The 

 epidermis, or epithelium, over this hard infiltration, at first does not ex- 

 hibit any lesion ; but soon the epithelial covering begins to exfoliate, 



