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CHRONIC INFECTIOUS DISEASES 



sondylomata, exanthemata, or other consequences of the infection, ap 

 pear ; and, after the latter have subsided, another interval of exemption 

 usually ensues, ere a second series of disorders disturbs the apparent 

 good health of the patient. For these alternations, which usually re- 

 cur again and again during the course of the disease, no satisfactory 

 explanation has as yet been furnished. The time which intervenes 

 between the healing of the primary ulcer and the appearance of the 

 secondary symptoms, as well as that between the various outbreaks 

 of the secondary manifestations themselves, varies greatly in different 

 cases. The causes of this difference, and the influences which shorten 

 or prolong the period of latency, are likewise in a great measure un- 

 known. It seems, however, that in vigorous constitutions, and in per- 

 sons who live luxuriously, the secondary symptoms set in sooner, and 

 recur at shorter intervals, and that the length of the period of latency 

 is somewhat dependent upon the treatment adopted. 



Barensprung^ relying upon a large experience, affirms that, when 

 mercury is not employed, a period of latency of several months, or even 

 years, never occurs, and that the secondary symptoms and their re- 

 lapses appear within six weeks at latest, after the healing of the in- 

 durated ulcer, or after the subsiding of the outbreak last treated. 

 He does not hesitate to declare a patient treated without mercury to 

 be safe and permanently cured, who continues free from constitutional 

 symptoms three months after treatment has been discontinued. If 

 this assertion could be substantiated, the well-authenticated cases of 

 latency of syphilis, during a period of ten or twenty years, would be 

 attributable entirely to mercurial treatment. Such protracted periods 

 of latency, however, if they really do occur, are at all events extremely 

 rare, be the treatment non-mercurial or mercurial. It is equally rare, 

 also, for secondary symptoms to arise prior to the healing of a recent 

 primary sore. As a rule, they do not make their appearance until 

 from eight weeks to three months after infection, and the relapses 

 usually follow one another at similar intervals. 



A certain degree of regularity can be recognized in the manner in 

 which the various manifestations of the disease succeed one another 

 After the healing of an indurated ulcer, there is a great probability 

 that in a few weeks or months it will be followed by condylomata, a 

 maculous exanthema, or by a syphilitic angina ; but, at this stage, the 

 patient is quite secure against rupia, syphilitic lupus, or disease of the 

 bones. Conversely, an individual, who for years has suffered repeated 

 relapses of syphilis, is in danger of destructive disease of the skin and 

 subcutaneous areolar tissue, of caries and necrosis of the bones, but not 

 of broad condylomata, or of sypmlitic roseola. The disorders and 

 complications of disorders which stand first in order in the series of 





