CONSTITUTIONAL SYPHILIS. 773 



syphilitic affections are called secondary affections ; others, which are 

 akewise frequently combined one with another, but which appear later, 

 are called tertiary affections. The former are usually considered to 

 include indolent buboes, the condylomata, the exanthemata with the 

 exception of rupia and lupus, the superficial ulcers of the mucous mem- 

 brane, and iritis ; while lupus, rupia, disease of the bones, and the 

 gummy tumors of the submucous and subcutaneous areolar tissue, and 

 the disorders of the muscles and viscera, belong to the tertiary class. 

 Upon comparing the two classes, it will be found that the secondary 

 diseases are less malignant, that is, are less destructive than the ter- 

 tiary; and that they usually are limited to the superficial tissues, to 

 the skin and mucous membrane ; while the tertiary affections attack 

 the deeper-seated, " more noble " organs. This mode of classification, 

 however, makes it impossible to draw a sharp boundary between the 

 two forms, and it is idle and unprofitable to dispute as to whether the 

 intermediate varieties rank as secondary or tertiary, such as sarcocele, 

 which, though not one of the earlier consequences of infection, still 

 usually precedes lupus and disease of the bone, and which, in respect 

 to its malignity and to its locality, occupies an intermediate position. 

 In rare and exceptional instances, disease of the bones forms one of the 

 early symptoms of general syphilis. The opponents of the treatment 

 by mercury attribute this early appearance of the so-called tertiary 

 accidents to the mercury, and even go so far as to assert that the em- 

 ployment of mercurials, by aggravating the pernicious influence of 

 syphilis upon the organism, actually is the cause of the tertiary mani- 

 festations ; and that, under non-mercurial treatment, syphilis does not 

 affect the bones. Although both statements, in their fullest accepta- 

 tion, are decidedly untrue, yet neither of them is quite without foun- 

 dation ; for, if the disease be not subdued, while the constitution has 

 been ruined by immoderate and reckless dosing with mercury, perni- 

 cious forms of syphilis, such as lupus and disease of the bones, are more 

 liable to arise than when it still lurks in the system of a robust indi- 

 vidual. It would almost seem, indeed, that the constant increase in 

 malignancy which shows itself in each succeeding attack, in cases of 

 syphilis where mercury has not been employed, is the result of deterio- 

 ration of the constitution induced by the previous attacks. At all 

 events, the contrary effect is seen in robust constitutions, in whom, 

 when the disease is not completely extinguished at first, each relapse 

 is less severe than the preceding one. 



While, with the exception of a slight fever, which usually precedes 

 and accompanies the secondary symptoms, the disease is borne for a con- 

 siderable length of time without constitutional disturbance, yet, when 

 the attacks recur constantly, when the patient's rest is continually dis- 



