774 CHRONIC INFECTIOUS DISEASES. 



turbed by nocturnal pain, when protracted suppuration consumes his 

 strength, and, above all, if an active mercurial treatment be superadded, 

 a general marasmus, the so-called syphilitic cachexia, sets in. This term 

 is not exactly appropriate, since it does not proceed directly from syphi- 

 litic infection, but indirectly from the nutritive disturbance to which it 

 leads, or from the method of treatment adopted. Accordingly, the 

 syphilitic cachexia has no peculiar features by which it may be distin- 

 guished from other non-specific forms of cachexia. Even amyloid de- 

 generation of the liver, spleen, kidneys, and other organs, which often 

 accompanies the syphilitic cachexia, is not peculiar to this disease, but 

 also develops in the course of other non-syphilitic diseases of bone as 

 well as in malarious affections, scrofula, and rickets. 



TREATMENT. The treatment of the primary syphilitic induration 

 and primary syphilitic ulcer must be directed mainly against the con- 

 stitutional disease, the first manifestation of which we have found it to 

 be. Abortive treatment is out of the question, save when we have to 

 treat an excoriation produced during a suspicious coitus ; but in such a 

 case, after destroying the affected part, we cannot tell whether the 

 absence of induration and of subsequent symptoms is the result of 

 the treatment or not, as we have no criterion for distinguishing an in- 

 fected excoriation from a non-infected one. The extirpation of an in- 

 duration, or its destruction by means of caustics, is altogether useless. 

 As a general rule, a new induration forms upon the edges of the wound 

 thus produced. Besides the use of constitutional remedies, the primary 

 syphilitic sore should be treated according to the principles already 

 laid down for treatment of the chancre. First of all, the utmost clean- 

 liness must be maintained. Washes, mild or strong, according to cir- 

 cumstances, should be used, together with gentle applications of lunar 

 caustic, or sprinklings with red precipitate, and the like. Internally, 

 unless contraindicated by special circumstances, I treat the primary 

 ulcer and primary sore with mercurials. I am well aware that the in- 

 duration is capable of disappearing without their use, and that this 

 treatment affords no guaranty against the appearance of consecutive 

 symptoms ; but the indisputable fact, that the secondary symptoms are 

 fewer and later in appearing when treated by mercury than when 

 treated without it, induces me to prefer the former treatment to the 

 latter. Besides, a cautious employment of this drug is far less liable 

 to be followed by mischievous results than is asserted by its opponents. 

 In the first year of my practice I did not employ mercury in syphilis, 

 but in my second I commenced to use it upon almost every indurated 

 sore, and hi all cases of secondary disease. The number of patients 

 which I have treated in this manner cannot of course be compared with 

 that treated in the course of a year or two in the syphilitic ward of one 



