this morbid lesion on other parts of the body; in females, it occurs in exceptional instances only.

The Syphilitic Diathesis.

Although one is justified in assuming that after the Hunterian induration has taken place, and the indolent buboes have appeared, the general toxæmia is established, since no induration can be produced anew on the persons afflicted with the local lesions mentioned by inoculating them with syphilitic virus; nevertheless, patients suffering from the early phenomena of syphilis are apparently in good health for a time, and we are totally unable to discover the least sign of the consecutive phenomena of the disease that are destined to develop in the various tissues of the body. This period of quiescence in the development of the constitutional phenomena is described as the second period of incubation. In order to explain this interval that takes place between the occurrence of the induration and of the indolent swelling of the glands, on the one hand, and the outbreak of the remainder of the constitutional phenomena, on the other hand, it is assumed that the syphilitic virus is dormant for a while in the system, and then becomes active again. This hypothesis is supported in a measure by the fact that frequently, even in the latter periods of constitutional syphilis, a temporary period of apparent extinction of the disease occurs (latency of syphilis).

It is our opinion that in syphilis the disease of the lymphatic system, at any rate, is of prime importance, and that the syphilitic virus is conveyed to the blood by the lymphatic vessels; and that by the constant mutual interchange that takes place between the blood and the lymph the syphilitic virus permanently changes specifically the entire quantity of the blood. Our senses, however, are not capable of perceiving the morbid alteration of the blood produced by the syphilitic virus. With the same degree of justice that we assume the diseased condition of the lymph from the morbid alterations of the lymphatic vessels and glands without being able to prove the morbid alterations of the lymph, so do we feel justified in assuming the diseased condition of the blood from the morbid state of the rest of the tissues of the body. And just as the

lymph must be diseased before the affection of the lymphatic vessels and glands appears, so must the blood be morbidly changed before any sign perceptible to our senses will indicate its diseased condition in the various tissues of the body.

These pathological disturbances of the composition of the blood that are undemonstrable, being only inferable from the results, have been designated by the name of syphilitic diathesis-a condition that is intended to fill up the gap between the infection that had taken place and the pronounced syphilitic dyscrasia.

Pathological Alterations of the Blood of Syphilitic Persons.

After the Hunterian indurated lesion has lasted for eight or ten weeks, those phenomena gradually appear which incontestably prove that certain morbid alterations of the blood have taken place. The skin of the patient loses its fresh, healthy, rosy color, and gradually acquires a waxy, sallow, chlorotic hue. At the same time a general emaciation ensues in many cases. So far, neither chemistry nor the microscope has succeeded in finding any pathognomonic products in the blood of syphilitic patients.

We believe that although the syphilitic blood-disease begins with the absorption of the syphilitic virus, still it is just as little possible in the early days of the disease to prove the alteration of the blood as in most other infectious diseases. The macroscopical alterations on the syphilitic patient compel us to assume that the nutritive element, at least the albumen of the blood, has suffered some kind of change. The altered blood, on the one hand, then exercises an extraordinary amount of irritation upon the lymphatic glands, whereby they become hypertrophied; on the other hand, by the disease of the lymphatic glands, a retroactive effect upon the blood must also take place, either because the abnormal increase of cell-life of the glands causes larger numbers of white blood-corpuscles to enter the blood, or because after ischemia of the lymphatic glands has ensued, the formation of blood-corpuscles is entirely arrested. But neither leucemia nor oligamia and chloræmia are the causes of the original blood-disease-they are simply its effects.

[Quite recently Lustgarten and Doutrelepont have found, in the morbid product of the syphilitic diseases and in the discharges, bacilli which in form resemble tubercle bacilli, but are distinguished from them by the staining. The bacilli are mostly inclosed in cells, from two to eight in one cell; very few of the latter are found in the center of a syphilitic exudation, but in larger numbers at its borders, and in the adjacent apparently still normal tissues.

The bacilli are always found in the initial syphilitic lesion, in the papules, in the gumma nodes, and in the discharge from a syphilitic chancre and from the papules. This fact, taken in connection with the negative results obtained by similar researches, made into the most varying morbid products, renders it highly probable that these bacilli actually constitute the syphilitic poison. This probability becomes still greater since we have learned that bacilli are likewise the contagium of infectious diseases that are analogous to syphilis-lepra, tuberculosis, etc.—though this will not be irrefutably established till we are able to generate the bacilli outside of the human body, and to produce syphilis by inoculations with a bacilli product obtained by cultivation.]

Eruptive Fever of Syphilis.

The first eruption of general syphilis is usually preceded by febrile movement, which is not unlike that occurring in catarrhal or rheumatic affections. The patients are hot, restless, and sleepless, and feel uncomfortable, tired, and suffer from loss of appetite. In some cases, a ravenous appetite comes on. The expression of the face becomes dull, the skin pale, the eyes sunken and tired. At the same time the individuals. are tortured by vague rheumatic, intermitting pains, which now afflict the head, next the shoulders, and then again some of the joints and limbs of the body, or localized neuralgias, for instance, of the infra-orbital nerve, are present. In many patients a blowing heart-murmur is audible. The pulse often reaches one hundred and ten per minute, and some increase of temperature is also noticeable. The patients suffer from nightsweats, and their urine deposits a heavy sediment of uric-acid salts and urerythrin.

The eruptive fever subsides on the outbreak of the morbid phenomena in the various organs and on different parts of the body, but sometimes it returns again in the course of the affection, when sequelae or relapses ensue. The eruptive fever usually attains its acme in twenty-four or forty-eight hours; then it generally remits, as in acute exanthemata. In regard to the influence of the remedies that have been resorted to in a given case, upon the increase of the temperature, it may be said the inunction of blue ointment usually causes a slight increase of the temperature, but later on in the disease it is often followed by abnormal diminution of the temperature. The treatment with the preparations of iodine at first does not seem to have any marked effect upon the temperature; later on, it causes an increase, but soon after using them the temperature returns to the normal.

Time of Eruption of General Syphilis.

According to our experience, the eruption of secondary phenomena never takes place before the eighth week after infection. Remedial measures may postpone the outbreak of syphilis, but they can not prevent it; we possess no remedy with which we can eradicate the disease, and, still less, annihilate it, in the first few weeks of its existence. On the other hand, injurious influences, such as violent mental excitement, excesses in Baccho et Venere, forced marches, traveling at night, etc., may hasten the outbreak of the secondary phe

nomena.

Localization of the Syphilitic Foci.

All the tissues of the human body may become diseased by syphilis; still, the morbid process seems to have a preference to become localized upon the common integument. Next in frequency, certain parts of the mucous membrane-for instance, the nares, fauces, mouth, larynx, oesophagus, rectum, vagina, uterus, urethra, etc.; next the periosteum, the endosteum, and the bones themselves (especially some flat and a few long tubular bones), the perichondrium, and the cartilage of certain organs, the septum nares, and larynx, for instance, and certain serous membranes, the perimysium and the iris-are attacked.

Of the fibrous membranes, the albuginea testis and the sclerotic coat of the eye are the only ones that are affected. The submucous and subcutaneous tissues are often attacked; the liver, spleen, heart, kidneys, lungs, brains, and certain nerves, the blood-vessels and bowels, are less frequently diseased.

The Cachexia produced by Syphilis.

If syphilis has once engendered certain morbid alterations in some of the organs that play an important part in the economy, the constitution of the patient is sure to suffer from a cachexia that will completely exhaust him, and the disease will terminate in death. This is especially the case when, in consequence of amyloid degeneration of the kidneys, albuminuria or hæmaturia is produced. Certain conditions of the individual-bad living, complications with other diseases, such as tuberculosis, gout, scurvy, improper treatment, etc.—are likely to hasten such an unfortunate termination.

Combinations of Syphilis.

Acute diseases exercise a remarkable degree of influence over syphilis, especially over the early phases of the disease. The muco-papular syphilide of the skin, and of the mucous membrane, quickly disappears on the occurrence of an acute affection, but returns as soon as the latter subsides. On the other hand, the dry and ulcerative forms of skin lesions, mucous patches, plaques muqueuses, syphilitic diseases of the bones, are but little affected by acute maladies.

Chronic diseases may not only coexist with syphilis, but will accelerate its course. This is especially the case with the consumptive affections, such as tuberculosis, scurvy, etc. A combination of gout and syphilis renders both morbid processes obstinate to treatment. Syphilis exercises a most injurious effect over pregnancy, frequently resulting in abortions and miscarriages. On the other hand, pregnancy retards the retrograde development of syphilis, the anti-syphilitic remedies being hindered in their action by the process of gestation.

In regard to the influence of syphilis upon the course of a wound, clean cuts heal in syphilitic persons as rapidly as