Quotation from: Manual of Surgery

Written by: Alexander Miles and Alexis Thomson


Lastly, attention must be directed to the remarkable variations observed
in different patients. Sometimes the virulent character of the disease
can only be accounted for by an idiosyncrasy of the patient.
Constitutional symptoms, particularly pyrexia and anaemia, are most often
met with in young women. Patients over forty years of age have greater
difficulty in overcoming the infection than younger adults. Malarial and
other infections, and the conditions attending life in tropical
countries, from the debility which they cause, tend to aggravate and
prolong the disease, which then assumes the characters of what has been
called _malignant syphilis_. All chronic ailments have a similar
influence, and alcoholic intemperance is universally regarded as a
serious aggravating factor.

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