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VENEREAL DISEASES (from " venery," i....
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VENEREAL DISEASES (from " venery," i.e. the pursuit of See also:Venus, the goddess of love) , a See also:general See also:term for the diseases resulting from impure sexual intercourse. Three distinct affections are included under this term—gonorrhoea, See also:local contagious ulcers, known as chancres, and syphilis. At one See also:time these were regarded as different forms of the same disease. They are, however, three distinct diseases, due- to See also:separate causes, and have nothing in See also:common except their See also:habitat. The cause in each See also:case is a definite specific See also:virus, a micro-organism. In the case of gonorrhoea the virus attacks the mucous membranes, especially that of the urethra, the vagina and the uterus. Chancres attack the mucous membranes and the skin. In syphilis the whole See also:system comes under the See also:influence of the See also:poison. Though these three affections are generally acquired as the result of impure sexual intercourse, there are other methods of contagion, as, for example, when the accoucheur is poisoned whilst delivering a syphilitic woman, the surgeon when operating on a syphilitic patient, the wet-See also:nurse who is suckling a syphilitic See also:infant, and so on. An individual may be attacked by any one or any two of the three, or by all at the same time, as the result of one and the same connexion. But they do not show themselves at the same time. In other words, they have different stages of See also:incubation. In gonorrhoea the disease appears very rapidly. So also in the case of the soft chancres, the first symptoms commencing as a See also:rule three or four days after inoculation. It is different, however, with syphilis, the See also:period of incubation being twenty-eight days, though it may be much longer. The length of the period of incubation, there-fore, is of See also:great diagnostic help in the case of syphilis.
For many years the term " venereal disease " was used 'very loosely, though the writers before the See also:year 1786 had a tolerably clear See also:idea that three distinct diseases were included under the term: the lues venerea, now called syphilis, gonorrhoea, and a See also:condition leading to bubo and associated with a multiple chancre which is known at the See also:present See also:day as " soft sores." See also: The germs find entrance during coitus and multiply at enormous See also:rate, spreading to all the glands and crevices of the membrane, and setting See also:free in their development a toxin which causes great irritation of the passage with inflammation and swelling. They remain quietly incubating for three or four days, or even longer; then acute inflammation comes on, with profuse See also:discharge of thick yellow See also:matter, with much scalding during micturition, and there may be so much local See also:pain that it is difficult for the See also:person to move about. Microscopic examination of the discharge shows abundant pus corpuscles and See also:epithelial cells from the membrane, together with swarms of diplococci (gonococci). The inflammatory See also:process may extend backwards and give rise to acute prostatitis (see PROSTATE GLAND), with retention of urine; to the duct of the testes and give rise to acute epididymitis (swollen testicle) ; and to the See also:bladder, causing acute cystitis. It may also cause local abscesses, or, by irritation, set up crops of warts. The treatment of acute gonorrhoea is best carried out if the patient can See also:lie up for a while. He must avoid all fermented drinks and See also:rich foods, and sexual and other excitement, and he should drink freely of such things as See also:barley-See also:water, in See also:order to dilute, and lessen the irritation. of, the urine. Hot See also:baths are comforting. Laxatives should be freely given. The urethra should be frequently washed out with a warm See also:solution of permanganate of potash, a See also:grain to the See also:pint, and, later, a weak solution of one of the See also:zinc or See also:silver salts may be used as an injection. Capsules of See also:copaiba or oil of See also:sandalwood, and a See also:paste of See also:cubebs See also:pepper, have a beneficial influence, and, later, if the See also:man is de-pressed, See also:quinine and See also:iron will be found useful. In ten days or a fortnight the inflammation gradually subsides, a thin watery discharge remaining which is known as gleet. But inasmuch as this discharge contains gonococci it may, though scarce noticeable, set up acute specific inflammation in the opposite See also:sex. In the case of the See also:female the inflammation is apt to extend to the uterus and along the Fallopian tubes, perhaps to give rise to an See also:abscess in the See also:tube (salpingitis) which, bursting, may cause fatal See also:peritonitis. A lingering gleet may be due to the presence of a definite ulceration in the urethra, as shown by examination with a slender tube illuminated by See also:electricity—the endoscope. The See also:ulcer having been induced to heal by the application of a nitrate of silver lotion, all discharges cease. Chronic inflammation is necessarily associated with the formation of interstitial fibrous See also:tissue, and the contraction of this new formation causes narrowing of the urethra, or stricture. Thus gleet and stricture' are often associated, and the occasional passage of a large See also:bougie may suffice to cure both. Often, however, a stricture of the urethra proves rebellious in the extreme, and leads to diseases of the bladder and kidneys which may prove fatal. One of the most important points in the management of a case of gonorrhoea is to prevent all See also:risk of the septic discharge coming into contact with the See also:eye. It sometimes happens that the patient inadvertently introduces the germs into his own eye by his See also:finger; or that his eye, or the eye of some member of the See also:household, becomes inoculated by the use of an infected See also:towel. If this happen, prompt and energetic See also:measures must be taken to See also:save the eye. If so be that at the time of delivery a woman be the subject.of gonorrhoea, there is great See also:probability of the eyes of the infant being affected. The symptoms appear on the third day after See also:birth, and the disease may end in See also:complete See also:blindness. The name of the disease is ophthalmia neonatorum (see BLINDNESS). By the term gonorrhoeal See also:rheumatism it is implied that the gonococci have been carried by the See also:blood stream to one or more See also:joints in which an acute inflammation has been set up. It is apt to occur in the third See also:week of the disease, and it may end in permanent stiffness of the joints or in abscess. - In rare cases the germs find their way to the pleura or pericardium, setting up an inflammation which may even end fatally. For a man to marry' whilst there is the slightest risk of his still being the subject of gonorrhoea would tie to subject his wife to the probability of infection, ending with chronic inflammation of the womb or of septic peritonitis. ~Yet it is often extremely difficult to say when a man is cured. That there is no longer any discharge does not suffice to show that he has ceased to be infective. Nothing less than repeated See also:examinations of the urethral mucus by the See also:microscope, ending in a negative result, should be accepted as evidence of the cure being complete. And these examinations should be made after he has returned to his former ways of eating, drinking and working. B. Local Contagious Ulcers. Chancroid, soft chancre or soft sore is so named in contradistinction to the Hunterian sore of syphilitic infection, the one characteristic of which is its hardness. The soft chancre is a contagious ulcer of the genitals, due to the inoculation of a distinct See also:form of micro-organism, the bacillus of Ducrey; and, provided that the specific germ of syphilis is not inoculated at the same time, the chancre is not followed by constitutional See also:affection. In other words, the disease is purely local, and if some of the discharge of one of these ulcers is inoculated on another See also:part of the See also:body of the individual-a sore of an exactly similar nature appears. This See also:reproduction of the sore can be done over and over again on the same individual. always with the same result. But in the case of the Hunterian sore, inoculation of the individual from the See also:primary sore gives no result, because, as explained below, the constitutional disease has rendered the individual See also:proof against further infection. The soft sore is often multiple. It makes its See also:appearance about three days after the exposure, and as it increases in See also:size free suppuration takes See also:place. It is often of about the size of a silver threepence. Its See also:base remains soft. In individuals broken down in See also:health, the ulceration is apt to extend with great rapidity, and is then spoken of as phagedaenic. Just as an individual may See also:contract syphilis and gonorrhoea at the same connexion, so also he may be inoculated simultaneously with the bacilli of the soft chancre and the spirochaete of syphilis. In this case the soft chancres may make their appearance, as usual, within the first three or four days, but though passing through the customary stages they may refuse quite to heal, or, having healed, they may become indurated in the second See also:month, constitutional symptoms following in due course. The virulence of soft sores being due to the presence of harmful germs, the See also:surface of the sores should be touched with pure carbolic See also:acid, which has the effect of destroying the germs and converting the sores into healthy ulcers. Or the chancres may be treated by the application of See also:lint soaked in weak carbolic lotion. If the sore happens to be under a tight prepuce, and the germs are of great activity—as is apt to happen in such a case—ulceration may extend with extreme rapidity. It is advisable, therefore, to remove or to See also:lay open the prepuce, in order that the sores may be effectively dealt with. Bubo.—The bacilli from the soft sore are apt to find their way into the lymphatic vessels, and so to reach the glands in the See also:groin, when they set up destructive inflammation. Under the influence of See also:rest the inflammation may subside, but if it continues and suppuration threatens, the gland had better be laid open and scraped out. If a speck of the contents of the abscess be inoculated on to the skin, a soft chancre is again produced. C. Syphilis. The cause of . syphilis, whether inherited or acquired, is the presence in the blood and tissues of the same. organism, which can be demonstrated in the various secondary .lesions, in the blood and in the See also:internal See also:organs. The name of the germ is Sprrochaeta pallida;' it is a protozoon of See also:spiral form, from 4 to 20 µ in length and ,a in See also:diameter, with a flagellum at either extremity. It possesses motility of three kinds—a lashing, a corkscrew and a to-and-fro See also:movement. It stains See also:pale See also:pink with Giemsa's fluid. At the time of See also:writing (1910) it has not been found practicable to make an artificial cultivation of the spirochaete. But it may generally be found in primary and secondary syphilitic lesions by the aid of a 1I2 in. oil-See also:immersion See also:lens—and abundant See also:patience. The pale, spiral, See also:hair-like germ is also found in See also:children who inherit syphilis. Inoculations of the spirochaete in monkeys have produced the characteristic primary (Hunterian) sores, which have proved infective to other monkeys. And in the reproduced primary sores, as also in the secondary lesions following them, the same specific micro-organism has been demonstrated. Syphilis is an infective See also:fever, and its See also:life-See also:history may well be compared with that of vaccinia. A See also:child is vaccinated on the See also:arm with vaccine See also:lymph—for two or three days nothing is observed; but on the See also:fourth day redness appears, and by the eighth day a characteristic vaccine vesicle is formed, which bursts and sets free a discharge which dries into a scab. If on the eighth day the clear lymph in the vesicle is introduced at another point in the child's skin, no characteristic local effect follows. The system is " protected " by the previous inoculation; this See also:protection will last for some years, and perhaps for life. There is, then, exposure to a poison; its introduction locally; a period of incubation; a characteristic appearance at the seat of inoculation; a See also:change in the constitution of the individual, and protection for a variable period. So with syphilis. The syphilitic poison is introduced at the seat of an See also:abrasion either on the genital organs or on some other: part of the surface of the body. The poison lies quiescent for a variable period. The See also:average period is four See also:weeks. A cartilaginous, See also:button-like hardness appears at the seat of inoculation. If this is irritated in any way, an ulceration takes place; but ulceration is an See also:accident, not an essential. From the primary seat the system becomes infected. The virus, passing along the lymphatic vessels, attacks the nearest See also:chain of lymphatic glands. If the See also:original sore is in the genital organs, the glands in the groin are first attacked; if in the See also:hand, the glands of the See also:elbow or armpit; if on the See also:lip, the glands below the See also:jaw. The affected glands are indurated and painless; they may- become inflamed, just as the primary See also:lesion may, but the inflammation is an accident, not an essential. In due course the poison may affect the whole glandular system. The body generally is so altered that various skin eruptions, often symmetrical, break out. Any irritation of the mucous membrane is followed by superficial ulcerations, and in the later stages of the ' From xatrn, See also:long hair, on See also:account of the waving, hair-like appearance of the germ.disease skin-eruptions, scaly, pimply, pustular or tuberculous in type, appear. These eruptions do not itch. The individual is as a general rule protected against a second attack of syphilis, although there have been rare cases recorded in which individuals have been attacked a second time. In weakly See also:people, in severe cases, or in cases that have not been properly treated by the surgeon, syphilitic deposits termed gummata are formed, which are very apt to break down and give rise to deep ulcerations. Gummata may attack any part; the skin, muscles, See also:liver and See also:brain are the favourite sites. It by no means follows that because the infecting sore is small, unimportant or quickly healed, the attack, of which the sore is the first (primary) symptom, will be mild. The most serious See also:train of symptoms may follow the healing of a primary sore which has been so unimportant as scarcely to have attracted the See also:attention of the individual, or actually to have escaped See also:notice. Indeed, it not infrequently happens that the most serious forms of secondary or See also:tertiary symptoms succeed a sore which was regarded as of such trivial nature that the individual declined to submit himself to treatment, or quickly withdrew himself from-it to enter a' See also:fool's See also:paradise. The advisability of ceasing from treatment should always be determined by the surgeon, never by the patient; See also:mercurial treatment must be continued long after the disappearance of the secondary eruptions. It is the disease which the surgeon has to cure, not the symptoms. The patient is apt to think only of the symptoms. Is the. disease curable? " This is the question constantly put by the patient on his coming for treatment. The See also:answer is: " Yes; beyond doubt." But the individual must be made to understand the See also:necessity of his submitting himself trustfully and patiently to a prolonged' course of treatment. A second question is as to whether, in.the course of the disease, his hair will fall out, his body will be covered with sores and his See also:face with blotches, and if his bones will beattacked. . Here, again, the answer will be that prompt submission to treatment will sender all such calamities extremely improbable. Another question often put is as to whether the disease is contagious or infectious. Obviously, if a man has a primary sore or a secondary eruption upon the lip or See also:tongue he should use his own See also:glass, See also:cup or See also:spoon, and should refrain from kissing any one. If due care thus be taken no danger is likely to ensue. The diagnosis of syphilis is often difficult. The first appearance of the sore about four weeksafter exposure to the risk of infection, its hardness, the indolent enlargement of, the associated lymphatic glands, and the occurrence of rash or of sore See also:throat, are all helpful. But when the primary sore occurs on the finger, the face or, indeed, in any extra-genital region, it is apt to be lacking in the usual characteristics, and so the diagnosis may for a while be missed. In the case of doubt, the blood of the patient should be submitted to the delicate test known as the Wassermann reaction. The General Treatment of Syphilis.—It is impracticable to lay down a hard and fast See also:line for the treatment of the disease, for no two individuals are exactly alike, neither does the disease follow a strict path in all cases. But experience has amply shown that in the See also:early stages of the disease, See also:mercury, at least for the present, is the only See also:drug on which reliance can be placed. See also:Guaiacum was at one time extensively used, and somehow or another See also:sarsaparilla acquired abubble reputation; but the See also:practical surgeon of to-day ignores these drugs in the treatment of syphilis. Still, mercury must be prescribed with great See also:judgment. For a man worn out by alcoholic or other excesses, or with health broken down by See also:tuberculosis or other exhausting disease, mercury must be given with great caution. In times past, its 'reckless See also:administration until profuse salivation was set up, or until the See also:teeth See also:fell out and the very jawbones became diseased, deservedly brought the mercurial treatment into disrepute. " Better the disease than the remedy," said public See also:opinion, and not without See also:reason. But this-See also:miscarriage of treatment is absolutely a thing of the past. Before placing a, patient under mercurial treatment it ought to be seen that there is no unwholesome condition of his gums, and that his teeth are put in a satisfactory See also:state; unless this is done, the administration of small doses of mercury may have the effect of producing salivation, and, in consequence, a temporary cessation of the treatment. In any case the gums must be. watched, and the treatment stopped if tenderness occurs. There are several ways of giving mercury: (a) by the mouth; (b) by rubbing a mercurial ointment into the skin; (c) by injection into the muscles; (d)'by inhalation of mercurial vapour. In-See also:unction is especially suited for those whom mercury given by the mouth causes See also:diarrhoea or other disturbance; in a private; See also:house, however, it is found " dirty " and objectionable. The See also:fumigation-treatment is carried out by seating the naked man on a See also:cane-bottomed See also:chair and covering him over with a blanket; See also:calomel being volatilized, its fumes are. carried under the blanket along with See also:steam. Treatment by See also:intra-See also:muscular injections is increasing in popularity, but in carrying it out, great care must be taken that no septic germs are introduced. The preparation of mercury is given in solution or mixed with oil, and is usually injected about once a week into the muscles of the buttock or, See also:loin. The "See also:grey oil," ' which is much used for injections, consists of finely divided metallic mercury in some fluid See also:fat. Calomel is also used suspended in See also:olive oil. After a few months of weekly injections there should be some weeks of rest from treatment. But the most usual, and, perhaps, the most satisfactory method of administering mercury is by the mouth, in the form of pills or mixtures. The pills generally contain metallic mercury finely divided, as in " See also:blue pill " and as in pills made of "grey See also:powder, finely or as calomel, or some other See also:salt of mercury, such as the bichloride or tannate. The preparation given in a mixture is usually a solution of perchloride of mercury. Whilst the individual is undergoing mercurial treatment his See also:diet must be regulated. See also:Plain See also:meat, roast and boiled, and vegetables which cannot cause indigestion or diarrhoea, will form his See also:chief See also:food. See also:Spirits and See also:liqueurs should be absolutely forbidden, but a glass or two of wholesome See also:wine or See also:beer may occasionally be allowed. If there is any secondary eruption of the tongue, mouth or throat, smoking must be forbidden. The See also:dress must be warm, and there should be no exposure to extremes of See also:cold or See also:heat, nor should excessive work or amusement be undertaken. Briefly, it may be said that the subject of syphilis should live See also:low and 'think high. It has been said by an See also:English physician who delighted in epigrams, "Syphilis once, syphilis ever "; but this is not true. If the individual places himself unreservedly and continuously under the treatment of a trustworthy practitioner, he may confidently look forward to a cure; and, if so be that he is eventually married, may depend upon his children showing no sign of his unfortunate infection. Unlike whooping-cough, smallpox or See also:pleurisy, syphilis is not a disease which, See also:left untreated, See also:cures itself in the course of time. Syphilis is a disease which peculiarly calls for treatment, and that treatment, to be effectual, must be prolonged. To promote the healing of an ulcer, or to get rid of a cutaneous eruption, the result of syphilis, is not to treat syphilis. It is merely to free the patient of a symptom of the disease. To cure syphilis—and the disease is curable—the treatment must be patient and prolonged. And it must be for the surgeon to say to the individual that he may consider himself as cured, not for the patient to take upon himself the See also:assumption that, because no secondary or tertiary symptoms have been seen for a certain number of months, he is cured. In the midst of the uncertainties which surround the subject of syphilis, the question sometimes arises as to whether the treatment by mercury, for instance, is of the importance which is ascribed to it. Two instances may be given in proof of its undoubted value. First, a woman who has been infected and never properly treated, becomes pregnant, and though, perhaps, showing signs of See also:good health in every other respect, has a miscarriage; pregnancy and miscarriage follow each other at See also:short intervals, four, six or eight times. Then, at last, she is put upon mercurial treatment, and, See also:ring to her full time, bears a healthy infant. Second, an infected but healthy-looking woman, who has not been, properly treated, produces a child who, in the course of a few weeks, becomes. shrivelled and wan. His food does him no good, and daily he becomes more miserable. At last some mercurial ointment is spread upon his " binder," and he quickly becomes healthy and happy, and, in due course, if the treatment is persevered in, is entirely cured. When should the Treatment of Syphilis be begun?—The answer to this important question is: " As soon as the disease is diagnosed." As soon as it is seen that the primary sore is hard, and that the glands in anatomical association with it are swollen, mercury should be administered. It may not prevent, the outbreak of the secondary symptoms, but it may greatly modify them. But if a surgeon is in doubt as to whether a sore is truly an infecting one, he should wait before condemning the individual as 'syphilitic, and placing him under the necessity of submitting himself to perhaps a two years' treatment, which, after all may not have been necessary. Time would quickly clear up doubt. Abortive Treatment.—When it is remembered that the germs of syphilis have been incubating at the seat of inoculation for a month, more or less, before the primary sore or chancre makes its appearance, it may be taken for granted that the removal of the sore' by wide See also:dissection, or its destruction by cautery, will not prevent the occurrence of secondary symptoms. For during those weeks the germs were finding their way into the' lymphatics and the blood vessels and were producing a general infection. When the disease has undergone„ a sufficient treatment by mercury, or when a patient presents himself with lesions which denote the fact that the disease has passed into the tertiary See also:stage, a solution of iodide of See also:potassium is given in See also:combination with that of perchloride of mercury, or the iodide, is given by itself_ In these conditions the effect of the potassium salt is often most remarkable. It is a drug of the greatest "value, and, recognized as such, is apt to be found an important ingredient in popular " blood mixtures." It given, however, in doses larger than can be See also:borne by the patient, its poisonous effects are manifested by a metallic See also:taste, by watering of the eyes and by the breaking out on the back and shoulders-of scattered pimples: . Thus, mercury in some form isthe recognized and proper treatment for syphilis in the secondary's'tage, and iodide of potassium in the tertiary. And, for as much as one cannot say where the secondary stage ends and the tertiary begins, it is a common practice to com-bine the mercuric with the potash salt in the treatment of certain phases of the disease. In 1910 attention was hopefully directed towards Professor Ehrlich's treatment of syphilis by a complex preparation of See also:arsenic, conveniently spoken of as " 6o6." Gummata.—The most characteristic form of the generalized syphilitic infection, which may not See also:manifest itself for several years after the reception of the virus, is a new growth in various organs —the liver, testes or brain, the muscles (tongue and jaw-muscles especially), the periosteum, the skin and the lungs. The deposits are called gummata from the tenacious appearance of the fresh-cut surface and of the discharge oozing from it. The structure consists of small See also:round cells among thin See also:fibres; it closely resembles granulation-tissue, only that the cells are smaller and the intercellular substance (fibres) denser. Molecular See also:death, or See also:necrosis, overtakes. this See also:ill-organized, new formation at various central points, owing to the inadequacy of the blood See also:supply. One remarkable feature of the process is the overgrowth of cells in the inner coat of the See also:arteries within the affected See also:area, which may obliterate the See also:vessel. Gummata, and the ulcers left by them, constitute the tertiary manifestations of syphilis. In a large proportion of cases only the secondary symptoms occur, and not the tertiary, the virus having presumably exhausted itself or been destroyed by treatment in the earlier manifestations. Inherited Syphilis.—In the syphilis of the offspring it is necessary to distinguish two classes of effects—there are the effects of general intra-uterine mal-See also:nutrition, due to the placental syphilis of the See also:mother; and there are the true specific effects acquired by See also:inheritance from either See also:parent and conveyed, along with all other inherited qualities, in the sperm-elements or in the ovum. These two classes of effects are commingled in such a way as not to be readily distinguished; but it is probable that the ill-organized growth of See also:bone, at the epiphysial line in the long bones (sometimes amounting to suppuration), and on the surfaces of the membrane-bones of the See also:skull (See also:Parrot's nodes) is a result of general placental mal-nutrition, like the corresponding errors of growth in See also:rickets. The rashes and fissures of the skin, the snuffles and such-like well-known symptoms in the offspring are characteristic effects of the specific taint; so also the See also:peculiar overgrowth in the liver, the interstitial See also:pneumonia See also:alba of the lungs and the like. As in rickets, it is in many cases some months after birth before the congenital syphilitic effects show themselves, while other effects come to See also:light during childhood and youth. It must be remembered that the moist eruptions and ulcerations about the mouth and anus of the infant, as well as the skin affections generally, are charged with the spirochaetes and are highly contagious. From the second to the See also:sixth year there is commonly a rest in the symptoms that are regarded as characteristic, but the tibiae may become thickened from periostitis, or a See also:joint may become swollen and painful, and resolve under mercurial treatment. The characteristic See also:physiognomy gradually manifests itself if the child is not treated with mercury—the flattened See also:nose, the square forehead, the radiating lines from the mouth, the stunted figure and pallid face. During the second dentition, the three signs, as pointed out by See also:Jonathan See also:Hutchinson, may be looked for—the notched incisor teeth of the upper jaw, interstitial corneitis and syphilitic deafness. Perforation of the soft or hard See also:palate may occur, and ulcerations of the skin and cellular tissue. Destruction of the nasal bones, See also:caries of the forehead and skull, of the long bones, may also take place. Colles' See also:Law. —A woman giving birth to a syphilitic infant cannot be inoculated with syphilis by the infant when she is suckling it; in other words, though the mother may have shown no definite signs of syphilis, she is immune; whereas the syphilitic infant put to the See also:breast of a healthy woman may inoculate her nipple and convey syphilis to her. This is known as Colles' Law, and it is explained by the theory that, the mother's blood being already infected, her skin is proof against a local cultivation of germs in the form of a Hunterian sore. Syphilis and See also:Marriage.—The question as to how soon it would be safe for a person with secondary syphilis to marry is of extreme importance, and the disregard of it may cause lasting See also:mental See also:distress to, the parent and permanent See also:physical injury to the offspring. A man who finds himself to be the subject of secondary syphilis when he is engaged to be married would do well honourably to free himself from responsibility. But should a person who has been under See also:regular and continuous treatment See also:desire to marry, consent may be given when he has seen no symptoms of his disease for two full years. But even then no actual promise can be made that his troubles are at an end. The transmission of syphilis to the third See also:generation is quite possible, but it is difficult of See also:absolute proof because of the See also:chance of there having been intercurrent infection of the offspring of the second generation. Additional information and CommentsThere are no comments yet for this article.
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