Treatment of secondary symptoms.—Secondary symptoms usually appear from the sixth to the sixteenth week, but are not unfrequently protracted beyond that period; they are commonly ushered in with fever—a general sense of being ill—a quickened pulse, headache, loss of appetite, pains in various parts of the body, and restlessness at night; in short, there is disturbance of all the vital functions, until it is determined which structures are to be the retreat of the common enemy. Some authors assign the skin and throat as more liable to attack than others; but I think the distinction dependant mainly upon the natural or morbid idiosyncrasy of the invalid. At all events, the inquiry here would be foreign to the design of this work, and less useful than the advice, how best to combat the evils when and wherever they occur. I have already stated secondary symptoms to consist of eruptions, ulcerations, and disfigurations of the skin, ulcerations of the mucous membranes of the mouth, throat, and nose, pains in the joints, swellings of the bones and their coverings, and inflammation of the various fibrous textures of the body.
Treatment of syphilitic eruptions.—The cutaneous eruptions of syphilis present considerable varieties, assuming a scaly, papular, tubercular, or pustular appearance. Formerly it was the opinion that no eruption wasvenereal, unless characterized by a scurfy exfoliation, and teinted of a copper color. Thistestis not now relied on. In thesimpler forms, we find that the skin becomes mottled at first, which appearance may partially die away and reappear, deeper in color, and the spots become more numerous in extent. The patient should be apprized that, when the disease has progressed thus far, it is not in its nature to depart unbidden; but it advances usually from bad to worse.
The mottled dots enlarge, exfoliate, or scurf, or desquamate, as it is called, leaving the subjacent circle thicker and thicker, and of the same color as the cuticle which peels off. In the ordinary uninterrupted progression, scabs form, suppurate, and constitute an ulcer, like a chancre, which ulcer assumes all the varieties of chancre. In other cases, the eruption, instead of being scaly, “has a raised surface, from which a whitish matter usually oozes.”
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The scaly copper-colored eruption, denominated, according to its severity and appearance, syphilitic lepra or psoriasis, is regarded as most characteristic of true syphilis, and is the most frequent. The annexed is a drawing copied from nature; it is alluded to a few pages further on: its pattern is frequently to be met with. A celebrated writer, Mr. Carmichael, attaches considerable importance to the character and appearance of the eruptions. He divides the venereal disease into four species or varieties: 1st, the scaly venereal disease, which he considers consequent upon the ordinary chancre; 2d, the papular, consequent upon gonorrhœalulceration; 3d, the tubercular; and 4th, the pustular, he names from its appearance. These distinctions, if correct, must be more interesting to the surgeon, than serviceable to the patient, for the principles of treatment must be alike in all. Now, although mercury may be denied to possess any specific influence over the syphilitic poison, either by its chemical action or neutralizing power, except as a counter-irritant to the system, yet the inability of nature to shake off the pestilential hydra, unassisted by the weapons of the physician, is most apparent; and the most powerful of which is, that class of medicines called alteratives, none of which are more deserving, none more manageable, if the least judgment be displayed, than mercury.
The constitution, when under the influence of syphilitic poison, is being led like a willing horse to its own destruction; and unless the system be entirely revolutionized, that event is not likely to be retarded. Here mercury[5]maylend its powerful aid, and may be carried even so far as to produce mild ptyalism or salivation. But there are instances where mercury is inadmissible. The patient, however, need not despair; extensive resources are still open for him—the preparations of antimony,[6]the mineral acids, sarsaparilla (Forms49,50,51), iodine (Form52), and a host of others may be resorted to; and last, though not least in importance, is the medicated vapor and fumigating bath. From my connexion with an establishment of that kind, my disinterestedness might be questioned in advising the employment of bathing. As well might the apothecary who deals in his own drugs, or the tradesman who vends his own wares, be suspected of disingenuousness; the reply I would offer should be, that the reader or invalid need not pin his faith on my assertion, unless it so please him; or if he does, may the onus lie at my door. But for his sake, and to bear out my own assertion, I offer this declaration, that, for the last twenty years, in conducting my establishment(wherein more cases of syphilitic eruption have presented themselves, than probably have fallen under the notice of any other medical man in London within the same period), no case, of which I have had the management, has failed of being cured.
Where syphilitic eruptions terminate in ulceration, the same local treatment should be used as advised for chancres. Among the prescriptions will be found formulæ for many useful topical applications, such as ointments, lotions, and fumigations, for all the external developments of syphilitic disease, with appropriate observations appended to each.
Treatment of syphilitic sore throat.—It has already been mentioned, that the order of appearance of secondary symptoms depends more upon the modified state of health than any fixed law of disease. Syphilitic sore throat may precede or follow the cutaneous eruptions; and it not unfrequently happens, that all forms of the disease are present at the same time: therefore, although they are here separately considered, it will be found that the treatment corresponds nearly in all, the only difference being in the local applications.
Syphilitic sore throatconsists of ulcerations of thefauces,tonsils, andsoft palate. The inflammation begins in the part affected. There is a redness, and sensation of dryness. A small white spot is perceptible, which rapidly spreads, is detached, reappears, and in four-and-twenty hours, if seated on the tonsils, a cavity, as if a portion ofthem had been scooped out, is observable. The ulcer has a sharp margin, and its excavated surface is covered by a whitish or yellowish adhesive matter. At other times, the ulceration will be more superficial, but not less rapid in its progress, extending over the upper part of the palate, and back part of the throat. Here the general treatment is precisely the same as in the other forms of the disease, viz., rest, abstemiousness, low diet, aperient, saline, and alterative medicines, the blue pill, preparation of antimony, the bath, and total exclusion from all excitement. The topical treatment consists of fumigations, gargles, styptic lotions, nitrous acid gas, blisters over the larynx, rubbing in of any counter-irritating ointment; the object being throughout to watch, and endeavor to improve the patient’s health, support the strength, and mitigate and remove the local symptoms.
In the affections of the nose and palate, the fumigations are indispensable; injections must also be used, and styptic lotions applied with a camel’s-hair brush. These cases are very tedious, and, fortunately, in the present day, of rarer occurrence than formerly; and the patient, thus severely attacked, would be more prudent to rely upon some confidential medical adviser, than to trust in his own management.
Treatment of venereal affections of the bones and joints.—Nodes are alleged, by medical men of great authority, to be of rare occurrence, except the patient has been taking mercury; but the observation is not always correct.
Their treatment, of course, must be regulated by various circumstances. When the pain and inflammation are severe, leeches, bleeding, warm fomentations, or cold evaporating lotions composed of vinegar and water, must be resorted to. When they are chronic and painful, without redness and inflammation, the greatest relief will be experienced by the application of the ointment of iodine and morphine (see Form53), also by the internal employment of iodine in doses of five to ten drops twice or three times a day. Where they are very obstinate, blisters will be often useful in promoting absorption. When they ulcerate, the treatment for chancres must be had recourse to. But the most invaluable remedy, alone or in conjunction with any of the preceding, is the vapor bath; it seldom fails to give instantaneous relief. I have seen patients, who were rendered almost insensible by the pain of nodes in the head, chest, and other parts of the body, experience an entire remission of the pain, and a diminution of the swelling, by the application of one bath; and a course of six or a dozen is rarely inefficient in effecting permanent recovery.
It has already been mentioned that rheumatism of the bones and joints, and in fact of various parts of the body, is unfortunately but too frequently an accompaniment or a consequence of syphilitic disease: and an observer will discover that nodes rarely exist without rheumatic inflammation (of which by-the-by they are a species) being more or less present.