OF SYPHILIS.
Syphilisis another and a more violent form of the venereal disease than gonorrhœa. All its effects and symptoms are divided into two conditions,primaryandsecondary; the former being those which arise either from the direct application of the virus or poison to the part where the ulceration first shows itself, or from the irritative and specific effects of the poison on the absorbent vessels and glands, as it is passing through them on its way to the circulation.
Hence, among the first—the primary—may be classed theulcer, orchancre, which in almost every instance is situated on the parts of generation, and may or may not be followed by a swelling in the glands of the groin, constituting that form of the complaint calledbubo.
The secondary symptoms may be defined to be all those effects of the disease which take place subsequently to, and in consequence of, the absorption of the poison into the system: comprising sore throat, cutaneous affections—both eruptions and ulcers, pains in the bones and joints, and swellings thereon, callednodes.
I will first consider the symptoms of primary syphilis—chancreandbubo.
The coverings and linings of the body differ according to their situation. The former, the integuments become hardened by exposure and exercise, and preserve their velvety softness where protected by clothing, and where they are subject to less use—instance the hands, feet, face, and abdomen. Certain functions are assigned to each. The covering of the feet takes on a horny hardness, and in like manner the hands of a laborer assume a glove-like protection. The abdomen, by being constantly clothed, preserves its soft texture. The lining membranes of the body have also separate offices to perform—theserousandmucous, as they are called. Theserousis a name given to those lining the cavities; themucous, to those having outlets. From the glans penis being generally covered by the prepuce, the parts in contact are called mucous. It differs, however, in sensitiveness, from the urethra. The entire covering also of the penis is of a very delicate and tender structure; and hence also, from sexual intercourse, these parts become the chief seat of syphilis. Gonorrhœaconfines its attacks to mucous membranes, or, in other words, secreting surfaces. In fact, the matter deposited on the common and exposed skin is harmless; so also, but to a less degree, is that of syphilis. Gonorrhœa is frequently seatedonandaroundthe glans, and the inner surface of the prepuce; but more frequently, by a hundred fold,withinthe urethra. The delicate surface, then, of the glans and prepuce, losing some of its sensitiveness by frequent exposure, and losing also the defence of the secretion which mucous membranes pour out, becomes accessible to an occurrence of syphilis—a disease that is readily communicable, by inoculation, to almost any part of the body. To quote Hunter, he says: “It is an invariable effect, that when any part of an animal is irritated to a certain degree, it inflames and forms matter, the intention of which is to remove the irritating cause. This has been before stated; but it is common only to secreting surfaces; and when the same cause is applied to non-secreting surfaces, ulceration is set up. This is not only the case in common irritation, but also in specific cases, as in syphilis, burns,” &c.
It is somewhat difficult to explain how a chancrous sore is produced. Surmises are at our service, and those which are founded upon certain facts are the more likely to be true. For instance, a person receiving syphilis must contract it from another individual having it. The mere solitary act of coition will not spontaneously produce it, provided the party be clean, for that surely is not an excess; but having connexion with an infected one, and thereby exposing a healthy surface to a diseased one, becomes an infraction of one of nature’s laws. Well, the patient contaminating the other must have a chancre, which giving off, by contact, its morbid secretion, produces a specific result, namely, a small pimple.
In men, the disease is generally contracted upon the frænum, glans penis, or prepuce, or upon the common skin of the body of the penis, but most frequently upon the interior. From the peculiar and alterable structure of the penis and its prepuce, the poison, unless well washed off, is apt to lodge in the folds thereof, and sooner or later it manifests its influence, which may occur in twenty-four hours, or may be withheld for months. Generally, however, seven or eight or nine days puts the patient out of suspense. The first symptoms consist in an itching, succeededby a redness of the part, out of which is soon observed to spring up a small elevation or pimple. In connexions where haste, disproportion of size, or much excitement or excess prevails, an absolute abrasion of the skin often takes place, and the parts where such occur are generally the everted portion of the prepuce, or the frænum of the same.
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The accompanying drawings represent the extent of the redness and the first appearance of the pimple. The upper diagram alludes to the irritation and excoriation around the frænum, and the lower, the first evidence of a chancre. I am describing the most common form of chancre, such as is known in the profession as Mr. Hunter’s chancre. A perceptible hardness next ensues round the pimple, which becomes more elevated when it ulcerates, or, in other words, the head gets broken off and a little hollow is left. The tumor (for such it may be called) is generally of a limited circumference, seldom exceeding the size of a silver penny, unless in an advanced stage of the disease. When a chancre attacks the frænum, and undermines it, as it were, the frænum is often destroyed; and of course, with its destruction, departs its property of controlling or of directing the orifice of the urethra in urinating, or in the emission of the semen.
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This drawing exhibits three ulcers: one on the prepuce, another under the frænum, having eaten its way through, as marked by the black cross-line, and the third situated on the glans.
When the pimple appears on the outside of the prepuce for instance, it assumes generally a larger form, and, as the head is broken off, crust after crust rises up, until the process of ulceration has very far advanced, or the applications that are generally employed prevent its re-formation. In the former instance, thecrusts are attributable to evaporation of the discharge; in the latter, their absence is already explained by the prevention of the same. There is such a thing as sympathy in eruptive disorders. In skin affections of the corners of the mouths of children, we often see the inflammation cross from corner to corner. The same is observable where the attacks comprise the angle of an eye. So is it with the penis, a structure equally as delicate; and accordingly the edges of the prepuce often put on a jagged appearance resembling chaps on hands.
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Witness the above wood-cut. It portrays an ulcer somewhat diffused on the prepuce, and the ragged edge of the same structure. The sketch just introduced was taken from a patient perhaps only a fortnight old with the disease. Being a rackety, dissipated young man, and regardless of the treatment suggested, a week’s neglect produced the followingalteration:—
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A new ulcer sprung up, the old one increased in size, and the entire edge of the prepuce became involved in the irritation.
Phymosis and paraphymosis occur in syphilis as they do in gonorrhœa. The treatment is the same in both. Warm, soothing applications are indispensable; and occasionally, to prevent adherence between the glans and prepuce, the scalpel must be had recourse to. I have already expressed my conviction that the progress of the disease rests asmuchormoreupon the condition of the party receiving it, than the specific property of the complaint.
“If the inflammation spreads fast and considerably, it shows a constitution more disposed to inflammation than natural; if the pain is great, it shows a strong disposition to irritation. It also sometimes happens that they begin very early to form sloughs; when this is the case, they have a strong tendency to mortification. Bleeding is alsoa consequence owing to exposure of the ulceredcorpus cavernosum.”—Hunter.
The reader will recollect that it has been stated that chancres, like the many symptoms of gonorrhœa, differ in their characteristics. Quoting from authorities, and, as will be further illustrated, the following may be taken as the summary of the most prominentappearances:—
The ordinary chancre is characterized by a hollow centre, a hard and ragged edge, a yellow surface, with a deposite of tenacious matter, and a red and inflammatory margin. There is also a hardness felt at its base on taking the part up between the fingers. This has already been shown; but as illustrations multiply, the possessor of this publication, especially if he be an invalid, will recognise the annexed. It exhibits the ordinary chancre on the inner part of the prepuce, the glans, and the orifice of the urethra—no unfrequent seat of chancre.
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Many ulcers assume a very indolent form, and remain quiescent for a long period. One patient I knew, who consulted me for rheumatism, and who disavowed ever having had syphilis. He took vapor baths, which assuaged the pain, but did not remove it. Accident discovered to me the existence of a sore on the penis, by observing the dressings of the same, carefully placed on the corner of the mantel-piece in the bath-room. The following was the appearance of the sores. He had endured them for nearly three months, nor had he perceived much alteration, either for better or worse. The disease was properly healed, and he soon got well.
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Another kind is one denominated the superficial, with raised edges. It is more frequently seated at the upper part of the prepuce, and creating a thickening of it, ending in phymosis, which lasts a long time after the cure of the ulcers. This kind of chancre is sometimes very obstinate, and continues many weeks. The followingillustration portrays its presence near the edge of thecorona glandis.
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There are two other kinds of sores called thephagedenicandsloughingulcers and chancres.
The phagedenic is a corroding ulcer without granulations. It is also destitute of any surrounding induration, but frequently its circumference is of a livid red color. When the disease is injudiciously treated, the whole of the penis will be destroyed in a very short time. The absence of coloring detracts from a faithful representation of the kind of sore just alluded to. The drawing is sketched from Mr. Skey’s work on Syphilis.
a—The ulcer.View larger image
a—The ulcer.
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a—The ulcer.
a—The ulcer.
a—The ulcer.
a—The ulcer.
a—The ulcer.
Another and more confirmed specimen from the same authority is presented. It represents thesloughingulcer.
a—The ulcer on the prepuce.b—The ulcer on the penis.View larger image
a—The ulcer on the prepuce.
b—The ulcer on the penis.
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a—The ulcer on the prepuce.b—The ulcer on the penis.
a—The ulcer on the prepuce.b—The ulcer on the penis.
a—The ulcer on the prepuce.b—The ulcer on the penis.
a—The ulcer on the prepuce.b—The ulcer on the penis.
a—The ulcer on the prepuce.
b—The ulcer on the penis.
I have witnessed the sloughing, or, in other words, the loss of the entire top of the glans and prepuce, within half a dozen days. The subjoined drawing (overleaf) represents a tumefied state of the penis, ulceration on the glans surrounding the orifice of the urethra, phymosis of the prepuce,and ulcers in different stages on the outside thereof. The sketch was taken from Wallace’s work. Such are often met with. Chancres, as before stated, often become irritable, spread rapidly, and slough, more particularly in persons of intemperate and dissipated habits, or when the case has been improperly treated; and openings into the urethra are formed to a considerable extent, sometimes to the destruction of the glans, or a portion of the penis.
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The illustrative companion to this paragraph exhibits an ulcer that has wormed its way through the prepuce, as marked by the black line.
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Warts are often met with, as in gonorrhœa, and, like those, will arise from simple local irritation, from the accumulation of the natural secretions, or want of cleanliness. They are hard and soft, and require different treatment accordingly. They are not contagious; that is, they do not communicate a venereal affection, but they very readily produce a similar disease in parts they come in contact with. The story is here well told by the engraver’s aid.
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It often happens that the ulceration appears checked. A tumor (see next page) will form, and the surface will look very red and angry—will even yield a moisture, and finally disappear. I say finally, because it frequently proves very obstinate, and trespasses upon the patience and forbearance almost to induce despair. It usually is very irritable, the itching being most troublesome. The illustration was taken from a patient who had been an invalid several months.
a—The tumor.View larger image
a—The tumor.
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a—The tumor.
a—The tumor.
a—The tumor.
a—The tumor.
a—The tumor.
After a certain time, varying in proportion to the virulence of the disease, the poison is conveyed by the numerous absorbents (which run from the penis) to the glands in the groin, one or more of which become inflamed and enlarged, producing that well-known swelling, already alluded to, calledbubo. Ulcers, too, are sometimes situated within the urethra, as is seen in the annexed cut.
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