SECONDARY SYMPTOMS.
Inthe same manner as bubo, which is more usually preceded by ulceration, but which may occur without it, secondary symptoms, or that form of the disease wherein the constitution is involved, may be carried into the circulation without any local effect on the part to which the poison was first applied being produced; or, in other words, secondary symptoms need not necessarily be preceded by primary. I have already stated that secondary symptoms are also much modified, both as to the time, form, and severity of their appearance, by the state of health of the patient affecting and affected; and hence the varied degrees of syphilitic maladies. By referring to past pages, it will be seen that the mucous membrane of the throat and nose,the skin or surface of the body, and the periosteum and bones, are the structures in which secondary symptoms develop themselves, and accordingly I now proceed to their several consideration in detail. To illustrate each of them practically, I will first select diseases of the skin. They consist of four marked species, distinguished as the scaly, papular, pustular, and tubercular.
The most frequent form of eruption is the scaly, and called syphilitic lepra. It is characterized by dry, flat, and round patches, of different sizes, and of a coppery-red color. Each spot is ushered in by a minute but hard elevation of a purplish hue, that gradually radiates in size until it acquires its limit. It then puts on a scaly appearance, and, as it desquamates, with the exception of the centre, which is sometimes left white, maintains its copper color. These patches may be distinguished from ordinary leprosy by their color, and their running on to ulceration, if uncontrolled by medicine, and again by their more speedily yielding to judicious treatment; when they become paler in appearance, cease to exfoliate, and die away, leaving, however, a coppery stain. Syphilitic eruptions occur in all parts of the body, and are to be observed on the head, face, back, legs, feet, hands, scrotum, &c. (see wood-cut, page 118), but they are much modified in their external characters by the region they affect.
The pustular form of syphilitic eruption is also illimitable as to situation and extent. The pustules, at the onset, are scarcely to be distinguished from the patches of lepra, being of similar color. They differ in size, some being very large, and others very small. When they have existed about a week, a purulent fluid escapes, which hardens and crusts, constituting a conoid tumor, and surrounded by a copper-colored areola. This crust after a while drops off, leaving the under surface of the same teint as the margin. The pustular form of the disease is mostly consecutive to primary infection of the genital organs, and is often complicated with affections of the throat, nose, &c.
Syphiloid tubercles ordinarily attack the face, more particularly the nose, angles of the lips, ears, &c. They vary in size, are dispersed or grouped together, and are of a purplish copper color. Like the pustular, they terminate in ulceration, which on healing leaves an indelible scar. This and other forms of syphilitic disease are very irregularin their attacks, first selecting one spot, then another, then several together, so that the body presents often at the same time many stages of the eruption. The papular form of eruption is generally intermixed with the pustular and tubercular. It is less strongly marked, but, like the others, successive in its development, and usually complicated with primary symptoms.
There is a form of cutaneous disfigurement, entitled syphilitic exanthema, in which the skin is discolored by coppery-red blushes that disappear under pressure of the finger. There are also deep and painful fissures and excrescences, calledvegetations, from their resemblance to raspberries, strawberries, cauliflowers, and leeks, observed in syphilis, and most commonly they are to be found about the lips, nose, eyebrows, chin, genitals, &c.
It may not be unimportant to know that syphilitic eruptions are contagious by inoculation, and that secondary symptoms may be transmitted from one individual to another.
When I was a pupil of the London hospital, a woman and her child presented themselves for treatment. The mother was completely covered with copper-colored scaly eruptions, obviously and unequivocally syphilitic. The child also had venereal sore throat, and ulceration of the mouth. The account which the mother gave of herself was, that the eruption appeared a few weeks after her confinement; and, upon further inquiry, it was discovered that the husband had had a chancre of the penis: that was cured, but secondary symptoms showed themselves upon him. It was during the presence of the latter that he had intercourse with his wife, at about the sixth month of her pregnancy. The surgeon of the week gave it as his opinion, that the disease was conveyed by the male semen being absorbed by the mother, which was sufficient to occasion the disease. The mother, husband, and child, all submitted to mercurial treatment and fumigations, and in a few weeks entirely recovered.
Treatment of Secondary Symptoms.—Now in the treatment of these cases, all of which are more thanskin deep, it is evident that, unless the cause which produces them be expelled, all local repellants only exhaust the physical energies of the patient; for the cure by such means but provokes a speedier reproduction of the disease, and hence the necessity of constitutional as well as topical remedies.I have fully explained my views regarding the employment of mercury; and every day’s experience convinces me that, where the constitution is imbued with the venereal virus, there is no alternative but to employ the most active alteratives, to effect a decisive and speedy change in the state of the patient’s health. Various habits require various preparations; the blue pill, the oxymuriate, calomel, and the external application of the unguentum hydrargyri fortius, are highly useful. I have, however, of late, been in the habit of employing the proto-ioduret of mercury, with unqualified success; nor do I limit its administration to internal exhibition; it may be used externally. The advantage of this preparation over others is, that it rarely, if ever, produces ptyalism.
In old and inveterate cases, combined with the use of the warm and vapor bath, both of which may be impregnated with it, it has wrought wonders; and in cases that had proved rebellious to every other means, although sedulously employed, it had effected a speedy and decisive cure. In the cure of an elderly person, covered almost from head to foot with syphilitic ulceration, the internal and external application of the proto-ioduret occasioned, at the end of a few weeks, the entire disappearance of the sores, leaving only a slight livid trace. In ulceration of the throat, nose, and in fissures of the genitals, indolent buboes, &c., the success is no less remarkable than effectual.
The following is the formula, which may of course be altered according tocircumstances:—