SYPHILITIC SORE THROAT.
Theperiod that elapses between the appearance of the primary and secondary symptoms has already been stated to vary from six weeks to six months; and some medical writers assert that, if months may elapse, upon the same principle years may, and therefore the patient who has once been afflicted with the primary form of the disease is never exempt from the liability of the secondary. That syphilis, and diseases resembling it, do occur at every period of life, is a fact of daily observation; and it is a matter of less moment to know whether the invalid has ever had chancre or bubo than is generally supposed, for the treatment of every form of syphilis, and complaints putting on like appearances, should be conducted on similar principles. If mercury do possess anti-venereal properties, it will be found no less obnoxious to ordinary sore throats, ordinary ulceration, and cutaneous disfigurement. The presence of any of the abovenamed diseases indicates a habit predisposed to their occurrence; and that susceptibility may be induced by a variety of causes, the most prominent of which are those that debilitate the constitution, such as syphilis itself, or the remedies exhibited for its extermination, cold, fever, intemperate or impoverished diet—all of which more or less abstract from, or derange the distribution of, nervous energy. As in the cure of these diseases, their removal depends upon an entire alteration of the system, upon that principle alone should mercury, or any other remedy be administered, not upon its supposed specific neutralizing or annihilating antisyphilitic power.
All this, of course, is a question of experience; and as I profess that this work should convey the result of mine, I do not hesitate to express my conviction that secondary symptoms do present themselves years after a primary affection; but at the same time I admit their more frequent occurrence to be within three months; and, with regard to diseases resembling the above, they are entirely independent of such influences, and are the result of circumstances from which no man is free. Of syphilitic ulcerations of the throat, which are rarely solitary symptoms ofthe disease, being usually accompaniments to articular eruptions or rheumatic pains, there are several forms. They are ushered in by feverishness, languor, and a peculiar contour of the countenance, particularly expressive of anxiety and debility. Of the first form of ulcerated throat, and which is perhaps the least frequent, is an excavation of the tonsil, with a tumid and red margin, accompanied by a stiffness and uneasiness in swallowing. A more common form, and which, from its occasioning little or no inconvenience, is seldom discovered by the patient until it degenerates into a worse state, is that where the ulceration is more superficial, resembling fissures rather than ulcers, and being situated at the back part and edges of the tonsils, and low down the throat. From the absence of pain and difficulty in swallowing, the medical man is usually the first to detect it, when, on opening the mouth, the throat—that is, the hinder part of the fauces—will be discovered red and somewhat swollen; and on pressing down the tongue with a spoon or spatula, the ulceration will be apparent.
The last form—the phagedenic—is the most formidable, both in symptoms and effects. It is characterized by fever, and great pain and difficulty in swallowing, from the beginning; all denoting acute inflammation of the throat. The first appearance of ulceration is on the soft palate, where a small aphthous spot is discovered, surrounded by a deep erysipelatous redness, that proceeds rapidly to involve the neighboring parts, which soon assume the appearance of one extensive slough. This latter disease requires prompt and active treatment, else the bones of the palate and nose become implicated, exfoliate and occasion a permanent deformity.
The process of cure in these cases must be regulated by circumstances. In persons of full habit, blood-letting will be requisite to arrest at once the inflammation. An active purgative should also be taken; when, if the ulceration resist these anti-phlegmonous measures, there is no alternative left but to subject the system to the influence of mercury. The proto-ioduret pill will be found the best form, and the diet drink should be taken in conjunction. The vapor bath, which can be medicated with poppies, marsh-mallows, and ivy-leaves, or any other emollient herb, will be found to ease deglutition, promote perspiration, and afford ease. Local applications, such as gargles,styptics, &c., are indispensable. Subjoined are a few formulæ, withremarks:—
Ulceration of the larynx is an occasional consequence of syphilis; but fortunately a rare one, as it is generally fatal.
All the symptoms enumerated in this section have been known to succeed gonorrhœa, and demand similar treatment. The advocates for the analogy between gonorrhœa and syphilis herein find a ready explanation for such anoccurrence, which those adverse to the above opinion have no other means of controverting than by submitting that its rarity is no very substantial proof. Similar results also transpire from the imprudent, or too free use of mercury. The following case is a prototype of the many:— The patient was a person about thirty years of age, and was thus affected: there was considerable inflammation in the entire back part of the throat; the tonsils were excavated to some depth by ill-looking ulcers, the uvula shared also in partial destruction; the tongue was swollen, the tip and front part of it fissured, and on the left side an irritable ulcer was apparent; the nose discharged a disagreeable fluid, and occasionally gave off crusts of hardened secretion. The body of this person, including the head, was thickly sprinkled with venereal blotches of the usual copper color. His health was much impaired, and he stated the disease to have been of nearly twelve months’ duration from the first to the last.
The treatment consisted of the exhibition of mercury in the form of the proto-ioduret, and the sarsaparilla. The ulcers were touched with nitric acid, and submitted to mercurial fumigation. At the end of two months he was convalescent. In cases of ulceration of the throat and nose, I have used the nitrate of silver, both in substance and solution, with good effect.