Dissertations on Inflammation, Vol. 2

by John Burns

There are several other ulcers, which appear upon the penis after coition, which probably depend upon the application of a peculiar contagion. These[78] are sometimes superficial and phagedenic; they spread fast, and heal rapidly, frequently in the course of a night after precipitate has been applied. At other times they are deeper, and more like a little cup; the surface is smooth and glossy, without any appearance of granulations; the discharge is thin, and the base and margin quite soft. The best remedy is the caustic, with the subsequent application, precipitate, or ung. hyd. nit. dilut. When buboes form, I have always found them heal without the use of mercury. If, however, the bubo be the first symptom which appears, as is sometimes the case, (for the morbid agent is occasionally absorbed before it excites action in the part to which it is applied), then it is generally much more difficult to heal than when it is preceded by a local action, and induced by the absorption of matter generated there.

If these local, or primary symptoms, be not speedily removed, a general disease is induced, as we see in the case already mentioned, and as is proved by numberless other instances. These general affections are marked by ulcerations of different parts; and the ulcers have a different appearance, according to the nature of the morbid agent. In some cases they are better and worse at intervals. Mercury has, in almost all these cases, been used; but, although some are ameliorated by it, yet others resist its action. At first, indeed, they generally appear to heal; for the mercurial action, when forming, interrupts the progress of the former diseased action; but, whenever the mercurial action is fully induced, we sometimes find that the appearances change, and the progress generally becomes quicker than formerly[79].

There is a disease which is not unfrequently confounded with syphilis, but which is distinct from it; I mean small ulcers about the mouths of children, which are more like aphthæ than any thing else; but, soon after their appearance, small blotches appear in the body, which become first raised into a little flat vesicle, and then ulcerate superficially. These ulcers have a watery appearance, not much unlike tetters; but the appearance of the vesication, and dark colour of the preceding blotches, prevent any confusion. Nurses who suckle these children have generally small calyciform ulcers on the nipples, of a pale colour, and discharging a thin watery matter. I have had no opportunity of ascertaining what constitutional symptoms would be produced by the continuance of the disease in the nurse, as I have generally found that the application of diluted citrine ointment to the nipple produced a cure, without any internal medicine. The constitutional symptoms in the children were cured by the same local applications, with small doses of calomel internally[80].

I have likewise observed ulcers on the lips, throat, and mouth, which at first had a very doubtful appearance; but they evidently are distinct from syphilis, and belong to the suppurating sores. When superficial, the buff-coloured matter, or inorganised substance which covers them, has a fibrous, or thready appearance, the margins are slightly tumid, and of a florid, or kind of pink colour. The application of caustic, or burnt alum, is often sufficient of itself to cure these; but small doses of mercury sometimes accelerate the cure. At other times these sores penetrate deeper, and affect the bones. The surface, which is deep, is covered with a thick yellow slough, like an overacting ulcer. The margins are tumid, ragged, and of a light, or pink colour. Sometimes the disease spreads along the gum, which becomes soft, ulcerated, and separates from the teeth, which very frequently become black, and, when the sockets are affected, drop out. I have not had an opportunity of observing these sores go the length of inducing constitutional symptoms. It is not easy to ascertain the cause of these sores; sometimes they succeed the use of mercury; but, at other times, it is impossible to blame any evident agent. The transplanting of teeth sometimes has been the mean of inducing sores similar to these; and, in these cases, the disease has generally passed for syphilis[81]. But although the venereal disease may have been inoculated in this manner, it is certain, from the appearance of the ulcers, from their rapid progress, and from the sudden effect produced by a very small quantity of mercury, that the disease, which is commonly induced by transplanting teeth, is not syphilitic.

Sibbens is another disease which has been very frequently confounded with syphilis, and is by many considered to be only a variety of that disease; but they evidently are different, as appears from the mode of infection, and the properties of the contagion[82], the appearance of the ulcers, their progress, and certain circumstances in their cure, particularly their requiring less mercury than venereal ulcers in the same state, and from their yielding readily to preparations of mercury, which do not accomplish a cure of syphilis.

This disease appears first on the part which is most directly acted on by the contagion. This part becomes red and inflamed, having an erysipelatous appearance. Ulceration quickly takes place on a particular spot, and spreads rapidly along the whole inflamed part. The disease then advances more slowly; the erysipelatous appearance spreads around the margin of the ulcer, and ulceration follows upon the inflammation. In the course of some time (the precise period is not fixed), the skin becomes affected with blotches, or sometimes clusters of small pustules, the intervening space betwixt each being affected with an erysipelatous inflammation. These spots soon ulcerate, and the surface rises up into a fungous, which is irregular, and has an aspect somewhat betwixt the look of the venereal sore and a very bad scrophulous ulcer. The bones next become affected, particularly at the articulating surfaces, which swell, and become carious. It is said that the secondary ulcers in general appear first upon the genitals; but, of all those whom I have examined, no affection of these parts had taken place, from which I would infer, that the disease has no peculiar tendency to affect these in preference to other parts. It is likewise said that the disease sometimes disappears from one part, whilst it breaks out in another; but this also I have never witnessed. The primary ulcers also have no tendency, like some others, to change their appearance, and become milder, or heal by continuance, but spread, destroying the nose, orbits of the eyes, and face. The constitution seems to suffer much more from this disease than from syphilis, in the same length of time; for the patient soon assumes a pale sallow look; and hectic comes on much sooner than in syphilis.

The cure of this disease is effected by washing the sores with solution of corrosive sublimate, or dressing them with precipitate ointment, at the same time that we use mercury internally, without which no escharotic, or local application whatever will effect a cure. In general, less mercury cures this disease than syphilis; and it is worthy of remark, that permanent cures may be obtained by the hyd. mur. corros. which is not the case with syphilis. When the bones are affected, we must, in conjunction with the specific remedy, use such applications as the state of the bone, considered as a simple affection, will require.

The cynanche maligna, and scarlatina, are also diseases producing ulceration in the throat. The sores are of the suppurating kind, a thick lymphatic-looking, or inorganised substance being thrown out, instead of organic particles, or granulations. This, in the former disease, very soon becomes black, and putrefies; but the slough so formed differs materially from that caused by gangrene; for, in this disease, unless in the very last stages, there are no real gangrenous sloughs. It is unnecessary here to make any particular observations on these diseases.