View larger image
In the progress of the disease, the pharynx, or top of the gullet, is brought under its influence, and the ulceration spreads through it to the vertebræ or back-bone. Extending its course, it next attacks the larynx, or top of the windpipe, when, if not arrested, it will soon destroy life. Attending this affection of the larynx, there is always loss of voice—the patient speaks in a low whisper. It is more fatal than any other form of the venereal disease.
The mucous membrane of the nose stands next in order, as subject to the influence of syphilis. The patient’s attention is first directed to it by an incrustation which forms in the nostril. On this being removed, a quantity of blood, mixed with purulent matter, is discharged. In two or three days, similar incrustations are formed, and under them ulceration takes place, which frequently lays bare the bone, and occasions it to exfoliate; and this exfoliating often continues after the venereal action has ceased. The number of bones which come away is often very considerable, and horrible deformity is the result.
The periosteum and bones become in their turn affected by swellings called nodes—the periosteum first, and the bones subsequently. Of these, the cylindrical, being most exposed to vicissitudes of temperature, are commonly the first attacked. Those which are much covered by muscle are rarely affected, as, for instance, the back part of the tibia, or large bone of the leg, while nothing is more common than to see nodes on its anterior part, which is only covered with skin and periosteum. They occur on the fibula only when it is slightly covered, and only on the ulna, or elbow-bone, when similarly circumstanced. Nodes on the os humeri, or shoulder-bone, except on the outer side, are of very rare occurrence, but are frequently found on the clavicle, or collar-bone, at its scapular and sternal articulations.
In the following wood-cut is an illustration of the most frequent situation of nodes on the forepart of the tibia, or chief bone of the leg. The swelling is considerable; the upper one proceeding to suppuration, and the lower indicating merely a tumefaction of the lower part of the bone, near the instep.
View larger image
The symptoms which mark the disease are as follow: The patient experiences in the evening a sensation of pain in the bone which is afterward the seat of the node. In the course of a few days, a swelling appears in the evening, which disappears again on the following morning. It is excessively painful and tender at night, but in the morning it is hardly perceptible, and the tenderness is almost gone. At this particular period the periosteum is only affected; but when the inflammation has continued some time longer, the bone is diseased and becomes enlarged. The rationale is this: An inflammation of the periosteum ensues. In a short time a deposite takes place between it and the surface of the bone. This deposite, in the first instance, is only a serous fluid, but a cartilaginous substance is soon secreted, which is gradually converted into bone.
When attended to early, their treatment is very simple; but occasionally cases of considerable difficulty will arise.