Large quantities of fluid will be found fluctuating between the periosteum and the bone, which, when unaccompanied by redness and inflammation of the skin, may be absorbed by proper treatment, but which more usually is only curable by evacuation; and, unless great care be used, exfoliation of the bone will ensue to a very great, and sometimes fatal extent. The eyebrows, forehead, and temples, are often the seat of fluid tumors varying from the size of peas and beans. Their cure must be effected by absorption, or destruction of the bone is often produced.
The flat bones are also subject to syphilis. The one most commonly attacked is the os frontis, the symptoms being just the same as those on the skin. The side bones of the head now and then are affected; the os occipitis, or back-bone of the head, very rarely; and the os temporis, or temporal bone, being well covered with muscles, and exposed to very little change of temperature, is never affected.
The os frontis, being the most exposed, is the most frequently attacked. Suppuration sometimes takes place; and when this has occurred on the front, it has happened that the same suppurative process has occurred interiorly between the dura mater, or the external membrane of the brain, and the internal surface of the bone. The matter presses upon the brain, and death is the consequence, if the pressure be not removed by the use of the trephine or trepanning instrument. This is a degree of severity to which the disease rarely reaches now-a-days, from the more extended knowledge and improved treatment of modern times.
It must be observed, generally, of both these diseases—that of the throat and nose, and this of the bones—that they are oftener the result of improper treatment, such as the excessive use of mercury, and exposure to great vicissitudes of weather while under its influence, inducing what is called the mercurial disease (which in fact is, or was, of more frequent occurrence than the constitutional syphilitic one), than the result of the natural tendency of the disease in an otherwise healthy individual.
On the treatment of Syphilis.—I consider it a fair presumption that any invalided reader, except he be an accidental one, of this book—by which I mean one, not having sought its possession—must be acquainted with the association of mercury and syphilis. If not, let him be told for the first time, that such association exists as between copaiba and gonorrhœa; or perhaps what may be rendered more familiar to him, namely, as between quinine with ague, or colchicum with rheumatism. That for upward of three hundred years past mercury has been held an antidote to venereal affections; and still is, in many forms of the same, acknowledged indispensable for their removal.
From old notions afloat, that syphilitic patients to be cured must be salivated to the extent of furnishing or filling two or three wash-hand basins daily with saliva—that the teeth drop out, that the breath becomes horribly fetid, and that the consumer of the poison sacrifices one third of his probable existence, even though he get well—the greatest possible prejudice exists against mercury, and the generality of uninformed patients have acquired a most uncompromising dread of the remedy. From the frequent difficulty in getting patients to submit knowingly to mercurial treatment, many new means have been caught up, and some judiciously applied.
This new method has its advantages; but it does not realize all that is promised. It consists in advising rest, cleanliness, simple soothing applications, and, on the other hand, mild astringent ones, a temperate diet, fresh air, an easy mind, sarsaparilla, and other alterative medicines. There are many believers in the efficacy of simplicity; and the success that follows such treatment of nine tenths of the ailments of humanity, bears out the usefulness of the preceding methods; but the remaining tithe have alike a claim upon our consideration, and of this tithe the syphilitic invalids form a large portion.
The anti-mercurial advocates have, however, a salvo, and admit now and then, an exception to exist, that particular cases do require a mercurial course, but then it should only be adopted in its mildest possible form, merely with a view to act on the general health, rather than for any specific property of its own. Again, there are books, which are very elaborate, and what is equally important, modern ones, written by talented men,[4] which still profess faith in the curative powers of mercury, and employ it as the chief agent in the cure of the venereal disease. Instead of administering it to the same extent as formerly—instead of attempting to produce salivation to the flow of quarts—they merely aim at producing an impression on the constitution; they are satisfied with a proof that their patient is under mercurial influence: this is ascertained by a coppery taste in the mouth, a slightly increased secretion of saliva, and the presence of the accompanying, but temporary depression.
Now the question to be resolved is, which of the two methods is the correct one. The many forms of disease of the sexual structures satisfy me, that their treatment should be modified by circumstances; but I believe I am wise enough to know, and certainly old enough to have observed, that the severer forms of syphilis, and even the milder in some constitutions, require the aid of mercury for their cure; in fact, will yield to no other plan of treatment, thereby admitting the specific virtues of the remedy.
The principles, therefore, which I advocate in the treatment of syphilis, are precisely those I depend upon in gonorrhœa, or, to familiarize the analogy, in a fit of indigestion, or an attack of local or general inflammation. Where the health is disturbed, the first step is to attempt restoration. The fact is almost too familiar to every one to need repetition, that, as is the condition of the health, so is the resistance it is capable of opposing to disease. The next proceeding is, to attempt the subdual of the prevailing symptoms. Syphilis, whether in the form of chancre, bubo, or any of its secondary varieties, induces more or less fever, inflammation, and interruption to the important offices of digestion, and other vital processes, which consequently require the promptest attention. Equally various are the local indications of syphilis—the ulcers may be common, superficial, phagedenic, or sloughing, each requiring various treatment, as hereafter will be specified; but, above all, too much reliance can not be placed on the dietetic and physical regimen—two comprehensive significations, which are, after all, the Alpha and Omega of the Materia Medica. With this declaration, I pass on to the treatment in detail of the more frequent and, I may add, leading features of syphilis.