Treatment of venereal affections of the bones and joints.—Nodes are alleged, by medical men of great authority, to be of rare occurrence, except the patient has been taking mercury; but the observation is not always correct.
Their treatment, of course, must be regulated by various circumstances. When the pain and inflammation are severe, leeches, bleeding, warm fomentations, or cold evaporating lotions composed of vinegar and water, must be resorted to. When they are chronic and painful, without redness and inflammation, the greatest relief will be experienced by the application of the ointment of iodine and morphine (see Form [53]), also by the internal employment of iodine in doses of five to ten drops twice or three times a day. Where they are very obstinate, blisters will be often useful in promoting absorption. When they ulcerate, the treatment for chancres must be had recourse to. But the most invaluable remedy, alone or in conjunction with any of the preceding, is the vapor bath; it seldom fails to give instantaneous relief. I have seen patients, who were rendered almost insensible by the pain of nodes in the head, chest, and other parts of the body, experience an entire remission of the pain, and a diminution of the swelling, by the application of one bath; and a course of six or a dozen is rarely inefficient in effecting permanent recovery.
It has already been mentioned that rheumatism of the bones and joints, and in fact of various parts of the body, is unfortunately but too frequently an accompaniment or a consequence of syphilitic disease: and an observer will discover that nodes rarely exist without rheumatic inflammation (of which by-the-by they are a species) being more or less present.
SECONDARY SYMPTOMS.
In the 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 irregular in 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.