In long-standing cases of syphilis, where either much mercury has been taken, or the constitution weakened by low living or careless treatment, a painful affection of the bones, periosteum, tendons, and ligaments, frequently arises. Where the inflammation attacks the bone or periosteum, it usually exhibits itself in the form of a tumor, that is at first hard and acutely painful, then becomes soft, and does not always subside without ulcerating, and occasioning a tedious and unhealthy sore. These tumors are called nodes, and are extremely rapid in growth, very uncertain in their duration, and sometimes disappear as quickly as they come. When the inflammation is seated in the ligament and tendons, rheumatism is established. Both these affections are very harassing to the patient; the pains are severest at night, and wholly prevent sleep, the countenance becomes sallow, appetite, strength, and flesh fail, and hectic fever completes the list of troubles consequent upon these forms of the disease. Nodes and rheumatic pains may exist independently of, or in connexion with, other syphilitic symptoms. Cases having already been related of gonorrhœal rheumatism, which are analogous to those proceeding from venereal absorption, any further detail of such would be superfluous. The treatment should also be conducted on the same principles in the one as in the other.
The specific virtues of the vapor bath will be attested by one trial. I have seen innumerable instances of immediate relief from a single application. There are few forms of syphiloid disease more distressing than these pains in the bones; the patient is all but distracted with the agony he endures. The relief he experiences from the vapor bath surpasses belief; it verily appears to be magical. It constitutes the best opiate we have.
Temporary relief, however, is not all that we want. It is no use to remove the effect, and leave the cause behind. The aid of medicine is indispensable. Formulæ of the most appropriate remedies will be found among the prescriptions. The general directions as to diet, regimen, and clothing, dispersed throughout these pages, must be strictly attended to. The stomach must not be at any time overloaded with indigestible food. Milk diet is the best; milk thickened with farinaceous food, mild tonics to restore the tone of the stomach and impart strength, alteratives, sarsaparilla (Form [58]), the old Lisbon diet drink, and all the suggestions hitherto offered with a view of improving the constitution, should be carried into effect.
SYPHILITIC SORE THROAT.
The period 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 of the 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, with remarks:—
| Take of— | |||
| Honey of borax | 1 | oz. | |
| Emulsion of bitter almonds | 5 | oz. | |
| Mix. To be used six or seven times a day. | |||