Among the later manifestations of hereditary syphilis are opacities of the cornea from interstitial keratitis. This may occur in children who are apparently in good health and free from other signs of hereditary disease. The condition is rather obstinate, but it can be made to disappear under suitable treatment. Retinitis occurs frequently in young women, and is likely to lead to atrophy or detachment.
The Teeth.
—The permanent teeth often show peculiar changes that are distinctive, especially in those who have shown signs of corneal involvement, which, having been first described by Hutchinson, are frequently alluded to as Hutchinson’s teeth. When they first appear they are smaller than natural and irregular. Later they become notched. The crescentic notches show best upon the incisor teeth. Sometimes the canines are also affected, being narrow, rounded, and peg-like, with jagged edges. These teeth are usually so formed that they do not meet properly, and so small that they scarcely touch each other. The most characteristic changes are met with in the upper incisors, which may be affected when all the others are fairly normal. In such cases they will be found narrow and short, with a single broad notch at the edge, with perhaps a furrow passing from it upward and on both anterior and posterior aspects. Notching is usually symmetrical. No conclusions can be drawn from the teeth if they are normal, as they may be, but when they present the above-described features they prove a very important indication.
The relations between syphilis and rickets have attracted much attention, and there is little doubt but that rachitic changes are prone to occur in subjects with inherited syphilis. The two conditions are sometimes blended in various degrees and ways, and yet it is not safe to say that rickets is always an expression of inherited syphilis.
TREATMENT OF SYPHILIS.
There is no question but that some of the above-described lesions constitute as disgusting and repelling diseased conditions as the physician or surgeon is ever called upon to treat. In spite of these circumstances, however, it is generally believed that syphilis is a most satisfactory disease to treat. This is because of the almost mathematical certainty with which results can be predicted and estimated. There is nothing more satisfactory in therapeutics than the rapidity with which many pronounced and serious manifestations of syphilis will disappear under the influence of proper treatment. These statements, however, should be modified to make room for exceptional cases, where the disease assumes a malignant type, owing probably to some defect in the patient’s constitution, or where patients show peculiar idiosyncrasies and susceptibilities to the influence of mercury and iodine. Such cases happen occasionally and prove difficult of solution, while they sorely try the surgeon’s ingenuity and resources.
In the majority of instances syphilis is a curable disease. A patient should be first impressed with the necessity of faithfully following the directions of his physician, and continuing under treatment for a period of at least three years after the disappearance of the last manifestation of the disease. The disease is curable, but only by the judicious combination of two principal remedies, i. e., mercury and iodine. Those rare instances in which cure seems to have followed lines of treatment which do not include the use of these two drugs are so exceptional and misleading that they should not be considered criteria. Mercury and iodine are powerful remedies, needing to be administered with caution and judgment. Unfortunately there is no arbitrary limit of time for any given case. The time stated above is that usually considered requisite. While syphilis may be curable in some cases in less than the stated time, it is better to give it longer treatment than is absolutely required rather than the reverse. The treatment entails no unpleasant consequences. Warnings as to the approach of toxic symptoms from the drugs can be easily recognized.
Of the two drugs the preparations of mercury are the more important. The surgeon may adopt as his motto, mercury, more mercury, and again mercury, and if he begins with this measure early in the disease he may be able to conduct it to a successful termination with but little resort to iodine. Iodine is effective rather in those cases where treatment has been begun relatively late, and where it seems necessary to make a double impression upon the disease.
When the nature of the primary lesion is positive treatment should begin with the first visit of the patient to the surgeon. When there is uncertainty regarding the character of the venereal sore, treatment may be postponed until the appearance of the first eruption. As soon as this has appeared the treatment should be hastened. It is necessary to begin with mercury. The patient’s mouth should be examined by a dentist and all tartar removed from the teeth, especially from the gingival borders, at which lines the gums are likely to become sore when mercury is too freely used. All diseased teeth should be extracted or filled, and the mouth and its contents should be put in normal condition. The dentist should be informed as to the reason for the visit. Smoking should be discontinued, especially when there are mucous patches, since it is apt to irritate and make subsequent lesions of the mucous membrane more likely to occur. The habits of the patient should be regulated as to alcohol and other indulgences, and he should be warned as to the infectious nature of the disease, in order that others may be protected. In many instances tonic, even roborant treatment may be advantageously combined with the antispecific. It will be found that the anemia so characteristic of well-marked secondary syphilis will improve materially under the influence of mercury alone.
Should the disease occur in a married person, or develop after marriage, caution should be given as to the danger to offspring, and to the other associate in the marriage relation, which might follow the occurrence of pregnancy.