This disease had a very early origin. It was known among the Jews, as we learn very clearly from the fifteenth chapter of Leviticus. Dr. Adam Clarke's Commentary upon this chapter, at least, makes it apparent. David, the king of Israel, has unconsciously left on record, in the thirty eighth Psalm, a most graphic description of Tertiary 394
Syphilis, experienced in his own person. Dr. Clarke says: , It is most likely the Psalm was written in reference to some severe affliction that David had, after his illicit commerce with Bathsheba; but of what nature, we are left to conjecture from the third, fifth, and seventh verses." The Psalm is dated not quite a year after the act alluded to, about the right time for the terrible symptoms David describes to make their appearance.
The term syphilis is from a Greek word signifying filthy. There is one unvarying sign of this disease, the existence of an ulcer or ulcers, usually upon the genital organs. The French call this ulcer a chancre. The common name is simply venereal sore, or ulcer. A pimple first appears; on the summit of this a pustule forms; then the rupture of the top of this brings to view the ulcer or sore. This ulcer is shallow, more or less circular or oval in form, bounded by a perpendicular and slightly jagged border, and furnished with a smooth, yellow base, moistened by an unhealthy secretion. The skin around the sore is a little thickened and inflamed. This is a simple venereal ulcer. It generally lasts about five weeks, and then heals.
But it is not always thus simple. It may be an inflammatory chancre, attended by excessive inflammation. It may be what is called a sloughing chancre, characterized by the perishing and falling off of large parts of flesh. It may be gangrenous, or marked by a tendency to mortification. It may be phagedenic, or eating, being distinguished by a rapid loss of substance, or eating away of flesh. Or, finally, it may be indurated, being noted for the peculiar hardness of the base, and of the flesh immediately around it.
A venereal sore is the result of impure connection with a person having the syphilitic disease. The poisonous secretion of a sore, applied to the skin of a healthy person, produces inoculation, and a new sore upon the previously healthy person is the result. This chancre appears in a few days after coition, a certain time being required for it to produce its effect, as in the application of vaccine matter to the arm.
Bubo. The next symptom in the order of occurrence, which frequently follows the ulcer, is the bubo. It is named from a Greek word which means groin, from its usually appearing in that part. It is a painful swelling of the inguinal gland in the groin, and is caused by the absorption of virus or poisonous matter from the chancre. This gland is one of the lymphatics, a class of vessels as numerous, all over the system, as the veins and arteries. They are likewise called absorbents. Those that originate from the private parts absorb the poison from a venereal sore, and convey it to the glands in the groin, which being poisoned by it, inflame and swell.
The bubo generally appears in from one to two weeks from the appearance of the ulcer. It is usually upon the same side which the chancre occupies upon the penis. When the bubo advances to suppuration, and becomes an open sore. it is then a glandular chancre.
Vegetations. These are peculiar growths appearing upon different parts of the skin, which resemble certain vegetables. They are found most frequently, in the male, on the head of the penis, and on the membrane lining the foreskin. In the female, they are found at the entrance to the vagina, and not infrequently in the vagina itself.
They sometimes appear on the neck of the uterus. Primary Disease. Thus far, the diseases noticed are what are called primary. If properly treated, and cured in season, the constitution is not infected, and no subsequent troubles appear. But a result so fortunate as this is not common. Generally, the treatment is either too long delayed, or is too brief and superficial. The poison is, in consequence, absorbed into the circulation ; the whole constitution becomes infected; the fluids and solids are so acted on and altered, in fact, that a special constitution is created. For this reason the affections of the skin, the mucous membranes, the bones, etc., which follow, are called
Constitutional. These constitutional diseases never appear immediately, as the result of an impure connection, but only after those affections already noticed. The primary diseases are local; the constitutional affections are general. The first thing which strikes the eye in these constitutional complaints is the color and appearance they give the skin. It has a reddish, coppery tinge, and a peculiarly dirty appearance.
The order in which the several parts are affected, are, first, the skin and mucous membranes; second, the hard substance surrounding the bones, called periosteum, the tendons, and the bones themselves.
Those affections which appear upon the skin and mucous membrane are usually called secondary, because they are the second to appear; while those affecting the bones, etc., are denominated tertiary, because, in the order of their appearance, they are in the third class.
Eruptions of the Skin, and Ulcers. Of the constitutional eruptions, there is a great variety, so great that I cannot, in small space, give a minute description of them. The breast and arms are not infrequently the first to be affected. Attending these eruptions there is little uneasiness, and no pain; though there is sometimes a slight itching. The first breaking out is usually of a copper color, some what paler than it subsequently is. The eruption is often in the form of blotches, elevated only a very little above the skin. They are composed of small pustules, with a little fluid in them, which soon dries away, and the whole may be rubbed off like bran. This may leave the skin looking tolerably sound, and inspire the belief that no further mischief is to be experienced. No hope can be more delusive. Parts afflicted with this complaint show no tendency to heal. The first crop of pimples is soon followed by a second, which produces a thicker crust, and yields a larger amount of bran. This rubbed off, small ulcers appear underneath.
Vesicular Uruptions. There is another syphilitic affection of the skin, which appears in the shape of vesicles, Eke smallpox. These dry and leave a scab.
Scaly Eruptions. There is still another affection, which is in the form of scales, and one scale will be piled upon another. It begins with an eruption of copper colored blotches, which become covered with scales; these are succeeded by scabs, and when these fall off, shallow ulcers are left with copper colored edges. (Fig. 135.) This is a stubborn form.
Tubercular Eruptions. In another variety of the disease, broad, red, copper colored tubercles, or hard elevations appear, most commonly about the sides of the nose, or on the cheeks. Gradually they suppurate, and are succeeded by deep ulcers, terminating in scars. This is an unfavorable form of the, disease, and usually appears some considerable time after the primary symptoms, in persons whose constitution has been shattered. PLATF, V.
This rather belongs to the tertiary form of the disease; and in addition to the above, patches of unhealthy inflammation are apt to form on the tongue, and after a time break, disclosing ragged, orange colored ulcers. PLATF, VI. Fig. 2.
Many other forms of eruption exist; but in a popular work like this, it would be useless to make the nice distinctions which their description would require.
Some of the worst forms of the secondary affections are found upon the mucous membrane of the mouth and throat. These correspond, in number and size, with the affections of the skin. They affect the lips, the internal sides of the cheeks, the tongue, the tonsils, the pharynx, the soft palate, the nasal cavities, etc. They are terribly destructive in their effects, forming gaping ulcers, and eating deeply into the parts. They often make shocking work in the whole mouth and throat; and, when attended with considerable inflammation, make it almost impossible to swallow anything, or even to open the mouth. I have often seen breaches through the palatine arch (PLATF, VI, Fig. 1), and even the whole arch destroyed (PLATI VI, Fig. 2). Persons have often died from starvation, not being able to swallow. The ulcers sometimes take hold of the tonsils, and dig them out as if it were done with a punch."
These ulcerations affect the mucous membranes of the genital organs. In the female, they often affect the vagina and the neck of the womb, and thus may exist for a long time, as the cause of whites, without being suspected as such. They affect also the mucous lining of the fundament and the large bowel. They sometimes exist in the ear, and more often in the eye. This latter affection passes under the name of syphilitic iritis. In PLATF, V. the artist has well represented this form of constitutional disease in the eye.
The disorder having, by frightful ulcers, run riot upon the delicate structures of the skin and mucous membranes, advances boldly onwards, attacking the muscles, the tendons, the hard covering of the bones and the solid bones themselves. No part of the human frame not even the skeleton can escape this devouring complaint. The bones of the nose and face are generally the first to be attacked. These perish slowly, falling away piece by piece, the nose, in the mean time, sinking down nearer to a level with the cheeks. From these parts the disease may spread to the bones of the whole system.
These affections of the bones are attended by pains of almost every kind and degree. These pains are sometimes fixed in one Place; at other times wandering, the whole skeleton being painful. In these 1,,.tter cases, they seem to the sufferer to reach the very marrow. Sometimes when the pain is fixed in one place, the feeling is such as might be supposed to be experienced if the bone were being bored. These pains are most terrible during the night.
Upon those parts where the skin is near the bone, as the forehead, or shin, syphilitic nodes or tumors often appear, which are hard, like cancerous tumors. Besides the above, there are the loss of the hair (alopecia), blindness, deafness, and various other mischief's, resulting from syphilis, which need not be described.
Is the Constitutional Disease Communicable? Many believe, even among those who are eminent in the profession that the constitutional forms of the disease are not communicable. A few years ago, indeed, this latter opinion was generally received. It is now quite extensively doubted, or rather disbelieved. Facts are constantly occurring under the eye of unprejudiced physicians, which make it very evident that the constitutional disease may be communicated from one person to another.
The Disease Hereditary. It is no small amount of suffering, bodily and mental, which the individuals endure who contract this disease. But the inflictions visited upon them, severe as they are, are small compared with the aggregate of ills entailed by it upon the long line of their posterity. Whether it be the man or the woman whom the syphilitic virus has inoculated if it be allowed to be absorbed, so as to affect the constitution, it will be very likely to be sent down to the children, and children's children. The divine law which links the sins of the father with the sufferings of even the third and fourth generation, is nowhere more painfully illustrated than in the scourging descent, through many generations, of this terrible disease. It may be passed down to posterity by either of the parents; but if both be diseased, the transmission will be more certain. If the mother be infected, she will infect the child while carrying it. If the father's constitution be poisoned, the child will receive the infection from him, through the semen, and will be likely, while in the womb, to infect the mother. I recollect but one author of note (Ramsbotham) who has mentioned this mode of infection. I have myself seen two cases of it.
This constitutional disease, whether it exist in the mother, or be communicated to the child, and thence to her, by an infected father, is a frequent cause of abortion. Throughout nature, blight is the result of a diseased parentage. Mature fruit is seldom obtained from infected seed.
Is the Constitutional Disease Curable? No question connected with the complaint possesses a greater interest than this. None is pressed more earnestly upon the physician. In a certain sense the disease is curable. Its outward manifestation may be wholly repressed. Tb e health of the person suffering from it maybe restored, and become, in an important sense, good. But this cure is never brought about by nature; it may be, and is often effected by medicine. I have never failed to effect such a cure in any case which has come under my treatment., Such results may properly, in general terms, be called cured.
Yet there is a sense in which a cure never occurs. It is a well attested fact, that a system once thoroughly pervaded by the poison is never completely purged of it. It may be shorn of all its active malignancies; but it has too intimately permeated the tissues and solid bones to be wholly expelled. Pursue it as we will with the remedial forces of our art, it still takes refuge in the most subtle processes of animal life, still infects the currents of being, and finds expression in the scrofula, in the lupus, and in the scaly affections of other generations. Dr. Erasmus Wilson, the great authority in skin diseases, says: , I feel convinced that a considerable proportion of those diseases which pass under the name of scrofula are the produce of the syphilitic poison, are, in fact, not scrofulous, but syphilitic." Astrue thought the same, and suggested, what is doubtless true, that the transmission of syphilis must occur through several generations before it becomes scrofula. Bierchn, Camper, Stoll, Portal, Hufeland, and Alibert, have all advocated the Same opinion.
This is doubtless right, though there are many authorities on the other side. He must be a poor observer who cannot discover a probable filial relationship of scrofula to syphilis.
A variety of facts, admitted by the whole profession, go far towards demonstrating this relationship. Scrofula is always hereditary. It is a disease of the parent, imparted to the offspring. But there is scarcely any disease so certainly sent down to posterity as syphilis.
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