Volume 12

Encyclopaedia medica / under the general editorship of Chalmers Watson.

Date:
1899-1910
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Encyclopaedia medica / under the general editorship of Chalmers Watson. Source: Wellcome Collection.

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    temporising policy, and not to give the patient mercury until there is unequivocal evidence that he has really contracted syphilis. This appears to be a satisfactory plan to pursue until the diagnosis of syphilis is founded on some scientific basis, for at present it rests merely on clinical evidence. Mercurial treatment to be of any service requires a very prolonged course and a clear understanding of the principles involved both on the part of the surgeon and the patient. It is a waste of time and money to carry it out on a patient who has not syphilis, whilst if he has syphilis, and he knows it, he is the more likely to carry out the treatment in its integrity than if he has the lingering hope that after all he had only an inflamed soft sore. The constitutional treatment of primary syphilis consists, therefore, in the administration of mercury as soon as the evidence of syphilitic infection is irrefragable. Until this is established the patient should be given some tonic which may bring him into the best possible condition of health, with a view to the long and depressing period of treat- ment which is before him. Secondaky Syphilis.—The appearance of the primary sore is followed after a varying period by further and more generalised symptoms, which show that the syphilitic poison has increased within the body, and is now affecting the entire system. The secondary symptoms, as they are called, follow the initial manifestation in nearly every case. Some- times they are so slight as to be entirely overlooked, both by the surgeon and by the patient, but in a few cases where the patient has been kept under the observation of reliable and experienced practitioners the secondary symptoms have not occurred. Indeed, there is some tendency to divide the various stages of syphilis, by lines which are too hard and fast, in accordance with Eicord's classification, into primary, secondary, and tertiary syphilis. Nature rarely works by abrupt divisions, and in syphilis, as in all other diseases, the symptoms of one stage merge into and often coexist with those of another. It may be stated, with these reservations, that the secondary symptoms of syphilis occur about six weeks after the appearance of the initial manifestation, and that the secondary stage lasts from one to two years. The patient often presents no symptoms of constitutional infection for some time after the appearance of the initial lesion, though a careful examination will show that the lymphatic glands are becoming enlarged in various parts of the body. The glands do not attain any great size, they show no tendency to suppurate, and they are freely movable in the sur- rounding tissues and upon each other. They do not usually cause any pain or discomfort, so that they may pass entirely unnoticed by the patient, even when their outline is clearly visible to the eye of a trained observer. The chain of glands at the posterior border of the sternomastoid muscles— the glandulce concatenate—the posterior occipital glands, and those behind the ears, are most commonly enlarged and are most easily felt. The epi- trochlear glands, situated two or three fingers' breadth above the internal condyle of the humerus, are said to be so uniformly enlarged in syphilis as to be almost pathognomonic if the more ordinary causes can be excluded. The epitrochlear gland is examined by bending the patient's elbow, slightly adducting his arm, and placing the hand outside his arm so that the fingers are inserted into the groove between the biceps and the triceps, The enlargement is not limited to the superficial glands, for the prevertebral, the lumbar, iliac, and femoral glands are often affected, the mesenteric glands being more rarely involved. This glandular enlargement is wholly independent of any skin or visceral lesion. It remains for an indefinite