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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    period, though the glands generally diminish in size when mercury is ad- ministered, and the number and position of the glands involved varies in every individual. The patient often presents certain symptoms of malaise in the interval between the appearance of the sore and the secondary symptoms, which can only be considered as evidence of a progressive absorption of the syphilitic poison by the various tissues of the body. These symptoms are often so slight as to constitute little more than a malaise, which might be attributed to the popular dread of the disease if similar symptoms did not occur during the prodromal period of tetanus and hydrophobia, where we know that toxins are being produced in an infected body. The patient complains of a sense of general discomfort, with weakness, lassitude, and disinclination to follow his usual occupations; he may be sleepless, and his appetite fails; his complexion becomes sallow, his skin is pale and dry, and his eyes are dull and heavy-looking. He has rheumatic pains in his bones and joints, which are worse at night, and he suffers from neuralgia of the face and scalp, or even of the intercostal and sciatic nerves. The painful joints are sometimes a little swollen by a serous synovitis. These vague symptoms may culminate in a sharp attack of fever, which precedes by a few days the first decided sign of secondary syphilis. The fever which ushers in the secondary manifestations of syphilis is often considerable, for the temperature may rise to 104° F., being high at night and falling nearly to normal in the morning. It rarely lasts more than three or four days, and it is occasionally distinctly remittent in character. There is a corresponding quickening of the pulse, and the respiratory rhythm is accelerated. A faint blush may appear at different parts of the trunk whilst the patient is still* feverish, but the blush dis- appears and the temperature falls in many cases as soon as the first rash becomes visible. A remarkable peculiarity of the syphilitic poison is the readiness with • which it attacks points of least resistance in each body in much the same manner as does influenza. The full force of the syphilitic inflammation is felt by different tissues in different individuals: thus in one the mucous membranes suffer most; in another the fibrous tissues, so that the bones, joints, and blood-vessels are unduly affected; whilst in another the nervous system, and in yet another the viscera, are more particularly attacked. It is not surprising, therefore, to find that a typhoidal condition, a temporary inflammation of the kidneys, pleurisy, enlargement of the spleen, and many other indications of localised but transient syphilitic inflammation occur during the early periods of secondary syphilis. Affections of the Skin {Cutaneous Syphilide).—The affections of the skin are certainly the most important signs of secondary syphilis, for until they appear it is at present impossible to say that a patient has acquired syphilis. The mucous membranes are implicated simultaneously with the skin, the lesions being called condylomata or mucous patches. The cutaneous syphilides are either scaly, papular, eczematous, pustular, or bullous, for, as Mr. Jno. Hutchinson has well said, while syphilis may imitate all forms of skin disease, it can create no originals. The rashes of secondary syphilis, as a rule, only involve the superficial layers, so that they do not often ulcerate, and they have certain features which seem to distinguish them from similar eruptions which are not of syphilitic origin. The secondary syphilitic rashes, like all other manifestations of secondary syphilis, are comparatively slight, and, unless they are subject to irritation