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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    in shape, and they are often multiple. At a later stage they become the seat of shallow ulcerations with a greyish-yellow surface and uneven edges. This colour makes the patches appear as if they had been formed by pencilling the surface with nitrate of silver, and it is in allusion to this characteristic that they are often called Plaques opalines by the French writers on syphilis. Prognosis.—Mucous patches disappear without leaving any trace in about a month, under simple treatment, in people who are careful to keep their mouths clean and free from irritation, but the patches recur again and again, as a rule, during the first period of secondary syphilis, and as they are a constant source of infection the practitioner should keep them well in mind when he sees his patient. In unhealthy people, and in those who are careless and dirty as regards their mouths, mucous patches may cause considerable trouble, because they may ulcerate rather deeply, or they may coalesce to form larger masses. They often become cracked, especially at the corners of the mouth, where they may lead to permanent scarring, as is often seen in children who have been the subjects of syphilis. Treatment. — The patient should be warned of the risk he runs of conveying the infection to other persons by kissing, using drinking-vessels or eating-utensils in common. He should be exhorted to use gargles of borax, chlorate of potash, or alum at frequent intervals. I usually paint the patches with chromic acid solution of the strength of 10 grains to the ounce, alternating it occasionally with potassium bicyanide, 15 grains to the ounce. Local applications of chloride of zinc, 20 grains to the ounce, or of nitrate of silver, 30 grains to the ounce, are also useful, and the application of tincture of iodine is sometimes very serviceable. But it is well in every case for the practitioner to make the application himself, either with the patient in a good light or with his throat illuminated from the head mirror of a laryngoscope, as he will then be able to make a methodical investiga- tion of the whole of the mucous membrane of the mouth and pharynx. All causes of irritation should be removed as far as possible, so that smoking should be prohibited, and stimulants forbidden. The mucous membrane of the tongue, like that of the mouth generally, may be the seat of an erythema or of mucous patches, but as it is somewhat more liable to irritation, and has a thicker covering of epithelium, it proves more refractory to treatment. Various fissures are developed, and the epithelium undergoes modification into the condition known as psoriasis of the tongue, or leukoplakia. Secondary symptoms of syphilis are rather rare in the nasal mucous membranes. They are usually nothing more than a slight hyperemia of the mucous membrane, leading to a chronic catarrh with a muco-purulent secretion. Mucous patches can sometimes be seen at the external angle of the nostrils, or just inside the nasal fossae either on the anterior part of the septum or on the inferior turbinate bone. Similar patches may be seen by posterior rhinoscopy on the margins of the posterior nares. The treatment consists in the administration of a nasal douche of Condy's fluid, two drachms to a pint, or of bicarbonate of soda, 30 grains to the ounce. The larynx is affected with tolerable frequency during secondary syphilis, either in the form of a chronic hypersemia, superficial ulceration, or as condylomata. The condylomata generally appear as smooth yellow projections, either round or oval, and varying in diameter from an eighth to a third of an inch. They are usually situated on the epiglottis and on the inter-arytenoid commissure, more rarely on the vocal ends themselves, and being less exposed to irritation they are not so liable