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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    to ulceration as the condylomata occurring on the pharynx. The laryngeal manifestations of secondary syphilis generally occur from six to twelve months after infection. The symptoms are generally slight, a little cough and hoarseness, which may pass on into complete aphonia, being all that the patient complains of. A perch!oride of mercury spray of the strength of 1 in 1000 is often of great service when it is combined with the internal administration of mercury. The neighbourhood of the anus, the vulva, and the inguinal folds are often the seat of flattened ulcerated patches, secreting a scanty viscid secretion, which are known as condylomata lata. The discharge is often' stinking, and is highly infectious. Condylomata are associated with a great want of cleanliness on the part of the patient. They are cured by keeping the parts perfectly clean and dry, whilst the patient is put upon a course of mercury. The drying is ensured by dusting the condylomata with a mixture of calomel and oxide of zinc, or if the discharge is too profuse the patient may be placed in a bath of perchloride of mercury of the strength of one-half to one per cent. Condylomata of long standing, or which are exuberant, may require the application of a Pacquelin's cautery or of cauterisation with nitrate of silver. The Eye.—Iritis.—Inflammation of the iris is one of the chief mani- festations of secondary syphilis in the eye, as it has been estimated that nearly 60 per cent of all cases of iritis are due to this cause. It may occur within six weeks or two months of the primary lesion, and is often accompanied by cyclitis. It is usually acute, one eye being first affected, though the other eye soon becomes inflamed. Symptoms.—There is some congestion of the conjunctiva and circum- corneal zone, with photophobia and lacrymation. The pain, however, may not be a very marked feature, though the patient may complain of some neuralgia over the forehead and down the side of the nose. In a typical case one or more beads of lymph can easily be seen to be situated upon the iris, and the pupil is small and irregular in shape. More often, however, no such beads of lymph are present, and the whole iris appears thick and dull. The inflammation runs its course in about a month or six weeks, and is singu- larly amenable to treatment by mercury. Eelapses are not very common in cases which have been cured by treatment, but if they are left to under- go resolution it is not unusual for adhesions to be formed between the margin of the iris and the front surface of the lens. These synechias may be the cause of fresh irritation, which results in renewed attacks of iritis, or,, if complete, they may cause a chronic inflammation ending in glaucoma. Treatment.—The after-effects of a neglected syphilitic iritis are so disastrous that every effort must be made to cure it absolutely. The patient should be kept in a darkened and well-ventilated room so long as he complains of photophobia, and he should be forbidden absolutely to use his eyes. Kepeated instillations of sulphate of atropine, 2 grains to the ounce, with fomentations of belladonna, are imperatively called for until the pupil is widely dilated and the inflammation has subsided. These instillations may be supplemented with fomentations of belladonna, as by these means the tendency to the formation of synechias is reduced to a minimum. If atropin increase the tendency to conjunctivitis, it must be replaced by duboisin or hyoscyamin. Three leeches or a small blister applied to the temple, where tlfe hair has been shaved away over a small area to hide the subsequent scars, will often relieve the pain. The patient must be put upon full doses of mercury (p. 17), which should be