III. AILMENTS ACCOMPANYING SYPHILOID ERUPTIONS.
Secale 111. – General Observation.
The phenomena which we intend to mention in the following paragraphs under this designation, are described by most writers on syphilis as “complications of syphiloid eruptions”; this term, however, conveys a wrong idea of what would have been said, if the matter had been examined from the right point of view. Complications are, generally speaking, extraordinary and embarrassing phenomena, supervening during the course of a malady, in addition to its main symptoms; phenomena that would not have appeared, if the malady had run a simple and natural course, and which are caused either by the violence of the malady itself, or by other accessory circumstances outside of its proper range. This is not the case in regard to the syphilitic phenomena co-existing with the syphilidae, for the reason that the main disease is not the existing syphiloid, but the syphilitic disease itself; so that the syphilitic phenomena appearing simultaneously with the syphiloid, which itself is only a symptom, cannot be considered as complications of the latter. The case is indeed different, if it is not the disease, but the symptomatic syphiloid that is viewed as the main object of cure; in such a case we may indeed talk of complications that impede, or embarrass the plan of treatment; but such complications would only be therapeutical, not pathological complications, since they all constitute integral parts of the malady, as the false membrane is an integral part of croup, and the stitch in the side an integral part of pleurisy. Inasmuch as it is our aim never to convey to our readers a wrong idea, on any page of this work, of what we mean by the object of cure, and inasmuch as the term “complications of syphiloids” does convey a wrong idea, we have preferred the expression “Simultaneous, or accompanying complaints” by which we mean, complaints that may break out in other localities simultaneously with a syphiloid, or other complaints, simultaneously with which the syphiloid may co-exist; since in many of these cases the main phenomena are not to be found on the skin, but on the primary affected parts. A proper knowledge of these accompanying complaints is equally important for a homoeopathic physician, as for an allopath; though not in the same manner for the former, as for the latter. It facilitates the diagnosis of syphiloid eruptions, as such; and aids us in discovering the proper remedy in the case. We will, therefore, consider this subject further: (1) by pointing out the primary symptoms, during the presence of which syphiloid eruptions may supervene; (2) the secondary symptoms, by which syphiloids may be accompanied; and (3) the non-syphilitic cutaneous diseases, during which syphiloid eruptions may break out as a complication of the former.
Secale 112. – Primary Symptoms simultaneously with which Syphiloid may occur.
In a former paragraph (84), we have already stated that secondary phenomena may not only arise after the disappearance of primary symptoms, but likewise even during their presence. This is more particularly true with reference to syphiloids, some of which initiate, and, as it were, announce the advent of the secondary period in the character of premonitory symptoms. In this respect, however, not all syphiloid hold the same rank. While some of them almost always justify the suspicion that syphilitic phenomena are still perceptible on the sexual organs, such as old chancers during the period of reproduction, older or more recent buboes, incipient or older mucous tubercles, figwarts, with or without gonorrhoea, etc., there are other syphiloid, on the contrary, that do not reveal any thing of the kind, and where every trace of the primary symptoms has disappeared. Primary phenomena are still most frequently to be found co-existing with syphilitic measles (roseolae syphiliticae), sometimes with syphilitic eczema, the venereal itch, and, in general, all forms which, like those just mentioned, set in with general symptoms of malaise and fever. Less frequently will primary symptoms be found with syphilitic herpes, rhypia, syphilitic acne, impetigo, ecthyma, and tubercles; in their case secondary affections such as ulcers in the throat, affections of the mouth, bone-pains, etc., will shed light on the true nature of these eruptions; although a closer inspection may reveal even here, if not open chancres, at least suspicious-looking cicatrices somewhat raised above the sound skin, and having a more or less copper-color appearance. In the case of women, these eruption, are often accompanied by a suspicious discharge from the vagina, which s not a genuine gonorrhoea although the French class all these discharges under the same general name of blennorrhoea or blennorrhagia. This suspicious discharge corresponds to the balanorrhoea of males, which is likewise very apt to supervene during the presence of the secondary symptoms, and may enlighten us concerning the true nature of the existing syphiloid, which, in its turn, may shed light on the real character of the blennorrhoea. In general, these eruptions have no fixed rule, either as regards time or pathological relations; after the primary stage is past, they may break out at any time, when and how they choose, without its being possible to explain why, in one case, they act differently from another; in one patient, for instance, the same syphiloid may make its appearance while the primary symptoms are still in full bloom, whereas in another patient it may not manifest itself until the primary symptoms have all disappeared.
Secale 113. – Accompanying Secondary Complaints of a Different Kind.
We have already directed the reader’s attention to the fact that a syphiloid, specially in constitutional syphilis of long standing, scarcely ever appears alone, but always in company with other eruptions, such as syphilitic papules with pustules, scaly eruptions, or tubercles; or eczema, impetigo, pemphigus, etc., with maculae, and so on, presenting an exceedingly checkered combination. Besides this, these syphiloids may be accompanied by secondary and (falsely-named) tertiary phenomena of various kinds. Hence nothing in more erroneous than the proposition, that used to be taught as a dogma in our schools. “The course of syphilis is divided in four periods: (1) chancre and buboes, and after they disappear: (2) chancre in the throat and cutaneous eruptions, and after their disappearance; (3) affections of the bones, gummata and other phenomena; (4) general syphilis and death!” More correct recent observations have shown that this is not exactly the course of things. As soon as secondary period has commenced, all the syphilitic phenomena occurring subsequently to the primary invasion, may manifest themselves successively or simultaneously, without any definite order as to time. Hence, syphiloids may co-exist with other syphilitic phenomena, if not with all of them, at least several at once, though, in severe cases, the whole series may manifest themselves at the same time; secondary chancres, mucous affections of the throat, mouth, and nose, exostoses, bone-pains, caries. There is scarcely a syphiloid of some extent and importance, where, even if all primary symptoms had disappeared years ago, the diagnosis, is not facilitated by co-existing affections of the throat and mouth, or by bone-pains, gummata, exostoses, etc. During the presence of these syphiloids, it likewise happens that simple wounds of the skin become disproportionately severe, suppurate and change to ulcers that have all the characteristic signs of chancre, by which means a flood of light may likewise be shed on the character of the existing eruption. In a syphiloid eruption where the constitutional affection has already lasted a long while, a remarkably characteristic symptom, which may supervene independently of the specific color of the syphiloid, is a peculiar affection of the pigment of the skin, specially in the face and on the forehead, sometimes on the chest, neck, and lower limbs, consisting of spots that almost represent liver-spots, continuing unchanged for years, of a brownish hue, irregularly rounded, and remaining visible after or during the appearance of the most varied syphiloids, without passing off in the least until the whole of the syphilitic disease is extirpated. Another, much more dangerous condition, may become associated with the syphiloid, which is nothing less than a general cachexia; this however, only sets in when several other syphilitic affections in other tissues accompany the syphiloid eruptions. In consequence of this cachexia, the poor patients may become covered with wounds, sores, and cicatrices of every description, and, deprived of one or more of their senses, specially of the senses of vision and hearing, may wander about as disgusting and emaciated cadavers, with a wilted, lax, dry, sallow and livid skin, reminding one of the cachexia of cancer. Fortunately, a condition thus aggravated is exceedingly rare, and indeed occurs only in cases where all care had been neglected, and the patients had been of feeble health previous to the infection; although it may likewise to occasioned, as it not unfrequently the case, by bad management with mercury, at least to a certain extent.
