Secale 125.–Tissues where the Intermediate Forms are located.
These intermediate forms may not only occur on the mucous membranes of the bones, but likewise in other tissues. Hahnemann already mentions, as a consequence of suppression of sycosic, and hence syphilitic gonorrhoea, “a contraction of the flexor surfaces;” and several recent authors not only speak of “bone pains, but likewise of “muscular pains,” or even of “muscular swellings”, which are said to take place together with other secondary phenomena, and which may located in the tendons and aponeuroses. The so-called gummata or gummatose swellings, which, as some would have it, do not occur in the osseous system, but in the cellular tissue, are as well as known at the present times as exostoses or tophi, with which the former, more specially if they happened to be seated in the neighborhood of the bones, were apt to be confounded. The lymphatic vessels are less frequently affected although a species of secondary buboes may occur, but not often. Whether, as some assert, the syphilitic disease may show itself in other tissues, causing, for example, organic affections of the bowels, stomach, lungs, liver, spleen, etc. and affecting even the heart, and, lastly the brain and spinal cord, is another question, that may, perhaps never be decided with certainty, and may be doubted so much more,. as there are authors who, without any further examination, attribute every morbid symptom of internal organs that may happen to manifest itself during the presence of syphilitic phenomena, tom the action of the syphilitic virus; not to mention those who, if individuals had a gonorrhoea or chancre once in their lifetime, trace even cancer of the stomach, pulmonary tubercles, softening of the brain, indurations of the liver, and other similar affections, even if they should only occur twenty or thirty years subsequently to the syphilitic infection, to the action of this virus; yea, even scrofulosis tuberculosis, in fine, all the derangements that Hahnemann sets down to the account of psora, are charged to syphilis as their fountain head. There is no doubt that, besides the already know syphilidae, affections of the mucous membranes, osseous system, etc., there may be many other syphilitic products that are overlooked, and have remained unknown up to the present time. Pathological forms, such as rhagades or secondary ulcers, which are as yet distinguished from syphilidae by their isolated appearance, may, perhaps, hereafter be recognized as intermediate forms of secondary syphilis. Be this as it may, we can never do too much for the perfect investigation and complete knowledge of syphilitic phenomena, and it is for this reason that we mention in the subsequent articles of this chapter not only the known intermediate forms, but likewise those regarding which opinions still differ. We shall class the affections to be described in the following four categories: (1) syphilitic rhagades and secondary ulcers; (2) the phenomena occurring on the mucous membranes; (3) the affections of the osseous system; (4) phenomena in other tissues.
II. SECONDARY ULCERS AND SYPHILITIC RHAGADES.
Secale 126.–Symptomatic description of the same.
These phenomena, among which we do not number the ulcers occurring on the mucous membranes, show themselves on the skin in the shape of ulcerated sores, which are distinguished from the syphiloids proper, or from syphilitic exanthems, by this, that they are not eruptions, properly speaking, but true sores, not developing themselves out of previous syphilidae, but breaking out at once in their original specific form, and likewise by this other feature, that they do not, after the fashion of syphilidae, spread over large surfaces, but, like primary chancre, are confined to definite localities. In most cases they appear several weeks after the cicatrization of the protopathic primary ulcer, but may not break out until several years after, in which latter case they are preceded during this whole period by secondary phenomena. They break out most frequently around the arms and on the sexual organs; but they may likewise show themselves on the mammae, even on the umbilicus, eyelids and ears, and not unfrequently between the toes. With few exceptions, these ulcers, as a general rule, resemble primary chancres, and like these, may remain stationary, whereas, in other cases, they become painful, inflamed, dipping down to the subjacent textures, and even assuming a phagedaenic character. In common with primary chancres, they first appear in the sharp of a red spot which soon becomes sore, ulcerates, dips down like a cup, and assumes all the signs of a syphilitic ulcer. In some rare cases they are preceded by a painless induration and swelling of the subjacent tissue, which as in the case of primary chancres, may continue long after cicatrization has taken place provided the ulcers were closed by purely external means, without the internal use of suitable specific antidotes. On the body of the penis, scrotum, mammae, and on other similar parts, they first begin with a red hard, round, isolated pimple, which rapidly bursts, discharging an acrid serum, and forming a hard and thick crust, whose thickness and size increase in proportion as the ulcer continues to spread. If breaking out in some fold of the skin, or on parts that are in constant motion, for instance around the arms or between the toes, they almost always form open ulcers, and, instead of the round chancre form, they may assume an oblong shape, which, however, will always become rounded, if the fold where they are located is drawn out into a level. Hence, wherever, they may appear, they are readily recognized, and, by their chancre resembling properties, can be easily distinguished from non syphilitic ulcers, even if no other syphilitic phenomena should be present, either on the skin or mucous membranes, although in such a case, which is indeed not very rare, a certain degree of uncertainty must necessarily exist. We will therefore subjoin a few remarks on such ulcers, when they break out on the sexual organs, and likewise when they show themselves at the anus and rectum, or in other localities.
Secale 127.– Secondary Ulcers on the Sexual Organs generally.
Among the different forms which writers on syphilis describe under this name, and of which some authors declare that they show themselves as frequently, if not more so, on the inner surface of the prepuce, behind or upon the glans and on both sides of the fraenulum, as upon the outer skin of the prepuce or penis, there are undoubtedly many that have nothing further in common with syphilis than that the name of syphilitic ulcers is falsely attributed to them, on which account it is absolutely necessary to establish their diagnosis upon a firm basis. In the first place, herpes praeputialis may be mistaken for a secondary ulcer in persons that had been afflicted with chancre at some previous period. Herpes, however, always announce itself by the breaking out of several closely-crowded vesicles upon an inflamed, but not circularly circumscribed spot of the inner or outer side of the prepuce, forming very superficial ulcers, whose surface has a bright red appearance, and never exhibits the lardaceous base of the chancre. Besides this praeputial herpes, we have another most likely mercurial symptoms that has to be carefully distinguished from syphilitic chancres. These are perfectly red and exceedingly superficial erosions, mostly on the prepuce, and lined with a yellowish white mucus, which superficial practitioners, more particularly among the French, class, under the name of fugative chancres or chancres volants, among secondary syphilitic products, and which break out again every three or six months, specially if the patient has already undergone a mercurial treatment. Of an entirely different nature are the true secondary chancres, which, when breaking out on the glans, always denote the prevalence of a very old constitutional syphilis. These secondary chancres have more or less shaggy borders, a red- brown and granular base, or, if they had become phagedaenic, are covered with a dirt-gray scurf, and, like many other secondary symptoms of syphilis, break out in most cases after a very hard and painful swelling of that portion of the glans where they threaten to become located. Very frequently the phagedaenic destruction spreads to the meatus urinarius, which, unless the accident is prevented by the timely introduction of a bougie, may remain permanently and irremediably constricted, even after cicatrization has taken place. When appearing on the prepuce, they easily give rise to a malignant phimosis or paraphimosis, which, after a time, and unless precautionary measures are taken in season, may lead to gangrene, and, in case the body of the penis becomes involved, cause the most violent haemorrhage, and compel the amputation of the diseased organ. The prepuce is not unfrequently perforated by these secondary ulcers, even as the fraenulum is often destroyed by the primary chancre. If located on the body of the penis, they frequently destroy the spongy portion, and by this means may, like those located on the glans, cause very violent and dangerous haemorrhages. Otherwise these chancres are probably consecutive phenomena belonging to the transition period, rather than secondary; in many cases they may not be anything else than old and neglected primary ulcers; in my practice they have occurred to me so often, that I had almost doubted the existence of secondary chancres, and to judge by the descriptions which I had read of them, had fancied that they had been confounded with old, neglected primary chancres, until quite recently I observed two cases, one after the other, one of the glans, the other on the body of the penis, where these new chancres, after the primary chancres had been removed by cauterization, had broken out simultaneously with pustules eruptions; in a third case, where a horrid-looking pustulous exanthem of the face had been considerably improved by Mercurius sol. Hahn. 2, a dose every other day, two chancres broke out anew on the outer border of the labia majora, in places where the cicatrices of two former chancres could be seen they were not mercurial but syphilitic ulcers, and were readily healed with Nitri. ac.
