Secale 128.–Secondary Ulcers on the Female parts.
Most of these ulcers which presents themselves for treatment are, most likely, consecutive symptoms of the transition stage from the primary into the secondary period, although I have met them in company with unmistakably secondary phenomena. They are most frequently seen near the inferior commissure, at the entrance of the vagina and on the perineum. The pratings of old- school physicians concerning the difficulty of curing ulcers located near the inferior commissure must, however, not be referred to the nature of these ulcers, but should be understood of the peculiar manner in which these gentlemen treat such ulcers, exclusively by external means, and thus securing their cicatrization. If treated with appropriate specific remedies internally, they yield to such treatment neither sooner not later than any other ulcers of the same class, no matter where located; only these which are seated at the entrance of the vagina (if of a phagedaenic character, and after having lasted a long time, may perforate the walls of the vagina, and may penetrate into the rectum; and those that are seated anteriorly, may find a passage into the urethra, and give rise to incurable fistula of this canal. Even on the neck of the womb, these secondary chancres have made their appearance; and it is here that on account of the accompanying stinging pains; of the badly colored ichorous discharge from the vagina, and of a peculiar feeling of weight in the rectum; as well as on account of the swelling, of the increased warmth, and of the ulcerations of the neck of the womb, which are readily discovered by exploring the parts with the finger these ulcerations have frequently been mistaken for cancer, until their true nature was ascertained. But even in such cases, where the physician should never lose sight of the possibility of confounding syphilitic with cancerous ulcerations, the previous history, and the initial symptoms of the case, in addition to other syphilitic symptoms that may likewise be present, may excite suspicion, which an examination with the speculum may soon clear up. It is true that such an examination is not always easy, for there are cases where the physician even if he should suspect a syphilitic infection cannot, and dare not give utterance to such a thought. If we consider how many pure minded, virtuous, and sensitively modest women, whose husbands fancied themselves cured, and radically freed from all syphilitic taint, have been infected by them with this horrid disease, without the poor patients having the least suspicion regarding the true nature of their ailments, it is not difficult to understand that so many syphilitic ulcerations have been mistaken for cancerous disease, and have been treated accordingly. I have had women come to me, who had been treated by allopathic physicians for cancerous ulcerations, and who, being unwilling to submit to another examination, were treated by me,. for a long time, without any abatement of the pains or the discharge(although with our present means relief can be afforded, even if patients are suffering with cancer), until, suspecting a syphilitic taint, I finally had recourse to Mercurius sol. Nitri. ac., by which means I not only effected a rapid improvement, but a complete cure; in no case did the treatment last beyond months.
Secale 129.– Syphilitic Rhagades at the Anus and entrace of the Vagina.
These rhagades consist of narrow, elongated ulcers, or cracks in the folds of the anus. They are more or less numerous, scarcely ever show themselves except in cases of unmistakable constitutional syphilis, and may be confounded by inexperienced persons with rhagades, or lacerations caused by the passages of hard excrements, by the introduction of a foreign body, or even by haemorrhoids. These last-mentioned rhagades, however, are easily distinguished from syphilitic ones, by the fact that they are seldom very numerous., and always exhibit a red (more or less bleeding) surface, and not very elevated borders; whereas, syphilitic rhagades are numerous, rest for the most part upon a rather hard and swollen surface, and have a rather hard and lardaceous base, with red, hard, raised edges. According to some authors, these rhagades, are, in some cases, quite superficial, not very painful, with soft and smooth edges, and secretion of a whitish pus, in which case it undoubtedly be very difficult to decide whether they are of a syphilitic nature, or not. If I may trust my own experience, I am disposed to assert that rhagades of this description are never syphilitic; I have met with such rhagades when all primary or secondary syphilitic symptoms were entirely wanting, but a disposition to haemorrhoids or common tetter existed, or where the patient suffered with nothing else than mercurial symptoms. The authors who have stated such anomalous doctrines, in their rage to discover everywhere symptoms of masked syphilis, go so far as to regard the common pruritus of the anus and scrotum as ordinary signs of the syphilitic disease, in all cases. The case is different where these rhagades are deep and painful, with hard and raised edges, and secretion of a bloody, acrid serum, which corrodes the neighboring parts. In such a case, their syphilitic nature can almost always be taken for granted; and a further examination will almost invariably reveal the existence of other secondary symptoms, either upon the skin or on the uneven surfaces.
Besides these rhagades, true chancres often are seen on the border of the anus as well as in the rectum, close above the sphincter. These chancres are never secondary, but always primary, caused by direct infection, in consequence of a criminal attempt a sexual connection, and in all cases one of the most terrible products of the syphilitic virus. If these primary chancres occur at the anus, they frequently occupy the same folds where the rhagades are located but are not as numerous as a these, very frequently they constitute a single ulcer, are less in circumference, and distinguished in nothing from primary chancres, either as regards appearance or edges, except by their oblong form, which is owing to the shape of the fold where they have become located. When seated at the entrance of the rectum, they are located higher up than the rhagades, always above the sphincter of the anus, except by the oozing, which, however is not always perceptible, and generally passes off with the excrements.
Secale 130.–Secondary Ulcers on other portions of the external skin.
Among these we mention, as first in rank, the syphilitic rhagades between the toes, which are almost always overlooked, although they are scarcely ever unaccompanied by other secondary syphilitic phenomena, principally affections of the throat. Always in a state of ulceration, they resemble pretty accurately the rhagades at the anus; they are somewhat raised, oblong, deep, and of a violet-red; at the same time they incline to spread towards the balls of the feet, and may render walking very troublesome and painful. They may likewise show themselves in the shape of the cracks around the rounded borders of the nails, where they secrete, like the former rhagades, a purulent, ichorous, very fetid serum.
On the mammae, on the contrary, truly secondary ulcers are very rare; most of these ulcers, which are principally seen on the mammae of nursing women in the shape of mucous tubercles are undoubtedly caused by infection communicated by syphilitic infants; they do, however, exist on the mammae of other women, in which they are always accompanied by syphilitic phenomena on the skin, or mucous membranes.
Such chancres have likewise been perceived on the umbilicus, where they generally commence with a more or less livid redness, deep in the tissues of the umbilicus. This redness is succeeded by an ulceration that very soon assumes all the characteristic appearances of chancre. In most cases, these ulcers are likewise attended with other symptoms of constitutional syphilis.
Ulcers breaking out on the eyelids (where figwarts may likewise become located) are sometimes perhaps of a primary nature, and are caused by contract with the fingers, to which some of the syphilitic matter was adhering; nevertheless they are more frequently secondary than primary ulcers. If secondary they generally break out on the free margin of the eyelids, very soon spreading over their outer or inner surface, if not over both at one and the same time; they are most generally accompanied by violent inflammation, in which the conjunctiva becomes involved. After healing, they generally leave irregular cicatrices behind, resembling those after burns; and not unfrequently they cause a falling out of the eyelashes, which, in such a case, never grow again.
Such ulcers may likewise break out on the ears, where they usually become seated on the posterior or anterior surface of the concha, or even in the outer meatus auditorius. If seated between the ear and the mastoid process, they generally resemble oblong rhagades; whereas, if located on the other parts, they look more like slimy tubercles and hepatic excoriations, but are always of difficult recognition, unless other syphilitic signs are simultaneously present. Some of these ulcers likewise assume the form of deep phagedaenic ulcers, with abrupt edges a lardaceous and uneven base, occasionally exhibiting red and bleeding spots, or covering themselves with a scurf. If phagedaenic, they may penetrate deep into the internal meatus, destroy the ossicula, and in this manner, cause an incurable deafness. In most cases of such deeply-penetrating ulcers, nothing, fortunately, remains but a buzzing in the ears, which will, however, bid defiance to all the remedial agents that are employed against it.
