(a) Syphilitic conjunctivitis is recognized by a peculiar, brick-red, sharply circumscribed wreath of vessels in the conjunctiva and sclerotica surrounding the latter organ, where it unites with the cornea, with a wall about a line in width. This inflammation is always very painful,, and attended with great photophobia.
(b) Iritis Syphilitica is characterized by contraction or distortion of the pupils, with immobility of the iris, which projects beyond the cornea like a pad; there is profuse lachrymation, violent pains in the orbits, and discoloration of the iris. Syphilitic iritis is distinguished from simple traumatic iritis by its less rapid course, which is always chronic, and by the pains setting in more particularly at night,. and being felt not only in the orbit and eye, but invading the whole of the affected side of the face and head. If left to itself, syphilitic iritis often causes, after a short period, the most extensive destructions of all the tissues of the eye, commencing with the iris. At the commencement of the disease, it is not always easy to distinguish it from rheumatic iritis, so that it often becomes necessary, in case of a dubious diagnosis, to examine the throat of the patient, and the whole surface of the skin, with a view of ascertaining the existence of other secondary signs of syphilis in these localities; for this inflammation seldom makes its appearance during the primary period of chancre, but is almost always accompanied by simultaneously existing affections of the skin and throat; nor can the ring-shaped redness, nor the distortion of the pupil, or the discoloration of the iris and the effusion of lymph, be regarded as diagnostic signs, since all these changes occur in every case of iritis. Condylomata or tubercles, however, growing out of any portion of the iris, are diagnosis signs. At first, they are brown-red; afterwards, yellowish; project beyond the level of the iris, and sometimes increasing in size, so as to press the iris back. In other respects, in no disease are relapses so frequent as in iritis; even if the disease terminates favorably, the eye remains for a long time sensitive to cold and damp weather, dreads the light, and discharges a more or less copious quantity of tears.
Secale 137.–Prognosis of the previously name Diseases.
In most respects, the prognosis is the same as that of syphilis generally. Some of the above-mentioned forms, however, involve more or less danger, both on account of the organs affected, as well as on account of the nature of the phenomena characterizing the invasion of the poison in each special case. For this reason, it seems desirable that a few remarks should be offered on this subject. The most dangerous of all are, undoubtedly, the phagedaenic ulcers; and among this class, more specially those that are seated in the throat and eyes. For all that, the prognosis of chancre in the throat, as long as the bones and cartilages have not yet been destroyed, is not so very unfavorable, particularly if no other secondary phenomena are present, and relapse have not yet taken place. Ulcers on the velum are likewise much worse than those that are seated on the palate, and in the pharynx, for the reason that the former, after being healed, may leave the velum lacerated by irremediable perforations. Of course, the prognosis is somewhat dependent upon the existence of syphilidae that may happen to co-exist with the ulcers in the throat. If the syphilidae are but slight, and of a transitory nature, there is not so much danger of seeing there disease of the throat converted into speedily-destroying ulcers. On the contrary, if the accompanying syphilidae are of a malignant and destructive nature, the affection of the throat many assume a similar character, unless the disease is speedily arrested in its course.
This remark concerning the accompanying syphilidae, likewise applies to affections of the nose, larynx, ears, and eyes. The danger, or absence of danger in these affections, is proportionate to the more or less dangerous character of the accompanying accessory phenomena. If these are malignant, syphilitic ozaena, even if cured, may result in permanent loss of smell, and in an irreparable caving in of the nose. Laryngeal ulcers, where they do not terminate fatally, by the supervention of phthisis, may entail an incurable aphonia. Syphilitic otorrhoea may leave a permanent buzzing in the ears, or an incurable deafness, behind; and syphilitic iritis may not only cause loss of sight; in the affected eye, but likewise the most hideous destruction and disfigurement of the tissues.
As regards prognosis, syphilitic iritis is the very worst disorder of any that can arise, after badly-managed or neglected primary ulcers. Not only is there great danger of a complete destruction of the eye, but, even if the diseases is healed, the eye remains much smaller;or, if the treatment had been badly managed, horried fungoid growths may shoot up from the body of the organ, so that, unless they can be cured by internal treatment, it would have, after all, been more desirable to lose the eye that to carry such horried malformations about through life.
In a great measure, the prognosis is, fortunately, determined by the treatment instituted for all these different affections. If conducted with powerful escharotics or mercurial frictions, we cannot except to accomplish much good; on the contrary, if these affections are treated internally, with appropriate agents, and the treatment is begun in season, we may, even in the worse cases, promise a reasonably satisfactory cure.
Secale 138.–Treatment of Syphilitic Affections of the Mucous Membranes.
For the same reasons as those that have already been detailed (Secale 131), I use Mercury in all chancrous ulcerations; if resembling the simple of Hunterian chancre, I employ Mercurius sol.; in the phagedaenic form I prefer Mercurius corr., until an improvement sets in, after which, I continue the treatment with Mercurius solubilis. If condylomatous growth have started up, I give Nitri. ac., or Cinnabaris, less frequently Thuja, from which I have never derived any benefit in deep seated phagedaenic chancres, but a good deal in ulcerated erosions of the throat. Regarding the dose: I never give, in urgent cases, lower than the second trituration of Mercury, in one-half-grain dose, morning and night, giving only one dose every morning on the third and fourth day, and after this period, one dose every other day. Until now, I have had every reason to be satisfied with this preceding, even in a case of phagedaenic chancre of the throat, attended with incipient iritis, where Merc subl., followed by Mercurius. first induced an improvement, and afterwards achieved a perfect cure of both the chancre and the affection of the eye. I have never yet had a chance to treat a full case of syphilitic iritis, with the characteristic tubercles or condylomata, but should not hesitate to give Cinnabaris first, and if this should not speedily improve the case, should change to Nitri. ac. in the above mentioned case of ulceration of the larynx, I had produced some little improvement with Lachesis, even before being acquainted with the syphilitic nature of the case, until it was distinctly revealed by the corners veneris on the forehead. For syphilitic crusts and ulcers in the nose, which I have never had occasion to treat, except ion cases where a good deal of Mercury had already been used, I have always use Aurum 3, with the best success.
Whereas mercurial preparations have always helped me out in secondary chancres on the different mucous surfaces, on the contrary, I have never derived much benefit from them in exanthemetic, herpetic, but slightly ulcerated erosions of the throat or other mucous surfaces. All such cases are benefited by Lachesis more specially by Lycopodium, and no less by Nitri. ac., Thuja, Cinnabaris, or even Sulphur. I explain this by the circumstance that all these higher forms, according to my observations, only break out in cases where the primary ulcers had already been treated with Mercury; but where the treatment had only commenced towards the termination of the transition stage, or where the internal use of mercury during the primary stage had been associated with cauterization of the ulcer, in both of which cases Mercury had, indeed, abated the intensity of the malady, but, on the other hand, had allowed it time to coalesce with other morbific principles in the body. Be this as it may, the physician can never investigate with too much care the history of any syphiloid that presents itself for treatment; more particularly, he should endeavor to find out how soon after the first appearance of the primary symptoms their treatment had commenced, and in what manner it was conducted.
Secale 139.– Therapeutic Observations of other Physicians regarding the above-mentioned Forms.
In comparison with the cures of primary ulcers, with which our literature abounds, we have but few cases of secondary affections of the mucous membranes, and, in fact only general remarks, the most important of which we will here recapitulate, accompanied by our own additions.
