Secale 209. – Suspicious Symptoms.
Strictly speaking, a few suspicious signs might perhaps be pointed out. This was likewise the opinion of the older physicians. Although these signs are not definitely characteristic, and do not even occur in every case of masked syphilis, yet they do manifest themselves in some cases and afterwards confirm their syphilitic character by the fact that, through the operation of certain extra-ordinary causes, they very frequently assume an evident and unmistakable character of constitutional syphilis. Among these signs we number: A certain pale, faintish-white, or dirty-yellow complexion, with an unclean forehead; occasional breaking out of isolated pimples on the hairy scalp or in the whiskers, not itching, but scurfy; emaciation of the features, with dry coryza and crusty nostrils, or discharge of fetid, purulent nasal mucus, without and distinct sign of a regular ozaena syphilitica; moreover, frequent attacks of a slight angina with evening hoarseness, ill-defined redness, and a varicose condition of the vessels; frequent appearance of erosions on the inner surface of the prepuce, without any definite character, soon disappearing again, never itching, and resembling herpes praeputialis; isolated attacks, of bone-pains; scattered appearance of isolated pustules or indurated pimples which are scarcely noticed, and disappear again in a short-time; rhagades on the inside of the joints of the hands or fingers; slight swellings of single bones, scarcely perceptible; lowness of spirits, sadness. These symptoms do not occur simultaneously, but singly, and are generally so mild that they are overlooked by the patient, and that even the physician, unless he should have his suspicion, is disposed, on account of their ill-defined and imperfect development, to regard them as ordinary symptoms of an arthritic, scrofulous, rheumatic, or catarrhal disposition or diathesis, until they finally become more marked, and their true nature can no longer be misapprehended. Many sudden outbreaks of a syphilis that had been forgotten for years, and undoubtedly foreshadowed by such apparently trifling symptoms in the course of years; their true nature remains unknown; but, whenever several of them exist together, the physician will do well to keep his eyes wide open, and to institute careful and cautious inquiries into the past history of the patient’s ailments. However, such inquiries should not be conducted with an anxious mind, nor should such symptoms lead the physician at once to jump at the conclusion that there is a latent syphilitic taint, except the character of each symptom reveals some undoubted analogy with corresponding syphilitic manifestations. In this respect, grave mistakes are committed by many pathological manuals, which present to their credulous readers even haemorrhages, dropsies, gastric ailments, chest and nervous affections, haemorrhages, paralysis of the feet, statement on the neck and chest, occasional glandular swellings, etc., as symptoms of a latent syphilis. Of course, it is possible that all these affections may develop themselves as consensual affections, during the course of very violent venereal diseases where special organs have become involved, of themselves, they cannot be regarded as symptoms of a latent syphilis, for the reason that they do not constitute idiopathic phenomena, either of the primary or secondary period of this disease; on the contrary, belong to an entirely different range of diseases, and, if they occur in the syphilitic disease at all, constitute purely accidental disturbances. A symptoms which, of itself, cannot take upon itself the characteristic appearance of a syphilitic phenomenon, cannot be regarded as a suspicious symptom; a suspicion of this kind can only be properly entertained when several of these symptoms are present, and there is no other disease to which they could be traced as characteristic manifestations. Of far great importance to a correct diagnosis are the symptoms occurring in children including a correct discriminative distinction between mercurial and syphilitic symptoms, on which account we shall consider infantile and mercurial syphilis in two separate articles.
II. INFANTILE SYPHILIS.
Secale 210. – General Symptoms.
We have already stated, in No.186-189, in what manner children may become affected with syphilis: (1) according to some authors, at birth (which we feel disposed to doubt, see No.213), while passing through the vagina and vulva where syphilitic ulcers are seated (syphilis adnata); or, (2) in consequence of one of the parents or both having syphilitic symptoms on the sexual parts at the moment of conception (syphilis congenita); or (3) in consequence of father or mother, although apparently in perfect health, being tainted with latent syphilis (syphilis hereditaria). On this occasion we have directed the reader’s attention to the general symptoms by which hereditary syphilis distinguished form congenital syphilis, as well as from that which is acquired at birth; nevertheless, we deem it advisable to once more present a cursory view of the symptoms which characterize infantile syphilis in either of the above-mentioned forms. In general, these symptoms are no other than the various symptoms that have been described in the preceding chapter as belonging to the primary and secondary forms of the venereal diseases; in the first place, however, some of these symptoms are particularly proper to children, and others assume a somewhat altered form when manifesting themselves on children, be this owing to the greater tenderness of their skins, or to other causes. Usually the mucous membranes are attacked first, next the outer integuments, afterwards the lymphatic glands, and, lastly, the bones; sometimes, however, all these different tissues simultaneously. If the mucous membranes are attacked, we see at their openings on the surface of the body either protopathic or consecutive discharges, ulcers, even true chancres, mucous tubercles, fig-warts, and fungoid growths; in the glandular system we have buboes, enlargements, or swellings of various kinds; and in the osseous system we discover exostoses and caries, which, however, occur less frequently than other derangements. According to the results which Diday and Bertin have obtained through observations continued for a long series of years, there have appeared: (1) chancres and other ulcers about the mouth, on the palate, tongue, shoulder-blades, umbilicus, labia majora, glans and extremities; (2) fig-warts and other vegetations, on the tongue, at the inferior commissure, in the vagina; (2) syphilitic pustules and tubercles on the head, chin, shoulders, chest, abdomen, labia majora, nates, thighs, and legs, arms, fingers, and toes; (4) vesicular eruptions on the neck and legs; (5) swellings and buboes on the head, neck, shoulders; discharge from the nose and vagina.
What deserves special notice in this kind of syphilis is the peculiar expression of all these children form the moment when these syphilitic phenomena first make their appearance. The skin, specially in the face, loses its transparency looks dusky as if painted: the more this tint spreads the more marked it becomes. It is specially striking on the lower half of the forehead, on the nose, eyelids, cheeks; it occurs much less frequently on the more depressed portions of the face, for instance, in the inner canthi, the folds in the cheeks, etc. Even if this peculiar tint does not seem to extend over a large surface, yet the whole skin partakes of it more or less; the child becomes pale, of a yellowish hue, and the skin has a peculiar lack-lustre appearance, by which the syphilitic affection of such children, when seen at the breast, at once betrays itself. Sometimes this yellowish tint is so distinct that the skin seems coverted with liver spots; most generally, however, the tint is not very striking, so that it would scarcely be noticed but for the fact, that it is almost always accompanied by the peculiar lack-lustre appearance of the skin. Usually this tint is preceded by a general pallor, and requires form eight to ten days for its full development.
Secale 211. – Cutaneous Affections.
In the case of syphilitic children, the skin symptoms show themselves first and foremost. Among them we distinguish:
(1) The pemphigus of new-born infants, which we have described in the second division, and which usually breaks out in the palms of the hands, and on the soles of the feet, and consists of vesicles which, surrounded by a violent-red areola, reveal, after bursting, ulceration of the subjacent integuments.
(2) The various pustules and tubercles, appearing either flattened, salient, tubercular, scurfy, ulcerated, or chancrous, the first named of which, the so-called flat or mucous tubercles, mostly break out on the scalp, in the face, on the chin, scrotum, at the margin of the anus, on the thighs, hands, and feet; whereas the ulcerous, phagedaenic tubercles sometimes covers both extremities.
