Among the secondary syphilitic diseases of the mucous membrane, may be espe cially noticed (1) mucous tubercles, (2) deep ulcer of the tonsils, and (3) syphilitic laryn gitis. Mucous tubercles appear as small tense eminences inside the cheeks, on the arches of the palate, on the lips, on the generative organs, and on the rectum. A solution of corrosive sublimate applied locally (one or two grains to the ounce of water), or calomel, proves an effective local application. Deep ulcer of the tonsils is best treated by corrosive sublimate given iuterually, in doses of of a grain three times a day, in compound tincture of bark and water; and also used as gargle (in the proportion of 2 grains to a mixture of 7ounces of water and 1 of honey. Syphilitic ulceration of the larynx, commonly known as syphilitic laryngitis, is characterized by pain or tenderness in the region of the thyroid cartilage (see LARYNX), huskiness of the voice, a hacking cough from attempts to expectorate, with occasional expulsion of purulent matter mixed with blood. If the disease is not checked, enervation, night-sweats, and dangerous exhaustion, ensue, and life is often terminated by suffocation.
In noticing the secondary symptoms, syphilitic iritis must not be overlooked; its symptoms and treatment are described in the article IRITIS.
Our limited space precludes more than a very brief allusion to the more important tertiary syphilitic The most important of these are those which attack the bones and their coverings. They may be included under the heads of acute and chronic periostitis (the latter being very common), nodes and exostosis, inflammation of bone, caries, and necrosis; next-to these are tertiary affections of the skin and mucous mem brane, which consist mainly of intractable ulcerations attacking the face (especially the nose and lips), nails, ears, and mucous membranes of the various openings of the body; and diseases of the glands. In many of these cases a modified form of mercurial fumi gation is most useful; but if mercury, even in this form, is thought inexpedient, in con sequence of the general debility of the system, iodide of potassium, combined with any of the preparations of sarsaparilla, may be employed. Bark, iron, and the mineral acids are also of service in restoring the strength; and opium, by relieving the nocturnal pains which are so frequently present, will also prove most useful. The reader who wishes to pursue this subject further may be referred to Aitken's Science and Practice of Medicine, in which he will find an account of the tertiary syphilitic affections of the nails, heart, brain, lungs, liver, and tongue.
The SYPHILIS ON CHILDREN is a subject which must not be omitted in an article on this disease. If the constitution of either the father or mother of an infant is saturated with the syphilitic poison, the child may be born with certain symptoms indicating that it is suffering from congenital syphilis. Moreover, the child of a mother having a primary sore, but no constitutional symptoms, may be inoculated with syphilis during the act of delivery; or the disease may be communicated in vaccination (if the matter be derived from an impure source); or by contact with syphilitic sores on the persons of wet-nurses or others.- All these cases are included in the infantile variety of the disease. One of
the most striking symptoms of true congenital syphilis is that which is popularly known as the snuffles, in which a discharge collects in the nose, and sometimes blocks it up so completely that the infant is unable to suck for any length of time. The skin presents an eruption of spots, which are usually somewhat coppery, but sometimes of a rose-red tint; while on the soles of the feet and the palms of the hands the cuticle scales off, and an appearance like that of psoriasis is presented; and flat mucous tubercles occur at the parts where the skin and mucous membrane merge into one another. 'White ulcers of a crescentic form often occur in the mouth; and With these symptoms there is nearly always observed " the wizened and shrunken look, the anxious expression, and the dirty hue of the skin (a kind of dirty greenish yellow), which imparts to the infant a peculiarly repulsive aspect of old age."—Holmes, "On the Surgical Diseases of Childhood;" op. cit., vol. iv. p. 830. Congenital syphilis frequently causes the death of the fetus at about the fourth or fifth month; and if a woman is repeatedly delivered of dead children from the fourth to the seventh month, the practitioner may fairly conclude that a syphilitic taint is probably present. In other cases the child is born alive with the "snuffling" and eruption; but, in the majority of cases, the infant when born is apparently healthy, and the disease does not show itself till about six weeks after birth.
When congenital syphilis is diagnosed with certainty the medical attendant has a very important duty to perform, from which he must not shrink from any feelings of delicacy. He must discover which of the parents is affected, and must prohibit further cohabitation until the secondary symptoms have been completely removed by the treat ment which has already been described. "Neglect of this precaution," says Mr. Holmes, in his excellent memoir on congenital syphilis (contained in the 4th vol. of his System of Surgery), not only entail on the couple the misery of a family of deformed, puny, and ailing children, but to the woman at least is fraught with grave personal danger. Whatever may be the case among the poor, there is no doubt that, in the better classes, congenital syphilis is usually derived from the father, the mother being unaffected except through the fetus." There is scarcely a doubt that a woman carrying a syphilitic fetus may become thus infected with secondary syphilis by the exchange of fetal and maternal blood in the placenta; and this explains how it is that women who have never had the primary infecting sore occasionally show all the symptoms of secondary syphilis after living for some years with husbands similarly affected.