The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen.

Erichsen, John

Date:: 1860

Credit: The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen. Source: Wellcome Collection.

444/1034 (page 442)

$symptoms, resembling those of ordinary inflammatory fever, but of rather a low type. In proportion to the severity of these is usually the rapidity of the pro- gress and the extent of the local manifestations. In other cases again the patient gradually falls into a feeble and emaciated condition, becoming sallow and earthy-looking, with loss of hair, and depression of mental and bodily vigor. In this condition not only are the nutritive func- tions impaired, as is evidenced by his becoming weak and thin, but the repara- tive actions are lessened, wounds do not heal kindly, and fractures are slow in uniting. The syphilitic affections occurring on the skin and mucous membranes are usually of a secondary character, though some belong to the tertiary group; whilst those of the bones and diiFerent organs, as the larynx and testes, are com- monly tertiary. Although the integumental structures are usually first affected, yet it sometimes happens that the disease manifests itself upon the deeper and more important tissues, without having previously implicated any others. Constitutional syphilis is not by any means a necessary consequence of the primary disease; many of those affected with chancre escape all after-conse- quences ; in this respect much will depend upon the duration and nature of the primary sore, its treatment, and the state of the patient's health. That the duration of the local disease influences materially the occurrence of constitutional syphilis, cannot I think be doubted. Ricord states that there is no instance of secondary syphilis occurring if the chancre be destroyed before the fifth day after the inoculation of the poison. This may be so, but the state- ment appears to me to be scarcely capable of proof, as it is certainly of very rare occurrence for a chancre to be detected and completely destroyed so as to be con- verted into a simple granulating sore by the fifth day after the infection. It is seldom that it is observed much before this period, and even if it be, no surgeon could be sure of its complete destruction at so early a period after its occur- rence. Ricord also appears to incline to the belief that the quantity of pus absorbed from these primary sores destroyed before the fifth day does not influ- ence the nature or severity of the secondary symptoms, and in fact that the patient runs no greater risk from one than from a dozen of them. In this doc- trine I cannot agree, for I can see no reason for placing syphilis in a different category to any other animal or vegetable poison, in all of which the constitu- tional effects are certainly proportioned to the extent of the local infection; at the same time I fully admit that the treatment of the sore and the state of the patient's health influence the severity of the constitutional phenomena to a very considerable extent, and probably, indeed, to a greater degree than any other cause. That the treatment of the primary sore exercises considerable influence, cannot be doubted. The liability to constitutional syphilis is, I believe, mate- rially lessened by a mercurial course, and the severity of the secondary symp- toms is not in any way increased if that course be properly conducted. The state of the patient's health also greatly influences the probability of the occur- rence of constitutional syphilis. If, after the cure of the primary disease, his health continue good, no infection of the system will manifest itself; but if broken or cachectic, then secondary syphilis will occur cotemporaneously with, or at a very early period after the primary disease; and indeed I generally look upon the chance of the speedy supervention of secondary syphilis as more im- mediately dependent on this, than on any other cause. It is remarkable for how long a time the syphilitic poison will continue dormant in the constitution with- out producing any local manifestation of its existence, until this is developed under the influence of a broken state of health. I have at present under my care an extremely severe case of constitutional syphilis, in which twelve years have elapsed since the occurrence of the primary disease, during the whole of which time no secondary aflection occurred until the patient's health gave way from other causes. And I have had lately an oflScer under my care in whom$