I shall adopt the plan as outlined by Dr. Fox, and include under the head of diathetic diseases the strumous, the syphilitic, and the leprous diseases of the skin. There are some objections to this classification, but they do not outweigh the advantages of the arrangement. In struma, syphilis, and leprosy the changes in the skin are but a small part of the whole disease, and only evidence of a disposition on the part of the tissues of the body, as a whole, to become changed and disordered.
This disease does not require to be dealt with very elaborately. “It is scrofula of the skin,” and only a part of the general diathetic condition, which is evidenced by the ordinary signs of struma in greater or less degree of expression. As regards the skin, scrofula is generally characterized by the appearance at the outset of indolent, dull red, soft, tubercular formations, that rapidly suppurate, and are soon covered over with darkish scabs, from beneath which oozes an unhealthy pus. Ulceration to a greater or less degree takes place, with the formation of exuberant granulations at times, and the healing is accompanied by distinct scarring. The whole disease is of the most chronic character. One can scarcely mistake the strumous ulceration for any other disease; it may spread and cover a large extent of surface, and in this case the ulcerated surface is half covered by darkish irregular crusts, whilst the ulcers discharge a thin disagreeable dark pus, and granulations are flabby and pallid, bleeding freely on being touched; the edges of the ulcers are livid, and various attempts at repair are made. The mucous surfaces of the nose or eye may be inflamed and slightly ulcerated and onychia may be present. There are old scars of former strumous disease, and the whole aspect of the patient is a sufficient tell-tale of the disease.
The old school advises the use of cod-liver oil, iodide of iron, the phosphates of lime and iron, and locally an astringent ointment of tannin; or acetate of lead; or mercurial plaster; or iodide of lead ointment to the indolent ulcerated surfaces. Residence at the seaside is also advisable.
These patients should be allowed an abundance of fresh air, plenty of outdoor exercise, and a generous diet When the ulcers have formed, dress them with the iodide of starch paste.
Alnus rubra.-Enlargement of submaxillary glands, strumous enlargement of tonsils; obstinate impetigo and porrigo, chronic diarrhoea; scrofulous disease of hip-joint; disease of mucous membranes, which arise from or alternate with eruptions of the skin.
Arsen. iod.-Diseases of mucous membranes, characterized by a peculiar and persistently irritating corrosive character of the discharges; constant susceptibility to take cold; excoriated nostrils and lips; swollen and covered with scabs.
Arsen. met.-Great emaciation, clay-colored face, blue margin around the eyes; great weakness of all the limbs; want of disposition to do anything, and constant inclination to rest; lax muscles; swelling of the cervical glands; distended abdomen; diarrhoea; scurfy eruptions and ulcers; ophthalmia; carcinoma.
Asafoetida.-Glands hard, swollen, hot, and throbbing, with shooting jerking pains; soft enlargement of bones, with curvature; ulcers with high hard edges, sensitive to touch, easily bleeding, pus profuse, greenish, thin, offensive, even ichorous; phthisis when suppuration threatens; osteitis and caries; scrofulous ozaena; hardness of hearing, with thin purulent discharge of offensive odor; scrofulous, bloated, clumsy children, with phlegmatic temperament.
Asclepias tub.-Strong tendency to tubercular development; sharp pains in different parts of the body, with muscular soreness, changing from one part to another; impaired strength, rather feeble digestion and assimilation; glandular enlargement about neck; vesicles; pimples and pustules all over the body.
Aurum met.-Scrofula, ruddy complexion, light haired, sanguine temperament; glands painfully swollen; ozaena, with caries of nasal bones; fetid otorrhoea from caries of mastoid process; caries of cheek bones; tearing, boring, burning stitches in zygoma; red and swollen tonsils; profound ulceration in throat.
Badiaga.-Dandruff or dry, tetter-like appearance of scalp, with slight itching; scrofulous ophthalmia, with hardening of the Meibomian glands; tonsils red and inflamed; indurated glands; glandular swellings on left side of face, throat, and neck, some hard, some suppurating; small hard lumps along tibia; flesh feels sore as if it had been beaten, and very sensitive to touch or friction of clothes.
Baryta carb.-Physical and mental debility; atrophy, great weakness; face red and abdomen bloated, glands swollen, indurated; fatty or encysted tumors; coryza, nose, and upper lip swollen, scurfs under the nose; chronic induration of tonsils; sensation as of a plug in throat, worse swallowing solids; crawling in rectum, expulsion of ascarides; cannot retain the urine; chronic cough, with swollen glands and enlarged tonsils; worse after slightest cold, with soreness in chest and when coughing; chronic torticollis; pimples, ringworms, humid sores.
Bellad.-Hard, swollen, and ulcerated glands; muscular debility, with difficulty of learning to walk; photophobia, inflammation of eyes and eyelids; cough, with mucous rales; otorrhoea; emaciation and atrophy; ulcers; inflammatory swelling of nose and lips; frequent epistaxis; frequent sore throat, with swelling; distended and hard abdomen; enuresis day and night; premature development of mind; blue eyes and blonde hair.
Berberis aquifol.-This remedy is highly recommended by several physicians. Dr. Mallery uses the following prescription.
Rx. Fluid ext. berberis.
Syrup simplex, aa 3iv.
M.S. Teaspoonful every four hours.
Bromium.-Swelling and induration of the glands; enlargement of thyroid, in children with light hair, blue eyes, and fair skin; pimples and pustules; boils on the arms and face; hard swelling of left parotid, edges of opening smooth, discharge watery and excoriating, swelling remaining hard and unyielding; tonsillitis; swallowing of fluids more different than of solids; hard uneven tumor in right mammae, firmly adherent to its surroundings, with lancinating pains, worse at night; stiffness of neck.
Calcarea carb.-Malassimilation; tardy development of bony tissue; large head with open fontanelles; curvature of the back and vertebrae or other ricketic affections; herpes, tinea, crusta lactea; hard or suppurating glandular swellings; ulcers, exostosis, or caries; hard and enlarged abdomen, with swelling of mesenteric glands; emaciation and voracious appetite; thirst constant, even after drinking; profuse perspiration of head; thin and wrinkled face, with dim eyes; dry and flaccid skin; difficulty of learning to walk; difficult dentition; red swelling of nose; bronchocele; swelling of upper lip; frequent bleeding of nose; feet cold and damp; craves eggs.
Calcarea iod.-Tendency to alternate diarrhoea and constipation;no thirst; pustular eruption, sore and painful, with desire to rub and scratch it, though it makes it worse; abdomen enlarged, breath offensive; cold sticky perspiration, feet cold and damp; restless, fretful, and irritable; pus fro, abscesses thin and ichorous; granular inflammation of membrana tympani; scrofulous ophthalmia.
Calcarea phos.-Emaciation, dirty-white or brownish complexion; skull soft, thin, crepitating when pressed, especially in occiput; craves bacon, salt meat, and potatoes; swelling of the epiphyses, difficult teething, slow closing of the fontanelles; curvature of spine to the left, lumbar vertebrae bent forward; abscesses near lumbar vertebrae; incipient mesenteric tabes, with much fetid diarrhoea. Tendency to tuberculosis.
Chimaphila.-Glandular enlargement, especially of lymphatics; enlargement of mesenteric glands; ulcers of an indolent and flabby character; tumors in mammae.
Cina.-Child feels uneasy and distressed, does not want to be touched, is not pleased or satisfied with anything, leaves his head side-ways all the time, rubs nose constantly; pale sickly- looking face; hunger and thirst soon after eating, with gnawing sensation in stomach; abdomen hard and distended; itching at anus; ulcers with scanty discharge; inability to retain urine.
Cistus Can.-Glands swollen, inflamed, indurated, or ulcerated; drawing tearing pains in all joints; itching all over the body, without eruption; herpetic eruption of various parts; chronic scrofulous ophthalmia, feeling as if something was passing around in the eye, with stitches; watery, bad-smelling pus discharged from ears; tetters on and around ears; swelling of parotids; eczema of nose; caries of lower jaw, with suppurating glands in neck; cool feeling in stomach and abdomen; cool eructations; chronic diarrhoea; swelling and suppuration of glands of throat; scrofulous ulcers on back; desire for acids and acid fruit, but they cause pain and diarrhoea.
Conium.-Swelling of glands, with tingling and stitches; marasmus with frequent sour belching, worse during night; erratic itching of all parts of body; humid, burning, corroding, crusty herpes; blackish ulcers, with bloody, fetid, ichorous discharges, especially after contusions; ophthalmia with, photophobia; blennorrhoea bronchialis; asthma; carcinoma.
Corydalis form.-Scrofulous cutaneous diseases, accompanied by feeble digestion and poverty of blood; scrofulous syphilitic diseases.
Cornus circin.-Scrofulous ophthalmia, herpes of eyelids; ulcerations of tongue, gums, and mouth.
Graphites.-Swelling and induration of glands; eczema capitis of entire scalp, forming massive dirty crusts, which mat the hair together; eczema beginning as a moisture behind left ear, and spreading over cheeks and neck; thick, yellowish, fetid discharge from nose; dry scabs in nose, with sore, cracked, and ulcerated nostrils; painful nodules on lower jaw; chronic catarrhs of stomach and bowels; glandular swelling in groins; fissures and rhagades; turbid urine; unpainful swollen glands on nape of neck.
Hecla lava.-Scrofulous ostitis or periostitis, resting on a syphilitic basis, and especially affecting the bones of face and of antrum highmori; difficult dentition; rachitis; hip disease; white swelling; induration and infiltration of cervical glands, studding the neck like a row of pearls; toothache from swelling about the jaws; abscesses of gums from decayed teeth.
Hepar.-Glands inflame, swell, and suppurate; hard burning nodosities; unhealthy skin: slight injuries suppurate; stinging burning of edges of ulcers, discharging bloody pus; humid eruption of fetid odor, feeling sore, itching violently; nodosities on head, relieved by covering the head warmly and from sweat; discharge of fetid pus from ears; boils on face, lips, and chin; cancerous ulcers; disposition to phlegmonous sore throat, catarrh, or bronchitis; atrophy.
Hydrastis.-Chronic catarrhs of mucous membranes wherever situated; cancerous cachexia; cancers hard, adherent; skin mottled; puckered, with lancinating cutting pains; atony of muscles.
Hypophosphite of Lime.-One of the best remedies we have for so-called scrofulous manifestations. It fully answers Hahnemann’s indications for the use of Calcarea carb. in scrofulous affections, especially when occurring in children, namely, the overgrowth, the large head and open fontanelles, the distended abdomen, the tendency to swelling of lymphatic glands, the tendency to brain affections, to catarrhal discharges, abscesses, etc.
Iodum.-Emaciation, in spite of the necessity of eating every few hours; swelling and induration of glands, the whole of the lymphatic system being involved; swelling of mesenteric glands; bronchocele; scrofulous women, with dwindling and falling away of the mammae.
Kali bichr.-Scrofulous ulcers and skin diseases; discharges from mucous membranes tough, stringy, sticking to the parts; caries of the bones of the nose; strumous ophthalmia; pustular diseases of skin, secreting a watery fluid when broken or drying up into a yellow tough mass; fat, chubby children; fat, light- haired persons.
Kali hydroiod.-It distends all tissues by interstitial infiltration; enlarged glands; tophi; exostosis; swelling of bones; necrosis; all worse at night; bronchial and submaxillary glands swollen, ulcerating, atrophied; goitre; papules on face, back; small boils on face, head, neck, back, and chest, leaving scars; pustules on cornea, without photophobia, redness, or pain.
Lithium carb.-Skin rough as a grater, harsh, dry; dry itching eruption like ringworms; milk crust; whole body, bones, joints, muscles, sore as if beaten.
Lycopodium.-Swelling and suppuration of glands; herpes and ulcers; humid suppurating eruptions, full of deep rhagades, breeding lice, itching violently; intertrigo; raw places, readily bleeding; boils which do not mature, but remain blue; scalp covered with scabs; chronic enlargement of tonsils.
Lapis albus.-Scrofulous affections, abscesses, and sores; enlargement and induration of glands, especially cervical; glandular tumors, where physiologically no glands are usually found; goitre; cretinism.
Mercurius.-Glandular swellings, with or without suppuration; cachectic affections; exostosis, curvature, caries, and other affections of bones; eruptions and corrosive herpes with crusts; tinea capitis; crusts in the face; suppuration, especially if too profuse; ulceration of tonsils.
Mercurius biniod.-This is one of our best remedies. It is especially in the relief of those tardy engorgements and ulcerations which follow the discharge of the softened scrofulous matter. It may be given during the growth or swelling of the gland with the hope of dispersion, as we cannot always surely know whether the enlargement is attributable to the presence of scrofulous matter or to simple congestion and engorgement.
Natrum carb.-Swelling and induration of glands; emaciation, with pale face, dilated pupils, dark urine; skin dry, rough, and chapped; suppurating herpes, with yellow rings; goitre; swollen cervical glands; humid herpetic eruptions and ulcers on nose, lips, and around mouth; burning fissures on lower lips.
Oleum jec. ars.-Only indicated in patients of a slender and lean figure, thin, transparent skin, with a frequent pulse, great excitability of the nervous system, and high specific gravity of the urine-all signs of an accelerated metamorphosis.
Petroleum.-Swelling and induration of glands; unhealthy skin; small wounds ulcerate and spread; polypi; salt rheum on arms and hands, red, raw, burning, moist, or covered with thick crusts; herpes on knees and ankles.
Phytolacca.-Swollen tonsils; indurated glands; glands and bones inflamed and swollen.
Psorinum.-Pale, sickly, delicate children, whose body always has a filthy smell, even after a bath; deeply penetrating, ichorous ulcers; skin dirty, greasy-looking, with yellow blotches here and there, at times itching; scratching gives temporary relief; hair dry, lustreless, tangles easily; pustules and boils on head; scalp looks dirty and emits an offensive odor; wants to have the head covered even in hot weather; purulent offensive otorrhoea; submaxillary and lingual glands swollen, sore to touch.
Rhus tox.-Swelling of glands; herpes in the face and other eruptions discharging pus or forming crusts; emaciation; hard and distended abdomen.
Sarsaparilla.-Great emaciation, skin shriveled or lies in folds; herpetic circular ulcers, forming no crusts, red granulated bases, white borders; deep burning rhagades; milk- crust; ophthalmia after checked tetters; marasmus of children; neck emaciated.
Silicea.-Swelling and suppuration of glands; exostosis; curvature, and caries of bones; pale and bloated; disposition of skin to ulcerate; eczema, impetigo, herpes; tendency to boils, which leave indurations; carbuncles; malignant pustule; blepharitis; otorrhoea; canine hunger, with nervous irritable persons; desires only cold things; swelling and induration of cervical glands and parotitis; imperfect nutrition, not from want of food, but from imperfect assimilation.
Spongia.-Swelling and induration of glands; skin and muscles lax; light hair; fevers; yellow scabby eruption; suppuration of external ear; insatiable appetite and thirst.
Sulphur.-Scrofulous and rickety complaints; emaciation of children, face has a very old look; dry flabby skin; glandular swellings; indurating and suppurating; ulcers, with raised swollen edges, bleeding easily, discharging fetid pus, surrounded with pimples; humid offensive eruptions, with thick pus, yellow crusts. itching, bleeding, and burning; ophthalmia and blepharitis; purulent offensive otorrhoea; painful eruptions around chin; lips dry, rough, and cracked; curvature of spine from softening of vertebrae; hangnails; burning of soles, wants then uncovered; children dislike being bathed; especially suitable for lean stoop-shouldered persons.
Theridion.- Scrofula, rachitis, caries, necrosis, when other remedies fail reach the root of the evil, and destroy cause; itching on scalp; itching behind ears, she would like to scratch them off, chronic catarrh of nose, discharge offensive, thick yellow or yellowish-green; Phthisis florida, in beginning.
Syphilis is a disease that involves, not only the skin, but every other organ and tissue of the body. Its cutaneous relations, however, are those which chiefly concern us.
The first visible lesion of syphilis usually appears in from ten to twenty days after an infective intercourse, as a small papule or erosion, going on to ulceration, and most frequently situated on the genital organs. Extragenital chancre, however, may be met with in a variety of locations, more frequently, perhaps, about the mouth than elsewhere. This lesion is termed a chancre. In a short time a limited induration of the subjacent tissue occurs, so that the chancre when taken between the fingers appears to have a hardened base. This induration may be, and frequently is, absent in genital chancres in women, and the lesion may be altogether overlooked. In the course of two or three weeks after the appearance of the chancre certain of the lymphatic glands become involved, and take on enlargement and hardness. The glands chiefly noticeable in this respect are the inguinal, cubital, post-cervical, and post-auricular.
About this time, or a little later, we may expect a generalized outbreak upon the skin.
The various manifestations of syphilis on the skin, or syphilides, as they are commonly called, present different types and degrees of severity, and involve the skin either superficially or deeply. We may, however, classify them to a certain extent, and in doing so will find that they partake of one or the other of the following characters, namely : macular, papular, tubercular, pustular, squamous, bullous, and gummatous, together with ulceration, occurring with, or following, any of the five types last mentioned.
The appearance of the first cutaneous eruption ushers in what is termed the secondary period of the disease.
As a rule, the first eruption is macular, and consists of small, rosy points or spots usually called syphilitic roseola. These present little or no elevation, and disappear under pressure, showing that they are little mote than points of congestion. They usually pass away within a few weeks, with or without treatment. They are chiefly met with on the trunk and extremities.
Another and much rarer macular lesion is the pigmentary syphilide, which appears as dark-colored spots on the neck, and almost wholly confined to young females. After a time a portion of the pigmentary deposit fades away, producing a somewhat characteristic appearance some what resembling vitiligo.
After the macules of syphilis have disappeared, or even before they are quite gone, a generalized eruption of papules may appear. These are solid elevations, and not unfrequently present minutes scales at their apices. Should the patient be broken in health, a tendency to pustulation and ulceration may be developed; and we may have the papules becoming purulent at their summits, or we may have a frankly pustular eruption from the outset. As the disease progresses there is a tendency to deeper involvement of the integument and larger size of the lesions, so the papules are not uncommonly followed by tubercles, not perhaps as numerous as the papules, but still freely distributed over the entire surface. These not infrequently undergo ulceration and become covered with greenish-black crust.
In addition to the foregoing, we may have the appearance of reddish and not greatly elevated patches, covered with white scabs, constituting the so-called squamous syphilide. These various manifestations may occupy a year or more in their evolution, l and embrace the secondary period of the disease. After the disappearance of these various eruptions, there is not infrequently a decided halt in the progress of the disease, and the patient may go on for a considerable period, for years even, without a fresh outbreak. When it does come, however, it ushers in what is known as the tertiary stage of the disease.
In the tertiary period of syphilis the eruption are usually of a tubercular or ulcerative character, and, instead of being generally and somewhat evenly distributed over the surface, they are usually collected into groups; for instance, half a doze or more tubercles may form a group or patch, and there may be one or several such patches. As a rule, the number of patches is limited. The individual lesions sometimes disappear by absorption, but very frequently undergo ulceration, and in either case leave indelible scars. In this stage of syphilis we meet with the lesions known as the gumma. It consists of a small tumor, which usually undergoes softening throughout its entire substance, and terminates by ulceration. This lesion is not confined to the skin, but may involve almost any organ of the body.
Concomitants of Syphilis.- The disease we are describing does not vent its entire energy upon the skin, but early in its history it exhibits its presence on the mucous membranes by the development of rather large, flattish tubercles in the mouth and about the genital organs and around the anus. It is in females especially that the mucous patch or condyloma reaches its highest development.
Early in the disease, too, the hair may fall out, so that an almost complete alopecia of the scalp may occur before it is checked by treatment. This early alopecia, however, is not permanent, as the hair begins to grow again as soon as the patient is brought under the influence of proper constitutional treatment. During this period, also, inflammation of the iris is a not infrequent complication.
Ulcerations, more or less extensive, of the soft palate and tonsils, may supervene among the early or late symptoms of the disease.
In the tertiary period painful swellings are met with along the course of the long bones, especially the tibia and in the flat bones of the skull. These nodes, as they are called, are due to an inflammatory deposit beneath the periosteum, which is usually accompanied with considerable pain, worse at night. The gummy deposit, separates the periosteum from the bone, and, by depriving the bone-tissue of its proper nourishment, produces necrosis.
An interesting case is reported of ulcerating gummata of the scalp scalp forty-four years after infection, as occurring in a man aged 63, who contracted syphilis when between eighteen and twenty years of age. Typical syphilides followed, relapsed a number of times and finally disappeared without treatment. When he was twenty-four years (about five years after infection) he married. His wife miscarried once, but remained healthy, dying at sixty. His eldest son developed psoriasis palmaris when seven years old again when eighteen, which was caused by anti- syphilitic treatment; in other respects, as well as his younger sister, remained well. The patient himself was affected by herpes zoster in 1878. In 1886 a gumma appeared on the left parietal bone, which ulcerated and exposed the bone and caused necrosis. Gradually the bone was cast off, and necrosis of the diploe appeared. As, however, demarcation proceeded slowly and symptoms of pressure on the brain set in, trephining was decided upon, which exposed a collection of pus under the necrosed bone. Improvement set in on anti-syphilitic remedies. Soon, however, an attack occurred during which he lost consciousness; then the functions of the brain became disturbed, intelligence gradually waned, oedema of the extremities set in, new gummata appeared on the scalp, and the patient died. Post-mortem there were found thrombosis of the iliacs, caries and necrosis of the left parietal bone, thickening of the meninges, beneath it, but no pathological changes in the brain.