Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
#Secondary Syphilis.#--The following description of secondary syphilis
is based on the average course of the disease in untreated cases. The
onset of constitutional symptoms occurs from six to twelve weeks after
infection, and the manifestations are the result of the entrance of the
virus into the general circulation, and its being carried to all parts
of the body. The period during which the patient is liable to suffer
from secondary symptoms ranges from six months to two years.
In some cases the general health is not disturbed; in others the patient
is feverish and out of sorts, losing appetite, becoming pale and anæmic,
complaining of lassitude, incapacity for exertion, headache, and pains
of a rheumatic type referred to the bones. There is a moderate degree of
leucocytosis, but the increase is due not to the polymorpho-nuclear
leucocytes but to lymphocytes. In isolated cases the temperature rises
to 101° or 102° F. and the patient loses flesh. The lymph glands,
particularly those along the posterior border of the sterno-mastoid,
become enlarged and slightly tender. The hair comes out, eruptions
appear on the skin and mucous membranes, and the patient may suffer from
sore throat and affections of the eyes. The local lesions are to be
regarded as being of the nature of reactions against accumulations of
the parasite, lymphocytes and plasma cells being the elements chiefly
concerned in the reactive process.
_Affections of the Skin_ are among the most constant manifestations. An
evanescent macular rash, not unlike that of measles--_roseola_--is the
first to appear, usually in from six to eight weeks from the date of
infection; it is widely diffused over the trunk, and the original dull
rose-colour soon fades, leaving brownish stains, which in time
disappear. It is usually followed by a _papular eruption_, the
individual papules being raised above the surface of the skin, smooth or
scaly, and as they are due to infiltration of the skin they are more
persistent than the roseoles. They vary in size and distribution, being
sometimes small, hard, polished, and closely aggregated like lichen,
sometimes as large as a shilling-piece, with an accumulation of scales
on the surface like that seen in psoriasis. The co-existence of scaly
papules and faded roseoles is very suggestive of syphilis.
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