In most cases, if the question is merely to distinguish syphilitic products from similar products of syphilitic diseases, such a diagnosis is comparatively easy. All syphilitic products are so characteristic in their appearance that any one who has seen them only once, and has read our description of these products in the following paragraphs, can scarcely ever remain in doubt concerning their true nature, so much more as, besides the anamnestic influences bearing upon the case, the diagnosis is facilitated by this other circumstance, that these secondary forms or products never occur singly, but always in company with others; for instance, ulcerations of the mucous membranes, or affections of bones, in company with suspicious cutaneous eruptions, or several kinds of the different syphilidæ, such as pustules, maculæ, herpes, etc., at one and the same time. At the same time, a close examination will very frequently reveal the existence of old chancres in the period of reproduction, or remnants of badly healed cicatrices, even mucous tubercles, or other remnants of the second or transition-stage of the primary period; for the reason that the secondary period does not set in after the completion of the primary period, but while the transition-stage is still running its course, or even simultaneously with its commencement. This takes place likewise with other diseases, where the different stages are not always sharply circumscribed. This simultaneity, in the manifestation of different forms, likewise distinguishes the secondary period of syphilis with great definiteness from the primary. If, in the course of a neglected chancre, sycosic gonorrhoea, or other primary appearances, pustules or other syphilitic manifestations on the skin supervene, we may rest assured that the secondary period has already commenced and that the existence of a general constitutional infection will very soon become
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| syphillitic lesions on tongue |
manifest by the supervention of other symptoms. If the diagnosis of true syphilis is in all cases unattended with any marked difficulties, on the other hand, it is not always equally easy to diagnose the true character of similar appearances in case they appertain to non-syphilitic diseases; the probability is, therefore, that phenomena which have not the remotest connection with syphilis may be mistaken for syphilitic symptoms much more frequently, than that a somewhat practised physician should misapprehend truly syphilitic phenomena for manifestations of a non-syphilitic disease. Such misapprehensions are more apt to occur in regard to mercurial symptoms, which, after the effects of mercury have reached a certain point, share with secondary syphilis the faculty of not only producing local phenomena that are readily mistaken for syphilitic appearances, but of producing several of them at once and at the same time. There is no other way of avoiding such misapprehensions than to become perfectly familiar with the analogous effects of Mercury. In order to facilitate this study, I have added at the close of this work an article on the so-called mercurial syphilis, which the practitioner will do well to compare with the symptoms in the case of patients, who, some time previous, had been treated with large quantities of Mercury for real or supposed syphilis, who had been much exposed to the influence of Mercury in their business. Many of these mercurial symptoms I have seen breaking out even after a persistent homoeopathic treatment with large doses, not only ulcers and aphthæ in the buccal cavity, but likewise papulæ and flat ulcers on the skin, of a very suspicious look, but distinguished from syphilitic ulcers by the pruritus which is never present with the last-named products of disease.