GENERAL QUESTIONS IN SYPHILIS, ETC. 443
II.
SYPHILIS AND VENEREAL DISEASES.
GENERAL QUESTIONS IN SYPHILIS, THERAPEUTICS, ETC.
CHARLES W. DULLES, M.D.
Second attack of syphilis. — At a meeting of the Medico- Chirurgical Society of Louisville, Yandell reported a case of a man above 50, strumous, and suffering " numerous and severe manifesta- tions of secondary syphilis. . . . Under quinine, iron, cod-liver oil and malt, together with the moist mercurial vapor-baths, he was, within a few months, entirely cured. . . . During the two following years he had no relapse. . . . A few months since . . . a semilunar, gristly induration, immediately behind the top of the glans penis, demonstrated that he was the victim of an indurated chancre. Un- der the same treatment that was used in the first instance he is rapidly recovering."
HoLLOWAY reported a case where a colored man, aged 58, was treated in his clinic an entire year for "consecutive" syphilis. Under persistent mercurial and iodide treatment he slowly recovered. Last winter he came again, and had "an indurated, split-pea-like chancre, which was located upon the preputial mucous membrane, near the corona gland is. The mucous membrane of the glans and prepuce and a narrow circle of the contiguous skin were free from pigment. . . . The inguinal lymphatics were symmetrically enlarged and painless." After the use of calomel and opium internally, and dryness locally, in three weeks "the chancre had disappeared. There had been no secondary symptoms three months after."
Sigmund has said, in his latest utterance upon this subject, " The extremely {^^^ instances of a repeated attack of syphilis (re-infection) which I have myself observed, have left me much in doubt as to the entire correctness of the previous or of the present diagnosis. Further, I should add, that I know no case in my own circle of observation in which, after an established attack of syphilis, a later, new and second infection followed. I know, of course, cases so designated, a more careful observation of which, however, controverted the di- agnosis of a second infection." The cases we have quoted above are both (as reported) open to the criticism of lacking the element of faultless accuracy of observation, which is of the utmost impor- tance in such unusual circumstances. Of the first (Yandell's) it will be noted that the diagnosis of the earlier (?) attack was in a stru- mous sul)ject, and no details of the syphilitic manifestations are given, while the assumption of a later attack rests upon finding a gristly induration, — nothing else is stated.
