Volume 12

Encyclopaedia medica / under the general editorship of Chalmers Watson.

Date:
1899-1910
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Encyclopaedia medica / under the general editorship of Chalmers Watson. Source: Wellcome Collection.

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    Berengario da Carpi. The first outbreak was very severe, as is usual when a disease attacks an unprotected population, but the symptoms became milder when it had lasted a few years, though there were occasional out- breaks of a more severe type. Distribution.—No country and no people are exempt from syphilis. It is most common where opportunities for promiscuous intercourse are most abundant or are most readily tolerated, as in large towns and where the pioneers of a more highly civilised race are brought into contact with people in a lower state of culture. It is rarely seen in the country districts of Europe, where each knows his neighbour, for, with ordinary precautions, infection is always due to direct contact, so that any syphilitic individual has only a limited power of spreading the disease. The more benign forms of syphilis are seen in those leading healthy lives, whilst its worst ravages occur in those whose health is undermined by alcoholic excess, sexual debauchery, or unhealthy surroundings. And yet, though this is the rule, there is no question that certain people are much more severely affected by syphilis than others, for in this as in every other disease the susceptibility of the individual patient must be taken into account. General Pathology.—The general character of syphilitic manifesta- tions is that of a chronic inflammation, which in its more pure forms shows but little tendency to suppurate. The cause of the disease is still unknown. Many observers have described various micro-organisms which they have believed to be specific, but it has not yet been found possible to produce the disease either by inoculation with these organisms or by the toxins which they manufacture. It is remarkable, too, that syphilis cannot be inoculated upon animals, even the higher primates, yet no human being appears to be immune, from earliest infancy to extreme old age, unless he has been pro- tected by a previous attack. Syphilis consists microscopically of numbers of small, round cells, some of which are derived from the connective tissue, whilst others are immigrant leucocytes. These cellular infiltrations show a singular tendency to undergo resolution in the earlier stages of the disease; whilst in the secondary and tertiary stages they develop into a low form of fibrous tissue-scar or fibroid tissue—or the individual cells may coalesce to form giant cells, whilst others undergo fatty and hyaline change. This infiltration of round cells is especially liable to occur in the perivascular lymphatics and in the neuro- glia of the central nervous system. The syphilitic poison bears a direct relation to these cells in some way which is not yet known, though it is probable that they manufacture it when an infinitesimal amount has once been introduced into an unprotected body. The characteristic inflammation of the later stages of syphilis is known as a gumma, the word being derived apparently from a simile adopted by Pracastoro in his poem on Syphilis when he wrote mox in lentum durescere gummi. The gumma in its typical form is a whitish or yellowish- white globular mass, which varies in size from a small pea to a walnut as it is seen with the naked eye. It is often circumscribed, but never encapsuled; it may invade the neighbouring tissues, and is surrounded by an inflamed zone, though no vessels penetrate the gumma itself. The tissue is some- times tough and leathery in consistence, at other times it is soft and pulpy. It grows with varying rapidity, and with all the symptoms of an in- flammatory swelling. Like all other syphilitic lesions a gumma may disappear completely, but when it suppurates and can discharge on the surface of the body, it leaves a perfectly circular, crater-like ulcer with a