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.

    17/546 (page 5)
    sloughy base and an undermined edge. In these cases repair is slow,—unless anti-syphilitic remedies are given,—and a depressed scar is produced. Modes of Infection.—The primary syphilitic lesion, whether it be a hard sore or merely an erosion, is acutely contagious ; in the secondary stage syphilitic lesions of the skin and mucous membranes are very infectious, the mucous patches and condylomata seeming to be more liable to spread the disease than the papules and tubercles. Both in the primary and secondary stages the blood is capable of transmitting syphilis, and the lymph seems to have a similar power, though its action in this respect is less certainly known. It is not known either whether the tertiary manifestations of the disease are infective, though it seems probable that the earlier lesions are dangerous, whilst the later ones are inert. Infants with syphilis, whilst they have mucous patches and condylomata, are as capable of infecting others as those who have acquired the disease later in life, but infants with hereditary syphilis seem to be less capable of transmitting the disease than those who have acquired the disease just after birth. So far as is known at present, the syphilitic poison can only be inoculated by the trans- ference of diseased cells or the debris of cells from the affected person to an abraded surface on the recipient, and the inoculation of a fluid free from cells or containing only healthy cells is insufficient to produce the disease. The urine, milk, and sweat, therefore, are innocuous unless the glands from which they are derived are actually syphilitic, but the saliva may transmit the disease, because the mouth is so often the seat of mucous patches. This statement, however, finds an exception in the semen, which may be inocu- lated with impunity, though it has the power of transmitting syphilis to the ovum it fertilises. Syphilis can only be caused by inoculation with the syphilitic poison obtained from a pre-existing case of syphilis, but the poison is of great potency, and has some power of withstanding external influences. It is usually acquired during sexual intercourse, and the seat of inoculation therefore in about 90 per cent of the cases is at, or near, the genital organs. Indeed, the overwhelming proportion of cases of syphilis due to venereal infection has somewhat masked the fact that syphilis from a pathological standpoint is a chronic infective granuloma starting from a local lesion, the disease being one which in all probability must be classed between leprosy and cancer. Inoculation with the syphilitic virus at any point is always suc- cessful in an unprotected person, and may lead to the disease in all its forms. It is not uncommon, therefore, for persons to contract syphilis accidentally and without venereal intercourse. Syphilis obtained in this manner is sometimes called Syphilis insontium or Syphilis of the innocent, a thoroughly unscientific expression, for ethics have no place in pathology. Women, from their habit of kissing babies and casual acquaintances; surgeons, accoucheurs and midwives, from the nature of their occupation, are specially liable to contract syphilis. Certain occupations have been fruitful in the spread of syphilis, notably glass- blowing, where the blowing-tube is passed from mouth to mouth. Out- breaks of syphilis have been traced to arm-to-arm vaccination, and some years ago I saw several Jewish children who had been inoculated during the performance of ritual circumcision. Dr. Bulkley, who has paid special attention to these unusual sources of infection, states that in extra-venereal syphilis, chancres of the lip are much the most numerous, the principal cause for the sore in this situation being kissing. Chancres of the breast and nipple, which come next in frequency,