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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    away, are affected uniformly and at a very early stage of the inflammation, for the endothelial cells are swollen and proliferating, whilst the walls are infiltrated with the small round cells always found in syphilitic inflammations. The peri- vascular lymphatics soon become crowded with similar round cells, whilst the lymphatic vessels themselves are enlarged and thickened. It appears, therefore, that the initial inflammatory lesion of syphilis spreads along the lymphatic spaces in the outer coats of the blood-vessels—the peri- vascular lymphatics—until the nearest lymphatic glands are reached, and from these glands the inflammation spreads to other glands more remote from the seat of inoculation. The general glandular enlargement, however, is evidence of con- stitutional infection, and is not the result of inflammation spreading from one chain of lymphatics to another. Treatment of Primary Syphilis.—It is probable that in the case of syphilis, as in all other inoculable diseases, the virus takes some short time to enter the tissues, and that if any abrasion or sore could be disinfected shortly after inoculation, the further spread of the disease would be arrested. The circumstances under which syphilis is contracted, whether genitally or extra-genitally, are prohibitive of such disinfection, unless perhaps in the case of a surgeon or midwife knowingly inoculated in the course of their duties. Excision, cauterisation, and even the most careful disinfection are useless when the primary sore has become manifest, for analogy with all other infective diseases shows that the initial manifestation is only evidence of general infection. Yet the fears of patients have led to divers experi- ments in the way of local removal, but without any definite satisfactory results. The treatment of primary syphilis, therefore, resolves itself into treat- ment of the chancre, and constitutional treatment of the disease of which the chancre is the local indication. The simplest means are usually sufficient to cure the chancre, which has indeed a tendency to undergo spon- taneous resolution if it be not irritated and if it is kept clean. The sore in its simpler forms should be gently washed night and morning with warm boric lotion, a piece of dry gauze or lint being laid over it in the intervals to protect it from injury and to absorb any slight serous discharge which may be produced. More active measures must be taken when suppuration occurs, the bathing should be more frequent, and a lotion of 1 in 2000 biniodide of mercury may be substituted for the boric lotion. Many patients have a distinct objection to the use of iodoform, chiefly on account of its smell when it is carelessly applied, but it is often a most excellent application, and if care be taken not to spill it over the clothes it can be used with a minimum of discomfort. Black wash and lotio plumbi are also very serviceable applications whose advantages have withstood the test of time. There is great diversity of opinion as to the proper treatment to be adopted constitutionally about the time of the appearance of a sore. Every one is agreed that mercury should be given as soon as syphilis is recognised, for mercury is the antidote to syphilis, and the induration of a hard sore disappears more rapidly when mercury is administered than when it is withheld. Every one, however, is equally agreed that the first and most important question to decide is that which is the most difficult in the majority of cases, viz.: Is this patient suffering from syphilis, or is the sore which he presents due to some local inflammation ? The greater his experience the more does a practitioner recognise the many pitfalls which beset the diagnosis of syphilis in its earliest stages, and the more reluctant is he to pronounce a definite opinion in the many doubtful cases which come under his observation. It has become a rule, therefore, to adopt a