Clinical lectures on the physiological pathology and treatment of syphilis : together with a fasciculus of class-room lessons covering the initiatory period / by Fessenden N. Otis.

  • Fessenden Nott Otis
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on the physiological pathology and treatment of syphilis : together with a fasciculus of class-room lessons covering the initiatory period / by Fessenden N. Otis. Source: Wellcome Collection.

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    the immediate effect of the general dissemination of the diseased cells or virus throughout the organism was attributed the appearance of this so-called roseola of syphilis. Its accession was accepted as im- portant only as announcing the constitutional infection. Very many cases occur where, either with or without treatment, no farther man- ifestation of syphilis takes place during the entire active period of the disease, and yet these apparently mild cases, when not efficiently treated, are sometimes sufferers in after years from grave forms of syphilitic sequelae. If, at this point, we take up again the natural history of syphilis, in typical cases, we shall find presenting, an inflammatory engorgement of the mucous membrane of the tonsils, the border of the soft palate, and often of the whole faucial region. In this connection your attention is directed to the fact that the ton- sils have been accepted as belonging to the lymphatic system, repre- senting a simple form of lymphatic gland. Although no direct com- munication has yet been demonstrated between the follicles composing the gland and the adjacent lymphatic vessels, Frey has shown that the surface of each follicle is invested by an extraordinarily close net-work of lymphatic vessels. 1 The investigations of His, Reck- linghausen, and Teichman have confirmed this statement, and have further shown that the lymph vessels so investing a follicle are greatly dilated, so much so that the follicle is quite covered in by them, leaving only that extremity or pole uncovered which is directed toward the surface of the mucous membrane. 2 The entire pharynx is much richer in lymphatics than the sur- rounding mucous membrane.3 Here, then, in common with the en- gorgement and hyperplasia which has been observed at about this period in the lymphatic system at other points, we should expect early manifestations of similar disturbance. . Reasoning a priori, we should expect that these lymphatic accesso- ries, when implicated in obstructive trouble, would be more readily engaged in true inflammatory engorgement, as they are brought, by more superficial distribution into a more intimate connection with the blood vascular system than occurs in lymphoid glands of a higher order. This is just what we do find, leading in certain instances to quite extensive tissue loss through a consequent ulcerative process. Now, also, at about this time, we begin to find, in a very consider- able proportion of cases, a true papular eruption of the skin, — usually first observed along the borders of the hair, especially prominent and noticeable along the upper part of the forehead. It may also be seen scantily developed on the back, breast, and extremities. Again, it may 1 Human and Comparative Histology, Strieker, Syd. Ed., vol. i., p. 328. 2 Ibid., page 328. 3 Ibid., page 326