among the nations of Europe to an extent and with a severity before then unknown. In reviewing the entire subject many of the arguments in favor of the historical antiquity of these diseases are, it must be admitted, weakened by the indefiniteness of the descriptions given. The bones alleged to be both prehistoric and syphilitic are either lacking in the display of unmistakable lesions of that disease or cannot conclusively be demonstrated to be both of prehistoric sepulture and since then wholly undisturbed by the hand of man. The arguments in favor of a prehistoric syphilis in America and of its subsequent deportation to Europe are weighty, but not without flaw. The conclusions are simple: the evidence of a remote antiquity for the venereal diseases in general is very strong. In the absence of the definite distinctions between them now established, and of a recognition of the pathological connection between the local manifestations of such diseases and their systemic effects, great confusion has existed in the past. Lastly, the venereal diseases have all, without question, been confused inextricably in the past, not merely with each. other, but with a large number of dermatological affections, such as lepra, psoriasis, scabies, eczema, simple and venereal warts, and leucorrhoeal and catarrhal discharges. In the examination of patients affected with one or several of the disorders here considered, a systematic method is of as much value as in other departments of medicine. Besides ascertaining the name, age, residence, married state, occupation, and previous history of the patient, as well as the habits respecting the use of both alcohol and tobacco, it is desirable to know, for reasons that appear later, in the case of both man and woman, the record as respects living and dead children, miscarriages and abortions on the part of a wife, and the relative order of these, as well as the period in pregnancy when a series of abortions or miscarriages occurred. In securing the history of the family and of any antecedent disease it is necessary to record all facts respecting any prior disease of the skin, persistent headache, especially with nocturnal exacerbation, any attacks supposed to be rheumatic, and any persistent or ulcerative affection of the throat, eyes, scalp, or nails. In the case of venereal disease it is important to know whether the patient can sleep at night without rising from the bed to empty the bladder; whether there is pain on micturition, and, in the latter event, whether the pain occurs before, during, or after the passage of the stream. In the physical examination of patients the several bodily organs should be investigated with care, the surface of the body, when found practicable, being searched for traces of any existing or past exanthem, and particularly for scars, each of which may throw light on the conditions existing. The superficial glands of the body accessible to the fingers should be searched with a view to determining any enlargement or induration. The mouth, nostrils, eyes, and ears require minute observation of lesions present; and even in the absence of the latter the nails may exhibit markings indicative of the character, and at times of even the date, of prior nutritional changes. In the case of male patients the entire surface of the body may often be exposed for examination, and the genital region then requires detailed inspection. By the fingers and the eye the physician can usually determine the existence of pediculi or nits in the pubic region, an eczema or a psoriasis of the cutaneous surface of the penis or the scrotum, mollusca of the latter region, or the evidence of scabies. By manipulation it will be discovered whether there is an inguinal hernia, a nondescended testis, a left- or more rarely a right-sided varicocele, a gumma of the body of the testicle, or traces of an ancient epididymitis involving the globus minor or major as a sequel of a preceding blennorrhagia. By the fingers alone it will often be practicable to recognize a urethral stricture, a periurethral phlegmon, an enlarged prostate, a syphilitic or a chancroidal bubo, a severe phimosis, a subpreputial sclerosis or other lesion, or a urethral chancre. In point of fact, a urethral sclerosis that cannot be recognized by the digit of the trained physician is among the greatest of rarities. Indeed, one might here enumerate the entire list of diseases of the ano-genital region, evidences of which the examining surgeon should not permit to escape his observant eye and trained touch. In all classes of women the examination should be made with the special consideration to which the sex is entitled. A follicular or furuncular affection of the labia, a catarrhal discharge from the vulva, a sclerosis of the meatus or of the fourchette, or a stellate chancroid of the anal region, may often be determined by inspection alone. The physician must know to distinguish. between a languette accompanying a syphilitic stricture of the rectum and a hemorrhoidal tumor. He must be capable of recognizing the marked differences between a pruritus of the vulva, which is simply tormented by scratching, and an eczema of the same part. By carefully inspecting the dry and "sticky" mouth of a woman it can be determined with reasonable probability, before subjecting the urine to chemical analysis, that an "eczema" of the vulva is due simply to a glycosuria. The fingers should differentiate an inflammation of the vulvo-vaginal gland due to gonorrhoea from a syphiloma of the labium. Scabies of the genital region in a woman will usually be an echo of characteristic burrows about the axillæ or the breasts. By the touch one should be able to discover a hydrocele of the canal of Nuck, a varicocele, a carcinoma, an elephantiasis, a contracture of the vagina, a laceration, an atresia of the hymen, or a vaginismus. Nor should it be concluded in either sex that a deter mination of the virgin state precludes the possibility of venereal disease. The physician should ever be on the alert to recognize a chancre of the tonsil, an infecting sclerosis of the lip in the child who has kissed a syphilitic nursling, a gonorrhoea affecting the vulva or the eyes of an infant, a paralysis in the middle period of life due rather to a pachymeningitis than to an apoplectic effusion. Lastly, the physician entrusted with an intimate knowledge of the sources of diseases that are viewed with shame, loathing, and remorse, often imperilling the life of the individual, the safety of the uninfected, and the happiness of a home, has a part to perform which demands a high order of intelligence and sympathy. His it is to protect the innocent, to guard sacredly the secrets confided to his keeping, to conserve the family relation, and at the same time to bring the sufferer to a successful termination of the disease. It is difficult to decide that any one of these functions has a higher importance than another. It is only as the physician discharges his full duty in all points that he ultimately wins that trust and confidence which are the foundation of the largest professional success. SYPHILIS. Synonyms.-Lues venerea; Morbus gallicus; Pox; "Bad disorder;" Fr. Vérole; Ital. Sifilide; Ger. Lustseuche; Krankheiten der Französen; Span. Sifilis; Swed. Radezyge. Syphilis is a general infectious disorder transmitted. from one individual to another by both contact and inheritance, chronic in course, and displaying in a more or less determinate sequence symptoms involving one or several of the organs of the body. It is classed with the infectious granulomata, and it is due to the toxic effect of the invasion of the bodily tissues by a morbific germ. Though the identity and relations of the latter have not completely been established (as has been done in the case of the bacilli of tuberculosis and lepra), no doubt can be entertained as to its existence and potency. ACQUIRED SYPHILIS. Syphilis is said to be acquired when transmitted in another way than by inheritance. The term "contactsyphilis" has also been employed to distinguish the former from the latter. Etiology. The micro-organisms which are effective in the production of this disease have not yet been incontestably demonstrated. Donné, Hallier, Lostorfer, Klebs, Doutrelepont, Lustgarten, Fordyce, and many others have repeatedly, by difficult and delicate methods. of staining, recognized bacilli in syphilitic tissue. The failure to distinguish the exact micro-organism whose toxine may be efficient as a cause of the disease is due partly to the fewness of the bacilli present in any one section, to the circumstance that the bacilli found in the smegma præputii are either identical with or very sim 25 |