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of. It would require, however, more room than is allotted to my paper, to go more into detail; moreover the possibilities of the aforesaid proportion are increased beyond measure by the influence of education which usually so injudiciously interferes with nature, so that, in her shortcomings, by human waywardness and inability the condition out of bad is made worse.
Before bringing this paper to a close, I must emphasize upon it, however, that it is out of undue deference to psychological tradition that the brain is exclusively dwelt upon as the organ of the mind. There is an abuse of this notion in its restriction to the sense of intellect or more strictly to that of our understanding and reasoning faculties, a restriction which is in obvious contradiction to the plainest facts of every day's observation. It is literally true and logically incontrovertible, that there is not one organ in the body that is not an organ of the mind.
L. W. INGHAM, M. D., OMAHA, NEB.,
The pathology of syphilitic infection, as applied to the various manifestations of the disease by some of our more modern writers, is widely at variance with most of our leading authorities. Arthur Cooper, in Quain's Dictionary of Medicine, defines syphilis thus: "A specific, contagious, non-infectious disease, communicable by contact of the breach of surface, or by hereditary transmission. Syphilis is characterized by a period of incubation, and (except in the case of inheritance) by certain changes at the seat of contagion and in the proximate lymphatic glands. These are followed by an eruption upon the skin and mucous membrane, and sometimes by lesions of the deeper tissues and viscera."
Cooper's ideas are not in harmony with those of Dr. F. N. Otis and others, who believe in infection from contact with syphilitic matter upon an abraded surface. Dr. Beale furnished a germ theory for syphilis as well as for vaccina, variola and other contagious diseases, which was very generally accepted by medical men over the country. Two parties have arisen, one declaring that immediately upon being poisoned with syphilis the whole body became involved in the morbid process, while the other party asserted that one to several days might elapse before inoculation and constitutional symptoms would arise. The initial lesion of syphilis,
one party would say, was the result of the general infection caused by the local reaction at the point of inoculation; the other would declare that it was the direct result of the application of the virus, and that the invasion was gradual from the point of the inoculation, to that of a general consitutional disturbance. Great stress has been laid upon excision of the chancre as a means of relief from the constitutional effects. Kollicker, Auspitz and others, in 1876, advocated this doctrine, and introduced a formidable array of clinical notes in support of their theories and practice. On the other hand, Berkeley Hall insists, upon what he calls just as good ground as Auspitz and Kollicker claim for excision, that it will do no good to cut out a chancre, nor in any way prevent the syphilitic lesion or infection. To this very day these parties are diametrically opposed to each other, and that, too, upon grounds purely scientific.
The past quarter of a century has brought to light many discoveries of a pathological and physiological character to help the surgeon determine the precise nature of diseases. The microscope has been the means of discovering hidden and mysterious elements in syphilitics as well as in nearly all other specific diseases. Since the published investigations of Beale, a vast number of scientists have endeavored to fathom the various vexatious questions which have been brought into print by both of these diametrically opposed factions. It is a strange commentary upon surgical practice that issues of such vital importance as this cannot be decided in the same way by the men of the same school of practice, and of even advantages as regards education and clinical experience. From the position of these two parties we must infer that the study of syphilis requires more than ordinary investigation in order to place it upon a rational basis. Accordingly we cannot hope for any satisfaction from the published accounts of Virchow, Wagner, Billroth, Burdon, Ranvier, Cornil, Chauveau, Ricord, Bumsted, Sanderson or Van Burden and Keys, to settle this question; but we must look to Beale for a starting point that will harmonize with other contagious diseases, such as vaccina, variola, etc.
Beale claimed that a diseased germinal cell was the starting point of the disease in all cases; that this cell contained the properties and powers of the human white blood-corpuscle, in so far as proliferation, movement and growth were interested; that it was more active, and though smaller and less tenacious of life, was still capable of carrying its vitality to another place to deposit, provided a suitable pabulum was furnished. He says that “another cell with similar characteristics and descended from degraded cell-elements of human origin, was the starting point of true syphilis.” Now all previous efforts have failed to point out the true physical representative of syphilitics virus as applied to normal tissue.
Writers have severally accounted for syphilis in a way peculiar to themselves. Lostorfer failed to discover any substantial virus in a chancre, and classed it in the catalogue of other poisons, "a mysterious power to enter and vitiate the blood.” Bumstead, in his work on Venereal Diseases, says: “The existence of a syphilitic virus has sometimes been called in question, but to-day it is established beyond a doubt. The daily experience of every surgeon demonstrates that in syphilis there exists a contagious element, by means of which the disease is communicated; and, though this morbid poison has never been detected by the senses, the microscope or chemical analysis, its presence is fully proved by its effects. Thus the essential element of this disease has always remained concealed and probably will until our knowledge in general of the principles of life and the nature of disease is very much greater than now.”
The initial lesion may be noticed from an excessive proliferation of the white cell-elements after the poison has come in contact wici an abraded surface. It progresses through the lymph-channels, breaking down vessels of nutrition, and causes "dense cell-accumulation” in and about the parts indurated. This, I think, may be the primary cause of the general infection. If we study the syphilitic germ, we find it follows the course of the diseased white bloodcorpuscle. When the poison is received upon an abraded surface it is at once absorbed into the tissue and proliferation ensues, forming a nodule of white blood-corpuscles, producing stasis of white blood-cells. These cells are of a roving disposition, and wherever they chance to lodge in the human body a local irritation is set up and a new pabulum formed, capable of increased action, growth or proliferation. These cell-elements in the vessels or around them stop the nutrition and cause the proliferation or growth spoken of.
To my mind the period of incubation of syphilis is the time that cell-proliferation occupies at the point where the poison is absorbed. It can have no definite period, as it will take longer for a diseased cell to reach a lymphatic vessel from a chancre on the corona of the penis than farther back, and vice versa. The shortest stage of incubation would occur from inoculation at the frænum præputii, where the lymphatics are situated, immediately under the epithelium. Now, as all fluids progress toward the lymphatics from the periphery of the body, these diseased cells, as soon as loosened from the indurated seat or chancre, are carried through tissue-space to the lymphatic vessels, and, by them, through the lymph-channels to the lymph-reservoir, and finally reach the general circulation through the arterial channels. It is safe to declare that the tissuespaces are so many open highways carrying fluids toward the lymphatic vessels and channels, and finally to the lymphatic glands.
Lymphatic enlargement is a suspicious symptom, whether there are any other symptoms present or not, and may be regarded as of paramount importance in the diagnosis. It is of no importance that a swelled gland is not painful. This is often the case in the primary stage, and may be regarded as a better evidence of syphilitic infection than where the glands are tender and painful. These lymphatic enlargements are directly traceable to cell-accumulation, which goes steadily on till a passage is effected by the cells through the glands, when the enlarged gland slowly subsides. It is at this period that a second stage of incubation begins, through the appearance of the roseola upon the skin, which will remain for a certain indefinite time, and then decline, leaving copper-colored spots upon the skin, which disappear very slowly.
It has been shown by microscopic examination that stasis of blood and paresis of the nerves of the blood-vessels take place from some influence exerted upon the sympathetic nerve-centers, causing dilatation of the capillaries with blood-stasis, which leaves the copper stain upon the cutis. Here, again, in the cutis, we find cell-proliferation going steadily forward, surrounded by a papular formation, which, by most authors, is designated as papular eruption. Baumler says that syphilitic papular eruption is a "wellmarked, circumscribed cell-infiltration of the papillary body of the cutis. It is often impossible with the microscope to distinguish an isolated secondary papule from a commencing primary affection."
Syphilitic iritis is one of the most complicated affections of the eye, destroying the iris and, in a very large majority of well-marked cases, causing total blindness. All the talk about simple or plastic iritis, serous iritis, parenchymatous or suppurative iritis, in contradistinction to other inflammations of the eye, is supreme nonsense. In all of the cases that have come under my observation the serous membrane covering the iris was involved, and a pseudo-membrane was also forced out as a means of supply or waste, or for whatever purpose you may elect, for there are many purposes, perhaps, that it could be used for with which I am not familiar.
The tertiary stage of syphilis is that stage succeeding the secondary, and is characterized by deep ulcers upon the skin and membranes, rupia or an advanced form of eruption, and widespread infiltration of the sub-cutaneous, cellular and sub-mucous tissue, blood vessels, muscles, viscera, liver, spinal cord and brain. The skin exposed to view about the head and neck often presents a cachexial appearance. There is an earthy pallor and a shrunken or pinched condition of the skin, accompanied by pus cavities of more or less magnitude. Gummy growths develop in the mouth,
, sometimes along the dorsum of the tongue, lining membranes of the cheek, pharynx and externally upon the skin. These growths are sometimes classified as syphilitic tubercles when found in the cellular tissue. These tubercles or growths are the product of cellproliferation, which reaches a certain stage, when it softens and pus is discharged, leaving a deep cavity, which is said to heal by granulation.
In this stage of the disease I have not found anything to convince me that it is infectious, or even contagious. The vital force of the cell-element has been exhausted and the pus from the tubercles is devoid of syphilitic product and wholly incapable of producing the disease by inoculation. I know that many of the learned syphilologers will not agree with these views, but if any of them will make any considerable number of trials from the true tertiary stage of syphilis, they will be convinced beyond peradventure of the truthfulness of the statement. I inoculated one subject five different times with syphilitic tubercular matter from five different tertiary subjects without producing any general constitutional disturbance, and not more than a simple sore at the seat of inoculation. Three years have elapsed since I made the experiment, and the subject presents no signs of syphilitic infection in any part of the body.
The diagnostic signs of tertiary syphilis are, briefly, gummy growths upon the skin, the well-defined tubercle, thin, watery pus, brain lesion, diseased bones, enlarged spleen, pallor of the skin and a general state of cachexy. These, taken together with the other symptoms mentioned in the earlier part of this paper, will be sufficient history to enable the practiced surgeon to properly classify the disease.
Malignant syphilis is spoken of by some writers as occurring in some subjects at or during the secondary stage of the disease. Arthur Cooper describes it thus: “There are, again, cases, fortunately not common, to which the term malignant or galling syphilis has been applied, in which the disease from the first pursues a rapid, destructive and sometimes uncontrollable course.”