Author of Diseases of the Skin, Psora, Pseudo-psora and Sycosis.
Distribution of Syphilis.
We can truly say that, if any disease more than another, follows the lines of trade and commerce, it is syphilis, and as the nineteenth century found man reaching out with his trade every corner of the inhabited earth, so syphilis is wont to appear and spread with its usual severity. It follows ship lines and rail- roads, strengthening itself at great centers of trade, seaports, army and navy cantonments and in all kinds of camps where many human beings are collected together, especially in times of war.
Climatic conditions seem to influence it very little, for we find it, not alone in temperate zones, but in the torrid and the remotest inhabited points of the cold zones, such as Greenland, Iceland, Norway, Sweden and North Russia. It is not a malady of fifth or of the poor. It is a disease that spreads when men are closely aggregated temporarily. Thus it is met with most frequently in large capitals and in densely populated cities; where trade meets and where exchange of commodities takes place. It is a disease of the second and third decades of life in both sexes, at a time of life when the activities of life are at their highest point in respect to travel and trade and intercourse with the world.
Syphilis prevails extensively in Russia and in its great cities, in Norway, Sweden, Germany and Poland. Intemperate habits are, no doubt, the most promising factors in increasing the disease in all countries, as my experience in practice for many years has demonstrated. Men from thirty to fifty usually contract it while in a state of intoxication. This is true, to a greater or less extent, in such cities as London, Liverpool, Manchester, New York and Chicago. Usually from five to eight per cent of all venereal diseases are syphilitic. In the densest populated cities of Europe, about five in one thousand are affected with the disease.
One prominent authority estimates that in Paris alone they have constantly from two to four thousand newly infected cases. One prominent authority estimates that in Paris alone they have constantly from two to four thousand newly infected cases. What has been said of its prevalence in Europe may safely be said of the Far East-Japan, China, Asiatic Russia, Syria, Asia Minor and Afghanistan. In Egypt, the cities of Cairo and Alexandria, so largely visited by foreigners, the disease is met with frequently, even among the natives. In tropical islands and in tropical zones of the Orient, it is not infrequently blended with leprosy, inducing its worst forms, often developing, with the aid of the hot, sultry climate and unsanitary conditions, the gravest forms of the disease.
The Western Hemisphere is by no means free from syphilis. It is frequently met with in Montreal, Ottawa, Quebec, Chicago, San Francisco, New Orleans, Philadelphia, New York, Baltimore, Buffalo and Boston, and not infrequently in smaller towns and cities. I am sage in saying that it is quite common among the American negroes, combining with scrofula and the white plague, tuberculosis, and inducing, often, the most destructive processes that can come to humanity. We also find it to be prevalent in cooks, waiters and domestic servants, as porters in hotels. Among the immigrants that come to this country in large numbers affected by this disease are the Spanish, from South America, French Canadians, Mexicans, Scandinavians, the lower classes of Jews and those of German birth.
Evolution and Course of Disease.
Syphilis is conveyed from one individual to another (“contact syphilis”) and by inheritance. The acquired from may be conveyed either by a physiological or pathological fluid or living or dead protoplasm. The morbid matter may come directly from one individual to another or by indirect methods. For a long time the nature of this virus was unknown, but today our modern pathologists have determined that its infective essence is a micro-organism. All infected persons become virus carriers. The power of the infection wanes however, in its virulence with the progress of the disease, that is in the infective forms, which is not true of the transmitted forms.
Infected individuals cured of the disease are said to be immune from a second infection no animal can be infected, unless it be those of the monkey tribe. This is not true of the gonorrhoeal or tubercular virus, which attacks most animals. Syphilis is on the whole, a human malady, this being the case by virtue of the sui process of the disease. The mucus, or secretion from the mucous patch or the primary lesion, chancre, is said to be the most virulent from of the virus. The virus usually enters the circulation by an abrasion of the skin or mucous membrane, and at this point of entry, the first pathological process begins.
At that moment, the period of the evolution of primary lesion begins and the systemic intoxication is but a matter of a couple of weeks (“fifteen to forty days”) The general average is three weeks or thereabouts. There is but one from of syphilis and it is undefined in its degree of malignancy by the constitutional bases from which the seed comes, and the ground in which it is planted; the habits of the infected one, whether they be temperate or not; if they are addicted to tobacco, alcohol, beers, wines, coffee or the eating of much animal food depends much on its malignant action on that organism Again, if there is already a scrofulous or tubercular soil, the chances are that every movement of the syphilitic invasion will be of a similar malignant from.
A little farther on in the disease, the glands of elimination, the blood and lymph vessels, become overtaxed with work and soon manifest profoundly the deeper invasion of the whole organism. It may be well to mention here that the mildest forms of chancre my be followed by the gravest forms of the disease. Of course, this is not true if followed up with the homoeopathic remedy in the potentized from. Usually it seldom progresses beyond the papular form of a skin eruption, but in writing about syphilis or any other disease, we must leave all that out until it comes to the treatment or we do not get a clear conception of violent inroads of the disease.
The next step in the disease is the involvement of the lymph vessels and glands, usually the glands nearest the chancre are involved. They increase from a soft fullness to a marble hardness and they may be single or multiple. We see this taking place from the sixth to the tenth day after the appearance of the primary sore, the chancre. This is the beginning of the manifest systemic involvement. All the time this process had been going on from the moment of infection, but the human eye could not detect it. This is why the books insist the disease is first local. All this is erroneous teaching. It is never local except to the mind so material that it cannot follow the dynamic action and movement of disease.
The whole effect of the system whether it be the circulatory, the blood, the lymph or the glandular elimination process shows the deep resentment of the presence of the morbific elements in the circulation. Its every effort is now to combat and, if possible, drive out its enemy. This is why we see all these excesses, these hurrying to and fro in the circulation, the violent explosive eruptions upon the skin, the hyperplasia, the hypertrophied glands, which are overworked at times to the point of dissolution. No wonder we have violent stasis of the disease, epilepsy, insanity and all the multiple forms of paralysis when we see men, who claim to be healers of the sick, creating all these processes by local application or injections of death-dealing drugs.
The primary stage of syphilis is generally known as that stage or phase of the disease which precedes all signs of infection and is attended only by local changes in the point of infection or innoculation. This local change is characterized and known by the name of chance. It assumes different forms, but a typical one assumes the form of an ulcer usually round and with clean cut edges. As soon as this lesion is fully recognized,the specific character of the disease is at once recognized. It becomes the flag of distress, the S.O.S. of great danger to the organism.
It establishes, as with an oath, the fate of the human being so infected. Soon after the appearance of the chancre, the whole organism is involved by a slow systemic infection. This infection, or involvement, has been divided into three well- defined stages, and known in all languages and in all literature on the disease as the primary, secondary and tertiary stages. Each stage has it time periods and its own peculiar phenomena. Not infrequently we find preceding the primary lesion, general malaise and a cachexia peculiar to this disease. Sometimes a general dyscrasia develops, showing clearly the deep systemic derangement that precedes the secondary stage of the disease.
The duration of primary syphilis varies in each individual from forty to one hundred days, and even longer. From nine to eleven weeks is a safe estimate,perhaps. This time is divided in to two periods, the time elapsing between the moment of infection and appearance of the chancre, which is from seventeen to thirty days,the second, pause or rest period, coming between the disappearance of the chancre and the secondary stage, known as the eruption stage,when the glands, skin and mucous membranes show forth the full power of the disease in its secondary expression. Both of these rest periods may be said to be germinal periods,or periods of incubation, preceding which the disease involves the whole organism, even every cell and every fibre of the human sufferer.
The second incubative period also varies with the individual. It advances more rapidly in patients subjected to bad hygiene, vitiated air, mercurial treatment,slower,of course,if applied locally. The secondary eruptions are suppressed by these bad methods of practice and the tertiary stage is hurried on until we have a mixed eruption of secondary and tertiary lesions. Cold is said to retard the appearance of the secondary eruptions,and heat hastens it. The chancre has appeared as early as form ten to fourteen days,but usually it is from three to four weeks before it makes its appearance. We do not look for the secondary manifestation earlier than the fortieth day from the appearance of the chancre.
The Initial Lesion.
The initial lesion, or primary sclerosis (chancre) is the special symptom for study in the primary disease. It begins at the point of innoculation or entrance of the virus. The first thing observed,if seen early enough,is a papule, slightly elevated, flat on the top,which imparts to the touch slight resistance, due to infiltration.
There are many forms of chancre mentioned in the different works on syphilis, but we will mention but three special forms: The Superficial Erosion, the Indurated Papule and the true Ulcus Durum or the true Hunterian Ulcer. The papule soon changes, and if you watch these changes you will notice, as the next step, a slight abrasion followed by a scanty, sticky secretion. This is the beginning of the true ulcer formation. Thus far the lesion seems trivial and offensive and not infrequently the specific notice of it is overlooked. Even to the trained eye it is still insufficient to make a diagnosis until further development reveals the true nature of the disease. Gradually, however, the infiltration increases and becomes distinctly indurated, either a papule or a patch. This induration is seldom absent and figures largely in making a diagnosis of the diseased spot.
In degree it varies greatly; sometimes it is of a medium hardness to the touch and again assuming a cartilaginous density. It may be superficial or deeply set in the skin, firm and rounded like an elevated flat papule. When the infiltration is slight, we may be aided in our diagnosis by rolling the lesion under the tip of the finger, when we may discern the well-defined, sharp margin of the ulcer. The ordinary inflammatory eruption has doughy feeling, with no well- defined hardness, as we find so clearly marked in the soft chancre. The true chancre develops slowly is in no hurry to disappear and when it does disappear; leaves a slight pigmentation which, farther along in the disease becomes definitely diagnostic as a single symptom. We notice, further, that this pigmentation begins to disappear gradually from the center. Occasionally we see, in the end, a whitish patch resembling scar tissue.
The true chancre is, as a rule, single, while the non-infecting chancre is multiple, or soon becomes so, the discharge, scant, thin and it not innoculable, while in the non-syphilitic chancre the discharge is copious and of pus-like character.
It might be well to add, in a more descriptive way, something of the three special lesions of chancre already mentioned.
Ist. The dry scaling papule. In some cases it runs its whole course as a dry scaly papule, increasing in density at the base. There is always a slight desquamation of the cuticle, the surface remaining dry, the epithelium being intact, the erosion firm and smooth.
2d. The superficial erosion. This represents the chancre commonly met with, the uncomplicated, simple chancre. It appears as a small, round or oval spot, the surface slightly moist, smooth and usually of a raw hamlike appearance. The whole lesion, or more commonly the center,is covered with a gray film, the surface of the lesion being flat or dome shaped. Occasionally it is transformed into a mucous patch and is constantly moist and raw looking.
3d. The ulcerating chancre. This form is known as the Hunterian chancre. It when first seen, may assume the form of a true ulcer, the form being round or oval,the edges clear cut,as having been performed with a sharp chisel,funnel shaped, the edges being clear and decisive. There is no other ulcer like it. The chancroid ulcer comes very close to it in appearance, but the edges are less clear and defined, while the prevalent secretion and other marked features help us to differentiate its true nature and character. Only occasionally, from inflammatory irritation, does it assume a character anything like a chancroid or other ulcer.
The mixed chancre. This form can only be accidental and is always a secondary infection.
Location of infection, as given by Dr. Morrow,is of vital interest when we come to study the methods and forms of infection and its venereal character.
Genitals and pre-genitals 677I
Chance of the lip I84
Fingers and hands 33
Buccal cavity 4
Locality of the chancre. All of the tissues are not equally susceptible to the syphilitic infection; for instance, the power of absorption over a muscle is not so great as that of cellular tissue where the absorbative vessels are plentiful or where it is in direct communication with the absorbents. Of course, in intra- ureteral infection, the infection becomes general and no longer local, as in acquired syphilis. The majority of cases where the origin of syphilis is upon the male organs, are found in the sulcus coronae glandis where abrasions are more liable to occur. However, the virus is readily absorbed from any mucous surface. The inner surface of the prepuce, the fraenum and the outer surface of the fore skin are most frequently found to be seat of the disease. The lesion will be found either as an erosion or the true Hunterian chancre.
The presence of abundance of secretion in those parts increases the tendency to an ulcer. According to Bassereau, of three hundred and sixty syphilitic chancres, fourteen were in the urethra, but all were near the meatus. In the female genitals, the lesion is usually found on the labia majora, the labia minora, the fourchette, the clitoris, or in the region of the meatus urinarius and, lastly, in the commissure of the vulva and vagina. If the lesion is found upon the uterus, it is generally found upon the anterior lip and is smooth and flat and of a grayish color, covered by a false membrane and encircled by a dark red border.
Extra genital chancre is more common in women than in men. One author averages them in men to be one to one hundred nineteen, while in women it is one to ten or twelve. The chancre is seldom found upon the rectum.
When the mammary gland becomes the seat of the infection, it is not uncommon to find multiple lesions. They are usually found at the base of the nipple and occasionally upon the nipple. The lesions may be in the form of an erosion, a fissure or true ulcer. The lesions are well defined and the adjoining glands are swollen and enlarged, the disease often extending to the axillary glands.
Syphilitic infection of the mouth is very common, due, no doubt, to kissing, but there are other methods, as in the use of tooth brushes, spoons, and other table utensils. It is most frequently found upon the lips, then on the tongue. Induration is usually marked, and it appears as a fissure or an ulcer. When the lesion is upon the tongue, it is generally flat, smooth and quite red; all the lesions of the mouth are well defined, generally very red in color and the adjoining glands involved. If the lesion is found upon the tonsil, it may be mistaken for some form of tonsillitis, but to an experienced eye its specific nature is readily recognized.
The ulceration and induration may be slight but is usually well marked, not infrequently taking on the appearance of malignancy and assuming the diphtheritic type, but the absence of great soreness, tenderness and pain usually helps in distinguishing the difference at once; besides the marked constitutional disturbance, the prostration and the odor help us to quickly decide in making a diagnosis.
Syphilis of the extremities is rare and is generally found upon the fingers about the nails.
A work like this would not be complete if we did not insert a table showing the differences between the simple chancre or chancroid ulcer and the primary lesion of syphilis, or hard chancre, the contrast from the beginning being distinctly marked and unmistakable.
Primary Syphilis. Simple Chancroid.
Often not venereal. Generally venereal.
Produced by mediate or Produced by immediate contagion
immediate contagion from from the secretion of another
the secretion of a syphilitic chancrous lesion.
Usually from 17 to 30 days. Reaction within 24 hours.
III. First Appearance.
A papule or slightly eroded A pustule or ulcer spots.
IV Number of Lesions.
One usually. Generally multiple.
Not uncommonly extra genital. Almost without fail up on the
Ulcer or lesion, firm, elastic Compressible, soft non-elastic
and with sharply defined edges. ill-defined, soft to touch.
Sometimes dry and scaly, red or Always moist, with pus-like
grayish, slightly moist at times. secretion, generally copious.
Generally round, with well First round, soon becoming
defined margins. angular in outline, with
Ulceration often absent, edges Ulcer deep, with perpendicular
smooth, sloping ulcer, usually Jagged edges.
Secretion scanty, of a Secretion copious and
serous nature. purulent.
Slightly sensitive. Sensitive.
Not innoculable upon a syphilitic Always innoculable upon
persons. others even upon the
Polyadenitis; indolent; scarcely Monoadenitis; acute;
suppurates. supporting and virulent.
Mixed chancre. In mixed infection, it is difficult for even the experienced physician to make an early diagnosis. It therefore becomes extremely necessary to acquaint ourselves well with this initial lesion of which so much has been said. In the majority of cases of mixed infection, the inflammatory effects due to the mixed infection obliterates the fine distinguishing points of the initial or primary sore. Usually this mixed infection involves the chancroid as well as the true syphilitic virus. We then have both the sycotic as well as the syphilitic elements to deal with, as chancroid is but an ulcerative form of sycosis, while the true gonorrhoea is the catarrhal from.
Time, however, the revealer of all things, will soon show clearly, as the disease advances, its true nature, whether syphilis is present or not. In the meantime, care should be taken not only to guard yourself in a diagnosis as well as to protect others from infection. A carcinomatous papule may be mistaken for the initial lesion of syphilis in the mouth or on the genitals, but his is so rare that it is of slight consideration. The rapid evolution of syphilis, of course, distinguishes at once the nature of syphilis. A tubercular ulcer in the mouth or tip of the tongue cannot be taken for syphilis, even by those unfamiliar with the syphilitic lesion, if they put to the test the soft character of the tubercular lesion. Secondary eruptions, I can readily see, might confuse the unexperienced, but never in the first stage of syphilis.
The pathological anatomy of syphilis. The microscope reveals, in all stages, a dense cellular tissue and an infiltration of masses of large round cells. They seem to be a constant element in this disease. They pile up at the edges of all lesions and are also seen, to a marked degree, in the chancre and throughout all syphilitic processes.