SYPHILIS



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.

TABLE I.

Genitals and pre-genitals 677I

Chance of the lip I84

Breast 4I

Fingers and hands 33

Tongue 17

Nose 8

Cheek 6

Buccal cavity 4

Unclassed 2I.

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.

John Henry Allen
Dr. John Henry Allen, MD (1854-1925)
J.H. Allen was a student of H.C. Allen. He was the president of the IHA in 1900. Dr. Allen taught at the Hering Medical College in Chicago. Dr. Allen died August 1, 1925
Books by John Henry Allen:
Diseases and Therapeutics of the Skin 1902
The Chronic Miasms: Psora and Pseudo Psora 1908
The Chronic Miasms: Sycosis 1908