Secale 181. Of the Parts susceptible of the Infection.
On looking over those localities and tissues of the body where symptoms of syphilitic contagion are seen, we find that, not by any means, are all these parts equally sensitive to the syphilitic contagium, and that it is particularly the mucous membranes that possess this sensitiveness to the highest degree. Whether this sensitiveness is graduated according to the nature of the organs-existing in the highest degree in the sexual organs, less in the rectum, still less in the mouth, nose, lips, eyes, etc., and not at all in the stomach is a question of much more difficult solution than the authors of many compendia imagine. If the genitals are much more frequently affected than other parts, this does not show their greater sensitiveness, but is owing to the fact that these parts are brought in contact with the syphilitic contagium much more frequently than other parts. The ready communication of the infection to the buccal mucous lining, through poisonous kisses, would seem to show that this membrane, of itself, is just as liable to becoming infected as the sexual organs; the mucous lining of the stomach might, perhaps, be found equally sensitive, if it were possible to establish a much more direct contact between it and the contagious matter, than is done by means of the pills prepared for the purpose of conducting these experiments. As regards the mucous lining of the rectum, I have seen several cases of primary condylomata, chancres, and fig-warts in this organ, that evidently originated in unnatural gratification of the sexual passion. Notwithstanding, I have seen several cases of this kind, I have, on the other hand, met with cases where the direct contact of idiopathic gonorrhoeal virus with the lining membrane of the rectum remained without any result whatsoever. I have felt disposed to infer from this circumstance, that this virus can only infect the lining membrane of the urinary organs, and that of the eyes. In regard to the external skin, in a state of perfect integrity, I do not altogether share the assertions of authors, that it is inaccessible to the action of the venereal contagium. I have seen cases where the friction of the diseased penis against the thigh and the axilla of a woman, induced in one case a syphilitic ulcer, and in other a bubo Lagneau, of Paris, likewise speaks of a chancre at the umbilicus, that originated in a similar manner. It is possible that, in these cases, the epidermis had become more or less inflammed, and had assumed a form some what resembling that of a mucous membranes; but the known cases of ulcers on the thigh and scrotum, after these parts had been bathed for sometime during sleep with the discharge from a diseased penis, are likewise facts. Massa speaks of a young man who touched the chancrous pudendum of a woman with his fingers, after which his hand became swollen, and covered with syphilitic ulcers. “The Paris Journal de Medecine,” of the year 1759, relates the case of an accoucheur, whose hand and fingers were perfectly uninjured, and who became infected with syphilis, in consequence of attending upon a syphilitic women, and, in his ignorance of the character of the infection, communicated it to his own wife. Such cases are, however, very rare, and a closer inspection might, perhaps, show that the epidermis was more or less broken in every case. It is well-established fact, that open sores in the skin, and inflamed potions of skin, like erysipelas, are more susceptible of infection than the mucous membranes themselves, and that the syphilitic disease, in such cases, is more dangerous, and runs a much more rapid course.
Secale 182. Of the Channels through which the Poison is introduced into the Body.
It is scarcely necessary to repeat that the act of coition is the most frequently travelled road by which the venereal contagium is introduced into the body. It is likewise known, that direct contact with the diseased organ, be it the sexual parts, the anus, mouth, or tongue, is another frequent channel of communication. What is still questionable, is, whether the infection can be caught from an otherwise perfectly sound woman, who had connection with a diseased individual immediately previous. Widemann, a contemporary of the great epidemic, not only deems this possible, but warns his readers against having anything to do with a woman who had connection with an infected individual shortly before. Later physicians have doubted the possibility of such an infection, without, however, adducing any convincing proofs in favor of their doubts. Supposing even that the contagium had at once been removed from the pudendum by absorption, and that the woman had washed herself immediately after connection, a small portion of infectious matter may yet have remained adhering to the parts. That this is possible, has been shown me by the following case: A young man had connection with a woman, immediately after which he washed himself, and on the same day had connection with a healthy girl. A fortnight after, both this girl and himself, had chancres. An examination showed that the other girl was diseased. If a chancre exists on the lips, in the mouth, or throat, the syphilitic disease may be communicated through a kiss, in consequence of the spittle becoming united with the secretion from the chancre. For the purpose, it is not necessary that the tongue should be inserted into the mouth of the infected individual, the simple contact of the lips is sufficient to effect contagion in such cases. The communication of the infection is very much facilitated by the fact that the syphilitic disease had become localized in a small pustule in the corner of the mouth, which often escapes the patient’s own notice, and may have been the means of imparting the disease to more than one individual, without the patient himself being aware of the existence of the pustule. Examples of this kind are not unfrequent. Muritanus relates a case where every nun of Sarenta became infected by kissing a little girl whom an infected stranger had first kissed on the mouth. Nursing at the mammae constitutes another channel through which the infection is frequently communicated. Syphilitic infants may infect their nurses, and nurses with syphilitic nipples may infect their nurslings, and the disease may spread in this way over a large circle. Portal elates a case where an infant that had been brought from Paris to Montmorency infected its nurse, the nurse infuse her husband the husband gave the disease to another women until and whole town had caught the infection. Vercelloni, Disbon, and other physicians relate similar cases. Van Swieten relates a case where a woman, whose business consisted in drawing the milk out of breasts of recently confined women, continued it even after she had a chancre on her tongue; the consequence was, that first a number of women and afterwards their husbands, and even their children caught the disease, and many them died. In a similar manner the disease may be spread by using tobacco pipes, drinking-vessels, wind instruments and the like, to which the pus from chancres on the lips, tongue etc.., is adhering and more particularly by the insertion of syphilitic teeth, by which means a great deal of mischief has already been done.
Secale183.-Unusual channels of Communicating the Infection.
The above-described channels of communicating the infection are the most natural and most common; beside these, there are other mode of communication, among which inoculation or the insertion of the poison under the epidermis for purposes of experimentation, or the unconscious transfer of the contagium to open sores deserves particular mention. In this category belong he not infrequent case of midwives and accoucheurs who are infected with the disease, when attending upon syphilitic women, if there is the least sore on the fingers or hands; or the cases of surgeons, if they cut themselves when operating on infected parts: in this way may become infected with out having the least suspicion of the taint. Van Swieten, for instance, relates the case of several peasants in Moreover, who according to Schenk’s statements, caught syphilis in consequence of being cupped with cups that had been used shortly before on an individual infected with a disease. Daguerre reports that a miller who undertook to cure people, infected them with syphilis by his lancet, which the never patients has likewise transmitted the disease in consequence of the infected spittle being inserted into the wound. Whether this poison, can be communicated by the uninjured epidermis, is another question. We have mentioned, No. 181 the case of an obstetrician who, although his kin was perfectly sound, was nevertheless infected by waiting upon a syphilitic woman in confinement. Cazenave relates of a young hospital- physician that, a few days after examining several syphilitic women, he was attacked with a syphilitic eruption on his hands, the skin of which was intact. Such cases may occur; but if we consider how little trifling injuries of he skin, punctures with needless and the like, are headed, more particularly after they seem entirely healed, and the scurf, if there was any, has become detached and if we, moreover consider the large number brothels come in daily contact with the syphilitic contagium without ever experiencing the least traces of an infectious disease upon their own persons, we certainly are bound to accept all such reports with a great deal of caution and allowance. The same remark applies in a much higher degree to cases in which the infection is said to have been communicated by sleeping in. the same bed with infected persons;by wearing their pantaloons or other grants, or by resorting to public water-closets. Such cases may likewise occur, in as much as a portion of infectious matter may have accidentally come in contact with a susceptible part of the body; for instance, when sleeping with an individual affected with chancre, the chancres section may touch the sexual organs, lips, nose, or eyes of the non-infected individual, or the tip of the glans may touch a spot in the water-closet, where a portion of gonorrhoea matter, from one recent traces of syphilitic secretions may remain adhering to the bed-clothes and come in contact with the mucous lining of other boon-infected individuals., But, in all such cases infection infection takes place in consequence of a direct contact of the contagium with the exposed part, and it will have to be admitted that, in order to secure with a result, an extraordinary coincidence of circumstances is required to take place. Indeed, it is not in this sense that communication of the infection by the skin is understood;those who advocate it mean. that person whom are thoroughly syphilitic can communicate the disease by their general secretions; for instance, by their breath, and even by the bed-clothes and garments of which these secretions adhere. We shall examine this point in. the next paragraph.
