V. SYPHILITIC AFFECTIONS OF OTHER TISSUES.
Secale 147.- Syphilis of the Cellular Tissues, Gummatose Swellings (gummata.)
Ranging the secondary syphilitic affections that may occurs in other tissues beside the mucous membranes and bones, according to the frequently of their occurrence, we shall have to assign the first rank to the affections of the cellular tissue, where the so-called gummata are located, which, even now, are considered by many physicians who value their diagnosis quite highly, as identical with periostoses, from which they are, however, as far apart as bones are from cellular tissue. A periostosis is seated on the bone; a gummatose swellings, between the integuments and muscles, and is seen in all the different layers and in every portion of the cellular tissue, on the thighs, calves, arms, a nd neck, even on the head, where, as in any other portion of bone without much fleshy covering, swelling may develop itself close to the bone, which may even become involved in the swelling, and affected with caries, provided the gummata penetrates to a sufficient depth. Nevertheless, the true seat of these tubercular swelling is in the cellular tissue, where they commence in the shape of a lump, which, without any sign of inflammation, and only accompanied by dull pains and some tension, continues to grow very gradually for months, and even a whole year, until it has reached its full development, after which it terminates in suppuration. The cutaneous covering remains intact for a long time; after a time, however, it begins to turn red, and to coalesce with the swelling, until the tears, and several small foramina arise, that soon unite in one large ulcer with hard, everted edges, and a grayish base. If such a tubercle is opened before it passes into a state of suppuration, it is found to contain a cellular substances filled with a yellow, honey-like fluid; the suppuration never spreads over the whole swelling, which always secretes only a small quantity of a thin, ichorous pus, and continues to suppurate until the outer shell, in which this tubercular swelling seems to rest, is gone, after which the loss of substance begins to be repaired, leaving a cicatrix like those that are causes by burns. If these gummata break out on the head, they may be associated with caries of the skull-bones, of which they seem to constitute the proximate cause. These gummata seldom break out at once at every point; in most cases, they succeed each other in different parts, for months, and even years; very often, several of them are found congregated in the same locality. Although their true locality is beneath the integuments of the extremities, yet they are likewise met with beneath the mucous membrane of the mouth, palate, and fauces, even in the parenchyma of the tongue, which feels as if stuffed with hazel-nuts, that may lead one to suspect scirrhous indurations, and even carcinoma, after suppuration has set in; indeed, such a pathological condition bears some resemblance to carcinoma of the tongue. Most authors are of opinion that such gummatose swellings always denote a deeply-rooted constitutional syphilis, and that syphilitic phenomena of the worst sort will invariably follow in its train, even if they should not yet have made their appearance at the first outbreak of the gummatose disorganizations, The apprehension is undoubtedly well founded, in some cases; on the other hand, other authors have seen such gummata run their whole course without giving rise to any signs of constitutional syphilis. I have only seen two cases of gummata-one case being a woman, and the other a Russian traveller. Both patients had had a chancre six and eight years ago, had been affected with several secondary symptoms, and for the last three years had been affected with these gummata, being the remaining isolated symptoms of the syphilitic disease.
Secale 148.- Syphilitic Affections of the Muscles, Tendons, and Aponeuroses.
We have already stated, at the beginning of this chapter, that among the sequelae f suppressed sycosic gonorrhoea, Hahnemann mentions a contraction of the flexor tendons of the extremities as one of them. In corroboration of Hahnemann’s testimony, it may be said that even the great skeptics among the allopaths, Lagneau, Bell, Ricord, and others, regard this symptom of contraction of tendons as one that not unfrequently occurs simultaneously with other syphilitic phenomena.
Another morbid manifestation in the tendons and aponeuroses consists of a sort of aponeurotic swellings and tendinous tophi that sometimes grow to a considerable size, and are said in the fibrous tissue of the tendons and aponeuroses. Most usually the swellings are of from consistence, and seem to consist in a circumscribed hypertrophy of the fibrous tissue of the tendons, with effusion of plastic lymph in the interstices. They are generally the seat of a greater or less degree of painfulness, which is increase by moving the affected part. Not unfrequently they appear simultaneously with exostoses of the neighboring bones. If lasting for a long-period without suppurating, they may become ossified, and this ossification may involve the whole tendon, or may be limited to a small portion thereof, and may from a sort of sesamoid bone, Most frequently they occur on the surface of the tendons, in which case the swelling is more perceptible, and forms a sort of abrupt prominence in the course of the tendon, not unlike a ganglion. If seated within the substance of the tendon, the swelling has either an oval or spindle-shaped form.
Beside the above-mentioned, there are, according to the observation of Benison, of Strasbourg, still other tubercles in the flesh of the muscles. These tubercles commence like a coal, circumscribed soft swelling, of a somewhat firmer consistence than that of oedema, and on being cut through. are seen filled with a plastic, grayish-looking substance, which, as if slowly progresses, softens into a glutinous, ropy fluid, not unlike a solution of gum. If, from some cause or other, the course of such a tubercle becomes acute, pus forms in the interior of the muscle; the softened fibres are destroyed, and far-spread disorganizations may be the consequence of such softening; it is not by any means impossible that the psoas and lumbar abscesses in the pelvic region should originate in a syphilitic taint, on which account practitioners cannot be sufficiently mindful of such a possibility. In other cases these swellings terminate in indurations, first assuming the consistence of cartilage, and afterwards of bone; the remarkable masses of bone that have been discovered in the muscles of the thighs, in the glutei muscles, etc., of some cadavers, are probably derived from syphilitic tubercles in the interior tissue of muscles. In other respects, these swellings may occur in all muscles; yea, certain organs whose parenchyma is like that of muscles, or where muscular tissue predominates, such as the lips and tongue, seem to be more particularly liable to such a disorganizing process. If located in the tongue, these swellings may appear on the edges, at the tip or root of this organ in which case they almost always interfere with speech, and must no be confounded with the condylomatous growths on the mucous surfaces, from which they are, moreover, distinguished by their structural difference. On the lips, they might be more easily confounded with carcinoma; here, however, they occupy most generally the central portion, whereas carcinoma manifests itself on the free border of the lips in the shape of a wart-shaped tubercle, with stinging pains. These swellings may finally develop themselves in the muscles of the velum palati, as well as in those of the larynx, where they may run through all the above-mentioned stages, from simple, soft or suppurating swellings to cartilaginous or ossified indurations.
Secale 149.- Syphilitic Affections of Internal Organs.
Authors entertain very different opinions on this subject. Whereas, some of them assert that the syphilitic virus does not exert the least influence on any other organs than the external skin, the mucous membranes, and the bones; others, on the contrary, pretend to have seen the liver, kidneys, and stomach, even the lungs and heart, the brain and the spinal cord affected by syphilitic phenomena. There is no doubt that in caries of the skull-bones of vertebrae, the membranes of the brain and spinal cord an become involved in the ulcerative process; the statement, however, that syphilitic affections can originally develop themselves in these organs will have to be substantiated by more reliable testimony.
As regard the abdominal viscera, the celebrated Doctor Cazenave, of Paris, indeed, relates a case where the syphilitic character of the intestinal phenomena is almost demonstrated. A man of thirty five years, whose body was covered with syphilitic ulcers, was at the same time attacked with a violent purulent dysenteric diarrhoea. The patient has upwards of sixty discharges a day. The condition justified the conclusion that the same ulcerative process that was going on on the skin, had likewise developed itself in the bowels; a conclusion that was the more justifiable, since the diarrhoea, which had almost destroyed the patient’s life, improved in the same ratio as the tubercular ulcerations on the skin began to heal under appropriate treatment. The same author quotes other cases where the autopsy of individuals who had died of syphilitic cachexia, revealed syphilitic ulcers in the bowels, more specially at the termination of the ileum, and in the whole tract of the caecum, some of which resembled the elevated, some the Hunterian chancre, with everted, abrupt edges, the destructive process not being arrested till it reached the serous covering. All such patients had been suffering during the latter part of their sickness with colic and diarrhoea.
