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The surfaces of the body are the chief seats of elimination of the syphilitic virus; hence, we find its effects most evident on the mucous membranes, the skin, the periosteum, the neurilemma, the joints, the testis, and the secreting membrane of the eyeball. The mucous

and the eruption on the skin continued. She was again confined in March, 1831, but the child was dead, and she has not been pregnant since. Her health, which was excellent before, has been wretched since the contagion."

"About six weeks after I first saw Mrs. F.," the nurse above referred to, "another respectable married woman, Mrs. H., applied to me, having a large sore on one of her nipples, a copper-colored eruption on the skin, and ulcers on both tonsils." Dr. Price ascertained that her husband was perfectly free from any trace of venereal disease, but that she was nursing the child which had been sent home by Mrs. F. The child, she said, had "an eruption similar to that on her own skin; it had also a very sore mouth, and sores about the fundament."

Dr. Price further ascertained, in respect to the last patient, Mrs. H., that she had, with the view of supplying each child with its proper share of food, carefully kept each to its own breast; nevertheless, her own child evinced symptoms of syphilis; there was an eruption on the skin, and sores about the arms; the poison having been imbibed from the parent with her milk. That child, Dr. Price informs me, is now (1851) dying of consumption.

Two years and five months after the birth of the above child, Mrs. H. was again confined. "In a fortnight, the infant became covered with the same kind of copper-colored eruptions as the other child had. Its nails came off, and in six weeks it died, a miserable object."

Twelve months later, Mrs. H. was confined for the third time; in a fortnight the child became affected like the preceding, and lost its nails. It, however, recovered.

Dr. Price treated both mother and children with mercury, but the disease seemed to resist its influence. He then had recourse to the iodide of potassium, which carried off the remains of the eruption on the mother, and restored her to health. She has given birth since to six healthy children.

Another fact of interest was developed in the course of this case. While the mother was suffering from the infection in the first instance, her husband was affected with "excoriations on the glans and prepuce, and extensive desquamation of the cuticle covering the scrotum, and the upper and inner parts of the thighs. These appearances soon yielded to treatment; but they were unquestionably the result of intercourse with his wife."

Dr. Hector Gavin reports another interesting case bearing upon the same point in the Lancet for July 18, 1846.

membrane of the genital apparatus probably performs a special function in this respect; and this circumstance may explain the greater amount of accumulation of the virus which seems to take place in those organs.

In this way, also, we may find an explanation of an event so constant in women laboring under constitutional syphilis, namely, miscarriage. Miscarriage is the rule in such cases; and the more severe the effects of the virus upon the ovum and its contents, the more free seems the mother from disease. On the other hand, when abortion does not take place, and the foetus is little affected by the poison, the sufferings of the mother are augmented.

CHAPTER II.

PRIMARY SYPHILIS.

THE local action manifested in a part to which the poison of syphilis has been applied, is similar to that which follows vaccination: a pimple is at first developed, a pustule forms on the summit of the pimple, and the rupture of the dome of cuticle or epithelium which contains the pus, brings into view a small ulcer

or sore.

It does not, however, follow that all these stages should be complete; sometimes the local action is limited by the production of a pimple, and sometimes it goes.no further than the pustular stage. These are circumstances of constant illustration in vaccinia, and in the example of the variolous poison, and are equally present in syphilis.

When the local action attains its complete stage, or that of ulceration, the ulcer will be found to be shallow, more or less circular or oval in form, bounded by a perpendicular and slightly jagged border, and furnished with a smooth yellowish base, moistened by an ichorous secretion. The skin immediately surrounding the sore is moderately inflamed and somewhat thickened. This is the "progressive stage" of the simple syphilitic sore or chancre, and in this condition, with perhaps a little increase of size, it may remain for several weeks. In the next place, granulations begin to form upon its floor; pus is poured out upon its surface; and the sore

gradually fills up, and ultimately heals. This latter is the "reparative" stage of the sore, during which it is perfectly harmless and non-contagious; but during the entire period of the progressive stage, it is contagious. The natural duration of the simple chancre, when uninfluenced by treatment, is from three to five weeks.

Instead of pursuing always the above "simple" course, which implies a healthy state of constitution of the patient, attention to rules, and regular habits, it is easy to conceive that opposite conditions to these may give rise to inflammation and its consequences; that the sore may be an inflammatory chancre, or even a sloughing or a gangrenous chancre. There is nothing, however, in the inflammatory chancre that would not be found in a sore of any other kind, occurring in a similar state of constitution of the patient. But it is interesting to note that, as in a case of ordinary inoculation, the virus-forming action of the sore is destroyed by the excess of inflammation, and that such a sore is rarely followed by constitutional infection. As a local disease, it may be sufficiently terrible, but a simple treatment, founded on the common principles of surgery, brings it by degrees into a healthy and healing state.

In certain states of the constitution, usually such as arise from debility, and accompanied by great nervous irritability, and frequently an anæmic state of the system, there is sometimes found another and a more serious form of complication of the syphilitic sore, namely, phagedæna. The phagedanic sore is characterized by rapid loss of substance, not occasioned by absorption, as in common ulceration, nor mortification, as in the sloughing sore, but, by a kind of dissolution of the tissues, they become disintegrated, sometimes gelatinized, and they seem to melt away, leaving a large excavated space, extending entirely through the skin and subcu

taneous cellular tissue to the fibrous tissue beneath. The cavity of the sore is moistened with a colorless or sanguinolent ichor; the edges are dry, thin, excavated, and here and there reddened or blackened by the opening of small vessels and the desiccation of effused blood; and the skin immediately around the sore is indurated, and has an erysipelatous redness. The cure of this kind of sore requires the restoration of the constitution to its normal state of tone and rest; and, if the local destruction continue, the employment of strong nitric acid as an escharotic. Like the sloughing chancre, the phagedænic sore very rarely gives rise to constitutional infection.

It will be seen that the two forms of syphilitic sore last described, namely, the sloughing chancre, and the phagedænic chancre, are mere modifications of the simple chancre, modifications dependent on the state of constitution of the patient. There remains, however, to be described another form of sore which is pathologically different from the preceding, which is characterized by a peculiar hardness of the base, or of the tissues immediately around it, and which is therefore termed the indurated chancre.

The indurated chancre is more slow and chronic in its properties than the simple chancre. It is unattended with pain; remains stationary for weeks, and even months, and gives out scarcely any secretion, and that of an ichorous kind. The indurated chancre varies much in size; it is often no larger than a split pea; sometimes it increases to the size of a shilling, in which case it may assume a sloughing action in the centre, from the density of its base, and the consequent interference with the circulation necessary for its complete nutrition. The floor of the chancre is smooth, and devoid of granulations: it is bluish or livid in color, and

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