CHAPTER IX
SYPHILIS
Definition.--Virus.--ACQUIRED SYPHILIS--Primary period: _Incubation, primary chancre, glandular enlargement_; _Extra-genital chancres_--Treatment--Secondary period: _General symptoms, skin affections, mucous patches, affections of bones, joints, eyes_, etc.--Treatment: _Salvarsan_--_Methods of administering mercury_--Syphilis and marriage--Intermediate stage--_Reminders_--Tertiary period: _General symptoms_, _gummata_, _tertiary ulcers_, _tertiary lesions of skin, mucous membrane, bones, joints_, etc.--Second attacks.--INHERITED SYPHILIS--Transmission--_Clinical features in infancy, in later life_--Contagiousness--Treatment.
Syphilis is an infective disease due to the entrance into the body of a
specific virus. It is nearly always communicated from one individual to
another by contact infection, the discharge from a syphilitic lesion
being the medium through which the virus is transmitted, and the seat of
inoculation is almost invariably a surface covered by squamous
epithelium. The disease was unknown in Europe before the year 1493, when
it was introduced into Spain by Columbus' crew, who were infected in
Haiti, where the disease had been endemic from time immemorial (Bloch).
The granulation tissue which forms as a result of the reaction of the
tissues to the presence of the virus is chiefly composed of lymphocytes
and plasma cells, along with an abundant new formation of capillary
blood vessels. Giant cells are not uncommon, but the endothelioid cells, which are so marked a feature of tuberculous granulation tissue, are practically absent.
When syphilis is communicated from one individual to another by contact
infection, the condition is spoken of as _acquired syphilis_, and the
first visible sign of the disease appears at the site of inoculation, and is known as _the primary lesion_. Those who have thus acquired the disease may transmit it to their offspring, who are then said to suffer from _inherited syphilis_.
The Virus of Syphilis.#--The cause of syphilis, whether acquired or
inherited, is the organism, described by Schaudinn and Hoffman, in 1905, under the name of _spirochaeta pallida_ or _spironema pallidum_. It is a delicate, thread-like spirilla, in length averaging from 8 to 10 [micron] and in width about 0.25 [micron], and is distinguished from other spirochaetes by its delicate shape, its dead-white appearance, together with its closely twisted spiral form, with numerous undulations (10 to 26), which are perfectly regular, and are characteristic in that they remain the same during rest and in active movement (Fig. 36). In a fresh specimen, such as a scraping from a hard chancre suspended in a little salt solution, it shows active movements. The organism is readily destroyed by heat, and perishes in the absence of moisture. It has been proved experimentally that it remains infective only up to six hours after its removal from the body. Noguchi has succeeded in obtaining pure cultures from the infected tissues of the rabbit.
[Illustration: FIG. 36.--Spirochaeta pallida from scraping of hard
Chancre of Prepuce. x 1000 diam. Burri method.]
The spirochaete may be recognised in films made by scraping the deeper
parts of the primary lesion, from papules on the skin, or from blisters
artificially raised on lesions of the skin or on the immediately
adjacent portion of healthy skin. It is readily found in the mucous
patches and condylomata of the secondary period. It is best stained by
Giemsa's method, and its recognition is greatly aided by the use of the
ultra-microscope.
The spirochaete has been demonstrated in every form of syphilitic lesion, and has been isolated from the blood--with difficulty--and from lymph withdrawn by a hollow needle from enlarged lymph glands. The saliva of persons suffering from syphilitic lesions of the mouth also contains the organism.
[Illustration: FIG. 37.--Spirochaeta refrigerans from scraping of Vagina. x 1000 diam. Burri method.]
In tertiary lesions there is greater difficulty in demonstrating the
spirochaete, but small numbers have been found in the peripheral parts of
gummata and in the thickened patches in syphilitic disease of the aorta. Noguchi and Moore have discovered the spirochaete in the brain in a number of cases of general paralysis of the insane. The spirochaete may persist in the body for a long time after infection; its presence has been demonstrated as long as sixteen years after the original acquisition of the disease.