Group I

(syphilitic ulcer of the stomach) is chiefly represented clinically in the literature. I have observed two cases belonging to this class. In the first case (Mrs. A. K.) other signs of tertiary syphilis existed, while in Case 2 (Carrie W.), aside from the lesion of the stomach, nothing further of luetic nature could be found. In both cases the customary methods of treatment of gastric ulcer were entirely or partially unsuccessful, while antisyphilitic therapy was followed by complete recovery.

The Second Group

The Second Group (syphilitic tumors of the stomach) has received but scant mention in the literature, as far as I have been able to learn, except in a few reports of autopsies, but has not been described as having been recognized during the lifetime of the patient. I have described two cases (C. K. and William C.) belonging to this group. The occurrence of syphilitic tumors of the stomach is quite rare, but none the less important. They may run their course in a similar manner as carcinoma, and readily be mistaken for the latter. On palpation such a gummatous tumor may evince all the characteristics of a malignant neoplasm, and even the symptoms may so strongly resemble those of cancer as to be confounded with the latter. It would appear, therefore, advisable in every case of neoplasm of the stomach to bear in mind the possibility of syphilis, and to question the patient as to any previous history of that disease, and examine for any other syphilitic manifestations on the body.

1Dieulufoy: "Syphilis de restomac." Bulletin de l'Academie de Medecine, 1898, No* 20, p. 578.

2 Founder: Cited by Dieulafoy, loc. cit.

3Simon Flexner: "Gastric Syphilis, with Report of a Case of Perforating Syphilitic Ulcer of the Stomach." American Journal of the Medical Sciences, 1898, N. S., cxvi., p. 424.

4 W. A. Mackay: "The Hole of Syphilis in the Etiology of Simple Ulcer of the Stomach." Lancet, 1898, ii., p. 1701.

E. Fraenkel: "Zur Lehre von der acquirirten Magen-Darm Syphilis." Yirchow's Archiv, Bd. 155, p. 507, 1899.

6AristoiT: "Zur Kenntniss der svphilitischen Erkrankungen des Magens bei hereditilrer Lues." Zeitschrift f. Heilkunde, 1898. xix.. p. 395.

7Max Einhorn: "Syphilis of the Stomach." Philadelphia Medical Journal, February 3d, 1900.

The Third Group Of Syphilitic Pyloric Stenosis

The Third Group Of Syphilitic Pyloric Stenosis is of great practical import. In one of the cases I have observed (Carl S.) a thickened pylorus could be felt as an oval tumor which disappeared under continued antisyphilitic treatment. At the same time the symptoms of ischochymia receded and the patient recovered. In a second case (George W.) the pylorus was not palpable, and the diagnosis of the commencing constriction had to be based upon the results of internal examination of the stomach. In both cases the customary medical measures indicated in benign pyloric stenosis proved insufficient, while the administration of potassium iodide soon effected the improvement.

From the remarks just made it appears distinctly that tertiary syphilis may produce severe gastric affections which are susceptible to antiluetic treatment.

In the therapeutics of intractable diseases of the digestive apparatus, therefore, the possibility of a syphilitic origin of the trouble must never be forgotten.