Syphilis Of The Glandular And Nervous Tissues

The principal lesions affecting these tissues are gummata and diffuse infiltrations. They will be considered in connection with the special organs involved.

We will now consider the principal lesions to which the different organs are liable, commencing with those of the penis.

Penis

The chancre and the flat condyloma, or mucous patch, have already been noticed. These, however, are not the only lesions which may affect the organ. Well along in the secondary stage ulcerations may occur upon the glans, or upon the integument of the organ. In the former case they frequently coexist with similar lesions upon other parts of the skin, and present no special peculiarities. On the glans the ulceration may partake of almost any form and aspect, and may sometimes be mistaken for other venereal lesions, as chancroids. With a clear and definite history, no difficulty should be experienced in distinguishing them; but when this is wanting, it is often no easy matter to say, with positiveness, that a given lesion is or is not syphilitic, and the treatment alone may be the means of establishing the diagnosis.

Testicles

Syphilitic lesions of these organs rarely occur until late in the disease, and usually under the form of diffused interstitial infiltrations, leading to a usually painless uniform enlargement of the organ, termed orchitis. The increase is gradual, and without acute symptoms, and may produce inconvenience solely by its size, which is sometimes two or three times that of the normal organs. If we have a distinct syphilitic history, and consider the indolent nature of the lesion, there will in general be little difficulty in diagnosis. The affection is to be distinguished from gonorrhoeal epididymitis, from hydrocele, from haematocele, and from simple inflammation depending upon traumatic causes. In syphilitic disease the testicle proper is involved; but in the gonorrhoeal affection, the epididymis is the principal seat of the inflammation, the testicle not participating, or at most to a minor extent. In epididymitis the inflammation is acute, and the parts painful and tender. The other affections are to be distinguished by the rules laid down in works on surgery.

Instead of the diffuse form of orchitis, we may find one or more gummy nodules scattered through the substance of the organ. These may subside under treatment, or soften and discharge through the scrotum. The affection is to be differentiated from tubercular and cancerous disease.

Vulva

Chancre of the vulva is very often an extremely trivial affair. If situated upon the mucous surfaces of the labia majora, or upon the labia minora, or upon the neighboring mucous membranes, it may, though rarely, consist of a well-marked lesion, with characteristic induration. Very frequently, however, we find little more than a superficial erosion, with the least possible degree of parchment hardening.

In many instances the lesion may exist and disappear unknown to the patient. As a rule, the lesion is single, in marked contrast with the chancroid, which is frequently multiple. After the disappearance of the chancre, or even before it is entirely gone, additional syphilitic lesions may appear upon and around the vulva. These are early secondary manifestations, the so-called "mucous patches." They are usually multiple, as many as fifteen or twenty being present at the same time. This lesion presents itself under three principal forms. These are the superficial erosion, the slightly elevated and circumscribed mucous patch proper, and the hypertrophic patch or condyloma. The superficial erosion is devel-oped upon the mucous surfaces of the labia majora, on the labia minora, and other parts of the vulva. The lesion is circular or crescentic, and is sometimes underlaid by an appreciable parchment induration. In this case it may, with difficulty, be distinguished from the chancre.

The multiple character of the lesion, the sometimes irregularity of contour, and the prior occurrence of a chancre, are the principal aids to diagnosis. The raised patch or mucous patch proper develops upon the regions above mentioned, but is most distinctly exhibited upon the cutaneous surfaces immediately adjoining. It differs from the ppreceding in being somewhat elevated. The surface is eroded, and usually covered with a grayish, sometimes diphtheroid exudation. These lesions vary in size; many of them may be flat papules, the size of a small pea, while hers may be half an inch or more in diameter.

The condyloma is simply an overgrown mucous patch. The causes favoring the development of this and the preceding lesions are heat, moisture, and uncleanliness, and where these exist to a marked extent the mucous patch is stimulated to excessive growth, both in height and diameter. Neighboring patches may touch and become confluent, so that we may find an extensive raised vegetating surface exuding a certain quan-tity of the fetid pus. The lesions mentioned are all early syphilitic manifestations.

Later in the disease, however, we sometimes meet with distinct ulcerations, often accompanying, and analogous to the ulcerative lesions of the skin. These can usually be diagnosticated as syphilitic, though often with difficulty distinguishable from chronic chancroids. Sometimes the history or subsequent developments will alone enable a diagnosis to be made.

Still later in syphilis, well along in the tertiary period, gummata may make their appearance about the vulva.

These are distinguished as submucous or subcutaneous nodules, or small tumors, which may subside under treatment, or else soften and suppurate, and discharge externally. Subsequent cicatrization and contraction of the tissues may produce more or less deformity of the organs.

Syphilis Of The Vagina And Uterus

The vagina is very rarely the seat of syphilitic lesions, either primary or secondary. The neck of the uterus presents them more frequently. In either case they may appear under the form of chancre, or secondarily as superficial erosions, flat papules, or ulcerations.