Syphilis Of The Spinal Cord

Gummy tumors of varying size are some-times found in the cord, usually in connection with the membranes, and frequently accompanied with symptoms of meningeal inflammation. If the tumors attain sufficient size to interfere with the functions of the cord various paralyses may result. If the gumma be located low down, paraplegia may be induced; if higher up, the sphincters may be involved, and if the tumor is situated on the cervical region, the nerves leading to the muscles of respiration may be interfered with. In this latter case the af-fection, unless checked, will prove fatal.

Course

The natural course of syphilis is so seldom observed that we are really without exact data with which to compare its march when modified by remedial agencies. As ordinarily met with, however, we pretty constantly find that no two cases exhibit the same manifestations in the same succession; this is due in part to differences of constitution or idiosyncrasy, and in part to effects of different methods of treatment. In general, however, the earlier manifestations of constitutional disease are of a superficial character, while the later ones affect the tissues profoundly. There is frequently a distinct interval of months and even years between the secondary and tertiary lesions; while on the other hand, these latter may invade the skin and deeper organs while the former are still present. The kind of treatment employed undoubtedly influences the course of the disease. Injudicious treatment, if simply inefficient, may render the disease exceedingly capricious, or, on the other hand, proper medicines employed in excess may greatly aggravate the patient's condition.

In some instances the disease would appear capable of undergoing a spontaneous cure, a year or two of mild lesions being succeeded by complete recovery. In other cases, which perhaps have been influenced little, if at all, by treatment, a long period of freedom from disease may be followed by manifestations of the gravest type. The course of syphilis then is so uncertain that it is impossible to predict the sequence which the various lesions will follow, and it is equally impossible at any given time to assert that the disease has finished its career.

Diagnosis

Under ordinary circumstances, and in the majority of cases, the diagnosis of syphilis is comparatively easy.

The chancre, or first manifestation of the disease, is to be distinguished from chancroid. Mucous patches, whether occurring about the genitals, the anus, or the mouth, can hardly be mistaken for anything else, especially if the inguinal and post-cervical glands are enlarged, and a chancre has predated. It must be remembered, however, that in females a large proportion, if not a majority, of chancres pursue their course without attracting the attention of the patient. In many cases, too, their previous existence will be denied. The various cutaneous manifestations of the disease are to be distinguished from non-specific eruptions by their color, configuration, distribution, previous history, etc. If proper attention has been paid to their peculiarities at the clinic, little difficulty will in general be experienced, as there are but three or four non-syphilitic affections that are likely to be closely counterfeited. Syphilitic roseola may in many cases be indistinguishable from simple roseola (rotheln) in its objective aspects. The history, however, and the course of the eruption will usually assist the diagnosis. Lichen planus sometimes very closely resembles a papular syhilide, so closely, indeed, that even an expert may be in doubt. The diagnosis between a squamous syphilide and certain not very typical forms of psoriasis is also sometimes difficult. When the eye cannot decide our recourse is to the history. The squamous syphilide has probably been preceded during a year or two by other eruptions differing from it In character; psoriasis, by previous attacks of the same eruption which have appeared from time to time for perhaps many years. Some of the pustular syphilides may resemble acne, more particularly the affection of the sebaceous glands that often follows the excessive use of bromide of potassium, the so-called "bromic acne." Ulcerative lesions about the face are sometimes difficult to distinguish from lupus. In these cases a careful study of the patient's history, and the appearances of former scars, if any such exist, are often of more value in a diagnostic point of view than the aspect of the lesion itself. Further, the syphilitic ulceration has probably lasted but a few months, while the lupous disease may have been present for years.

Syphilitic bone pains and nodes present little difficulty in diagnosis, but the affections of the viscera and of the nervous system will frequently baffle the most careful and expert diagnosticians. In fact, a correct diagnosis in many cases can only be determined by carefully watching the effects of treatment.

Prognosis

The general prognosis in syphilis is good, both as regards the removal of existing lesions, and the ultimate comfort of the patient, in cases that are seen early in the course of the disease, and are subjected to judicious treatment. On the other hand, cases that have been neglected or badly treated in the beginning are more difficult to manage, and more apt to present frequent relapses. Besides these, there are a number of other circumstances that modify the course, and consequently the prognosis. Among them may be mentioned the general health of the patient, his habits as regards temperance in eating and drinking, and his ability to procure proper and sufficient nourishment, medical attendance, etc. His occupation, if one necessitating much exposure, may likewise influence the result. In addition it must be remembered that some cases are naturally light, and that others, on the contrary, are particularly severe. These various elements therefore must be borne in mind whenever we consider the prognosis of syphilis, either with respect to a particular case, or as regards the disease in general. The various lesions, too, have each their separate and individual prognosis. The chancre is rarely more than a temporary inconvenience. Occasionally, however, it becomes complicated with phagedenic action; and more or less sloughing may seriously impair the symmetry and usefulness of the affected organs. Ulceration about the soft and hard palates may permanently impair the voice, and be accompanied with even more serious inconvenience. Necrosis of the bones may confine the patient to bed, and interfere, for a greater or less time, with his usual occupations. Affections of the eye, if not promptly treated, may seriously impair vision, and disease of the nervous centres may produce permanent disability or speedy death.