EARLY NERVE INVOLVEMENT IN SYrinms.—Syphilitic toxins occupy a very prominent position in the etiology of early syphilitic nerve disease. They also bear a more remote relation to same of the early types of nerve-phenomena. They apparently act in several ways, viz.: (A) By direct intoxication of nerve-tis sue. (B) By the induction of vasomotor changes via the sympathetic ganglia or the so-called monarchial vasomotor cen tre in the medulla. (C) Direct intoxica tion and irritation of blood-vessels in the nervous system. Organic or functional nervous disturbance is produced by syph ilitic new growth in numerous ways, viz.: 1. By invading the lymphatics surround ing nervous structures. 2. By involving the tissues, chiefly the lymphatic vessels, surrounding the blood-vessels supplying or draining the part. 3. By invading the arterial walls. 4. By infiltration of con nective and other tissues about nervous structures. 5. By involvement of the nerve or brain parenchyma proper. G. By involving nerve-sheaths or the cere bro-spinal meninges. These various con ditions act by producing: 1. Irritation.
2. Pressure-innutrition, and occasionally degenerations. 3. Passive hypermmia and oedema from venous obstruction. 4. Localized anmmia (ischfemia) from arterial obstruction. 5. Blocking up of the affected area by lymphatic obstruc tion.
Any of these conditions may occur in both the active and the sequelar periods, and prove very destructive. It is rare that extensive destruction of tissue from breaking down of the neoplasm occurs in the earlier nervous lesions. It is to lbe remembered, however, that gummy may develop at an early period from the intrinsic malignancy—precocity—of the disease.
The Period of So-called Tertiary Syphilis. —'PITT TUBERCULAR SYPIIIIIDE (G UALRY INFILTRATION).— One of the most frequent and important of the tertiary lesions, or sequeloe, is the tubercular eruption. This has been said to be due to a localized accumulation of morbid cell-material in the tissues— so-called "gummy infiltration"—that is the type-basis of all tertiary lesions. This gummy material is termed by Wagner "syphiloina," and is described by him as an infiltration of cells and nuclei, the cells not being capable of differentiation from the normal white blood-cells or len coeytes and the nuclei themselves pre senting no characteristic appearances. He states that their morbid effects are due to a mere interference with the func tion and nutrition of affected parts by simple pressure. BM:miler also claims that the histological elements of syphilomata lack specific microscopical characters.
The tubercular, or gummy, lesion may develop in any situation, its favorite lo cations being the cellular tissue, skin, bones, liver, testes, brain, and kidneys, and, in children especially, the lungs.
Syphilis can manifest itself in the veins. There are two forms of syphilitic phlebitis. The first is acute or subacute, and corresponds to the secondary period of the disease. The other form is chronic, and corresponds to the tertiary period of the disease; it may be localized (gunnua of a vein) or generalized (phlebosclero sis). The phlebitis of both secondary and tertiary syphilis affects the veins of the lower extremities by preference. The prognosis is generally favorable, the average duration being two months. R. Heuzard (These de Paris, No. 179, '93).
This gummy material is a grayish-red, homogeneous mass of greater or less con sistency, that may be found in the par enchyma of any organ or tissue of the body, either as a diffused or circum scribed infiltration, but never capsulated. When this accumulation of morbid mate terial is superficial and exposed to un equal pressure, and when it is excessive or involves the walls of the blood-vessels, "thus giving rise to localized innutrition from pressure or vascular obstruction, the whole mass is liable to disintegrate and form an open lesion, or break down into pus or puruloid material that may sorb through fatty or granular degenera tion without ulceration. It has been demonstrated that the longer the dura tion of the active period, and conse quently the more pronounced the changes in the lymphatic structures produced by its lesions, the greater the liability to tertiary lesions of a severe type.
After the removal of the cells by fatty degeneration there is always a tendency to recurrence. This explains the diffi culty of curing the disease at this period. This tendency is due to an increased in jury to the lymphatic structures already greatly impaired by the lesions of the active period of syphilis. This impair ment consists in the formation of fibrous tissues as a result of low inflammatory action mechanically set up by the cells. This fibrous formation, of course, inter feres, in a measure, with tissue-nutri tion in different localities by producing changes in the vascular walls.
A careful consideration of all the facts thus far presented leads to the conclusion that the various lesions and different de grees of severity of the phenomena of the so-called "tertiary stage of syphilis" de pend upon (1) the amount of damage pro duced by the lesions of the active period of the disease and its duration, and (2) the constitutional condition of the in dividual independent of specific infec tion.