SYPHILIS.
Etiology and Symptoms.—Syphilis is due to the inoculation of a healthy indi vidual with the secretion of a syphilitic subject or syphilitic blood. The disease is most usually transmitted during sexual congress, but is quite frequently eon tracted in other ways. The conditions for inoculation are such that the disease may be transmitted extragenitally with great facility. It occurs through contact of the infectious principle of syphilis with a surface in a healthy individual from which the epidermis has been re moved. The removal of the epidermis is essential, because the syphilitic infec tion has no corrosive properties per se.
Clinical experiences that apparently disprove this assertion are explicable by certain additional factors attendant upon the exposure to syphilitic infection; thus if the syphilitic infection be associated with another type of infection which pos sesses specially corrosive properties, the epithelium may be destroyed by the lat ter, this facilitating the absorption of the former. Uncleanliness favors the macera tion and removal of epithelium, and if, under these conditions, a syphilitic secre tion be brought into contact with the part, the epithelium may be removed by causes entirely independent of the syph ilitic infection, after which the latter takes effect. When the syphilitic infec tion is associated with chancroid—the most corrosive of the venereal infections —the absorption of the syphilitic virus is greatly facilitated. Whether there is any antagonism between the chancroidal in fection and that of syphilis sufficient to offset the favoring action of the corrosive property of chancroid in the absorption of syphilis is open to question.
It is obvious that indiscriminate sexual congress is the most potent predisposing cause of syphilitic infection. Uncleanly habits and local circumstances favoring the retention of secretions, physiological or pathological, are important predis posing causes. When the local circum stances favor a development of extreme sensitiveness and a tendency to abrasion of the epithelium under slight causes, the predisposition to infection is greatly en hanced. Extreme length of prepuce in the male and the labia in the female are important predisposing causes. Alcohol
ism is an important predisposing cause, for two reasons: first, because it tends to produce irritability of the mucous membranes of the sexual organs; sec ondly, because of its tendency to produce moral obliquity and indifference as to results on the part of those who indulge to excess. In many instances individuals while under the influence of alcohol con tract syphilis from sexual exposure which would be abhorrent to the patient when in his or her normal condition.
Six cases of syphilis, in five of which the infection is attributed to wounds from dental instruments, and in the sixth case to an instrument (tonsillotome) in the hands of a physician who never boiled his instruments. W. L. Baum (Jour. Amer. Med. Assoc., Jan. 27, 1900).
The immediate cause of syphilis is in fection by a peculiar morbific principle contained in syphilitic blood or the se cretion of the syphilitic lesion. This principle, although it has never been positively demonstrated, is now quite generally believed to be a germ.
Incubation Period of Syphilis.—After the poison of syphilis has been absorbed a certain period elapses before its mor bid effects become manifest. This period lasts, upon the average, about twenty one days, but varies considerably from this in different cases. Fournier relates a case in which the period was seventy five days; Guerin, one of seventy-five days; and the writer has noted a case of seventy days. Instead of being pro longed, the period may be shorter than usual; thus, Hammond relates one of three days, and Dr. Nott, of New York, since deceased, reported his own case as developing within twenty-four hours after wounding his finger in operating upon a syphilitic subject. Taylor reports a ease in which the initial lesion appeared upon the second day, induration upon the fourth day, and general symptoms during the sixth week. It may, however, be accepted, as a practical rule, that true chancre does not appear before the tenth day. Any sore appearing prior to that time is probably chancroid or some sim ple affection, while any appearing later is quite likely to prove true chancre.