Despite the unsatisfactory results thus far attained in the bacteriology of syph ilis, we are, perforce, almost compelled to accept it as of germ origin. The starting-point of the disease is certainly the absorption of a peculiar morbific principle or contagion, the results of which are consistent only with the germ theory. Fessenden Otis, some years since, following Besiadecki and others, ex pounded the most logical and ingenious theory of syphilitic infection thus far advanced. He claimed that the on tag bun consists of a degraded infectious cell of very minute proportions, which acts by incorporating itself with the nor mal leucocyte and its derivatives. This view is in nowise inconsistent with the germ theory, and by supposing the in corporation of a specific bacillus with the "syphilitic germinal cell" of Otis, his views are apparently brought up to date. This much may be said regarding the in fection of syphilis, namely: however de ficient we may be in positive knowledge of the syphilitic micro-organism, we at least have fairly definite views of the manner of its action.
Primary Local Changes from Infec tion.—Although, for the sake of clear ness of clinical description, syphilis may be considered a local disease during the first few weeks of its existence, it is never theless true that it is practically constitu tional from its inception, because we have thus far no means of preventing its systemic results. But, so far as its clin ical and pathological histories are con cerned, the disease is exclusively local until after the lapse of some weeks fol lowing its inception.
The first effect of the syphilitic infec tion is a gradually increasing accumula tion of leucocytes—i.e., white blood-cells, or lymph-cells—at the site of inocula tion, produced by a modification of the normal leucocytes and connective-tissue elements through the influence of the syphilitic infection. This phenomenon probably begins immediately after the infection takes place. It is, however, gradual in its development; hence a cer tain period elapses before the changes are apparent.
The previously normal accumulated cells (the syphilized cells of Besiadecki, Otis, et al.) contain the germs of the syphilitic infection. They become larger, more granular, and contain numerous nuclei; are infectious, and possess exag gerated powers of proliferation and amce bold movement. Associated with these characters is a marked tendency to retro grade metamorphosis. When removed to the tissues of a healthy individual, these cells, by virtue of their infectious ness, i.e., by virtue of the syphilitic germ they contain, produce changes in the normal leucocytes in their new environ ment, exciting rapid proliferation in them, as well as undergoing rapid changes themselves. Whether the in
fecting principle be a degraded cell of poisonous properties, the infectious nu cleus of a degraded cell, a bacillus, or a cell containing a bacillus,—the two lat ter, one or both, being most likely,—is of no importance in the subsequent his tory of syphilitic events, nor does the existence or non-existence of a micro organism militate against the plausibility and practicality of the views of syphilitic pathology originally presented by Besia decki and Otis. This much is certain, however, that just as the leucocyte is the primordial cell in the normal physio logical processes of growth, so is it the basis of all so-called pathological proc esses, and particularly those of syphilis, when modified in the manner peculiar to the particular disease.
Taking as our point of departure the initial lesion of syphilis, we note a local ized proliferation of the now infected and perverted cells, and, following the infec tion in its course, thickening of the lym phatic vessels and enlargement of the lymphatic glands. After a time infection bearing—i.e., microbe-carrying—cells, or perhaps independent micro-organisms, free themselves from the initial accumu lation, travel on through the lymphatics, enter the receptaculum, chyli, and are finally emptied into the circulation by the thoracic duct, to be then driven to the superficies of the body, the central nervous system, and the viscera with the general blood-current.
Conclusions in regard to the histo pathology of syphilis: I. Syphilis pri marily infects the lymphatic system and spreads by the lymphatics. 2. The in fection of the blood-vessels occurs from the perivascular lymph-spaces. The veins are less resistant, and consequently show the most marked changes. while the ar teries, certainly in the earlier lesions, are not so prominently affected as the veins. 3. The specific living syphilitic poison is originally and probably permanently located in the lymphatic system, whence it invades the blood-vessels and leads to the appearance of general manifesta tions. After such a general outbreak there is established, either in conse quence or independent of an antiluetic treatment, an hoematogenous immunity. This latter, however, lasts only a lim ited period of time, when a new invasion of the blood-vessels from lymphatic foci may take place. Whether a final com plete hrematogenous and histogenous immunity may be established with the proper treatment or without it, is a question for discussion. Maximilian Herzog (Chicago Mcd. Recorder, Apr., '99).