VISCERAL INVOLVEMENT. — Visceral engorgements and infiltrations are by no means uncommon in syphilis, congestion characterizing the early secondary, dif fuse infiltration the late secondary, and distinct gummy deposit the sequelar period. Tenderness over the liver, spleen, and kidneys is occasionally ob served in early syphilis. Transient albu minuria is not uncommon.
Syphilis of the stomach is not so rare as might be believed. The lesions pre sent themsel es under various forms: limmorrhagic erosions, ecchymosis of the mucous membrane, gummous patches, etc. When the symptoms of ulcus sim plex are observed in a syphilitic person, it is natural to suppose the gastric le sion is of itself syphilitic. It should never be forgotten, when in presence of gastric ulcer, to look for syphilis in the antecedents of the patient and apply the treatment accordingly. Dieulafoy (Can ada Lancet, Aug., '98).
To the few case!: of undoubted gastric syphilis on record a fatal case is added: The microscopical features of the ulcer demonstrated its syphilitic nature, but gave no support to the view that it had been produced by the softening of a gumma. The appearance was more that of an indirect necrosis of the mucous membrane brought about by combined softening of the submucous gummatous infiltration, and obstruction and obliter ation of the blood-vessels. The mucous membrane, thus deprived of its nutri tion, beeame necrotic, was removed. and
an ulcer resulted. Simon Flexner (Amer. Jour. Med. Sei.. Oct., '9S).
In CO cases of recent syphilis, an un doubted enlargement of the spleen yield ing to specific treatment was found only 4 times. Splenic enlargement was also found twice in 4 eases of syphilis. From these and other observa tions it appears that in early stages of syphilis enlargement of the spleen can only seldom he made out with certainty. At present, therefore, the condition of the spleen does not help one to draw any conclusions regarding diagnosis or treat ment. C. Bruhns (Dent. Arch. f. klin. Sled., vol. p. 451. '99).
Syphilis of the heart is rare and is fol lowed by interstitial or guunnatous myocarditis. It may affect the coronary arteries alone. The symptoms are the same as in other forms of myocarditis. Some improvement will follow specific treatment, which confirmF, the diagnosis. The prognosis depends upon the age of the patient. In gonorrhoea, on the other hand, endocarditis is not uncommon, the myocardium only becoming involved sec ondarily. Gonorrhoeal endoearditis may be acute and malignant or chronic and benign. The diagnosis is not so difficult as that of syphilitic myoearditis. G. Fischer (La Presse Med., Jan. 15, 1902).