Concomitants of Syphilis

The disease we are describing does not vent its entire energy upon the skin, but early in its history it exhibits its presence on the mucous membranes by the development of father large, flattish tubercles in the mouth and about the genital organs and around the anus. It is in females especially that the mucous patch or condyloma reaches its highest development.

Early in the disease, too, the hair may fall out, so that an almost complete alopecia of the scalp may occur before it is checked by treatment. This early alopecia, however, is not permanent, as the hair begins to grow again as soon as the patient is brought under the influence of proper constitutional treatment. During this period, also, inflammation of the iris is not an infrequent complication. Ulcerations, more or less extensive, of the soft palate and tonsils, may supervene among the early or late symptoms of the disease.

In the tertiary period painful swellings are met with along the course of the long bones, especially the tibia and in the flat bones of the skull. These nodes, as they are called, are due to an inflammatory deposit beneath the periosteum, which is usually accompanied with considerable pain, worse at night. The gummy deposit, separates the periosteum from the bone, and, by depriving the bone-tissue of its proper nourishment, produces necrosis.


An interesting case is reported of ulcerating gummata of the scalp forty-four years after infection, as occurring in a man aged 63, who contracted syphilis when between eighteen and twenty years of age. Typical syphilides followed, relapsed a number of times and finally disappeared without treatment. When he was twenty-four years old (about five years after infection) he married. His wife mis­carried once, but remained healthy, dying at sixty. His eldest son developed psoriasis palmaris when seven years old and again when eighteen, which was caused by anti-syphilitic treatment; in other respects, as well as his younger sister, remained well. The patient himself was affected by herpes zoster in 1878. In 1886 a gumma appeared on the left parietal bone, which ulcerated and exposed the bone and caused necrosis. Gradually the bone was cast off, and necrosis of the diploe appeared. As, however, demarcation proceeded slowly and symptoms of pressure on the brain set in, trephining was decided upon, which exposed a collection of pus under the necrosed bone. Improvement set in on anti-syphilitic remedies. Soon, however, an attack occurred during which  he lost consciousness; then the functions of the brain became disturbed, intelligence gradually waned, oedema of the extremities set in, new gummata appeared on the scalp, and the patient died. Post­mortem there were found thrombosis of the iliacs, caries and necrosis of the left parietal bone, thickening of the meninges, beneath it, but no pathological changes in the brain. The ulcerations of syphilis are somewhat peculiar, and, once seen, can hardly be mistaken afterward. They are usually round, and with clean-cut margins, as if punched out, differing in this respect from the overhanging walls of scrofulous ulcers, or the sloping margins of the simple variety.


Late in the disease, and among the tertiary group of symptoms, we meet with a peculiar deformity of the phalanges, commonly known as dactylitls syphilitica, the appearance of which is so peculiar and characteristic that it should not be mistaken for anything else. This lesion is rare, however, and perhaps unknown to many physicians, and the illustration best shows its characteristic features.

Necrosis of the nasal and palatal bones may occur late in the disease.

Syphilis is an all-pervading disease, and may involve the viscera as well as the more superficial organs. The liver, kidneys, lungs, brain, spinal cord, etc., may become the seat of gummy tumors, which, according to their location and size, may do more or less damage, even to the extinction of life.

Dr. Marchiafava thus describes the lesions found by him in the kidney in two cases of hereditary syphilis: "The organs were of normal size, but the cortical substance was of a grayish color, and dotted with minute whitish nodules, corresponding to the glomeruli. Under the miscroscope, the lesions were seen to proceed from a diffuse arteritis of the glomerular and afferent vessels. The arteries were contracted, and finally obliterated, and became converted into a hyaline mass. The vascular loops of the glomeruli were thus destroyed, as was also, at a later period, the epithelium of the convoluted tubules which derives its nourishment from the afferent vessels." Dr. Ingram has observed, in twelve cases of congenital syphilis, concentric enlargement of the wrists. This enlargement has more the appearance as if two fine silk ligatures had been tied around the wrist immediately above the joint, the strands being placed about half an inch apart and tied tight enough to hide themselves in the flesh. To the touch they have all the dense hard feeling that callus does when thrown about a fracture.