Vincent's hospital WITH SIXTY-NINE IILUSTRATIONS IN THE TEXT AND NINE PLATES, SEVEN OE WHICH ARE COLORED new york and london d. 192-205 CHAPTER XV CHANCROID Definition — The streptohacilhis — Frequency — Methods of contagion — Situation and number — Symptoms and course: Incubation ; Onset ; The ulcer — Complications: The mixed sore; Inflammation; De- struction of freedom ; Gangrene and phagedena ; Lymphangitis ; Inguinal adenitis — Diagnosis — Treatment: Abortive ; Palliative ; Prevention of bubo; Treatment of complications . 206-221 CHAPTER XVI THE INITIAL LESION The chancre: Synonyms; Description; Pathology; Multiple chancre; Types ; The eroded chancre ; The Hunterian chancre ; The Indur- ated papule ; Exceptional varieties ; Complications ; Lymphan- gitis; The mixed sore; Inflammation; Gangrene and Phagedena; Transformation into a mucous papule; Vegetations; Duration; Reinduration ; Diagnosis ; Prognosis ; Treatment — Characteristics of chancre in various locations: Of the male genitals; Urethral; Of the female genitals; Cervical; Extragenital chancre; Buccal; Tegumentary^T/z^ adenitis of chancre: Symptoms; Unusual varieties; Diagnosis; Treatment 222-241 TABLE OF CONTENTS xv CHAPTER XVII DIAGNOSIS OF THE INITIAL LESION PAGES Requirements for diagnosis: The test of time — Differential diagnosis: Of genital chancre; Herpes; Scabies; Chancroid; Gumma; Table of differential diagnosis — Differential diagnosis of chancre of the mouth: Of the lip; Within the mouth; Vincent's angina; Chancre of the tongue 242-252 CHAPTER XVIII SYPHILITIC TOXEMIA Acute syphilitic toxemia: Hematology; Pathological anatomy; Fever of early syphilis; General debility; Prodromes; Nervous symptoms; Symptoms of local congestion; Of the skin and mucous membrane ; Of the lymph nodes ; Of the bones ; Of the joints and muscles ; Of the brain and meninges ; Of the abdominal viscera; Alopecia — Chronic syphilitic toxemia: The fever of late syphilis ; Arterial and visceral sclerosis ; Amyloid degeneration of , the viscera 253-270 CHAPTER XIX SYPHILIS OF THE SKIN: GENERAL CHARACTERISTICS General clinical characteristics: Slow and progressive development; Polymorphism; Absence of inflammation; Absence of pain and itching; Peculiar color; Rounded form; The scale; The crust; The ulceration; The scar; General clinical characteristic of secondary and tertiary syphilids— 6^^n^ra/ pathological char- acteristics: The papule ; The macule ; The tubercle ; The gumma 271-279 CHAPTER XX SECONDARY SKIN SYPHILIDS The macular syphilid: Varieties; Duration; Diagnosis; Differential diagnosis — The papular syphilid: Varieties ; Diagnosis ; Differen- tial diagnosis — The vesicular syphilid — The bullous syphilid — The pjustular and crusted syphilids: Herpetiform ; Varicelloid ; Acnei- form; Impetiginous; Ecthymatous — The squamous syphilid: Diagnosis — The pigmentary syphilid 280-301 xvi TABLE OF CONTENTS CHAPTER XXI SECONDARY SYPHILIDS OF SPECIAL REGIONS INCLUDING ONYCHIA PAGES Moist papules: Erosions and condylomata — Squamous eruptions of the palms and soles— Onychia: Atrophic; Detachment of the nail; Hypertrophic ; Other varieties — Paronychia: Squamous ; Ulcera- ting; Treatment — Eruptions in the scalp: Pustular or crusted syphilids ; Vegetating syphilid — Eruptions about the face: Corona veneris; Diffuse infiltration; Vegetation .... 504—526 CHAPTER XXXVI HEREDITARY SYPHILIS: RELAPSES: LATE LESIONS: DIAGNOSIS: PROGNOSIS: TREATMENT Relapses in early childhood — Late hereditary syphilis: Diffuse peri- ostitis ; Parenchymatous keratitis ; Treatment — Stigmata of XX TABLE OP CONTENTS PAGES hereditary syphilis: Hutchinson's triad; Dental stigmata; Hutchinson's teeth; Foumier's teeth; Ocular stigmata; Auditory- stigmata — Diagnosis of hereditary syphilis: In infancy ; Examina- tion of the family record ; Diagnosis in later years — Prognosis — Treatment in infancy; Local treatment; Treatment of relapses after the second year 527-542 Index 543 LIST OF PLATES PLATE I.- Fig. It is even possible for one of twins to be healthy, the other infected.

CLINICAL PROFESSOR OF GENITO-URINARY SURGERY, NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL; LECTURER ON SURGERY, CORNELL UNIVERSITY MEDICAL school; SURGEON TO ST. What is the probability of infection from contact by kissing or sexual intercourse with a person known to be syphilitic ? xiii CHAPTER X PRINCIPLES OF THE TREATMENT OF SYPHILIS PAGES Prevention — General principles of treatment — The routine treatment: Hygiene ; lodids do not prevent relapse ; Mercury does prevent relapse; Mercury is a tonic; In the routine treatment tonic doses of mercury are more effective than poisonous doses; So long as a sufficient amount of mercury is exhibited it matters not whether it is given by the mouth, by the skin, or by injection; The symptomatic treatment: For early secondary lesions mercury; for early painful symptoms iodid ; Gummatous lesions may be cured by iodid but better by mixed treatment ; Sclerotic lesions and lesions difficult to classify require mixed treatment; Lesions of the nervous system require treatment for short' periods with intermissions of hygienic treatment; Symptomatic treatment should always be vigorous and continued after the lesion has apparently healed; Vigorous treatment is that which effects prompt improvement; Local treatment avails little . 13S-150 CHAPTER XI THE ROUTINE AND SYMPTOMATIC TREATMENT The routine tonic treatment: How to administer treatment; The Vigorous interrupted method ; The modern interrupted method ; The continuous tonic treatment ; Method of administering mer- cury; Tonic treatment; Tonic treatment after late relapses; When to begin routine treatment — Treatment of the lesions of syphilis 1 51-160 CHAPTER XII PHYSIOLOGICAL EFFECTS AND TOXICOLOGY OF MERCURY Beneficial effects of mercury — Toxicology: Salivation; Treatment of salivation; Entero-colitis ; Nephritis; Dermatitis; 111 effects of prolonged mercurialization ; Contraindications . 1 69-1 9 1 CHAPTER XIV THE l ODIDS: MIXED TREATMENT Therapeutic indications — lodism: Coryza; Indigestion; Acne and other skin lesions; Toxemia; Salivation; Neuralgia; Edema; Other lesions— Method of administration and dosage: The one hundred per cent solution; The minim drop; The time of ad- ministration ; Dilution ; The diluent ; Prevention of iodism ; Sub- stitutes for potassium iodid ; Dose ; Duration of treatment ; How to increase the dose — Mixed treatment — The test course . It usually lasts from four to six years; but during this time abortions, syphi- litic children, and healthy children alternate in a most confus- ing succession.

The world's great authorities, Fournier, Neumann, PREFACE IX Lang, Hutchinson, Finger, and Taylor — to mention only a few to whom a special debt is due — have been drawn upon freely for information, and reference upon disputed points has been made for the convenience of the student to the latest, the most comprehensive, or the most accessible monographs. Zabriskie, those upon Syphilis of the Nervous System ; Dr. ' Rosinski ( "Die Syphilis in der Schwangerschaft") offers the latest con- tribution to this side of the argument. Let us, therefore, array the evidence upon each side.

Thus we hope to spare the reader aimless divagations among the litera- ture, and ourselves the laborious sciolism of copious bibliography. Hurd has reviewed the chapters upon Syphilis of the Nose, the Throat, and the Upper Air Passages ; Dr. In favor of paternal heredity is alleged the obvious fact that father and child are certainly syphilitic, the mother apparently sound.


Concerning the matter herein set down, it is impossible to be egotistical. Middleton, that upon Syph- ilis of the Eye ; and Dr. Finally, while including in my general debt of gratitude all those whose writings or whose illustrations upon syphilis I have been able to lay my hands on, I must acknowledge a more pre- cise indebtedness to the many others who have lent kindly per- sonal aid to the matter in this volume : to my father, facili principi ; to my associate. Chetwood, for privilege to tabulate cases observed by him, as well as for the keen interest with which he has shared the labor of testing various methods of treatment; to Drs. g., by a kiss or in suckling), or from an indifferent person (e. In these two latter instances (4 and 5) the disease in the infant is acquired syphilis, differing from hereditary syphilis in the presence of a chancre at the point of inoculation, and the absence of the grave visceral lesions of fetal syphilis. But pathologists have always maintained at least an attitude of doubt concerning this unique seminal transmission which is not even alleged for any disease except syphilis. pallida be found ; Distribution and fate — Experimental syph- ilis: Inoculation; Prophylaxis; Inoculation immunity; Serum diagnosis and treatment 22-34 CHAPTER IV THE NATURE OF SYPHILIS The contagiousness of gumma: Persistence of spirocheta — Cause of relapses: Trauma and syphilis; The cause of parasyphilids^ Immunity: Racial immunity; Is our race immunized? In so long a series syphilis plays, as might be expected, the same pranks as in its course in the individual. Most exceptionally, the woman recently infected with syphilis and untreated may bear only healthy children. As a rule, the recently infected woman bears at least one syphilitic child, but, if well treated (probably) bears healthy ones thereafter. If not treated, she usually has several miscarriages be- tween the fourth and seventh months, two or three children who die at birth or within the first three months of their lives, and others who survive — syphilitic. — Hereditary syphilis — Clinical types of the disease: Mild early syphilis ; Malignant early syphilis ; Mild but persistent syphilis ; Relapsing syphilis ; Malignant late syphi Us ; Mild late syphilis CHAPTER III ETIOLOGY OF SYPHILIS The Spirocheta pallida: Methods of staining; Diagnosis; Where may 5. Thus syphilitic children — aborted, stillborn, dying in infancy, or living in spite of the infection — may follow one another for ten, fifteen, even twenty years. In certain of the views advanced, where this treatise differs from the majority of text-books, I am willing to share the respon- sibility with my son. Yet it is perhaps too much to say that even these cases have been intelligently treated. only 2 — escaped bearing at least one syphi- litic child ; and this exception is fully compensated for by 3 who, before realizing they had the disease themselves, infected SYPHILIS AND MATERNITY "67 a child whom they had previously brought into the world healthy. All have received treatment at our hands, but a large minority have received most of their treat- ment, and especially of their important early treatment, at the hands of others. Of the infecting 41 23 bore I syphilitic child (or fetus), of whom 5 bore healthy children later.

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