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Treatment: Salvarsan Methods of administering mercury Syphilis and marriage Intermediate stage Reminders Tertiary period: General symptoms, gummata, tertiary ulcers, tertiary lesions of skin, mucous membrane, bones, joints, etc. Second attacks. INHERITED SYPHILIS Transmission Clinical features in infancy, in later life Contagiousness Treatment.
Syphilitic sequestra are heavier and denser than normal bone, because sclerosis usually precedes death of the bone. The bones especially affected by gummatous disease are: the skull, the septum of the nose, the nasal bones, palate, sternum, femur, tibia, and the bones of the forearm. In the bones of the skull, gummata may form in the peri-cranium, diploë, or dura mater.
"The chronic, so-called secondary and tertiary manifestations of venereal diseases, such as ulceration of bones and fleshy tissue, gummata of the brain, sclerosis of the spinal cord, arthritic rheumatism, degeneration and destruction of other vital parts and organs of the body, are not so much the result of the original gonorrheal or syphilitic infection, as of the destructive drug poisons which have been taken to cure or rather to suppress the primary lesions and acute inflammatory symptoms.
#Later Lesions.# In the skin and subcutaneous tissue, the later manifestations may take the form of localised gummata, which tend to break down and form ulcers, on the leg for example, or of a spreading gummatous infiltration which is also liable to ulcerate, leaving disfiguring scars, especially on the face. The palate and fauces may be destroyed by ulceration.
In tertiary lesions there is greater difficulty in demonstrating the spirochæte, but small numbers have been found in the peripheral parts of gummata and in the thickened patches in syphilitic disease of the aorta. Noguchi and Moore have discovered the spirochæte in the brain in a number of cases of general paralysis of the insane.
In the tertiary stage the joint lesions are persistent and destructive, and result from the formation of gummata, either in the deeper layers of the synovial membrane or in the adjacent bone or periosteum. Peri-synovial and peri-bursal gummata are met with in relation to the knee-joint of middle-aged adults, especially women.
While a considerable number of syphilitic children grow up without showing any trace of their syphilitic inheritance, the majority retain throughout life one or more of the following characteristics, which may therefore be described as permanent signs of the inherited disease: Dwarfing of stature from interference with growth at the epiphysial junctions; the forehead low and vertical, and the parietal and frontal eminences unduly prominent; the bridge of the nose sunken and rounded; radiating scars at the angles of the mouth; perforation or destruction of the hard palate; Hutchinson's teeth; opacities of the cornea from antecedent keratitis; alterations in the fundus oculi from choroiditis; deafness; depressed scars or nodes on the bones from previous gummata; "sabre-blade" or other deformity of the tibiæ.
During the secondary period the lesion usually consists in effusion into the sheath; gummata are met with during the tertiary period. Arborescent lipoma has been found in the sheaths of tendons about the wrist and ankle, sometimes in a multiple and symmetrical form, unattended by symptoms and disappearing under anti-syphilitic treatment.
The affected muscle is larger and firmer than normal, and its electric excitability is diminished. In tertiary syphilis, individual muscles may become the seat of interstitial myositis or of gummata, and these affections readily yield to anti-syphilitic remedies.
The best treatment is to excise the affected bursa, or, when this is impracticable, to lay it freely open, remove the tuberculous tissue with the sharp spoon or knife, and treat the cavity by the open method. Syphilitic disease is rarely recognised except in the form of bursal and peri-bursal gummata in front of the knee-joint.
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