An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![iiiociihitioii \)\ this liiiuid. Tlic tears and Siiliva ohtaiiiccl from sy])liiliti(; per- sons liave boon inoculatcil upon liealthy persons witliout ])roducing tlio disease. As the blood itself is iin(loul)tedly eontaj^ious and inoculable, while the fluids of the various secretions do not possess these ))roperties, it is very probable that the passage of the serum of the blood through the glandular membranes and cells arrests the contagious particles and renders the secreted fluids liannless. Whatever may be the lesion or fluid or organism determining the transmission of syphilis, it appears that except in cases of hereditary syphilis the result is always the same, an infecting chancre, preceded by a period of incubation. SECTION I.—PRIMARY SYPHILIS. The Chancre.—AVe are not in possession of absolutely conclusive evi- dence as to whether or not the virus of syphilis remains localized during the period of primary incubation, but it is probable that when inserted under the skin it remains there a certain length of time Avithout any other action than gradually to pre]>are the cells which are in immediate relation with it for the hyperplasia which soon constitutes the chancre. The chancre ahvays appears at the point of inoculation. If Ave suppose that the syphilitic poison is from the first carried everywhere in the economy, it is difficult to understand why there is not, during one or two months, any other lesion elsewhere than at the point of entrance. The primary lesion is invariably met Avith at the point inoculated, never elscAvhere; and secondarily, a neighboring gland is SAVollen after the appearance of the chancre, then sev- eral glands; such glands, as we know from our study of other diseases, arrest for some time the diffusion or generalization of morbid products and tumors. This conception of the localization of the virus at the beginning of the con- tamination is very important in a practical point of view. It Avould indicate that the destruction of the chancre at the moment of its appearance Avould pre- vent syphilis. While there is great difference of opinion among syphilogra- phers upon this point, the weight of authority is against the probability of the abortion of syphilis by excising or otherAvise destroying the chancre. Most authorities are agreed, how'ever, that cauterization or excision of an abraded or absorbing surface soon after exposure, and before the development of the chancre, is strongly indicated, and has probably in several cases prevented constitutional infection. The infecting chancre has a period of incubation varying from ten days to six weeks, the average being about three Aveeks. It is an excellent general rule for prognosis in cases of suspicious ulcers upon the genitals to assume that if an interval of ten days or more has elapsed between the last exposure to contagion and the development of the sore, the latter is probably the initial lesion of syphilis. It begins sometimes by a superficial papule, Avhich generally extends in circumference and depth ; sometimes by an excoriation or a superficial fissure, often very slight. As it spreads upon the skin there are seen accom])anying redness and desquamation of the epidermis: upon the mucous membranes a superficial abrasion or an ulceration covered by a grayish or yelloAvish false membrane ; there is also observed an induration, sometimes giving the sensation of a hard nodule, fibrous or cartilaginous; at other times, that of a thin plate like parchment or paper. There may be no absolute loss of epidermis over the surface of a chancre, but merely a gradual thinning of the e])idermic layers from the margins of the sore tOAvard its center. Ulceration, Avhen it exists, is a simple cup-shaped depression; its surface is smooth and the margins are not](https://iiif.wellcomecollection.org/image/b21217014_0178.jp2/full/800%2C/0/default.jpg)
