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SYPHILIS OF THE STOMACH.
1450
SYPHILIS OF THE STOMACH.—THE FILTERABLE VIRUSES.
neglected the skin of the animal has a peculiar mousy odour and becomes very loathsome. In human beings the individual lesion is a very small and thin-walled vesicle, slightly smaller than the ordinary eczema vesicle, and surrounded by a narrow zone of bypersemia, very like that of varicella, but only about one-eighth the size. These lesions are always scattered discretely over the surface and not in grouped ’, lesions. The intense irritation leads to the decapitation of the little vesicles, and their original site becomes covered with either a serous or blood scab. No burrows are found, and thus it is very difficult to discover the actual parasite. This latter fact makes it necessary to trace up the source of origin, if possible, to an "itchy"dog, and in one of the instances alluded to in the article the patient was re-infected three times before it occurred to the medical man to investigate the socalled "eczema"of his patient’s dog. The course of the disease in the human being is about six weeks, in the absence of treatment and of re-infection ; and, if treated, the ordinary treatment for human scabies is quite efficient, the disease showing less tendency to relapse because the parasite doe" not burrow. In the dog and cat the average duration of treatment to effect a cure is about three or four weeks ; and here again, unless a re-infection occurs, the cure is permanent.
cases gastric symptoms occurred as early as two years after infection, in 2 cases after four years, and in 2 cases after
five years. The majority of cases occurred in the tertiary period. In the congenital cases there was a multiplicity of lesions-gummata of the liver, intestines, bones, or lungs. Such multiplicity was present in only a minority of the acquired cases. The gastric lesions were various-gumma, The gummata occurred in all ulcer, and peritonitis. parts of the stomach, and varied in size from microscopic lesions to ones of the size of the hand. In some cases they were circumscribed, in others widespread. When near the pylorus they produced the symptoms of stenosis due to a neoplasm. Sometimes they ulcerated deeply and even led to perforation. Large parts of the stomach were sometimes involved, giving rise to such diagnoses as linitis, chronic hypertrophic gastritis, and pyloric stenosis. Hmmorrhage may result from erosion of a blood-vessel. Finally, in con-
sequence of massive infiltration or adhesions hour-glass contraction of the stomach may be produced. Thus, syphilis of the stomach presents the protean character of the disease in other parts. It is often mistaken for other gastric diseases. Probably it is more common than is supposed, and some of the intractable cases of so-called simple ulcer or gastric tumour, if more closely scrutinised, would turn out to be syphilitic. Suspicion should be aroused by a history of syphilis or the presence of the Wassermann reaction. SYPHILIS OF THE STOMACH. Pain was present in 67 per cent. of the cases, and was SYPHILI’4 of the stomach has rarely been observed ; its prone to occur after eating. Nocturnal pain was observed diagnosis has often been missed and useless operations in some cases. Tenderness was often marked; it is the performed. In the Albany Medical Annals for October result of extension of the gummatous process to the serosa. Dr. Jerome Meyers has published an interesting case and Haemorrhage occurred in 30 per cent. of the cases, and was exhaustively reviewed the literature of the subject. A often so profuse as to be fatal. Sometimes it was the first Emaciation was a marked symptom in 47 per man, aged 24 years, came under observation on May 27th, symptom. 1911. He contracted syphilis five years before, and had cent. of the cases. Vomiting may occur, and is dependent been treated with mercury for four years. For six months on the site of the lesion. The physical signs are the same he had suffered from dull pain under the right costal as in other organic gastric conditions, such as tumour, ulcer, attention should be directed to margin, which later extended across the middle line and or stenosis, but in became localised under the left costal margin and in the the presence of multiple lesions with tenderness and umbilical region. The pain occurred immediately after rigidity. The test meal does not give anything characeating and lasted half an hour. Vomiting took place only teristic ; the gastric juice may be normal, hyperacid, or once. There was muscular rigidity in the epigastrium and anacid. The prognosis is good provided the patient is not under both costal margins for a distance of about four centi- too debilitated by the mechanical effects of the tumour, or metres. The lower border of the stomach was two finger- there are not adhesions and peritonitis. Unless recognised breadths below the umbilicus. On the anterior aspect of the ’, early the latter cases are not favourable, and specific treatleft knee was a large copper-colonred ulcer. A test meal I ment is of little value. In other cases, even when there is a was well-digested and showed a total acidity of 62, and free large tumour or profuse hoemorrhage, mercury and iodides was acid The treated ulcer 42. for gastric hydrochloric patient give brilliant results. and improved, but fever and sweating occurred. On June llth THE FILTERABLE VIRUSES. an irregular slightly nodular hard mass was felt beneath the left rectus muscle, extending 4 or 5 centimetres from the THE list of diseases due to "filterable viruses "-microbes costal margin. It moved with respiration and was tender on which pass through filters with pores too small to give palpation. The spleen was palpable 1’ 5 centimetres below the passage to bacteria-is longer than might be supposed. ribs. The Wassermann reaction was strongly positive. Thirty diseases are known or suspected to belong to this class. Radiography after a bismuth meal showed that the pyloric The filters used are the Berkefeld (made of diatomaceous portion of the stomach was dilated. Gummatous infiltra- earth) and the Chamberland (made of unglazed porcelain), tion of the stomach was diagnosed. Under 15-grain doses which have been used for many years for separating bacteria of iodide of potassium and mercurial inunction the pain from their products of growth. Professor S. Flexner, in the disappeared in a few days and the mass became softer. On Huxley Lecture, published in these columns (see THE LANCET, July 8th he had gained 10 lb. and was eating well and free Nov. 9th, p. 1273), showed how the discovery of filterable from pain. The mass could still be felt, but was softer, and parasites had increased our knowledge of infection and its there was no rigidity or tenderness. He moved away to a control, and in the Boston Medical and Surgical Journal distant State, and wrote in January, 1912, that he was Dr. S. B. Wolbach has given recently an interesting free from any stomach trouble. Dr. Meyers has studied summary of our present knowledge in this direction. andtabulatecl 59 recorded cases of gastric syphilis, con- Researches began with the discovery by Loeffler and genital and acquired. Of 49 acquired cases, 31 occurred Frosch in 1898 that the virus of foot-and-mouth disease in males. The youngest patient was 18 and the oldest 60 would pass through the finest porcelain filters. Independently years. The earliest period at which the condition occurred and soon afterwards Beijerinck found that the "mosaic .after the primary lesion was 10 months (in the youngest disease" of the tobacco plant was due to a virus patient), and the latest 25 years (in a man of 48). In 4 with the same property. He drew the conclusion, which is --
palpation
-
SYPHILIS OF THE STOMACH.—THE FILTERABLE VIRUSES.
neglected the skin of the animal has a peculiar mousy odour and becomes very loathsome. In human beings the individual lesion is a very small and thin-walled vesicle, slightly smaller than the ordinary eczema vesicle, and surrounded by a narrow zone of bypersemia, very like that of varicella, but only about one-eighth the size. These lesions are always scattered discretely over the surface and not in grouped ’, lesions. The intense irritation leads to the decapitation of the little vesicles, and their original site becomes covered with either a serous or blood scab. No burrows are found, and thus it is very difficult to discover the actual parasite. This latter fact makes it necessary to trace up the source of origin, if possible, to an "itchy"dog, and in one of the instances alluded to in the article the patient was re-infected three times before it occurred to the medical man to investigate the socalled "eczema"of his patient’s dog. The course of the disease in the human being is about six weeks, in the absence of treatment and of re-infection ; and, if treated, the ordinary treatment for human scabies is quite efficient, the disease showing less tendency to relapse because the parasite doe" not burrow. In the dog and cat the average duration of treatment to effect a cure is about three or four weeks ; and here again, unless a re-infection occurs, the cure is permanent.
cases gastric symptoms occurred as early as two years after infection, in 2 cases after four years, and in 2 cases after
five years. The majority of cases occurred in the tertiary period. In the congenital cases there was a multiplicity of lesions-gummata of the liver, intestines, bones, or lungs. Such multiplicity was present in only a minority of the acquired cases. The gastric lesions were various-gumma, The gummata occurred in all ulcer, and peritonitis. parts of the stomach, and varied in size from microscopic lesions to ones of the size of the hand. In some cases they were circumscribed, in others widespread. When near the pylorus they produced the symptoms of stenosis due to a neoplasm. Sometimes they ulcerated deeply and even led to perforation. Large parts of the stomach were sometimes involved, giving rise to such diagnoses as linitis, chronic hypertrophic gastritis, and pyloric stenosis. Hmmorrhage may result from erosion of a blood-vessel. Finally, in con-
sequence of massive infiltration or adhesions hour-glass contraction of the stomach may be produced. Thus, syphilis of the stomach presents the protean character of the disease in other parts. It is often mistaken for other gastric diseases. Probably it is more common than is supposed, and some of the intractable cases of so-called simple ulcer or gastric tumour, if more closely scrutinised, would turn out to be syphilitic. Suspicion should be aroused by a history of syphilis or the presence of the Wassermann reaction. SYPHILIS OF THE STOMACH. Pain was present in 67 per cent. of the cases, and was SYPHILI’4 of the stomach has rarely been observed ; its prone to occur after eating. Nocturnal pain was observed diagnosis has often been missed and useless operations in some cases. Tenderness was often marked; it is the performed. In the Albany Medical Annals for October result of extension of the gummatous process to the serosa. Dr. Jerome Meyers has published an interesting case and Haemorrhage occurred in 30 per cent. of the cases, and was exhaustively reviewed the literature of the subject. A often so profuse as to be fatal. Sometimes it was the first Emaciation was a marked symptom in 47 per man, aged 24 years, came under observation on May 27th, symptom. 1911. He contracted syphilis five years before, and had cent. of the cases. Vomiting may occur, and is dependent been treated with mercury for four years. For six months on the site of the lesion. The physical signs are the same he had suffered from dull pain under the right costal as in other organic gastric conditions, such as tumour, ulcer, attention should be directed to margin, which later extended across the middle line and or stenosis, but in became localised under the left costal margin and in the the presence of multiple lesions with tenderness and umbilical region. The pain occurred immediately after rigidity. The test meal does not give anything characeating and lasted half an hour. Vomiting took place only teristic ; the gastric juice may be normal, hyperacid, or once. There was muscular rigidity in the epigastrium and anacid. The prognosis is good provided the patient is not under both costal margins for a distance of about four centi- too debilitated by the mechanical effects of the tumour, or metres. The lower border of the stomach was two finger- there are not adhesions and peritonitis. Unless recognised breadths below the umbilicus. On the anterior aspect of the ’, early the latter cases are not favourable, and specific treatleft knee was a large copper-colonred ulcer. A test meal I ment is of little value. In other cases, even when there is a was well-digested and showed a total acidity of 62, and free large tumour or profuse hoemorrhage, mercury and iodides was acid The treated ulcer 42. for gastric hydrochloric patient give brilliant results. and improved, but fever and sweating occurred. On June llth THE FILTERABLE VIRUSES. an irregular slightly nodular hard mass was felt beneath the left rectus muscle, extending 4 or 5 centimetres from the THE list of diseases due to "filterable viruses "-microbes costal margin. It moved with respiration and was tender on which pass through filters with pores too small to give palpation. The spleen was palpable 1’ 5 centimetres below the passage to bacteria-is longer than might be supposed. ribs. The Wassermann reaction was strongly positive. Thirty diseases are known or suspected to belong to this class. Radiography after a bismuth meal showed that the pyloric The filters used are the Berkefeld (made of diatomaceous portion of the stomach was dilated. Gummatous infiltra- earth) and the Chamberland (made of unglazed porcelain), tion of the stomach was diagnosed. Under 15-grain doses which have been used for many years for separating bacteria of iodide of potassium and mercurial inunction the pain from their products of growth. Professor S. Flexner, in the disappeared in a few days and the mass became softer. On Huxley Lecture, published in these columns (see THE LANCET, July 8th he had gained 10 lb. and was eating well and free Nov. 9th, p. 1273), showed how the discovery of filterable from pain. The mass could still be felt, but was softer, and parasites had increased our knowledge of infection and its there was no rigidity or tenderness. He moved away to a control, and in the Boston Medical and Surgical Journal distant State, and wrote in January, 1912, that he was Dr. S. B. Wolbach has given recently an interesting free from any stomach trouble. Dr. Meyers has studied summary of our present knowledge in this direction. andtabulatecl 59 recorded cases of gastric syphilis, con- Researches began with the discovery by Loeffler and genital and acquired. Of 49 acquired cases, 31 occurred Frosch in 1898 that the virus of foot-and-mouth disease in males. The youngest patient was 18 and the oldest 60 would pass through the finest porcelain filters. Independently years. The earliest period at which the condition occurred and soon afterwards Beijerinck found that the "mosaic .after the primary lesion was 10 months (in the youngest disease" of the tobacco plant was due to a virus patient), and the latest 25 years (in a man of 48). In 4 with the same property. He drew the conclusion, which is --
palpation
-