Tuberculin.
—Finally the treatment of tuberculosis cannot be dismissed without a reference to the glycerin extract made from a filtered culture of the tubercle bacillus, containing the peculiar toxalbumin first prepared by Koch, forever associated with his name, and first given to the world in 1890, when its announcement created a furore and aroused hopes that have never been completely realized. Yet in spite of disappointments which have often followed its use, it is a remedy of great value when judiciously used in selected cases. The diagnostic value of the material should also not be forgotten, as by its use one may possibly decide in doubtful cases as between tuberculous or some other disease. The best preparation for use today is that made by Koch’s new process, by which the possibility of the presence of microörganisms is eliminated. It contains those constituents of the bacilli which are insoluble in glycerin, and which have distinct immunizing power. On the market it is known as tuberculin rest, indicated simply as T. R. The initial dose is ¹⁄₅₀₀ Mg., to be increased with each injection. Its effect, e. g., on lupus, is very marked.
CHAPTER X.
SYPHILIS.
The younger generation, when studying the subject of syphilis, should be referred back one hundred years or more to the time when the opinions held by John Hunter generally prevailed—when venereal diseases were grouped under one heading, and considered to be but three manifestations of the same morbid condition. It took years for the profession to break away from this mistaken teaching, and a generation had passed before gonorrhea was separated from the others. This left chancroid and syphilis still more or less confused in the minds of many, and until the middle of the previous century they were considered as different types of the same disease by some of the most experienced observers. Thus it happened that those who made a special study of this subject were grouped into two classes, the unicists and the dualists, according as they held to the unity or duality of syphilis and chancroid. It was a question of importance, and differences of opinions led to bitter antagonisms. Its importance inhered in this: either all venereal sores were to be subjected to constitutional treatment, or else differences in treatment were to be made according to the local or constitutional nature of the malady. Men sacrificed their own health, even their own lives, in their willingness to make experiments upon themselves, and auto-inoculability was proved by one observer through some 1700 inoculations produced upon his own body. Such devotion to medical science has been rarely eclipsed. In the latter half of the eighteenth century came clearer distinctions, and toward its close there were none who ranked as authorities who held to the old view of the unity of these diseases.
Syphilis is a disease of ancient if not of respectable origin. We read much of the possibility of so-called pre-Columbian syphilis, implying by that term that the Spaniards who came over to this country found it here and carried it with them back to Europe. This is probably the case, and yet the disease antedates the Christian era, as may be established by familiarity with ancient literature, whether Arabian, Egyptian, or Hebraic. No one can read the Psalms of David, for instance, without finding therein intrinsic evidence that the writer thereof, whoever he may have been, suffered from this disease. Of its antiquity, however, as well as of its universal distribution, we need not speak. History has shown that whenever it has appeared in a community previously unaffected by it, it has assumed malignant and epidemic features, and has spread rapidly while claiming many victims; on the other hand, in those communities where it has long been domesticated, it assumes usually a milder type, as though a racial immunity were being gradually established.
Syphilis is an infectious chronic disease, acquired either by inheritance or by contagion, mediate or immediate, with a certain period of incubation, characterized by an initial lesion at the site of infection, which is followed in time by a series of systemic disturbances, usually quite characteristic, in a commonly determinate order. A large proportion of these consist of neoplastic lesions of the general type of the infectious granulomas. In the majority of instances it is of distinctly venereal origin, although not always. It is known among the common people as pox, while a frequent synonym for it in foreign literature is lues venerea, or often lues alone, the adjective being luetic.
Syphilis is always transmitted as such and is not interchangeable with leprosy, tuberculosis, or anything else, although it is not unfrequently complicated with them as well as with cancer. It has certain resemblances to the exanthemas in its periods of incubation, and in the fact that one attack is supposed to confer immunity, as well as that many of the typical symptoms of syphilis pertain to the skin and mucous membrane; further resemblances may also be found in each case.
Within certain limits the specific infection of syphilis, or, as it is frequently spoken of, the specific disease, passes through a somewhat regular program in which periods of activity and latency seem to alternate. The first visible lesion is at the point of entrance of the virus, in acquired cases, after a certain period of incubation, and is known always as the chancre. Of course, in inherited syphilis no chancre or primary sore is found. Then occurs a second period of incubation, during which there is a still more widespread general infection of the body, in which at first the lymphatic system seems to suffer most. This is characterized by a certain degree of fever, progressive anemia, malaise, tenderness and pain in bones and joints, all of which indicate a progressive toxemia.
Manner of Contagion.
—The manner of contagion in acquired cases is naturally most often that of the sexual act, although contagion may come from many sources, including unclean utensils, pipes, etc., as well as the instruments of the dentist or the surgeon. Some abrasion of the infected surface is almost invariably presupposed, since it is not established that the virus of syphilis will enter an unbroken surface, though it may lurk thereon; but the abrasion may be trifling and occur in such situation, especially on the female genitalia, as to be undiscoverable or unnoticed. It is then possible that patients may speak truthfully when denying the existence in the past of any venereal sores. The transmission of infection from parent to offspring in the uterus will be discussed later.