Imágenes de páginas
PDF
EPUB

interstitial tissue; the cells of the tubules waste, the Malpighian bodies shrink, and their envelopes thicken. This process of cirrhosis is usually confined to a few points, and only by exception pervades the kidney generally. Interstitial inflammation is much more common than the gummy deposits, of which Virchow and Beer have described some examples.1 A syphilitic kidney has the surface unevenly marked by deep seams. The capsule is tough, adherent to the diseased parts, and leaves the surface rough when torn off. Section shows the cortical substance connected with one or more pyramids to be diminished, harder, and lighter in colour than elsewhere. If a gummy nodule is connected with this cirrhosis, a circumscribed, soft yellowish patch is found. White seams or lines often pass across the kidney from the pyramid to the surface, with which the gummy nodule may be connected or surrounded.

The cirrhosis of syphilis, by thus only partly implicating the kidney, is usually distinguished from that produced by other causes, which besets the whole gland rather than any part of it.

During life, albumen and casts are often present in the urine, as in other forms of slow nephritis.

Amyloid degeneration sometimes attacks the kidneys of syphilitic patients, but in what manner syphilis effects this change is uncertain. Wilks is unable to point out a direct connection between them as cause and effect. Lancereaux did not find any amyloid degeneration in twenty post mortems of visceral syphilis; the changes he did note were, in four, interstitial nephritis; in one, gummy tumours. In many of the cases, no alteration of the kidney

1867.

3

Eingeweide Syphilis von Arnold Beer, SS. 33, 63, 93, 132. Tübingen,

2 Guy's Hospital Reports. 1863.

3 Loc. cit., p. 291.

was observed. Virchow1 believes that amyloid degeneration is brought on by the cachexia of syphilis. Klob2 found this change present where the lesions characteristic of syphilis were well marked. This form of degeneration is in no way different from amyloid disease set up by other causes. When set in operation, the degeneration first attacks the smaller arteries and coverings of the Malpighian tufts; the latter become large, white and opaque, and easy to distinguish from the surrounding cortical substance. The capsules are rendered still more evident if solution of iodine be poured over the kidney, when they assume a hue much browner than the other parts. The arteries are first attacked; but in time the amyloid disease extends to the capillaries, and even, according to Beer, to the stroma of the kidney itself.

THE GENERATIVE ORGANS.

The external genitals in both sexes are naturally the most frequent seat of early ulcers, chancres, &c. They may also be attacked by the later gummy formations.

In the corpus cavernosum penis gummy nodules sometimes form, though it is an extremely rare affection and of slow development. It begins as a small lump in one of the corpora cavernosa, being situated nearly always, according to Zeissl, in the posterior third. It is painless, and causes no inconvenience while the penis is flaccid. During erection, a peculiar kind of chordee is produced, the affected corpus is. not injected, or only partly injected with blood, and the penis curves over towards the groin on the injured side. Should the nodule be situate on the upper surface rather than to one side, the penis is turned backwards to the

1 Virchow: Krankhafte Geschwülste, Bd. ii. S. 471.

2 Pleischl und Klob: Wiener Med. Wochenschrift, S. 113. 1860.
3 Loc. cit.

belly, so much so in some cases, according to Ricord, as to resemble a ring, and render intercourse impossible. These nodules have not been observed in the corpus spongiosum, which, on the contrary, in gonorrhoea, is the part most frequently attacked by acute inflammation of its spongy substance and chordee. The course of these exudations is very slow, they may disappear spontaneously or remain indefinitely until removed by treatment.

The Vasa deferentia, Vesicula Seminales and Prostate are so rarely attacked, that instances of syphilitic affections in these organs are almost unknown. Lancereaux1 refers to a case of gummy swelling of the cord recorded by Verneuil, in a patient where a similar growth was found in the wall of the right auricle, whence Verneuil concluded the tumour of the cord had a syphilitic origin.

The Epididymis.-It was believed until recently that syphilis only reached the epididymis when the testis was far advanced in disease; but there is probability that the epididymis is also occasionally affected while the testis remains untouched. M. Deon has described an indolent disorder of the epididymis which chiefly affects the globus major, causing slow enlargement of that body, and thickening of the remaining part of the epididymis. This enlargement occasions very little pain, does not extend to the testis, and subsides after a duration of a few weeks. It is most frequent during the earlier stages of syphilis, within the first six weeks after infection, and commonly attacks both organs. Mr. Curling, who corroborates the observation of Hamilton, that the epididymis enlarges in tuberculous persons infected by syphilis, remarks it to be surprising that so many as sixteen cases of this rare affection should have fallen to the

1 Loc. cit., p. 279.

2 Archives Générales de Médecine, Nov. et Dec., 1863.
3 Discases of the Testis, 3rd edit., 1866, p. 300.

lot of one observer alone in less than a year.

The following

case, recently under my care at University College Hospital, was possibly similar to M. Deon's. A man, ætat. 22, applied for relief for a swelled testicle, which was also a little painful. The right epididymis was enlarged, chiefly at the upper part; the testis itself was not altered, and the whole organ had very little tenderness. The patient had noticed this engorgement of the epididymis about one week, and there had been no discharge from the urethra. I found on examination an indurated chancre under the foreskin, enlarged glands in the groin, and a roseolar rash over the whole body, including even the face and extremities. The patient was directed to wear a suspensory, and take mercury to make the gums sore. The enlargement of the epididymis almost completely subsided in ten days, but no discharge from the urethra then showed itself. The patient pursued his occupation of porter the whole time that the epididymitis was present, and it is certainly possible the inflammation owed its origin to a strain.

The Testis.-The affections of this organ known by the names of Syphilitic sarcocele, S. orchitis, S. albuginitis, are nearly always late products of syphilis; they are commonly delayed till two or three years after infection before they make their appearance, and they are often much later still. They may begin much earlier than this time; it sometimes happens that other affections belonging to the late stages of syphilis appear rapidly one after the other in a short time after contagion; in such cases the testis may be attacked like the other organs. Zeissl has never seen them before ten months after infection. Bumstead and Ricord say they have seen the testis diseased as early as the fourth or fifth month. One case has come under my notice where the testis enlarged at the end of the sixth month, but the alteration in this instance resembled

subacute orchitis more than the peculiar enlargement of syphilitic sarcocele. This patient had also nodes and rupial eruption at the time the testis enlarged. All the symptoms were rapidly relieved by the iodides of mercury and potash. At the time of the outbreak in the testis, symptoms of a syphilitic character are generally present in other parts of the body, such as periosteal affections, hepatic disease, pustular eruptions, tubercles, and ulcers of the skin and mucous membranes. On the other hand, the poison, after several years of apparently complete freedom from its influence, will show its returning activity sometimes in the testicle alone. Sarcocele is a rare complication of syphilis compared with other affections. Less than one per cent. of those treated by Zeissl for constitutional syphilis in the Vienna Hospital were so afflicted.

Early writers on syphilis appear to have been indistinctly aware of the occurrence of syphilitic disease in the testis, but Sir Astley Cooper was the first in this country to give, in his lectures on diseases of the testis, a clear description of the nature and course of this malady.

Causes.-Zeissl and others believe that the testis is never attacked by inherited syphilis, but that the disease has been acquired in all cases. Ricord certainly suggests that some of the affections of the testicle occurring at puberty may be ascribed to inherited syphilitis. This is extremely doubtful; at any rate, the testis is not attacked in infancy, Probably, the immediate cause of the morbid action in most instances, is a blow or slight injury of some kind, or excessive sexual indulgence. The presence of cancerous or tubercular disease in the organ has been suggested by Zeissl, as also an exciting cause in syphilitic persons. Gonorrhoea and Epididymitis have apparently no influence in rousing the deve lopment of sarcocele of this kind.

Course and Symptoms.-The enlargement of the testis

« AnteriorContinuar »