SYPHILITIC HEPATITIS, SYPH1LOMA OF THE LIVER. 681 



or was not so well cared for, or when he had haemorrhage from the 

 stomach. 3 



CHAPTER IV. 



SYPHILITIC HEPATITIS, SYPHILOMA OF THE LIVEK ( Wagner). 



ETIOLOGY. Among the internal organs of the body, the liver ap- 

 pears to be the one most frequently affected by constitutional syphilis. 

 At all events, syphilitic hepatitis or syphiloma of the liver is correctly 

 interpreted earlier than the syphilitic affections of any other organ. 



Syphilitic disease of the liver is not unfrequently found in the 

 bodies of children who have had congenital syphilis. Among the dis- 

 turbances of nutrition due to acquired syphilis, syphilitic hepatitis 

 comes rather late, so that it is classed among the tertiary rather than 

 among the secondary syphilitic diseases. 



ANATOMICAL APPEAKANCES. From numerous microscropic ex- 

 aminations of organs affected with syphilitic disease, it is true 

 Wagner has come to the conclusion that not only the form ap- 

 pearing as circumscribed deposits (gummy tumors of Virchow), but 

 also the diffuse syphilitic degenerations of the organs, depend on the 

 development of a specific neoplasia, syphiloma, but the appearance to 

 the naked eye of livers in which structural change has resulted from 

 constitutional disease varies so greatly, in different cases, that it still 

 appears proper to describe different forms of syphilitic hepatitis We 

 may distinguish a syphilitic perihepatitis, a simple interstitial syphi- 

 litic hepatitis leading to diffuse induration, and a third form called by 

 Virchow gummous hepatitis. The latter, whose syphilitic nature 

 was long since recognized by Dittrich^ is most readily recognized and 

 distinguished from other forms of liver disease. In it we find spots, 

 from the size of a hemp-seed to that of a hazel-nut, or even walnut, in 

 the liver, which in recent cases have a medullary appearance, but, 

 after they have existed a long while, form yellow, cheesy masses. 

 These spots, which, previous to DittricKs explanation, were regarded 

 as cancer in the stage of recovery (which they greatly resemble), arc 

 rticlosed by a dense tissue, and dense connective-tissue striae extend 

 from them in various directions toward the surface of the liver. On 

 the surface even we may notice deep furrows, which give the liver a 

 peculiar lobulated appearance, and which are caused by the paren- 

 chyma of the liver being destroyed in some places and being replaced 

 by contracting connective tissue. In the diffuse syphilitic indurations 

 of the liver, we find more or less extensive parts transformed into a 

 nard, dense tissue. The gland-substance is mostly destroyed and re- 

 placed by connective tissue. The simultaneous occurrence of the 



