CONSTITUTIONAL SYPHILIS. 771 



aescriber 4 simple and a gummy myositis. The former depends upon 

 proliferation of the interstitial connective tissue, producing an indura- 

 tion of the latter, while the primitive muscular fasciculi suffer atrophy, 

 and perish. In the latter form, tumors, often of considerable size, arise 

 in the muscles, and upon section show reddish-white or yellowish- 

 white, slightly striped deposits, which are usually not absolutely dry. 

 Microscopic examination reveals a finely-cellular, dense granulation of 

 the intramuscular substance, with premature fatty degeneration, in 

 which the cells perish, leaving a granular, fatty, and apparently struc- 

 tureless mass. Similar masses are sometimes found in the substance 

 of the heart. Perhaps some cases of induration of portions of the car- 

 diac muscles depend upon simple syphilitic myocarditis. 



Among the syphilitic diseases of internal organs, syphilitic hepatitis 

 has been described in detail. Wagner and other authorities have ob- 

 served syphilitic lesions in other organs, the spleen, the kidney, arid 

 even the pancreas, which closely corresponded with those found in the 

 liver, sometimes inducing thickening in the envelope of the viscus, some- 

 times diffuse induration of its substance, and sometimes producing cir- 

 cumscribed nodules in it. Dittrich has already recognized the occur- 

 rence of syphilitic disease of the lung, in the form of nodular, firmly-re- 

 sisting indurations, either of a white color, or else stained black, by 

 deposit of pigment, and which enclosed dry, cheesy accumulations. It 

 would also seem that, besides this gummous pneumonia, an interstitial 

 syphilitic pneumonia also occurs. It may sometimes be very difficult, 

 or even quite impossible, to decide whether a disease of the lung de- 

 pends upon syphilis or not. 



Syphilitic affections of the encephalon consist in part of chronic in- 

 flammation of the meninges, which may involve the pia mater, the 

 arachnoid, or the dura mater, in the form of a pachymeningitis externa 

 (endocranitis) or interaa; and, among other symptoms, sometimes give 

 rise to palsy of one of the cerebral nerves. Sometimes, syphilitic de- 

 posits occur, which formerly were often mistaken for inspissated ab- 

 scesses, or for caseous tubercles. (See " Diseases of the Brain.") 



It follows, from this brief enumeration of the various syphilitic dis- 

 eases of the tissues and organs, that the points on which the disease 

 localizes itself are far more numerous than was formerly supposed ; 

 and that Wagner's statement, that syphilis attacks all the tissues which 

 contain vessels, is fully warranted. 



The General Course of Syphilis. It is a remarkable fact that, 

 while the syphilitic taint at times gives rise to palpable symptoms, at 

 others no sign of the persistence of the infection can be detected, ex- 

 cepting the enlargement of the lymphatic glands, After the healing 

 of the primary ulcer, a period of several weeks usually elapses before 



