140 PROTEIN THERAPY 



General paralysis, tabes and tertiary lesions are said to be very un- 

 common in countries in which the skin lesions are most manifest ; racial 

 differences seem to play some role, too, in the variation of distribution. 

 In our American negro it is stated that the parasyphilitic manifesta- 

 tions are less frequent than in the white race, although vascular lesions 

 are certainly common enough. According to some syphilogra- 

 phers even malignant syphilis, when in its early stages it is most 

 manifest in the skin, is prone to spare the internal organs. According 

 to a number of investigators the possibility must be considered that 

 this effect is due to selective affinity of certain strains of the spirochete 

 (Nichols, Matzenauer, etc.) ; Hoffmann would rather implicate the 

 immunizing effect that is due to the early skin involvement. Clinically 

 it has been shown that tabetics and general paralytics seldom give a 

 history of severe luetic skin involvement; usually the history given 

 is that the skin manifestation was merely transient and that there 

 were no other secondary manifestations. Bloch assumes that it is the 

 failure of the skin allergy that is the chief cause, particularly of nerve 

 syphilis, either because of the constitutional inability of the skin to 

 react or because the opportunity was not given the skin to react. 



The wide distribution of the spirochete soon after it gains admission 

 to the body would, in my opinion, rather exclude this latter explana- 

 tion. But it must be remembered in this connection that the spirochete, 

 or rather the reaction that the spirochete sets up in the tissues, is rela- 

 tively easily influenced by nonspecific means. One has but to recall the 

 effect of tuberculin on the involution of the syphilitic papule, the 

 effect of the injection of colloidal metals (particularly silver) on the 

 rate of proliferation of Spirochceta pallida in experimental animals, the 

 effect of intercurrent diseases on the manifestations of syphilis, the 

 pronounced effect of the iodids on the absorption of gummata and in 

 the alteration of the skin reaction to luetin, etc. If the secondary 

 lesion and the gumma are so easily affected by these means it is very 

 probable that the inflammatory reaction in the skin, no matter how 

 produced (even if by the specific inciting organism) with its resulting 

 absorption of enzymes and of protein split products may act as a 

 nonspecific agent and have some therapeutic effect on lesions located 

 internally. It has even been suggested that the efficacy of the mer- 

 curial inunction over other methods of mercurial therapy is due to the 

 fact that the skin is stimulated mechanically. 



The fact that the tissues of the central nervous system afford a 

 very favorable milieu for the spirochete when once it has penetrated 

 must not be lost sight of. The meninges, being relatively easily pene- 

 trated by the spirochete, are infected early and often in syphilis. It 

 is the ectodermal brain substance which has to bear the brunt of the 

 spirochetal changes, for the pia, although early involved, seems to rid 

 itself much more readily. Both the brain substance and the cornea, 

 containing neither lymphocytes nor adventitial cells, react but poorly 



