ORGANIC SYPHILIS. 
By HENRY A. ROBBINS, M. D. 
OF WASHINGTON, D. C. 
Clinical Professor of Dermatology and Genito-Urinary Diseases, 
Medical Department, University of Georgetown. 
A lecture delivered at the Central Dispensary and Emergency 
Hospital of Washington, D. C., on April 12, 1893. 
Reprinted from the Virginia Medical Monthly, July, 1893. 
QJBSON BROS. PRS. WASH. Abt. VII. 
ORGANIC SYPHILIS.* 
By HENRY A. ROBBINS, M. D„ of Washington, D. C. 
CLINICAL PROFESSOR OF DERMATOLOGY AND GENITO-URINARY DISEASES, MEDICAL DEPARTMENT, 
UNIVERSITY OF GEORGETOWN. 
Sir Astley Cooper, in his lecture on Surgery, taught that 
" some parts of the body are incapable of being acted upon 
by the venereal poison, such as the brain, the heart, and 
the abdominal viscedf. .Indeed," he writes, " this poison 
does not appear to be capable of exercising its destructive 
influence on the vital organs, or on those parts most essen- 
tial to the welfare and continuance of life." 
This statement of Sir Astley, who is probably oftener 
quoted than any surgeon of ancient or modern times, is liable 
to be productive of infinite harm, for the very opposite of it 
is now proved to be the truth. 
In direct opposition to the views above expressed are the 
statements of my old teacher, Dr. Samuel Wilks, of Guy's 
Hospital, who says ; " Syphilis in its ultimate form is capable 
of affecting every organ of the body ; the internal may be- 
come equally as obnoxious to the effects of the virus as the 
external. Many obscure and intractable organic disorders 
are cases of visceral syphilis, and it cannot be too forcibly 
impressed upon the young practitioner that syphilis may 
affect not only the cranium, but the brain within it, or the 
nerves; not only the muscles of the limbs and tongue, but 
the heart; not only the pharynx, but the oesophagus ; not 
only the larynx, but the trachea, bronchi, and lungs ; also the 
*A lecture delivered at the Central Dispensary and Emergency Hospital 
of Washington, D. C., on April 12, 1893. Reprinted from the Virginia, 
Medical Monthly, July, 1893. 2 
liver, spleen, and other viscera." {Guy's Hospital Report, 
Vol. IX, 1863.) 
Van Swieten taught that "no organ escaped the influence 
of venereal poison, and recognized it as the cause of gummy 
tumors, exostoses, deep-seated pains, apoplexy, epilepsy, 
blindness, deafness, paralysis." 
Benjamin Bell, however, was the first writer who put forth 
clinical facts in support of his belief that " venereal disease 
induces blindness, deafness, amaurosis, phthisis, rheumatism, 
epilepsy, and mania." 
Aitkin says : "A history of syphilis in soldiers is too often 
the starting point of a fatal disease. The impairment of 
the health takes its origiW from the date of the infecting 
syphilitic sore. Early implication jdi the lymphatic glands 
leads to impoverishment of the blood as an immediate re- 
sult, and then to the degeneration or wasting of tissues, 
which attends the general cachexia, and which eventually 
terminates in death, with complicated and varied lesions, es- 
pecially implicating the internal viscera." 
I. will first call your attention to syphilitic lesions of the 
brain. Medical literature is exceedingly rich in material on 
this subject, and your acquaintance with it may be your 
starting point to a successful professional career. A correct 
diagnosis, and your knowledge of the treatment, will make 
you famous as the direct result of an apparently miraculous 
cure of a patient who may have baffled the skill of leading 
physicians. 
Bonnet, Ricord, Callerier, and Lallemand have described 
gummatous tumors of the brain. Ricord described them as 
syphilitic tubercle of the brain. 
Virchow described lesions of the great vessels in those 
who died from syphilis with lesions in the brain. 
Dr. Steenberg (physician for the insane at Schleswig) be- 
lieved that a great proportion of the syphilitic affections of 
the brain are subsequent to lesions of the arteries; he also 
observed syphilitic localizations in the organs of circulation 
generally. 3 
Dr. Wilks says : " In the cases where cerebral symptoms 
have long co-existed with syphilis, a quantity of tough yel- 
low, fibrous tissue united together the surface of the brain 
with the adjacent membrane, and this again is adherent to 
the bone. The cortical substance of the brain at the affected 
spot is often partly destroyed, and the adventitious material 
occupies its place. The question has still to be solved as to 
what structure is primarily affected. Many have given the 
authority of their name to the opinion that the disease com- 
mences first in the bone, but simply for the reason that the 
osseous is that which had so long been recognized as liable 
to be affected. But, since we know now that other structures 
may be similarly attacked, we are prepared to look for its 
commencement in other parts, and even in the brain struc- 
ture itself. The cases which are so frequently met with are 
those where the deposit involves both sides of the dura 
mater, and includes in it the bone on one side and the brain 
on the other. The probabilities are in favor of its occur- 
ring in the dura mater first, as it arises in the periosteum on 
the exterior of the cranium" 
The nervous symptoms are alteration of intelligence, of 
sensibility, and of motion. These in connection with local 
lesions, as caries, or necrosis of the facial bones, or of the 
cranium ; or tumors on the external surface of the cranium, 
such as gummata, periostitis, or exostosis, at once point to 
cerebral syphilitic lesions, which are sometimes expressed by 
persistent epilepsy. 
According to Zambaco, besides neuralgia, long recognized 
as one of the results of syphilitic poisoning, chorea appears 
as being occasionally developed under its influence. 
Paralysis is the most frequent result of the syphilitic 
poison upon the nervous tissues. Jonathan Hutchinson re- 
marks " That so frecpiently is syphilis a cause of paralysis, 
that in all cases where it happens without evident cause, and 
in which syphilitic antecedents are even possible, it is advis- 
able to try the effects of specific treatment. Undoubtedly 4 
we often by such means get a clue to the real nature of many 
an obscure affection of the nervous system." 
Professor Jakstch says hemiplegia is the most frequent 
form of syphilitic paralysis, and may appear from five or ten 
months to eighteen years after the primary lesion, but in 
most instances from three to ten years, and often very in- 
sidiously. These conclusions were derived on an anaylsis 
of fifty-two cases-twelve occurred in his own practice. 
Paralysis of the muscles of the trunk was not made out 
in a single case. 
Enough has been said on syphilis of the brain to lead you 
to further research, and the time you give the subject will 
amply repay you. You will have to go over your anatomy, 
and you will have to look up all mental diseases, which you 
will find to be interesting, improving, and useful, both to 
yourselves and your future patients. 
Virchow describes syphilitic growths in the substance of 
the heart, and refers to those recorded by Ricord and Le- 
bert. Ricord, in his Atlas, calls them " syphilitic muscular 
nodes in the substance of the heart." They were found in 
the substance of the ventricles, and consisted of firm cheese- 
like masses. There was a history of chancres and ulcerated 
tubercles of the skin. Lebert reports that gummata were 
seen at a comparatively early stage of development in his 
case, and were found in the wall of the right ventricle. 
There were tubercles of the skin, of the subcutaneous tissue, 
genital organs, and bones of the skull. In Virchow's case 
there were syphilitic gummata in the testicles. 
In the Museum of the British Army Medical Department 
at Netley there are two preparations which show such gum- 
mata in the substance of the heart. " One occurred in the 
case of a soldier, twenty-four years of age, under treatment 
for venereal ulcers, of nine months' duration, in various 
parts of the body. He had lost his palate, and eventually 
sunk from exhaustion, with symptoms of phthisis. Sections 
of the muscular substance of the heart showed several iso- 5 
lated deposits in its substance and beneath its serous cover- 
ing, and isolated portions of the lungs were converted into 
a substance of the consistence of cheese." 
On January 9th of the present year (1893) John S. Bris- 
towe, M. D., LL. D., F. R. S., of London, read an article on 
Syphilitic Affections of the Nervous System before the 
Medical Society of London. I take the liberty of quoting 
two of his cases, illustrative of syphilitic arterial disease. 
"The first of these was brought before the Pathological 
Society by Dr. Walter Edmunds on May 3, 1892. The 
patient was a man aged thirty-six, who came under Sir Wm. 
MacConnar's care on account of an aneurism on the right 
side of the neck, which had been rapidly increasing in size. 
He had, a few days before admission, been seized with a 
sudden attack of faintness, and after admission the mere 
handling of the tumor frequently brought on similar attacks. 
Owing to this circumstance, the belief that his arteries were 
extensively diseased (for no trace of pulsation could be felt 
in any of the arteries of either upper extremity, and there 
was a loud basic systolic murmur), and to the fact also that 
the patient was exceedingly ill, it was decided not to attempt 
any operative procedure. The patient had well-marked syphi- 
lis twelve years previously. He died comatose twelve days 
after admission. The heart was large, and the pericardium 
adherent by easily broken down adhesions. The valves were 
healthy. A gumma about two inches in diameter projected 
from the groove between the right auricular appendage and 
the pulmonary artery. The whole of the thoracic aorta, in- 
cluding the arch, was enormously thickened, all the coats 
being involved, but the outer coat much more so than either 
of the others. In places they were collectively more than 
eight times as thick as natural. The thickening extended 
along the innominate and right subclavian, the latter of 
which would admit of the passage of a bullet probe. The 
right common carotid was healthy, but the right internal 
had springing from it near its origin a globular aneurism 
about two inches and a half in diameter. The left common 
carotid was diseased, and only admitted a bullet probe; and 
the left subclavian, about an inch from the aorta, ended in 
an impervious fibrous cord. The cerebral and abdominal 6 
arteries were all healthy, and no other visceral syphilitic 
lesion was discovered. 
" The second case was exhibited before the same Society 
and on the same evening by Dr. Herbert Hawkins. It was 
that of a girl aged eleven, who was admitted into St. Thomas' 
Hospital suffering, it was supposed, from acute nephritis. 
After experiencing one or two short attacks of illness, prob- 
ably due to infarction of the lungs, she was observed on Feb- 
ruary 7th to have swollen and cold legs, and, a few days after, 
swelling of the face. She was admitted on the 20th, being 
at this time extremely ill. She had general dropsy, was 
passing very little urine, which contained a small quantity 
of albumen, but no casts, and there was evidence of pul- 
monary congestion. Subsequently she passed a little blood 
on one occasion with her urine, which continued to be for a 
time very scanty, but, during the last four days of her life, it 
became fairly abundant and ceased to be albuminous; the 
lower part of her lungs became solid ; her pulse of high ten- 
sion, she presented the Cheyne-Stokes breathing, and died (ap- 
parently from uraemic poisoning) on March 22d. At the 
post mortem examination gross disease was found in nearly 
all the arteries of the body. The first part of the aorta was 
studded with gray translucent spots and patches, from the 
size of a split pea to that of half a crown ; and for a length 
of three inches, immediately above the bifurcation, the 
thickening was so great that the channel barely admitted a 
bullet probe. Similar patches were observed in the common 
carotids and subclavians, in the left internal carotid as it 
entered the cranial cavity, and in the right internal carotid 
involving the origin of the middle cerebral. There was 
similar disease throughout the pulmonary arterial system. 
The renal arteries towards their entrance into the kidneys 
were completely obstructed by clots, which were old and 
white at the periphery, but red and comparatively recent 
centrally. There was an old infarct in the kidney, but 
neither organ showed any evidence of nephritis. The liver 
presented a patch of peritonitic thickening, and was rather 
large. The spleen was large and firm, and its capsule thick 
and covered by old adhesions. The lower and back parts 
of both lungs were consolidated and contained large in- 
farcts. There was haemorrhage into each lateral lobe of 
the cerebellum, the clot in each case being the size of a 
hazel nut." 7 
"There can be no doubt, however, that the lesions in this 
case were the result of congenital syphilis." 
I find in London lancet (Jan. 1, 1887) the following: 
" Syphiloma of the Heart.-At a late meeting of the Lon- 
don Pathological Society, Dr. W. Pasteur showed a speci- 
men of syphiloma of heart from a woman, aged thirty, who 
was taken to Middlesex Hospital in articulo mortis. She 
was probably a prostitute. None of the ordinary signs of 
syphilis were visible except in the heart. The liver had a 
peculiar marbled appearance. There was some recent lymph 
on the surface of the left ventricle, which was hypertrophied 
and dilated. Grayish opaque patches of varying size and 
distribution were seen in the wall of the ventricle and sep- 
tum. At least one-half of the ventricle was diseased. The 
right ventricle was less diseased. The patches were ill-defined 
and translucent at the edges. There were milky looking 
patches on the endocardium. Microscopical sections showed 
infiltration of corpuscular growth, which was very vascular 
at the margin; the nuclei were spirical and distended. In 
some of the vessels of the heart doubtful evidences of peri- 
arteritis were to be seen, and possibly also of endocarditis. 
The liver showed numerous accumulations of small round 
cells, like that met with in some forms of interstitial hepatitis 
of congenital syphilis." 
Syphilitic lesions in the lungs have been fully described 
by many authors. The patient may have all the symptoms 
of tuberculosis, and yet there may be no tubercle existing in 
the lung. There is great dyspnoea and periosteal tenderness, 
and the bodily temperature is not generally increased. I 
will relate the following typical case, who was a patient of 
Alfred Fournier at Hopital St. Louis, Paris : 
The patient was admitted on March 1, 1884. He had 
been wasting for two months, as he said, and lately he had 
become so easily fatigued that he was unable to work. He 
was 39 years old. He had only had a cough for a few days, and 
had not suffered from night-sweats or haemoptysis. After 
admission, however, he spat a blood-stained, muco-purulent 
fluid. At the left apex there were all the signs of a large 8 
and advanced cavity-cavernous breathing, gurgling and 
and cracked-pot sound on percussion. Over the right lung, 
the breathing was somewhat blowing in character, with sub- 
crepitant rales. Fournier diagnosed tuberculosis of both 
lungs, but most advanced in the left. The left tibia was 
enlarged and irregular, and on the same were two gummy 
ulcers. The discovery of these signs led to the administra- 
tion of iodide of potassium in a daily dose of 60 grains. 
After two months' treatment, the signs of lung mischief had 
almost disappeared, and the nodes had considerably dimin- 
ished in size. Eleven months later, the patient was again 
seen. His general health was then excellent, and the chest 
lesions appeared to be completely cured. The patient, how- 
ever, had only continued the iodide for a month after his dis- 
charge, and ulceration had reappeared in the left leg. 
Attention is directed to the fact that there were no phys- 
ical chest signs in this case, by which the diagnosis between 
tubercle and syphilis could be made. It was only by effects 
of treatment that the true nature of the affection became 
evident. 
Dittrich and Gubler were the first to give an accurate de- 
scription of syphilitic deposits in the liver. Virchow de- 
scribed peri-hepatic lesions, and simple gummy interstitial 
hepatitis. The former never occurs alone, but is generally 
associated with the latter. The hepatic substance atrophied, 
and the deposit contracting, is eventually absorbed, causing 
a cicatrix-like mark. The liver lesions are usually among 
the later symptoms of syphilis, and are well described by 
Virchow and Wilks. 
In former years, I passed several months in walking the 
wards of Guy's Hospital, and was present daily in the path- 
ological room, which was under the supervision of the late 
Dr. Moxon, whose sad death occurred a few years ago. Dr. 
Moxon found syphilis deposits in the spleen, consisting of 
sulphur yellow nodules, of the size of peas, plentifully 
scattered, deep seated, and fatty in their centre. Gummata 
have been found in the pancreas. 9 
Specific Nephritis.-I take the following from the Annales 
de Dermatologic et de Syphilographie, April, 1881 : 
" M. Barthelemey at first quotes from the London Clinical 
Society. At a meeting of this body, held in January, seve- 
ral cases of hereditary syphilis were reported, in which, 
among other affected organs, the kidneys had been involved, 
being the seat of parenchymatous nephritis. Referring to 
such patients, Mr. Hutchinson stated that when death oc- 
curred as a consequence of syphilis, the fatal result was di- 
rectly due to the nephritis. Dr. Coupland was convinced 
that patients who had been suffering for a long time from 
syphilis acquired a true predisposition for parenchymatous 
nephritis, and were liable to death from this condition. As 
a result of his personal researches, M. Barthelemey offers the 
following : Nephritic lesions are among the complications 
of all the stages of syphilis, even of acquired disease. Such 
nephritic complications are always grave. Nevertheless, 
they are sometimes curable, not only when they occur in 
adults as a result of acquired syphilis, but also in children 
affected with the hereditary disease. Together with other 
specific lesions, they have this characteristic in common : 
their gravity is in proportion to the age of the patient's 
syphilis, and the period of time which has elapsed before 
specific treatment was begun. In children affected with 
hereditary syphilis, specific nephritis should always be taken 
into consideration, when the patients are subjected to acci- 
dents for which nephritis may be held accountable. When 
a physician meets nephritis in an adult, he would do well 
to think of the possible specific origin of the renal difficulty 
in view of the great number of cases of unsuspected syphilis." 
In 1878, Dr. L. P. Yandall, of Louisville, Kentucky, re- 
ported Medical Journal, May, 1878) a case of 
syphilitic albuminuria which is of great interest. 
The patient was an intelligent German, sixty years of age, 
and was an inmate of the Louisville City Hospital, Dec. 1, 
1876. "He was a subject of general dropsy, and on the 
card over his bed was written, 'albuminuria.' His pale, 
waxy-looking skin, puffy eye-lids, constant indigestion, 
slight bronchitis, disturbed vision, hemicrania, pain in the 10 
back, muscular debility, and frequent nocturnal micturi- 
tion, all confirmed the diagnosis, and examination of the 
urine showed it to be excessively albuminous, and abundant 
in tube casts and renal debris." 
" Deriving no comfort from treatment, and indeed grow- 
ing gradually worse all the time, and having no hope of 
recovery, he begged to be allowed to desist from treatment, 
and the request was granted at the end of two weeks." 
The patient's nose had the " saddle-shaped " appearance, 
so often associated with tertiary syphilis, where the nasal 
bones have come away. This, with other indications of 
syphilis, decided the doctor to give the patient the therapeu- 
tic test. The doctor prescribed a scruple of the iodide of 
potassium, to be taken in skimmed milk or water, every 
three hours when awake-the doses to be increased ten 
grains each every day till iodisrn, gastric disturbance, or 
relief of symptoms should occur. He took on several occa- 
sions an ounce of the medicine daily, and never had any 
discomfort from it. "He got iron and bitter tonics at the 
same time. His improvement was marked at the end of a 
few days. The throat rapidly healed; his strength, appe- 
tite and color returned, and the urine ceased to evince any 
sign of renal disease. In two months he was well." 
The cases reported above show that organic syphilis is 
not detected in many cases by the physician, and it will 
never be known how many have died, or may die, where 
the cause of death is certified as coming from morbus 
Brightii, disease of heart, apoplexy, phthisis pulmonalis, 
marasmus, etc., but where in the dim background stands the 
grim monster, Syphilis. 
They also show that when a proper diagnosis is made, 
what brilliant results follow the proper treatment. 
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