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Western Medical Reporter.
wbom the syphilis is not in active efflorescence, will
heal' quite as promptly and perfectly as in entirely A Monthly Epitome of Medical Progress. MAR 18 l healthy individuals. This is not true, however, of
suppurating and infected wounds; such lesions heal Vol. XVII. JANUARY, 1892. No. 1.
verk slowly or not at all, until thorough and vigorous
The difference between a clean, incised wound (which, ORIGINAL ARTICLES.
when aseptically made and antiseptically dressed, is productive of little or no irritation from the first and
of absolutely none after the lapse of a few hours), and Syphilis in its Relations to the Repair of Surgi- pathological processes that produce continuous irrical Lesions. 1
tation, is very marked in syphilitic subjects. We
know that the latent tendency of connective tissue By G. FRANK LYDSTON, M, D.,
cells to proliferation and degeneration greatly exceeds Professor of the Surgical Diseases of the Genito-urinary Organs the physiological limits when once the organism beand Syphilology, in the College of Physicians
comes tainted with syphilis; continuous irritation is and Surgeons, Chicago.
prone to develop this latent energy of syphilized cells, I am frequently asked whether a proposed surgical plasia, ulceration, and perhaps sloughing: If we add
with resulting prolonged suppuration, tissue-hyperoperation is safe, in view of the fact that the patient
to the irritating effects of the lesion itself the condiupon whom it is proposed to operate is suffering from
tion of sepsis, the morbid process is necessarily exagmore or less recent syphilis. I also find that general
gerated. practitioners often advise patients that fall under my
When secondary syphilis is active and severe syphcare against surgical operations, for the sole reason
ilides are present, any surgical lesion may determine that said patients are affected with constitutional
a deposit of syphilized material at the particular point syphilis more or less remote.
involved. This material may break down and ulcerI have been quite observant of the phenomena at
ation of tissue result. tending the healing of operation wounds in syphilitic it would, however, seem that this tendency is modi
So far as my observations go, subjects, and I have come to the conclusion that per
fied chiefly by the primary resistance of the patient, se syphilis has little or no effect in retarding repair.
rather than by the severity of the syphilis, and I In many syphilitics I have had operation wounds heal
think it will be found that when once patients with with exceptional promptness. An excellent illustra
active syphilis do badly, more reliance is to be placed tion of the favorable course of simple incised wounds
upon tonics than upon vigorous anti-syphilitic measin syphilitic subjects is to be found in the excision of
ures. Virulent surgical processes, such as erysipelas, the primary lesion of syphilis. In a large number of
vaccinia, and chancroid, occurring in broken down cases of excision of hard chancre I have found that
patients with constitutional syphilis, whether latent primary union was the rule. In mixed sores I have
or active, are especially liable to determine a deposit on several occasions seen reinfection and chancroidal
of syphilitic neoplasm in the affected tissues. ulceration following excision. I will state that these
With regard to the behavior of erysipelas in this cases of mixed sores were operated upon entirely ex
respect, I will call attention to the fact that it has perimentally, as I do not consider it good practice to
been recently claimed that erysipelas is curative of deal with such sores in this manner. In some cases
syphilis. I think that I am justified in being a little -and in a far greater proportion than those that
dogmatic regarding this particular point, as at the practice excision have acknowledged-induration of the cut edges will occur, but this only happens sever
New York Charity Hospital, which has a number of
pavilions devoted exclusively to cases of erysipelas, al days after primary union of the incision has occurred. If the operation be performed some days exceptional opportunities for the study of erysipelas
of which a large number are annually treated, I had after the chancre has ceased to progress, and has become stationary, induration of the cut edges is not
as seen in syphilitic patients. I have seen many cases likely to occur.
of erysipelas occurring in syphilitic subjects, but I In some instances induration of the
have failed to see any constitutionally curative effects cicatrix will occur as a consequence of irritation a
from erysipelas; on the contrary, syphilitic patients week or more after the incision is perfectly healed; but
that became debilitated by severe erysipelas were these untoward phenomena are not the result of im
quite apt to be returned to the hospital within a comperfect repair, but are the result of a rapid prolifera
paratively short time suffering from an outcropping tion of cells determined by irritation of the cicatrix af
of syphilitic lesions. It was an experience so familter the process of ordinary tissue-repair is completed.
iar as to be a matter of routine observation, that the The question of the possible local character of the
sinuses and suppurating surfaces remaining after chancre and reinfection of the cut surfaces enters into
phlegmonous erysipelas in syphilitic patients were consideration in this connection, but does not con
very obdurate until constitutional treatment was incern us here.
stituted. In patients with latent secondary syphilis, suppur
Horwitz' reports a case in which a patient with ation, sloughing, and ulceration in operation wounds are frequently attributed to the constitutional taint deep and extensive syphilitic rupia was apparently
cured by a severe attack of erysipelas. The same when the fault lies in the technique of the operation. Notwithstanding the fact that this explanation is very
author reports another case in which an ulcerating consoling to the surgeon, it is my opinion that a clean
gumma of the leg was attacked and apparently cured
by an attack of erysipelas. Neumanno reports two aseptic operation in patients that are syphilitic, but
'Read before the Chicago Academy of Medicine, July 10, i The Medical News, March 21, 1891. 1891,
*Allg. Wiener med. Zeitung, 1888.