An Address Delivered at the Opening of the Section of Medicine
Authors: T. M. Anderson
Journal: BMJ (1888)

In a paper published recently in the JourNAL,1 entitled "1Is Mercury an Antidote to Syphilis?"I find the following remarks: "Diday, and in this opinion I am inclined to agree with him, considers that modern syphilis, as the present generation sees it, is, in most cases, a mild disease generally curable enough; and adds that but few cases are followed by visceral disease or affec- tions of the nerve-centres.He in no way disapproves of mer- cury; but recommends it only when severe outbreaks of the disease take place in order to lessen their effects onII the health.Mild ' syphilis he treats without mercury."But few cases of syphilis are followed by affections of the nerve centres, and mercury is only necessary for severe outbreaks of the disease!As I have reason to believe that thllese are not only the views of the writer of the paper, but also of a large number of our professional brethren, and as they are almost diametrically opposed to my own experience, it appears to me that the subject which I have selected for discussion is one of great importance in the interests of the community.MIy view may be stated thus-that just because "mild" syphilis is apt to be treated in a cavalier fashion, and without due care and per- sistence, disease of the nervous system is very apt to follow in its wake; and that such disease is much more common than is gene- rally supposed.As a basis for the following remarks I hlave col- lected twenty-four cases which have occurred recently in my own practice, and of which I have sufficiently accurate records, although they constitute but a fraction of those which have come under my observation.In order to pave the way for the subsequent discussion, perhaps my best plan is to consider, in a series of propositions, the grounds upon which the syphilitic nature of a lesion of the nervous system may be suspected.Many of these are, of course, familiar to all, but it is necessary to refer to them shortly in order to complete the picture.1.A History of the Entrance of the Syphilitic Poison into the Sygstem.-Positiveevidence of this is of great value, but negative evidence should not divert us from our suspicion, if, for other reasons, a syphilitic basis is probable.Many patients are ignorant of, or forget their having contracted syphilis (for the initial lesion is often a very triflinig matter, and the poison may enter the system in a great variety of ways), while many are loath to admit that they have ever exposed themselves to such infection.The interval, too, which has elapsed since the time of infection is often so long as to put us off our guard, and to render it likely that we may fail to connect the disease of the nervous system with the syphilitic contamination as cause and effect; while, with certain limitations, it may almost be said that the longer the poison has lain dormant in the system the more likely are internal organs to suffer.Of the twenty-four cases above mentioned there were thirteen in whichl the time of infection was known, and in them the intervals elapsing before the nervous affection set in were 21, 3, 41,, 6,7, 9, 10, 13, 13, 16, 18, 25, and 30 years.We must also bear in mind that diseases of the nervous system may be the result of hereditary syphlilis, the history and evidences of which must be carefully 'inquired into.2. The Discovery of other Manifestations of Syphilis.-Intlhose comparatively infrequent cases of implication of the nervous system in the seconidary stage of syphilis, we are pretty sure to find evidences of the dlisease on the skin, mucous memibranes, ete.But as the nervous system generally suffers in tihe late stages, such evidences are not certain to be found, and, when present, they are usually much less numerous.What we must specially look for now are tubercular eruptions, serpiginouis ulceration.gummy tumoursA in the subcutaneous tis-sues.deep ulcer, tion of