CONTRIBUTORS TO VOLUME XXV. D. B. BLAKE, M.D., Tennessee. J. S. CAIN, M.D., Tennessee. A. M. CARTER, M.D., Missouri. S. . CHAILLE, M.D., Louisiana. C. W. CHANCELLOR, M.D., District of Columbia. A. B. COOKE, M.D., Tennessee. C. W. CRIMPTON, M.D., Washington Territory. T. D. CROTHERS, M.D., Connecticut. A. E. DOUGLAS, M.D., Tennessee. MATIOS DUQUE, M.D., Cuba. A. M. ELMORE, M.D., Texas. T. J. HAPPELL, M.D., Tennessee. D. M. Key, M.D., Louisiana. W. F. KING, M.D., Tennessee. LRUIS LEROY, M.D., Tennessee. THOS. L MADDEN, M.D., Tennessee. T. S. MOTTER, M.D., Ohio. E. D. NEWTON, M.D., Georgia. 8196 STON MEDIS THE PERFECT LIQUID-FOOD exhibits 50% Choicest Norway Cover 10th the Soluble Phosphates.— PHILLIP'S EMULSION. Pancreatized. R THE CHAS. H. PHILLIPS CHEMICAL CO., 77 PINE ST., NEW YORK. By J. A. WITHERSPOON, M.D.. Professor of Practice of Medicine and Clinical Medicine, Vanderbilt Mr. President and Gentlemen of the Academy: In selecting the subject of Visceral Syphilis, I had three considerations in mind: First, that it did not properly belong to the specialist upon venereal diseases because more cases come under the care of the general practitioner, and the fact that he * Read at Nashville Academy of Medicine, Nov. 25, 1902. deals more with the primary and secondary lesions; second, be. cause I believe from my own observation that it is far more common than we think; and thirdly, the obscurity of its symptoms and the secret nature of the trouble causes many cases to go unrecognized. As the subject is entirely too broad to discuss in this paper, I have selected syphilis of the liver, as it is the most favorable and frequent site of the trouble. Not being unmindful of the frequency of Nervous Syphilis, which presents often the most obscure and irregular symptoms of either an epileptic, paralytic, cerebro or spinal tumor type. The lungs are peculiarly immune to syphilis, and but few cases have been reported. In my own experience I can only recall two cases in which I felt confident lung syphilis existed. The gastro-intestinal tract is not infrequently involved, but by far more commonly associated with hepatic syphilis, which, I believe, is common. Clinically, I would divide syphilis of the liver into localized and diffused, and while most of the cases belong either to the congenital or tertiary types, yet we must not overlook the fact that not infrequently in the secondary stage, we will have a painfully enlarged liver associated with an irregular type of fever, gastric disturbance and jaundice; but it is to the chronic cases I shall direct your attention. Since Galen ascribed syphilis to a "congesteo excrementorum," and placed the whole faulty process upon the liver, the organ has borne the brunt of the fight in the abdomen. The pathology begins primarily around the blood vessels, and is first a cellular infiltration in the interlobular spaces; this, together with increased vascularity, produces an enlargement of the organ. This stage may exist for some time, to be followed by an increase in the fibrous tissue, which, by contraction, lessens the size of the organ, producing an irregular contraction with deep furrows on the convex surface. Occasionally the liver undergoes amyloid degeneration and remains smooth and enlarged. The above types belong to the diffused variety. The circumscribed or local type is a gummatous deposit and may involve a lobe or a part of a lobe, and histologically consists of a central cheesy matter of degenerated cells surrounded by newly formed cells and fibrous tissue. This is covered with vascular granules. The whole mass either softens and is ab |