Dyspeptic symptoms not infrequently occur in the secondary and tertiary stages of syphilis. While in the secondary stage, however, the digestive disturbances are attributable to the constitutional condition, to the fever, etc., and hence are to be regarded as concomitant phenomena of the original disease, without any special involvement of the stomach, the affections of the stomach in the tertiary stage of syphilis are of independent nature, caused by anatomic processes in that organ.

The lesions of the stomach during the tertiary stage of syphilis may assume various forms (erosions, ulcers, tumors, stenosis of the pylorus, gastralgia, etc.), all of which present the features of the ordinary types of these affections; their syphilitic nature cannot be recognized by the symptoms alone. Diagnosis of their syphilitic origin is facilitated, first, by the demonstration of a previously existing luetic infection; secondly, by syphilitic manifestations in other portions of the body; and thirdly, by the successful results of anti-syphilitic treatment.

1 Eppinger: Prag. ined. Wochcnschr., 1881, Nos. 51 and 52.

2 Litten: Virch. Arch., Bd. 67, p. 615.

3 Musser: Philad. Hospital Reports, 1890, vol. 1, p. 170.

It is scarcely necessary to mention that syphilitic subjects may suffer from any of the diseases of the digestive tract without there being any connection between the latter and antecedent lues. Indeed, these cases probably constitute the majority. Hence it is the more difficult to decide in any given case whether the disease of the stomach is of syphilitic nature or not. Yet this is quite often possible.

Syphilis of the stomach has been observed by An-dral,1 Wagner,2 Lancereaux,3 Cornil,4 Chiari,5,6 Stol-per,7 Gaillard,8 Mracek,9 Osier,10 Hemmeter,11 Dieulafoy,1 Fournier,2 Flexner,3 Mackay,4 Fraenkel,5 Aris-toff,6 and myself.7.

1G. Andral: Cliniquc medicale, Paris, 1884, t. ii., pp. 99, 201-207.

2E. Wagner: "Das Syphilom, oder die constitutionelle syphilitische Neubildung." Archiv f. Heilkunde, Bd. iv., p. 225.

3Lancereaux: "Traite de la syphilis," 1866, p. 406.

4V. Cornil: "Lecons sur la Syphilis," Paris, 1879, p. 406.

5H. Chiari: "Lues hereditaria mit gummoser Erkrankung dcsgalk-leitenden Apparates und des Magens." Prager med. Wochenschrift. 1886, No. 47, S. 461.

6 Chiari: "Ueber Magensyphilis." Festschrift f. R. Virchow, 1891, ii., p. 297.

7 Stolper: "Beitrage zur Syphilis visceralis." Bibliotheca Medica. 1896, C, Heft 6.

8L. Gaillard: Archives generales de Medecine, 1896, i., pp. 66-88.

9F. Mracek: "Lehmann's med. Handatlauten," Bd. vi., "Syphilis und venerische Krankheiten," Munchen, 1898, p. 52.

10W. Osler: "The Principles and Practice of Medicine," New York, 1891. p. 178.

11J. C. Hemmender: "Diseases of the Stomach," 1897. p 556.

Among the cases which I have observed it is best to differentiate three groups of syphilitic diseases of the stomach, namely:

I. Gastric ulcer of syphilitic origin.

II. Syphilitic tumor of the stomach.

III. Syphilitic stenosis of the pylorus.