Syphilis

“ To be able to put one's finger so definitely on the cause of syphilis is an advantage which cannot be overestimated. More than in almost any other disease the identification of syphilis at its very outset depends upon the seeing of the germ that causes it in the discharge from the sore or pimple which is the first evidence of syphilis on the body. On our ability to recognize the disease as syphilis in the first few days of its course depends the greatest hope of cure. ”

“ There are few things about our situation with regard to syphilis that deserve more urgent attention than questions connected with the cure of the disease, and few things in which it is harder to get the necessary coöperation. On the one hand, syphilis is one of the most curable of diseases, and on the other, it is one of the most incurable. At the one extreme we have the situation in our own hands, at our own terms—at the other, we have a record of disappointing failure. As matters stand now, we do not cure syphilis. ”

“ It takes a good deal out of the graphic quality of the thing to say that most syphilis is concealed, that most syphilitics, during a long period of their disease, are socially presentable. Of course, when we hear that they may serve lunch to us, collect our carfare, manicure our nails, dance with us most enchantingly, or eat at our tables, it seems a little more real, but still a little too much to believe. ”

“ The individual suffers as much from the ravages of Syphilis as society. Lucky is the man who can say that he is perfectly cured from Syphilis after two or three years of the most thorough treatment. Lucky is the man if he can be sure that later in life, after he may have forgotten all about his primary infection, the dormant germs of Syphilis lurking in the deep recesses of his body will not attack his most vital organs, as arteries, heart, or brain, and will not strike him down to permanent invalidism or slow but hopeless agony of an incurable disease. ”

“ Probably one in every five cases of syphilis in women is communicated by the husband in the marriage relation. There are so many sources and modes of its contagion that it is spread from one person to another in the ordinary relations of family and social life—from husband to wife and child, from child to nurse, and to other members of the family, so that small epidemics of syphilis may be traced to its introduction into a family. Syphilis is the only disease which is transmitted in full virulence to the offspring, and its effect is simply murderous. ”

“ Syphilis is a chronic, infectious, and sometimes hereditary, constitutional disease. Its first lesion is an infecting area or chancre, which is followed by lymphatic enlargements; eruptions upon the skin and mucous membranes; affections of the appendages of the skin, (hair and nails) ; chronic inflammation and infiltration of the cellulo-vascular tissue, bones and periosteum, and later, often by gummata. This disease is caused by a microorganism known as the spirochaeta pallida or treponema pallidum of Schaudinn and Hoffmann. ”

“ When the multitudes of germs present in the secondary period have died out, whether as a result of treatment or in the normal course of the disease, a woman who still has syphilis latent in her or even in active tertiary form, may bear a healthy child. Such a child may be perfectly healthy in every particular, and not only not have syphilis, but show no sign that the mother had the disease. It is in the period of active syphilis, the three, four, or five years following her infection, that the syphilitic mother is most likely to bear syphilitic children. ”

“ The Public Attitude Toward Syphilis.—First of [Pg 142] all, in order to understand the mental state of the patient, consider once more the attitude of the world at large toward the victim of syphilis. A few who are frankly ignorant of the existence of the disease to start with are unprejudiced when approached in the right way. But ninety-eight persons in a hundred who know that there is such a disease as syphilis are alive to the fact that it is considered a disgrace to have it, and to little else. ”

“ If we fail to find the germs, it is no proof that syphilis is absent, and we reëxamine and take blood tests at intervals for some months to come, to be sure that the infection has not escaped our vigilance, as it sometimes does if we relax our precautions. In recognizing syphilis, the wise layman is the one who knows he does not know. The clever one who is familiar with everything "they say" about the disease, and has read about the matter in medical books into the bargain, is the best sort of target for trouble. Such men are about as well armed as the man who attacks a lion with a toothpick. ”

“ When syphilis is communicated from one individual to another by contact infection, the condition is spoken of as acquired syphilis, and the first visible sign of the disease appears at the site of inoculation, and is known as the primary lesion. Those who have thus acquired the disease may transmit it to their offspring, who are then said to suffer from inherited syphilis. ”

“ Unlike whooping-cough, smallpox or pleurisy, syphilis is not a disease which, left untreated, cures itself in the course of time. Syphilis is a disease which peculiarly calls for treatment, and that treatment, to be effectual, must be prolonged. To: promote the healing of an ulcer, or to get rid of a cutaneous eruption, the result of syphilis, is not to treat syphilis. It is merely to free the patient of a symptom of the disease. ”

“ Nobody knows how much syphilis is cured, partly because nobody knows how much syphilis there really is, and partly because it is almost an axiom that few, except persons of high intelligence and sufficient means, stick to treatment until they can be discharged as cured. Take into consideration, too, the fact that the older methods of treating syphilis were scarcely equal to the task of curing the disease, and it is easy to see why the idea has arisen, even among physicians, that once a syphilitic means always a syphilitic, and that the disease is incurable. ”

“ The Sexual Transmission of Syphilis.—The sexual [Pg 118] transmission of syphilis is beyond question the most important factor in the spread of the disease. Here all the essential conditions for giving the germ a foothold on the body are satisfied. The genitals are especially fitted to keep the germs in an active condition because of the ease with which air is excluded from the numerous folds about these parts. It is remarkable what trifling lesions can harbor them by the million, and how completely, especially in the case of women, syphilitic persons may be ignorant of the danger for others. ”

“ Hereditary syphilis practically is not contagious except during the eruptions and active manifestations in infancy, such as the nasal discharge and the other sores in the mouth and about the genitals. As adults they can enter into the intimate relations of life without risk. Many of them, while perhaps having positive blood tests while the disease is active, later become negative without treatment. Some of them even recover from the disease to the extent that they can acquire it again, since there is no absolute immunity. ”

“ The germ of syphilis, on the other hand, secures its place in the body without exciting very strenuous or wide-spread opposition. The body does not come to its own defense so well as with a more active enemy. The fitness of the germ of syphilis for long-continued life in the body, and the difficulty of marshaling a sufficient defense against it, is what makes it impossible to cure the disease by any short and easy method. ”

“ The same thing is true of the layman. Syphilis which starts from a chancre elsewhere than on the genitals runs the same course and may conceal itself quite as effectively as syphilis from the usual sources, and for that reason may even more easily escape notice because misinterpreted at the start. It is my personal impression that careful study of patients with syphilis, and of those who live with them, would bring to light many overlooked extragenital infections, especially among those who [Pg 120] are the victims of crowding, poor living conditions, and ignorance. ”

“ When treating of this subject, and when speaking of both the usual mode of the infection of syphilis and its primary local symptoms generally escaping notice at the era of the first appearance of the disease, Swediaur observes,—“It is worthy of remark, that although many authors, since the year 1500, make mention of the genital organs, and say that syphilis may more generally (ut plurimum) be communicated by coition; not one before that time (1500) points out the (primary) affection as essential or characteristic of the disease. ”

“ In the first five years of an inefficiently treated infection, and sometimes longer, this danger is a very near and terrible one, to which thousands fall victims every year, and among them, perhaps, some of your friends and mine. Dangerous syphilis is imperfectly treated syphilis, and at any moment it may confront us in our drawing rooms, in the swimming pool, across the counter of the store, or in the milkman, the waitress, the barber. ”

“ The recognition of Syphilis is beset with peculiar difficulties, due to the fact that Syphilis has a remarkable tendency to imitate in appearance all possible diseases. This simulation is rendered particularly effective because Syphilis has universal and 135all-pervading distribution in the human body, and not a single part, organ, or tissue is free from the invasion of syphilitic poison. ”

“ As we have seen that the pathology, the stages, and the general course of hereditary syphilis are all closely related to or identical with the same phenomena in the acquired disease, and so know that they both depend upon the same ultimate cause, whatever that may be—a virus, a fungus, or a degraded cell—it follows that the same principles should govern us in the treatment of the one as in that of the other. ”

“ Relatively Non-contagious Character of Late Syphilis.—The older a syphilis is, the less dangerous it becomes. It is the fresh infection and the early years which are a menace to others. It will be recalled that the germs die out in the body in immense numbers after the active secondary period is over, so that when the tertiary stage is reached, there is only a handful left, so to speak. The germs in a tertiary sore are so few in number that for practical purposes it is safe to say they may be disregarded, and that [Pg 111] for that reason late syphilis is practically harmless for others. ”

“ Emotionally, he varied between depression and a sanguine attitude.
64Although there was no symptom directly suggesting syphilis in the Harrison case, the slightly abnormal pupillary reactions and the amnesia warranted the suspicion of syphilis. The blood and spinal fluid both proved positive to the W. R.; the gold sol reaction was of the “paretic” type; there were 18 cells per cmm.; there was considerable globulin, and an excess of albumin. On the whole, therefore, we felt entitled to make the diagnosis General Paresis. Why should not a careful observer have considered syphilis seriously? ”

“ Briefly, it may be said that the subject of syphilis should live low and think high. It has been said by an English physician who delighted in epigrams, “Syphilis once, syphilis ever”; but this is not true. If the individual places himself unreservedly and continuously under the treatment of a trustworthy practitioner, he may confidently look forward to a cure; and, if so be that he is eventually married, may depend upon his children showing no sign of his unfortunate infection. ”

“ Conversely, the healthy child who is nursed by a syphilitic woman stands an excellent chance of contracting the disease, since the woman may have sores about the nipples and since the germs of syphilis have been found in the milk of syphilitic women. The only person who should nurse a syphilitic child is its own mother, who has syphilis and, therefore, cannot be infected. A Wassermann blood test with a thorough examination is the least that should be expected where any exchanges are to take place. ”

“ Every case of syphilis means more cases of syphilis, and the danger of still more each day that the contagious patient is at large. No physician has done his duty unless, after seeing a case of syphilis, he attempts, through a social worker or otherwise, to get knowledge of others from whom this disease has been acquired, or to whom it may be freshly spread. At the Massachusetts General Hospital each patient with syphilis is asked to bring to the clinic for treatment the person who infected him. ”

“ Other observers maintain that the amoebae may pass through the walls of the intestine, through the peritoneal cavity, and so on to the liver where they give rise to typical abscesses.
Syphilis. — It has long been recognized that syphilis is a specific infective disease, but although characterized by fever, anaemia, and increased growths of tissue followed by rapid degeneration and ulceration of tissue, it is only within quite recent years that a definite parasitic organism, present in all cases of typical syphilis, has been isolated and studied. ”

“ The most dangerous and deceiving feature of syphilitic lesions is that they develop painlessly and without acute distress or discomfort to the patient, who becomes aware of the disease only after a considerable amount of tissue is destroyed and irreparable damage has been done. No man who has a syphilitic chancre is safe from a possibility of development of complications of Tertiary Syphilis unless his blood, after repeated tests, has been pronounced pure and free from syphilitic poisons. ”