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Syphilis (vulgarly called Pox) is a contagious disease, is, indeed, a type of that class of dis eases capable of being contracted only by the direct introduction of a special poison into the body of a person. The poison is, in this case, communicated directly by sexual intercourse or indirectly by inheritance. To this rule there are, however, exceptions which will be noticed. How the disease first originated, where, that is to say, the first poison came from, it is impossible to state. It appears, however, to have occurred in Europe, and certain parts of Asia. from the earliest times. It has spread round the entire globe, by means of the com merce between countries, though some regions have escaped its attack. It is not affected by climate. During the latter part of the fifteenth century the disease assumed an epi demic form throughout the whole of Europe.

One attack of syphilis protects against a second, but then the disease does not run its course in the brief period occupied by other fevers, such as small-pox, scarlet fever, &c. Its progress occupies months, even years, and sometimes continues throughout the life of the person who has contracted it.

The disease is due to a spiral organism (see Vol. I., p. 496), described by Schaudinn in 1905, called Treponema Pallidum, or spiro cheeta; and where the diagnosis is doubtful it may now be made certain by the employ ment of a test, Wassermann's, which, however, requires the resources of a bacteriological laboratory.

Symptoms.—The fearful character of this disease will be best understood by an account of the progress of an ordinary untreated case.

The first occurrence of the disease is the ap pearance of a sore, called the hard chancre, at the place where the poison UM been introduced, usually some part of the genital organs. This sore, however, does not appear for a consider able time after the poison has been received. There is a period, that is to say, corresponding to the period of incubation or hatching of ordinary fevers, which has been referred to on p. 518. This interval is on an average four weeks. It may be only a little over two weeks, while, on the other hand, it may extend to nearly six weeks. During this interval there is nothing whatever to lead the person who has exposed himself to the disease to suspect the possibility of its existence. A person whose conduct has rendered his infection only too pro bable, after failing to discover anything for a week or two, may conclude that he has (nnde servedly) escaped, but this conclusion is not justified so early as this. The form which the sore takes on its first appearance is that of a small red dark-coloured pimple, which slowly grows larger. The person may be, and often is, unaware of its presence, since it is not pain ful nor itching. in a few days the pimple is broken by the separation of a part of the sur face, and speedily a little ulcer is formed. The ulcer is of a peculiar character. It is not deep

but shallow, and all round the sore is a firm ridge of a dark-red appearance. If the part be taken between finger and thumb it has a hard feeling, as if a little mass of gristle had been deeply imbedded in the substance of the skin. The ulcerated surface is grayish, and rather dry, only a scanty thin discharge being pro duced by it. In about six weeks it reaches its complete formation, when it is about the size of a split pea, and it thereafter begins to diminish. When it is healed it leaves a white scar that will never disappear. The scar is below the level of the surrounding parts, which are some what hardened, and of a darker colour than is usual. So little trouble does this sore occasion that the person may from first to last be igno rant of its existence. The sore is single ; several of them do not occur on the same person. While this is the usual form and course of the sore, it may appear as a mere scratch or crack, heal ing easily and leaving scarcely any recognizable scar. What has been described is the true, hard chancre, the first result of the activity of the special poison of syphilis. But there is another sore, called soft chancre, or chanchroid, also the result of the introduction of a poison, obtained in the same way as the preceding, but which never gives rise to syphilis. It is described elsewhere (see INnax). It is painful, pours out abundant discharge, is accompanied by inflam mation and swelling, but has not the hard gristle-like feeling of the true chancre. More over, matter from the soft sore, getting into a scratch on any other part of the same person's body, will reproduce a similar sore ; while, on the other hand, matter from the true chancre cannot produce a second sore on the same person, though it can produce a sore like that it came from on another person. One or two weeks after the appearance of the true chancre, the glands in the groin become affected. In fig. 130 on p. 285 is a representation of the glands in the groin. Those marked d. e. f. in the figure receive material from the genital organs, and if the poison of syphilis has been there introduced, it in time reaches the glands and affects them. They increase in size, not necessarily all of them, but several. The increase is slow and painless. On pressing with the finger they are felt to be hard and are freely movable in their positions. They may become as large as almond shells, and so they remain for years, not coming to matter, and giving rise to no trouble, but pre senting almost conclusive evidence of the exist ence of syphilis. This is another distinguishing feature between hard and soft chancre, for the poison from a soft sore reaches the same glands, but causes in them inflammation and formation of matter, so that one or more buboes, as they are called, are produced, that is, abscesses, which are extremely stubborn and slow to heal.

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