And now there follow evidences that the poison has not only passed up from the spot where it was introduced, into lymphatic glands, but has gained entrance to the blood, and has affected the constitution. These evidences are called the secondary symptoms of syphilis, or briefly secondaries. The first of these is the appearance of a rash on the skin, which comes out in from six weeks to three months after in fection, usually in about sixty or seventy days. The rash is at first of rosy red spots, which ap pear about the chest and belly, and may cover the whole body like a crop of measles. They soon become dull red or brown, and finally dis appear, to be succeeded by pimples, which have a coppery colour. The pimples by and by fade, leaving copper-coloured stains in the skin, which take some time to disappear, but leave no scar. They begin on the trunk of the body, but spread to the arms and legs, and, unlike many ordinary skin affections, do not miss the palms of the hands and soles of the feet. They may come out in crops, off and on, for several months. Moreover, this rash of syphilis is capable of assuming many various forms ; but, whatever the form, one great peculiarity is the coppery colour of the staining of the skin which attends it. The skin of the scalp is often affected, scales forming, and the hair loses its gloss, becomes dry, and tends to fall out, so that baldness may be produced.
Some amount of feverishness, loss of appetite, paleness, weakness, headache, and rheumatic like pains, often very severe, are not uncom monly experienced just before the appearance of the rash.
On p. 413 it is explained that mucous mem branes, the covering of red parts like the lips, inside of the mouth, throat, &c., are practi cally of the same structure as the skin. Renee it is not surprising that affections of the mucous membranes occur similar to those of the skin. The mouth and throat commonly suffer; the tonsils (p. 195) are liable to ulcerate, the nos trils and box of the windpipe sharing in the trouble. Raised patches about the corners of the mouth and anus (p. 189) are frequent.
Now it is certain that the matter that oozes from, or covers, these ulcers and raised patches is capable of communicating the disease. This is a fact of the utmost importance to observe. What it implies is this, that a person who has such syphilitic ulcers or patches in throat, or mouth, or tongue, is capable of communicating the disease by a kiss, if the slightest crack or fissure exists on the lip of the person kissed, by which the poison could enter. Moreover, for the sante reason, a healthy person using, without cleansing, cups, tumblers, &c., that have been just previously used by a syphilitic person may contract the disease. Thus while at the beginning of these paragraphs on syphilis it has been said that the disease is usually con tracted by impure sexual intercourse, it is not uncommon to find it, in perfectly innocent persons, acquired by such other ways as have been indicated. For example, a hard chancre
on the lip is often seen. A child who has inherited syphilis from its parents may com municate it to its wet nurse during suckling, and a wet nurse by the same means may com municate it to a child. Besides the affections of skin and mucous membranes, mentioned as secondary symptoms of the disease, others are common. Serious inflammations of the eye— inflammation of the iris and of the retina and optic nerve (p. 482)—are quite ordinary results. Affections of 'bones and joints, indicated by severe pains of a rheumatic character, usually worse at night, are also frequent. The bone affections are commonly marked by the appear ance of small painful lumps, usually on the shin bones, to which the term "nodes" is applied. In fact the diseases which may arise in the progress of the secondary stages of syphilis, due to the poison in the blood, are innumerable, and are only properly treated when their cause is recognized. This secondary stage lasts for from six to eighteen months, during which the general health of the patient is liable to serious disturbance and depression. At the end of that time the disease may dis appear, even without treatment, and not again trouble the patient. Symptoms are, however, apt to show themselves now and again still indicative of the operation of the poison, such as the occurrence of skin diseases of various kinds, of ulcers, &c., which are obstinate, even refusing readily to yield to treatment.
Moreover, at a variable interval after the end of the secondary stage, what are called tertiary symptoms may reveal themselves. The chief evidence of the third stage is the formation of collections of inflammatory mate rial in various parts of the body, in skin, mucous membranes, muscle, bone, liver, and other internal organs, brain, and spinal cord. These new growths are called gummata. These growths readily ulcerate and break down, causing destruction of the substance of the part in which they happen to be. They may disappear without ulceration, but still their disappearance is attended by destruction of the part in which they are lodged and con sequent contraction of the part, shown by deep and permanent scars. In the skin the growths form flat elevated patches of a deep purplish red colour, called syphilitic tubercles. Such destructive growths may form in the gullet, leading to contraction and difficulty of swal lowing; in the box of the windpipe, attacking the vocal cords (p. 389) and causing hoarseness and loss of voice; in the nostrils, producing destruction of the gristly parts, giving rise to offensive discharge (STINKNosE, p. 473), and ending in falling in of the bridge of the nose; and in many other parts may similar growths occur. Tumours may form in the brain, and may cause deafness, blindness, paralysis, and other symptoms dependent upon their posi tion. Intense and persistent headaches con tinuing for weeks without intermission are extremely suspicious of syphilitic disease of the brain.