The period of the active manifestations of syphilis, embracing the primary and secondary stages, extends over a year or more. In many cases all symptoms disappear, and no further evidence of the disease is felt. Patients rarely die during the second stage. After an interval of months or years, in a certain proportion of cases, the so-called 'tertiary' or third stage of syphilis sets in. Insidious degenerative changes may have been going on during the interval and now become manifest, suddenly or gradually. The characteristic lesion of this stage is the gamma, which consists of a soft elastic tumor composed of cells and fibrous tissue. Gummata may develop in any situation, skin, bones, liver, testes, kidneys, lungs, or brain, and vary in size from a hemp-seed to a walnut. They are very prone to break down and ulcerate, often resulting in great loss of tissue and hideous scars and de formities. The bony framework of the nose is frequently destroyed in this manner. The skin is apt to be the seat of a variety of deposits which tend to form sluggish ulcerations, slow in heal ing, and leaving scars surrounded by deeply pigmented skin. Several disorders of the ner vous system are referable to syphilis; some, like hemiplegia, due to syphilitic degeneration of the arterial walls; others, like localized paralysis and convulsions, to gumnmata on the surface of the brain or the roots of the nerves; others again, like locomotor ataxia, are only indirectly trace able to syphilis.
Congenital syphilis shows itself in many and curious ways. Children born of parents suffering from syphilis in the first or second stage may be infected with the disease. The infection may be derived from the father alone, the mother be ing healthy; or from the mother alone, the father being healthy; or from both father and mother. Or the mother may acquire syphilis after con ception and convey it to the child in liter°. A curious law, to which there seems to be no ex ception, is that if a child inherits syphilis from its father, the mother being originally healthy, the infant may infect a wet nurse, but not its own mother, who is in some way protected against infection although she may have shown no evidences of the disease. As a rule the effect of syphilis in the parents is to cut pregnancy short, with resulting miscarriages, premature or still birth. Children may be born alive, presenting lesions of any stage of the disease. In many cases the child is at birth apparently healthy, fat and plump, but in a few weeks develops a char acteristic catarrh, vulgarly termed the 'snuffles,' shows a rash, with ulcerations about the lips, genitals, and anus, and gradually wastes away until the face acquires a typical withered, shrunken, and aged appearance. Most of these children die in infancy.
The treatment and prophylaxis of syphilis is a matter of great importance, since there is no dis ease so widespread in its dissemination nor so potent in its influence upon the human species.
Prevention depends on education in matters of sexual hygiene on the part of the public, eleva tion of the moral tone of the individual, and in segregation and inspection of prostitutes. The latter is practiced with good results in many cities of the Old World, and attempts are con stantly making toward the same end in the States. Great ignorance prevails among the laity as to the nature, effects, and treatment of syphilis. The only remedies of any value are mercury and iodides; but these must be given with care and under close observation, and should be combined with tonic remedies, accord ing to the needs of the particular case. Lay medication is apt to be ineffectual, if not dan gerous. Mercury may be given by inunetion, fumigation, hypodermically or by the mouth. Ex cessive doses of mercury are likely to produce a series of very unpleasant symptoms (see MEn CURY; SALIVATION) , and its unwise use in the hands of the ancient practitioners has resulted in a popular distrust of the drug. As a rule mercury is of greatest value in the first stages of syphilis, a combination of iodine and mercury in the sec ond stage, and iodine alone, usually in the form of potassium iodide, in the tertiary period. When these drugs are given skillfully and for proper periods of time, there is every reasonable pros pect of a permanent cure. The time of treatment should extend over at least two and one-half years after all visible signs of the disease have disappeared and marriage should be prohibited during this interval. The general health must be watched, and exercise in the open air, full diet, and appropriate tonics administered. in the syphilis of infants mercury is best given by inunction. Children somewhat older may take mercury in the form of gray powder in small doses. The two other drugs that seem to exert almost a specific effect in children are cod-liver oil and the iodide of iron. For a fuller descrip thin of this disease, consult: Lydston, A Text book on the Gcnito-Urinary, and Sexual Discuses (Philadelphia, 1900) ; Fournier, Syphilis and Marriage (trans. by Morrow, New York, 1881) ; id., Danger social de la syphilis (Paris, 1901).
SY'RA (Lat. Syrtis, from Gk. 110pos). An island in the ;Egean Sea, belonging to the Cy clades, and situated nearly iu the centre of the group. 10 miles southwest of Tinos. Area, 31 square miles (Map: Greece, F 4). It is for the most part barren and rocky, and its natural products are insufficient to support its population. Its importance is due to its being the site of Ilermopolis (q.v.), the capital of the nomarchy of the Cyclades and one of the chief commercial ports of Greece. Population of the island in 1S96, 26,856.