VENEREAL DISEASE (SYPHILIS).—A remarkably widespread, con tagious disease, which is generally transmitted through uncleanly sexual intercourse. Contagion may, however, occur from other than sexual con tact ; for instance, by kissing, or by using articles (glasses, dishes, etc.) that have been used by a syphilitic person. This may happen when a person who has the smallest wound or abrasion on the skin or on a mucous mem brane comes in contact with the secretions of a person having active syphilis. Contagion takes place only if the exposed person has been free from syphilis ; for whoever has had the disease remains, almost without excep tion, immune for the balance of his days. Another, and unfortunately very frequent manner of contagion, is by inheritance, from either parent or from both. This fact is of great social significance, for the offspring of syphilitic parents frequently die in the womb, and the living ones (as a rule prema turely born) can rarely he kept alive. Those who are saved develop poorly, and are badly equipped for life's struggle ; they are backward in mind and body, lead a miserable existence, and are a burden to themselves and to others.
The onset of syphilis is, almost without exception, marked by the appear ance of a so-called chancre, a more or less compact, nodular swelling of tissue (the size of a bean), occurring at the part where the first contact with the syphilitic poison took place. On account of the usual, though not in variable, hardness of the tissue, it is spoken of as a hard chancre. This develops, as a rule, about 2 to 3 weeks after infection, sometimes in from 5 to 8 days, and marks the first stage in the development of the disease. On account of its painlessness and small size, the chancre may remain unobserved for some time, especially as some persons do not believe in the possibility of contagion after such a long interval. Later on, other symp toms appear, which, if studied carefully, soon point to the nature of the trouble. The lymphatic glands situated near the chancre begin to swell, usually without pain, and may attain considerable size. At the end of a further period of development (lasting 3 to 5 weeks), the virus has entered the blood, poisoning the entire body. This is the second stage of the dis ease, and is characterised by general disturbances, such as headache, rheu matic pains, mild febrile attacks, loss of hair, general swelling of the glands, and a rash on the skin and on the mucous membranes. This rash is of value in diagnosing the disease. However, as it may occur in various forms, and
as it closely resembles eruptions that are not syphilitic, it can he recog nised only by an experienced physician. A person who, conscious of having been exposed to the danger of contagion 6 to 10 weeks previously, notices small and large red spots on his chest and abdomen, or small scabs and crusts on his head, lips, and tongue, and on the mucous membrane of his cheeks, or swelling of the tonsils, pain on swallowing, or hoarseness, also loss of hair and swelling of the glands, had best put himself in the care of a physician, who will diagnose his case and give the necessary treatment. Syphilis is a very slowly developing disease, and does not necessarily end with the disappearance of the above-mentioned symptoms. For several years after, milder or graver relapses may occur, until the end of 3 or 4 years ; and in cases which received insufficient treatment, it may be 7 or 8 years before a subsidence of the symptoms takes place, which usually marks the end of the early stage of the disease.
The danger of syphilis lies in the late syphilitic accidents. These impair the tissues of the body, destroying them through degeneration, swelling, hardening, contraction, and scar-formation. After the symptoms of the first period have disappeared, a normal condition generally ensues. The later symptoms, however, not only menace the functional capacity of a single organ, hut in some cases vital organs become affected, thus endanger ing the life of the patient. On account of the organic complications, syphilis terminates fatally in more cases than is commonly supposed. Quite often there results an additional incurable disease, such as tabes dorsalis, or general paresis, which, although not threatening immediate danger, creates permanent disturbances, and makes life a burden. One need consider only the frequent deformities resulting from ulceration, falling in of the bridge of the nose, diseases of bones and joints, destruction of the soft and hard palates, etc. How often these late syphilitic symptoms may appear cannot be answered definitely. In the majority of cases, the end of the first period marks the end of the trouble, and the patient is cured ; but if treatment was delayed, or inadequate, in the first stage of the disease, these secondary symp toms are liable to occur. When treatment is undertaken methodically from the beginning, and kept up for a sufficiently long time, the patient rarely suffers from later developments.