Syphilis is a markedly contagious, infective, and inoculable disease. It gains entrance at a wounded spot, and from thence gradually infects the body. It may manifest itself during the whole of the patient's life, and is capable of being transmitted to the offspring. It has many analogies with the exanthemata, and may be regarded as one of the most important of that group. Syphilis (other than hereditary) can only be propagated by direct contagion or by the transmission of the virus through some vessel or medium which has recently been contaminated. It is most commonly caused by impure sexual intercourse. As the result of this, after a symptomless incubation period of about three weeks, there forms at the point of infection a single painless ulcer, with a hard cartilaginous base and scanty secretion known as the Primary Sore—Hard Chancre.—Associated with this a change is seen in the nearest glands into which the lymphatics of the ulcerated spot discharge, and this change extends to all the lymphatic glands of the body. They are enlarged, bullet-like, painless, and do not become matted together as in ordinary inflammations. The sore and glandular enlargement constitute the primary stage of syphilis, and last from the date of inoculation for about eight weeks. This is followed by the secondary stage. It may be preceded by malaise, headache, and fever, and is characterised by skin eruptions, variable in kind and duration, which are symmetrical, do not itch, fade, and leave no trace. Amongst the first is a brownish-pink evanescent mottling—Roscola—on the chest, abdomen, and flanks. This is succeeded by a papular rash, which in its turn frequently assumes a more scaly appearance—Psoriasis. Similar changes are seen in the mouth, on the tongue, and about the anus, in the form of mucous patches, cracks, fissures, shallow ulcers, and condylomata. The hair is frequently shed, and crusts form on the scalp. Syphilitic inflammations of the eye (Iritis), ear, testes, and periosteum also occur.
The secondary symptoms go on for about a couple of years, become more irregular in duration and character, and gradually cease as the period of the tertiary stage develops. This may show itself long after the cessation of secondary symptoms. The disease is no longer contagious, but the lesions which arise are much more serious to the patient. Masses of cells of low vitality, known as gummata, non-vascular, with a pronounced tendency to break down and ulcerate, may arise in any of the tissues. They are asymmetrical and are specially prone to affect the connective tissue, skin, bone, muscle, and viscera. They frequently simulate malignant tumours, and are a fertile source of many of the diseases of the brain and spinal cord, giving rise to epilepsy and various forms of paralysis. In some instances tertiary syphilis is lifelong, and resists treatment most obstinately.
The precise nature of the syphilitic virus is at present unknown. There is reason to believe that a micro-organism similar to that of tubercle is the cause. This would seem to proliferate in the primary sore, to be carried along the lymphatics, and so to infect the whole of the tissues. Attempts to excise the sore have not met with success in preventing the disease. Syphilis is one of the most frequent causes of abortion, and the infants of syphilitic parents show the manifestations of secondary syphilis in the form of skin eruptions. In more advanced life hereditary syphilis is recognised amongst other things by the irregular and peg-shaped teeth, the depressed broken-like nose, and traces of inflammation of the cornea. It is noteworthy that the mother sometimes displays no evidence of the trouble, her children cannot infect her, while they may readily infect their nurse and other healthy people with whom they are brought in contact.
The treatment of syphilis requires that one should aid the elimination of the disease, combat the anaemia caused by it, antagonise the tendency to the formation of gummata, and prevent the spread of the infection. It is necessary to warn the patient that during the whole of the primary and secondary stages he is a cause of danger to others, and that, while his normal evacuations are innocent, the discharges from any sore or abraded surface and his blood are most virulent. Hence the utmost care must be taken to avoid contagion through the medium of the utensils he uses at meal-time, &c. He should lead a regular life, taking due exercise and avoiding strains and excess of all kinds. The anaemia and the syphilitic virus itself are met by the administration of mercury. This should be given in small doses over a prolonged period, say of twelve to eighteen months, with frequent short breaks. By this means the secondary symptoms are alleviated, and the tertiary stage may be prevented.
In later secondary eruptions iodide of potassium may be combined with the mercury, and in tertiary conditions the iodide alone is indicated. Large doses of iodide—10 or 15 grains thrice a day—are frequently required in cerebral and spinal syphilis. The patient who suffers from syphilis should not be allowed to marry until he has passed six months without showing any evidence of secondary mischief, and that too without taking mercury. At least two years should have elapsed since he contracted the disease.
In the event of a mother producing syphilitic children she alone should be allowed to nurse them. As a rule syphilis is very amenable to treatment, provided the patient be otherwise strong and leads a regular life. Syphilis is a disease of remote antiquity, and is found all over the globe. It is now probably becoming much milder in its effects, although occasionally local outbreaks do occur which display all the malignancy which characterised it during the middle ages.
The extraordinary prevalence of this disease during the latter part of the 15th century led to the unfounded belief that it had come from the New World with the Spanish navigators, though the name Morbus Gallicus, or the Neapolitan Disease, was that now commonly given. It seems probable that at an earlier date, when its cause had not been recognised, it was often confounded with other diseases, such as leprosy. The word was borrowed from the name of a hero in Fracastoro's poem Syphilidis Libri III. For its history and treatment (including Syphilisation, a suggested method of securing a mild form of the illness and subsequent prevention by inoculation), see Häser, Geschichte des Medicins; Rosenbaum, Die Lustseuche im Altertum (1888); and the Manuals by Lancereaux (1869), Lee (1875), Cooper (1884), Hutchinson (1887), and Von Zeissl (New York, 1887).