The Spread of the Germs Over the Body.—The secondary stage of syphilis, like the primary stage, is an arbitrary division whose beginning and ending can scarcely be sharply defined. Broadly speaking, the secondary stage of syphilis is the one in which the infection ceases to be confined to the neighborhood of the chancre and affects the entire body. The spread of the germs of the disease to the lymph-glands1 in the neighborhood of the primary sore is followed by their invasion of the blood itself. While this may begin some time before the body shows signs of it, the serious outburst usually occurs suddenly in the course of a few days, and fills the circulating blood with the little corkscrew filaments2, sending showers of them to every corner of the body and involving every organ and tissue to a greater or less extent. This explosion marks the beginning of the active secondary stage of syphilis. The germs are now everywhere, and the effect on the patient begins to suggest such infectious diseases as measles3, chickenpox, etc., which are associated with eruptions5 on the skin. But there can be no more serious mistake than to suppose that the eruptions which usually[Pg 36] break out on the skin at this time represent the whole, or even a very important part, of the story. They may be the most conspicuous6 sign to the patient and to others, but the changes which are to affect the future of the syphilitic are going on just at this time, not in his skin, but in his internal organs, and especially in his heart and blood-vessels and in his nervous system.
Constitutional Symptoms.—It is surprising how mild a thing secondary syphilis is in many persons. A considerable proportion experience little or nothing at this time in the way of disturbances7 of the general health to suggest that they have a serious illness. A fair percentage of them lose 5 or 10 pounds in weight, have severe or mild headaches, usually worse at night, with pains in the bones and joints8 that may suggest rheumatism9. Nervous disturbances of the most varied10 character may appear. Painful points on the bones or skull11 may develop, and there may be serious disturbances of eye-sight and hearing. A few are severely12 ill, lose a great deal of weight, endure excruciating pains, pass sleepless13 nights, and suffer with symptoms suggesting that their nervous systems have been profoundly affected14. As a general thing, however, the constitutional symptoms are mild compared with those of the severe infectious fevers, such as typhoid or malaria15.
The Secondary Eruption4 or Rash.—The eruption of secondary syphilis is generally the feature which most alarms the average patient. It is usually rather abundant, in keeping with the wide-spread character of the infection, and is especially noticeable[Pg 37] on the chest and abdomen16, the face, palms, and soles. It is apt to appear in the scalp in the severer forms. The eruption may consist of almost anything, from faint pink spots to small lumps and nodules, pimples17 and pustules, or large ulcerating or crusted sores. The eruption is not necessarily conspicuous, and may be entirely19 overlooked by the patient himself, or it may be so disfiguring as to attract attention.
Common Misconceptions Regarding Syphilitic Rashes.—Laymen should be warned against the temptation to call an eruption syphilitic. The commonest error is for the ordinary person to mistake a severe case of acne, the common "pimples" of early manhood, for syphilis. Psoriasis, another harmless, non-contagious21, and very common skin disease, is often mistaken for syphilis. Gross injustice22 and often much mental distress23 are inflicted24 on unfortunates who have some skin trouble by the readiness with which persons who know nothing about the matter insist on thinking that any conspicuous eruption is syphilis, and telling others about it. Even with an eye trained to recognize such things on sight, in the crowds of a large city, one very seldom sees any skin condition which even suggests syphilis. It usually requires more than a passing glance at the whole body to identify the disease. If, under such circumstances, one becomes concerned for the health of a friend, he would much better frankly25 ask what is the matter, than make him the victim of a layman's speculations26. It is always well to remember that profuse27 eruptions of a conspicuous nature,[Pg 38] which have been present for months or years, are less likely to be syphilitic.
The Contagious Sores in the Mouth, Throat, and Genitals.—Accompanying the outbreaks of syphilis on the skin, in the secondary period, a soreness may appear in the mouth and throat, and peculiar28 patches seen on the tongue and lips, and flat growths be noticed around the moist surfaces, such as those of the genitals. These throat, mouth, and genital eruptions are the most dangerous signs of the disease from the standpoint of contagiousness29. Just as the chancre swarms30 with the germs of syphilis, so every secondary spot, pimple18, and lump contains them in enormous numbers. But so long as the skin is not broken or rubbed off over them, they are securely shut in. There is no danger of infection from the dry, unbroken skin, even over the eruption itself. But in the mouth and throat and about the genitals, where the surface is moist and thin, the covering quickly rubs or dissolves off, leaving the gray or pinkish patches and the flattened31 raised growths from which the germs escape in immense numbers and in the most active condition. Such patches may occur under the breasts and in the armpits, as well as in the places mentioned. The saliva32 of a person in this condition may be filled with the germs, and the person have only to cough in one's face to make one a target for them.
Distribution of the Germs in the Body.—The germs of syphilis have in the past few years been found in every part of the body and in every lesion of syphilis. While the secondary stage is at its[Pg 39] height, they are in the blood in considerable numbers, so that the blood may at these times be infectious to a slight degree. They are present, of course, in large numbers in the secretions33 from open sores and under the skin in closed sores. The nervous system, the walls of the blood-vessels, the internal organs, such as the liver and spleen, the bones and the bone-marrow, contain them. They are not, however, apparently34 found in the secretions of the sweat glands, but, on the other hand, they have been shown to be present in the breast milk of nursing mothers who have active syphilis. The seminal35 fluid may contain the germs, but they have not been shown to be present either in the egg cells of the female or in the sperm36 cells of the male.
Fate of the Germs.—The fate of all these vast numbers of syphilitic germs, distributed over the whole body at the height of the disease, is one of the most remarkable37 imaginable. As the acute secondary stage passes, whether the patient is treated or not, by far the larger number of the spirochetes in the body is destroyed by the body's own power of resistance. This explains the statement, that cannot be too often repeated, that the outward evidences of secondary syphilis tend to disappear of themselves, whether or not the patient is treated. Of the hordes38 of germs present in the beginning of the trouble, only a few persist until the later stages, scattered39 about in the parts which were subject to the overwhelming invasion. Yet because of some change which the disease brought about in the parts thus affected, these few germs are able to produce much[Pg 40] more dangerous changes than the armies which preceded them. In some way the body has become sensitive to them, and a handful of them in course of time are able to do damage which billions could not earlier in the disease. The man in whom the few remaining germs are confined largely to the skin is fortunate. The unfortunates are those who, with the spirochetes in their artery40 walls, heart muscle, brain, and spinal41 cord, develop the destructive arterial and nervous changes which lead to the crippling of life at its root and premature42 death.
Variations in the Behavior of the Germ of Syphilis.—Differences in the behavior of the same germ in different people are very familiar in medicine and are of importance in syphilis. As an example, the germ of pneumonia43 may be responsible for a trifling44 cold in one person, for an attack of grippe in the next, and may hurry the next person out of the world within forty-eight hours with pneumonia. Part of this difference in the behavior of a given germ may be due to differences among the various strains or families of germs in the same general group. Another part is due to the habit which germs have, of singling out for attack the weakest spot in a person's body. The germ that causes rheumatism has strains which produce simply tonsillitis, and others which, instead of attacking joints, tend to attack the valves of the heart. Our recent knowledge suggests that somewhat the same thing is at work in syphilis. Certain strains of Spiroch?ta pallida tend to thrive in the nervous system, others perhaps in the skin. On the other hand, in certain persons, for example,[Pg 41] heavy drinkers, the nervous system is most open to attack, in others the bones may be most affected, in still others, the skin.
Variations in the Course of Syphilis in Different Persons.—So it comes about that in the secondary stage there may be wide differences in the amount and the location of the damage done by syphilis. One patient may have a violent eruption, and very little else. Another will scarcely show an outward sign of the disease and yet will be riddled45 by one destructive internal change after another. In such a case the secondary stage of the disease may pass with half a dozen red spots on the body and no constitutional symptoms, and the patient go to pieces a few years later with locomotor ataxia or general paralysis46 of the insane. On the other hand, a patient may have a stormy time in the secondary period and have abundant reason to realize he has syphilis, and under only moderate treatment recover entirely. Still another will have a bad infection from the start, and run a severe course in spite of good treatment, to end in an early wreck47. The last type is fortunately not common, but the first type is entirely too abundant. It cannot be said too forcibly that in the secondary as in the primary stage, syphilis may entirely escape the notice of the infected person, and he may not realize what ails48 him until years after it is too late to do anything for him. Here, as in the primary stage, the lucky person is the one who shows his condition so plainly that he cannot overlook it, and who has an opportunity to realize the seriousness of his disease. It used to be an old[Pg 42] rule not to treat people who seemed careless and indifferent until their secondary eruption appeared, in the hope that this flare-up would bring them to their senses. The necessity for such a rule shows plainly how serious a matter a mild early syphilis may be.
The Dangerous Contagious Relapses.—Secondary syphilis does not begin like a race, at the drop of a hat, or end with the breaking of a tape. When the first outburst has subsided49, a series of lesser50 outbreaks, often covering a series of years, may follow. These minor51 relapses or recurrences53 are mainly what make the syphilitic a danger to his fellows. They are to a large extent preventable by thorough modern treatment. Few people are so reckless as wholly to disregard precautions when the severe outburst is on. But the lesser outbreaks, if they occur on the skin, attract little or no attention or are entirely misunderstood by the patient. Only too often they occur as the flat, grayish patches in the mouth and genital tract20, such as are seen in the secondary stage, where, because they are out of sight and not painful, they pass unnoticed. The tonsils, the under side and edges of the tongue, and the angles of the mouth just inside the lips are favorite places for these recurrent mucous54 patches. They are thus ideally placed to spread infection, for, as in the secondary stage, each of these grayish patches swarms with the germs of syphilis. Similar recurrences about the genitals often grow, because of the moisture, into buttons and flat, cauliflower-like warts55 from which millions of the germs can be squeezed. Sometimes[Pg 43] they are mistaken for hemorrhoids or "piles." With all the opportunities that these sores offer for infection, it is surprising that the disease is not universal. Irritation56 from friction57, dirt, and discharges, and in the mouth the use of tobacco, are the principal influences acting58 to encourage these recurrences.
Relapses in the Nervous System and Elsewhere.—Mucous patches are, of course, not the only recurrences, though they are very common. At any time a little patch of secondary eruption may appear and disappear in the course of a short time. Recurrences are not confined to the skin, and those which take place in the nervous system may result in temporary or permanent paralysis of important nerves, including those of the eyes and ears. Again, recurrences may show themselves in the form of a general running down of the patient from time to time, with loss of weight and general symptoms like those of the active secondary period.
The secondary period as a whole is not in itself the serious stage of syphilis. Most of the symptoms are easily controlled by treatment if they are recognized. Now and then instances of serious damage to sight, hearing, or important organs elsewhere occur, but these are relatively59 few in spite of the enormous numbers and wide distribution of the germs. Accordingly, the problems that the secondary stage offers the physician and society at large must center around the recognition of mild and obscure cases and adequate treatment for all cases. The identification of the former is vital because of the recurrence52 of extremely infectious periods throughout[Pg 44] this stage of the disease, and the latter is essential because vigorous treatment, carried out for a long enough time, prevents not only the late complications which destroy the syphilitic himself, but does away with the menace to society that arises through his infecting others, whether in marriage and sexual contact or in the less intimate relations of life.
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1
glands
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| n.腺( gland的名词复数 ) | |
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filaments
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| n.（电灯泡的）灯丝( filament的名词复数 )；丝极；细丝；丝状物 | |
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measles
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| n.麻疹，风疹，包虫病，痧子 | |
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eruption
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| n.火山爆发；（战争等）爆发；（疾病等）发作 | |
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eruptions
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| n.喷发，爆发( eruption的名词复数 ) | |
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conspicuous
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| adj.明眼的，惹人注目的；炫耀的，摆阔气的 | |
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disturbances
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| n.骚乱( disturbance的名词复数 )；打扰；困扰；障碍 | |
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8
joints
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| 接头( joint的名词复数 )； 关节； 公共场所（尤指价格低廉的饮食和娱乐场所） （非正式）； 一块烤肉 （英式英语） | |
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rheumatism
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| n.风湿病 | |
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varied
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| adj.多样的，多变化的 | |
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skull
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| n.头骨；颅骨 | |
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severely
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| adv.严格地；严厉地；非常恶劣地 | |
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13
sleepless
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| adj.不睡眠的，睡不著的，不休息的 | |
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affected
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| adj.不自然的，假装的 | |
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malaria
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| n.疟疾 | |
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abdomen
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| n.腹，下腹(胸部到腿部的部分) | |
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pimples
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| n.丘疹，粉刺，小脓疱( pimple的名词复数 ) | |
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pimple
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| n.丘疹，面泡，青春豆 | |
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19
entirely
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| ad.全部地，完整地；完全地，彻底地 | |
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tract
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| n.传单，小册子，大片(土地或森林) | |
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contagious
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| adj.传染性的，有感染力的 | |
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injustice
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| n.非正义，不公正，不公平，侵犯（别人的）权利 | |
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distress
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| n.苦恼，痛苦，不舒适；不幸；vt.使悲痛 | |
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inflicted
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| 把…强加给，使承受，遭受( inflict的过去式和过去分词 ) | |
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frankly
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| adv.坦白地，直率地；坦率地说 | |
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speculations
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| n.投机买卖( speculation的名词复数 )；思考；投机活动；推断 | |
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profuse
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| adj.很多的，大量的，极其丰富的 | |
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peculiar
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| adj.古怪的，异常的；特殊的，特有的 | |
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contagiousness
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| [医] （接）触（传）染性 | |
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30
swarms
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| 蜂群，一大群( swarm的名词复数 ) | |
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flattened
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| [医]（水）平扁的，弄平的 | |
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32
saliva
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| n.唾液，口水 | |
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secretions
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| n.分泌（物）( secretion的名词复数 ) | |
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34
apparently
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| adv.显然地；表面上，似乎 | |
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seminal
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| adj.影响深远的；种子的 | |
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sperm
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| n.精子，精液 | |
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remarkable
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| adj.显著的，异常的，非凡的，值得注意的 | |
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hordes
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| n.移动着的一大群( horde的名词复数 )；部落 | |
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scattered
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| adj.分散的，稀疏的；散步的；疏疏落落的 | |
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artery
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| n.干线，要道；动脉 | |
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spinal
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| adj.针的，尖刺的，尖刺状突起的；adj.脊骨的，脊髓的 | |
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42
premature
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| adj.比预期时间早的；不成熟的，仓促的 | |
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pneumonia
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| n.肺炎 | |
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44
trifling
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| adj.微不足道的；没什么价值的 | |
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45
riddled
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| adj.布满的；充斥的；泛滥的v.解谜，出谜题(riddle的过去分词形式) | |
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46
paralysis
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| n.麻痹(症)；瘫痪(症) | |
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47
wreck
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| n.失事，遇难；沉船；vt.(船等)失事，遇难 | |
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48
ails
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| v.生病( ail的第三人称单数 )；感到不舒服；处境困难；境况不佳 | |
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49
subsided
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| v.（土地）下陷（因在地下采矿）( subside的过去式和过去分词 )；减弱；下降至较低或正常水平；一下子坐在椅子等上 | |
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50
lesser
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| adj.次要的，较小的；adv.较小地，较少地 | |
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51
minor
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| adj.较小(少)的，较次要的；n.辅修学科；vi.辅修 | |
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52
recurrence
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| n.复发，反复，重现 | |
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53
recurrences
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| n.复发，反复，重现( recurrence的名词复数 ) | |
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54
mucous
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| adj. 黏液的，似黏液的 | |
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55
warts
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| n.疣( wart的名词复数 )；肉赘；树瘤；缺点 | |
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56
irritation
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| n.激怒，恼怒，生气 | |
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57
friction
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| n.摩擦，摩擦力 | |
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58
acting
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| n.演戏，行为，假装；adj.代理的，临时的，演出用的 | |
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relatively
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| adv.比较...地，相对地 | |
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