Syphilis is one of the oldest diseases in human history. Its ravages and destruction of health and life thruout many centuries up to our days have been such that it has been called a “black plague,” in distinction from the great “white plague,” tuberculosis. It is hard to say which one of the scourges of humanity is superior in its destruction and wrecking of humanity. While tuberculosis apparently carries away more lives in their prime and selects victims principally among the young at the very height of individual happiness and social usefulness, Syphilis surpasses its terrible rival in its universal character of distribution, in the easier mode of infection, and more lasting presence of the poison in the human body. No country or climate is free from the scourge of Syphilis. No age, no station of life gives protection from its infection. Syphilis claims its millions of victims in all parts of the universe. It has populated cemeteries with untold numbers of bodies of still-born babies and infants who died in the early months of life; it has filled the insane asylums of the world with thousands of hopelessly insane men and women; it has crowded the institutions for the incurable and defective with paralytic adults and children crippled mentally and physically from birth.
The individual suffers as much from the ravages of Syphilis as society. Lucky is the man who can say that he is perfectly cured from Syphilis after two or three years of the most thorough treatment. Lucky is the man if he can be sure that later in life, after he may have forgotten all about his primary infection, the dormant germs of Syphilis lurking in the deep recesses of his body will not attack his most vital organs, as arteries, heart, or brain, and will not strike him down to permanent invalidism or slow but hopeless agony of an incurable disease.
Great as the latest medical discoveries in the recognition and treatment are, the course of the disease is so insidious and treacherous, and the treatment requires such persistence and patience and such expenditure of time and money, that probably no more than half of the syphilitic patients carry out to the end the treatment and period of medical observation, and thousands and thousands of them are sure to be stricken down later in life with the above mentioned terrible after-complications of Syphilis, and are doomed to premature invalidism, paralytic diseases, and insanity.
In every disease an early and correct diagnosis is an essential condition for a successful treatment. This is particularly true in Syphilis. The early recognition of Syphilis can prevent a development of most dangerous complications, can forestall the destruction of most vital nervous centers and organs.
The recognition of Syphilis is beset with peculiar difficulties, due to the fact that Syphilis has a remarkable tendency to imitate in appearance all possible diseases. This simulation is rendered particularly effective because Syphilis has universal and all-pervading distribution in the human body, and not a single part, organ, or tissue is free from the invasion of syphilitic poison. Until lately the diagnosis of Syphilis was based on the rather uncertain basis of clinical experience, but the latest medical discoveries have put it upon a more definite foundation, and rendered it immeasurably more certain.
The first step in this direction was the discovery by a French scientist, Shaudin, of a germ producing Syphilis, a germ that he has called Spirocheta pallida. Spirocheta under the microscope looks very much like a corkscrew, and can be easily demonstrated in all fresh Syphilis sores. A finding of Spirocheta at once and absolutely establishes a diagnosis of Syphilis. Another valuable method by which a doubtful or latent case of Syphilis can be recognized is a blood test, known by the name of its discoverer as Wasserman Test. This is a very complicated test, requiring a highly-developed technic, and it can be properly done only in specially equipped laboratories.
The Wasserman test is not as absolutely sure and positive as finding of Spirocheta, yet it is very useful, and indeed indispensable in many cases of latent Syphilis, i. e., Syphilis that does not show any active symptoms like sores, breaking out, etc.
There is one more way to test the blood for Syphilis—luetin test, discovered by a Japanese scientist, Noguchi. Luetin test is made by injection in the skin of a certain substance, and also is very useful in old and latent cases of Syphilis. Recognition of Syphilis by the appearance and character of the sores and skin eruptions is in many cases very difficult, and can be done in doubtful cases only by a physician specially trained in this class of diseases.
The clinical course of Syphilis is usually divided, for the sake of convenience of presentation, into three periods.
The first manifestation of Syphilis in the human body is a primary syphilitic sore, so-called hard chancre. This chancre appears usually two or three weeks after exposure, and this is a very important point to remember. Most men think that every venereal disease shows up a day or two after intercourse, and if a week passes without any signs of infection, they congratulate themselves upon having escaped the penalty of the transgression. Therefore when, two or three weeks after the exposure, they notice a small pimple or nodule on the genital organs, they ascribe it to some accidental cause, and never think of the possibility of it being of a venereal nature. This error of judgment is rendered particularly easy by the fact that the initial syphilitic sore has such a harmless, insignificant appearance, and is commonly so free from any pain, discomfort, or acute distress, that the patient, as a rule, ignores it, believing it will pass away by itself, or applies some ordinary salve. Only after they see that this “pimple” does not disappear, and gets harder and bigger in size, only then they become alarmed and consult a physician. This is the reason that so many patients present themselves to the physician when the syphilitic poison has already spread all over the body and has broken out in a general eruption.
A deceiving appearance and mild clinical course of primary syphilitic chancre that gives to a patient a false feeling of security cannot be too strongly emphasized and warned against. The following injunction seems to be well indicated to all men taking chances with venereal infection: Beware of the little, painless, insignificant pimple on the genital organs, that comes up two or three weeks after exposure and shows a tendency to become firm and hard on touch.
Primary syphilitic chancre may look like a plain pimple or swelling without any sore on it, or it may present a greasy-looking ulcer with a very slight discharge, but all syphilitic chancres have one characteristic feature always present; this is a hard, almost wooden feel and firm consistence on touch.
Shortly after the appearance of primary chancre the patient notices a swelling of the glands in the groin on one or both sides, which feel like hard nuts, syphilitic buboes. These buboes never turn into an abscess, and remain hard for many, many months, until, under treatment, they slowly go down.
The fact that a man two or three days after an exposure begins to show a sore of Chancroidal type does not mean that he is already safe from developing a syphilitic chancre besides. In fact, it is a quite common occurrence that after development of typical Chancroid, in a week or two this sore begins to change in appearance and turns gradually into a syphilitic chancre. In other words, this man has contracted a double infection of both chancres, only their appearance takes place at different times, according to the difference in the length of time of their periods of incubation. The treatment of these mixed cases is naturally of more complicated character.
The secondary period of Syphilis begins with the first evidence that the syphilitic poison has spread all over the body, and that Syphilis from a local sore has become constitutional-blood disease. It takes usually about six weeks from the time of appearance of the primary chancre until the development of the constitutional symptoms. The very first symptom of the constitutional syphilis is a general rash, which has such a peculiar appearance that no competent physician has any difficulty in recognizing its nature. Together with the skin eruption, so-called “mucous plaques” can be seen in the throat, on the tongue, lips, etc. Very often syphilitics of the secondary period suffer from attacks of fever and get rapidly run down and wasted. In fact, an experienced physician can recognize a syphilitic by a peculiar paleness and general appearance suggesting slow waste of the body by some chronic poison.
The most common complaints in the secondary period of Syphilis are: Severe headaches and boring pains in the bones, particularly at night; different skin eruptions and patches of mucous plaques around the mouth or genital organs. These mucous plaques contain millions of active spirochetae, and for this reason the secondary period of Syphilis is the most dangerous period for transmission of the infection. The secondary period may last from a few months to one to two years, depending on the gravity of the case and the character of treatment.
The tertiary period of Syphilis is the longest in duration and the most dangerous stage of the disease. It gradually succeeds the secondary active period of Syphilis and lasts, if not treated thoroughly, for many years, and sometimes thru the entire life.
The main characteristic of this period is that its lesions (sores) are fewer, but they are very deep and penetrate to the most vital and important organs, such as blood vessels, heart, spinal cord, and brain. This is the time when syphilitic germs, after a long period of apparent cure of the disease, suddenly renew their destructive activity and strike down their victim with some permanently crippling and incurable chronic disease. It has been mentioned before that Syphilis does not spare a single part or organ or tissue of the body. Anywhere, in the deepest recesses of the most vital and life-bearing centers of the body, a tumor of tertiary Syphilis can form, so-called Gumma, that has a natural tendency to break down, forming an ulcer and leading to a terrible destruction of tissues.
We shall not tire the reader by a detailed description of the possible results of this destruction of the body; it is sufficient to say that death is a welcome relief to the crippled, palsied, and insane victims of advanced Tertiary Syphilis. We shall mention only two diseases that are definitely proven to be after-results of Syphilis—diseases that are both incurable and that count as their victims countless thousands of men all over the world.
The first, a progressive paralysis, a chronic, progressively increasing insanity, that draws out for many years and invariably ends fatally, after a long agony of physical and mental decay and waste.
The second disease is Locomotor Ataxia, a chronic, slowly-spreading decay of the spinal cord, in which are located the most important nerves controlling the sensation and locomotion of the body. As the result of the slow death of these nerves, a man is gradually transformed into a helpless and hopeless paralytic, doomed to stay bedridden for life.
Any and all complications of Tertiary Syphilis can arise and strike down a man in a most insidious and unexpected manner. The most dangerous and deceiving feature of syphilitic lesions is that they develop painlessly and without acute distress or discomfort to the patient, who becomes aware of the disease only after a considerable amount of tissue is destroyed and irreparable damage has been done. No man who has a syphilitic chancre is safe from a possibility of development of complications of Tertiary Syphilis unless his blood, after repeated tests, has been pronounced pure and free from syphilitic poisons.
Nowhere else are the ravages of Syphilis more destructive and cruel; no other disease punishes the offspring for the sins of its parents so ruthlessly and wantonly; no other scourge inflicts its terrible retribution on the second generation at such a tender age as hereditary Syphilis. Hereditary Syphilis is undoubtedly the saddest and most gruesome chapter in the long black record of Syphilis.
The offspring may inherit Syphilis from his father thru sperma (semen), from his mother thru ovum and blood circulation, or it may get infection from both parents at once. Most of the cases are due to infection from the father. Fortunately, experience has shown that the older the case of Syphilis is, and the better it has been treated, the more chance the offspring has to escape a syphilitic heredity, and the milder will the infection be if it be inherited.
If a man in the active stage of Syphilis marries a healthy woman, whether she herself be infected or not, she will not bear living children for a certain period of time. The first two or three years she will miscarry in the early months of pregnancy, a truly merciful provision on the part of nature, as death is certainly preferable to the drawn-out agony of the little creature, mutilated and crippled from birth. A little later the wife of a syphilitic is able to carry children to a full term, but they are born with the indelible stamp of loathsome heredity on their dwarfed bodies. The appearance of such children is as pitiful as it is repulsive. Wizened, old-looking faces, stunted bodies, numerous sores and skin eruptions, bone deformities, soft joints, due to decaying of bone ends and skulls distended with water; these and many other defects are the legacy these innocent victims come into the world with. Naturally, the vitality of such children is so low that many of them die in early infancy. Yet some of them can be saved by an early and thorough treatment. The farther it goes the more healthy-looking children are born, the fewer evidences of syphilitic heredity they present, and the later in life these evidences develop. Gradually, as the father or both parents receive proper treatment, their offspring born are more and more healthy and free from taint. There is no question whatsoever that syphilitic parents, one or both, can have, after they have cured themselves, perfectly healthy children, physically and mentally free from any blood taint or possibility of later relapses.
It is remarkable that while modern science has introduced hundreds of new drugs for different diseases, Syphilis, with one exception, is still treated with the same drug that was used centuries ago; this drug is mercury; the only thing that has changed is the method of administration. Mercury, or rather its different salts, are used now in a number of ways. It can be used internally, in powders, pills, and mixtures; hypodermically, intradermically, thru inunctions (rubs into the skin), intramuscularly, and even intravenously. Which particular method and which particular salt of mercury is to be preferred, depends on the judgment of the physician and the character of the case. The main condition of the success of treatment is not the selection of this or the other method of treatment, but in the thoroughness, persistence, and systematic use of it.
Mercury is proven to be an excellent germicide, and it cures Syphilis by killing its germs—Spirochetae.
Until very recent days mercury was our only anchor sheet in the fight against Syphilis, but in 1910 the great German scientist, Professor Paul Ehrlich, discovered that a certain chemical combination of arsenic, called by him Salvarsan, has a wonderful germicide effect on Spirocheta of Syphilis. Salvarsan is known also as 606, and its latest modification, Neo Salvarsan, is known as No. 914, because Ehrlich had to re-examine 605 different combinations of arsenic before he has developed and adopted 606, and he had to re-examine 913 combinations before he has adopted No. 914. At the time of its discovery the greatest enthusiasm prevailed, and it was claimed and expected by many that one injection of Salvarsan would be able to kill all the spirochetae in the body, and thus bring about a complete cure of Syphilis. Unfortunately, subsequent experience has shown that these expectations were unfounded. Salvarsan is a great remedy and one injection of it may heal up very rapidly most destructive syphilitic lesions, but neither one injection nor two nor three can with certainty produce a perfect and absolute cure of Syphilis.
The consensus of opinion of the most reliable and competent of medical observers at the present time is that the best results in the treatment of Syphilis are obtained by combined use of mercury and salvarsan, beginning with a few injections of Salvarsan and following up with a thorough mercurial treatment. The great usefulness and striking healing properties of Salvarsan in Syphilis are particularly to be appreciated, because mercury is not tolerated by many patients beyond a certain limit. Push beyond this limit, mercury produces symptoms of mercurialism—chronic mercurial poisoning, manifested by swollen and painful gums, bad smell from the mouth, stomach disorders, diarrhea, etc., which may prove serious and even dangerous. One of the most important measures of prevention of mercurialism in a patient undergoing mercurial treatment is to keep the mouth and teeth in a clean and healthy condition.
One more drug should be mentioned, which, besides mercury and Salvarsan, is used more than any other drug in the treatment of Syphilis. This drug is Potassium Iodide, which is very useful and surpasses anything else in its remarkable quality to absorb deep-seated syphilitic tumors (gummata) of the tertiary period.
Besides these three drugs, which are called specific, because their action is almost infallible, there are very few drugs used in Syphilis, mostly tonics to build up and strengthen the system, weakened by syphilitic poison. The general regime in Syphilis is much more liberal than in Gonorrhea, both as to choice of food and drink and as to the permissible amount of physical exercise or pleasure. This is particularly true in the late tertiary period of Syphilis. In the acute secondary stage of the disease, moderation and a regular mode of life is absolutely essential for the favorable course of the disease. The use of alcoholic liquors at this stage is absolutely prohibited, but it is tolerated in moderation if no active symptoms are present. Smoking and chewing are also prohibited if any sores or patches are present in the mouth. As mentioned before, these mouth patches, as the sores of this period, are highly contagious, and the patient, for the sake of others, must have his own table utensils and all articles of personal use. He is also cautioned to avoid in every possible way a close physical touch with others.
The question, when can a syphilitic marry? is as momentous and difficult to answer as a similar question in Gonorrhea; in other words, this question means, When can a syphilitic be declared perfectly cured and free from any danger of transmitting the infection to his wife and children? Until very recent years, before the three great discoveries in the realm of Syphilis had been made (the discovery of Spirocheta, Wasserman blood test, and Salvarsan), the physicians adopted from experience a rule which proved to hold good in the majority of cases. This rule reads that no syphilitic should be allowed to marry before three years passed since the time of primary infection. This rule was adopted on the assumption that the effects of three years’ treatment and the natural weakening of the virulence (intensity) of the syphilitic poison with the age of the disease give a reasonable assurance of safety to the wife and offspring. It is true that in most of the cases the family was fairly well protected by the long duration of observation period, and remained free from the infection, yet the physician had no exact and definite basis for such prediction, and while the family was well, some of these men developed many years later various dangerous and incurable complications of the advanced Tertiary Syphilis. Fortunately, now, in the light of new knowledge at our command about Syphilis, we are able to gauge the condition of the patient as to the degree of his cure of Syphilis in a very exact and definite manner. One test, tho, is not conclusive, particularly if it be negative. Positive Wasserman test is a fairly good evidence that syphilitic germs, spirochetae, are still present in the body in a dormant, if not an active, state, but a negative test, to be conclusive, must be repeated several times, covering a long period of time under various conditions, such as before and after a course of treatment. It should be remembered that while different active lesions in Syphilis are controlled and cleared up under modern methods of treatment very rapidly, a perfect elimination of spirochetae from the system is much more difficult, and it is always a time-consuming procedure. There are many cases of Syphilis where, after the primary general rash, sore throat, and other symptoms of the early secondary period, no other active symptoms of any kind develop subsequently, so that the actual manifestations of Syphilis are limited to a very few weeks or months, but even in these cases should a blood test be persistently negative for a period of half a year’s time, at least another half year should elapse before a final blood test is made. In the mildest and most thoroughly treated cases, a year’s time should be the shortest waiting period for giving a permission of marriage. In many more cases, probably in the majority, this period must be extended to two or three years, and in a few cases of malignant or destructive character, even much longer than this.
Thus the modern methods of treatment have shortened enormously the period of active manifestation of Syphilis, and have placed in our hands powerful means to control and to check the most malignant and destructive syphilitic lesions, but the period of quarantine in regard to marriage is not shortened very much, though its estimation is made immeasurably more certain, definite, and reliable.
Syphilis can be considered at the present time as perfectly curable and readily amenable to treatment, provided a correct and early diagnosis is made and a thorough, systematic, and persistent treatment is administered.