The Third Great Plague / A Discussion of Syphilis for Everyday People

by John H. Stokes

Chapter IV

The Nature and Course of Syphilis (Continued)

The Secondary Stage

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-glands 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 filaments, 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 measles, chickenpox, etc., which are associated with eruptions on the skin. But there can be no more serious mistake than to suppose that the eruptions which usually 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 conspicuous 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 disturbances 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 joints that may suggest rheumatism. Nervous disturbances of the most varied character may appear. Painful points on the bones or skull may develop, and there may be serious disturbances of eye-sight and hearing. A few are severely ill, lose a great deal of weight, endure excruciating pains, pass sleepless nights, and suffer with symptoms suggesting that their nervous systems have been profoundly affected. As a general thing, however, the constitutional symptoms are mild compared with those of the severe infectious fevers, such as typhoid or malaria.

The Secondary Eruption 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 on the chest and abdomen, 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, pimples and pustules, or large ulcerating or crusted sores. The eruption is not necessarily conspicuous, and may be entirely 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-contagious, and very common skin disease, is often mistaken for syphilis. Gross injustice and often much mental distress are inflicted 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 frankly ask what is the matter, than make him the victim of a layman's speculations. It is always well to remember that profuse eruptions of a conspicuous nature, 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 peculiar 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 contagiousness. Just as the chancre swarms with the germs of syphilis, so every secondary spot, pimple, 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 flattened 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 saliva 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 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 secretions 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, apparently 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 seminal 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 sperm cells of the male.