SYPHILIS. 788 SYPHILIS. and recommended inunctions of mercury for its cure, its authentic and general recognition dates from a severe outbreak of the disease in the army of Charles VIII. of France during the siege of Naples. It was known as 'the Neapolitan dis- ease' and as the morbus (lallicus. The di.sease spread with frightful rapidity and virulence, and during the following years was so widely dis- seminated as to be considered a form of plague. The armies of the various countries were nearly decimated, and no class of society escaped its ravages. It was not at first recognized as a venereal dis- ease. Its true nature appears to have been im- suspected at this time, as it was again a little previous to the time of .John Hvniter (q.v.), after whom was named the Hunterian or hard venereal sore. Hunter, although the greatest surgical philosopher of the eighteenth centuiy, believed that there was but one venereal disease ; that gonorrhoea, chancroid, and syphilitic chancre were merely variations of the same constitutional affection. Nearly half a century later (1831) Ricord established the identity of gonorrhtea, but failed to distinguish between chancroid and chancre. This was left to one of his pupils, Bassereau, to accomplish in 1856. The severe epidemics of the fifteenth century have never been repeated, although syphilis has since pre- vailed with continually decreasing virulence. This is due in part to improved personal hygiene, better imderstanding of the disease, and rational treatment, but also doubtless to the fact that successive generations have transmitted a certain degree of immunity to their descendants. See Immunity. The nature of the morbific principle — the matcries tnorbi — of syphilis has not been de- termined. No specific mieroiii'ganism has been discovered. Syphilis is peculiar to man. At- tempts to inoculate the lower animals, with the possible exception of the monkey, have been uni- formly unsuccessful. A disease somewhat re- sembling sj-philis is observed in the horse. This is known as nutUnUe du coit or equine syphilis. The negro race is believed to l.>e more susceptible to syphilis and to have it in a severer form than the Caucasian. This may be explainable on the ground that the disease is a comparatively new one to the darker race, which has not had time to acquire immunity. . Syphilis requires for its transmission contact of the specific poison existent in the secretions or discharges of a syphilitic patient with an abraded surface of skin or with a mucous mem- brane. The blood is also capable of transmitting sj-philis. Although the disease is as a rule ac- quired through sexual intercourse, ^'i/philis iii- sontium, or syphilis of the innocent, is of fre- quent occurrence. Physicians may become in- oculated by contact with syphilitic patients, and innocent patients, on the other hand, may be in- fected, though rarely, by surgical and dental in- struments. The saliva of syphilitic individuals contains the specific virus, and in this way in- oculation may occur by kissing, and the use of pipes, spoons, cups, pencils, sticks of candy, plugs of tobacco, etc. Cireat care is necessary when one member of a family is affected to prevent trans- mission of the disease to others, sinte in the fa- miliar intercourse of relations great danger ex- ists. After the poison of syphilis has been absorbed a certain time elapses before its effects become manifest. The abrasion heals over and there are no visible signs of danger. This is the period of incubation and lasts on the average three weeks, but may vary from ten to seventy days. At the end of this period a hard thickening ap- pears at the site of inoculation, and this soon breaks down into a discharging sore or ulcer, the discharge from which is extremely contagious. This ulcer is situated on an indurated base and is surrounded by dense tissue, and from this fact is known as the 'hard' chancre. It is the char- acteristic initial lesion of syphilis, and is usual- ly single. Another period of apparent quiescence now ensues, during which the patient is con- scious of no trouble besides the sore. This is the so-called secondary incubation period, lasting from four to six weeks or perhaps longer. A characteristic set of svmptoms now appears. The jioison has been absorbed by the lymiihatics, and upon examination the glands of the groin, axilla, neck, and in fact of the entire body will bo found enlarged and indurated. A rash, somewhat re- sembling that of measles, breaks out upon the chest and abdomen, spreading thence to the face, extremities, and back. The rash may vary wide- ly in character, presenting in different cases macules, papules, nodules, scabs, vesicles, or pustules. The eruption is usually superficial and fades gradnall,v without scarring, difl'cring in this respect from the tertiary rashes or 'late syphi- lides.' The rash marks the secondary stage of syphilis, and is attended with constitutional dis- turbances. There is slight fever, with severe noc- turnal headache, pains in the bones, and general malaise. The tonsils, soft palate, and lymphatic tissues of the pharynx become swollen, and to- gether with the gums, tongue, and inner side of the cheeks are the seat of 'mucous patches.' These are small grayish or whitish papules or shallow ulcers which discharge a most infectious material. It is through them that by far the greater number of cases of 'innocent' syphilis occur. Mucous patches are also apt to appear on the inner surface of the nose, the eyelids, about the genitals and arms. The throat is sometimes so sore and painful that eating solid food becomes impossible. Coincident with these changes in the skin and mucous membranes, sev- eral other tissues are afl'ected. The periostemn covering the tibife, skull, clavicles, or sternum becomes the seat of infiammatory thickenings or nodules (see Node), tender to the touch, but soon disappearing. The joints may swell. The hair may come oft" in considerable quantities, either in patches, or as a general thinning. The finger-nails are dr.v. brittle, and lustreless. The Ivmph glands continue swollen during the sec- ondar.v period of the disease. They may be felt in chains along the neck and groins. A small gland just above the inside of the elbow, the epitrociilear, is almost invariably aflVcted in syphilis and rarel.v in other diseases, and is there- fore a valuable aid in the diagnosis of doubtful cases. Syphilitic iritis is apt to occur during this stage. It usually afl'ects one eye at a time, and is manifested by photophobia, irregularity of the pupil from adhesions of the iris, swelling, and congestion. Later in the disease other eye tissues — the choroid and retina — may suffer seri- ously. Deafness may result from infiltration of the labvrinth of the ear.
