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The Third Great Plague - A Discussion of Syphilis for Everyday People
by John H. Stokes
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Backwardness of the United States in the Movement.—It will be apparent, from the foregoing review of the world movement against syphilis, and the essentials of a public policy toward the disease, that the majority of our efforts in this direction have been decidedly indirect. We have no national program of which we as a people are conscious. It is all we can do to arouse a sentiment to the effect that something ought to be done. In these critical times we must mobilize for action in this direction with as much speed at least as we show in developing an army and navy, slow though we are in that. To limit our efforts to the passing of freak state legislation regulating the price of a Wassermann to determine the fitness of a person for marriage, when both Wassermann test itself, and Wassermann test as evidence of fitness for marriage, are likely, under the conditions, to be absolutely worthless, is to play penny eugenics. The move to take the gag from the mouth of the physician when an irresponsible with a venereal disease aims to spread his infection by marriage is at least intelligent, preventive, even if indirect, legislation, because it acts before and not after the event. Although at the present time we cannot boast a single example of a complete program of direct legislation, the example of Michigan, which is providing free hospital treatment for adults and children with syphilis, should be watched as the first radical step in the right direction. If war and our mobilization for defense leave us with every hospital and dispensary and public health resource and all the expert judgment we have available within our borders enlisted finally in a great campaign against gonorrhea and syphilis, it will have accomplished a miracle, though it will have done no more than war has done for Europe. If it leaves us even with our more progressive states committed to an expanding program of universal efficient and accessible diagnosis and treatment, it will have conferred a blessing.

Relation of War to the Spread of Venereal Disease.—The frequent reference to the relation of war to the problems of sexual disease seems to justify a concluding paragraph on this aspect of the matter. Much of the impetus which has carried European nations so far along the road toward an organized attack on syphilis and gonorrhea, as has been said, is undoubtedly due to the realization that war in the past has been the ally of these diseases, and that a campaign against them is as essential to national self-defense as the organization of a vast army. Conflicting reports are coming from various sources as to the prevalence of syphilis and gonorrhea among European troops, although hopeful indications seem to be that troops in the field may have even a lower rate of disability than in peace times (British figures). The most serious risks are encountered in troops withdrawn from the front or sent home on leave, often demoralized by the strain of the trenches. The steady rise in the amount of syphilis in a civil population during war is evidenced, for example, by the figures of Gaucher's clinic in Paris, in which, just before the war, 10 per cent of patients were syphilitic; after the first sixteen months of the war 16.6 per cent were syphilitic, and in the last eight months, up to December, 1916, 25 per cent had the disease. There can be no doubt that a campaign of publicity can do much to control the wholesale spread of infection under war conditions, and we should bend our efforts to it, and to the more substantial work of providing for treatment and the prevention of infectiousness, with as much energy as we devote to the other tasks which preparedness has forced upon us. The rigorous provisions proposed for continental armies should be carefully studied, and in no cases in which either syphilis or gonorrhea is active should leave or discharge be granted until the infectious period is over. Compelling infected men to remain in the army under military discipline until cured might have a deterrent effect upon promiscuous exposure. In addition we should create as rapidly as possible a mechanism for keeping inactive cases under surveillance after discharge until there can no longer be the slightest doubt as to their fitness to reenter civil life. Observers of European conditions in the population at large are emphatic in saying that home conditions must have as much attention as the army, and that suppression of open prostitution, a watchful eye on the conditions under which women are employed or left unemployed, and the control of contributory factors, such as the liquor traffic, must be rigorously carried out. Nation-wide prohibition will do much to control venereal disease.[18] It is interesting and significant that little reliance is being placed on the obsolete idea that prostitution can be made a legitimate and safe part of army life solely by personal prophylactic methods, or by any system of inspection of the women concerned. It is a hopeful sign that this conception is at last meeting with the discredit which has long been due it.

[18] Through the effect on prostitution. A well-known and very intelligent prostitute, with whom this question was recently discussed, rated the liquor traffic first among the influences tending to promote prostitution.

The question has occurred to those interested in compulsory military service as a measure of national defense as to whether the mobilization of troops for training will favor the spread of sexual disease. Unfortunately, there are no satisfactory figures for the civil population showing how many persons per thousand per year acquire syphilis or gonorrhea, to be compared with the known figures for the onset of such infections in the army. Arguing from general considerations, however, there seems to be no reason to suppose that the army will show a higher proportion of infections than civilians. In fact, there is every ground for believing that the percentage will be lower, since the army is protected by a fairly efficient and enforceable system of prophylaxis which is taught to the men, and they live, moreover, under a general medical discipline which reduces the risk of infection from other than genital sources to the lowest possible terms. In opposition to the conception that the sexual ideals of the army are low, it may be urged that they are no lower than those of corresponding grades in civil life, and that hard work and rigid discipline have a much better effect in stiffening moral backbone than the laxities of present-day social life. In the last analysis, the making of the moral tone of the army is in our own hands, and by putting into it good blood and high ideals, we can do as much to raise from it a clean manhood as by submitting that same manhood to the temptations and inducements to sexual laxity that it meets on every street corner.

This chapter closes the discussion of syphilis as a problem for the every-day man and woman. It represents essentially the cross-section of a moving stream. Today's truth may be tomorrow's error in any field of human activity, and medicine is no exception to this law of change. It is impossible to speak gospel about many things connected with syphilis, or to offer more than current opinion, based on the keenest investigation of the facts which modern methods make possible. None the less, the great landmarks in our progress stand out with fair prospect of permanent place. The germ, the recognition of the disease by blood test and dark field microscope, the treatment and prevention seem built on a firm foundation. As they stand, without regard to further advances, they offer a brilliant future to a campaign for control To that campaign, each and every one of us can address himself with the prospect of adding his mite of energy to a tremendous movement for human betterment. For every man or woman to whom the word syphilis can be made to mean, not a secret, private, shameful disease, but a great open problem in public health, a recruit has been called to the colors. There are no signs more hopeful of the highest destiny for humanity than those of today which mark the transition of disease from a personal to a social problem. Such a transition foreshadows the passing of syphilis. In that transition, each one of us has his part. Toward that consummation, a goal only to be won by united and stubborn assault, each one of us can contribute the comprehension, the sympathetic support, the indomitable determination, which make victory.



INDEX

ABORTION, syphilis as cause of, 95

Abortive cure and marriage, 127 of syphilis, 27, 86 salvarsan in, 73, 79, 89 time required for, 87

Accidents, late, 45. See also late syphilis

Advertising in regard to treatment for syphilis, 175, 176

Alcohol, effects of, in syphilis, 137

America, backwardness of, in movement against venereal diseases, 181 state control of venereal diseases in, 170

American Social Hygiene Association, 165 pamphlets, 161

Antibodies in disease, 54

Antiseptics, effect of, on germ of syphilis, 27

Appearance of chancre, time elapsing before, 29

Armpits, contagious patches in, 38

Army and navy, Metchnikoff prophylaxis in, 162 probable outlook for venereal diseases in, 184 proposed measures relative to venereal disease in, 183 syphilis in, 25

Arsenic in salvarsan, 71

Arteries, effect of syphilis on, 47

Australia. See West Australia

BABIES, hereditary syphilis in, 99

Baltimore Vice Commission, report of, 134

Baths in treatment of syphilis, 140

Bath-tubs not means of transmitting syphilis, 114

Berlin, syphilis in clerks and merchants of, 25

Birth, premature, 95

Blaschko and German sexual disease program, 177, 180 estimate of syphilis in Berlin, 25

Blindness in hereditary syphilis, 104

Blood, Spirochaeta pallida in, during secondary stage of syphilis, 35 test for syphilis, 54. See also Wassermann test vessels, late syphilis in, 46

Board of Health, activities of, against syphilis, 165 national, need for, 167

Body, invasion of, by germs in secondary stage of syphilis, 35

Bones in hereditary syphilis, 102 late syphilis (gumma) in, 46 Spirochaeta pallida in, 39 supposed effect of mercury on, 63

Bordet and Wassermann, blood test for syphilis, 14

Brain, late syphilis of, 48 softening of, 48 Brawl chancre, 116

Breasts, contagious patches on, 38

Brooklyn Hospital Dispensary, 171 health exhibit by, 175

CABOT, Hugh, comment on reporting syphilis, 179

Cancer following smoker's patch, 138

Chafe, chancre resembling, 30 relation of, to infection with syphilis, 28

Chancre, 29 and cold sores, 30 appearance of, 30 brawl, 116 combined with chancroid, 30 concealment of, by gonorrhea, 30 contagiousness of, 109 contracted during engagement, 117 cure of syphilis in stage of, 85 developed from kissing game, 117 diagnosis of, prevented by improper treatment, 32 ease with which overlooked, 30 enlargement of glands near, 33 extra-genital, from lax relations, 134 importance of early recognition of, 31, 34 in women, 30 location of, 28 of the lip, 117, 119 on knuckle (brawl chancre), 116 painlessness of, 30 soft, 30. See also chancroid tertiary symptoms following, 45 urethral, in men, 30 variations in, 30

Chancroid, 16 and syphilitic infection, 30 confusion of, with syphilitic chancre, 31

Child, death of, in syphilitic miscarriages or abortion, 95 early signs of hereditary syphilis in, 99 effect of syphilitic eye trouble on development of, 103 healthy, born of syphilitic mother, 94 infection of wet nurse by syphilitic, 100 necessity of teaching sexual self-control to, 160 older, effect of hereditary syphilis on, 102 transmission of syphilis from mother to, 92 treatment of syphilis in, before birth, 97 unborn, effect of syphilis on, 98

Child-bearing, effect of syphilis on, 95

Children, adopted, syphilis in, 106 syphilitic, mental condition of, 101

Clap, 16. See also gonorrhea

Clinics for pay patients to secure better treatment, 173 inadequate, for venereal disease, 170 night, necessity for, 171

Cold sores and chancres, 30

College students, syphilis in, 25

Commission, Baltimore Vice, 134 Sydenham Royal, 164

Complications, serious, of syphilis, 45

Compulsory treatment, state provision for, 169

Conception, influence of syphilis on, 95 treatment of syphilis occurring in mother after, 97

Coney Island Health Exhibit, 175

Contagiousness of moist sores in syphilis, 27, 38, 110 of secondary relapses in syphilis, 42 syphilitic sores, 38 of syphilis, 109. See also infectiousness, infection, and transmission and medical examination of prostitutes, 135 control of, by salvarsan, 73, 74, 122 detection of, by examination of patient, 123 disappearance of, in late syphilis, 110 duration of, in late syphilis, 112 under treatment, 123 effect of incomplete cure on, 83 of local irritation on, 43 of mercury on, 64 of moisture on, 27, 38, 110 of time on, 111 of tobacco on, 138 estimate of risk for wife, 125 factors tending to increase, 112 five-year rule in relation to, 124 hereditary, 100, 105 ignorance of, in women, 135 impracticability of quarantine in control of, 121 in wet nurses, 101 inability of mercury to control, 123 obstacles to control by treatment, 123

Continence as personal prophylaxis, 161 economic forces opposing, 157

Copenhagen, dispensaries for treatment in, 171

Cost, economic, of mental disease due to syphilis, 51 of living, effect of, on marriage and sexual life, 158 of treatment, effect of, 84, 149

Cups, drinking, transmission of syphilis by, 113

Curability of syphilis, critical estimate of, 90

Cure, importance of, for the wife, 128 incomplete or symptomatic, danger of, 82 of early syphilis, abortive, 27, 34, 86, 127 of hereditary syphilis, 107 of syphilis, 124, 126, 129. See also five-year rule abortive, salvarsan in, 73, 79, 89 complete, responsibility of the physician in regard to, 84 effect of cost on, 84, 149 stage of disease on, 85 importance of, 90 in early stage, 27, 86 in primary stage, 85. See also cure of syphilis, abortive in secondary stage, 86, 88 methods of determining, 90 obstacles to, 80 radical or complete, 80 Wassermann test in, 58 symptomatic, in late syphilis, 87 time required for, 87

DARK-field examination, use of, in recognizing contagious recurrences, 111 germ of syphilis in, 22 importance of using, 22 use of, in recognizing early syphilis, 33

Deafness and loss of speech due to hereditary syphilis, 104

Deaths due to hereditary syphilis, 98, 99 due to late syphilis, 48

Denmark, free treatment of syphilis in, 169

Disgrace, syphilis and, 142, 144

Disinfection of hands, dishes, etc., by washing and disinfectants, 114

Dispensaries for syphilis in large cities, 170

Drinking of alcoholic liquors, effect of, in syphilis, 137

"Drops," 69

Drug stores and drug clerks, evil influence of, 175 prescribing, suppression of, 168, 174

Drying, effect on germ of syphilis, 27

Dumbness (loss of speech) in hereditary syphilis, 104

Dyes, relation of, to salvarsan, 70

EARS, secondary recurrences affecting, 43

Ears, trouble in, in hereditary syphilis, 104

Eating utensils, transmission of syphilis by, 113, 115

Education and character in the control of syphilis, 160 as means of controlling contagiousness of syphilis, 122

Ehrlich, Paul, 70

Engagements, syphilis contracted during, 117 to marry in syphilitics, precautions in connection with, 129

England, action of, against drug stores prescribing for syphilis, 176 provision for treatment of venereal disease in, 169 treatment not compulsory in, 180

English-speaking countries, attitude on Metchnikoff prophylaxis in, 177

Eruptions, absence of, in serious syphilis, 46 effect of mercury on syphilitic, 64 in hereditary syphilis, 100 non-syphilitic, 37 recurrent, 42, 43 secondary syphilitic, 36 syphilitic, effect of salvarsan on, 74

Estimate of damage caused by syphilitic eye trouble, 103 of frequency of relapse and recurrence in secondary syphilis, 125 of increase of syphilis during war, in Paris, 183 of percentage of marital syphilis, 119 of percentage of non-genital syphilis, 119 of prevalence of gonorrhea, 26 of syphilis, 24, 25 of risk of infecting wife, 125 of syphilis in prostitutes, 134

Examination, medical, before marriage, 130 limitations of, in detecting contagiousness, 123

Excesses, effect of, on the syphilitic, 137

Expense of treatment, effect of, 77, 84, 149

Expert advice, importance of, 32 in secondary stage of syphilis, 86 in pay patient clinics, 174 services, value of, in control and treatment of syphilis, 173

Eye trouble in hereditary syphilis, 103 in later life, 105 in secondary syphilis, 36

Eyes, secondary syphilitic recurrences affecting, 43

FAMILY, economic forces working against, 158 transmission of syphilis in, 116

Fathers of families, encouragement of early marriages by, 159 syphilis in, 93, 126

Fiancee, non-genital chancre in, 129

First sore, 29. See also chancre

Fist chancre, 116

Five-year rule, 124, 126, 129 in relation to marriage, 126

Founder's estimate of prevalence of syphilis, 24

France, increase of syphilis in, during war, 183

GAUCHER'S estimates of increase in syphilis during war in France, 183

Genital syphilis in lax individuals, 133

Genitals, contagious sores on, 38, 112 fitness of, for harboring germs of syphilis, 118

Germ of syphilis, 40. See also Spirochaeta pallida

Germany, action of, against drug store prescribing for syphilis, 176 attitude on Metchnikoff prophylaxis in, 177 compulsory treatment of venereal disease in, 180 sentiment against reporting of venereal disease in, 179 society for preventing sexual disease in, 164 syphilis in, 25

Germs, behavior of, in various diseases, 40

Glands, enlargement of, in neighborhood of chancre, 33 in chancre of the lip, 33

Gonorrhea and syphilis, measures to prevent spread from army to general population, 183 concealment of chancre by, 31 confusion of, with syphilis, 13, 16, 31 drug store treatment of, 175 estimated prevalence of, 26 in prostitutes in Baltimore, 134 Gonorrhea, transmission of, by toilet seats, 114

Great Britain. See England

Gumma, 46. See also syphilis, late effect of treatment on, 47 nature of, 46

Gummatous infiltration in hereditary syphilis, 102 in late syphilis, 46

HAITI, origin of syphilis in, 11

Hata, 70

Headaches in syphilis, 36

Health, effect of secondary syphilis on, 36 Exhibit, Brooklyn Hospital Dispensary, 175

Hearing, disturbances of, in hereditary syphilis, 104 in secondary syphilis, 36

Heart in hereditary syphilis, 102

Hereditary syphilis, apparently healthy children with, 101 as cause of abortions and miscarriages, 95 of death, 98 blindness in, 104 bones and teeth in, 102 contagiousness of, 100, 105 deafness in, 104 early signs of, 99, 100 effect of accident and injury in, 105 eye trouble in, 103 heart, blood-vessels and nervous system in, 102 Hutchinson's teeth in, 102 immunity in, 106 in adopted children, state provision for care of, 106 in infant, 99 in unborn child, 98 late, in older children and adults, 101 moral costs of, 99 non-transmission of, by marriage, 105 treatment of, 107 in school hospitals, 108

Hoffmann's rule for marriage of syphilitics, 124

Hospital beds, number of, needed for venereal disease, 171 treatment for hereditary syphilis, 108

Hospitals in treating venereal disease, 171 special venereal, 167, 171

Hot Springs in treatment of syphilis, 140

Hunter, John, 13

Husband, probability of infection of wife by, 125

Hutchinson's teeth in hereditary syphilitics, 102

Hygiene, personal, of the syphilitic, 136

IDIOCY in hereditary syphilis, 101

Immunity in syphilis, absence of, 139 hereditary, 106

Incubation period of syphilis, 28, 29

Infection, break in skin necessary to, 28 double, with gonorrhea and syphilis, 30 with syphilis and chancroid, 30 point of entry of, site of chancre, 29 risks of, 32 time elapsing after, before chancre appears, 29 unsuspected risk of, 161 with syphilis favored by moisture, 27

Infectiousness of syphilis. See contagiousness of syphilitic discharges, 28

Infiltration, gummatous, in late syphilis, 46 in hereditary syphilis, 102

Injections, mercurial, 66

Innocence, question of, in transmission of syphilis, 118

Inoculation, favorable ground for, 114

Insane asylums, amount of syphilitic mental disease in, 50

Inunctions, advantages of, 66 disadvantages of, 65 mercurial, 65 number required for cure, 66

Iodid of potash, 69

Irresponsible mental attitude in syphilis, 150, 151

Irritation, effect of, on contagious recurrences, 43

Italy, non-compulsory treatment in, 180 provision for treatment of venereal disease in, 169

KERATITIS, interstitial, in hereditary syphilis, 103

Kernels. See glands

Keyes' estimate of risk of infection of wife by husband, 125

Kissing, rules governing, in syphilitics, 138 transmission of syphilis by, 116

Knuckle chancre, 116

LATE syphilis, non-contagious character of, 110 premature development of, 45 prospects for cure in, 86

Latent or concealed syphilis, 22

Law, Ohio, relative to physicians and marriage of syphilitics, 131 controlling professional confidence, 131 crippling physician in relation to marriage of syphilitics, 131 providing for compulsory treatment in various countries, 180

Legal control, necessity for, in irresponsible syphilitics, 153

Legislation, conservative, 167 indirect, against venereal disease, 169 undesirable and freak, 166

Legs in locomotor ataxia, 49

Lemberg, study of prostitutes in city of, 134

Lesion, primary. See chancre; also sore

Life, well-balanced, for syphilitic, 137

Lip, chancre of, glands in, 33

Liquid medicine, giving of mercury in form of, 65

Liquor, alcoholic, effect of, in syphilis, 137 traffic, importance of abolition of, in prevention of venereal disease, 184

Liver, Spirochaeta pallida in, 39

Locomotor ataxia, 48 frequency of, 51 stomach symptoms in (gastric crises), 49 symptoms in legs, bladder and rectum, 49 syphilitic germs in spinal cord in, 49 treatment and prevention of, 52

London, syphilis in, 24

Luetin test, Noguchi, 79

MALARIA, comparison of, with syphilis, 62

Marriage and abortive cure of syphilis, 127 and five-year rule, 126 and syphilis, 125 and Wassermann test, 130 annulment of, for concealment of syphilitic infection, 132 early encouragement of, by state, parents, employers, 159 effect of economic forces on, 158 medical examination for syphilis before, 130 of hereditary syphilitics, 105 of persons with syphilis, inability of physician to prevent, 131 of syphilitics, Hoffmann's rule for, 124 syphilis acquired in, 120

Massachusetts, syphilitic mental disease in, 51

Medical examination before marriage, 130 in relation to syphilis, 130 of prostitutes, 135, 136

Mental attitude in relation to syphilis, 141 morbid, in syphilis, 153 disease and hereditary syphilis, 101

Mental disease and syphilis, 50 Hygiene, National Committee for, 166

Mercury, 62 and salvarsan, combination of, in controlling contagiousness, 124 comparative value of, 68 deceptive value of, 64 effect of, on syphilis, 63 inability of, to control contagiousness, 123 ineffectiveness of, by mouth, 65 injections of, 66 injurious effects of, 67 inunctions (rubs), 65 methods of administering, 64 of using in treatment, 62 misconception in regard to, 63

Metchnikoff and Roux, 14 prophylaxis in syphilis, 162

Michigan, legislative measures against syphilis in, 182

Military service, universal, and spread of venereal disease, 184

Miscarriage and abortion, syphilis as cause of, 95 repeated, 95

Misconceptions regarding cure of syphilis with salvarsan, 72 syphilis in children, 100

Moisture, effect of, on contagiousness of syphilis, 27, 38, 110 relation of, to infection with syphilis, 27, 38, 110

Moore, Noguchi and, 48

Moral problems in relation to syphilis, 18

Morality, sexual, in relation to syphilis, 18

Morals, syphilis and, 144

Morbidness in syphilitics, 153

Mother, knowledge of, in adopting a child, 106 syphilitic, apparent good health of, 93 period of greatest danger to child, 94 treatment of syphilis in, 97

Mouth, administration of mercury by, 64 contagious sores in, 38, 42. See also mucous patches effect of mercury on, 67 late syphilis in, 47

Mucous patches, 38, 42 cancer following, 138 effect of salvarsan on, 74 of tobacco in predisposing to, 43, 112 susceptibility of prostitutes to, 136

NATIONAL Board of Health, need for, 167

Neck, enlargement of glands in, 33, 34

Neosalvarsan, 75

Nervous strain, effect of, on syphilis, 137 system, complications, relation of, to mild secondary syphilis, 45, 46 examination of, in determining cure of syphilis, 90 relapses, 43 Spirochaeta pallida in, 39

New York City, clinics and dispensaries in, 170 reporting of syphilis in, 178

Noguchi, 48 test, luetin, 79

Non-genital syphilis, estimate of percentage of, 119 in lax individuals, 133, 134

Notification of venereal disease. See reporting

Nurse, accidental infection of, with syphilis, 116 wet, syphilis in, 100

Nursing mothers, syphilitic germs in milk of, 39 of syphilitic child by mother, 101

OHIO, law permitting physician to prevent marriage of contagious syphilitic person, 131

Overwork, effect of, on syphilitics, 137

PAPEE'S study of prostitution in Lemberg, 134

Paralysis, general, danger to others in, 49, 50 estimated frequency of, 51 mental symptoms in, 49 of insane, 48 syphilitic germs in brain in, 49 treatment and prevention of, 52

Paresis, 48. See also paralysis, general

Paris, increase of syphilis in, during war, 183

Physician, accidental infection of, with syphilis, 116 cooeperation of, in educating syphilitic, 148 importance of informing, in regard to syphilis, 105, 140 inability of, to prevent marriage of persons with syphilis, 131

Physician proper person to administer Metchnikoff prophylaxis, 163

Piles, contagious sores mistaken for, 43

Pills, ineffectiveness of, in treating syphilis, 65 mercury, 65

Pinkus' estimate of syphilis in Germany, 25

Pontopidan's estimate of number of hospitals needed for venereal diseases, 171

Population, civil, syphilis in, 183 general, prevention of venereal disease in, during war time, 184

Potash, iodid of, 69

Pregnancy, syphilis acquired during, 94 treatment of mother during, 97

Prevalence of gonorrhea, estimates of, 26 of syphilis, estimates of, 24, 25

Prevention of locomotor ataxia and general paralysis, 52 of syphilis. See prophylaxis

Primary lesion. See chancre stage. See also chancre contagiousness of syphilis in, 109 cure of syphilis in, 85

Prohibition, national, importance of, in controlling venereal disease, 184

Prophylaxis, educational, 157 state provision for, 168 Metchnikoff, 162 utilization of, in public campaign, 177 moral, of syphilis, 156

Prophylaxis, personal, of syphilis, continence in, 161 general instruction in, 169 in army and navy, 162 physician proper person to administer, 163 unsatisfactory features of, 162

Prostitutes in Baltimore, gonorrhea in, 134 medical examination of, 135 syphilis in, 134

Prostitution, abolition or repression of, 156, 157 and syphilis, 18, 133 clandestine, risks of, 136 effects of liquor traffic on, 184 regulation of, 156

Psoriasis, confusion of, with syphilitic eruptions, 37

Public Health, syphilis as problem of, 18 Service, United States, estimates of prevalence of syphilis, 24 opinion about syphilis, 141 sentiment and reporting of syphilis to health officers, 178

Publicity, campaign for, 176

QUACKS, suppression of, 168, 174 treatment of syphilitics by, 140

Quarantine and freak legislation, 167 compulsory, for irresponsible syphilitics, 153 limitations of, in controlling spread of syphilis, 121 temporary, for syphilis, in hospitals, 172

Quiescent period following entry of germ, 28

RAILROAD MEN, locomotor ataxia and general paralysis in, 50

Rash. See eruption

Recurrences, contagiousness of, 111 estimated frequency of, in secondary syphilis, 125 in secondary stage, 42, 43

Re-infection with syphilis, 139

Relapses, contagious, in syphilis, 42 frequency of, in secondary stage, 125 in nervous system, 43

Reporting of syphilis, attitude of various countries on, 179 to health officers, 178

Resistance of body to syphilis, 29, 107, 112

Rest, need of, in syphilis, 137

Restaurants, risk of transmitting syphilis under conditions found in, 115

Rheumatism, symptoms resembling, in secondary syphilis, 36

Ricord, founder of modern syphilology, 13

Rub, mercurial. See inunction

Rule, five-year, 124, 126, 129 for marriage of syphilitics. See marriage for personal hygiene of syphilitics, 136 governing miscarriage and abortion due to syphilis, 96 sexual relations in syphilitics, 138 variations on, in hereditary syphilis, 96

SALIVA, syphilitic germs in, 38

Salvarsan, accidents due to, 78 action of, in syphilis, 73 and abortive cure, 73, 79, 89 and mercury, comparative value of, 68, 89 in pregnancy, 97 animal tests on, 71 arsenic in, 71 as a social asset, 78 cheap, vital importance of, 172 combination of arsenic and dye, 70, 71 correct administration of, 77 discovery of, 70 effect of first dose, 78 of insufficient treatment with, 76 on mucous patches, 74 expense of treatment with, 76 importance of, in controlling contagiousness of syphilis, 73, 74, 122 in treatment, 89 in control of syphilis in prostitutes, 157 methods of giving, 75 misconceptions regarding cure by single dose, 72 need for governmental control, 77 patent rights on, 172 preliminary tests of, on man, 71, 72 price of, 172 repeated doses, 76 use of, does not justify relaxation of rules for marriage, 127 value of, in syphilis, 73

Scandinavian countries, compulsory treatment of venereal disease in, 180 free treatment of venereal diseases in, 169 provision for reporting venereal disease in, 179

Scars following gummatous changes, 46

Schaudinn and Hoffmann, 14, 22

School-hospitals for hereditary syphilis, 108

Secondary stage of syphilis, 35 contagious relapses in, 42 contagiousness in, 110 cure in, 86 eye trouble in, 36 headaches in, 36 loss of weight in, 36 problems of, 42 rash (eruption) in, 36 rheumatic pains in, 36 severe, 36 spontaneous disappearance of symptoms, 39 time required for cure, 88

Secrecy, professional, right of syphilitics, 139 right of syphilitic, in connection with reporting of disease, 178

Self-control. See sexual self-control

Self-deception in regard to risk of infection, 161

Self-treatment in syphilis, 140

Semen, Spirochaeta pallida in, 39

Sexual characteristics of syphilitic children, 102 morality, development of, 145 relations, abstinence from, economic influences opposing, 158 of syphilitics, rules governing, 129, 138

Sexual relations, transmission of syphilis by, 117 self-control, economic forces opposing, 157 teaching of, 159 transmission of syphilis, question of guilt or innocence, 118

Silverware, transmission of syphilis by, 115

Single dose cure of syphilis with salvarsan, 72

"606." See salvarsan

Skin, recurrences of secondary eruption in, 43 unbroken, importance of, in preventing contagiousness of eruptions, 38

Sleeping sickness, 70

Smoker's patches, 138

Smoking (tobacco) in syphilis, 138

Snuffles in hereditary syphilis, 100

Social evil and syphilis, 165. See also prostitution problem of syphilis, 15

Soft ulcer or sore, 16. See also chancroid

Soldiers, syphilis and gonorrhea among, in present war, 183

Sore throat in secondary syphilis, 38

Sores, contagious, effect of salvarsan on, 74 in prostitutes, 136 in syphilis, 38 transitory character of, 123 contagiousness of moist, 27, 38, 110 of open, 109 on nipples in wet nurses, 101 primary. See chancre soft, 16. See also chancroid tertiary. See syphilis, late, gumma

Sperk's estimate of frequency of relapse in secondary stage, 125

Spirochaeta pallida, 27 average life of, on objects outside body, 113 destruction of, in body, 39 discovery of, 14, 22 distribution of, in internal organs, 39 effect of antiseptics on, 27 of drying on, 27 of salvarsan on, 74 growth of, 27 in brain, in general paralysis of insane, 48 in hereditary syphilitic children, 99 in late syphilis, 45 in lymph-glands, 34 in secondary syphilitic eruptions, 38 in spinal cord, in locomotor ataxia, 49 invasion of body by, in secondary stage, 35 low vitality of, 27 mode of entry into body, 28 sensitizing of body to, 39 strains or type of, 40 variations in behavior of, in different persons, 40

Spleen, Spirochaeta pallida in, 39

Stage of syphilis, relation of, to curability, 82 secondary, of syphilis, 35. See also secondary stage; secondary syphilis; contagiousness; transmission; and Spirochaeta pallida

Stage, tertiary, of syphilis, 45. See also syphilis, late

State, encouragement of early marriage by, 159 provision of, for recognition and treatment of syphilis, 168

Stigma attaching to syphilis, harm done by, 143 of syphilis, effect of, on venereal hospitals, 167

Still birth, relation of syphilis to, 96

Still's statistics on death from hereditary syphilis, 98

Stomach in locomotor ataxia, 49

Sweat-glands, absence of Spirochaeta pallida in, 39

Sydenham Royal Commission, 164 views on reporting of venereal disease, 179

Symptomatic cure in late syphilis, 87

Symptoms, absence of, in syphilis, 23 constitutional, of secondary syphilis, 36

Syphilis, absence of immunity in, 139 accidental, in physicians and nurses, 116 acquired, in children, 95 in marriage, 119 action of mercury in, 63 of salvarsan in, 74 active, relation of, to miscarriages and abortion, 96 adequate dispensary service for treating, 171 ageing effect of, in child, 99 and civil population, 183 and engagements to marry, 129

Syphilis and marriage, 125 and mental disease, 50 and prostitution, 18, 133 and public prejudice, 141 and sexual problems, 18 and war, 183 as cause of death in children, 98 of miscarriages and abortion in women, 95 as public health problem, 18 as social problem, 15 blood test for, 54 broader outlook concerning, 146 comparison of, with malaria, 62 compulsory treatment of, 180 concealed forms of, 23 concealment of, by gonorrhea, 30 confusion of, with gonorrhea, 13, 16, 31 problem of, with various issues, 16, 17, 165 congenital, 94. See also syphilis, non-hereditary constitutional symptoms of, 36 contagiousness of, in secondary stage, 110 course of, summary, 52 cure of, 90 danger from irresponsible persons infected with, 150 deaths from, 48 definition of, 21 diminishing virulence of, 12 early, methods of recognizing, 32 educational prophylaxis of, 157 epidemic of, in sixteenth century, 11 eruption in secondary stage, 36 essentials of campaign against, 168 false silence in regard to, 15 five-year rule regarding contagiousness, 124, 126, 129 freak legislation in regard to, 166 guilt or innocence in transmission, 118 harm done by stigma attaching to, 143 hereditary, 92 accident and injury in, 105 contagiousness of, 100, 105 destructive changes in, 101, 102 early signs of, in children, 99, 100 late signs of, 101 mental symptoms in, 101 of eye, 103 treatment of, 107 history of, 11 importance of prohibition in controlling, 184 important advances in knowledge of, 17 in adopted children, 106 in British working men, 24 in families, detection of, by Wassermann test, 128 in father or mother of family, 92, 93, 126 in men who have only had gonorrhea, 31 in prostitutes, 134 in United States, estimates of, 26 in wet nurses, 100, 101 inability of physician to prevent marriage of persons with, 131 incomplete cure of, 82 influence of, on progress of mediaeval medicine, 13 innocent, in fiancee, 129 suffering of, caused by, 19 late, attributable to insufficient salvarsan treatment, 73 curability of, 86 destructive effect of, 47 in nervous system, 48 most serious forms of, 47 seriousness of, 45 tissue changes in (gumma), 46 measure to prevent spread of, from army to general population, 183 medical examination for, as means of detecting contagiousness, 123 of prostitutes for, 135 mental attitudes in relation to, 141 Metchnikoff prophylaxis of, 162 mild, dangers of, 41 relation to complications in nervous system, 45 mistaken conceptions of, 13 moral prophylaxis of, 156 morbid fear of, 154 non-genital, 28 or extra-genital, 119 obstacles to control of contagiousness of, 123 to social control of, 141 passive, transmission of, by prostitutes, 135 personal hygiene of, 136 prevalence of, 23 in lax individuals, 133 prevention of, by sexual self-control, 159 public attitude toward, 141 quacks and self-treatment in, 140 radical or complete cure, 80 reinfection with, 139 relation of mouth and tongue cancers to, 138 reporting of, to health officer, 178 risk of acquiring, from prostitutes, 136 of infecting wife with, 125 secondary, cure of, 86 time required for cure of, 86 sexual transmission of, 117 stages of, 26 state provision for treatment of, in Denmark, Norway, Italy, England, Germany, West Australia, 168, 169 tertiary, 45 transmission and hygiene of, 109 by kissing, 116 to and by wet nurse, 100, 101 treatment of, 60 at Hot Springs, 140 with salvarsan, 75 unnoticed manifestations of, 41 variations in course of, in different persons, 41 Wassermann test for, 54 world movement against, 164

Syphilitic, average type of, 148 child, nursing of, by mother, 101 ideal conscientious type of, 147 irresponsible types of, 151 morbid mental states, 153 personal hygiene of, 136 should tell physician he has disease, 140 rule governing care of personal articles used by, 139 rules governing kissing in, 138 sexual relations in, 138 well-regulated life for, 137

Syphilophobia, 153

TABES dorsalis, 48. See also locomotor ataxia

Taboparesis, 50

Teeth, effect of mercury on, 63, 67 (Hutchinson's), in hereditary syphilis, 102

Tertiary stage, 45

Test for syphilis in blood, 54. See also Wassermann test Noguchi, luetin, 79

Throat, contagious sores in, 38

Time treatment principle in relation to marriage, 124, 126, 129

Tobacco, effect of, in syphilis, 43, 112, 138

Toilet seats not means of transmitting syphilis, 114 transmission of gonorrhea by, 114

Tongue and tonsils, contagious sores on, 42 cancer of, following contagious mucous patches, 138

Towels, transmission of syphilis by, 113, 115

Transmission of syphilis by dishes, etc., effect of washing and disinfection on, 114 by infected articles, 113 by kissing, 116 by sexual contact, 117 effect of treatment on risk of, 124 from father to mother, 93 from mother to child, 92 increased risk of, in tobacco users, 138 medical examination in prevention of, 123 not by door-knobs, bath-tubs, or toilet seats, 114 passive, by prostitutes, 135 personal responsibility in, 124 to wife, 125 under conditions of crowding and bad sanitation, 115 of everyday life, 114 unlikely in marriage of hereditary syphilitics, 105

Treatment, intraspinal, in syphilis of nervous system, 79 lack of effect of, on deafness in hereditary syphilis, 104 obstacles to control of contagiousness of syphilis, 123 of chancre may prevent recognition, 32 of syphilis, 60 advertising in regard to, 176 backwardness of this country in public provision for, 170 by drug clerks, 175 by quacks, 140 compulsory, 180 control of contagiousness, 122, 124, 126 dispensary service necessary for, 171 efficient, 88 expense of, 76, 173 expert advice in, 174 hospitals in, 171 importance of salvarsan in, 89 in pay-patient clinics and hospitals, 173 necessity for cheap salvarsan in, 172 various state provisions for, 168, 169 Wassermann test in, 57 with salvarsan and mercury combined, 89 specific methods of, 60

Troops, syphilis and gonorrhea in, 182

UNITED STATES. See America

VEDDER'S estimate of prevalence of syphilis, 25

Venereal disease, 16 and marriage, annulment of, 132 effect of universal military service on, 184 European and American provision in regard to care of, 169, 170 importance of national prohibition in controlling, 184 proposed military measures in connection with, 183 relation of war to spread of, 182 world-wide movement against, 164 hospitals and freak legislation, 167

Vermont, reporting of syphilis in, 178

Vice Commission, Baltimore, syphilis in prostitutes, 134

Virulence of syphilis in 15th and 16th centuries, 12

Vomiting in locomotor ataxia, 49

WAR, control of venereal diseases during, 183, 184

War, relation of, to spread of venereal disease, 182

Warts, contagious syphilitic, 42

Washing, effect of, on transmission of syphilis by dishes, 114

Wassermann test, 54 as evidence of fitness to marry, 130 difficulties of, 55 effect of mercury on, 67 of treatment on, 58 factor of error in, 56 importance of expert performance of, 174 to pregnant mother, 97 in connection with adoption of children, 106 in determining cure of syphilis, 58, 90 in family where one member is syphilitic, 128 in freak legislation, 167 in late hereditary syphilis, 106 in syphilitic mothers, 93 negative, development of infectious sores in spite of, 123 meaning of, 56 on spinal fluid, 59 persistently positive, 58 positive, meaning of, 56 practical details concerning, 59 provocative, 130 use of, in recognizing early syphilis, 33

Weight, loss of, in secondary recurrences, 43 in secondary syphilis, 36

Welander homes for hereditary syphilis, 108

West Australia, action of, against drug stores prescribing for syphilis, 176 attitude of, on personal Metchnikoff prophylaxis, 177 compulsory treatment of syphilis in, 180 state provision of, for treatment of venereal diseases, 170

Wet nurses, syphilis in, 100

Wife, importance of cure for, 128 infection of, by husband during pregnancy, 94 risk of infecting, 125

Williams, syphilis and mental diseases, statistics on, 50

Womb, chancre on neck of, 30

Women, child-bearing, effect of syphilis on, 95 employment of, in connection with problem of controlling venereal diseases in war times, 184 miscarriages and abortions in, due to syphilis, 95 syphilis in lax, 133

Worry and anxiety, effect of, on syphilitic, 137



Transcriber's Note

The following variably hyphenated words have been left as in the text.

Everyday Every-day everyday every-day extragenital extra-genital lifelong life-long lifetime life-time makeup make-up newborn new-born

All bold text has been surrounded by + symbols.

A List of Illustrations has been added to the text of the file.

THE END

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