The Third Great Plague | Page 9

it gets a real foothold, there is an immediate
and severe reaction, the body puts up a fight, and in ten days or so has
either lost or won. The germ of syphilis, on the other hand, secures its
place in the body without exciting very strenuous or wide-spread
opposition. The body does not come to its own defense so well as with
a more active enemy. The fitness of the germ of syphilis for
long-continued life in the body, and the difficulty of marshaling a
sufficient defense against it, is what makes it impossible to cure the
disease by any short and easy method.
+The First Sore or Chancre.+--The primary lesion, first sore or
chancre,[6] is the earliest sign of reaction which the body makes to the
presence of the growing germs of syphilis. This always develops at the
point where the germs entered the body. The incubation period ends
with the appearance of a small hard knot or lump under the skin, which
may remain relatively insignificant in some cases and in others grow to
a considerable size. Primary lesions show the greatest variety in their
appearance and degree of development. If the base of the knot widens
and flattens so that it feels and looks like a button under the skin, and
the top rubs off, leaving an exposed raw surface, we may have the
typical hard chancre, easily recognized by the experienced physician,
and perhaps even by the layman as well. On the other hand, no such

typical lesion may develop. The chancre may be small and hidden in
some out-of-the-way fold or cleft, and because it is apt to be painless,
escape recognition entirely. In women the opportunity for concealment
of a primary sore itself is especially good, since it may occur inside the
vagina or on the neck of the womb. In men it may even occur inside the
canal through which the urine passes (urethra). The name "sore" is
deceptive and often misleads laymen, since there may be no actual
sore--merely a pinhead-sized pimple, a hard place, or a slight chafe.
The development of a syphilitic infection can also be completely
concealed by the occurrence of some other infection in the same place
at the same time, as in the case of a mixed infection with syphilis and
soft ulcers or chancroids. Even a cold-sore on the mouth or genitals
may become the seat of a syphilitic infection which will be
misunderstood or escape notice.
[6] Pronounced shan'-ker.
+Syphilis and Gonorrhea may Coexist.+--It is a not uncommon thing
for gonorrhea in men to hide the development of a chancre at the same
time or later. In fact, it was in an experimental inoculation from such a
case that the great John Hunter acquired the syphilis which cost him his
life, and which led him to declare that because he had inoculated
himself with pus from a gonorrhea and developed syphilis, the two
diseases were identical. Just how common such cases are is not known,
but the newer tests for syphilis are showing increasing numbers of men
who never to their knowledge had anything but gonorrhea, yet who
have syphilis, too.
+Serious Misconceptions About the Chancre.+--Misconceptions about
the primary lesion or chancre of syphilis are numerous and serious, and
are not infrequently the cause for ignoring or misunderstanding later
signs of the disease. A patient who has gotten a fixed conception of a
chancre into his head will argue insistently that he never had a hard
sore, that his was soft, or painful instead of painless, or that it was only
a pimple or a chafe. All these forms are easily within the ordinary
limits of variation of the chancre from the typical form described in
books, and an expert has them all in mind as possibilities. But the

layman who has gathered a little hearsay knowledge will maintain his
opinion as if it were the product of lifelong experience, and will only
too often pay for his folly and presumption accordingly.
+Importance of Prompt and Expert Medical Advice.+--The recognition
of syphilis in the primary stage does not follow any rule of thumb, and
is as much an affair for expert judgment as a strictly engineering or
legal problem. In the great majority of cases a correct decision of the
matter can be reached in the primary stage by careful study and
examination, but not by any slipshod or guesswork means. To secure
the benefit of modern methods for the early recognition of syphilis
those who expose themselves, or are exposed knowingly, to the risk of
getting the disease by any of the commoner sources of infection, should
seek expert medical advice at once on the appearance of anything out
of the ordinary, no matter how trivial, on the parts exposed. The
commoner sources of infection