HEALTH AND DISEASE 307 



SO small as to escape detection, there is little satisfaction to be gained from 

 this fact. The stage of the disease during which the sores appear lasts from 

 a few weeks to two or three years, depending on whether the disease is 

 properly or improperly treated. After this stage, the disease, although it may 

 persist, can no longer be transmitted in the usual manner. 



The spirochetes cannot force their way through the unbroken skin or 

 mucous membrane. They can enter only through a break in the surface. 

 Although theoretically the invasion may occur at any point on the body, 

 it rarely does so outside of the genital organs and lips. About 5-10 per cent, 

 of all cases start from the lips and such cases are usually caused by kissing. 



When infection occurs, events follow a characteristic order. The spiro- 

 chetes at first show none of the aggressive characteristics which mark their 

 later activity. These they develop about a month after infection has oc- 

 curred. The invading spirochetes are so slow^ in gaining a foothold that 

 during the first twelve hours they can be eradicated and the disease pre- 

 vented. This fortunate opportunity^ for preventing syphilis makes possible 

 an effective prophylaxis. It is an opportunity afforded by very few diseases. 



Syphilis is a mild disease, but, paradoxical as it may seem, the mild diseases 

 are often the most persistent. Mild diseases do not eUcit an acute reaction 

 on the part of the body. Consequently, they persist, and in persisting they 

 become chronic diseases. There are no acute stages in the progress of 

 syphilis. Its duration is marked by years rather than days. The first symp- 

 toms of syphilitic infection is a chancre, a round ulcerated area which ap- 

 pears at the point of infection. The margin of this ulcer is swollen and 

 feels hard under the touch. It is painless, is associated with no feeling 

 of illness, and gives no indication in itself of the serious nature of the in- 

 fection. It persists for three or four weeks before it shows any tendency 

 to heal. 



During the primary stage of syphilis the spirochetes are mostly in the 

 area about the chancre and for the first week the disease cannot be de- 

 tected by testing the blood with the Wassermann reaction. Nevertheless, 

 an examination of the material from the chancre under the miscroscope 

 with dark field illumination shows the spirochetes in great numbers. Under 

 proper treatment applied early in its primary stage the disease can be 

 stopped so quickly that no manifestation other than the chancre develops. 

 The treatment of syphilis becomes more difficult and the results of the 

 treatment less certain as the disease advances through the secondary and 

 into the tertiary stage. 



From their focus in the chancre the spirochetes spread into the blood 

 and are carried throughout the body. The general manifestations of the 

 disease develop and give rise to the secondary stage of the disease about 

 two months after the original infection and at about the same time the 

 chancre is healing. An eruption appears on the skin and the mucous mem- 



