426 Syphilis 



papule, grows larger, undergoes superficial indolent ulcera- 

 tion, and eventually heals with the formation of an indurated 

 cicatrix. It is in this lesion that the spirochaete first makes 

 its appearance. From this lesion, where it multiplies 

 slowly, it enters the lymphatics and soon reaches the lymph- 

 nodes, which swell one by one as its invasion progresses. 

 During this stage of glandular enlargement the organisms 

 can be found in small numbers in juice secured from a punc- 

 ture made in the gland with a hollow needle. This period 

 of primary symptoms (chancre and adenitis) includes part 

 of what is known as the period of secondary incubation, 

 which intervenes between the appearance of the chancre and 

 that of the secondary symptoms. It usually lasts about six 

 weeks. During this time the organisms are multiplying 

 in the lymph-nodes and occasionally entering the blood. 

 What fate the organisms meet when they reach the blood 

 in small numbers is not yet known, but the slow inva- 

 sion suggests that those first entering are destroyed, and 

 that it is only when their numbers are great and their 

 virulence increased that they suddenly become able to 

 overcome the defenses and permit the development of the 

 secondary symptoms. This period of secondary symptoms 

 corresponds to the invasion of the blood by the parasite. 

 It may continue from one to three years, during which time 

 the patient suffers from general symptoms, fever, etc., proba- 

 bly due to intoxication, and local symptoms, such as alopecia, 

 exanthemata, etc., due to local colonization of the organ- 

 isms. At the end of this period a partial immunity, such as 

 is seen in other infectious diseases (malaria), develops, the 

 organisms disappear from the blood, the general local and 

 constitutional disturbances recover, and the patient may 

 be well. Should he continue to harbor some of the micro- 

 parasites, however, there may be an insidious sclerosis of 

 the blood-vessels and parenchymatous organs consequent 

 upon the growth and multiplication of the parasites, or 

 there may be after many years a period of tertiary symptoms 

 characterized by the sudden appearance of severe lesions 

 in which the parasites are very few in number. 



The specific organisms are present in juice expressed 

 from the primary lesion, in juice from the bubos and en- 

 larged lymph-nodes; in the blood, in the roseola, and all 

 of the secondary lesions, and sparingly in the tertiary 

 lesions. 



