I don’t really expect everyone to be as interested in old medical descriptions as I am, but I find them utterly compelling. For reasons you can gather from the description below, syphilis is known in medical circles as “The Great Imitator”. This is why House M.D.’s minions frequently raise it as a possible diagnosis in their medical mystery cases, along with lupus, another great mimic.
The spirochaete that causes syphilis is now called Treponema pallidum. However, the natural history of the disease in an individual had been known for a long time. (And yet, white Americans still performed the cruel, racist Tuskegee study.) There was quite a period of confusion, however, in which it was thought that syphilis and gonorrhoea were the same disease. This confusion was caused by an experiment gone wrong. John Hunter, an 18th-century pathologist, in the true spirit of pioneering investigators everywhere, infected himself deliberately with gonorrhoea, using the pus from an infected patient. Unbeknownst to him, the patient was also infected with syphilis, and Hunter contracted both diseases. His well-publicised conclusion that the two diseases were the same set back STD knowledge for fifty years.
The first well-documented syphilis epidemic was in Europe in the 1400s, but the origin of the spirochaete is disputed. Some believe it originated in Europe or Africa, as early as Hippocratic times; other believe it originated in the new world, and was brought back by sailors around the time of Columbus.
T. pallidum was only just discovered around the time the Ladies’ Handbook was published. At the time, it was treated with potassium iodide or mercury (orally or as topical ointments). Salvarsan (arsephenamine) injections took their place around five years after publication of this book, hailed as a miracle cure at the time, despite the inevitable arsenic toxicity. Penicillin wasn’t to come along till the 1940s.
It is not clear from this writeup that the authors known that congenital syphilis is transmitted through the placenta. They don’t seem to. Before that was known, it was thought that congenital syphilis somehow came directly from fathers, or from wet-nurses. Still women are notably invisible in this piece. Note that prostitution is seen not as a danger to women, but as a threat to the “enlightened man”, and that they authors are promoting a sort of demand-side abolitionism.
Chapter III: “Outside The Marriage Circle” (Part 2)
NATURE AND CAUSE.- Syphilis, like gonorrhoea, is a contagious disease. It is also caused by a micro-organism, or germ, known as the spirochaete pallida. Outside the human body this germ survives but for a few hours. Within the body, however, it lives not only for one, but for even two or three generations. In other words, the germ of syphilis not only outlasts its unfortunate victim, but destroys his progeny as well. Syphilis is propagated by two methods: inoculation, and hereditary transmission; the first form being known as acquired syphilis; the second, as congenital syphilis. Acquired syphilis is invariable caused by contact with discharges from the sores of a syphilitic person. This contact is generally sexual, though from a sore on the lips or tongue it may be transmitted through kissing. It cannot be transmitted through the air, as drying destroys the germ of syphilis, but it may possibly be conveyed by utensils or clothing.
The course of the disease is that of a low infectious fever. Like other fevers, it has a period of incubation which is followed by acute symptoms. The disease is generally divided into three stages – primary, secondary, and tertiary.
SYMPTOMS, COURSE, AND PREVENTION.- Primary Stage: Generally within two or three weeks after the spirochaete pallida, the germ of syphilis, has found its way into the body through some minute break or abrasion of the skin or mucous membrane, a tiny red papule makes its appearance at the point of inoculation. This papule soon breaks down and becomes a shallow ulcer, the primary syphilitic sore or hard chancre. This sore is small, and so little painful as to be often entirely overlooked. Even when it is seen, it is given no particular attention by those who do not understand its significance. If this sore be gently pressed between the fingers, however, it will be noticed that this piece of skin feels very hard. The sensation is similar to that experienced on pressing the tip of the nose. This hardness, together with the stubbornness of this little canker sore in refusing to heal for several weeks or even months, generally indicates syphilis. This primary syphilitic sore gives off but little discharge. This little, however, is the deadly virus of syphilis. It contains the germs of this disease, and has only to be rubbed into the skin or mucous membrane, or to be introduced into the blood or lymph through a pin prick or tiny scratch, crack, or abrasion, to produce the disease in another.
The primary syphilitic sore is generally located on the external genitals, where it may easily be seen. Sometimes, however, and particularly is this the case in women, the sore cannot be detected except by careful medical examination. Indeed, it has even occurred in cities where prostitutes are licensed and subjected to medical examination at regular intervals that cases of syphilis are met with in which the disease has been communicated by a woman who had submitted to the usual examination, and had been pronounced free from the disease. This fact should serve as a warning to those who appear to think there is but little danger in promiscuous sexual relations.
Other situations for the primary sore are the lips or inside the mouth, or on the hands or fingers in the case of physicians and nurses who have contracted the disease through examining and treating syphilitic patients. Thus the disease may be conveyed by promiscuous kissing, the practice of allowing comparative strangers to kiss infants and children being particularly objectionable. Without doubt, innocent young girls have contracted syphilis through permitting such acts of familiarity. Other methods of contagion are through the medium of personal, table, toilet, and bed linen, dishes, and other utensils, and contact with the furnishings of public baths and lavatories. There is also danger in putting money, toys, pencils, pins, and other similar articles into the mouth; for it is possible that such things have recently been in contact with a syphilitic sore.
Sufficient has been said to show the need on the part of persons suffering with syphilitic sores to take care not to jeopardise the health of others by promiscuous kissing, spitting, the contamination of public towels and lavatories, and other similar practices. Such persons should receive all discharges from these sores on dressings which are afterwards burned. During this primary stage of syphilis, there may be no disturbance of the general health nor any symptoms to attract attention. There is, it is true, small nodules or kernels in the vicinity of the primary sore due to enlargement of the lymph glands. If the chancre be located on the genitals, the glands in the groins become swollen and tender soon after the sore makes its appearance, If the primary sore be on the lip or in the mouth, the enlarged glands appear at the angle of the jaw or on the side of the neck.
Secondary Stage: In the secondary stage there is evidence that the syphilitic poison has been distributed through the lymphatic system to every part of the body. There is generally more or less fever, and often slight soreness of the throat. Rashes appear upon the skin. The most usual form of rash slightly resembles measles. It appears first on the chest and abdomen, thence spreading to other parts of the body. One form of rash somewhat resembles smallpox, and others are slightly similar to skin diseases of different origin.
During this stage the patient feels ill and suffers from pains in the bones and head which are more severe at night. The congestion of the mouth and throat may become so troublesome that solid food cannot be swallowed, and mucous patches or secondary sores make their appearance. These are found, as their names denote, on the mucous membranes of the mouth and throat. They are also seen at the corners of the lips, and in the nose, under the arms, between the buttocks or thighs, and even between the fingers and toes. Along with the mucous patches appear warty syphilitic growths, or condylomata, as they are called. The discharge from these mucous patches, like those from the primary sore, are virulently contagious. Other inflammations of the secondary stage affect the eye and the ear, coverings of the bones, and lining of the joints, the hair, the nails, and the nervous system. Thus are caused not only blindness and deafness, but certain forms of apoplexy or paralysis, inability to move the eyes in a natural way, or dropping of their lids, variations in the size of the pupil. pains which are called rheumatic, but are worse at night, various thickenings and swellings known as gummata, and loss of the hair and nails.
Tertiary Stage: In some cases it is impossible to say just when the secondary stage of syphilis terminates and the tertiary stage begins. There is no plain line of demarkation between the two, nor can it be said at what time the tertiary symptoms will begin. They may immediately follow the secondary symptoms, or their appearance may be delayed for months or even for years. Much depends upon the methods of treatment employed in the earlier stages. Or, again, in some cases the disease remains latent or dormant after the disappearance of second stage symptoms until it reappears, not in the individual who acquired it, but in his children. Frequently the disease remains quiescent for so long a time that the patient thinks that he is cured. Of this insidious latency of the disease it has been said that no other communicable disease continues its manifestations after twenty years, and even fifty years, from the original infection. The chief factor in determining when tertiary symptoms shall appear and how severe they shall be, is the patient’s manner of life. They appear earliest and are most severe in those persons who indulge freely in the use of alcohol and tobacco and other injurious practices, and who fail to conform to the simple rules of hygiene.
The typical symptoms of this stage of the disease is the appearance of syphilitic tumors, called gummata, in various parts of the body. These may also appear to some extent during the secondary stage , but as a rule are more common and serious during this stage. Such syphilitic tumors may appear in any organ of the body. The brain and nervous system do not escape, and because of pressure from these tumors, or destruction of certain portions of the brain or spinal cord, various forms of paralysis are common during the tertiary stage. Thus locomotor ataxia, or general paralysis, may appear in a person past middle age who in youth contracted this disease.
Congenital Syphilis: In no other instance do we see so plainly as in congenital syphilis the truth of the statement that the sins of the fathers shall be visited upon the children. One of the saddest features of this unfortunate disease, which is the badge of so much misery and sadness, is its power to destroy innocent infants and children. Many of these tiny victims are destroyed before birth – which perhaps is a mercy. Others at birth show signs of the disease in its innumerable forms; indeed, every phase of the acquired form of syphilis, except the primary sore, may be seen in those who have inherited the disease. The syphilitic infant is generally a wasted, withered, wrinkled, old-looking child. Fissures and sores and eruptions, with “snuffles”, and discharge from the nostrils, are quite common. Such an infant is not likely to live. Other babies appear healthy at birth, but after a few weeks’ time develop “snuffles”, skin rashes, loss of hair and eyebrows, and may have fissures or sores about the mouth and other parts. Such symptoms usually appear between the third and twelfth week. Even though such children live, they do not thrive. Some apparently do, or may even recover, but the disease is apt to return at puberty. Those who live past this time are small and under-developed, and often appear like little children except that their faces look old. At puberty, the syphilitic child may develop eye and ear diseases, which result in blindness and deafness. They sometimes suffer from paralysis in various forms.
In short, it may be said that “syphilis is the only disease which is transmitted in full virulence to the offspring.” Indeed, it is transmissible even to the third generation, not in the sense of inherited predisposition, but in the literal sense that the syphilitic germs themselves pass from one generation to the next. This is true of no other disease, and is a literal fulfilment of the statement that the sins of the fathers shall be visited upon the children even unto the third and fourth generation.
“He, therefore, who exposes himself to venereal disease does not endanger alone his own health, peace, and happiness, but assumes a risk for posterity which is criminal on his part. The physician alone can understand the terrible nature of this disease, and could the people but see a tithe of what is witnessed by a physician who practises in this line, there would be such a wave of popular feeling and action that if it could not sweep prostitution far from the habitation of enlightened man, it would at least restrain its ravages by sanitary laws even more stringent than those applied to smallpox and other contagious diseases. The opinion is strong among many medical men that the person who communicates venereal disease should be punished as severely by the law as he who would voluntarily spread smallpox, commit arson, or murder.
These are strong words, but they are not too strong. What protection can there be for an innocent partner in marriage if venereal disease be brought to her from prostitution by the man she loves? What defence have innocent children into whose blood the virus is introduced before they are born? They duty devolves upon parents to secure authenticated proof that the prospective husband of a cherished daughter is free from venereal disease. If this duty be neglected, of what value is all their previous care in rearing and educating their daughters? A sound and honourable man will willingly secure medical testimony as to his soundness of health, and he on his side may reasonably expect from the young woman’s parents or from their family physician assurances of the soundness of his prospective wife’s inheritance. All necessary investigations could be conducted with entire privacy and dignity by the trusted physicians of the families concerned.
But the root of the evil goes deeper. So long as prostitution exists, so long as promiscuous sexual relations continue, venereal diseases will flourish; and so long as these diseases exist outside the marriage circle, they will continue to be introduced within its sacred precincts. As innumerable attempts made to regulate and control prostitution have proved futile, its abolition is the end to be attained. This may appear an impossible undertaking, but in no other way can venereal disease be rooted out. True sanitary and moral prophylaxis is not a question of making prostitution safe, but of preventing the making of prostitutes. This worthy object can only be attained through the wide-spread dissemination of a knowledge of the situation as it exists to-day, followed by such instruction and training of the young as will enable them to safely control the sexual instinct, from the normal utilisation of which we have nothing to fear.