Until the characteristic signs of the secondary stage have appeared, no anti syphilitic treatment whatever is given by the physician; otherwise the diagnosis would be obscure and irreparable harm might follow. The tertiary stage usually comes on, in untreated cases, at the expiration of two years. In this stage the lesions are mostly found in the deeper parts of the body, causing caries of the bones and other severe complications in the central nervous system and in any or all of the vital organs. It represents the gravest aspect of the disease, and may continue to cause ominous manifestations for the remainder of life. Syphilis being often compared with the exanthe-matous fevers, this tertiary stage corresponds with the period of convalescence in them; but in this disease it will be noticed that convalescence is prolonged for a lifetime if the malady be allowed to work out its natural course unmodified by treatment. The division between these three periods in not invariably sharply defined, and sometimes they coexist. Pathology, or a Consideration of the Gliaracteristic Progress of the Disease. The virus having been elaborated by the "colony" of bacteria at the site of the "initial lesion," it is then absorbed and disseminated throughout the entire system, producing certain deleterious effects of a protean, or exceedingly variable nature. Transformations then follow in the body which cause the disease to be classified along with leprosy, tuberculosis, actinomycosis, etc. the "infective granulomata".
The peculiar effect of the poison is to produce certain cells which, when aggregated, result in the formation of what is called "granulation tissue", "connective tissue", or tissue akin to "proud flesh" from which scars are generated. When these deposits of granulation tissue which may appear in any part of the body are young, they are vascular and proliferative; but soon the blood vessels in them become fewer, their nourishment is cut off, and they necrose, or die at their centres, eventually becoming cicatrized and causing profound nutritive changes in the various normal structures of the body.
In the secondary, and especially in the tertiary stages of syphilis, i.e., when the process has become constitutional, this proliferation of granulation-tissue is especially active, involving the blood vessels and lymphatics and forming new growths, called "gummata", which have a special predilection for invading the central nervous system and the vital organs. The earliest change produced by constitutional syphilis is an alteration in the blood whereby the red blood-corpuscles are much diminished in number and impaired in nutritive qualities, so that marked anaemia results. The virus next involves the lymphatic system, producing enlargements in all the superficial and deep lymphatic glands, those in the neck and on the inner surfaces of the elbows being specially prominent on account of their readily accessible positions. Along with this glandular enlargement there always is fever, usually slightly marked (102°-103° F.), but sometimes very high (103°-105° F.). With the fever there are loss of appetite, listlessness, depression of spirits, severe neuralgias, intense headache, great tenderness and pain in the bones, of a "bone breaking" character, pains in the muscles and joints, and sometimes hysteria, insomnia, hallucinations, delusions, delirium, mania and various morbid impulses and aberrations of mind. Then come the characteristic syphilitic eruptions of the skin and mucous membranes, of almost endless variety. Almost invariably there is a compromising falling out of the hair, which may result in slight or complete baldness, and various "syphilides", or granulation tissue deposits, develop over the body, showing a characteristic coppery color and a tendency to form scales. Along with all these symptoms, which have been merely touched upon, there are often grave manifestations involving the eyes, brain and spinal cord, the osseous system, the testicles, liver, spleen, pancreas, kidneys, and all the other organs and structures of the body. Let us here borrow the words of the most eminent modern syphilographer, Fournier, who is quoted by Taylor in his text book as follows (the parentheses art the author's): Is it or is it not necessary to treat a syphilitic patient? Is it or is it not beneficial that he should be treated? In order to answer a proposition thus stated, let us consider what risks such a patient runs, by stating his condition clearly.
To what dangers, in fact, is he exposed? Let us set forth his pathological balance sheet, if I may speak thus a balance sheet which, if not certain and inevitable, is at least probable and possible. What can such a patient have? What lesions is he liable to develop some day or other? And these lesions, are they of such a character that it will be urgent or advantageous that they should be treated? What he can have are at first lesions without any real gravity, but which are at least very disagreeable to some, particularly if they are visible: thus he may have cutaneous syphilides of various forms, very annoying syphilides of the mucous membranes, engorgements of the ganglia, alopecia (falling out of hair), and onyxis (distortions of the nails). In the second place, there are more serious lesions, from the fact that some of them are very painful: they are angina, cephalalgia (head pains), various pains with nocturnal exacerbations, insomnia, myalgia (muscular pains), pain in the joints, inflammation of tendons, periostitis, etc. Should not the possible anticipation of such troubles justify the intervention of treatment? But we have really a third order of lesions, which are much more serious and which may involve and compromise important organs.
Only to cite the most common of this group, we shall find affections of the eye, such as iritis, choroiditis, and retinitis, which are capable of impairing or even extinguishing vision; sarcocele, which may induce disorganization and atrophy of one or both testicles and thus produce impotence; gummy tumors (gummata), which often perforate and destroy the velum palati (soft palate) and leare a double and revolting infirmity; paralyses of the eye and face; hemiplegia and paraplegia; inflammation of bone, caries, ozaena (foetid breath), flattening and loss of the nose; without speaking of the possibility of hereditary transmission and of the introduction of syphilis into the family circle. But this is not yet all. If we consult n. manual of pathological anatomy, we shall find there described fatal lesions attributable to syphilis alone.