+Enlargement of Neighboring Glands.+—­Nearly every one is familiar with the kernels or knots that can be felt in the neck, often after tonsillitis, or with eruptions in the scalp.  These are lymph-glands, which are numerous in different parts of the body, and their duty is, among other things, to help fight off any infection which tries to get beyond the point at which it started.  The lymph-glands in the neighborhood of the chancre, on whatever part of the body it is situated, take an early part in the fight against syphilis.  If, for example, the chancre is on the genitals, the glands in the groin will be the first ones affected.  If it is on the lip, the neck glands become swollen.  The affected glands actually contain the germs which have made their way to them through lymph channels under the skin.  When the glands begin to swell, the critical period of limitation of the disease to the starting-point will soon be over and the last chances for a quick cure will soon be gone.  At any moment they may gain entrance to the blood stream in large numbers.  While the swelling of these glands occurs in other conditions, there are peculiarities about their enlargement which the physician looking for signs of the disease may recognize.  Especially in case of a doubtful lesion about the neck or face, when a bunch of large swollen glands develops under the jaw in the course of a few days or a couple of weeks, the question of syphilis should be thoroughly investigated.

+Vital Significance of Early Recognition.+—­The critical period of localization of an early infection will be brought up again in subsequent pages.  As Pusey says, it is the “golden opportunity” of syphilis.  It seldom lasts more than two weeks from the first appearance of the primary sore or chancre, and its duration is more often only a matter of four or five days before the disease is in the blood, the blood test becomes positive, and the prospect of what we call abortive cure is past.  Nothing can justify or make up for delay in identifying the trouble in this early period, and the person who does not take the matter seriously often pays the price of his indifference many times over.

Chapter IV

The Nature and Course of Syphilis (Continued)

THE SECONDARY STAGE

+The Spread of the Germs Over the Body.+—­The secondary stage of syphilis, like the primary stage, is an arbitrary division whose beginning and ending can scarcely be sharply defined.  Broadly speaking, the secondary stage of syphilis is the one in which the infection ceases to be confined to the neighborhood of the chancre and affects the entire body.  The spread of the germs of the disease to the lymph-glands in the neighborhood of the primary sore is followed by their invasion of the blood itself.  While this may begin some time before the body shows signs of it, the serious outburst usually occurs suddenly