into buttons and flat, cauliflower-like warts from which millions of the germs can be squeezed.  Sometimes they are mistaken for hemorrhoids or “piles.”  With all the opportunities that these sores offer for infection, it is surprising that the disease is not universal.  Irritation from friction, dirt, and discharges, and in the mouth the use of tobacco, are the principal influences acting to encourage these recurrences.

+Relapses in the Nervous System and Elsewhere.+—­Mucous patches are, of course, not the only recurrences, though they are very common.  At any time a little patch of secondary eruption may appear and disappear in the course of a short time.  Recurrences are not confined to the skin, and those which take place in the nervous system may result in temporary or permanent paralysis of important nerves, including those of the eyes and ears.  Again, recurrences may show themselves in the form of a general running down of the patient from time to time, with loss of weight and general symptoms like those of the active secondary period.

The secondary period as a whole is not in itself the serious stage of syphilis.  Most of the symptoms are easily controlled by treatment if they are recognized.  Now and then instances of serious damage to sight, hearing, or important organs elsewhere occur, but these are relatively few in spite of the enormous numbers and wide distribution of the germs.  Accordingly, the problems that the secondary stage offers the physician and society at large must center around the recognition of mild and obscure cases and adequate treatment for all cases.  The identification of the former is vital because of the recurrence of extremely infectious periods throughout this stage of the disease, and the latter is essential because vigorous treatment, carried out for a long enough time, prevents not only the late complications which destroy the syphilitic himself, but does away with the menace to society that arises through his infecting others, whether in marriage and sexual contact or in the less intimate relations of life.

Chapter V

The Nature and Course of Syphilis (Continued)

LATE SYPHILIS (TERTIARY STAGE)

+The Seriousness of Late Syphilis.+—­While we recognize a group of symptoms in syphilis which we call late or tertiary, there is no definite or sharp boundary of time separating secondary from tertiary periods.  The man who calculates that he will have had his fling in the ten or twenty years before tertiary troubles appear may be astonished to find that he can develop tertiary complications in his brain almost before he is well rid of his chancre.  “Late accidents,” as we call them, are the serious complications of syphilis.  They are, as has been said, brought about by relatively few germs, the left-overs from the flooding of the body during the secondary