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 period. There is still a good deal of
uncertainty as to just what the distribution of the germs which takes
place in the secondary period foreshadows in the way of prospects for
trouble when we come to the tertiary period. It may well be that the man
who had many germs in his skin and a blazing eruption when he was in the
second stage, may have all his trouble in the skin when he comes to the
late stage. It is the verdict of experience, however, that people who
have never noticed their secondary eruption because it was so mild are
more likely to be affected in the nervous system later on. But this may
be merely because the condition, being unrecognized, escapes treatment.
It is at least safe to say that those whose skins are the most affected
early in the disease are the fortunate ones, b