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The Third Great Plague
A Discussion of Syphilis
for Everyday People
By
John H. Stokes, A.B., M.D.
Chief of the Section of Dermatology and Syphilology
The Mayo Clinic, Rochester, Minnesota
Assistant Professor of Medicine
The Mayo Foundation Graduate School of the University
of Minnesota
Philadelphia and London
W. B. Saunders Company
1920
Published, November, 1917
Copyright, 1917, by W. B. Saunders Company
Reprinted July, 1918
Reprinted February, 1920
PRINTED IN AMERICA
PREFACE
The struggle of man against his unseen and silent enemies, the lower or
bacterial forms of life, once one becomes alive to it, has an
irresistible fascination. More dramatic than any novel, more sombre and
terrifying than a battle fought in the dark, would be the intimate
picture of the battle of our bodies against the hosts of disease. If we
could see with the eye of the microscope and feel and hear with the
delicacy of chemical and physical interactions between atoms, the heat
and intensity and the savage relentlessness of that battle would blot
out all perception of anything but itself. Just as there are sounds we
cannot hear, and light we cannot see, so there is a world of small
things, living in us and around us, which sways our destiny and carries
astray the best laid schemes of our wills and personalities. The gradual
development of an awareness, a realization of the power of this world of
minute things, has been the index of progress in the bodily well-being
of the human race through the centuries marking the rebirth of medicine
after the sleep of the Dark Ages.
In these days of sanitary measures and successful public health
activity, it is becoming more and more difficult for us to realize the
terrors of the Black Plagues, the devastation, greater and more
frightful than war, which centuries ago swept over Europe and Asia time
and again, scarcely leaving enough of the living to bury the dead.
Cholera, smallpox, bubonic plague, with terrifying suddenness fell upon
a world of ignorance, and each in turn humbled humanity to the dust
before its invisible enemies. Even within our own recollection, the
germ of influenza, gaining a foothold inside our defenses, took the
world by storm, and beginning probably at Hongkong, within the years
1889-90, swept the entire habitable earth, affecting hundreds of
thousands of human beings, and leaving a long train of debilitating and
even crippling complications.
Here and there through the various silent battles between human beings
and bacteria there stand out heroic figures, men whose powers of mind
and gifts of insight and observation have made them the generals in our
fight against the armies of disease. But their gifts would have been
wasted had they lacked the one essential aid without which leadership is
futile. This is the force of enlightened public opinion, the backing of
the every-day man. It is the coöperation of every-day men, acting on the
organized knowledge of leaders, which has made possible the virtual
extinction of the ancient scourges of smallpox, cholera, and bubonic
plague.
Just as certain diseases are gradually passing into history through
human effort, and the time is already in sight when malaria and yellow
fever, the latest objects of attack, will disappear before the campaign
of preventive medicine, so there are diseases, some of them ancient,
others of more recent recognition, which are gradually being brought
into the light of public understanding. Conspicuous among them is a
group of three, which, in contrast to the spectacular course of great
epidemics, pursue their work of destruction quietly, slowly undermining,
in their long-drawn course, the very foundations of human life.
Tuberculosis, or consumption, now the best known of the three, may
perhaps be called the first of these great plagues, not because it is
the oldest or the most wide-spread necessarily, but because it has been
the longest known and most widely understood by the world at large.
Cancer, still of unknown cause, is the second great modern plague. The
third great plague is syphilis, a disease which, in these times of
public enlightenment, is still shrouded in obscurity, entrenched behind
a barrier of silence, and armed, by our own ignorance and false shame,
with a thousand times its actual power to destroy. Against all of these
three great plagues medicine has pitted the choicest personalities, the
highest attainments, and the uttermost resources of human knowledge.
Against all of them it has made headway. It is one of the ironies, the
paradoxes, of fate that the disease against which the most tremendous
advances have been made, the most brilliant victories won, is the third
great plague, syphilis--the disease that still destroys us through our
ignorance or our refusal to know the truth.
We have crippled the power of tuberculosis through
knowledge,--wide-spread, universal knowledge,--rather than through any
miraculous discoveries other than that of the cause and the possibility
of cure. We shall in time obliterate cancer by the same means. Make a
disease a household word, and its power is gone. We are still far from
that day with syphilis. The third great plague is just dawning upon
us--a disease which in four centuries has already cost a whole inferno
of human misery and a heaven of human happiness. When we awake, we shall
in our turn destroy the destroyer--and the more swiftly because of the
power now in the hands of medicine to blot out the disease. To the day
of that awakening books like this are dedicated. The facts here
presented are the common property of the medical profession, and it is
impossible to claim originality for their substance. Almost every
sentence is written under the shadow of some advance in knowledge which
cost a life-time of some man's labor and self-sacrifice. The story of
the conquest of syphilis is a fabric of great names, great thoughts,
dazzling visions, epochal achievements. It is romance triumphant, not
the tissue of loathsomeness that common misconception makes it.
The purpose of this book is accordingly to put the accepted facts in
such a form that they will the more readily become matters of common
knowledge. By an appeal to those who can read the newspapers
intelligently and remember a little of their high-school physiology, an
immense body of interested citizens can be added to the forces of a
modern campaign against the third great plague. For such an awakening of
public opinion and such a movement for wider coöperation, the times are
ready.
JOHN H. STOKES.
ROCHESTER, MINN.
CONTENTS
PAGE
CHAPTER I
THE HISTORY OF SYPHILIS 11
CHAPTER II
SYPHILIS AS A SOCIAL PROBLEM 15
CHAPTER III
THE NATURE AND COURSE OF SYPHILIS 21
The Prevalence of Syphilis 24
The Primary Stage 26
CHAPTER IV
THE NATURE AND COURSE OF SYPHILIS (_Continued_) 35
The Secondary Stage 35
CHAPTER V
THE NATURE AND COURSE OF SYPHILIS (_Continued_) 45
Late Syphilis (Tertiary Stage) 45
CHAPTER VI
THE BLOOD TEST FOR SYPHILIS 54
CHAPTER VII
THE TREATMENT OF SYPHILIS 60
General Considerations 60
Mercury 62
CHAPTER VIII
THE TREATMENT OF SYPHILIS (_Continued_) 70
Salvarsan 70
CHAPTER IX
THE CURE OF SYPHILIS 80
CHAPTER X
HEREDITARY SYPHILIS 92
CHAPTER XI
THE TRANSMISSION AND HYGIENE OF SYPHILIS 109
CHAPTER XII
THE TRANSMISSION AND HYGIENE OF SYPHILIS (_Continued_) 121
The Control of Infectiousness in Syphilis 121
Syphilis and Marriage 125
CHAPTER XIII
THE TRANSMISSION AND HYGIENE OF SYPHILIS (_Continued_) 133
Syphilis and Prostitution 133
Personal Hygiene of Syphilis 136
CHAPTER XIV
MENTAL ATTITUDES IN THEIR RELATION TO SYPHILIS 141
CHAPTER XV
MORAL AND PERSONAL PROPHYLAXIS 156
CHAPTER XVI
PUBLIC EFFORT AGAINST SYPHILIS 164
INDEX 187
LIST OF ILLUSTRATIONS
PAGE
PAUL EHRLICH [1854-1915] 69
FRITZ SCHAUDINN [1871-1906] 112
E. ROUX 161
ÉLIE METCHNIKOFF [1845-1916] 161
The Third Great Plague
Chapter I
The History of Syphilis
Syphilis has a remarkable history,[1] about which it is worth while to
say a few words. Many people think of the disease as at least as old as
the Bible, and as having been one of the conditions included under the
old idea of leprosy. Our growing knowledge of medical history, however,
and the finding of new records of the disease, have shown this view to
be in all probability a mistake. Syphilis was unknown in Europe until
the return of Columbus and his sailors from America, and its progress
over the civilized world can be traced step by step, or better, in leaps
and bounds, from that date. It came from the island of Haiti, in which
it was prevalent at the time the discoverers of America landed there,
and the return of Columbus's infected sailors to Europe was the signal
for a blasting epidemic, which in the sixteenth and seventeenth
centuries devastated Spain, Italy, France, and England, and spread into
India, Asia, China, and Japan.
[1] For a detailed account in English, see Pusey, W. A.: "Syphilis
as a Modern Problem," Amer. Med. Assoc., 1915.
It is a well-recognized fact that a disease which has never appeared
among a people before, when it does attack them, spreads with
terrifying rapidity and pursues a violent and destructive course on the
new soil which they offer. This was the course of syphilis in Europe in
the years immediately following the return of Columbus in 1493. Invading
armies, always a fruitful means of spreading disease, carried syphilis
with them everywhere and left it to rage unchecked among the natives
when the armies themselves went down to destruction or defeat. Explorers
and voyagers carried it with them into every corner of the earth, so
that it is safe to say that in this year of grace 1917 there probably
does not exist a single race or people upon whom syphilis has not set
its mark. The disease, in four centuries, coming seemingly out of
nowhere, has become inseparably woven into the problems of civilization,
and is part and parcel of the concerns of every human being. The
helpless fear caused by the violence of the disease in its earlier days,
when the suddenness of its attack on an unprepared people paralyzed
comprehension, has given place to knowledge such as we can scarcely
duplicate for any of the other scourges of humanity. The disease has in
its turn become more subtle and deceiving, its course is seldom marked
by the bold and glaring destructiveness, the melting away of resistance,
so familiar in its early history. The masses of sores, the literal
falling to pieces of skeletons, are replaced by the inconspicuous but no
less real deaths from heart and brain and other internal diseases, the
losses to sight and hearing, the crippling and death of children, and
all the insidious, quiet deterioration and degeneration of our fiber
which syphilis brings about. From devouring a man alive on the street,
syphilis has taken to knifing him quietly in his bed.
Although syphilis sprang upon the world from ambush, so to speak, it did
the world one great service--it aroused Medicine from the sleep of the
Middle Ages. Many of the greatest names in the history of the art are
inseparably associated with the progress of our knowledge of this
disease. As Pusey points out, it required the force of something wholly
unprecedented to take men away from tradition and the old stock in trade
of ideas and formulas, and to make them grasp new things. Syphilis was
the new thing of the time in the sixteenth century and the study which
it received went far toward putting us today in a position to control
it. Before the beginning of the twentieth century almost all that
ordinary observation of the diseased person could teach us was known of
syphilis. It needed only laboratory study, such as has been given it
during the past fifteen years, to put us where we could appeal to every
intelligent man and woman to enlist in a brilliantly promising campaign.
For a time syphilis was confused with gonorrhea, and there could be no
better proof of the need for separating the two in our minds today than
to study the way in which this confusion set back progress in our
knowledge of syphilis. John Hunter, who fathered the idea of the
identity of the two diseases, sacrificed his life to his idea
indirectly. Ricord, a Frenchman, whose name deserves to be immortal, set
Hunter's error right, and as the father of modern knowledge of syphilis,
prepared us for the revolutionary advances of the last ten years.
There is something awe-inspiring in the quiet way in which one great
victory has succeeded another in the battle against syphilis in the last
decade. If we are out of the current of these things, in the office or
the store, or in the field of industry and business, announcements from
the great laboratories of the world seldom reach us, and when they do,
they have an impractical sound, an unreality for us. So one hears, as if
in a speaking-tube from a long distance, the words that Schaudinn and
Hoffmann, on April 19, 1905, discovered the germ that causes syphilis,
not realizing that the fact contained in those few brief words can alter
the undercurrent of human history, and may, within the lives of our
children and our children's children, remake the destiny of man on the
earth. A great spirit lives in the work of men like Metchnikoff and Roux
and Maisonneuve, who made possible the prophylaxis of syphilis, in that
of Bordet and Wassermann, who devised the remarkable blood test for the
disease, and in that of Ehrlich and Hata, who built up by a combination
of chemical and biological reasoning, salvarsan, one of the most
powerful weapons in existence against it. Ehrlich conceived the whole
make-up and properties of salvarsan when most of us find it a hardship
to pronounce its name. Schaudinn saw with the ordinary lenses of the
microscope in the living, moving germ, what dozens can scarcely see
today with the germ glued to the spot and with all the aid of stains and
dark-field apparatus. After all, it is brain-power focused to a point
that moves events, and to the immensity of that power the history of our
growing knowledge of syphilis bears the richest testimony.