"Know syphilis in all its manifestations and relations," says Sir Wm. Osler, M.D., "and all other things clinical will be added unto you." He called "syphilis" the "Great Imitator," because, to use the words of Dr. Thomas Parran, Surgeon General of The U. S. Public Health Service, "in its late stages it simulates almost every disease known to man." Osler added, "Know syphilis and the whole of medicine is opened to you." Some one else has declared "Syphilis" to be the "Great Masauerader." The Metropolitan Life Insurance Co., long notorious for spending its policy holder's money in carrying on Medical propaganda, issues a very misleading booklet "prepared with cooperation and advice of the American Social Hygiene Association," under the title, "The Great Imitator." S. Wm. Becker, M. D. Associate Professor of Dermatology and Syphilology in the University of Chicago, has a chapter in his book, Ten Million Americans Have It entitled, "Great Imitator."

   Dr. Richard C. Cabot of Harvard University and the Massachusetts General Hospital, says: "The variety of rashes which can be seen is simply without end. Syphilis can imitate any kind of skin disease, and it is not worth while to even try to recognize it." In a paper on The Skin and Syphilis, read before the New York Academy of Medicine, Jan. 15, 1926, Dr. Howard Fox, famous syphilologist of New York City, said: "Syphilis is of great importance because of its well known power of imitating other forms of disease and from the fact that it may involve any of the tissues of the body. That the physician who makes a periodical health examination should be able to recognize all the manifestations which this disease may produce, is asking an impossibility. No single individual possesses such a vast store of clinical knowledge."

   Dr. Udo J. Wile, professor of Dermatology and Syphilology at the University of Michigan defines syphilis as "a specific infectious disease, peculiar to the human race, acquired by direct infection or maternal transmission, of indefinite duration, chronic in its course, intermittent in maniestations, and capable of producing innumerable different types of lesions affecting any part of the body." Dr. Becker says: "There is no other disease that can produce such varied manifestations in so many different human tissues and structures. This similarity to other maladies has been one of the reasons why syphilis is so difficult to identify."

   For many years "syphilis" was divided into three stages: primary, secondary and tertiary. At present syphilologists prefer to divide it into two stages: early and late, one year after "onset" constituting the arbitrary dividing line. The period elapsing between the time of "exposure," or "infection" to the first appearance of symptoms ranges from 12 to 40 days. Dr. Becker says the time "varies from one week to four months, with an average of three and a half weeks." The "primary lesion" that now arises at the point of "infection" is a chancre or hard chancre, which Parran says, "usually is not painful" and "is apt to run a slow course, sometimes three to eight weeks. In its typical form the chancre is a round ulcer with sharp, raised edges, has a punched out appearance, and feels hard to the touch."

   However, Parran tells us, a chancre "may not be typical, if hidden in the genitals of a woman it may not be recognized at all. It may be so insignificant that the patient is unaware of its existence. On the lip it may simulate a fever blister; on the tongue or cheek, a cold sore or stomach ulcer; on the tonsils, a sore throat." He adds that "the only positive way of differentiating the hard chancre from other and benign ulcers is by a laboratory test called a dark-field examination."

   From other sources we learn that this "primary stage," as it was formerly called, "may be merely a red spot or blister or pimple," while Dr. Becker says, "It is common opinion that a primary lesion of syphilis, known as a chancre, always develops at the point of infection, and this was taught in medical schools up until a few years ago. Certain experiments with animals, however, have shown that it is possible to give such creatures systemic syphilitic infection without the appearance of a chancre. There appears, therefore, to be no good reason why man, also should not have syphilis without the appearance of a lesion. This, it is believed, explains why so many persons are infected with the disease without having experienced visible symptoms."

   Parran says that "it must be admitted that in many cases early symptoms are so light, and so like other maladies — a sore, a rash, sometimes indigestion, sometimes as fever —-that many a person may be honestly ignorant he has the disease until it has passed through the latent period and reappears, often years later, in the varied and ghastly forms of its later and less curable stages." Becker says that the dark-field examination is the only means of "detecting syphilis in the most curable sero-negative stage" — the "primary stage." Earlier physicians did not have the dark-field examination and could never positively detect "early syphilis."

   Medical authorties are a unit in admitting that this "stage of syphilis" gets well in a few days to a few weeks, "with or without treatment," and under all forms of treatment. Indeed many heal and there are never any subsequent symptoms. It is the rule to declare such cases not to have been "syphilis."

   What was formerly known as the "secondary stage" is now considered, along with the "primary stage," as constituting "early syphilis." This "second stage" is "characterized" by the development of a rash, or skin eruption, which "originally gave rise to the term the Great Pox, differentiating the disease from the smallpox." This eruption, says Dr. Parran "varies from the mildest and most transitory form to a severe rash covering the whole body. It may look like measles, or a food rash, or a case of chicken pox; in fact it may simulate closely almost any skin eruption. Fifteen years ago I was in Denver helping in a virulent smallpox epidemic. A case of smallpox was reported to me. I confirmed the diagnosis after I had examined the patient and put him under quarantine. Much to my embarrassment it turned out to be a case of secondary syphilis with an eruption all over the body resembling smallpox."

   He says that this "rash may or may not be accompanied by fever, headaches, indigestion or other symptoms from which everyone suffers at some time and ordinarily are not thought of in connection with syphilis. The same rash appearing in the mouth causes sores or ulcers, the so-called mucous patches which are viciously infectious."

   Becker says that the "secondary incubation period" that is, the period between the appearance of the chancre and the development of the "secondary rash," "is about six weeks." At this time, "there may occur lesions throughout the entire body, including a rash on the skin. In some instances this rash is so mild that it is not noticed." He tells of one case which resembled a "heat rash." Arthur C. Palm, Director of the Social Hygiene Foundation of Cleveland, says in his Death Rides With Venus, the eruptions of this "secondary stage" look so much like measles, chicken pox and various rashes that they "occasionally fool even the most skillful and experienced physicians."

   Dr. Becker says: "The early period of syphilis is essentially a benign period. It is unusual to see serious damage during this time. At least fifty percent of the patients have no symptoms whatever during this period." In others he says, "the throat may be covered with a membrane resembling that of diptheria, or the patient may have symptoms simulating those of tuberculosis. Severe anemia (lack of blood) is a development in some instances." When this "secondary stage" ends, the "disease" is said to pass into a "latent stage" during which "there may be no symptoms for many years," or "early lesions" may frequently recur. "Skin eruptions, mouth sores, and other disturbances may come and go from time to time." "During this period," says Becker, "the voice may be lost for a few weeks, especially in the case of women. At times during this period the hair, both of the scalp and the eyebrows may come out in spots."

   Dr. Parran says of this "latent stage" that "in practically all cases, even without treatment, sooner or later the disease becomes latent, at least for a time. All symptoms disappear. Periods of latency sometimes but not always are intersperced with skin affections, eye disorders, night pains, indefinite constitutional symptoms."

   This period of "latency" may last twenty to fifty years or more and the person never have any indication that he is sick — "infected." Becker says, "countless numbers of persons *** have been infected with syphilis all their lives without knowing it. Many persons infected with the disease for years die from other causes without ever having known they were syphilitic. *** Not long ago the author saw a man of sixty years who had happened to consult a physician for some mild complaint. A blood test was made and was found to be strongly positive. Examination showed that the man had been born with syphilis, but had had no symptoms whatever relative to it." He tells us, also, that "it is seldom that recurrent early lesions appear (during the "latent" period) later than three years after infection, and virtually never do they appear after five years." He says in another part of his book: "If all syphilitic individuals could be lined up the reader would be surprised to see what a healthy-looking group they actually were and also how many of his or her friends were among them." He quotes Dr. J. Earle Moore, Professor of Syphilology at Johns Hopkins Medical School, as saying that "in one man out of every five and in one woman out of every three, all early symptoms are so evanescent as to be unrecognized.

   The observant reader will be forcibly struck with the mildness of "syphilis" today in comparison to the virulence of the "syphilis" in the sixteenth century. The difference is as great as that between a few pimples on the face and a virulent form of typhoid fever. But let us pass on to the final, or "late stage."

   "In these and many other respects we know that syphilis of the sixteenth century was a vastly different disease from what it is now." Much of that "sixteenth century syphilis" was doubtless bubonic plague. Some of it was typhus fever, smallpox and other such troubles. Scrofula was very prevalent at that time and all diseases were more virulent than they now are, due to the low standard of living of the time.

   Parran says that "if syphilis were to strike now with its fifteenth century velocity, the people who had it would make no mistake that they had it." Again, "in many respects we would be better off if the nature of the disease itself had not been modified somewhat in successive generations since the fifteenth century. Its early stages brought painful and dangerous symptoms, death not infrequently. Now it is less virulent in its early stages, but presumably, more deadly in its later manifestations."

   Just why the more virulent form of "the disease" should be less deadly in its "late stages" is a problem they are content to leave unsolved. We would expect a more "virulent strain of the infection" to work greater havoc throughout its entire course in a people possessing less resistance than we have today. Since they also lacked "adequate treatment" and were unacquainted with its connection with its "late stages" they did not attempt to safeguard themselves against its "later manifestations."

   The "late" or "tertiary" stage represents the gross changes and degenerations of the larger organs, such as the brain, spinal cord, heart, arteries, eyes, hollow organs, etc. Gummas, or small tumors which feel like rubber to the touch, are said to be characteristic of this stage. These tumors are really due to chronic inflammation and are not "typical" Sometimes they break down, forming ulcers if on the skin; resulting in sloughing and resembling osteomylitis, or bone tuberculosis, if on the bone. They may also form in the brain, arteries or elsewhere. Dr. Parran says: "Some of the most horrible mutilations are seen when nasal and palate bones are destroyed. (The reader will please recall what is said elsewhere in this book about the effects of mercury. — Author) If in the liver, the organ swells, blocking circulation from the intestines, causing abdominal dropsy. If in the lungs the results resemble tuberculosis. In other instances there are eye complications, the same vague constitutional symptoms, night pains, 'rheumatism,' 'indigestion,' sometimes found in connection with latency."

   Dr. Becker says, "some diseases are unique in that they produce special symptoms which can be readily attributed to only one disease. This cannot be said of syphilis, which produces various types of destruction, resulting in impaired function. The signs and symptoms do not differ greatly from those associated with impaired function of the same organ resulting from other diseases. It is for this fact *** that syphilis is called the great imitator. It can passably imitate a great number of other disorders."

   He points out that "syphilis" of the larynx produces a hoarse voice just as tuberculosis of the larynx, or even a mere catarrhal bronchitis does. "Syphilis of the liver may produce ascites (a dropsical abdomen), jaundice, gall bladder symptoms, etc., as do many "other diseases" of the liver. "Involvement of the heart and great blood vessels results in damage similar to that from other infections of the heart, with impairment of the heart function."

   Forty thousand deaths a year are claimed to occur in the U. S. from cardio-vascular (heart and artery) "syphilis." Stretching or dilatation of the wall of the aorta producing an aneurysm, is said to be due to "syphilis." "Sudden death" from a "heart attack" is "the most frequent first symptom of cardio-vascular syphilis." Apoplexy with the resulting paralysis is "frequently" caused by "syphilitic destruction of the wall of the blood vessels in the brain."

   "Neurosyphilis" is the term given to "syphilis" of the brain and nervous system. It is said to be very rare "among primitive races," who are no more primitive than we are, but who are not treated with mercury and arsenic. "Neurosyphilis" manifests in such forms as "epileptiform seizures (epiletic fits) appearing for the first time at the age of thirty and strokes of paralysis in comparatively young patients (30 to 45)," primary optic atrophy (degeneration of the nerve of sight), true locomotor ataxia (tabes dorsalis), softening of the brain (general paresis, deafness from involvement of the auditory nerve, encephalitis, menengitis, etc.

   It will be noted that the "authorities" use the term "true locomotor ataxia." This is due to the fact that "other conditions," notably diabetes, may give rise to the atoxic gait. Primary optic atrophy is said to be 'virtually always due to syphilis," while tabes and paresis "are. now known to be due to syphilis and syphilis alone."

   Chronic nephritis (Bright's disease), congenital debility, and premature birth are said to be frequently due to "syphilis." Leukoplakia, a whitening of the mucous membranes of the mouth and elsewhere, is sometimes, though not always due to "syphilis." "Syphilis is only one of its several causes. The other causes of leukoplakia are excessive smoking, especially of pipes (the lesions sometimes are called smoker's patches), dental infection, irritation by artificial dentures, and similar aggravations."

   Dr. Tilden calls "syphilis" the great Don Quijote of disease and says: "Every part of the body contributes its mite to the great Quijote. If there is any uncommon symptoms it matters not what kind, it belongs to him; and, of course all blood and glandular symptoms are his. Not any derangement of bones, joints, tendons — in short, not anything developing in any part of the body from whatever cause — but will be declared his and treated as such."

   Either "syphilis" is a pathological mocking bird or else it is a myth, a phantom, a nightmare, a lie. Either it is so protean in its manifestations that it imitates practically every known form of disease, or else practically every known form of disease may be called "syphilis." It is certainly not possible to differentiate it from other forms of impaired health by its clinical manifestations. No physician living can tell by the symptoms whether a patient has "syphilis" or not.

   If the better trained physician of today cannot do this, it is certain that the physicians of the sixteenth, seventeenth, eighteenth and nineteenth centuries could not have done so. Did they, then, build up for us a mythical disease, which we have accepted without question? Does "syphilis" belong in the same category as hobgoblins, werewolves and rabies or hydrophobia? Is "syphilis" merely the handiwork of the doctor?

   Dr. Tilden says: "The very fact that one, or one thousand, of the best physicians on earth cannot determine positively that a given case is really syphilis ought to be proof sufficient that there is something desperately wrong with the Syphilis Theory.

   "Common-sense must declare that a specific disease is specific because of its invariable action under like conditions; but this is not true of the disease called syphilis; indeed, it is anything but true."

   Today no two authors describe the effects of "syphilis" to be the same. Contrast de Kruif's description with that of Becker; yes, Becker with Becker. The whole thing is so uncertain that they don't know from one page to the next how to describe it. Becker presents two very unlike pictures, but thinks both pictures are true.