Apprehensive patients who have committed sexual indiscretions are apt to regard as syphilitic any lesion which happens to be located on the penis—­for example, acne pustules, eczema, psoriasis papules, boils, balanitis, or venereal warts.

The local treatment of the primary sore consists in attempting to destroy the organisms in situ.  An ointment made up of calomel 33 parts, lanoline 67 parts, and vaseline 10 parts (Metchnikoff’s cream) is rubbed into the sore several times a day.  If the surface is unbroken, it may be dusted lightly with a powder composed of equal parts of calomel and carbonate of zinc.  A gauze dressing is applied, and the penis and scrotum should be supported against the abdominal wall by a triangular handkerchief or bathing-drawers; if there is inflammatory oedema the patient should be confined to bed.

In concealed chancres with phimosis, the sac of the prepuce should be slit up along the dorsum to admit of the ointment being applied.  If phagedaena occurs, the prepuce must be slit open along the dorsum, or if sloughing, cut away, and the patient should have frequent sitz baths of weak sublimate lotion.  When the chancre is within the meatus, iodoform bougies are inserted into the urethra, and the urine should be rendered bland by drinking large quantities of fluid.

General treatment is considered on p. 149.

#Secondary Syphilis.#—­The following description of secondary syphilis is based on the average course of the disease in untreated cases.  The onset of constitutional symptoms occurs from six to twelve weeks after infection, and the manifestations are the result of the entrance of the virus into the general circulation, and its being carried to all parts of the body.  The period during which the patient is liable to suffer from secondary symptoms ranges from six months to two years.

In some cases the general health is not disturbed; in others the patient is feverish and out of sorts, losing appetite, becoming pale and anaemic, complaining of lassitude, incapacity for exertion, headache, and pains of a rheumatic type referred to the bones.  There is a moderate degree of leucocytosis, but the increase is due not to the polymorpho-nuclear leucocytes but to lymphocytes.  In isolated cases the temperature rises to 101 or 102 F. and the patient loses flesh.  The lymph glands, particularly those along the posterior border of the sterno-mastoid, become enlarged and slightly tender.  The hair comes out, eruptions appear on the skin and mucous membranes, and the patient may suffer from sore throat and affections of the eyes.  The local lesions are to be regarded as being of the nature of reactions against accumulations of the parasite, lymphocytes and plasma cells being the elements chiefly concerned in the reactive process.