Chapter XXVIII: Venereal Diseases and Marriage

Syphilis is a disease that is contagious, inoculable, and transmissible by heredity. It may be acquired innocently, and it is so acquired in about 4 per centum of cases according to good authority, but the other 96 per centum is venereal. The disease attacks any part of the body within and without from the soles of the feet to the hair and finger-nails. The first evidence, where the case is not hereditary, is a hardened sore called a chancre; next the lymphatic glands swell, and many forms of skin-eruption occur; then follows a chronic inflammation of the cellulo-vascular tissues and the bones, and small tumours, called gummata, may develop in almost any part of the body. The disease may vary from a light attack to malignancy. There are periods in the course of the disease.

1. The period of primary incubation, or the time from infection to the appearance of the chancre. This is commonly three weeks.

2. The primary stage: the chancre forms and the neighbouring glands are affected. This stage lasts from three to ten days.

3. The secondary incubation, or the time between the appearance of the chancre and the development of what are called the secondary symptoms,--usually about six months.

4. The secondary stage. Here occur fever, anaemia, neuralgic pains, and the eruptions on the skin and the mucous membranes. This period lasts from twelve to eighteen months in the majority of cases.

5. The intermediate period. During this time there may be no symptom, or slighter recurrence of the secondary {312} symptoms. This period lasts from two to four years. It may end in recovery of health or be followed by tertiary symptoms.

6. The tertiary stage. In this period gummata form, or there may be diffuse infiltration of various parts of the body, chronic inflammation and ulceration of the bones, skin and other tissues, nervous diseases, and so on. The tertiary stage commonly begins from three to four years after the primary infection.

The three chief divisions, which are apt to blend one into the other, are the primary, secondary, and tertiary periods.

The affections of the secondary stage are often severe. There may be fever associated with weakness, headache, general malaise and pain, and this may be marked or rather light. In this stage iritis is liable to occur, and if it is not properly diagnosed and treated it will result in blindness.

The lesions of the tertiary stage may cause great destruction of tissues and very grave consequences. Cerebral syphilis, if unchecked, will inevitably cause paralysis or paresis. There may be loss of speech, epilepsy, coma, paralyses, apoplectic hemiplegia, and so on. The pain is harassing and often it amounts to great anguish. Whatever part of the brain substance is destroyed will not be restored.

In syphilitic affections of the spinal cord, if the inflammation is acute death ensues in a few days or weeks. _Tabes dorsalis_, or locomotor ataxia, is caused in about 93 per centum of cases of this disease by syphilis, and it is an incurable and dreadful malady.

If there is neuritis from the virus it becomes intense and causes muscular contractions, paresis, and paralysis. The optic, auditory, and olfactory nerves may be attacked and destroyed. The nose also may be destroyed and it commonly caves in. The bones of the face are frequently attacked in the tertiary stage and they rot away. The tibia is diseased more frequently than the other long bones.

The heart is rarely injured, but when it is, the prognosis usually is bad. In a large number of cases death is sudden and unexpected. If the arteries are involved the prognosis again is bad, because the symptoms here do not show until {313} too late for effective treatment When the liver is the seat of gummata these may be cured in the early stage, but in the later stage the prognosis is unfavourable. Some forms of renal syphilis are remediable, but others are not, especially the interstitial kind.

Syphilis is transmitted to a child congenitally, not as a tendency or predisposition, but as an active contagion. It may come from the father, the mother, from both parents, or by direct infection.

The transmission from the father is the most frequent. The spermatozoa carry the infection to the maternal ovum. Down to the end of the secondary stage, and half through the intermediate period between the secondary and tertiary stages of syphilis, a father or mother may beget a child that will be infected with hereditary syphilis, a shivering, blasted, rotten little wretch for whom a quick death is the greatest imaginable blessing, and it usually gets this blessing. In the acute stage of a virulent syphilis the disease is most likely to be transmitted; but sometimes, though rarely, a father that has been free from all symptoms of syphilis for many years may beget a child that is born with a virulent hereditary form of the disease.

Infection by the mother is more certain and more harmful than that from the father, because the intrauterine life of the child is poisoned throughout its course. Two-thirds of the cases of hereditary syphilis die either by abortion, or if they live to term they die shortly after delivery. If the mother is infected during the first eight months of pregnancy the child will nearly always be syphilitic, but if she is infected after the eighth month the child may escape.

If at the moment of conception both parents have the disease the child will almost certainly take it, and this infection will cause its death. In a series observed by Fournier, 28 per centum of the cases caused by paternal infections died and 37 per centum showed the luetic taint; in the cases caused by maternal infection 60 per centum died, and 84 per centum had syphilitic lesions; in the mixed heredity, that is when both the father and mother were luetic, 68.5 per centum died and 92 per centum were born syphilitic. When a child {314} is first infected at delivery the case is not technically classed as hereditary syphilis.

During the first year after the father or mother has taken syphilis the probability of infecting the child is the greatest. In the third year the liability of infecting the child is lessened, but present. In a series of 562 cases of hereditary syphilis observed by Fournier, 60 children, over 10 per centum, were infected more than six years after the primary parental infection. Carefully observed cases have been exceptionally found where infection of the child has occurred in the fifteenth and even the twentieth year after the original parental lesion. Fournier reports the case of one woman that had nineteen consecutive stillbirths from syphilis.

Mild parental syphilis may transmit hereditarily the most malignant type of the disease, and very virulent parental infection may result in a comparatively mild infection of the child, if any infection by syphilis may be called mild. That the parent shows no symptoms from an old infection is no proof that he or she is cured, or that the child may not be infected.

With proper treatment of the mother the infantile mortality in hereditary syphilis is reduced from 59 per centum to 3 per centum, and the children that are born living are not unfrequently free from syphilis. When a woman is infected at the conception of her child miscarriage takes place before the child is viable, from the first to the sixth month; later other miscarriages occur; later still, living but syphilitic children are born, of whom one-fourth die within the first six months; finally she may have children that are not infected.

If a syphilitic man has been properly treated he may, after four years, beget healthy children, and he commonly does, but he may be the father of syphilitic children. Syphilitic women properly treated may, after about six years from infection, bring forth healthy children, and they commonly do, but not always.

There is a wide diversity of opinion among the best authorities concerning the curability of syphilis. Gowers (_Syphilis and the Nervous System_. 1892) says: "There is no evidence that the disease ever is or ever has been cured, the {315} word 'disease' being here used to designate that which causes the various manifestations of the malady." He means there is no absolute proof that a person who has once been infected is ever so fully cured that he may marry without danger of transmitting the disease.

Fournier requires, as the minimum time, four years of methodical treatment before he deems the patient safe, but even this arbitrary fixing of the number of years is not warranted by experience. Many physicians hold that in the tertiary stage the disease is not transmissible, but that statement is not true. Commonly it is, sometimes it is not. After all symptoms have disappeared the disease has been transmitted.

In short, a person that wittingly marries any one who has had syphilis at any time is a fool; and if one of the contracting parties has had syphilis within the four years preceding the marriage the marriage is criminal, even if the syphilis has been carefully and skilfully treated by a physician.

Gonorrhoea is always a dangerous disease. In the male, beside the acute lesions, it can cause chronic or fatal inflammations along the various parts of the genito-urinary tract or in different organs of the body. When the disease becomes chronic it lasts indefinitely. It may then cause cystitis, or so affect the kidneys as to bring about very grave results; it may get into the circulation and induce gonorrhoeal rheumatism of the joints, especially of the knee joint, and result in a partly or completely stiffened joint. The heart may be affected and endocarditis ensue; there may be meningitis or inflammation of the cerebral membranes; the eye may be infected, and unless it is skilfully treated blindness will follow. Strictures of the male urethra from chronic gonorrhoeal inflammation often require major surgical operations for relief.

The disease in women has most of these complications, and other grave peculiar phases. All prostitutes have acute or chronic gonorrhoea, and 12 per centum, probably more, of reputable women are infected; and the suffering caused is very great. The gonococcus remains virulent for two or three years at the least in a man's chronic gleet, and if he marries he infects his wife. Should her womb be infected {316} she is seldom completely cured. If the Fallopian tubes are involved, and this happens frequently, they suppurate, and often they must be removed by coeliotomy. The woman suffers for a long time when the tubes are attacked by the disease, and she becomes sterile ordinarily.

When a child is born to a woman that has gonorrhoea its eyes are infected at delivery, and if it is not very skilfully treated it will surely lose its sight. Because of this danger, in maternity hospitals the eyes of all babies are treated at delivery as a precaution, and many physicians observe the same precaution in private practice.

When, therefore, a man has chronic gonorrhoea he should not marry until about four years after the last infection, and he should be carefully treated in the meantime. There is a popular opinion that gonorrhoea is a trifling disease, but the contrary is the truth: it is a grave disease, especially in women; and the person that carelessly infects another is certainly guilty of crime for which a long term in jail would be a light punishment.

AUSTIN OMALLEY.

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