SYPHILIS IN THE OFFSPRING OF SYPHILITIC PARENTS
FAMILIAL SYPHILIS. By P. C. Jeans, M.D., “American Journal of Diseases of Children.” January, 1916. Vol. XI. pp. 11–19.
As the result of syphilis numerous families remain sterile. The figures for sterility vary from 10 per cent. to 30 per cent., depending on the material studied. When there is an embryo there is a variety of fates to which it may come. Many marriages result only in abortions (nearly 13 per cent. in Haskell’s material[[53]]). Since the starting point in our material was a syphilitic child, we have no data bearing on this phase.
[53]. Haskell: Jour. Am. Med. Assn., 1915, lxiv, 890.
Among our syphilitic patients all the living children of 100 families have been examined, Wassermann tests made and the family history studied. In these 100 families there were 331 pregnancies. Of these 100 (30.2 per cent.) were abortions, 31 (9.3 per cent.) still births and 200 (60.4 per cent.) living births. Of the 200 living births 35 children died early and 4 died late, and 161 remained alive and were examined. Of these, 12 are now dead. Of the 35 who died early, 5 gave an undoubted history of syphilis and a number gave suspicious histories. Of the four who died late, one was an idiot. Of the 161 examined, 107 were clinically positive and had positive Wassermann tests. Five were clinically positive and had negative Wassermann reactions. Sixteen, who showed no evidence of syphilis, gave positive Wassermann reactions. Thirty-three, who gave no clinical proof of syphilis, gave a negative Wassermann reaction.
Of the five who were clinically positive but gave negative Wassermann reactions, one was a young infant who had snuffles and a large spleen. The mother and sister both gave a positive history and a positive Wassermann reaction. Shortly after beginning treatment the baby developed a syphilitic rash. The baby was removed from the hospital and a second Wassermann was not done. The second case was a nursing baby. The mother had active syphilis and was taking treatment. The baby had an active process in the nose. The third case was a 7-year-old girl who had a markedly sunken nose and who for that reason was the starting point for investigating that family. Both the mother and younger brother gave a positive Wassermann. The fourth case was a 4-year-old girl whose mother and younger sister were both positive and the patient had a general rash which was thought to be syphilitic. The fifth case was a 3-year-old boy with a positive history, and who had had some treatment. His mother and younger brother both had syphilis.
A negative Wassermann reaction is obtained in the presence of active syphilis only under certain definite conditions. As had been noted in cases not of this series, very young babies, even with undoubted active syphilis, not infrequently give a negative Wassermann. It has also been noted that even small amounts of mercury tend to cause a positive blood to react negatively.
H. Boas[[54]] states that of fifty-seven babies of syphilitic mothers giving negative Wassermann reactions at birth, thirteen during a three months’ period of observation developed syphilitic manifestations and a positive Wassermann, and two others showed syphilitic changes at necropsy, having had no manifestations during life.
[54]. Quoted by Haberman: Jour. Am. Med. Assn., 1915, lxiv, 1146.
LATENT SYPHILIS
It is seen that 10 per cent., of the children examined had latent syphilis, i.e., a positive Wassermann and no clinical evidence of syphilis. One of these children gave a history of epiphysitis at 3 months. Other than this no early history was acknowledged by any of the mothers. The question naturally arises, Are these children actively infected with syphilis? When we inquire into the history of those showing late manifestations, we frequently find, so far as obtainable history is concerned, that there has been no previous warning that the disease existed. One of our patients developed, as her first known symptom, an interstitial keratitis at 20 years. We know that the spirochete can lie dormant much longer than this and then manifest itself. One patient of this latent group who had taken very irregular treatment for about a year and who had never had previous manifestations, recently developed an active lesion in the throat. Another developed an interstitial keratitis after about two months of anti-syphilitic treatment. A positive Wassermann reaction in these apparently healthy children has the same significance that it does in the parent, and it is our belief that the children in this group are actively infected.
The fact that there are thirty-three children, 10 per cent. of the total pregnancies, who show no evidence of syphilis, and at the same time give a negative Wassermann reaction, is rather hopeful. Yet the pleasure to be taken in this fact is not altogether unalloyed. In this small group there were two mental defectives and an idiot, and it is impossible to say that all of this group are free from syphilitic infection. In one instance, one such negative child returned about a year after his original examination with a tertiary type of lesion and a positive Wassermann. Though no classification of those in this group showing stigmata of degeneration was attempted, it can be truthfully stated that a goodly proportion did show degenerative influences, either physical or mental.
TOTAL SYPHILIS IN THE FAMILIES STUDIED
In summing up the total syphilitic infection in these families, we find that where marital relations are uninvolved, all of the fathers and probably all of the mothers have been infected. Presuming that the abortions, stillbirths, all of the early deaths and at least one of the late deaths were due directly or indirectly to syphilitic infection, syphilis among the offspring amounts to 89 per cent. of the total pregnancies, and total syphilis in the family amounts to 93 per cent. of all its members.
SUMMARY
It is highly probable that all the mothers of syphilitic children have been infected with syphilis. Of eighty-five mothers of syphilitic children 86 per cent. gave positive Wassermann reactions. All of the remaining cases but six gave a history of infection or treatment, or both. Five of these six patients were examined at least ten years after the birth of their last syphilitic children and the infection is probably dying out.
Eighty-seven per cent. of the mothers deny all knowledge of the infection. The mothers are for the most part infected during the latent stage of the father.
Of 331 pregnancies in 100 families, 30 per cent. were abortions, 9 per cent. stillbirths, 61 per cent. living births. Of the living births 24 per cent. had died. Of those living 80 per cent. had syphilis.
Of the total pregnancies 90 per cent. were presumably syphilitic and although 10 per cent., seem free from syphilis, there is no proof that they all are. The total syphilis in these families amounts to 93 per cent. of the entire family.
For the most part our families followed Kassowitz’s rule; i.e., decreasing grades of infection in the children.
In case of syphilitic mothers bearing non-syphilitic children, it is probable that the infection in the mother is localized in places where it is not readily transmitted.
The idea that there are different strains of spirochetes receives some support from these families.
Transmission to the third generation, though not proved, is distinctly an occasional probability.
OBSTETRICS. A Text-book for the Use of Students and Practitioners. Whitridge Williams, Professor of Obstetrics Johns Hopkins University. Obstetrician-in-Chief to the Johns Hopkins Hospital; Gynecologist to Union Protestant Infirmary, Baltimore, Md. D. Appleton and Co., 1912.
Syphilis is one of the most important complications of pregnancy as it is one of the most frequent causes of repeated abortion, or premature labor. The influence of syphilis upon pregnancy differs materially, and three classes of cases are distinguished, according as infection has taken place: 1—before pregnancy; 2—at the time of conception; or, 3—during pregnancy. When inoculation with the specific poison has occurred before conception the disease nearly always gives rise to abortion or premature labor, more frequently the latter. Le Pileur obtained a striking illustration of the disastrous effects of syphilis from a study of the reproductive histories of 130 women, before and after its inception, 3.8 per cent. of the children being born dead before, as compared with 78 per cent. after infection. In premature labor due to syphilis the child is usually dead when it comes into the world; less frequently it is born alive with definite manifestations of the disease. When the mother is suffering from the affection at the time of conception the offspring is always syphilitic. P. 495.
THE PRACTICE OF OBSTETRICS. In Original Contributions by American Authors. Edited by Reuben Peterson, A.B., M.D., Professor of Obstetrics and Gynecology in the University of Michigan, Ann Arbor, Mich.; Obstetrician-in-Chief to the University of Michigan Hospital. Lea Bros. and Co., Philadelphia and New York, 1907.
In marked contrast to the comparatively slight interference of pregnancy with the course of syphilis is the decidedly unfavorable influence of syphilis upon the course of pregnancy. Syphilis, more often than any other infectious disease, is responsible for a great variety of pathological changes in the fetus, placenta and uterus, and for the premature interruption of gestation. Statistics show that the fetal mortality in this disease averages 50%. This figure is lower than that given in the preceding paragraphs for some of the acute infectious diseases, but considering the prevalence of syphilis among all civilized and uncivilized races, it is obvious that the effect of this disease deserves a most careful consideration, not only from the medical, but also from the economic and sociologic point of view. Fournier gives the fetal mortality for cases in which the maternal infection occurs simultaneously with fecundation as 75%, the fetal morbidity being above 91%. Page 347. (Hugo Ehrenfest, M.D.)
A TEXT BOOK OF OBSTETRICS. Barton Cooke Hirst, M.D., Professor of Obstetrics in the University of Pennsylvania; Gynecologist to the Howard and Orthopaedic and Philadelphia Hospitals, etc. W. B. Saunders Co., Philadelphia and London, 1912.
Syphilitis as the most frequent cause of habitual death of the fetus must be excluded before another cause is sought. P. 352.
Of 657 pregnancies in syphilitic women collected by Charpentier 35% ended in abortion, and of the children that went to term a large number were stillborn. Of 100 conceptions in syphilitic women only seven children were alive a year later. P. 333.
PRACTICAL OBSTETRICS. Thomas Watts Eden, Obstetrical Physician and Lecturer on Midwifery and Gynecology, Charing Cross Hospital; Consulting Physician to Queen Charlotte’s Lying-in-Hospital; Surgeon to In-Patient Hospital for Women. 4th Edition. C. V. Mosby Co. 1915.
Of all the systematic causes of abortion however, the most important in all respects is syphilis. In all probability more abortions are due to this disease than to any other cause. P. 220.
It will be clear from this enumeration of the conditions which cause it that abortion is not an uncommon event. From some recent statistics presented by Professor Malins to the Obstetrical Society of London it appears that in this country about 16% of pregnancies terminate by abortion, i.e., one abortion occurs to every five births of viable children, and further, it appears that abortion is nearly twice as frequent among the classes from which hospital patients are drawn as among the well-to-do. Women who are the subjects of syphilis or Bright’s disease often sustain a succession of abortions without carrying any pregnancy to term. P. 221.
THE PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, M.D., Professor of Obstetrics at the Northwestern University Medical School; Obstetrician to the Chicago Lying-in-Hospital and Dispensary and to Wesley and Mercy Hospitals, etc. W. B. Saunders Co. 1913.
Premature labor is produced by the same factors that bring on abortion, but syphilis plays the most common role here, it being estimated that from 50% to 80% of the cases are thus caused. Next comes nephritis. Habitual abortion means that successive pregnancies are interrupted at the same period of development. Syphilis is usually found as the active factor and more especially in miscarriages of the later months. Each successive abortion occurs at a later period until a living child is born, but it perishes from congenital syphilis, and finally the disease has become so attenuated that a viable child is born. P. 419.
Obstetricians should constantly be on the alert for this protean disease. Its baneful action is often discovered when least expected and it spreads its blight on all three individuals concerned in the procreation of the species, often being transmitted to the second generation. Ricord says that in Paris one in eight is syphilitic, and while in America conditions are better, the disease is not rare and in its lesser manifestations quite common, though often not diagnosed. P. 482.
Interruption of gestation is the commonest symptom (of syphilis) and von Winckel found 61% fetal mortality. P. 483.
THE PRACTICE OF OBSTETRICS. Designed for the use of Students and Practitioners of Medicine. J. Clifton Edgar, Professor of Obstetrics and Clinical Midwifery in the Cornell University Medical College; Visiting Obstetrician to Bellevue Hospital, New York City; Surgeon to the Manhattan Maternity and Dispensary; Consulting Obstetrician to the New York Maternity and Jewish Maternity Hospitals. 5th Edition Revised. P. Blakiston’s & Co., Philadelphia.
This (syphilis) is one of the most common causes of abortion. P. 321.
The causes of interrupted pregnancy may be placed in three classes. The maternal causes are divisible into systemic and the local. The systemic causes include obesity, marriages of consanguinity, pregnancies in rapid succession, etc., and the toxemia of kidney insufficiency. The local causes include all cases of acute and chronic pelvic congestion. P. 332.
Chief among the paternal causes is syphilis, tuberculosis, extreme youth or old age, great constitutional depression, exhaustion from any cause. P. 333.
MEDICAL GYNECOLOGY. Howard Kelly, A.B., M.D., LLD., F.R.C.S., Professor of Gynecological Surgery in Johns Hopkins University, and Gynecologist to the Johns Hopkins Hospital; Fellow of the American Gynecology Society; Honorary Fellow of the Edinburgh Obstetrical Society; Hon. Fellow Royal Academy of Medicine in Ireland; Fellow British Gynecology Society, etc., etc., etc. D. Appleton & Co., New York and London, 1912.
The susceptibility of syphilis to hereditary transmission is a fundamental character of the disease. It may be transmitted to the offspring directly by the infected sperm of the father, or from the infected ovule of the mother at the time of impregnation, or the infective principle may be conveyed through the medium of the utero-placental circulation during the course of pregnancy. P. 432.
Whether the infection is communicated through the sperm solely, the ovule, or the utero-placental circulation, the uterine death of the fetus is the most habitual expression of hereditary syphilis. Hereditary syphilis is one of the most common causes of abortion. P. 434.
Clinical observation shows most conclusively that certain dystrophies and organic defects in the subjects of hereditary syphilis may be transmitted to the third generation. P. 436.
While we cannot conclude that syphilis is transmitted in its essential nature as a virulent contagious disease, to the third generation, yet it is well known that heredo-syphilis kills the product of conception, or transmits to the survivor an impaired vitality with various dystrophies, and thus constitutes a chief factor in the physical, mental and moral degeneration of the race. From an exhaustive study of heredo-syphilis, Tarnowsky concludes that syphilis has an incomparably more fatal influence upon the species and on society than on the individual. P. 437.
PRINCE A. MORROW, M.D. Eugenics and Racial Poisons. Pamphlet published by the Society of Sanitary and Moral Prophylaxis, 105 W. 40th St., New York. 1912.
Syphilis is the only disease transmitted to the offspring in full virulence, killing them outright, or blighting their normal development. When the father alone is infected the mortality is about 38%. When the mother also becomes infected the mortality averages from 60% to 80%. Fully ⅓ of all infected children die within the first six months. Even when the subjects of inherited syphilis successfully run the gauntlet of diseases incident to infancy and childhood they do not always escape the effects of the parental disease. They are subject to various organic defects or stigma of degeneration, as they are termed. A final result of hereditary syphilis is the inability to procreate healthy children. If the subjects of inherited syphilis grow up and marry they are liable to transmit the same class of organic defects to the third generation.
FEWER AND BETTER BABIES, OR THE LIMITATION OF OFFSPRING. Wm. J. Robinson, M.D., Chief of the Department Genito-Urinary Diseases and Dermatology, Bronx Hospital and Dispensary; Fellow of the American Medical Association and of the New York Academy of Medicine.
There are thousands of syphilitic men and women who are perfectly safe as far as their partner is concerned, but are not safe enough to become parents. They cannot infect, but they must not give birth to children for fear that the children may have the taint in them. The use of preventives settles this problem and saves the world from thousands of pitiable hereditary syphilitics. P. 126.
MEDICAL GYNECOLOGY. Howard A. Kelly.
Two fundamental characteristics, contagiousness and susceptibility of hereditary transmission, give to syphilis an altogether special importance in relation to marriage. The statement has been made that syphilis constitutes a far greater danger to Society and the race than to the individual. The chief significance of syphilis as a racial danger comes from its hereditary effects. In addition, hereditary syphilis undoubtedly creates a terrain, or soil, favorable for the reception and germination of tubercle bacilli, and perhaps other bacilli. It does this by impoverishing the organism and diminishing the capacity of resistance against microbic invasion. From the view point of race perpetuation, syphilis is antagonistic to all the family represents in our social system. The essential aim of marriage is not simply the procreation of children, but of children born in conditions of vital health and physical vigor. The effect of syphilis is to so vitiate the procreative process as to produce abortions, or else a race of inferior beings, endowed with defects and infirmities and unfit for the struggle of life. It is this pernicious effect of syphilis upon the offspring which gives to the disease a dominant influence as a factor in the degeneration and depopulation of the race. P. 444.
When a married man has syphilis the first indication is to prevent contamination of his wife, the second is to guard against pregnancy. The interdiction of pregnancy should be absolute until time and treatment have exerted an attenuating and curative influence upon the diathesis. P. 448.
A consultation of the works of most authorities shows them to agree that the frequency of abortion to births at full term is from one in five or six to one in ten. P. 453.
SOCIAL DISEASES AND MARRIAGE. Social Prophylaxis. Prince Morow, M.D., Emeritus Professor of Genito Urinary Diseases in the University and Bellevue Hospital Medical College, New York; Surgeon to the City Hospital; Consulting Dermatologist to St. Vincent’s Hospital, etc. Lea Bros. & Co., New York and Phil., 1904.
The influence of inherited syphilis is manifest in the production of various dystrophies, malformations, and lesions of important organs, it seriously compromises the physical development, mental vigor and vital stamina of the descendants and constitutes a harmful factor in the degeneration of the race. The social aim of marriage is not simply the production of children who are to continue the race, but of children born in conditions of vitality and physical health fit to produce a race well-formed and vigorous, not to procreate beings malformed and stamped with physical and mental infirmity, destined to early death, or to drag out a miserable existence of invalidism. P. 21.
The statistics of European observers which have been collected from both private and hospital practice show in a most positive manner the noxious influence of syphilis upon the offspring. An analysis of these statistics taken from all quarters and aspects of the social condition of the parents show that when both parents are infected the mortality is 68 per 100. P. 27.
No other disease is so susceptible of hereditary transmission, so pronounced in its influence, and so fatal to the offspring.
While death in utero may occur as the most habitual expression of hereditary syphilis, its lethal influence is not limited to the period of intra-uterine existence. The child may be born alive, but in many cases the sentence of death is not commuted, it is simply reprieved, it may be for a few months, weeks, or only days. P. 212.
THE WORLD’S SOCIAL EVIL. A Historical Review and Study of the Problems Relating to the Subject. Wm. Burgess. With Supplementary chapter on a constructive policy by Judge Harry Olson, Chief Justice Municipal Court, Chicago. Saul Bros., Publishers, Chicago, 1914.
Based upon statements, experiences and opinions of physicians, public officials and other responsible persons, 50% to 80% of all men between the ages of 18 and 30 years contract gonorrhea. 10% to 18% of the male population contract syphilis. 40% to 60% of all operations upon women for diseases of the generative organs result from gonorrheal infection. 80% of the inflammatory diseases peculiar to women are the result of gonorrheal infection. A large per cent., some say one half, of still born and premature deaths of children is due to syphilis. 25% to 35% of all cases of insanity are caused by syphilis contracted years before. 15% to 20% of all blindness is attributed to these diseases. P. 159.
A CONSTRUCTIVE POLICY WHEREBY THE SOCIAL EVIL MAY BE REDUCED. Harry Olson.
The large group of mentally retarded persons who may be included in the term “sub-normal” number in this country, according to the best authorities about 300,000. An important distinction must be made between two groups of the defective classes, those who may, and those who should not enjoy social privileges as members of the community. From a racial and eugenic point of view the inborn, or heredity defectives are by far the most important because the defect is germinal and therefore transmissible to the offspring. This class forms 75% or more of the defective classes. When so many as 75% of the feeble-minded are such by reason of germinal or hereditary taint, and since perhaps 50% of the women of the underworld are sub-normal, it becomes at once apparent that not only in order to reduce the number of women in public prostitution, but also to protect the race itself, we must adopt other methods of eliminating vice than those now employed. P. 358–359.
PROCEEDINGS OF THE NATIONAL CONFERENCE ON RACE BETTERMENT. January 8–12, 1914. Published by the Race Betterment Foundation. Edited by the Secretary.
Statistical Studies. The Significance of a Declining Birth Rate. Frederick L. Hoffman, Statistician of the Prudential Insurance Company, Newark, N. J.
From an economic and social point of view a low birth rate and a low death rate would unquestionably be more advantageous than the opposite condition, which involves much needless waste of human energy and pecuniary expenditure. For reasons which require no discussion, every civilized country desires a normal increase in population, though a high degree of social and economic well-being is not at all inconsistent with even a stationary population condition such as for some years past has prevailed in France. P. 23.
All the available statistical information seems to justify the conclusion that the world’s population in general, and of the more civilized countries in particular is increasing at the present time at a more rapid rate than in earlier years—a condition largely the result of a persistent and considerable decline in the birth rate. P. 28.
The important causes of death which have increased during the five years ending 1910, as compared with the previous five years, are briefly the following:—Syphilis increased from 4.1 to 5.4, per 100,000 of population. Cancer, and other malignant tumors from 11.5 to 13.7; locomotor ataxia, and other diseases of the spinal cord from 7.3 to 8.4; all diseases of the circulatory system combined from 161.2 to 171.7; ulcers of the stomach from 2.9 to 3.6; diarrhea and enteritis under two years, from 89.0 to 96.2; diseases of the puerperal state considered as a group from 14.2 to 15.5; malformations, chiefly congenital, from 12.2 to 14.9; diseases of early infancy, chiefly congenital debility and premature births, from 73.9 to 75.0. P. 45.