At times locomotor ataxia begins with very severe pain seizures, known as crises. These may occur in the legs or arms or in the stomach or sometimes in other organs. Occasionally they are the first symptoms of the disease that are noticed, and they may continue for months or even years before other symptoms manifest themselves. This sometimes makes it difficult to recognise the disease for what it really is. The pains are usually most excruciating, are tearing or boring in character, and are sometimes described by the patient as being similar to the sensation that would be felt if a red hot iron were forced into them, or if a knife were inserted and then twisted round. Hence the descriptive name which has been applied to them of "lightning pains" which describes the suddenness of their onset and the intensity of their character. [{322}] Most of the ordinary anodyne or pain-killing medicines fall to influence them, and the patient is one of the most pitiable of objects while they last.
It is now conceded on all sides that at least 75 per centum of the cases of tabes are directly due to syphilis. Indeed this affection and paresis are sometimes spoken of as parasyphilitic affections. Unfortunately the ordinary treatment for syphilitic manifestations does not affect them in the least. So far as we know at the present time, there is nothing that will hinder the course or prevent the progress or alleviate the symptoms or have any curative action on either of these dreadful diseases. They are much more common in Europe than they are in this country, but have been seen here with quite sufficient frequency in recent years to make physicians, at least, realise the necessity for having young men appreciate the dangers they invite in thoughtlessly yielding to the temptations of great city life.
There are other affections which can be traced directly to the social diseases. One of the most important of these consists of certain brain tumours which may even cause death if not properly treated. These syphilitic brain tumours frequently cause paralysis and may lead to permanent changes in the nervous system with consequent loss of motor power. Whenever the symptoms of brain tumour occur, careful inquiry is made as to the previous existence of syphilis in the case, in order to determine, if possible, if this is the morbid agent at work. If there is a history of syphilis it is usually said to be fortunate, for brain tumours due to syphilis may be made to disappear by the proper use of mercury and the iodides. If the treatment of the case is delayed, however, alterations in the nerve substance take place which can not be improved.
This disease affects especially the blood vessels and, as a consequence of the thickening of the coats of the arteries, blood may be shut off from certain portions of the brain entirely. This will, of course, produce symptoms of paralysis. Indeed, whenever paralytic symptoms manifest themselves under forty years of age, the physician's first thought is sure to be that there is syphilis in the case. This is not always [{323}] true, for by heredity and very hard work occasionally arteries become so degenerate that they rupture before a patient has reached many years beyond forty, but the case is always suspicious. In this, as in the corresponding instance of brain tumour, treatment, if applied sufficiently early, may not only give relief of all the symptoms, but produce a complete cure. That is, at least the symptoms are relieved for the time, though there may be relapses. Usually these relapses are quite amenable to treatment, but sometimes they get beyond the control of the physician and death ensues. It is almost the rule where there have been serious nervous symptoms once, that recurrences of them must be feared, and they will eventually shorten the patient's life.
Syphilitic manifestations of serious character develop, however, not only in the nervous system, but also in certain of the important internal organs. The liver may become so much affected as to refuse to do its work. Solid tumours may develop in the stomach, or along the course of the intestines, resembling cancer so much that occasionally operations are performed for their removal. As a rule, however, these yield quite promptly to proper antisyphilitic treatment. Whenever an obscure intraabdominal tumour is present, accordingly, it has become the custom among physicians and surgeons not to make an absolute diagnosis nor to perform any serious operation until antisyphilitic treatment has been tried. The surprises of such treatment constitute a very interesting chapter in obscure diseases in medicine.
As we said at the beginning, it is perfectly possible to have contracted the disease innocently, and indeed, the first manifestations may be so mild as to fail to attract the patient's attention. In these cases there will be no history of syphilis, yet the test of antisyphilitic treatment will demonstrate that the disease has been present. Not a few physicians have died from these serious manifestations of syphilis after having contracted the disease through a cut on the finger or the prick of an infected needle in the ordinary course of their professional work. Some of these cases in young men prove to be especially malignant and fail to react to treatment, so that a fatal issue takes place within a few years.
On the other hand, in general it may be said that the disease is eminently curable, though it may require great care on the part of the patient and the avoidance of all excesses either of work or indulgence for the rest of life. It has often been noted that people who live in the midst of serious emotional strain are most likely to suffer from manifestations of syphilis in their nervous system. Hence it is that paresis and locomotor ataxia are comparatively quite common among actors, brokers, and financiers. They are also quite common among sea captains and military men who are exposed to severe hardships and have to assume weighty responsibilities. In such men the previous attack of syphilis has so weakened the nervous system that it degenerates under the strain placed upon it by the subsequent responsibilities. These diseases are very uncommon among clergymen and are less common in Ireland than in any other country in the world, which would serve to confirm the opinion that the venereal disease is a prominent factor in their causation.
We would not have the idea be assumed that syphilis is an incurable disease and is bound to be followed in all cases by the awful manifestations that we have described. There are many thousands of cases of syphilis that never have any of these serious manifestations at all. It is evident that some cases are completely cured and that no deleterious influence remains. On the other hand, it must not be forgotten that the presence of this disease in the tissues of either parent during the first five years of its course are almost sure to affect offspring born at this time. The children may suffer from the skin lesions of syphilis in their early life, may suffer from serious eye diseases a little later, and then eventually succumb to nervous and mental diseases resembling paresis and locomotor ataxia in early adult life. In fact it is this transmission of the disease that constitutes one of its saddest pictures, and the sins of the parents are indeed visited on the children.
Besides this severer type of social disease, there is what has been called sometimes a milder form. It consists only of a discharge with some fever, which is considered to last not more than a few weeks. As a matter of fact, however, the disease may continue to exist, though the symptoms become latent [{325}] and the patient may infect others when he least suspects it. This form of disease gives rise to many sad complications in family life. Practically all the severe eye diseases of newly born children, the ophthalmia from which so many eyes are lost, is due to this disease. Special medical care is now taken of these cases, and the serious consequences are not so often seen as used to be the case. Within a score of years, however, about one-half of the inmates of blind asylums owed their loss of sight to this disease. At the present time there still remains a very notable proportion of persons blind from early childhood whose infirmity must be attributed to the sad consequences of the social disease.