Should the husband have florid primary or secondary syphilis, and infect his wife at impregnation, abortion is the rule. The commonest cases are those where the husband has been treated for syphilis more or less thoroughly before marriage. Even if at the time of impregnation the husband has no apparent infective lesion, the child is usually syphilitic, or it may show signs of the disease later in life. Ibsen's Ghosts is founded on a case like this. If the syphilis is recent, or uncured, the child dies, macerates, and is expelled. These conditions recur in pregnancy after pregnancy, until the virus is removed by time or drugs. As the nucleus of the spermatozoön is too small to carry the spirochete of syphilis, the infection is through the semen in a manner not yet clear to us.
Wolff[155] studied a group of nine syphilitic women and their children. There were sixty-six pregnancies, but only thirty-three viable children were born. Of these last fourteen died in childhood, three committed suicide at twelve, twenty, and twenty-eight years of age; and of the thirteen still living only two were normal. The others are all feeble-minded, epileptic, hysteric, or otherwise neurotic. Post[156] tabulated the mortality in thirty syphilitic families in which there were 168 pregnancies. Of these fifty-three ended in still-birth or miscarriage and there were forty-four early deaths—a total loss of 57 per cent. Of the children that were born alive 38 per cent. are now dead, and of the seventy-one that are alive only thirty-nine are apparently healthy. There are very many cases of diseased children and adults with serious lesions of obscure etiology, and in a great number of instances of anemia, malnutrition, extreme nervousness, aortitis, bone diseases, vague pain, and similar conditions, the origin is congenital syphilis. Stoll,[157] in sixty-eight such cases, found a positive luetin syphilitic reaction, and a positive Wassermann in 17 per cent.
Gottheil,[158] professor of dermatology and syphilography in Fordham University, holds that if a man has gone through a modern treatment for syphilis, given by a competent physician and extended over three years, and if during the fourth year, without treatment, he repeatedly shows a negative Wassermann reaction, he may marry. That is the common opinion of physicians, but it is decidedly erroneous.
In one series of 562 cases of hereditary syphilis observed by the great syphilographer Fournier, sixty children, or over 10 per cent., were infected more than six years after the primary parental inoculation. He tells of one woman who had nineteen consecutive still-births from syphilis. Gowers[159] says: "There is no evidence that the disease ever is or ever has been cured, the word 'disease' being here used to designate that which causes the various manifestations of the malady." This statement is too sweeping, but it is very near the truth.
Bruhns recently reported the outcome of the Wassermann test repeated about yearly from 1908 to 1915 in one hundred private cases infected with syphilis ten or more years before the time of the report. In forty-two the test was constantly negative; in thirty-two, positive at first but negative later; in seven, constantly positive notwithstanding repeated courses of treatment; in three, positive at first, then long negative, but finally changing to positive again; in eight, negative at first, then positive, and finally negative; and in eight, negative at first but finally positive. The last three groups are particularly significant. In some the long negative reaction, for five or six years, indicated cure, and physicians would pronounce such cases positively cured; but suddenly they changed to a positive reaction without any clinical manifestations showing at the time. After renewed courses of treatment in the following two years the reaction became negative. Among the cases with constant negative reaction there were some who developed brain syphilis, or tabes, proving that they were not cured despite the absence of clinical manifestations of the disease and the negative Wassermann reactions. Professor Blaschko of Berlin, at the seventeenth International Medical Congress in 1913, in the presence of Ehrlich, Wassermann and Hata, said no one could even talk of a cure of syphilis until an interval of ten years without symptoms had occurred. Where a blood Wassermann is negative a spinal fluid reaction may be positive.
In from 60 to 75 per cent. of all cases of tabes or paresis members of the family other than the patient have shown infection. The proportion of infections in the families of tabetics and paretics is far larger than that found in families in which the syphilis does not go on to these extremes. Tabes is also called locomotor ataxia. It is a degeneration of a part of the spinal cord, with unsteadiness and incoördination of motion, lightning pains, disorders of vision, and other symptoms. Paresis is softening of the brain, with insanity and death.
These and other facts strongly indicate that the form of syphilis which ends in tabes or paresis remains infectious over a much longer time than ordinary syphilis does. No one has cured either tabes or paresis. Raven reported in 1914 an investigation of ninety families in each of which a case of metalues had developed. The interval between the date of infection and the marriage was known in about half of these, and it was four years in two families, five years in one, and from six to twenty-one years in ten! Fournier, in 4400 cases of syphilis, saw three cases where the tertiary symptoms appeared fifty years after infection, and in one case fifty-five years after infection. Bonnet[160] reported such a case which came to him for treatment fifty-four years after infection. The man had no children.
Syphilis that affects the nervous system as in tabes and paresis is an incurable syphilis, and there is no means whereby any physician, no matter how skilful he may be, can tell whether or not a given patient has such an infection. The physician, then, who tells a syphilitic that he or she is cured and lets such a person marry is responsible for all the evils that result from his rashness. Once a syphilitic, not necessarily always a syphilitic; but once a syphilitic, possibly and probably always a syphilitic, and that no matter what the treatment or the lack of clinical symptoms. Damaged goods of this kind are to be looked upon as damaged goods forever.
Any man or woman, then, who has ever had a clear case of syphilis (and the diagnosis is easy, as a rule) is likely to be for the remainder of life a source of syphilitic infection. There is even question of late of spirochete-carriers, as there are typhoid-carriers and diphtheria-carriers, who may infect others while not suffering themselves. If one who has been a syphilitic marries without informing the other party to the contract of the condition, the injustice is, without doubt, very grave. I should call such concealment a mortal sin, and a condition exposing the sacrament to sacrilege.