Neurosyphilis: question of marriage.
Case 98. Mr. Jacobs’ wife was admitted to the hospital with a diagnosis of general paresis. A few weeks after her admission, she died as a result of her disease. According to our routine, her husband and the children were examined for evidences of syphilis.
Mr. Jacobs’ blood serum was found on repeated tests to be positive. He resolutely denied any knowledge of a syphilitic involvement, but it was later learned from his brother that about two years before his marriage—that is, more than 25 years before we saw him—he had acquired syphilis and had had a very small amount of treatment.
Mr. Jacobs was put upon antisyphilitic treatment in the form of injections of .3 gram of salvarsan every two weeks with occasional intramuscular injections of mercury salicylate. After seven months of treatment, the blood serum still remained positive. At about this time, the patient came to us to ask about getting married again. He said that he was living with his sister, who kept telling him that he was the cause of his wife’s death, and this was so unpleasant that he desired to start a home for himself again!
1. What advice should be given? It is a general opinion that the longer the period after the initial infection, the less the chances of infecting a partner. This chance is further reduced under antisyphilitic treatment, of which a considerable amount had been given in the case of Mr. Jacobs. However, when one considers the trickiness of syphilis and the fact that there is some chance of infection, which we would apparently overlook if we gave him permission to marry at this time, the only possible course was to tell the patient that he should not consider marriage until his Wassermann had become negative and remained so for some time. The children in this case were negative.
2. What is the physician’s duty to the family of a syphilitic patient? It is our firm conviction that it is the duty of every physician to his syphilitic patient, to the patient’s family, and to the community, to examine the mate and the children for evidence of syphilis acquired or congenital and to offer treatment if it is found to be needed. This is one of the chief means at our disposal today to prevent the late disasters of syphilis, acquired or congenital, for by such examinations the syphilitic condition is discovered before lesions have occurred which are irreparable. We know that the mate and children of a syphilitic patient have been exposed to syphilitic involvement, and it is our duty as physicians in possession of such knowledge, and as guardians of the public health, to investigate such cases, so that if they be found to have syphilis, steps may be taken to treat them early.
3. How much danger is there of causing unhappiness and breaking up families by this procedure? This question offers a chance for many theoretical answers. The facts are, however, that in doing this as a routine for nearly three years and examining several hundred families, there has been no instance to our knowledge in which a family has been broken up or grave difficulties have been encountered by this procedure.
4. In what percentage are the mates or children of neurosyphilitics found to show definite symptoms of syphilis? It is our opinion that the situation in regard to neurosyphilitics is the same as for syphilitics in general: That the same laws of attenuation of virus, and of chance occur here as elsewhere.
Just as this book is going to press, we have learned that the distraught Mr. Jacobs, still desirous of starting a home for himself and feeling entirely well, consulted a physician. This physician took a sample of blood and had it tested at a competent laboratory, which reported the blood negative.
On the strength of this test, the physician felt himself warranted in recommending, or at least not advising against, Mr. Jacobs’ marriage, which has probably now taken place.