If the disease remains untreated, the appearances just described become more general and continually more severe; and after some time, quite new morbid symptoms are superadded (often as early as the third year, on the average five to ten years after infection, but also later), resulting from the transformation of the syphilitic morbid process into the tertiary stage. To these new manifestations belong the appearance of large nodules in the skin and other organs, which sooner or later undergo ulceration, the so-called “syphilitic gummata”; their ulcerative destruction may entail the greatest disfigurement or danger to life—for example, perforation of the hard palate; sinking of the bridge of the nose (the syphilitic “saddle-nose”); ulcerative destruction of large portions of the bones of the skull, of the intestine, of the liver, the lungs, the testicles, the bloodvessels (especially dangerous are gummous diseases of the bloodvessels of the brain), the brain, and the spinal cord. Apoplectic strokes occurring in comparatively young persons and nervous paralysis of the most various kinds, as well as sudden deafness and blindness, are in most cases referable to syphilitic disease. Many chronic diseases of the liver, kidneys, and nervous system, are consequences of previous syphilis; also calcification of the arteries, the very dangerous dilatation of the great bloodvessels, especially of the aorta (aneurism of the aorta), are very often of syphilitic origin.
By the researches of Alfred Fournier and Wilhelm Erb, we know to-day that two severe diseases of the central nervous system—tabes dorsalis or locomotor ataxy, and general paralysis of the insane (paralytic dementia)—are almost always (in about 95 % of the cases) referable to earlier syphilis. Among 5,749 cases of syphilis encountered in his own private practice, Fournier observed no less than 758 cases of brain syphilis, 631 cases of tabes, and 83 cases of softening of the brain. Tabes and general paralysis of the insane are all the more dangerous because they are no longer, properly speaking, “syphilitic” diseases, and therefore they cannot be cured by antisyphilitic treatment; they are severe degenerative changes of the central nervous system, which has been, as it were, prepared for their occurrence by the previous syphilis. These belong to the class of the so-called “parasyphilitic” diseases in which antisyphilitic treatment has little or no good effect.
Even more tragic are the consequences of syphilis to the family, the offspring, and the race. Syphilis in married life, congenital syphilis, and the degeneration of the race by syphilis—these are the tragic manifestations which come under consideration in this connexion.
In his admirable work on “Syphilis and Marriage,” Alfred Fournier, the greatest living authority on syphilis in all its manifestations and relationships, has described the momentous influence exercised by syphilis in conjugal life; and in his recently published work, “Syphilis a Social Danger,” he has dealt also with congenital syphilis and racial degeneration. He found that, on the average, among 100 women suffering from syphilis, 20 had been infected by their husbands, either at the very commencement of married life, or in its later course, or finally through the offspring after conception. Divorce on the ground of syphilitic infection by the husband is at the present day of frequent occurrence.
The transmission of syphilis to the child by inheritance may be effected either by the father or the mother; when both the father and the mother are syphilitic, it occurs with absolute certainty. The various possibilities of transmission, and the contingent immunity of mother or child, as they are expressed in Colles’s law (Baumès’s law), and in Profeta’s law, cannot here be further dealt with. If the mother has herself been infected with syphilis, or if she was previously syphilitic, either the child is not carried until term, abortion or miscarriage ensuing, or, finally, it is born with symptoms of congenital syphilis.[321]
The frequent occurrence of premature births and still-births in any family suggests strong suspicions that they are due to syphilis. The general mortality of the children in a family is regarded by Fournier as an important sign to the physician of congenital syphilis. Syphilitic infection of the father gives rise to a mortality in the children of 28 %; syphilis in the mother causes a mortality in the children of 60 %; when the disease affects both parents, the mortality among the children amounts to 68 %. Absolutely astounding is the mortality of the children of syphilitic prostitutes; it amounts to from 84 to 86 %.
Children born alive, suffering from congenital syphilis, are generally weakly,[322] of deficient body-weight; have often a flaccid, wrinkled skin, covered with typical syphilitic eruptions, and frequently with great purulent vesicles, especially on the palms of the hands and the soles of the feet (“pemphigus syphiliticus”); the internal organs also, the spleen, the liver, and the bones, exhibit morbid changes. Characteristic is the syphilitic affection of the upper air-passages, especially the syphilitic “cold in the head” (syphilitic rhinitis—“snuffles”), of new-born congenitally syphilitic children. Congenital syphilis further gives rise to severe disturbances of development and to phenomena to which Fournier has given the name of “late syphilis” (“syphilis hereditaria tarda”), because they first make their appearance in the later years of life.[323] Permanent debility, arrest of development, stigmata of degeneration, in the form of various malformations—as, for example, notching of the edge of the upper central incisor permanent teeth (a symptom first described by Jonathan Hutchinson), malformations of the nose, the ears, and the palate, dwarfing, deaf-mutism, malformations of the external and internal reproductive organs, rickets,[324] epilepsy, and mental weakness—are the consequences of congenital syphilis. Tarnowsky, Fournier, and Barthélémy have traced the consequences of congenital syphilis into the second and third generation, and so have discovered an important cause of racial degeneration. Syphilis in the grandfather can still exercise its disastrous influence in the grandson, and give rise to the above-mentioned stigmata of degeneration.[325] Indeed, congenital syphilis of the second generation often appears with the same severity as that of the first generation; and, like acquired syphilis, congenital syphilis in women can cause a predisposition to miscarriages and still-births.
According to statistics obtained by Edmond Fournier, relating to 11,000 cases of syphilis (10,000 men, 1,000 women) from the private practice of his father, Alfred Fournier, regarding the age at which infection occurs, it appears that in men it most commonly occurs between the ages of twenty and twenty-six years (the maximum number of infections during the twenty-third year); in women, between the ages of eighteen and twenty-one; 8 % of syphilitic males and 20 % of syphilitic females were infected before the age of twenty years. Syphilis is to a considerable extent at the present day a disease of inexperienced youth. This fact is important in relation to the problem of prevention and the problem of enlightenment.[326]
Of much less importance than syphilis is the purely local soft chancre, or chancroid, which never results in general infection. Chancroid is produced by a specific exciting cause, a chain-forming bacillus (streptobacillus), Bacillus ulceris cancrosi, which is found in the pus secreted by the ulcer. One or two days after infection, a small pustule forms at the site of inoculation, generally on the external genital organs. This pustule soon bursts, and a deeply hollowed ulcer makes its appearance, which usually undergoes rapid increase, and frequently, owing to the infective character of the pus, gives rise to new chancres in the neighbourhood of the original one, so that the soft chancre is commonly multiple. When suitably treated with antiseptic powders and cauterization, chancroid usually heals quickly; there are, however, very dangerous varieties of chancroid—for instance, the serpiginous chancre, which continues to creep irresistibly forward; and the phagedænic or gangrenous chancre, which puts the skill of the physician to the utmost test. A less dangerous but extremely disagreeable complication of chancroid is inflammation of the inguinal glands, most commonly only on one side; this painful “bubo” (painful in contrast with the painless syphilitic bubo) has a well-marked tendency to suppuration. If this occurs, and the pus finds its way to the surface, fistulas and new chancrous ulcers are liable to occur at the place where it opens. By rest in bed, the inunction of iodide ointment, the application of cold compresses, the injection into the bubo of a solution of nitrate of silver, and the internal use of iodide of potassium, this unfortunate course may be prevented.
A remarkable change of views has, in the course of the last thirty years, taken place in respect of the nature and importance of gonorrhœa.[327] Whereas formerly this was regarded as a comparatively harmless disease, we know to-day that gonorrhœa in the male, and still more in the female, gives rise to tedious dangers and painful morbid phenomena, and is the source of unspeakable sorrows, and of the miserable ill-health of numerous women, and that it is the chief cause of sterility in both sexes.