Frequency of Locomotor Ataxia and General Paralysis.—The percentage of all syphilitic patients who develop either locomotor ataxia or paresis varies in different estimates from 1 to 6 per cent of the total number who acquire syphilis. The susceptibility to any syphilitic disease of the nervous system is hastened by the use of alcohol and by overwork or dissipation, so that the prevalence of them depends on the class of patients considered. It is evident, though, that only a relatively small proportion of the total number of syphilitics are doomed to either of these fates. Taking the population as a whole, the percentage of syphilitics who develop this form of late involvement probably does not greatly exceed 1 per cent.
Treatment and Prevention of Late Syphilis of the Nervous System.—Locomotor ataxia and paresis, even more than other syphilitic diseases of the nervous system, are extremely hard to affect by medicines circulating in the blood, and for that reason do not respond to treatment with the ease that syphilis does in many other parts of the body. Early locomotor ataxia can often be benefited or kept from getting any worse by the proper treatment. For paresis, in our present state of knowledge, nothing can be done once the disease passes its earliest stages. In both these diseases only too often the physician is called upon to lock the stable door after the horse is stolen. The problem of what to do for the victims of these two conditions is the same as the problem in other serious complications of syphilis—keep the disease from ever reaching such a stage by recognizing every case early, and treating it thoroughly from the very beginning.
Summary
Summing up briefly the main points to bear in mind about the course of syphilis—there is a time, at the very beginning of the disease, even after the first sore appears, when the condition is still at or near the place where it entered the body. At this time it can be permanently cured by quick recognition and thorough treatment. There are no fixed characteristics of the early stages of the disease, and it often escapes attention entirely or is regarded as a trifle. The symptoms that follow the spread of the disease over the body may be severe or mild, but they seldom endanger life, and again often escape notice, leaving the victim for some years a danger to other people from relapses about which he may know nothing whatever. Serious syphilis is the late syphilis which overtakes those whose earlier symptoms passed unrecognized or were insufficiently treated. Late syphilis of the skin and bones, disfiguring and horrible to look at, is less dangerous than the hidden syphilis of the blood-vessels, the nerves, and the internal organs, which, under cover of a whole skin and apparent health, maims and destroys its victims. Locomotor ataxia and softening of the brain, early apoplexy, blindness and deafness, paralysis, chronic fatal kidney and liver disease, heart failure, hardening of the blood-vessels early in life, with sudden or lingering death from any of these causes, are among the ways in which syphilis destroys innocent and guilty alike. And yet, for all its destructive power, it is one of the easiest of diseases to hold in check, and if intelligently treated at almost any but the last stages, can, in the great majority of cases, be kept from endangering life.
Chapter VI
The Blood Test for Syphilis
It seems desirable at this point, while we are trying to fix in mind the great value of recognizing syphilis in a person in order to treat it and thus prevent dangerous complications, to say something about the blood test for syphilis, the second great advance in our means of recognizing doubtful or hidden forms of the disease. The first, it will be recalled, is the identification of the germ in the secretions from the early sores.
Antibodies in the Blood in Disease.—It is part of the new understanding we have of many diseases that we are able to recognize them by finding in the blood of the sick person substances which the body makes to neutralize or destroy the poisons made by the invading germs, even when we cannot find the germs themselves. These substances are called antibodies, and the search for antibodies in different diseases has been an enthusiastic one. If we can by any scheme teach the body to make antibodies for a germ, we can teach it to cure for itself the disease caused by that germ. So, for example, by injecting dead germs as a vaccine in typhoid fever and certain other diseases, we are able to teach the body to form protective substances which will kill any of the living germs of that particular kind which gain entrance to the body. Conversely, if the body is invaded by a particular kind of germ, and we are in doubt as to just which one it is, we can identify it by finding in the blood of the sick person the antibody which we know by certain tests will kill or injure a certain germ. This sort of medical detective work was first applied to syphilis successfully by Wassermann, Neisser, and Bruck in 1904, and for that reason the test for these antibodies in the blood in syphilis is called the Wassermann reaction. To be sure, it is now known that in syphilis it is not a true antibody for the poisons of the Spirochæta pallida for which we are testing, but rather a physical-chemical change in the serum of patients with syphilis, which can be produced by other things besides this one disease. But this fact has not impaired the practical value of the test, since the other conditions which give it are not likely to be confused with syphilis in this part of the world. The fact that no true antibody is formed simply makes it unlikely that we shall ever have a vaccine for syphilis.