The aim in syphilis, then, is to crush the disease at its outset by a vigorous campaign. Not until an amount of treatment which experience has shown to be an average requirement has been given, is it safe to draw breath and wait to see what the effect on the enemy has been. Dilatory tactics and compromises are often more dangerous than giving a little more than the least amount of treatment possible, for good measure. This is, of course, always provided the behavior of the body under the ordeal of treatment is closely studied and observed by an expert and that it is not blindly pushed to the point where injury is done by the medicine rather than the disease.
The Importance of Salvarsan.—Salvarsan is an absolute essential in the treatment of those early infections in which an abortive cure can be hoped for, and in them it must be begun without a day's delay. To some extent, the abortive cure of the disease, with its 100 per cent certainty, will therefore remain a luxury until the public is aroused to the necessity of providing it under safe conditions and without restrictions for all who need it. At all stages of the disease after the earliest it is an aid, and a powerful one, but it cannot do the work alone, as mercury usually can. But though mercury is efficient, it is slow, and the greater rapidity of action of salvarsan and its power to control infectious lesions give it a unique place. The combination of the two is powerful enough to fully justify the statement that none of the great scourges of the human race offers its victim a better prospect of recovery than does syphilis.
Is a cure worth while? There is only one thing that is more so, and that is never to have had syphilis at all. The uncured syphilitic has a sword hanging over his head. At any day or hour the disease which he scorned or ignored may crush him, or what is worse, may crush what is nearest and dearest to him in the world. It does it with a certainty which not even the physician who sees syphilis all the time as his life-work can get callous to. It is gambling with the cards stacked against one to let a syphilitic infection go untreated, or treated short of cure. It is criminal to force on others the risks to which an untreated syphilitic subjects those in intimate contact with him.
The Meaning of "You are Cured."—How do we judge whether a patient is radically cured or not? Here again we confront the problem of what constitutes the eradication of the disease. In part we reckon from long experience, and in part depend upon the refinement of our modern tests. Repeated negative Wassermann tests on the blood over several years, especially after treatment is stopped, are an essential sign of cure. This must be reinforced, as a rule, by a searching examination of the nervous system, including a test on the fluid of the spinal cord. This is especially necessary when we have used some of the quick methods of cure, like the abortive treatment. When we have used the old reliable course, it is less essential, but desirable. Can we ever say to a patient in so many words, "Go! you are cured"? This is the gravest question before experts on syphilis today, and in all frankness it must be said that the conservative man will not answer with an unqualified "Yes." He will reserve the right to say to the patient that he must from time to time, in his own interest, be reëxamined for signs of recurrence, and perhaps from time to time reinforce his immunity by a course of rubs or a few mercurial injections. Such a statement is not pessimism, but merely the same deliberate recognition of the fallibility of human judgment and the uncertainty of life which we show when we sleep out-of-doors after we have been suspected of having tuberculosis, or when we take out accident or life insurance.
Chapter X
Hereditary Syphilis
It seems desirable, at this point, to take up the hereditary transmission of syphilis in advance of the other modes of transmitting the disease, since it is practically a problem all to itself.
Syphilis is one of the diseases whose transmission from parent to child is frequent enough to make it a matter of grave concern. It is, in fact, the great example of a disease which may be acquired before birth. Just as syphilis is caused only by a particular germ, so hereditary syphilis is also due to the same germ, and occurs as a result of the passage of that germ from the mother's body through the membranes and parts connecting the mother and child, into the child. Hereditary syphilis is not some vague, indefinite constitutional tendency, but syphilis, as definite as if gotten from a chancre, though differing in some of its outward signs.