The Third Great Plague / A Discussion of Syphilis for Everyday People

by John H. Stokes

The Wet Nurse.—This is also the proper place to introduce a warning about the wet nurse. Women who must have the assistance of a wet nurse to feed their babies should, under no circumstances, make such arrangements without the full supervision of their physicians. There is no better method for transmitting syphilis to a healthy woman than for her to nurse a syphilitic child. Conversely, the healthy child who is nursed by a syphilitic woman stands an excellent chance of contracting the disease, since the woman may have sores about the nipples and since the germs of syphilis have been found in the milk of syphilitic women. The only person who should nurse a syphilitic child is its own mother, who has syphilis and, therefore, cannot be infected. A Wassermann blood test with a thorough examination is the least that should be expected where any exchanges are to take place. Nothing whatever should be taken for granted in such cases, and the necessary examinations and questions should not give offense to either party to the bargain. Syphilis is not a respecter of persons, and exists among the rich as well as among the poor.

Hereditary Syphilis in Older Children.—Hereditary syphilis may become a latent or concealed disease, just as acquired syphilis does. None the less, it leaves certain traces of its existence which can be recognized on examination. These are chiefly changes in the bones, which do not grow normally. The shin bones are apt to be bowed forward, not sideways, as in rickets. The skull sometimes develops a peculiar shape, the joints are apt to be large, and so on. Syphilis may affect the mental development of children in various ways. Perhaps 5 per cent of children are idiots as a result of syphilis. Certain forms of epilepsy are due to syphilitic changes in the brain. On the other hand, syphilitic children may be extraordinarily bright and capable for their years. Some are stunted in their growth and develop their sexual characteristics very late or imperfectly. It is one of the wonders of medicine to see a sickly runt of a child at fifteen or sixteen develop in a few months into a very presentable young man or girl under the influence of salvarsan and mercury. A few syphilitic children seem robust and healthy from the start. The signs of the disease may be very slight, and pass unrecognized even by the majority of physicians. Some of them may be splendid specimens of physical and mental development, but they are exceptional. The majority are apt to be below par, and nothing shows more plainly the insidious injury done by the disease than the way in which they thrive and change under treatment. Even those who are mentally affected often show surprising benefits.

Destructive Changes, Bones, Teeth, Etc.—Syphilis in children, since it is essentially late syphilis, may produce gummatous changes of the most disfiguring type, fully as extreme as those in acquired syphilis and resulting in the destruction or injury of important organs, and the loss of parts of bones, especially about the mouth and nose. Certain changes in the teeth, especially the upper incisors in the second set, are frequent in hereditarily syphilitic children, but do not always occur. These peg-shaped teeth are called Hutchinson's teeth. Individuals with hereditary syphilis who survive the early years of life are less likely to develop trouble with the heart, blood vessels, or nervous system than are those with acquired syphilis.

Eye Trouble—Interstitial Keratitis.—Two manifestations of hereditary syphilis are of obvious social importance. One of these is the peculiar form of eye trouble which such children may develop. It is known as interstitial keratitis, and takes the form of a gradual, slow clouding of the clear, transparent convex surface of the eyeball, the cornea, through which the light passes to reach the lens. While the process is active, the child is made miserable by an extreme sensitiveness to light, the eye is reddened, and there is pain and a burning sensation. When the condition passes off, the child may scarcely be able to distinguish light from dark, to say nothing of reading, finding its way about, or doing fine work. A certain amount of the damage, once done, cannot be repaired, although cases improve surprisingly if the process is still active and is properly treated. The course is slow, often a matter of years, and only too many patients do very poorly on the sort of care they can get at home. One eye case in every 180 has interstitial keratitis, according to reliable figures.[9] Of 152 with this trouble, only 60 per cent recovered useful eye-sight and the remaining 40 per cent were disabled partly or completely. Forty-three out of 71 persons lost more or less of their capacity for earning a living. In practically all cases it means the loss of months or years of school between the ages of five and ten and a permanent handicap in later life. These patients would belong in school-hospitals, if such things existed, where they could get the elaborate treatment that might save their eyes, and at the same time not come to a stand-still mentally. Any chronic inflammatory eye disease in children urgently needs early medical attention, and those who know of such cases should do what they can to secure it for them.

[9] Iglesheimer, quoted by Derby.

Blindness in hereditary syphilis may, of course, take the same form that it does in the acquired disease, resulting from changes in the nerve of sight (optic nerve). This form is entirely beyond help by treatment.

Ear Trouble—Nerve Deafness.—The second important complication of hereditary syphilis is deafness. This occurs from changes in the nerve of hearing and may be present at birth or may come on many years later. The deaf infant is usually recognized by its failure to learn to talk, although it may seem perfectly normal in every other way. Again, the child may hear well at birth and deafness may come on in later life,—as late as the twentieth year,—suddenly or gradually, and become complete and permanent. It is often ascribed to colds or to falls and accidents that happen to occur at the same time. If syphilitic deafness comes on before the age of ten years, it is very apt to result in the child's forgetting how to talk, and becoming dumb as well. It goes without saying that children whose syphilis made them deaf at birth never learn to talk at all, and are therefore deaf and dumb. Very little is known about how many of the inmates of asylums for the deaf are hereditary syphilitics, but there is reason to suspect the percentage to be rather large. Deafness in hereditary syphilis is practically uninfluenced by treatment.

Accident and Injury in Hereditary Syphilis.—It is a matter of great importance to realize the large part played by accidents, injury, poor health, or lowered resistance in bringing a hidden hereditary syphilis to the surface. A child may show no special signs of the disease until some time during its childhood it has a fall which injures or bruises a bone or breaks a limb. Then suddenly at the place where the injury was done a gumma or tertiary syphilitic change will take place and the bone refuses to heal or unite or a large sore may develop which may be operated on before the nature of the condition is realized. In the same way a woman with hereditary syphilis may seem in perfect health, marry, and suddenly after the birth of her first child, even as late as her twenty-fifth year, may develop syphilitic eye trouble. It must be realized that hereditary syphilis is as treacherous as the acquired disease, and can show as little outward signs before a serious outbreak. It is part of the duty of every person who suspects syphilis in his family or who has it himself to let his physician know of it, for the sake of the help which it may give in recognizing obscure conditions in himself or his children.

Marriage and Contagion in Hereditary Syphilis.—In general it may be said that, in the matter of marriage, persons who have hereditary syphilis and live to adult life with good general health can, after reasonable treatment, marry without fear of passing on the disease. Hereditary syphilis apparently is not transmitted to the children as acquired syphilis is. Hereditary syphilis practically is not contagious except during the eruptions and active manifestations in infancy, such as the nasal discharge and the other sores in the mouth and about the genitals. As adults they can enter into the intimate relations of life without risk. Many of them, while perhaps having positive blood tests while the disease is active, later become negative without treatment. Some of them even recover from the disease to the extent that they can acquire it again, since there is no absolute immunity.

Syphilis in Adopted Children.—A word might well be said at this point on the adoption of children with hereditary syphilis. In all probability this is not a common occurrence, certain factors tending to diminish the risk. A child adopted after its second year will not be so likely to have the disease, since most syphilitic children die before this age is reached. Agencies which arrange for the adoption of children are now much more careful about the matter than formerly, and a Wassermann test on the mother and also on the child, as well as a careful history in the case of the mother, is frequently available. The information in regard to the mother is quite as important as that about the child, since the child may have a negative test while the mother's may be positive. Children who have hereditary syphilis, even in latent form, should not be offered for adoption, and should become a charge upon the state. Families in which it later develops that an adopted child was syphilitic should not, however, be needlessly alarmed for their own safety, since, from the standpoint of infectiousness, the late forms of hereditary syphilis are not dangerous to others. The agency from which the child was adopted should assume responsibility for the child if the family cannot meet the situation. The state of Michigan has been a pioneer in this country in legislation which provides for the welfare of these children among others. A law has been enacted making it possible to provide for their medical treatment for an indefinite period in the state hospital at Ann Arbor, at the cost of the state.