Treatment of Hereditary Syphilis.—The question of the treatment and cure of a person with hereditary syphilis is in many respects a different one from that in an acquired case. The foothold which the germ has in the body in hereditary syphilis is stronger even than in an untreated acquired case. Many of the changes produced by it are permanent, and the prospects of completely eradicating it are correspondingly small. On the other hand, the child who survives hereditary syphilis has probably an enormous resistance to the disease, which in a measure compensates for the hold which it has on him. Treatment in hereditary syphilis becomes an extremely difficult problem because it must in many cases be carried out during infancy, and for that reason the coöperation of the patient cannot be secured. By treating the mother, we now know that we can accomplish a great deal for the unborn child. Once the child is born, its salvation will depend on unremitting care and labor. If it is skilfully treated and kept at the breast, it is estimated that it has even as high as ninety chances in one hundred of surviving to a useful life. Salvarsan can be given to even very small babies, and mercury also is employed with excellent results. Persistence and skill are essential, and for that reason, if possible, hereditary syphilis in active form in later childhood should have the advantage of occasional or prolonged treatment in special hospitals or sanitariums where the child could go to school while he is being built up and cared for. This is not like trying to salvage wreckage. Many syphilitic children are brilliant, and if treated before they are crippled by the disease, give every sign of capacity and great usefulness to the world. Welander, who was one of the greatest of European experts on syphilis, has left himself an enduring monument in the form of the so-called Welander homes, which have been established by cities like Copenhagen, Berlin, and Vienna to provide for such children the combined benefits of the school and the hospital. We cannot be too prompt in adopting similar provision for such cases in this country. There can be little excuse, eugenic or otherwise, for not doing the utmost that modern medical science is capable of for their benefit.
Chapter XI
The Transmission and Hygiene of Syphilis
The problem of the control of syphilis as a contagious disease is the least appreciated and the most important one in the whole field. It should be the key to our whole attitude toward the disease, and once given its rightful place in our minds, will revolutionize our situation with regard to it. For that reason, while some repetition of what has gone before may be unavoidable, it will be worth while to gather in one chapter the details relating to the question of how the disease is spread about.
Two bed-rock facts stand out as the basis for the whole discussion. First, for practical purposes syphilis is contagious only in the primary and secondary stages. Second, syphilis is transmitted only by open sores or lesions whose discharges contain the germs, or by objects which are contaminated by those discharges. Infection with syphilis by such fluids as the blood, milk, or spermatic fluid uncontaminated by contact with active lesions is at least unusual.
Contagiousness in the Primary Stage.—The chancre is always contagious. If it is covered with a dry crust, it is, of course, less so, but as soon as the crust is rubbed off, the germ-infested surface is exposed and the thin, watery discharge contains immense numbers of the organisms, especially in the first two or three weeks. This is just as true of a chancre on the lip or chin as on the genitals. Chancres which are in moist places, as in the mouth, or on the neck of the womb, or under the foreskin, are especially dangerous, because the moisture keeps the germs on the surface.
Contagiousness in the Secondary Stage.—In the secondary period, when the body is simply filled with germs, one would expect the risk to be even greater than in the primary stage. As a matter of fact, however, no matter how many germs there are in the body, the only ones that are dangerous to others are those that are able to get to the surface. A syphilitic nodule or hard pimple on the hand or face is not contagious so long as the skin is dry and unbroken over it. The sores which occur in the moist, warm, protected places, like the mouth, on the lips, about the genitals, and in the folds of the body, such as the thighs, groins, armpits, and under the breasts in women, are, like the chancre, the real sources of danger in the spread of the disease.
Relatively Non-contagious Character of Late Syphilis.—The older a syphilis is, the less dangerous it becomes. It is the fresh infection and the early years which are a menace to others. It will be recalled that the germs die out in the body in immense numbers after the active secondary period is over, so that when the tertiary stage is reached, there is only a handful left, so to speak. The germs in a tertiary sore are so few in number that for practical purposes it is safe to say they may be disregarded, and that for that reason late syphilis is practically harmless for others. Just as every syphilitic runs a gradual course to a tertiary period, so every syphilitic in time becomes non-contagious, almost regardless of treatment.