HEREDITARY SYPHILIS IN THE LIGHT OF RECENT CLINICAL STUDIES. Pamphlet. Borden S. Veeder, M.D., St. Louis, Mo. From the American Journal of the Medical Sciences, October, 1916. No. 4, Vol. CXII. P. 522.
In the present state of our knowledge we can summarize the evidence as pointing to the view that in hereditary syphilis the mother is always infected, although very frequently the infection is latent and that true germinal infection does not occur.
Syphilis as a Social Problem. No accurate figures are available as to the incidence of hereditary syphilis. The disease is not reportable, and even if it were it is doubtful if the records obtained in this way would be of any value, as the condition is frequently overlooked, and when recognized would be concealed in many cases because of the stigmata attached. With improved methods of diagnosis we are beginning to learn that it is far more common than previously thought, as many conditions in which the etiology was obscure have been found to be the result of a syphilitic infection. Hospital statistics are of little value in this connection. In St. Louis we have been particularly interested in hereditary syphilis, and have admitted many cases to the Children’s Hospital for study which would normally have been cared for in the out-patient clinic, and hence the proportion of syphilis to the total number of admissions is relatively high. We have seen between 300 and 350 children with an hereditary infection in three and a half years and have undoubtedly failed to recognize a number of cases. We have also found many cases of latent syphilis by testing the apparently healthy children of syphilitic families. What is more important is the number of obscure clinical conditions which have been found to be syphilitic in origin.
The importance and cost of syphilis to the family and the community is not generally appreciated. About this point we have collected some interesting information: For a period of about a year an attempt was made to obtain extensive data in regard to the family of every syphilitic child coming to the clinic, to examine all of the other living children as well as the parents, and to test the blood of each member by the complement-deviation method. In this way data was assembled for 100 syphilitic families. Many marriages (10 to 30 per cent.) remain sterile as a result of syphilis and others (13 per cent. according to Haskell) result only in abortions. Our material includes only those families in which a living child came under our direct observation and care.
In these 100 syphilitic families 331 pregnancies occurred which resulted as follows:
| Abortions | 100 or 30.2 per cent. |
| Stillbirths | 31 or 9.3 per cent. |
| Living births | 200 or 60.5 per cent. |
Thus 40 per cent. of the pregnancies terminated in the death of the fetus before term. If the parents had been healthy and of the same social strata we might have expected 30 to 35 deaths before term, or a mortality of 10 per cent. instead of 40 per cent.
Considering next the 200 living births: At the time the data were collected 39 were dead and 161 alive, but 12 of the 161 died during the course of the investigation. Of the 161 examined 107 had both clinical signs of syphilis and a positive Wassermann; 5 were clinically positive but gave negative tests (in all of these the family gave a history of syphilis); 16, although negative as regards clinical manifestations, gave positive reactions, and therefore belong to the group of latent syphilitics. Thus but 33 of the 161 living children were free from the infection, and if we attribute the deaths occurring before term to syphilis, we find that of the 331 pregnancies in 100 syphilitic families but 10 per cent. escaped the infection. The toll is summarized in the following table:
| 331 PREGNANCIES IN 100 SYPHILITIC FAMILIES | ||||
|---|---|---|---|---|
| 131 | or 40 per cent. | died before term | } | |
| 51 | or 15 per cent. | died after birth | } | 55 per cent. dead |
| 116 | or 35 per cent. | living but syphilitic | 35 per cent. syphilitic | |
| 33 | or 10 per cent. | living and free from syphilis | 10 per cent. escaped | |
| ——— | ||||
| 331 | ||||
If we add to this record and take into consideration the physical condition of the parents—both of whom were syphilitic in almost all of our cases—we begin to grasp the appalling importance of syphilis from a social standpoint.