Among our syphilitic patients all the living children of 100 families have been examined, Wassermann tests made and the family history studied. In these 100 families there were 331 pregnancies. Of these 100 (30.2 per cent.) were abortions, 31 (9.3 per cent.) still births and 200 (60.4 per cent.) living births. Of the 200 living births 35 children died early and 4 died late, and 161 remained alive and were examined. Of these, 12 are now dead. Of the 35 who died early, 5 gave an undoubted history of syphilis and a number gave suspicious histories. Of the four who died late, one was an idiot. Of the 161 examined, 107 were clinically positive and had positive Wassermann tests. Five were clinically positive and had negative Wassermann reactions. Sixteen, who showed no evidence of syphilis, gave positive Wassermann reactions. Thirty-three, who gave no clinical proof of syphilis, gave a negative Wassermann reaction.
Of the five who were clinically positive but gave negative Wassermann reactions, one was a young infant who had snuffles and a large spleen. The mother and sister both gave a positive history and a positive Wassermann reaction. Shortly after beginning treatment the baby developed a syphilitic rash. The baby was removed from the hospital and a second Wassermann was not done. The second case was a nursing baby. The mother had active syphilis and was taking treatment. The baby had an active process in the nose. The third case was a 7-year-old girl who had a markedly sunken nose and who for that reason was the starting point for investigating that family. Both the mother and younger brother gave a positive Wassermann. The fourth case was a 4-year-old girl whose mother and younger sister were both positive and the patient had a general rash which was thought to be syphilitic. The fifth case was a 3-year-old boy with a positive history, and who had had some treatment. His mother and younger brother both had syphilis.
A negative Wassermann reaction is obtained in the presence of active syphilis only under certain definite conditions. As had been noted in cases not of this series, very young babies, even with undoubted active syphilis, not infrequently give a negative Wassermann. It has also been noted that even small amounts of mercury tend to cause a positive blood to react negatively.
H. Boas[[54]] states that of fifty-seven babies of syphilitic mothers giving negative Wassermann reactions at birth, thirteen during a three months’ period of observation developed syphilitic manifestations and a positive Wassermann, and two others showed syphilitic changes at necropsy, having had no manifestations during life.
[54]. Quoted by Haberman: Jour. Am. Med. Assn., 1915, lxiv, 1146.
LATENT SYPHILIS
It is seen that 10 per cent., of the children examined had latent syphilis, i.e., a positive Wassermann and no clinical evidence of syphilis. One of these children gave a history of epiphysitis at 3 months. Other than this no early history was acknowledged by any of the mothers. The question naturally arises, Are these children actively infected with syphilis? When we inquire into the history of those showing late manifestations, we frequently find, so far as obtainable history is concerned, that there has been no previous warning that the disease existed. One of our patients developed, as her first known symptom, an interstitial keratitis at 20 years. We know that the spirochete can lie dormant much longer than this and then manifest itself. One patient of this latent group who had taken very irregular treatment for about a year and who had never had previous manifestations, recently developed an active lesion in the throat. Another developed an interstitial keratitis after about two months of anti-syphilitic treatment. A positive Wassermann reaction in these apparently healthy children has the same significance that it does in the parent, and it is our belief that the children in this group are actively infected.
The fact that there are thirty-three children, 10 per cent. of the total pregnancies, who show no evidence of syphilis, and at the same time give a negative Wassermann reaction, is rather hopeful. Yet the pleasure to be taken in this fact is not altogether unalloyed. In this small group there were two mental defectives and an idiot, and it is impossible to say that all of this group are free from syphilitic infection. In one instance, one such negative child returned about a year after his original examination with a tertiary type of lesion and a positive Wassermann. Though no classification of those in this group showing stigmata of degeneration was attempted, it can be truthfully stated that a goodly proportion did show degenerative influences, either physical or mental.
TOTAL SYPHILIS IN THE FAMILIES STUDIED
In summing up the total syphilitic infection in these families, we find that where marital relations are uninvolved, all of the fathers and probably all of the mothers have been infected. Presuming that the abortions, stillbirths, all of the early deaths and at least one of the late deaths were due directly or indirectly to syphilitic infection, syphilis among the offspring amounts to 89 per cent. of the total pregnancies, and total syphilis in the family amounts to 93 per cent. of all its members.