Profeta’s “Law.”
—Profeta first made the statement that the child of an infected mother who acquired the disease late in her pregnancy may not only be born healthy, but may be immune to subsequent infection, as are other healthy children of syphilitic parents. But, on the other hand, such a child may be anemic, puny, with small resisting power, or it may develop a late hereditary syphilis. When the ovum is infected by the father the healthy mother may escape, or she may acquire the disease through the placenta in her own uterus, or she may suffer from a mitigated form of syphilis whose principal features will appear as late manifestations of the disease.
Colles’ “Law.”
—Colles, in 1837, made the statement that such a mother may remain healthy with an acquired immunity to subsequent infection. The statements above made have often been alluded to as Profeta’s and Colles’ “laws.” These should, however, be regarded simply as statements of what usually occurs, and too much dependence should not be placed upon them. In fact, the immunity which the mother or the child may enjoy under conditions mentioned above is not likely to be permanent, though it may last for a varying period of time. There is no limit to the time when a parent may transmit syphilis to the child. The five-year limit given for the father is often overstepped, and the longer the man waits before marrying after acquiring the disease, and the more thoroughly he submits to judicious treatment, the less likely he is to convey it to offspring. This is the strongest kind of argument that can be used to delay marriage of syphilitics.
The indication of syphilis on the part of the mother is, in addition to those already given above, a tendency to miscarriage or abortion. The earlier she acquires the disease the earlier will the mishap occur. Should she escape the child may go on to full term, or it may die and be expelled as a dead fetus two or three months before the expiration of term. Should a child be born alive with hereditary syphilis, the evidences may appear at birth or within three months. Should a child apparently escape for six months it may grow up to be puny or develop some form of late hereditary disease, or it may possibly remain well. These children usually show developmental defect in some direction, and manifest a much weakened resisting power to other diseases; moreover, the spleen will usually be found enlarged.
Among the changes which may occur are the following: The skin becomes loose and resembles that of an old person. This is partly because it grows even faster than the tissues beneath it, so pronounced is the emaciation. Snuffles, or nasal catarrh, is one of the earliest features. This is due to specific swelling of portions of the Schneiderian membrane. Snuffles may occur in children without syphilis, but syphilis will nearly always produce snuffles, which may last for some time, and cause a widening at the root of the nose which will persist through life. Following the snuffles there usually appears a rash over the trunk and thighs and about the anus, accompanied by mucous patches. This will have the same bright, coppery tint as roseola syphilitica, already mentioned, which it much resembles. Sometimes it assumes the mixed type of eruption, while upon the palms and soles appears the so-called pemphigus syphiliticus. Should the child live nodular or gummatous syphilides may develop.
In the bone and cartilage characteristic changes are met at the lower end of the femur and at the costochondral junctions. This consists of an osteochondritis syphilitica. At the affected points enlargements take place, which may disappear under treatment or may go on to ulceration and necrosis. In the fingers and toes there are manifestations already described as syphilitic dactylitis.
The bones of the skull are likely to be involved in thickenings, especially about the anterior fontanelle, where they form the so-called Parrot’s nodes. These may disappear, with or without treatment, and the affected bone may undergo atrophy or may entirely disappear.
Among the viscera the spleen generally becomes affected first and then the liver. Syphilitic iritis may occur early, but is rather rare; ocular changes occur more often in the choroid. In the brain distinctive lesions may occur to such an extent as to lead to considerable thickening of the dura, with or without hydrocephalus, and subsequent imbecility or idiocy.
Deafness is not infrequent in hereditary syphilis. It may begin suddenly and at any age, even during infancy. It is produced by deep lesions which do not yield readily to treatment, and sometimes leads to deaf-mutism, especially when it occurs before the child has learned to talk.