In the vast majority of instances syphilis is contracted during sexual intercourse; occasionally, however, the buccal cavity is made to serve the ordinary purposes of the vagina, and the disease is transferred from or to the mouth. There are, however, many innocent ways of contracting the disease; for instance, using drinking glasses, cups, spoons, pipes, etc., which have been previously used by a syphilitic, etc.
Sternback reports a severe attack of syphilis in army surgeon, acquired in a peculiar manner. While attending a case of blennorrhoea of the eye he was attacked by the same disease and had leeches applied to the temple to combat the acute inflammatory symptoms. One of the leech-bites became the site of the initial sclerosis of syphilis, to be followed later by the usual secondary manifestations. After six months iritis developed, and shortly afterwards symptoms of severe cerebral syphilis. How the leech-bite was infected by the syphilitic virus is unexplainable.
It is altogether probable, however, that in tertiary syphilis, especially if a considerable number of years have elapsed since the first contraction of the disease, neither the blood nor secretions are contagious.
Syphilis may also result from hereditary transmission. Should the father alone be syphilitic, the offspring usually escapes; but if the mother be affected, the child will almost certainly suffer. In the majority of cases, when infection of the mother occurred but a short time before conception the foetus will die in utero, and be expelled before time. A second or third abortion may succeed, but ultimately the mother may give birth to a living child, which, however, may soon succumb to the disease. As the period of time from the date of infection becomes greater, the less does the poison affect the offspring, until a time arrives when the offspring of parents who have both been previously syphilitic may be born without apparent taint and grow up healthy children, reaching adult life without mishap. The symptoms of hereditary syphilis may be manifested shortly after birth by erythematous blotches, bullae, coryza, and marasmus, or may be deferred until about the period of puberty. In this event, interstitial keratitis, or various ulcerations, may be the chief features presented by the disease.
An interesting case was reported in 1889 of a child four months of age, whose parents had acquired syphilis fourteen years before. Though anti-syphilitic treatment had been insufficient, their syphilis ran a very mild course, and they experienced very few syphilitic manifestations. Their first child, born three years after their marriage, died from meningitis at the age of seven years; the second had a syphilitic eruption a the end of the second month; the third succumbed to cholera infantum; the fourth died in its first month, of broncho-pneumonia;; the fifth had an interstitial keratitis three days after its birth. This, the sixth child, showed an extensively distributed papular syphilide. At the time of conception, the parent did not show any syphilitic symptoms. Other cases have been met with of syphilitic infection from parents to children even twenty years after the primary infection in the parent.
Dr. Mackenzie gives the history of a case of congenital syphilis in which ulceration of the throat was a marked phenomenon. This progressed in spite of the remedies employed to check it, until the child was taken with a mild form of scarlatina, when the ulceration at once began to heal. When the stage of desquamation was reached, cicatrization was complete. In his remarks on the case, which is but typical of a class, he says that frequently specific ulcerations in children stubbornly refuse to cicatrize. Under such circumstances when remedial measures are apparently of little or no avail, they sometimes cicatrize, as if by magic, on the accession of an acute disease. While congenital syphilis affords no absolute protection against certain acute infections diseases, its existence in the individual seems often, other things being equal, to mitigate their severity and exert a favorable influence on their course.
Certain acute diseases, accompanied by an exanthem, favor the dissipation, at least temporarily, of the throat and other manifestations of syphilis. White at no period of the disease is the child exempt from these affections, they are more liable to be contracted during the period of latency, that curious interval of apparent health in congenital syphilis, which Cazenave has poetically called the sleep of the virus. These remarks are limited to scarlet fever, measles and chicken-pox, but they could doubtless be extended to embrace others of the exanthemata; or, in other words, to those diseased which present a certain analogical resemblance to syphilis. They do not apply, for obvious reasons, in the case of excessive virulence of the syphilitic cachexia or malignant epidemic influence of the inter- current disease. Of special interest is the effect produced by acute febrile upon the throat lesions of congenital syphilis.
Chronic inflammatory conditions and ulceration of the larynx, pharynx, and nasal passages are often influenced in a remarkable manner through the presence in the individual of an inter-current febrile affection. This is, moreover, eminently true of those acute blood diseases with special tendency to local manifestations in the throat, such as scarlet fever, measles, diphtheria, etc. According to personal experience, scarlatina and measles exert, as a rule, a favorable influence on the course of the throat affection, their supervention being of itself sufficient to cause its complete disappearance. The poisons of the two diseases, in their circulation in these regions, appear to be mutually destructive and the throat escapes by virtue of such reciprocal antagonism. The cure here may be permanent, or relapses of the inflammatory or ulcerative process may follow the removal of the antagonistic influence of the inter-current disease. These remarks do not apply to diphtheria. When this affection supervenes during the existence of lesions in the throat, the patients rapidly succumb to the disease. The existence of syphilis in the child apparently increases the tendency t membranous formation; indeed in some instances, apart from the presence of the diphtheritic process, there seems to be a special tendency to fibrinous formation in the nose and retronasal space.
Diagnosis.- To commence at the beginning, the initial lesion or chancre is to be distinguished from the same venereal ulcer (chancroid) by its long (two or three weeks) incubation, its plastic character, its indurated base and its slight tendency to secretion, and the single or very limited number of lesions.
The soft chancre, on the other hand, appears a few days after intercourse, presents a necrobiotic or ulcerative character, is not accompanied with the hard, infiltrated base, and may exist to the number of a dozen or more on the same patient.
In syphilis the initial lesion is usually accompanied with a number of moderately enlarged hard inguinal glands, while the chancroid and greatly inflamed and painful glands, which not infrequently go on to suppuration. In addition, we have in syphilis the other glandular indurations already noticed.
There are very few cases in which the earlier syphilitic eruptions cause any great trouble in diagnosis. Taking the history into consideration, neither the macular nor tubercular eruptions are liable to be mistaken for anything else. The papular eruption of lichen planus, however, may sometimes closely resemble a syphilide. The squamous syphilide may in like manner be mistaken for ordinary psoriasis. In most cases, however, we will learn (if the case is psoriasis) that the patient has had previous attacks of the same form of eruptions, while in syphilis the previous eruptions will have been of a different type.
In late syphilis a patch of tubercular lesions may be mistaken for lupus. The history, however, again helps us, for a lupus patch will have been many months, perhaps years, in forming, while the syphilitic lesions might have reached the same development in a few weeks.
The real difficulties that surround the diagnosis of syphilitic eruption, however, do not so often occur in simple, uncomplicated cases as in those where a syphilide coexists with some other eruptive affection. This we have seen at the same time a syphilide and an eczema, a syphilide and a psoriasis, a syphilide and leprosy, a syphilide and scabies, etc., and each of these separate eruptions pursued its own course apparently unmodified by the presence of the other.
Treatment.- In former times if was a question whether the disease or its treatment caused the greater inconvenience or suffering to the patient.
The treatment of a given case of syphilis will, of course, depend on the stage of the disease and the condition of the patient; but if the case comes at the beginning-that is, during the period of the chancre-the early or subsequent treatment may be pretty clearly mapped out in advance.
