In regard to the expectancy of life in syphilis, the following points are of value: I. Inherited syphilis is one of the most fatal of all disorders affecting man kind, and under the most favorable cir cumstances, apart from abortion, 90 per cent. of children born living subsequently die. 2. Acquired infantile syphilis is rare, and is easily treated, and probably a large proportion of all infants so af fected survive. 3. In acquired syphilis in adults between SO and 90 per cent. escape gummata. The percentage of pa tients affected with gummata who die probably does not exceed 2 per cent. 4. The expectancy of life is probably not affected by the coincidence of syphilis with other diseases, and the prospect that the patient with acquired syphilis will ever suffer from struma, cancer, or tuberculosis is exceedingly small. 5. The natural evolution of acquired syphilis in untreated cases is not in the direction of a fatal issue, but rather in the line of physical degeneration due to involve ment of the nervous system and the bones without affecting the organs es sential to life. 6. It is unfair to charge an extra risk for the insurance of syphilitic applicants otherwise in sound health. The syphilitic applicant for life insurance should be examined with a view not so much as to his syphilitic history as to his condition with relation to all the other items making up a satis factory risk. In other words, if he has a good family history, a sound constitution, excellent habits, and has reached but not passed a satisfactory age, his expect ancy of life is probably that of other individuals in similar conditions without added risk on account of syphilis. Ilyde (Med. Examiner. Apr., '9S).
Syphilis scions to be especially amen able to treatment. In 145 adults, 65 per cent. only showed mild transitory lesions which left no trace; 26 per cent. showed no destructive lesions of any sort. Only 6 per cent. exhibited con siderable severity for a time; even these finally cleared up completely, leaving no trace. J. A. McDonald (Med. Record, May II, 1901).
The urine of syphilitics, far from being hyperacid. is. on the contrary, hypo-acid. and this hypo-acidity is but little ditnin ished by a stay in the hospital : the acidity of the blood also suffers a con siderable diminution; the mercurial cure, acting upon the body in general, and probably the liver in particular, increases the hypo-acidity of the urine, and conse quently also the blood: finally, the mer curial cure, specifically for the syphilitic manifestations, is insufficient to bring on a complete cure, and it is necessary to combine with it a treatment acting upon nutrition in general and upon the nerv ous and hepatic functions hi particular. E. Buffs Archive-s Inter. de Phartn. et de Tiusr.: Amer. Jour. Sch. .1une, 1902).
When may a Syphilitic Marry 7—Our best authorities assert that, on the aver age, marriage is safe at the end of three years. Fournier gives the following re quirements for the guidance of syphilitics contemplating marriage: 1. Present free dom from specific symptoms. 2. Ad vanced period of the disease. 3. A con siderable period of absolute freedom from symptoms since the last specific mani festation. 4. A mild type of the disease.
5. Prolonged and thorough treatment. These requirements contain in a few words all that is necessary for us to im press upon syphilitic patients who con sult us with reference to their matri monial prospects.
A society has been formed at Paris for "Sanitary and Moral Prophylaxis" com posed of physicians, businessmen, offi cials, and others, the aim being an actual campaign against syphilis. Many practitioners now forbid marriage under four to six years of treatment. The new society aims to have a large repre sentative membership from all classes and to utilize all measures in the cam paign against syphilis and its great procuress, prostitution, education of the public in the dangers of venereal dis eases, official regulation, medical proph ylaxis by public evening dispensaries with private consultations and circu lars of instruction and warning, besides measures of a religious and moral order.
Among the measures which the league is advocating is training of girls to some trade, the closing of saloons with private rooms, opening the liberal careers more freely to women, warning young girls of the dangers that threaten them, fixing "parental responsibility" and legal penalties for damages from venereal contamination. The public should be warned of the dangers of ex tragenital contagion. A. Fournier (Se maine Ahd., May 22, 1901).
Congenital Syphilis.
Acquired Syphilis in Children.—Con genital syphilis should be differentiated from infantile syphilis in general. Chil dren may acquire the disease independ ently of hereditary transmission. The course and phenomena of acquired syph ilis in children are in nowise different from the same affection in the adult. Children may become inoculated with syphilis by kissing persons with oral or labial chancre, mucous patches, fissures, or ulcers, or it may acquire it by nursing its syphilitic mother or nurse.
The medico-legal question of the in fection with syphilis of the nurse by the nursling may be difficult and have pit falls for the unwary. In examining the nurse the discovery of a chancre in a position in which contagion from the child is possible is all-important. If a sore is present its induration and the existence of an indurated axillary bubo must be especially noted. If there is no sore, relics are to be looked for — a macula which is constant, but lasts only for a few weeks; a cicatrix which is ap parent in only two or three out of ten eases; induration which lasts for several weeks, and in the case of neoplastic-like chancres for up to five months; and a bubo which always remains for a certain time. The genital organs must be carefully examined and mucous patches in the form of papules or ero sions must be distinguished from chan cres, the presence or absence of buboes being especially noted. In examining the child the first point to be determined is: Is the syphilis acquired or congenital? In establishing the latter alternative the absence of chancre must be first ascer tained. Next the period at which the secondary symptoms became manifested is to be noted. Every case in which secondary symptoms occur in the course of the first two months of life is con genital.