PROGNOSIS IN HEREDITARY SYPHILIS In 18 families, with syphilitic parents, in which there were 161 pregnancies A. Fournier saw 137 still-births, i.e., S5 per cent. J. N. Hyde found 916 deaths during the first year of life in 1121 syphilitic births.
Statistics from the Foundling Home in Moscow dating from about 1870 state that 70 per cent. out of 2038 syphilitic children died during their first six months of life. Fruhinsholz had 37 deaths among 84 congenitally syphilitic children (68.5 per cent., 29 of these deaths occur ring during the first half year. Neither in private, nor in ambula tory clinical practice, however, .does such a condition exist as these figures taken from institutions would indicate. Furthermore, the prognosis in children born with manifest syphilis, especially those born with pemphigus, is much more unfavorable than that of children in whom no evidence of syphilis is present till a later period. Such syphilitic children can be completely and permanently cured, according to our observations, so that they can be reinfected in later years.
Of the early manifestations of hereditary syphilis, the exanthemata and the osseous affections offer a good prognosis, except those in which pemphigus is present at birth, while visceral affections present at birth give a more unfavorable outlook.
Complicating affections and intercurrent diseases have a great influence upon the fate of these congenitally syphilitic children, espe zially during the first few months. Pulmonary affections deserve the first rank, and following them, gastro-intestinal diseases. Syphilitic recurrences exercise a peculiarly weakening influence upon the infantile organism during the first few months of life, because they very materi ally lower the resistance of the child to intercurrent diseases. It is impossible to decide definitely whether or not a peculiar predisposition for certain diseases exists in older children with syphilitic inheritance. The only causes of death that we have found noticeably frequent in these cases are pulmonary tuberculosis and tuberculous basilar meningitis, which must not be confused with syphilitic meningitis. The greatest factor in determining the later fate of these cases is whether or not an early and rational therapy was instituted in the individual case.
From my case histories I find that the patients who had no recur rences were almost invariably those that had been rigidly treated with mercury according to our directions for weeks and months. Although
it cannot be denied that, in spite of careful treatment of the first period of eruption, recurrences are only too frequent, our experience teaches that in those children who were properly treated at an early stage, severe late manifestations in the form of destructive gummatous pro cesses never occurred. Hutchinson's triad, too, does not occur under these circumstances.
On the whole then the bad prognosis given to congenital syphilis by obstetricians and syphilologists must be greatly modified and replaced by a more favorable one.
The early affections of the central nervous system, especially those classed as meta- and parasyphilitic, do not offer a good prognosis as to permanent cure; while the disturbances of locomotion due to bone lesions, as well as the early osseous manifestations, yield rapidly to rational treatment and are completely cured.
Recurrences of hereditary syphilis are much more frequent in untreated cases; S5 per cent. of all my cases of congenital syphilis of the fourth to the sixth month were cases that had not been treated before, and were brought for examination on account of a recurrence. The prognosis as to permanent cure in these cases is somewhat less favorable than in those eases that are properly treated from the start. Those that are not treated early are the ones, for the most part, that later give evidence of late hereditary syphilis.
What prognosis shall we give to cases of late hereditary syphilis? Skin and bone manifestations as such are doubtless curable in the majority of cases, and yet they are much more difficult to eradicate than those of early syphilis. In general, it may be said that those afflicted with such manifestations are to be considered below par with reference to their permanent state of health, and, in later life, they are candidates for parasyphilitic affections of the vascular and nervous systems.
Even more than in the case of the gummatous process of late hered itary syphilis the parasyphilitic affections of this period depend upon the treatment of the early manifestations of the disease. In my exten sive material, tabes and paralysis occurred only in cases in which the early syphilis was inadequately treated.