The causes of death in syphilis are many and varied death by hepatic lesions, cirrhosis, and hepatitis gummosa; death by lesions of the meninges; by cerebral gummata and syphilitic encephalitis; by lesions of the spinal cord, which are more common than is generally believed; by exostoses (bony outgrowths) of the cranium and vertebrai; by lesions of the kidneys, of the larynx, and of the lungs; and, more rarely, by lesions of the oesophagus and rectum; death by consumption and progressive cachexia (depraved bodily condition). These are, in short, the possible consequences of syphilis, and such is the perspective offered to a person who contracts this contagion. Dare we call a disease benign which can end thus? Can a disease be called benign which is fraught with such serious accidents and whose pathological anatomy is so rich and varied? Dare we tell persons afflicted with this disease to leave it untreated, to let things go, and to wait patiently the possible results of such an infection, without warning them of it?"
Tertiary Lesions. In cases where syphilis runs its regular course, unmodified by treatment, certain lesions of a graver nature, called tertiary lesions, develop, usually in the third or fourth year of the infection, but sometimes even as late as ten, twenty, or even fifty years (Fournier).
With sufficient care in the treatment the tertiary symptoms may never appear; but strangely these gravest manifestations of syphilis are, on account of the negligence in treatment, more apt to follow in cases where the primary and secondary lesions have been mild. For this reason they are more common in women, because everything possible is done to keep them in ignorance when they are innocently infected. It is this "ignored syphilis" which presents the most shocking complications.
Tertiary syphilis is remarkable for its insidiousness and its disorderly course, no two cases being alike. Therefore it is impossible to write a full and clear account within short limits. Sometimes the lesions come on like wildfire within two to four months after infection and rapidly produce the most threatening complications and even death. This is called "galloping syphilis".
But as a rule these tertiary lesions appear some time after the second year. They differ from the secondary lesions in being slower in development, less numerous, and more destructive to the deeper parts of the body, e.g., the brain, spinal cord, heart, blood-vessels, bones, muscles, viscera, etc.
The tendency at this late stage of the disease is to a progressive growth of granulation tissue which produces nodules and tumors ("granulomata", "gummata", or "syphilomata"). With the lapse of time these new cell infiltrations ulcerate and necrose and otherwise cause cicatrization, or sclerosis, in the most vital tissues of the body. There is a special liability to the most horribly loathsome and disfiguring skin affections. Sometimes the palate and fauces are destroyed, so that the mouth, nose and pharynx are converted into one enormous cavity, allowing food to regurgitate through the nose and giving a distinctive nasal quality to the voice which the French call "duck's voice". In many cases the vocal cords are damaged, so that the voice forever after remains husky. Syphilis, in its later manifestations, is capable of infecting any or all of the tissues in the body; remotely it frequently causes death, or the most hideous distortions and malformations, insanity, paralysis, epilepsy, blindness, destruction of joints, sterility, etc.
Hereditary Syphilis. In the hereditary form of syphilis there is no initial lesion, or chancre, and it cannot be divided into well defined stages. The manifestations of the disease correspond in type to the secondary and tertiary stages, which often coexist. Prenatal infection may overtake the foetus from either the father or mother, or from both.
Paternal Transmission. After the father's chancre has healed, constitutional symptoms having become manifest, his semen may carry syphilitic infection during the process of conception, even though the mother be not inoculated. His share in procreation being limited to the mere. act of fecundation of the ovule, the blighting influence of paternal descent is not so marked as when the mother has constitutional syphilis. Without efficient treatment paternal transmission is probable for at least four years after his infection, and in some cases the child may be born syphilitic even after many years of apparent absence of all manifestations in the ancestor.
Maternal Transmission. After constitutional symptoms have appeared in the mother, the foetus is liable to be born syphilitic if born before the expiration of at least six years. Or a healthy foetus may become infected if the pregnant mother become syphilitic. Syphilis affecting women more profoundly than men, especially in its great tendency to produce a severe type of anaemia in them, the foetus has less chance of developing normally when the mother is tainted than when the morbid influence is derived solely from the father. For the proper development and nourishment of the foetus in utero it is necessary that the mother should have good health, and consequently maternal transmission is especially malign in its influence on the child. Furthermore, when the mother is syphilitic there is great risk of abortion and still birth, owing to syphilitic lesions in the placenta which interfere with the child's vitality.