Transmission from Both Parents. When both parents are syphilitic at the time of impregnation, the child will purely be tainted. About one third of such children will perish before birth, while almost all of those born will die within the first six months after birth. "According to Kassowitz,1 one third of all children procreated of syphilitic parents are dead born, and of those born living twenty four per cent die within the first six months of life. In his personal experience Fournier found that in private practice more than two out of three hereditarily syphilitic children died, either before, at, or soon after birth. In hospital practice Fournier found that out of 167 children born of syphilitic mothers, 145 died; which means that one child out of seven or eight survived. It having been claimed that Fournier's personal statistics made an exceptionally bad showing, and that they were exaggerated, he collected those from the whole world, his own excepted. He gathered the histories of 447 cases of children whose fathers or mothers were syphilitic, and found that out of this number there were 343 deaths, there being only 104 who survived. Of the 343 children who died, only six lived beyond the first year.
The proportion of living children, according to these statistics, is 1 to 4.3. We may understand why the lesions of hereditary syphilis are so severe and extensive, and why its fatality is so great, when we consider how early in foetal life the specific virus exerts its influence, and how thoroughly it must be diffused through the organism of the embryo".3 The longer the parents have had syphilis before they beget offspring the less is the chance of blighting of the foetus. Transmission is most certain within the first year after either or both parents have acquired the disease, and with the lapse of time the chances grow gradually less and less, though many years after all signs of syphilis have apparently disappeared from the parents, the children may be born syphilitic. This especially applies when the parents have not received efficient treatment. A healthy married woman, if she have a healthy husband, naturally becomes impregnated, harbors the child for nine calendar months, and thereafter suckles it for from twelve to twenty months. Then, if she be prolific, gestations and sucklings succeed each other for a number of times, births recurring approximately every three years. But the syphilitic woman is liable to have a greater number of pregnancies than if she were healthy for abortion after abortion occurs, and the failure to suckle of course renders her more subject to reimpregnation at an early date after each mishap.
In tainted mothers each succeeding abortion usually comes on later and later in the foetal development, until after a time a living child may be born, which, however, probably dies of syphilis. Then the next child may survive and develop, even though congenitally syphilitic, and perhaps the subsequent children may be entirely free from the disease. Thus we see that syphilis gradually loses its tendency to blight progeny, and that, unlike gonorrhoea, it does not usually sterilize men or women, though producing much the same ultimate result by causing successive abortions. "Conceptional Syphilis". Though long disputed, it is now pretty generally accepted that a healthy mother can be infected by a foetus which has been originated by the semen of a syphilitic father. In the large majority of instances the mother is infected with primary syphilis directly by the father; but after his chancre has healed he may have coitus with her without inoculating her, though his semen renders the foetus syphilitic. In this event the mother may acquire the disease from the foetus either by absorption of the toxins, or by direct reception of the germs of syphilis into her circulation, if there have been any laceration or solution of continuity at the placental site.
Prognosis in Hereditary Syphilis. When either or both parents are constitutionally tainted the probabilities are, as pointed out, that abortion after abortion will occur the foetuses being born macerated, or softened by processes of liquefaction. If the child be born alive it will probably be a wizened, deformed, stunted and blasted little thing, emaciated, having a peculiar senile expression, and corrupted through and through with the syphilitic virus. Fortunately they usually die within the first few months. Or the child may be born apparently healthy and not show any of the manifestations of this terrible disease until several weeks have elapsed. In other cases of hereditary syphilis the outbreak may be deferred until the time of the second dentition, or until puberty, or it may not crop out until the child's maturity. It is hardly necessary to dwell upon the special lesions which may appear throughout the life history of such a blasted innocent, since they are very similar to those referred to under acquired syphilis. Suffice it to say that failures in development and the most hideous and shocking deformities, blindness, deafness, paralysis, epilepsy, impairment of mental powers, idiocy, hydrocephalus, and a marked tendency to develop tubercular affections, are the rule.
Syphilis and Marriage. When may a syphilitic marry? Some years ago Fournier and Besnier said that a syphilitic might incur the chances of a possible tragedy by marrying, if he waited for four years after the initial lesion, provided that he had undergone a careful and prolonged treatment. But Besnier and others have recently advanced the limit, and it is now considered that even under the most favorable circumstances five years should elapse before marriage. Morel Lavallee,1 after presenting indisputable statistical evidence that secondary lesions appear in patients, even when under skilled medical observation, for five, ten, or even more years, maintains that it should be an invariable rule not to allow patients to marry for at least five years after infection, and not even then unless a whole year has elapsed without any appearance of secondary symptoms, e.g., mucous patches in the mouth, erosions on lips or tongue, etc. After five years, if vigorous specific treatment has been intelligently followed, the chances that syphilis will be transmitted to the offspring are slight, but in no case can a positive assurance of immunity be given.