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JAMA 100 Years Ago
July 21, 2010

The Ultimate Fate of Hereditary Syphilitics Among the Better Class

JAMA. 2010;304(3):356. doi:10.1001/jama.2010.895



Dr. Hochsinger at a recent meeting of the Gesellschaft der Aerzte in Vienna, discussed the results of a series of investigations, extending over twenty-five years, into the ultimate fate of children whose parents had contracted syphilis before the children's birth. Only the better classes of the population were considered and of these only families in which the doctor had opportunity of constantly observing parents and children for a long period. The results are rather unexpected. Altogether, 139 families with 569 children were observed. The 139 women had 263 syphilitic infants born alive, 253 dead babies and 53 living non-syphilitic children. Of the 263 affected children born alive, 55 died before reaching the age of 4, so that 208 individuals were the subjects of prolonged observation. Only 25 per cent. of all of them remained alive and without any attacks, and only 14 per cent. of the children died within their first year of life. All other patients have shown during their life, symptoms of disease traceable directly to syphilis. Apart from manifestations on the skin and the mucous membranes, especially affections of the nervous system, together with moral insanity, were most frequent. The well-known fact that hereditary syphilis plays a prominent part in the etiology of these conditions is borne out very well. On the other side, it was shown that if hereditary syphilitic persons remain healthy up to the age of puberty, the expectation of a healthy future life is justified. Recurrences of syphilis have a very deleterious influence on the somatic resistance of the children; 79 children out of the 263 died during the observation; of course the majority of the deaths occurred within the first year. The most affected organs were the lungs and the alimentary canal. According to the statistics of hospitals with their badly fed unhealthy applicants 70 per cent. of all syphilitic babies die in their first year. Dr. Hochsinger's observations deal with better families, where every possible care was available for the children. The most frequently attacked organs were in the new-born, the skin, the nose, then the viscera. The first-born child is generally more severely attacked than the second, this more than the third and so on. Also the number of recidives declines with the increasing number of children. Out of 123 first-born children, 93 (or 73 per cent.) had recurrences; out of 55 second-born babies, only 24 (or 45 per cent.) had recurrences, and out of 21 third children only 8 (or 38 per cent.) had recurrences. Where maternal lues was manifest, the children most often had developments of the disease, showing that the maternal manifest affection seriously influences the fate of the children. The characteristic feature of the late hereditary syphilis was always the gumma; infantilism and general maldevelopment were frequent. Chronic headache, migraine, is a very frequent concomitant, and very often a characteristic feature of hereditary syphilis. The absence of Hutchinson's symptom, as well as the fairly favorable results during the observations seem to show that an energetic long-continued antisyphilitic treatment may do much good for the unhappy offspring of a tainted family.

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