<A HUTCHINSON, JONATHAN>

Chapter XVIII, On Syphilis in its Relation to Marriage, from Jonathan Hutchinson’s Syphilis, 1887

<A HUTCHINSON, JONATHAN>
<N SYPHILIS>
<D 1887>

CHAPTER XVIII.

ON SYPHILIS IN ITS RELATIONTO MARRIAGE.

THE question as to how soon, after syphilis, a man or

woman may be permitted to marry, is one which it is

extremely difficult to answer. A due regard to the

interests of social life warns us against extreme

opinions. Whilst we must endeavour faithfully to

discharge our duty as skilled advisers of those who

consult us, we must avoid the position of alarmists.

Obviously it is a safe course as a simple matter of

medical science, to tell one who has had syphilis that

there is always risk, and that marriage is to be for

ever avoided. Such a course, or anything near it,

would, however, prevent thousands of happy marriages;

would swell the ranks of those who adopt concubinage

instead of wedlock, and whilst it would reduce

the sum of human happiness, would probably not

in the least diminish the prevalence of syphilis. We

must, therefore, seek to be reasonable and moderate

in our recommendations. Until quite recently the

period of waiting, which it was customary to enforce,

was exceedingly short, and according to present

opinions most inadequate. I have seen a certificate

signed by a president of the College of Surgeons

authorising a man to marry, and justifying the permission

by alleging that all secondary symptoms had

disappeared. As a matter of fact a mercurial course

which had been very successful was just over, and

exactly three months had elapsed from the date of

the chancre. Of late some authorities have insisted

on periods which seem to me unreasonably long, and

have caused an amount of alarm which is, I think,

much to be regretted.

My own rule, for the last twenty years, has been to

insist on an interval of two full years between the

date of contracting the disease and marriage. However

satisfactory the progress of the case, and however

absolute may have been the absence of symptoms

during the latter three-fourths of this period, I have

never relaxed this rule. I am cognisant of the consequences

in a very large number of marriages which

have taken place, with my professional permission, after

this interval, and with the single exception of the case

which is the subject of Commentary 178, I have never

known of any hurt to either wife or child. As a rule,

then, to which there are very few exceptions, I think

that we may hold that, after two years have elapsed,

there is no risk of hereditary transmission. I am

speaking of patients who have been under careful

mercurial treatment. Most of my own patients have

taken mercury in small doses for six or eight months

continuously in the first instance, and often for several

short periods subsequently. Many patients who were

wishful to marry as early as possible, I have advised

to continue mercury as a precaution through the

whole of the two years. Although, however, I have

myself had but few opportunities for observation

in cases not treated by mercury, yet I am quite prepared

to believe that the mere lapse of time is, in most

cases, a very efficient cure for syphilis so far as its contagious

properties are concerned. The virus appears

to die out, although, as daily recurring facts prove,

the individual’s own liability to suffer from tertiary

symptoms is by no means passed. Probably in a large

majority of cases the risk of transmission to children

is over long before the end of two years. Were

it not so it must be supposed that our predecessors

would have much oftener found their authorisations

falsified than would appear to have been the case.

In the present work many cases have been adduced in

which children born within very short periods of

syphilis in one or both of the parents, yet escaped all

evidence of taint. That tertiary symptoms are not

heritable I hold to be well established, and also that

they are not contagious between the parties themselves.

Whilst of opinion that two years is a reasonably long

interval between syphilis and marriage, I am by no

means in a position to deny that the transmission of

taint from parent to offspring may appear to continue

through far longer periods. The cases in which

it does so are, however, so exceptional, that they need

not, I think, influence our rule. They are to be explained

probably in several different ways. In some

instances (it may be in almost all) a second or even a

third introduction of the virus has occurred. Many

patients who may not care to conceal the fact that

syphilis has occurred before marriage, may yet persistently

disavow any exposure to it since. The first

syphilis is, they think, quite sufficient to guide the

surgeon to correct treatment, and that to make any subsequent

and more discreditable confession is not needful.

In other cases the transmission which was from

the father in the first instance is from the mother in

later ones, whilst in her the disease is of more

recent origin. Thus a man who is nearly at the end

of his two years’ probation, marries and begets a

syphilitic foetus. His wife receives the virus, and she

becomes afterwards the source from which their children

receive it.

Of almost all cases in which transmission to

offspring persists for very long periods, it is probably

true that the treatment has been inefficient. This

remark especially applies to wives who may have

received the disease from their husbands. In many

of such cases the treatment is very insufficient or

almost nothing. The husband being very anxious

to avoid arousing his wife’s suspicions, may allow

her, if the symptoms are not troublesome, to go

on without advice, or if advice be obtained, may be

very willing to leave off all treatment so soon as the

obvious troubles have been made to disappear. Speaking

generally, women are far less efficiently treated for

syphilis than are men, and married women are, of

all, the most likely to be neglected. Men know more

about the malady and are far more willing to submit to

protracted treatment. By remembering this we may

perhaps explain the general impression that the danger

of transmission to children lasts longer in the case

of mothers than of fathers. We must, then, in giving

an opinion in any individual case in which the question

is asked, “May I marry?” put aside the facts

supplied by isolated and exceptional cases, and base

our opinions upon general results. There are so many

fallacies in the exceptional cases that we are quite

justified in declining to allow their apparent lessons

to influence our decision under other and very different

circumstances. If a patient has been well treated, if

no tendency to recurrence of the chancre has been

shown, I believe that the surgeon is fully justified in

permitting marriage at the end of two years, and that

he may confidently assure his patient that under such

conditions the risk is infinitely small.

I have been speaking hitherto of cases in which

the person wishing to marry has been the subject of

undoubted syphilis. There are, however, cases in

which the diagnosis of the original sore may have

been doubtful. Thus it may have been questionable

whether the sore was only an abrasion, or a chancroid,

or herpetic, and the patient may wish for permission

to marry within a very short period of its occurrence.

I find that my late valued friend, Dr. Bumstead, lays

it down that marriage should not take place until at

“least three weeks after the disappearance of such an

excoriation.” I confess that I should incline to insist

upon a far longer period.

Cases of relapsing chancre and of herpes after

syphilis, present us with great difficulties. I have

known several cases in which married men were

liable to the recurrent chancre with the most typical

induration, and in which their wives never suffered.

I should, however, be very unwilling to consent to

marriage in any one liable to this occurrence unless

at least double the period I have recommended had

elapsed. Herpes of the penis is probably not contagious,

and the liability to it ought not, perhaps, to

interfere with the permission to marry. Its subjects

may, however, be suitably warned most carefully to

avoid intercourse whilst any traces of herpetic sores

are present.