That is a very interesting thought. This chap had 3 brothers who died in their 20’s. One had a son who died very young and I don’t, as yet know the causes of death but will delight my family over the christmas period by locating their death certificates.

This man’s daughter died aged 40 of a brain haemorrhage and he had one grandson who died shortly after birth and a second who was born deaf and dumb.

It’s all a bit odd but not entirely unusual given the age and conditions they lived in. I’m sort of wishing I hadn’t looked but at the same time the detective in me is rising to the fore.

Thanks again and a merry christmas to you too!

You’re more than welcome.

There may be another possibility – I didn’t really consider it last night but given his history it might – emphasis might – be possible that his wasn’t acquired syphilis but congenital. Congenital is almost a separate field and I don’t deal with it very often. I honestly don’t know if GPI could be an outcome in a congenital case – syphilis doesn’t always act the same in congenital – but I don’t know of any reason it couldn’t be. It might explain his early difficulties and why GPI onsets while he is so relatively young.

But again, that’s mere conjecture – I don’t know how likely or even possible it would be.

Best wishes with your studies. Merry Christmas!

Thank you so much for your reply, you are certainly thinking along the same lines as myself.

Last night I found records of someone matching his name and place of birth in an institution for deaf and dumb children in 1891 which may account for his absence on the census with his family. I wonder if he had other learning difficulties too. We shall never know.

My theory, which obviously could be totally incorrect, is that something happened there or afterwards. He is still missing in 1901.

When he signed up in 1916, we would have been in his 30’s which was strange. His records state he was only fit for home service. He married an older, widowed lady in 1911. He came from a large family who had repeatedly married into another large family (including the widow). Both families were neighbours and lived in rows of little victorian charity houses. Their lives were extremely hard. I am imagining he was only sent to France in 1917 when troops were getting thin on the ground. Poor, poor man. I cannot bear to think of how he suffered when returning home, being incarcerated in an asylum. Very interestingly, shortly after the war research was done in a clinic in our home town, namely the Mott Clinic, into the cure of Syphilis using malaria. I’m aware of the origins of the research and find it fascinating.

Many thanks again

It’s possible for neurosyphilis to onset within the first year of infection but that time frame is so short that if onset of tertiary (GPI in this case) was the reason for his discharge I’d expect a much earlier infection. If the GPI onset later it’s more probable that he contracted it in France but it could just as easily have been much earlier. Without his primary &/or secondary history it’s impossible to know when he contracted syphilis. If I had to guess, I’d bet on before he went to France but that’s just an educated guess based on the probabilities – it really is impossible to know for sure.

There are some older texts that mention larynx involvement in tertiary (since syphilis can literally attack any part of the body in tertiary, it’s certainly plausible). It’s impossible to say for certain or even with a good guess as to the probability but it’s possible that your great uncle also died of syphilis or a complication of it.

Tertiary has no hard and fast rules as to when it may occur. Most probably infection had been more than a year previous but even that is no guarantee. Primary and secondary are very predictable but tertiary is a wild card. It can onset quickly, slowly or not at all. As a result, it’s impossible to gauge when she might have been infected relative to anyone else.

Just because your grandfather was infected does not necessarily mean your grandmother was. Syphilis is only infectious in the first year of infection (some authorities say two years but I’ve not seen any documented secondary cases that were so long from the date of inoculation), specifically when symptoms are present so it is quite possible for a veteran to have contracted syphilis during service and yet not passed it to his wife. There’s no way to know for certain, of course, but it is easily possible that her blindness was unrelated to syphilis.

My state no longer requires pre-marital screening simply because incidence is too low to justify the cost. However, syphilis was once the leading cause of death in my state and on the top 10 list for the US. Given that it could be cured, marital bloods made a great deal of public health sense – catch it (hopefully) before or soon after transmission and get rid of it. Once treated the license was issued.

Also, fever can be a secondary symptom but isn’t always (I’ve rarely had pts recall a fever). Torso rash may or may not be present – I see far more palmer/plantar rashes than those on the torso. (I work in public health – I am not a physician or nurse.) Two months is rather minimal for secondary to appear. It can but it’s more accurate to say that secondary most often appears 4 weeks after the primary chancre resolves (the range is immediately after to 10 1/2 weeks after).

I’m curious, Dr Joseph, how do you monitor efficacy of treatment without the VDRL or an RPR?