Are primary syphilitic phenomena transmissible by inheritance? When we give ourselves the trouble to observe and not to fabricate theories to which we afterwards endeavour to make the facts apply, we very quickly see that this transmission never takes place. Attentive observation readily demonstrates to us the origin of the primary chancres; they are, however, very rarely observed in the newly-born. In these cases the mother always presents a chancre at the time, the pus of which becomes inoculated by means of an abrasion or of a wound made are hir in the child's skin. But this pus may originate from quite a different source; for example, from persons who attend to the child, or from the linen in which it is wrapped, so that the result will be the same: inoculation will be effected. It is not necessary to dwell upon this further to show that this is not one of the facts which is comprehended under the term of hereditary diseases; but it was necessary to give some details on this subject.

The true syphilitic symptoms, plainly transmissible by inheritance, are the secondary symptoms.

Missible

Is it by the germ at its origin, or rather by the materials extracted by the foetus from the maternal blood, that this communication takes place? This is a difficult matter to decide. On this point uly conjectures only can be made. However, if cases were met with in which a woman, who had no disease before her pregnancy, contracted chancres during gestation, followed by constitutional infection which became transmitted to her infant, it must be admitted that it is by the materials furnished to the foetus for its nutrition that the transmission has taken place. These facts require most careful observation.

But from the instant that secondary syphilitic symptoms give place to the tertiary symptoms, the hereditary transmission ceases entirely

or nearly so. Such at least is the result of the observations of M. Sys, an

Deville, who is in possession of a great number of facts in which the

patients were observed to miscarry, to give birth to still-born children, Cordua or to infected ones, during the whole time that the period of the

secondary symptoms lasted; but from the time that the tertiary to Cruitle

symptoms made their appearance, the same patients, having again become pregnant, gave birth to healthy children. It is, then, probably

a valuable element in diagnosis, to determine if a patient infected with Lary

constitutional syphilis is in the stage of secondary symptoms or in that

of tertiary symptoms. It is well understood that if a patient affected)with secondary constitutional syphilis undergoes a proper mercurial traus.

treatment, the syphilis is no longer transmitted. All that has been

previously stated relates to patients who have not been treated while uissible they were under the influence of syphilis.

Does a mother affected with tertiary syphilis (tertiary ulcerations,

coryza, ozæna, sub-cutaneous nodes, periostial swellings, exostoses, &c.)

62

HYGIENE OF INFANTS.

[Part I.

give birth to scrofulous children? No positive observation has yet Taus hits been produced in support of this opinion, which is not absolutely an But we know not what to think of this syphilitic

4

improbable one.

la origin of scrofula, when we see the persons who admit it cite in its support cases of the so-called transmission by parents who have had simple blennorrhagia, or by a mother who has had a simple ulceration of the neck of the uterus.

budicides, lise

The

A question still undecided is that of ascertaining if a nurse or a mother suckling her child, and contracting syphilis, may transmit this disease by lactation. M. Ricord believes not; and, in fact, we meet with more cases against the transmission than there are in its favour. It must, nevertheless, be admitted that the question requires to be studied over again, for certain facts appear to favour the possibility of a hush this transmission. Many difficulties occur in cases of this nature, but O Alua it is very astonishing to observe practitioners still allowing themselves to be deceived in certain cases by the nurses. In many cases syphilis is transmitted to children by nurses in the following manner, which it is right to remember. The nurse has chancres, the pus of these chancres inoculates the child; the child at first has a chancre (primary phenomenon), and then, in consequence of this chancre, but neither always nor inevitably, it has secondary syphilitic symptoms. The converse may take place, that is to say, the transmission may take place from the child to the nurse; for, besides the possible fact of a transmission by lactation, there is yet this circumstance, that children tainted with secondary symptoms may infect their nurse by originating around the nipples, to which their mouth is continually applied, a specific ulcerous inflammation, which often causes the loss of the nipple, and which soon determines other syphilitic symptoms. Practitioners should be fully alive to these facts in medico-legal cases.

ειδικών

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It was for a long time maintained that a child tainted from its birth with secondary syphilis, having no primary symptom, could not transmit that disease to its nurse. This is a mistake; and by attentive observation, the mind being free from every preconceived idea, it will be found that this may occur. I have seen several cases, and I am not the only one who has observed the like. I have seen children tainted with secondary syphilis transmit to their nurse, through the medium of fissures of the nipple, ulcerous inflammations causing loss of the end of the breast, and followed by sore throat, mucous tubercles, and syphilitic eruptions, &c. There are instances of children who have thus infected several nurses successively, and in which the other child, the foster brother or sister, has also contracted the disease. These facts are sufficiently numerous to engage attention, and if all are not equally explicit, there are sufficient of them to convince those not interested in this debate. Many of these cases will be found at the end of this work, in the

chapter specially appropriated to syphilis and to the transmission of this disease in the infant to the nurse.

[De Hery remarks that among other modes of communicating secondary syphilis, irreparable mischief is inflicted by tainted nurses infecting their foster children. A wet nurse, being thus disordered, but bearing no external evidence of her disease, is engaged to assist the natural mother, whose supply of milk is insufficient for the requirements of her offspring. The seeds of the malady are thus transmitted from the wet nurse to the infant, from the infant to its mother, and from the mother to her husband. Such kind of defilement may ensue upon casual contact of a sound infant with the breast of a different mother having the disease, and the evil may be accomplished by a single application.- Methode Curatoire ; Paris, 1552; p. 19.

Wiseman also has remarked, that "Nurses may either infect children, or be infected by them."-Chirurgical Treatises; book vii, p. 4; 1676.

Whitehead (on Hereditary Diseases; chap. ii; 1851) gives several instances of syphilitic infection through the medium of the breath of these, five were from the mother to the infant, in none of which was the nipple or adjacent parts excoriated— and one from the infant to its mother. In one case, the husband contracted a gonorrhoea during the fourth child-bed confinement of his wife, and communicated the infection, believing himself cured, after the term of her convalescence. The first symptoms in the wife were, vaginal discharge, irritable bladder, and flat tubercular eruptions about the vulva. At a later period, she had roseolous eruptions on the skin and iritis; and at this time the infant began to have eruptions, with sore mouth, husky voice, obstructed nasal breathing, &c., but it continued at the breast, without inconvenience to its mother, the usual length of time, and died, emaciated, at the age of sixteen months. The poison continued its ravages upon the system of the mother about fourteen years, and ended in malignant degeneration of the uterus, which had a fatal issue. During the period in question, the lives of ten children, born at the full term of gestation, besides an abortive pregnancy, fell an early sacrifice to the disease transmitted from their parent. In another case, the father was treated for primary syphilis when the infant was ten months old, who, as well as its mother, was then in perfect health. He appeared to be completely cured at the end of about two months, during which period, and for a length of time afterwards, no reinfection, on account of certain circumstances which existed, could possibly have taken place. Moreover, the symptoms which afterwards appeared in the wife, bore no evidence of a primary nature. The syphilitic affection appeared in the child befere any such manifestation was noticed in its mother, excepting purulent leucorrhoea. At fifteen months old, while still at the breast, the child had a crop of scaly blotches on the face and forehead, the nates, thighs, and abdomen, with sore mouth, noisy breathings, bad complexion, which symptoms were greatly ameliorated by the use of hydrarg. c. cretâ; at the age of fifteen months the child, who, in consequence of her indisposition and apparent inability to swallow a more solid diet, was still fed at the breast, had another necession of eruptions, more abundant and lasting than the preceding one. The throat, externally, was perceptibly swollen; the mouth inflamed and excoriated; the lips were cracked and angry; the eyes tender; the voice was husky; and the nasal breathing greatly incommoded. The cutaneous blotches were most numerous on the nates and face; more scattered on the extremities; still more distant on the body, except the upper and fore part of the chest. A yellow purulent secretion (blenorrhœa) escaped from the vagina, of which the labia were swollen and irritable; the anus was surrounded by a broad areola of papulous erythema.

These

There was tumidity of the abdomen, and dropsy of the ankles and feet. symptoms were not recent; they had existed several weeks; in addition, one or two lymphatic glands of the parotid region on one side of the neck, previous enlarged, began to inflame, and in a short time terminated in abscess, whence escaped a The considerable quantity of flocculent and very offensive pus. The child died at the age of twenty months. The only means of accounting for the origin of the child's decease, was, by imbibition through the medium of the lacteal current.

videns

In another case, the mother contracted primary syphilis from her husband, six weeks after her sixth delivery. All her previous children were healthy. The infant, also in health up to the date of its mother's accident, was covered with secondary syphilitic eruptions, and other symptoms, at three months old, several weeks before any secondary indications manifested themselves in its mother; and in a very similar instance, the mother contracted a primary affection from her husband, one month after her second delivery, the child and she being at the time in good health. Secondary symptoms, of characteristic form and of considerable severity, made their appearance in the infant a length of time before the complaint had assumed the secondary type in its mother.

In another instance, the primary affection, a gonorrhoea without complication,

Suport first appeared in the father; it then showed itself, under a severe form, in the

mother, who was actively treated, and considered cured in a few weeks; but the purulent discharge, with other inconveniencies, did not cease. She continued to suffer, acutely, from vaginitis, which was occasionally mitigated by local means, and as often returned; this, and the uterine disease already described-both resulting, doubtless, from the gonorrhoeal infection-were finally cured by local

(1 ls & (64, and general treatment, after having existed several years. When the infant was

three months old, six weeks after the reception of the poison by the mother, it had a violent attack of purulent ophthalmia, considered to be owing to imbibition of the poison through the breast milk. After the cure of this, as the child appeared plump and thriving, it was believed the taint had been eradicated. But, when twelve months old, on being weaned from the breast, the little patient had a violent attack of secondary syphilis, which resisted the simple measures first adopted, and was finally subdued by mercury. A tubercular eruption, occupying the back principally, with glandular swellings about the neck and throat, have continued to trouble him from that period until now-a space of fifteen years.

In another interesting case, a midwife became infected by digital inoculation, suckled her child fourteen weeks, which, at the age of six months, was pale, fretful, and manifestly out of health. There was a chancrous-looking ulcer under the tip of its tongue, and the rest of the mouth and throat was inflamed. It had hoarse voice, obstructed nose, and soreness of the anus, which was surrounded by an areola of erythema, the symptoms being evidently syphilitic. Hydrarg. c. cretâ was administered with complete success.-P.H.B.]

The period at which syphilitic symptoms show themselves in a child who has received the germ of it by hereditary transmission, is almost invariably from the first to the second month of extra uterine existence; nothing is therefore more common than to see syphilitic mothers giving birth to children who are at first apparently healthy, but, at the end of a month or six weeks, these infants are attacked with the syphilitic symptoms to which we are about to refer. Some persons maintain that they have seen syphilitic symptoms show themselves in

about

i infants at the eighth day after birth. This fact stands in need of unit confirmation, for nothing, in the present state of science, authorizes he us to believe in its truth. In order to arrive at a correct judgment on these cases of hereditary syphilis it must, moreover, be remembered

that many practitioners erroneously confound several of the eruptions Driestiens which appear in young children with syphilitic eruptions, of which, Syrup, however, they do not possess any of the characteristics.

Can hereditary syphilis betray itself by external symptoms showing ines as themselves on the child at the very moment of birth? This is still a disputed question. Practitioners of the highest standing, amongst whom ranks M. Ricord, believe that cases of this kind have been observed in an imperfect manner. M. Ricord, relying on this, amongst other reasons, that in the small number of cases which have been observed, the children were still-born, is rather disposed to believe that the pretended syphilitic eruptions were only the simple products of the commencing decomposition of the skin. This explanation is Sa probably not very correct; for M. Deville has had the opportunity

of observing in a still-born child well characterized and very numerous Supple triu mucous tubercles, on various parts of the body. We may then Einptions state that, almost invariably, hereditary syphilis does not manifest itself by apparent symptoms until towards the fifth or sixth week a bun after birth; but that it may, in some rare cases, produce syphilitic Observin eruptions before the foetus has seen light. In fact, in most of the childern cases of this kind observed up to the present time, the foetus had died in the mother's womb some days before the period of delivery; dying in but, very recently, children have been observed to be born, well formed, with evident symptoms of syphilis. M. Paul Dubois has observed

several cases of syphilitic pemphigus in children who have survived. uw days

M. Gubler has also observed a case; and I have witnessed the most curious of all these instances at the Hôpital de la Pitié, in a child whose case will be reported further on under the head of syphilis.

The symptoms of hereditary syphilis are composed of mucous tubercles, which are developed on all parts of the body, but especially 2,44 hitt in the neighbourhood of the folds of the joints and the perineum. These tubercles do not present in the child any more special character than in the adult, excepting their usually small size, their extreme softness, and the abundance of purulent matter which they secrete. It is very uncommon to see ulcerations appear on the palate, or velum palati. Probably, a form of chronic coryza, which was observed in four children who had red, irregular, ulcerated tubercles on the perineum, and who were the issue of syphilitic mothers, should be referred to syphilis.

As to the general phenomena, they may be wanting; but, generally, i the child is weak, loses its appetite, becomes pale and emaciated, and

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