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348. The growth which results from the action of the diseases of youth is not so rapid as may be at first imagined; it is always more considerable in appearance than it is in reality.

349. The influence of diseases on growth should be directly referred to the influence of the febrile state which accompanies them.

350. Exaggerated growth acts in its turn as a cause of ulterior disease; and pulmonary, cardiac, or paralytic affection may be the consequence of it.

BOOK XXVI.

ON SYPHILIS.

Syphilis is a very common disease of a specific nature, engendered by a poison which attacks the vital and nutritive processes, subverts them, and exhibits itself, sometimes externally, by local affections, which present a specific and characteristic appearance.

Syphilis in the adult begins to be well known in some of its phases, thanks to the labours of Hunter and Ricord.* The laws of primary syphilis have been especially determined, but those of the constitutional affections are still a matter of speculation, and future observations will doubtless modify them greatly, if they do not upset them altogether.

Much less is known of the syphilis of newly-born infants than that of adults, and the difference of age produces so great a difference in the external forms of the disease that it renders the diagnosis very obscure. This form has been carefully investigated by Jacques Catanée, Nicholas Massa, Fallopius, Botal, Ferrier, Harris, De Blegny, Boerhaave, Astruc, Rosen, Doublet, Mahon, Bertin, &c. The work of R. J. Bertint is the most valuable, from the number of his observations and from the acumen which marks them. Hunter, strange to say, scarcely notices syphilis in newly-born children, and the facts which he records are so disguised by theoretical hypotheses as to render them almost valueless. They are scattered throughout his book, and

* Traité de la maladie vénérienne, par J. Hunter, nouvelle edition, avec des editions par Ph. Ricord; Paris, 1852.

Traité de la maladie vénérienne, chez les nouveaux-nés, les femmes enceintes et les nourrices;

Paris, 1810.

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ingeniously classed under the title of Diseases which resemble Constitutional Syphilis. They are, as he would make it appear, anomalies of such a nature as are not found in any nosological chart, and which await some ingenious man to find them a name.

Syphilis in newly-born children may be primary, i.e., the result of accident, and acquired at the moment of birth or a short time afterwards, by means of a chancre contracted whilst passing through the external parts of the mother, or may be communicated by a stranger. It may be hereditary, and, consequently, constitutional, that is to say, transmitted by the father or mother during the generative process, or by the mother after conception, if at the commencement of her pregnancy she was infected with the disease.

1ST. OF PRIMARY SYPHILIS.

Primary syphilis in newly-born children presents the same characters as the disease in the adult. It commences by a chancre on the parts of generation, and more frequently in the mouth, on the face, or trunk. This chancre is cured, and there the matter may end; or, after the lapse of several weeks or months, secondary or tertiary symptoms supervene, as in the adult. These are well recognized facts in the present day, and on which it is unnecessary for me to dwell.

2ND. HEREDITARY SYPHILIS.

Hereditary syphilis is always constitutional, and, consequently, characterized by secondary symptoms; it may be the result of the father being himself the subject of inveterate constitutional syphilis. It is not less seldom the fault of the mother, who has at some former period been attacked with secondary symptoms, and who either has them at the time of her delivery or is about to have them at some later period. It is produced-1st. By the impure impregnation of the ovum by the father. 2nd. By the development of a diseased ovum by the mother. 3rdly. By contamination from the maternal blood * after conception, when the mother is infected for the first time, during the course of her pregnancy.

It is necessary for the transmission of the disease in the case of the mother, that she should still be the subject of the secondary symptoms of syphilis, for, according to the researches of M. A. Deville, it appears that tertiary symptoms do not affect the embryo. The ovum may be infected by the father when he is suffering either from secondary or tertiary symptoms.

It has been asserted, and Bertin has supported this opinion, that syphilis may be transmitted during lactation, and that a nurse, or a mother suckling her infant, and contracting syphilis may transmit w it by means of her milk. There is nothing proved as respects this suit

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point. Nevertheless, science is in possession of several facts which appear to favour the possibility of the poison being so transmitted. We may put to ourselves the question, why, if the milk of a woman who has been suddenly excited, produces instant convulsions in the child, the milk altered during its secretion by the syphilitic t poison, cannot produce that disease, since afterwards, when saturated with mercury or iodide of potassium, this same milk loses its noxious qualities, and, made healthy, becomes the medium by which the cure is affected. But these are questions to which no satisfactory answer can be given, and over which the greatest obscurity still hangs.

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Infection of the foetus, in the womb of the mother, is a frequent cause of premature death, and of abortion at the fifth, sixth, and seventh months. Nothing is more common than abortion at the L'Hôpital de l'Ourcine, and in the houses where women suffering under the venereal disease are received. The greater number of women who he told abort many times in succession, and that without external injury, who and b cannot go the full time, and who are delivered of still-born children, are women constitutionally tainted, and who are, either themselves or their husbands, affected with latent syphilis. The proof of this assertion is, that it is often only necessary to submit the husband and wife, or one of them, if the guilty party be discovered, to treatment, for a subsequent pregnancy to have a happy termination. I have known many ladies who have thus had two or three successive abortions, and, suspecting the existence of syphilis in the family, I have discovered it to be present, at one time in the father at another in the mother.

It only remained for me to administer the proper treatment for the disease, when these ladies were delivered of healthy children at the full time. All surgeons have had similar cases under their care.

Thus, then, in hereditary syphilis, the first common danger is the death of the foetus before the full time, and its premature expulsion; next follow the deeper lesions of the thymus gland, of the liver, of the lungs, and also the rare occurrence of local venereal affections on the body before birth-sometimes also children are born with syphilitic cutaneous eruptions but most commonly, if they reach the full time, they are born without any external traces of syphilitic disease. These affections show themselves at a later stage.

The time at which syphilitic symptoms show themselves in a child who has inherited the germ of the disease, is almost constantly about the first or second month of extra-uterine life; thus nothing is more common than to see mothers, whose constitutions are infected with syphilis, give birth to children who are at first to all appearance healthy, but at the end of a month or six weeks these children are attacked with syphilitic symptoms such as I am about to describe. Some observers have noticed syphilitic affections show themselves

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[Part III. ce in newly-born children on the eighth day after birth, but this circumсединая hu stance is very rare, and deserves to be carefully investigated, for fear of a mistake which might very easily be committed. It must be remembered, in order to form a just diagnosis of these cases of hereditary syphilis, that many surgeons mistake eruptions common to young children, for syphilitic affections, to which they do not present the slightest resemblance.

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Can syphilis show itself by external symptoms at the very moment of birth? This is still a disputed question. Practitioners of the greatest eminence, and amongst them ranks M. Ricord, believe that cases of this kind have been recorded in a very loose manner. M. Ricord founding his opinion, amongst other reasons, on this, that in the small number of cases which have been noted, the children were still born, was inclined to believe that these so-called syphilitic eruptions were only simply commencing decomposition of the cuticle. This perhaps is not a very satisfactory explanation, for M. Deville has had the opportunity of observing on a newly-born infant numerous and well marked mucous tubercles on different parts of the body. I have seen one case at the hospital of La Pitié, under the care of M. Michon, in a child who lived three days, and who was born before the full time, at seven months.

Spes In addition to mucous tubercles and red brownish copper-coloured pustules on the legs and arms, the vulva was swollen, the nymphæ ulcerated and covered with an abundant leucorrhoeal discharge, and onychia was present on all the fingers and toes.

At the autopsy I discovered no disease in the periosteum or in the structure of the long bones, the lungs and thymus gland were healthy, no change was to be seen in the liver, all the abnormal appearances were on the surface of the body.

The mother had contracted syphilis during the first month of her pregnancy, and had had a discharge, doubtless an undetected chancre, afterwards pustules on the labia. At the time of her delivery she was quite well.

It may be asserted then as a general rule, that hereditary syphilitic affections do not appear by outward signs, until about the fifth or sixth week after birth, but that they may in some rare cases produce syphilitic eruptions before the child has seen the light. In the greater number of cases of this kind which have hitherto been recorded, the child at the time of birth had been dead several days, but it may also be born alive. M. Paul Dubois has noticed several cases of syphilitic pemphigus in children who have survived.

M. Gubler has likewise seen a similar case at the Hospital of St. Louis, and I witnessed the most curious case of all at La Pitié, in the child whose case I have just related.

The symptoms of congenital syphilis are as numerous in their forms as they are uncertain in their seat. The local evidences of the syphilitic

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poison are internal or external, and may appear on the skin and mucous membranes, under the form of syphilitic eruptions, and in the internal ut organs, such as the thymus gland, the liver, the lungs, the bones, &c., under the appearance of plastic infiltrations, or unhealthy suppuration. On the skin, they show themselves in the form of desquamations of the epidermis, of the face, and extremities, fissures in the hands at the situation of the folds of skin, vesicles which multiply, become confluent, keee and form superficial ulcerations of greater or less extent, which have a jagged appearance, and present a red, livid, coppery surface, covered l with small greyish dry crusts. At other times they are in the form ptions. of ecthymatous pustules, or syphilitic tubercles, pustulous or mucous patches which appear on all parts of the body, but more particularly in res the neighbourhood of joints, or in the region of the anus or perinæum. These patches do not differ in the child from the appearance they exhibit in the adult, if we except their habitual small size, their marked flabbiness, and the abundance of purulent matter which they secrete. In other children they appear as syphilitic bullæ, and as more or less numerous phlyctenæ of pemphigus. In others again, it is a specific inflammation of the edge of the nail, which constitutes onychia, and I have counted twenty on the same child, i.e., as many as the fingers and toes. On the mucous membranes it shows itself in the form of pustules around the anus and mouth, of numberless fissures on the chapped lips, of aphtha on the internal surface of the cheeks, and very rarely' ulceration of the throat and soft palate, and also of numerous ulcerationsssof the nose, followed by an abundant secretion from the nostrils. Internally, in many glands, in some of the viscera and in the different organs, the lesions are not less various.

We already know that curious condition of the thymus gland which 1 M. P. Dubois has met with in many children, the issue of syphilitic parents, and themselves presenting symptoms of constitutional syphilis. The thymus presented nodules of inflammation and suppuration scattered throughout its substance. These cavities, full of pus, examined with the microscope, have not hitherto presented to M. Dubois any other pathogenic appearances than what I have just described; thus making the same reservations as I do, this talented professor was right to believe the change to be of a specific nature.

In the lungs, lobular nodules, with a yellowish plastic and greyish effusion, and with suppuration, have been noticed by Billard, Ollivier, Husson, Cruveilhier, as nodules of lobular pneumonia occurring before birth, and often coincident with syphilitic pustules. At least that is what Ollivier has stated in Billiard's work, and Cruveilhier in his Pathological Anatomy.* But M. Depaul has gone farther; he has *Anat. patholog, du corps humain, avec pl.; t. i, 15a livraison.

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