Secale 184- Limits of the Liability to Syphilitic Contagion.
Although it is generally admitted at the present day that syphilitic primary products, such as chancre, fig-warts, gonorrhoea, etc., can only be occasioned by direct contact of he morbid cessation with a spot that is susceptible to the action or influence of the contagium, yet there are not only lay-persons, but likewise physicians, who believe that the fluids of a patient may become so thoroughly poisoned by constitutional syphilis, that the disease may not only be communicated by contact with his person or clothes, but even by the air that has become impregnated with his breath, at least within a certain proximity, as when sleeping with him in the same bed. Without appealing, in examining this question, to the authority of our greatest writers on syphilis, such a Hunger, Babington, Cazenave, Ricord, Lagneau, etc., who, backed by a large number of the most careful observations, deny the possibility of the disease being communicated through these channels, I am prepared to state from personal experiences that, in numerous cases where persons whose constitutions were thoroughly saturated with the syphilitic disease slept for months with perfectly sound individuals, primary products were never caused in any other way except by direct contact of the infectious matter with the lips, mouth, or other equally susceptible localities. Whenever the eruption on the lips, affections of he mouth, or chancres in the throat, were knows to be of a secondary, not primary nature, I have never known kisses or any other contact of the mouths or tongues cause any appearance of syphilitic disease. This has been so uniformly true that, whenever primary symptoms resulted from any such causes, I have always felt certain that there aware primary products present in. the mouth, whereupon, an examination of the parts always resulted in confirming my suspicion. If an observation of this kind, however, r is to hold good, the consecutive phenomena have to be carefully distinguished from exclusively secondary products, and not both be mixed up together in one class, as if still done by a number of our physicians; the consecutive phenomena on the sexual organs, such as mucous tubercles, condylomata, etc., are always contagious; the truly secondary phenomena are not, or rather never, contagious. Now, if secondary phenomena themselves do not transmit the contagion, even when two bodies are placed in the most direct and most intimate contact with each other, how then are the sweat, saliva, clothing, etc. of such patients to acquire the power of infecting other individuals? What may have given rise to the supposition that those objects can become capable of communicating the disease, is probably the circumstance that syphilitic secretions do not lose their infectious power, even after they have become dried up for some time, and that this power again becomes active, after the fashion of certain infusoria, as soon as the fluidity of the succussion is restored. Thus, lint, to which old syphilitic matter is still adhering may infect a person by being placed upon a recent wound. A pocket- handkerchief, with which a syphilitic patient had wiped his chancres, may communicate the infection to a sound person, if he should use it for the purpose of blowing his nose, and the secretions from the nose should have liquefied the solidified chancrous pus.
In the same ways, pantaloons or bed-clothes may communicate the infection, in consequence of the dried-up chancrous matter becoming softened by the warm sweat of the patient and coming in contact with some susceptible art of his body. We have not yet found out how long such dried-up contagious matter may retain its infectious power; it is generally known however, that the idio- electrical bodies, such as glass, wool, silk, etc., retain this power much longer than electoral conductors, such as metals, coal, etc. The infectious power of the contagium is likewise very soon extinguished either by a high degrees of warmth, 25* to 50* R., or by intense cold; whereas, with a moderate degree of temperature, it may continue for years. According to some, the contagium, at the period when it emanates from the producing agent, loses all its infectious power for a few moments, specially when several acts of infectious coition have taken place in rapid succession one after the other; this point however, it may not be variety easy to prove.
Secale 185.-Circumstances by which the Power to transmit the Infection is either diminished or increased.
It is a well-known fact that there are individuals who cannot expose themselves in the least to venereal infection without either having chancre or gonorrhoea; whereas others, even prostitutes who abandon themselves with unbridled recklessness to the most libidous intercourse with the other sex, remain perfectly free from venereal taint even like animals, no species of which has yet been known to the susceptible of tea venereal disease of the human family. Again of several persons who have connection with the same syphilitic women one becomes tainted, the other, even of generally every susceptible may remain free from all contagion. These different degrees of susceptibility have been sought to be accounted for in different ways, more specially by the circumstances that both parties, the woman as well as the lover, observe the most perfect cleanliness after the act. Every frequent of brothels, who has never yet been caught, imagines that his apparent immunity is owing to the circumstance that, after having connection, he he makes it a point to always wash himself thoroughly. A want of cleanliness may evidently contribute a great deal toward aggravating existing ulcers or other products to a very high degrees; but it is a sad and pernicious mistake to suppose that the contagium can be removed by washing the parts immediately after connection. We know from thousands of cases that, in spite of the most thorough washing the contagium can be absorbed by the organism even during the act of coition,. and develop all he ill-effects of the poison. Another error is committed by Hunter, when he teaches that all danger of contagion is removed by washing off the traces of morbid secretion immediately previous to having connection he secretion of matter going on all the time, it is replaced just as fast as it is removed by washing. What has been said of the parts becoming blunted by frequent attacks is equally disproved by facts. A former inspector of the public health has assured me that these are prostitutes who, six months after having been discharged from the public dispensatories, have to be returned to these institutions, on account of again having become diseased, and they spend the best part of ten or fifteen years under medical treatment. Whether the susceptibility to disease is increased by a first attack, is not made out by such facts as we have reported. Nor is it sure whether mental emotions, or the use of spirits beavers, increase the susceptibility; the many cases of infection occurring during a debauch most likely occur in consequence of the parties being utterly unaware of what they are doing, or with whom they have connection. The same doubt exists regarding what many books teach of the influence of climate, temperament, and social position and circumstances, and the susceptibility of venereal contagion. It is true that the people of the North, persons of phlegmatic temperaments and in opulent circumstances are less liable to attacks than the people of the South, or persons of Sanguineous temperaments, or the working classes; but this is not owing to a less degree of susceptibility inherent in the former, but to the fact that they do not expose themselves with the same indiscriminate recklessness as the latter. What is, however, a more absurd opinion than any, is that the intensity of he contagium diminishes in proportion as the act of coition is repeated more frequently, and that the forms of the communicated infection consequently grow milder. The contagium always remains the same, producing, as the case may be, gonorrhoea, chancre, or consecutive products, and the subsequent intensity of the phenomena is so little dependent on the quantitative degree of infectious power inherent independent on the quantitative degree of infectious power inherent in the original matter, that an individual affected with a whole crop of chancres and buboes may only communicate a small, not very malignant chancre; whereas another individual, with a scarcely perceptible ulcer, may communicate the worst form of phagedaenic chancre. It is only the species (gonorrhoea, chancre, mucous tubercles) that is determined and communicated by the act of coition; all the rest depends upon the nature of the soil where the seed is planted, the same as in the vegetable world.
IV. HEREDITARY SYPHILIS.
Secale186.-General Remarks.
Although we have stated and plainly shown in the preceding article that secondary syphilis can neither be transmitted by the spitle, or the sweat, or the imperceptible perspiration of the patient, the case is different as regards the transmission of secondary symptoms in an indirect way, by the fathers seen during the act of coition, by the mother’s blood during pregnancy, or by the nurse’s milk while feeding the baby at the breast. This mode of transmitting the syphilitic disease, which may taken place even if no visible trace of the disease exists, is one of the most mysterious processes of communication; but should not be confounded with the manner in which the disease is communicated to the infant by syphilitic nipples, or by chancres, or tubercles in the vagina, with which the child may come in contact during its passage into the world nor should it be confounded with the case where the father or mother is infected with primary syphilitic ulcers during the act of generation, and the embryo becomes tainted at the very moment of conception (congenital syphilis). These three kinds of communication, the last- mentioned, as well as the two former, are direct modes of transmitting the contagium; the mode of transmission of which we are treating in this paragraph, and which results in the production of hereditary syphilis, takes place without, takes – place without any present influence of a developed contagium, and constitutes, so it say, progressive unfolding of the parental constitution that had become morbidly altered by a formerly contracted syphilitic disease, and which a transmitted to the offspring, in the same way as the scrofulous, tuberculous, arthritic, cancerous and other hereditary dispositions, diseases, or diathesis. It is uncertain whether ancient authors were acquainted with this mode of transmission of syphilitic constitution. It is not probable,. however, that they were, since, in using the term hereditary syphilis, they evidently meant a syphilis acquired by direct contact with some primary syphilitic product, such as charges in the vagina, etc. Fabre, for instance, remarks, that syphilis can be inherited, if, during the act of generation either the father of the mother is affected with syphilitic ulcers; or Van Swieten says, that the syphilis of he infant nay been caused by the syphilitic products with which the mother becomes tainted either during the act of generation or during her pregnancy. An essential distinction between the two modes of transmission of the disease consists in the fact that, when tainted with congenital syphilis, the child shows trace of the disease immediately after birth. or is still-born or dies soon after it is born, specially if the mother during her pregnancy, did not undergo a through anti- syphilitic treatment. In hereditary syphilis, on the contrary, the child is often born with every sign of good health, and the syphilitic symptoms, such as all sorts of exanthems, exostoses, affections of the mucous membranes, suspicious ulcers, etc., only develop themselves at a later period, sometimes not till year have elapsed, scarcely ever before three of six months after birth. How this transmission of the syphilitic disease takes place without the foetus becoming tainted with new infection; whether, in such cases, the blood of the mother, or the semen, the nurse’s milk constitutes the carrier of the tainted contagium, or of specifically-abnormal movement principle, which, without being able to infect healthy persons, can communicate itself to the fecundated germ (or the nursing by the nurse’s milk), and, as soon as the organism after birth enters its own sphere of independent development, continues the abnormally-excited movements of the infantile organism in the same directions as they had been going on in the organism of the father or mother; will, most likely, remain as much of a secret as the transmission of all other intellectual and moral quantities from the parents to the children.
