Secale 187 – Condition necessary for the Hereditary Transmission of Syphilis.
It has been generally accepted as a fact, that the mother, if she had been cured of syphilis a short time previous to the born of the child, or was still affected with secondary syphilitic phenomena, may give birth to a child tainted with the disease; an indispensable requisite to effect this result was suppose do be, that the mother must still exhibit unmistakable symptoms of the syphilitic disease. That this, however, is not necessary and that the disease can be transmuted by a mother in. he apparent enjoyment of perfect health, even years after every vestige of the infection had apparently been wiped out, is shown by a case related by Vassel, of France, where a woman who had had syphilis, of which she seemed to have been radically cured, had two children by a second husband, both to whom were born and died with unmistakable signs of syphilis. Her husband died of typhus, and never had shown the least symptom of syphilitic taint. What seemed still more remarkable was, that this same woman again gave birth to thee syphilitic children by a third husband whom she married soon after the each of this predecessor whereas she herself continued to enjoy the most blooming health, and not one of her husbands ever showed the least symptoms of syphilitic taint. Another remarkable circumstance in this case is, that the second of these children infected its nurse with syphilis. That the syphilitic disease may not only be inherited from the mother, but likewise from the father, and that the mother may be predisposed by a syphilitic husband for all time, for giving birth to syphilitic children, through she herself may never exhibit a single sign of any syphilitic taint, is authenticated by a remarkable case related by Vidal, Paris, where a woman, after having had a child that soon after its birth died with all the symptoms of hereditary syphilis, by a man who was infected with chronic syphilis of long standing, four years after this event gave birth to a syphilitic child by a perfectly sound man, without a single syphilitic symptom having ever broken out on her own person. Another mystery, or, at any rate, a fact in the generative sphere that has not yet been accounted for, is the following: If a perfectly white slut is impregnated for the first time by as black dog, some of her young will be white, some black, some spotted white and black, of, afterwards, she is impregnated by a totally white dog, the color of her first mate will reappear in more or less striking spots. the male impresses upon the female a type that shows itself in the subsequent offspring of the same mother. Cazenave relates several similar cases where mothers, who seemed perfectly free from all syphilitic taint, gave birth to syphilitic children, some of whom infected even their nurse’s On of these cases is remarkable for the fact, the a woman who had become infected during her pregnancy, but had been perfect cured, gave both to a perfectly healthy child, all of whose other children, however, were born syphilitic. if Cazenave, however, infers from these cases that the mother always remains sound as long as the husband is only affected with constitutional syphilis, I recall, in a, the readers’ attention too case from my own practice, No. 103, where the mother had never become tainted during the times that she lived with her constitutionally-syphilitic husband, but who, during the last month of her pregnancy, and more particularly after having been confined of a dead of child, broke out with a secondary exanthem, of he form of lichen, over her whole body, more particularly over her arms and legs. These cases, where the capacity of the father of directly transmitting the diseases had become roused again into activity, after it had been slumbering for a long time, and where, in one case, a mother was infected by her dead foetus, and, in the other, two nurses, by infants that were syphilitic at birth, and had been conceived under the influence of a latent syphilis are exceedingly remarkable, and, for the present, meet with something analogous only in certain plants, whose latent poison only develops itself during their stage of flowering and fructification.
Secale188.-Syphilis inherited from Nurses.
In the preceeding paragraph we have spoken of latent syphilis being communicated through father and mother. Syphilitic infection can likewise be communicated by the milk of a nurse. Such cases likewise come in he category of hereditary syphilis; for here to the disease is communicated by a latent contagium, not by means of the open and demonstrable action for the syphilitic virus, as is the case when the nurse has syphilitic nipples or chancrous ulcers on the mammae. These cases of syphilis that are inherited from nurse, are probably much more numerous than is generally supposed; indeed, most of the cases of syphilis, where the disease is transmitted by nurses, most likely belong to this category. I only know of two of such case, where the disease had undoubtedly been communicated by the milk from a nurse’s breast; one of these cases is recorded in Bertin’s “Treatise on the Syphilis of Pregnant Women and New-born infants,” and the other case occurred in my own practice. Bertin’s case is that of a perfectly sound farmer’s wife., who had never had syphilis any more than her husband, and whose perfectly healthy child was attacked with chancres ulcers on the labia five months after her birth, of the nature of which the surgeon who had been consulted on the subject was ignorant, and which he dried up with lead water, shortly after which, buboes and syphilitic pustules on the thighs and legs made their appearance. Until then the child’s parents had enjoyed perfect health; five months after the child had been taken sick, the nipples of the mother, who continued to nurse the child, were attacked with syphilitic rhagades; afterwards other syphilitic symptoms broke out in other localities. Upon inquiry it was found that an aunt sometimes tended the child, and that this aunt was affected with constitutional syphilis. In order to quiet the child, she not only put it very frequency to he own barest, but warmed the water, with which she was ion the habit this case doses not show weather the aunt had syphilitic ulcers in her mouth, and if may be supposed that she had not, for the reason that, if the contrary had been the case, the reporter would undoubtedly have made mention them; this case derives additional confirmation from another case, which I have watched myself even to the minutes details. It was the case of the child of a young German here in Paris, who having been educated in. the strictest principles,. only frequented religious societies, and, at the age of frequently-four years, in. state o perfect moral and physician soundness, married a young girl of seventeen equally free from all physical and moral taints. She gave birth to a robust and lovely girl, who, on account of her parents’; teaching music town through the day, had to be entrusted to a nurse, whom I examined with the greatest care, nipples, breast, skin, etc., and pronounced perfectly sound and free from all possible taint. In spit of all this care, syphilitic pustules broke out two months afterwards on the thighs and nates of the child. Upon further inquiry into the circumstances of the nurses family, who was still her child, soon after birth, had died of an inflammation of the throat, which the physician of the village had pronounced diphtheritic and that her husband was still affected with symptoms of an inveterate chronic syphilis, more particularly with ephelides on the breast and on other parts of his body which we have described in another division of this work as scattered, exceedingly chronic spots, resembling liver spots from which they are distinguished, however, by their circular, definitely-circumscribed borders. The nurse was dismissed and the child, having taken Mercurius 3, half a gain every four days, was soon freedy ad remained free, from every symptom of disease.
Secale189.-Diagnostic Signs of Hereditary Syphilis.
We have already stated, at the beginning of this article., that congenital syphilis shows itself at the birth of the child, whereas hereditary syphilis breaks out at a later period. As regards the time of its appearance, authors do not agree; some, like Fabre, Rosen, etc., assume that it may slumber in the body for years, and may not betray its existence until the age of pubescence. Generally, however, the disease begins to show itself in about eighteen or twenty months after birth, but may break out already in a few months. Most frequently the disease first manifests itself during the period of teething, in which case the manifestations never are of the order of primary, but invariably of that of secondary phenomena In most cases it is an exanthem, more particularly roseola syphilitica, that constitutes the beginning of the series, after which the affections of the mucous membranes make their appearance, first and most speedily followed by other ulcers and caries of bones, until death soon after relieves the sufferer from all earthly woe. This termination is the more frequent the younger the child; if the disease does not break out until the child is two years old, the prognosis is not so unfavorable. The constitution of such patients is always suffering in a remarkably characteristic manner. Such children are almost always the victims of a deeply searching marasmus, as if the organic tissues were being decomposed even during the lifetime of the sufferers; their skin is lived, lifeless, and dry, like parchment, and an appearance of old age and decay imparts to them an expression of cachexia, such as is witnessed in the case of older syphilitic individuals. such children may die already in the mother’s womb; if this happens, no sign of syphilis is seen on the bodies of such still- born children any more than on those of other children that are still-born from any other cause; whereas, if the syphilitic disease is acquired during the act of generally, syphilitic signs are never wanting, even on the skin of stillborn children, and are always the same that show themselves, in congenital syphilis a few days after birth, and belong more or less to the primary period of syphilis. In most cases of this kind, we find the sexual parts of such children studded with mucous tubercles, or syphilitic exanthems are found upon the skin, more particularly ecthyma (see No. 102), or the syphilitic pemphigus (sec No. 98). Except pemphigus, which is one of the most dangerous forms of secondary syphilis in the case of new-born children, all their other syphilitic affections are much more easily cured when acquired at birth or during the act of generation than when hereditary. We repeat not all children who are tainted, with hereditary syphilis die prematurely; manifests itself in their frames. it is difficult to decide what is the cause of he diversity of the degrees of intensity and danger manifested by such hereditary dispositions; some of these differences may perhaps originate in the circumstances that will be dwelt upon more fully in the next chapter, when surveying the first moment of infection to its definite and full manifestation,
