The Influence of Syphilis on Pregnaney.—Although the influence of syphilis on pregnancy is unquestioned, it is, however, Tiot absolute, and varies with the conditions according to which syphilis appears in women. The important fe,ature is the frequency of abortion and premature deliv ery. Among 657 syphilitic females, 231 miscarried, while 426 were de livered at term of living and dead children. But, as we have seen, four eases may be presented, and we must consider here: The father alone is syphilitic. The mother has never presented, nor does she now.present, any manifestations of syphilis. The idea of direct transmission from the father to the fwtus, without participation on the part of the mother, which was opposed for some time, has been defended by Trousseau, Diday, Bourgeois and many others. It remains to-day incontestible, and we have observed numerous cases.
As regards maternal syphilis we have seen that: 1st. The woman may be affected before conception; 2d. Syphilis and pregnancy may begin simultaneously; 3d. Syphilis may have been contracted after conception, at a period of pregnancy more or less advanced.
1st. Syphilis existing before Conception.—A syphilitic woman who be comes pregnant is far more predisposed to abortion than a pregnant woman who subsequently becomes syphilitic. This is especially observed.in cases of repeated abortion, and it is now a classical fact that all accoucheurs, both in France and abroad, with a few exceptions (happily rare), advise that, when successive abortions are observed in the same woman -without apparent cause, she should be put on antisyphilitic treatment, and that, too, not only when no specific manifestation is present, but even when she has never shown any.
When the pregnancy advances to term, the child may; 1st. Be born healthy and in good condition, and may remain so (this is exceptional); 2d. It may be healthy when born, but may, during the first three months after birth, rarely later, show symptoms of syphilis (quite frequent); 3d. It may show symptoms of syphilis from its birth, and may then either suc cumb quickly (the rule), or may be cured by appropriate treatment (the exception); 4th. Although apparently healthy when born, it may die within a few days, either by reason of its feeble condition in consequence of premature delivery (often), or from convulsions (when delivered at term.) 2d. Syphilis and Conception are concomitant. —Here, too, abortiOn is the rule, or at least delivery is often premature, and in consequence of the rigid treatment to which the mother is subjected the child may, in exceptional cases, be born healthy (or without evident traces of syphilis), and then, as in the former instance, may either be cured or may succumb.
3d.. Syphilis is contracted after the fourth or fifth Month of Pregnancy. —In this case the danger is less. Abortion does not take place, but de livery is often premature, and when the foetus reaches full term it may frequently be born healthy; or it may be apparently healthy when born, but may present syphilitic manifestations within two or three months after birth.
4th. Finally, the Woman contracts Syphilis only at the Termination of Prepiancy.—Then the danger is almost nil; pregnancy is concluded in the ordinary manner at term by the birth of a living, healthy child. It is during the secondary stage, that is, from the fourth month to the second year of this period, that maternal syphilis seems to predispose most to abortion. But, as we know, syphilis may be active at the end of three, four, five, six years, or even longer. Those women are most prone to abort who are affected with severe forms of the disease--those who, to use Fournier's expression, are affected " rudement et visceralement;" but, abortion may occur in all forms of the disease, even the lightest, and is often the sole expression of the diathesis. " There are a certain number of women," says Fournier, " who abort exclusively because of syphilis, without, at the same time, presenting or having presented, for a period more or less remote, any appreciable specific symptoms." In his opinion, then, even latent syphilis is still capable of causing abortion. We share this conviction fully.
We see, therefore, that syphilis is one of the diseases that deserves the greatest attention on the part of the accoucheur, and we realize the full importance of treatment in the interest of the mother a8 well as the child. Some writers (happily few) have nevertheless insisted that these ravages should be attributed, not to the pox, but to its antidote, mercury. Such a view could not be too strongly opposed, and all obstetricians agree with all the syphilographers in advising mercurial treatment during pregnancy, not only in the case of women who are actually affected by syphilis, or who show evidences of it, but in every instance in which the father has had syphilis, and where there have been repeated abortions without any known cause.