This rule is proved mathematically. Suppose that a child contracts syphilis on the day of its birth. The incubation period of chancre is three weeks at least —say, twenty days. The second incuba tion period averages about forty-five days—say, forty days; 20 4- 40=60. Therefore the secondary symptoms of ac quired syphilis cannot appear before sixty days (two months). Again, the presence of lesions peculiar to congenital syphilis will decide the question—eoryza, pemphigus, epiphyseal dislocations, ma rasmus, and cranial and nasal deformi ties. The examination of nurse and child being completed, the relation of the disease in one to that in the other is to be considered. There are three pos sibilities. Either may have contracted the disease from the other or the attacks may be independent. The previous con dition of the nurse should always he in vestigated, her child and husband (if there is one) should lie examined. The condition of the former is of the highest importance. Immunity is an almost ab solute proof of immunity of the mother. Syphilitic women may, with rare excep tions, beget apparently healthy children, but soaircely with recent secondary lyphi lis present. Next the priorny of disease in nurse or child must be ascertained if possible. When there is hereditary syphilis of the child, previons immunity of the nurse, her infection by a mam mary chancre which is in such a stage that it could have been acquired in the lactation being determined, the practi tioner is not justified in that her syphilis must have been acquired from the child. All that lie should say is that there are reasons which author ize the belief that the nurse could have acquired syphilis from the child. There may be other sources. Fournier (Lan cet, Jan. 22, '9S).
While it is the rule that a baby with hereditary syphilis does not infect its own mother, there are exceptions to this rule. However, their occurrence is so rare as to "prove the rule." The baby should not be taken from its mother's breast, but the mother should be warned and should be kept under observation. A syphilitic element often underlies eases of malnutrition which manifest them selves in many children, even of well-to do parents, by feeble vitality and poor de velopment of muscle and bone. All the usual hygienic and climatic measures will often fail to improve these children, though they will thrive when given anti syphilitic treatment. It is often neces sary to repeat this medication at inter vals up to puberty. So-called cases of retarded syphilis are really examples of an improperly treated syphilis of child hood reappearing years afterward, per haps not until the age of twenty or thirty. Such ]ate developments can be prevented by a sufficiently long course of specific treatment hi early life and oc casional inspection for several years af terward. A. Jacobi (PiTdiatrics, March 15, 1902).
The possibility of acquiring the dis ease by vaccination must also be remem bered, although non-humanized virus is now almost exclusively used, and such an accident can only occur through care lessness. There is also the possibility of contamination through criminal assault. Such cases have no bearing upon con genital syphilis, save that great care is to be exercised in differentiation.
It is held by many that either parent may transmit syphilis to the child, al though, so far as the father is concerned, the question to procreate a syphilitic child without first infecting the mother is still sub judice. The presence of the
syphilitic microbe is probably incom patible with the life of the spermatozoa; but, until the germ of syphilis has been absolutely demonstrated, we can only claim theoretically its necessity in this particular method of transmission. The most plausible view is that, while the presence of the syphilitic germ is neces sary in order that the semen should be inoeulable, its presence is unnecessary in order that the father should impress the foetus with conditions which, while not specifically syphilitic, are none the less derivatives of that disease.
It is a popular fallacy to regard a eon siderable number of cases in which the father of syphilitic offspring is syphilitic and the mother is apparently free from the disease as due to the sperm being syphilized.
It is supposed that the spermatozoon hears with it the syphilitic virus, and introduces it into the ovum at the mo ment of conception, and thus the off spring develops, syphilized from the start, the mother being and remaining absolutely free from taint. But it is in credible that the germ gain entrance into the spermatozoon, for the spermatozoon has not the means of ingesting foreign bodies, while there is no evidence that the syphilitic germ is ammboid and capable of making its way into the sper matozoon.
If the syphilitic virus gained entry into the unsegmented human ovum, its effects would lead to the destruction of the ovum. Foetal syphilis must origi nate at a later date, and, although syph ilis in the parents may doubtless have its effects upon the ovum and spermato zoa of the same, and lead to constitu tional disturbances in the offspring, progressive syphilitic lesions, the true syphilomata, in the foetus and infant are not inherited, but are congenital; that is to say, acquired in ?dem after con ception. If the mother be without sign of syphilis, and the child be syphilitic, the only satisfactory explanation is that the syphilitic virus has entered into the maternal organism and tissues, and has failed to induce any characteristic lesion at the point of entry, but has, through the placenta and choriouic villi, gained an entrance into the foetal tissues; the process arrested in the mother has been developed in the susceptible tissues of the child, and there is here an example of the variability in the manifestations of the disease dependent upon the react ive powers of the tissues. A further word in support of this contention is found in the significant way in which the liver is affected in congenital syph ilis. Extensive specific lesions of the liver in the acquired disease are rela uncommon. They are the most common of all lesions in the congenital affection. Were the ovum infected it would be difficult to explain why the liver should thus he especially singled out. This organ is the first to receive the blood coming by the umbilical vein; then, if the infection originates from the placenta, hepatic implication is the natural sequence. The essential differ ence between such congenital, or ante natal, and "acquired," or post-natal, syphilis is that in the former the virus passes immediately into the blood, and so becomes disseminated through the organism, while in the latter the dis semination is delayed. The second stage of acquired syphilis is the first stage of the congenital disease. J. G. Adami (Canadian Pract., July, '98).