Antenatal Prophylaxis.—One should endeavor to prevent the birth of syphilitic children by appropriate treatment of the syphilitic parents, either before, or after marriage. Healthy children, further, must be protected against infection by a rigid surveillance of wet-nurses, and by alI those measures that tend to prevent contact infection from one person to another. It is evident that a consideration of the "pro tection of the child against syphilis" should include also the "protec tion of the wet-nurse against syphilis from the child she nurses." With reference to the prevention of syphilitic births, we should begin, first of all, with marriage. The important point here is to deter mine the state of health of the person who is about to marry. It devolves upon the family physician to insist upon a frank confession on the part of the candidate for matrimony as to whether he has had syphilis, at what time, and with what symptoms, and not to permit. marriage until at least four years have elapsed since the primary infec tion, during three years of which he has been treated systematically, and during the last six months, at least, of this time he should have been wholly free from symptoms of syphilis. Even with all of these pre cautions, too ninny syphilitic children will still be born to such par ents. The only absolute protection against hereditary syphilis would be the prevention of the marriage of all men who have ever been syphi litic and their strict adherence to coitus condomatus in general.
In those rare cases where the woman was syphilitic before marriage, a much longer prohibition period should be enjoined, because the pos sibility of transmitting the disease to the offspring extends over a longer period of time in the case of the mother than of the father. Though it is permissible to allow marriage to the syphilitic if there has been a rigid enforcement of the above-named conditions, one should not encourage it.
Different conditions are presented to the physician if marriage has already taken place with one of the contracting parties syphilitic. If the man is in a period of latency, the woman free from syphilis, and the offspring nevertheless syphilitic, no matter whether born as the result of abortion, as still-births, or as manifestly syphilitic infants, the husband should undergo energetic treatment, to prevent the birth of other infected children. I do not consider it necessary to treat the mother in whom the physician has never seen evidence of syphilis, in the above circumstances, and I forbid the husband to have any intercourse with his wife during the period of treatment with mercury. If the wife becomes pregnant after the husband has completed this energetic treat ment with mercury, it is still a matter of dispute whether she, too, should be required to take a like treatment. Those who believe that syphilis can be transmitted only by the mother, would treat the preg nant wife even if she had never had symptoms of the disease (Matze nauer, Mracek); I consider such a course superfluous. If, however, the pregnant woman had shown symptoms of specific infection either before or during her pregnancy, or if there is evidence of such infection from the history, then she must be given a most energetic mercurial treatment. Riehl has recommended for this purpose combining the constitutional treatment of the mother during pregnancy with the local use of vaginal suppositories each containing mercurial ointment 1.0 Gm. (15 gr.), cocoa butter 1.0-2.0 Gin. (15-30 gr.), a procedure that has the warmest approval of Vorner.
If the date of primary infection of the husband is far removed and the wife, who has remained and is now free from syphilis, becomes preg nant, it is advisable to omit all antisyphilitic treatment of both parties and quietly await the termination of pregnancy.