TRANSMISSION OF SYPHILIS In acquired infantile syphilis there is a single mode of infection just as in later years, contact infection; hereditary syphilis on the other hand may be transmitted in two ways. We may have a germinal hereditary transmission through the germ-cells, or a direct intra uterine infection. Ever since Kassowitz's epoch-making work on this subject (1S76), the possibility of a germinal transmission has been undis puted, while intra-uterine infection by way of the placenta was held to play a subordinate part. Recently Matzenauer (1003), as Oedmansson did formerly, has maintained that a transmission from the spermatozoa to the ovum has not been proven, and that intra-uterine infection is the only conceivable method of transmission of syphilis from the parent to the offspring. He supports this view by the fact that a purely germinal transmission is unknown in any other infectious disease. His main thesis is: "Without maternal syphilis, there is no hereditary transmission of the disease of the child." It is not possible in a work of this kind to discuss this view in de tail: a view that would have at least the advantage of greater simplic ity if it were tenable. I, for my own part, must hold to the possibility of a purely paternal, i.e., spermatic, transmission of syphilis, a conclu sion that is based on many years of careful observation. With all due respect to Matzenauer's attempt to simplify this complex question of hereditary transmission of syphilis I cannot refrain from expressing my conviction, that in his zealous endeavor to refer all questions pertain ing to hereditary syphilis to intra-uterine infection by way of the placenta, he has, in more than one way, distorted clinical facts. With the large and constantly increasing literature on the subject of hereditary syph ilis, it is impossible to go into details and mention all of the past and present authorities, and their various views. It will be possible to take only a general survey of the most important views and questions bearing upon the subject. As to terminology, Solger and Martins maintain that if Matzenauer's view were accepted, the term ''hereditary syphilis" would be incorrect, and "congenital syphilis" should be put in its place, since only such disturbances could be looked upon as heredi tary, as had been transmitted through the germ. Schaudinn, in conjunc tion with Hoffman, has possibly found the specific cause of syphilis in their spirochaqe pallida. The demonstration of this bacterium, that is characterized by a special form with narrow, steep, and numerous con volutions (up to .14), is most satisfactorily made by staining with a modified Giemsa stain dried specimens obtained from the tissue juices of eroded syphilitic primary and secondary lesions. Buschke and Fis cher, Hoffmann, Levaditi, Salomon, Leiner, Nobecourt, Bayet, have all found the characteristic spirilla in the contents of the blebs of syphilitic pe mphigus. M. Oppenheim and 0. Sachs, however, could not find them
in the same lesion. In the liver, spleen, lungs, lymphatic glands (Bertarelli and Volpino, BrOnnum, Ellermann, Reischauer, Buschke, W. Fischer), and in the blood of children with hereditary syphilis, this parasite has been seen, so that Levaditi considers hereditary syphilis as a spirillosis. The frequent positive findings in hereditary syphilis, and the occurrence of spirochete pallida in the inoculation scleroses of monkeys, would lead one to attribute to this parasite a more impor tant role in the etiology of syphilis, than to the other microorganisms that have been advanced as the specific cause of this disease.
Classification of Hereditary Syphilis.—Two factors must be con sidered in the hereditary transmission of syphilis: 1. The hereditary transmission of the contagion, which leads to genuine, virulent infection in the offspring.
2. The hereditary transmission of certain constitutional changes that have been brought about in the parent by the specific poison, these changes manifesting themselves in the offspring as more or less well marked general disturbances such as one finds in the offspring of alcoholics, arthritics, etc.
Those belonging to the first group represent congenital syphilis in the narrower sense. This may be divided into syphilis that has mani • fested itself during intra-uterine life, and that which has appeared only post-partum. The former may be subdivided into syphilis embryonalis,. fcetalis, and neonatorum. The latter, according to the views of many, should be subdivided into syphilis congenita prfecox and tarda, de pending upon whether the congenital disease first manifested itself shortly after birth, or not until the time of puberty. That the latter. form has in no way been proven, may be stated in advance at this point. There is still less evidence of an inheritance of syphilis by the grandchild, i.e., the third generation, which, if it did exist, would form a.. special form of late syphilis.
The second main group no longer depends upon changes brought about by direct hereditary transmission of germs, but upon the devel opment of disease and of dystrophic conditions, such as arrest of de velopment, and constitutional disturbances, which do not themselves represent syphilitic affections, but are connected with, and dependent upon, the depraving influence of syphilis upon the general health of the parents (A. Fournier's Parasyphilis). Similar symptoms may as a result of syphilitic infection, either congenital or acquired, later in life, so that besides the congenital parasyphilitic affections, one must distinguish also those which appear later in life.
Sources of Hereditary syphilis may orig nate from the father, or from the mother, or from both at the same time.