Syphilis may be transmitted by indirect in heritance through the specifically infected sperm or ovule at the time of impregnation or through the utero-placental circulation in the course of pregnancy. Post-conception syphilis is applied to cases where the mother—or even both par cuts — may be healthy at the date of conception; the wife is infected during the course of preg nancy and she in turn transmits the disease to the child in utero through the vascular channels of the utero-placental circulation.
Syphilis may be transmitted directly from the father, the mother remaining healthy, al though in most cases the mother is infected by the foetus in utero. It may be transmitted di rectly by the mother, the father being healthy. The paternal hereditary influence is compara tively restricted; the influence of maternal heredity is much more certain and pronounced. When both parents, are syphilitic, the infection of the child is almost inevitable — especially, when the disease of the parents is recent and active. The percentage of deaths from mixed heredity varies from 60 per cent to 86 per cent. The quality of hereditary transmissibility is not impressed upon the syphilitic organism perma nently. As the disease grows older there is a progressive enfeeblement of the transmissive power, until it finally becomes extinct. The influence of heredity is rarely manifest after the fourth year; still, there are many well authenticated cases in which it may be pro longed five or six years or even longer. The attenuating influence of time upon syphilitic heredity is shown in a series of successive preg nancies. The first pregnancies terminate in abortions, which occur at a later and later period ; then, still-born children, or children liv ing at birth hut which soon die; then, syphilitic children, surviving but showing evidences of specific taint ; and, finally, healthy children, free from all signs of the paternal disease. Specific treatment also exercises a powerful corrective influence upon heredity. It frequently. happens that if syphilitic parents tmdergo active treat ment before the time of pro-creation the child is born healthy. If this treatment is now sus pended, the next pregnancy may result in a sYPhilitic child. Treatment seems, then, not to
entirely extinguish, but rather to hold in abey ance, the transmission capacity.
Hereditary Death of the child in ntero is the most habitual expression of _heredi tary syphilis. More than one-third of all syphi litic children born alive die within the first six rnonths of their existence. An analysis of statis tics from authenticated sources shows that only one child finally survives out of four syphilitic pregnancies. In the immense majority of cases infants with syphilitic taint begin to show signs of the disease from the second weelc to the second or third month. It was formerly thought that if there were no evidences of contamina tion within the first year it might be assumed that the child had escaped. It is now known that even if the syphilitic child has escaped the early manifestations of the disease it may be doomed to the lesions of late hereditary syphilis, which are especially liable to appear at the period of second dentition, the period of pu berty, from the 20th to the 30th year, or even hter.
When a child the subject of inherited syph ilis is born alive it may be apparently healthy and present no positive evidences of specific tami Very often lesions of the osseous systern are the only evidences of inherited disease mani fest at birth. After a certain period, usually within a few weelcs or months, the child may begin to show the stigmata of the parental dis ease. The surface manifestations of inherited syphilis, like those of the secondary stage of the acquired form, are eat first generalized and diffuse. Later, they become more discrete, with a tendency to localize themselves in eertain regions. Lesions of the internal organs often co exist with the earliest cutaneous manifestations. Hereditary syphilis is further differentiated from the acquired form by certain lesions which are its exclusive products. They are not in their essential nature syphilitic, but rather the result of changes impressed upon the fcetus in its formative or developmental stage. They present the characters of dystrophies or de generations due to perversions of nutrition. These dystrophies may affect the entire body or be limited to a single organ or a system of organs.