The disease may originate with the father. In this case much discus sion has arisen as to the mode in which the mother becomes affected, or as to whether she becomes affected at all. In cases where there is no evi dence of direct contagion, it has been held by some observers that the mother may be infected by tainted spermatic fluid, although no primary lesion is produced. Others believe 'that the infection only takes place at the time when conception occurs ; others, again, deny that even in this case can infection be conveyed ; while a fourth class insists that when the mother becomes herself syphilitic the virus is introduced only indirectly, being absorbed into her system from the tainted embryo. This discussion has, no doubt, great scientific interest, but is of little practical value. • Of far greater importance is it to remember that a man may beget a syphilitic child long after constitutional symptoms have ceased to appear in his own person. From the researches of Dr. Kassowitz it appears that when left untreated, a series of years—six, eight, ten, or even more—may elapse be fore a man is relieved from the obligation of transmitting the taint to his offspring. When mercurial treatment is adopted, the remedy destroys for a time the power of the virus, and the parent is then capable of begetting a healthy child. But this immunity from transmitting the disease is not permanent. In some cases the influence of treatment becomes exhausted after a longer or shorter time, and the poison recovers something of its former virulence.
With regard to the escape of a mother who has borne a syphilitic child, it seems certain that the escape must be incomplete, for she acquires a strange immunity from further infection. Long ago Colles laid it down as a canon that " a new-born child affected with inherited syphilis, even although it may have symptoms in the mouth, never causes ulceration of the breast which it sucks, if it be the mother who suckles it, although contin uing capable of infecting a strange nurse." This law holds good as com pletely now as when Colles wrote in 1837 ; and it is difficult to understand how the mother can be proof against the poison unless she be herself the subject of the disease.
Still, there is no question of the apparent immunity of many women the mothers of syphilitic children. Dr. Kassowitz has brought forward instances to prove that the most careful examination, combined with watch ing extending over many years, may fail to detect signs of syphilis in women who have borne diseased children. It certainly does appear possible that, as Mr. Hutchinson believes, a woman may have a form of disease too fee ble to give rise to external manifestations, but strong enough to protect her from further contamination. Mr. Berkeley Hill insists that in all these cases the escape of the mother is not real. He believes, too, that in most cases she has contracted syphilis in the usual manner by direct contagion, but that the primary sore has escaped notice through examination having been delayed too long after the date of infection.
The mother alone may be diseased, the father being healthy. In this case if the mother have contracted the disease shortly before conception, and exhibit the secondary rash during her period of gestation, the child probably never escapes. If four or more years have elapsed since her in fection at the time when she becomes pregnant, she may have lost her power of transmitting the disease and the child may be spared.
If the mother be actually pregnant when the virus first enters her sys tem, she may or may not communicate it to her offspring. Much depends upon the period of gestation at which infection took place. The more ad vanced the disease in the mother before her confinement, the more likely is the infant to inherit the taint ; and if a secondary rash have appeared upon the mother's body before the end of her pregnancy, the child usually suffers severely from the transmitted disease. In the initial stage of the malady the power of the mother to impart the taint is less certain ; and it is im probable that the foetus can be infected if the parent have not herself suffered from constitutional symptoms. Therefore, if she only contract the disease towards the close of her pregnancy, the infant has a fair chance of escape. There is no evidence to show that the disease contracted by the mother after the eighth month of her pregnancy can be communicated to the foetus in her womb.
The influence of mercurial treatment in destroying the transmissive power is very decided. If a woman who has borne a dead or diseased child be properly treated before or during her next pregnancy, the infant borne after treatment will be either perfectly healthy or will suffer very slightly from the inherited taint. Still, as in the case of syphilis in the father, the counteracting power of the remedy is apt to be diminished by time.
When a healthy infant acquires the disease after birth, it is usually dur ing lactation, the nipple of the mother or nurse having become infected by the mouth of another child who suffers from the disease. It is doubt ful if the milk alone of a syphilitic woman is capable of communicating the complaint. Again, accidental contact with specific purulent discharges, whether from a primary sore or a secondary lesion, may impart the disease. In either case the sore produced in the child is a primary one. Another method by which the syphilitic poison may be conveyed to a healthy child is by vaccination. The possibility of such communication was loll.. denied ; but many well-authenticated cases in which this deplorable accident has occurred have now been published, and the evidence in its favour is com plete.