father's disease. This supposition is difficult to reconcile with the fact that mothers in perfect health and vigour are unable to shield themselves from syphilis, nor does syphilis infect the weakly more readily than the robust; though it may take a more severe course in the former than in the latter.

Syphilis is supposed, when it passes through the fœtus to the mother, to attack her at once with the later forms of the general disease, without passing through the earlier manifestations. Among the fifty cases of Mr. Hutchinson already quoted, in Nos. 6, 12, 16, 20, 23, 26, 33, 41, and 45, the patients had not been infected more than two years, and some for a much less time, before they came under observation. They had suffered from sore throat, papular scaly eruptions, fall of the hair, condylomata, &c., which are the ordinary symptoms in persons who have been infected in the common way. Deep ulcers of the throat, serpiginous ulcers of the skin, disease of the bones, and such like, were remarked only in women who had been married many years, and had suffered a long time from syphilis. Several of these latter cases besides had suffered from the early rashes also. These cases contradict the inference that syphilis, if ever communicated from the child to the mother, differs in its course from the disease propagated in the common way; on the contrary, they fully show that syphilitic women, when pregnant, pass through the same forms of the disease as women not pregnant, and so far as the general character of the disease is concerned, it is immaterial whether they be infected during or previous to pregnancy. The primary disease was not looked for at the time likely to be found, hence it cannot be assumed to have been absent. Again, the foetus affects the mother with the disease in its later forms, and it is strange that the young child, when it infects other persons, its wet-nurse for

example, transmits the disease in a form exactly similar to that communicated between adults. At present our knowledge enables us to say that inherited syphilis passes readily from the mother to the child, probably also that when the original source is the father, the child gets it from the mother, who has been inoculated previously to the child's taking the disease. Lastly, there is little reason to suppose a fœtus ever infects its mother in utero.

Vehicles of Contagion. Of these the most undoubted are the secretions of syphilitic affections; the thin fluid of mucous tubercles and the discharge of the initial ulcer, developed at the point of inoculation, are perhaps the most frequent sources, because these affections are situated on the genitals and around the mouth, parts ordinarily and intimately applied in contact between individuals. Narratives of experimental inoculations of syphilis, from mucous tubercles and indurated chancres, are contained in the writings of Vidal de Cassis,1 Gibert, Hübbennet,3 Bärensprung, and many others, of whom Wallace,5 of Dublin, was the earliest who employed this means of investigation. The works of Hunter, Rollet, Diday," Langston Parker, Langlebert, Jeffrey Marston,10 Henry Lee, are stored with instances of incidental transmission of the disease by contamination with the secretions of secondary affections.

9

1 Traité des Maladies Vénériennes.

2

2 Traité des Maladies de la Peau et de Syphilis. 1853.

3 Die Beobachtung und das Experiment in der Syphilis.

11

4 Annalen der Charité, Berlin; and Friedreich, Lehre vom Schanker.

6 Archives de la Médecine, 1859; et Traité de Maladies Vénériennes.

7 Histoire Naturelle de la Syphilis, and Infantile Syphilis, 1859, pp. 154

158.

8 Langston Parker on the Modern Treatment of Syphilis.

9 Langlebert: Du Chancre produit par la Contagion des Accidents Secondaires de la Syphilis.

10 Marston: Medico-Chirurg. Trans., vol. xlv.

11 Henry Lee on Syphilis. 1863.

Diday, in his account of the transmission of syphilis from children to their nurses and attendants, has collected a number of instances of this kind.

For an illustration of contamination by the secretions of the general disease, the following examples, taken from my own notes, may serve :-J., 33, applied to me for relief with the following history. Some time before, while fighting, he had received a blow on the cheek and eye which drew blood; to prevent a black eye, the wound was sucked by his antagonist; after this treatment it quickly healed and disappeared. No further inconvenience occurred till six weeks later, when pimples appeared; these gradually enlarged, and a scab fell off from them. When he came under my care, there were elevated flat tubercles on the upper part of the cheek and lower eye-lid of the right side; they varied in size from a shilling to a split pea; they were not ulcerated, but desquamating and quite dry; they had a dull brownish red hue; the lymphatic glands at the angle of the jaw on the same side, were enlarged. The man was pale, but he had a rosy rash across the forehead, along the chest, and on the abdomen; there was no sore or scar on the penis, no enlargement of the inguinal lymphatic glands, and no history of any such having been present; he took mercury, and ultimately recovered, While he was under treatment, he brought me his former antagonist, whom I examined, and took the following note. F. M., 31, a wheelwright, related that when he sucked J.'s cheek, he had a sore mouth, and also some sores on his penis which had existed for six weeks or two months before he struck J. He recollects that the lumps now in his groin were there then; has never noticed any rash on his skin, or sore throat; he has been very well ever since. On examination the sore proves to be a fissure at the angle of the mouth, and one or two enlarged papillæ round it, which are moist

and scaling, but devoid of any induration. There is no ulceration of the mucous surface of the mouth and fauces, the lymphatic glands are not enlarged under the jaw at the back of the neck. The body is free from eruption of any kind, save one or two acne spots that have a coppery tint. On the penis are two scars with well-marked induration, the site, the patient says, of the sores he had at the time of his scuffle; the lymphatic glands in both groins are plainly enlarged, not at all tender, and the skin over them has its natural colour. He has never taken any medicine for his ulcers, and the only other inconvenience he has been conscious of is the persistent sore of the mouth. Small doses of mercury and iodide of potash were given for a few weeks, and the sore healed, while the induration on the penis much diminished. So far these cases have been already published in the "Lancet" of June 18th, 1864, but in addition to them I have notes of J.'s wife and child. When J. had been two months under my care, he brought his wife for an eruption on her chest, neck, shoulders and arms. These were covered by a fine lichenoid eruption of coppery colour, some of the minute papules being surmounted by a small clear vesicle. The inguinal glands were severally enlarged on both sides; one of the carunculæ myrtiformes was indurated and superficially ulcerated. Subsequently this woman had the scaling papular eruption, pustules of the scalp, sore throat, &c. J., when interrogated afresh, said he had not observed any eruption on his privates, but had not desisted from intercourse with his wife, though advised to do so when he first applied to me. On examination the privates were clear of eruption, and there was no gleety discharge. The wife brought her child on one of her visits. This child was born before its father had been inoculated, was healthy, and well-grown. The mother, though ill herself, had continued to suckle it until the day she brought it to the

hospital, this being done because the child was pale, and had lost its appetite. On examining him, I found a sore on the left side of the mouth at the inner border,

hard, elevated, and as large as a sixpence; the mouth elsewhere was quite healthy. Under the jaw on that side the glands were enlarged and knotty, very different to those on the opposite side; when the child was undressed there was no rash to be found elsewhere. The nostrils and the anus were clear, and there was no snuffling; the mother did not know how long the lump had existed on the mouth, or under the jaws. I examined the breast of the mother, and found on the right one at the outer side of the areola an elevated moist patch, from which a fissure passed to the nipple. This, I conclude, was the ground whence the child sucked in syphilis with his mother's milk.

Wishing to see the disease more clearly developed, I told the mother to wean the child, and feed him well; meanwhile, only giving him some steel wine. In a short time blotches appeared on the trunk, and sores at the anus and throat. The symptoms readily subsided with small doses of grey powder, and the infant regained his health and strength. Both mother and child have shown themselves to me, twelve months after their last symptoms, in the enjoyment of good health. My reasons for considering these three cases to have been communicated by the secretions of general syphilis are, that in the first and third cases, the primary disease began at the points to which these secretions had obviously been applied. In the second, the evidence is not conclusive, as the woman might have been infected by another man with an indurated chancre on his penis. She was a respectable married woman, and her husband was undoubtedly syphilitic; hence, we may consider it at least highly probable that she received her disease from him.