TWO LECTURES 
ON 
INHERITED SYPHILIS. 
BY 
JOHN S. PARRY, M.D., 
One of the Attending Accoucheurs tp the Philadelphia Hospital, etc. 
REPRINTED FROM THE PHILADELPHIA MEDICaJP^J^E^. 
PHILADELPHIA: 
J. B. LIPPINCOTT & CO. 
1872. Lippincott’s Press, 
Philadelphia. INHERITED SYPHIEI,^ 
liectttirie X. 
GENTLEMEN: I shall call your attention 
morning to inherited syphilis; a very important 
subject, because the disease is very frequent, is to be 
met with in all classes of society, is protean in its 
forms, and must often be recognized and treated under 
the most embarrassing circumstances. The moral and 
social questions connected with the disorder make it 
necessary for you to be perfectly familiar with its pecu- 
liarities, for the peace and well-being of families will 
often depend upon your decisions. See to it, then, that 
you are sufficiently well informed to furnish reliable and 
truthful opinions upon the subject. See to it that you 
do not hereafter disturb domestic happiness by untimely 
statements or errors in diagnosis. 
This hospital is very rich in illustrations of this dis- 
ease, and I shall avail myself of the opportunity of show- 
ing you some very interesting cases this morning; but 
I want to say in the beginning that I have not at present 
the material to illustrate all the different varieties of the 
disease, while the wards happen to be very well supplied 
with examples of some of the late lesions of the affec- 
tion. 
The history of the first patient whom I shall show 
you is as follows : 
Case I.—J. W., set. 2 months. In 1865 his mother had 
primary, followed by constitutional, syphilis, which she did 
not contract from her husband, who has always been a healthy 
man, and who was at that time away from home. She has 
had no severe tertiary manifestations. Her body is covered 
with scars of a previous skin-eruption, but she has not suffered 
from any acute symptoms for more than a year. Excepting 
with this child, she has not been pregnant since she contracted 
the disease. 
He was born March 29, and at this time weighed nine 
pounds and two ounces, and appeared to be healthy in eyery 4 
particular. When two weeks old he began to suffer from “ a 
cold in his head,” and when four weeks old a mottled erup- 
tion appeared over his thighs and buttocks. This gradually 
spread to the trunk and legs. Since then it has never dis- 
appeared. 
Present condition, June 4, 1872.—He appears to be fairly 
nourished, is quite fat, but his muscles are rather flabby. He 
is suffering from persistent though not severe coryza. The 
lips are not fissured. Over the forehead and upper part of 
the cheeks is a faint dark-colored mottled eruption. On the 
lower inner part of the cheeks and the chin the skin is “ bistre- 
colored,” or has the appearance of being stained by a solution 
of some dark-brown substance. The arms and upper part of 
the trunk are covered with obscure copper-colbred spots. The 
eruption is best developed upon the buttocks and lower ex- 
tremities, where there are numerous copper-colored, squamous 
spots, round or oval in shape, from a few lines to a quarter of 
an inch in diameter, and but slightly if at all .elevated above 
the surface. The palms of the hands and the soles of the feet 
are perfectly healthy. There are no mucous patches any- 
where. 
His general health is moderately good, though he is rather 
irritable and suffers a good deal from diarrhoea, the discharges 
being green and mucous. 
There are several points in this case that I hope you 
have noticed as I read the history. These are the fact 
that the disease has developed itself in an unequivocal 
manner in a child whose mother at the time of concep- 
tion and during her gestation was not suffering from 
progressing constitutional syphilis; and the occurrence of 
coryza, followed by a scaly eruption, in a child who at 
birth was very healthy and weighed more than new- 
born infants ordinarily do. I remember seeing this 
boy in the wards the day after his birth, and, as I did 
not then recollect that the mother had had venereal 
disease, I did not think of his being infected by this 
poison. This is not an uncommon history; and you 
must not think that syphilitic children are always born 
with the marks of the disease upon them. On the con- 
trary, the opposite is more frequently the case ; and of 
the children that we see here, many of them appear to 
be plump and hearty at birth, and do not present that 
old, weazened appearance which has been described by 
some authors. 5 
You have heard the account of the coryza by which 
he has been affected. This is one of the earliest, if not 
the very first, of the symptoms of the disease in a ma- 
jority of the cases. It is likely to attract the attention 
of the mother at an early period, because coryza, which 
is of little importance in older children and adults, in- 
terferes so much with the nursing of young infants that 
in them it becomes very important, and demands the 
care of the physician. In this instance it has not been 
at all severe. 
Certain important symptoms of congenital syphilis 
have not been developed in this child. In many or 
most cases of the disease, peculiar and very character- 
istic lesions of the mucous orifices follow the coryza of 
which we have been speaking, so that we often find it 
associated with linear fissures at the orifices of the nose, 
and upon the lips. These are comparatively superficial, 
have red bases, from which blood oozes, or they are 
covered with dry brown crusts. They radiate from the 
corners of the mouth, nostrils, and sometimes from the 
external angles of the eyes. When they are well devel- 
oped and are associated with coryza, they form such a 
characteristic picture that the experienced physician 
can determine the nature of the affection at a glance. 
When these lesions have healed, they often leave perma- 
nent linear cicatrices,—a fact which it is well to remem- 
ber, as these are so peculiar as to be very valuable in 
the diagnosis of late syphilitic manifestations, the nature 
of which may be doubtful. I say these symptoms have 
not been developed in this and some of the other chil- 
dren whom I shall show you. 
The cutaneous eruption in this instance is squamous, 
and you see that it has a distinct copper hue. In addi- 
tion to this, I ask you to notice the peculiar discolora- 
tion of other portions of the skin. You notice that 
the lower portion of the face especially is dark, and 
has a stained appearance. The peculiarities are not 
easily described, but the color has been compared to 
that of bistre, or staining from weak coffee. This ap- 
pearance has been described by Trousseau (Clin. Med., 
vol. iv., Philadelphia, 1871), whobelieves it to be pathog- 
nomonic of the disease which we are discussing. I 
consider it a most valuable sign ; and, although it is 
imperfectly developed in this case, the appearance is 6 
sufficiently characteristic to lead an experienced physi- 
cian to suspect this child to be the victim of congenital 
syphilis. 
In some cases, instead of having a squamous syphil- 
ide, such as is present in this child, the eruption consists 
of bullae,—pemphigus, as it is termed in the books. 
My own experience would lead me to conclude that 
this form of skin-eruption occurs in those cases in 
which the disease manifests itself very soon after birth. 
It usually appears within a few days or weeks after the 
commencement of extra-uterine existence. My experi- 
ence has also gone to show that it is only present in 
those cases in which the cachexia is profoundly devel- 
oped; and, while pemphigus is a very important, it is 
not a very common eruption in inherited syphilis. 
Some authors have gone so far as to look upon all cases 
of infantile pemphigus as very suspicious, and as nearly 
always having a specific origin. Indeed, I am not sure 
but that a few good authorities say that it always has. 
I am very positive that this is not true, for it has been 
my fortune to meet with many cases of infantile pem- 
phigus ; and if I were to draw a conclusion from what 
I have myself seen, I would say that no variety of 
skin-disease is more frequent than this among children 
between one and fifteen months old. But I presume 
that my experience has been somewhat peculiar, for I 
have seen pemphigus sweep through the wards of this 
hospital, upon two separate occasions, almost like an 
epidemic. But at these times it presented well-marked 
and very important characters. The eruption was very 
constant in its seat, being located upon the neck, chest, 
and back, while it appeared but rarely upon the ex- 
tremities, and, if at alt, never iipon the palms of the 
hands or the soles of the feet. This I conceive to be the 
important distinction between specific and non-specific 
pemphigus. The former in the majority of cases 
attacks the palms of the hands and soles of the feet, 
and is nearly always confined to these parts. If you 
meet with this bullous eruption limited to these loca- 
tions in young infants, you are justified in suspecting 
that they are the subjects of inherited syphilis. Ac- 
cording to my own belief, it would amount almost to a 
positive conclusion. 
In certain rare cases, specific pemphigus first makes 7 
its appearance upon other parts of the body. I have 
met with a few such, and in all of them the disease 
existed at birth or set in immediately after it. In 
one instance it appeared upon the face at the end of 
the first twenty-four hours, and spread very rapidly. Of 
these infants, those who were born alive perished in a 
short time ; and, indeed, out of all the cases of specific 
pemphigus which I have seen, I cannot now recall one 
who lived beyond a few months, while most of them 
succumbed within a few days or weeks. I have previ- 
ously hinted that it occurs in those who have inherited 
a severe form of the disease,—those whose systems are 
thoroughly saturated with the syphilitic poison. For 
this reason the prognosis of specific pemphigus is very 
serious,—a statement which is but a reiteration of a 
common opinion. I believe that all authors agree in 
regard to this point. 
In the patient who is now before you, the disease 
seems to have commenced about a week after birth, 
but there were no positive symptoms of it until 
the child was about four weeks old. This is not un- 
common, and inherited syphilis usually makes its ap- 
pearance within the first three months of life. Of 
Diday’s frequently-quoted cases, the affection com- 
menced in 86 out of 158 children before the termination 
of the first month. But this is not a rule to which we 
find no exceptions. Some time since, I showed the 
class an infant over a year old, whose mother had 
suffered severely from a constitutional disease, and 
who then had for the first time a mild syphilitic erup- 
tion upon the trunk. I have also seen several cases in 
which the first symptoms were noticed much later than 
this,—in the third year of life. One of these I shall 
show you presently. 
By what you see in this child, and from what I have 
already said, you have learned that the first symptoms of 
inherited syphilis are analogous to, and must be compared 
with, those of the secondary stage of acquired syphilis 
in adults. I think, too, that my experience in this hos- 
pital goes to show that just in proportion as the appear- 
ance of these is delayed until a remote period after 
birth, will they be mildly developed. In some instances 
they are so mild as to escape observation, or else they 
are not developed at all. I have reported such a case 8 
in the Photographic Review for February, 1871, and I 
shall now bring another one before you. 
Case II.—Inherited Syphilis without the History of 
Secondary Symptoms ; Severe Tertiary Lesions.—E. H., set. 8 
years. Her parents have had six children, of whom this one 
is the third. Of these only the eldest and our patient are now 
alive. The former is a healthy girl. The second child died 
early in its second year, of summer-complaint. The last three 
children are all dead, having perished within a few weeks 
after birth. Her father died four years ago, of haematemesis. 
His wife says that he never had syphilis in any form, but that 
she was suffering from the disease at the time she conceived 
this child. Four months after her birth, tertiary symptoms ap- 
peared, and she had nodes on various parts of the body. In 
the middle of 1870 she was the subject of active and severe 
tertiary syphilis. 
At her birth this child was perfectly well. She continued 
so until she was a month old, when an abscess formed on the 
back. This appears to have been the result of a contusion 
which she received at the time. From this time until she was 
two years old she continued well, so far as her mother was aware. 
Her mother denies that she ever had any symptoms of the 
disease with which she is now affected. She was then attacked 
by infantile paralysis, which presented the ordinary characters 
of the disease. Five or six months after the occurrence of 
the paralysis she began to suffer from convulsions. These 
were preceded by hard, painful swellings upon different por- 
tions of the head, but especially upon the forehead, where sup- 
puration finally occurred. This was accompanied with en- 
largement of the lymphatic glands of the neck. She was 
relieved by treatment, and remained pretty well until she was 
four years old, when she had nodes upon the upper part of the 
tibia, the backs of the hands, and the frontal bone. These 
were accompanied by cutaneous ulcers. 
When she was five years old, February, 1869, she was ad- 
mitted to this hospital, suffering severely from these symptoms. 
Shortly afterwards a node appeared at the outer condyle of the 
left humerus, and gradually increased until there was swell- 
ing of the whole elbow, with slight synovial effusion. From 
then until now she has suffered severely from repeated 
outbreaks of tertiary symptoms. Two years ago, otorrhoea, 
with which she had been affected at intervals, reappeared, and 
has continued ever since. Nine months ago she had an 
attack of interstitial keratitis, which has left the cornea of the 
left eye hazy. Two weeks ago she complained for the first 
time of sore throat, and with this she began to discharge 9 
offensive purulent matter from the nose and pharynx in con- 
siderable quantities. 
Present condition, June 5> 1872.—Pale and very anaemic. 
On forehead, in median line, is a depressed white scar, from 
which pieces of frontal bone were removed by Dr. Duer, last 
fall. There is a slight opacity of left cornea from a previous 
attack of keratitis. (Right eye lost in infancy.) Copious and 
very offensive, thick, purulent discharge from nostrils. Teeth 
small, upper central incisors imperfectly developed and slightly 
notched; but, though suspicious, they are not characteristic. 
Upon inspecting the throat, thick, yellow, and very fetid pus 
is seen running from the posterior nares into the pharynx. 
Upon the half-arches are superficial sloughing ulcers. She has 
a copious discharge of pus from the left ear. At various 
points upon the surface of the body are the cicatrices of pre- 
vious eruptions and ulceration. She now has substernal 
tenderness, and there are rapidly advancing nodes on each 
tibia. 
I hope that you have been fully impressed by the 
salient points in this case. The syphilitic origin of the 
disease is undoubted ; but, carefully as I sifted the his- 
tory, I could not learn that she had ever suffered from 
any of the ordinary secondary symptoms, while, as you 
notice, she had nodes upon the forehead when she was 
two years and a half old, and these were followed 
by a similar lesion on the extremities. I have had an 
opportunity of watching these swellings run their course, 
and they have all the characters of the nodes of acquired 
syphilis. Indeed, you can prove this for yourselves by 
examining those at present on the tibia. It is asserted 
by Mr. Hutchinson (Diseases of the Eye and Ear in 
Inherited Syphilis, 8vo, London, 1863, p. 216) that the 
nodes of inherited syphilis first affect the lower part of the 
humerus. I have now under my care a patient in whom 
the first bone-disease was in this part, but in this child 
the forehead was first involved; and I should certainly 
say, from the cases which I have seen in this hospital, 
that the forehead and tibia are as likely as the humerus 
to be primarily affected. But the most interesting point 
in the case is the alleged absence of secondary symp- 
toms. Some syphilographers, I know, doubt the cor- 
rectness of such histories as this one. I have already 
alluded to another which I published in the Photo- 
graphic Review February, 1871. In that instance the disease appears to have been transmitted from 
the father, and the child remained well until she was 
two years and nine months old, when nodes appeared 
on the tibia, and rapidly produced destruction of the 
bone. The illustration accompanying the history of 
that case shows that the disease of the osseous system 
was of no ordinary severity. Indeed, I do not remem- 
ber to have ever seen it greater in any of the many and 
terrible examples of acquired syphilis that I have had 
the opportunity of examining. The only authority, so 
far as I am now informed, who acknowledges that these 
tertiary lesions ofhereditary syphilis may be thus tardy 
in their appearance, and not be preceded by primary or 
secondary symptoms, is Melchior Robert (quoted by 
Lancereaux, Treatise on Syphilis, New Syd. Soc. ed., 
vol. i. p. 166). Of his opinion Lancereaux says, “This 
interpretation may appear hazardous.” There is evi- 
dently much difficulty in arriving at the truth, and I 
must confess that I have grave doubts about the sec- 
ondary symptoms not having preceded the tertiary in 
this and other similar cases. They may be so mild as 
to escape the notice, not only of the mother, but also of 
the physician. Allow me to illustrate this. I alluded 
a moment ago to the infant in whom the first symp- 
toms of the disease made their appearance when the 
child was over a year old. I speak positively about 
that child, for my colleague, Dr. Maury, was kind 
enough to give me his opinion in regard to him. The 
mother had been severely affected by constitutional 
syphilis, the skin being covered with scars, the cicatrices 
of nodes appearing over the superficial bones, and the 
hard palate and bones of the nose being totally 
destroyed. At the time of her conception, and during 
the whole of her gestation, there were no active symp- 
toms, but, on the contrary, she thought she had re- 
covered perfectly. Seeing that she had been so pro- 
foundly affected, I watched the child with great interest. 
There were absolutely no signs of the inherited disease 
until the period spoken of, when he had a sparse, poorly 
developed, scaly eruption upon the lower part of the abdo- 
men, the buttocks, and thighs. At this time he was little 
less than an infant Hercules, and I could hardly convince 
myself that the disease was specific in its origin, espe- 
cially as it disappeared spontaneously in a short time. 11 
But a little later he began to suffer from nodes, and then 
the nature of the disease was perfectly plain. Now, 
gentlemen, had this child not been watched from day 
to day, the initial lesion of congenital syphilis would 
have passed unnoticed. I suspect that such was the 
case with E. H., and also with my other patient whose 
history is published in the Photographic Review. 
Some may doubt that these are examples of hereditary 
syphilis. The only other explanation for the anomaly is 
to suppose that the disease was acquired by both chil- 
dren. But you will never meet with a more unequivocal 
history than that of the girl whom I show you this morn- 
ing ; while in the other patient of whom I have spoken, 
it was as clear as is generally obtained. The direct 
testimony of the parents is likewise opposed to such a 
view, for I was not oblivious of these objections when 
I was examining them. 
It seems to me from what I have seen that these 
mild secondary symptoms are to be met with in those 
children who are ordinarily said to inherit the disease 
from their fathers, or whose mothers have passed 
beyond the second into the third stage of the disease, 
or in whom the affection has been influenced by treat- 
ment, or is for the time arrested. Your attention will 
be called to this hereafter. The point which I wish to 
impress upon your minds at present is, that the severity 
of the secondary stage of inherited syphilis forms no 
measure by which you can determine what will be the 
extent of the tertiary lesions. The child who is before 
you this morning proves this; and I could support 
the opinion by citing several other striking examples 
which have fallen under my notice. The most severe 
bone-lesions may follow the most trivial secondary 
manifestations. This may probably be partly accounted 
for by the fact that but few of the infants who have the 
disease early in life are left without treatment, while a 
large number of these little patients succumb soon after 
the affection sets in, so that the treatment prevents these 
symptoms in the one case, while in the other the child 
does not live long enough for them to be developed. 
It is therefore probably those who suffer little or none 
in early infancy who live to reach the period when 
the tertiary symptoms manifest themselves. 
The patient whom I now have before me furnishes 12 
you with a good representation of the lesions of the 
third stage of inherited syphilis. You will find these 
phenomena described by few writers : indeed, the gene- 
ral opinion has seemed to be that these symptoms 
belong to the acquired disease in adults, and not to 
the inherited in children. 
There is one point upon which I wish to dwell for a 
moment before leaving the case. This is the course of 
the nodes when they were situated near large joints. 
We have had ample opportunity of studying this in 
our present as well as in some other patients. The 
danger is that you may mistake this condition for syno- 
vitis, especially if the secondary symptoms have passed 
unnoticed, and this is the initial bone-lesion of the 
third stage of the disease. I have seen this error com- 
mitted in one instance. This occurred when the node 
developed upon the lower end of the humerus. The 
patient, after a few days of complaint and inability to 
move the arm, had swelling of the elbow, accompanied 
by some synovial effusion. It is when the child is first 
seen at this stage that the error in diagnosis is most 
likely to be made ; but you will be able to arrive at the 
truth if you examine the joint carefully, and, above all, 
if you feel the node upon the epiphysis ; for it was in 
this part that the disease was located in the children 
of whom I have spoken. 
In this girl, the disease of the pharynx and nares is 
sufficiently well marked. This is entirely different from 
the coryza to which I directed your attention when the 
first patient was in the room. That was a secondary, 
and this is a tertiary lesion. That was probably due to 
simple erythema or mucous patches upon the Schneide- 
rian mucous membrane, while this, appearing as it has 
done simultaneously with the nodes in various parts of 
the body, is likely to be owing to disease of the bones of 
the nose. The fetor and other characters of the discharge 
support this opinion. I shall not be at all surprised if 
we have destruction of the hard palate of the child in a 
short time. This is not a very frequent lesion. Mr. 
Holmes (Surg. Treat, of Diseases of Children, 8vo, 
Philadelphia, 1869, p. 351) states that he has never met 
with it in inherited syphilis. I have already alluded to 
a case which I have recorded, in which there was an 
orifice an inch long by half an inch wide, in the roof of 13 
the mouth; and I have, at this moment, a child aged 
about eleven years under my care who has inherited 
constitutional syphilis, and who has nodes upon her 
forearms, tibia, and sternum. At the same time, she is 
suffering from caries of the hard palate ; though this 
has not progressed very far. 
Before dismissing this patient, I ask you to notice the 
condition of her eyes. As you have heard, the right 
one was accidentally destroyed in infancy. The other 
remained healthy until nearly a year ago, when she 
had an attack of interstitial keratitis. This gradually 
improved, but it has left the cornea somewhat hazy, 
so that its appearance resembles ground glass. I call 
your attention to this, so that you may note the results 
in certain cases of interstitial keratitis, which is an im- 
portant ophthalmic lesion of inherited syphilis. I for- 
tunately have the opportunity of showing you examples 
of the disease in its active stage. 
Case III.—Inherited Syphilis ; Interstitial Keratitis; Idiocy. 
—J. K., set. years, came under observation two years ago 
with a copious specific eruption and mucous patches. These 
in a great measure disappeared under the use of antisyphilitic 
remedies continued for some time, but for more than a year 
she has been taking no medicine. For some weeks she has 
suffered from irritability of the eyes, though she has shown but 
little disposition to avoid the light. Upon inspection, a small 
white spot, unattended by ulceration, is to be seennear the 
centre of the left cornea. There is no congestion around that 
structure. In the right eye, the disease has extended further, 
so that almost the whole cornea has become opaque, and has 
the appearance of ground glass, while around it is a well- 
defined but narrow zone of injected vessels. 
This, gentlemen, is a fair representation of the earlier 
stages of interstitial keratitis, but in some instances the 
disease progresses further than in this child, as it has 
done in the boy whom I shall now show you. 
Case IV.—Inherited Syphilis; Interstitial Keratitis follow- 
ing Nodes ; Idiocy.—P. K., set. years, has been under ob- 
servation for two years. He is the brother of J. K., and, like 
her, he is decidedly idiotic. When first seen, he was suffering 
from a squamous syphilide and mucous patches, which disap- 
peared under the use of specific remedies continued for several 
months. In May, 1871, he had a node on the left humerus, 
which caused him much pain, and finally yielded to iodide of 14 
potassium. From then until last fall he continued pretty well. 
At this time he was found to be suffering with sore eyes. The 
disease began in the cornea and gradually extended until the 
whole of both of these structures was involved. The left eye 
presents the usual ground-glass appearance, and there is an 
injected zone around the margin of the cornea. In the right 
eye the margin of the pupil is seen with difficulty through the 
cornea, which, instead of being non-vascular and white like 
ground glass, is deeply injected, and of a sort of brick-dust or 
salmon hue. Vessels can be seen traversing every part of 
its structure, while around it the tissues are deeply injected. 
There is no ulceration on any part of it, and the boy does not 
complain of intolerance of light. His upper central incisor 
teeth are well formed. 
In these two cases, you have examples of two stages 
of one of the most interesting of the ophthalmic lesions 
of congenital syphilis. These, like all the other effects 
of the disease, vary with its stage. You are well aware 
that during the early part of the secondary stage of the 
acquired affection in adults, the eye is liable to be 
attacked by serious inflammations; but the one which 
is chiefly interesting and important is iritis,—a disease 
which is by no means analogous to the one which we 
are now discussing. Iritis, while it sometimes occurs, 
is quite rare in infantile syphilis, much more so than it 
is in the acquired disease of adults. On the other hand, 
the affection of which these two children present ex- 
amples is, if we may judge by the cases in this hospital, 
sufficiently common, and is the more interesting because 
it has no analogue among the symptoms of the acquired 
affection. Keratitis is an inflammation of the cornea, 
and was until recently supposed to be scrofulous in its 
origin. In the last decade, however, Mr. Jonathan 
Hutchinson described it again, under the name of In- 
terstitial Keratitis, and gave it as his opinion that it 
never appeared except as the result of inherited syphilis. 
This statement has been questioned by some eminent 
authorities, but I know of no reason to doubt the con- 
clusions of Mr. Hutchinson. I have had the opportu- 
nity to examine a large number of cases of scrofula in 
the Children’s Department of this hospital, and I have 
never seen interstitial keratitis associated with other 
symptoms than those of inherited syphilis. 
In the first and the younger of these patients, the 15 
affection has but begun. In the one eye—the left one— 
you see that there is no manifestation of disease except 
a small opaque spot in the centre of the cornea. This 
is the way in which keratitis ordinarily commences. 
Sometimes the opacities are multiple, and the disease 
spreads from two or more centres at the same time. 
The location of these spots, in the beginning, is near 
the middle and in the substance of the cornea, and 
they spread from the centre towards the circumference 
until the whole of the structure, excepting a small circle 
upon its margin, has become opaque. This condition 
is already represented in the opposite eye, which pre- 
sents the characteristic ground-glass appearance of the 
disease. In addition, I ask you to observe one or two 
other striking peculiarities of these cases. Neither has 
any ulceration of the cornea, which is always true in 
uncomplicated keratitis. You notice, too, that upon a 
mere ordinary inspection the girl does not seem to 
suffer much with her eyes, and unless you examined 
them carefully you might fail to see that they were dis- 
eased. They are evidently somewhat irritable, for when 
she comes into a bright light she makes some effort to 
protect them; but the irritability is not great, for she 
never refuses to expose herself to the light in any por- 
tion of the ward if curiosity or pleasure tempt her. The 
same may be said of her brother; and this is true of 
nearly all cases of interstitial keratitis which I have had 
the opportunity of observing. 
A non-professional person would not suppose the 
girl to have any disease of the cornea, unless he made 
a somewhat critical examination. This is due to the 
fact that there is but little increased vascularity of the 
other structures of the eye. There is no deeply-injected 
zone immediately around the cornea, but only a little 
increase in the vascular supply. This is the usual con- 
dition in this disease, and I but describe one of its 
ordinary characters when I call your attention to this 
peculiarity. In some instances, however, you will see 
the inflammation pass beyond this stage, when the eye 
loses the smooth, slightly-polished, opaque, ground-glass 
appearance, and the cornea becomes slightly granular 
and faintly pink instead of white. This condition is 
illustrated in this boy,—the girl’s brother,—whose right 
eye is injected, red, with the cornea slightly roughened 16 
and salmon-colored, while around it there is an irregular 
zone of turgid vessels, fringes of which extend into the 
structure of the almost opaque cornea itself. This is a 
severe case of syphilitic keratitis, and is a very good 
illustration of the characters which it sometimes pre- 
sents when it has been neglected. 
I hope you have noticed that in both of these children 
the inflammation of the cornea is a symmetrical lesion. 
This is usual; though in the cases which I have 
seen, the disease was not equally severe in both eyes. 
It had usually advanced further in one than it had 
in the other when the patient sought advice. This is 
due to the fact that, though a symmetrical disease as 
ordinarily seen, interstitial keratitis usually begins on 
one side first, and after a short period attacks the other. 
Both of these children are over five years old. There 
is another child in the ward in whom the disease is just 
setting in as she is entering the twelfth year. Keratitis 
is a late manifestation of inherited syphilis, and is to be 
placed in the group of tertiary, rather than secondary, 
symptoms. You see that in the boy it followed the sub- 
sidence of the skin-eruption, while it appeared after a 
node upon the humerus. In the girl it has preceded 
any bone-symptoms. In E. H., however, it followed 
repeated outbreaks of nodes upon the forehead and 
humerus. In the other case which I alluded to as being 
at present in the ward, the commencing lesion is associ- 
ated with tertiary symptoms. 
Being a symptom of the last stage of the disease, 
keratitis is not to be looked for until the patient has 
passed beyond the period of infancy and entered upon 
that of childhood or adolescence. It usually occurs 
between the eighth and the eighteenth year. (Hutchin- 
son, loc. citat.) 
There is only one other point in connection with these 
two children to which I wish to direct your attention. If 
cannot have escaped your notice that they resemble 
each other in the most striking manner, and I now ask 
you to notice the fact that they are both idiots. I have 
for some time had a suspicion that there is a relation 
between idiocy and congenital syphilis,—that in a given 
number of syphilitic infants a larger proportion of them 
will be defective in mental development than among the 
same number of children not so diseased. I should 17 
not be willing to express a positive opinion upon this 
subject without having had further opportunities to in- 
vestigate it. I think, however, that the matter would 
repay examination. 
LECTTTBE II. 
GENTLEMEN:—The subject of inherited syphilis 
engaged our attention when I last had the pleas- 
ure of meeting you; and, as that topic was by no 
means exhausted upon that occasion, I shall return to 
it this morning. The first case which I have to show 
you to-day is a very interesting one, because it fur- 
nishes a good representation of what is said to be a 
rare syphilitic lesion. 
Case V.—Inherited Syphilis; Rupial Eruption on the 
Forearm; Dactylitis Syphilitica.—Mary W., colored, aged 
ii years. Her father is a healthy man. Her mother had 
no other children. Her mother died when Mary was eight 
weeks old, and is said to have been intemperate and to have 
led a loose life. She (the mother) suffered from skin-erup- 
tions before death, but no other account of syphilis could be 
obtained. During infancy, Mary was a very puny child, but 
we have no positive information in regard to her condition. 
When she was two years old, she had an eruption on the 
skin, which her grandmother says appeared as large red blis- 
ters, which afterwards became white and broke, when thick 
crusts formed over them. When these scabs were removed, 
there were ulcers beneath them. This eruption became gen- 
eral, and was accompanied by oval, elevated patches about 
the vulva, which, from the grandmother’s description, were 
mucous patches. 
She was first admitted to the hospital in May, 1870. At 
that time there was some enlargement of the lymphatic glands 
upon the right side of the neck, while the left shoulder, arm, 
and forearm were covered by well-developed rupial crusts. 
These were the remnants of the skin-disease which ap- 
peared when she was two years old. 
After remaining in the hospital for nearly a year, she was 
discharged without being improved. In December, 1871, she 
was readmitted. Some months before this time (the exact 
date cannot be determined) some of the fingers on her left 
hand began to swell, and when she was admitted her middle 
and ring fingers were much enlarged and very tense. In the 18 
middle finger the induration did not extend beyond the first 
phalangeal articulation, but it involved this with the proximal 
phalanx. In the ring finger the induration extended beyond 
and involved the most of the second phalanx. The swelling 
was firm, but not painful, and the affected part was not hotter 
than the surrounding surface. The rupia was gradually ex- 
tending downward, and she now had a crust upon the back 
of the hand. 
Present condition, May 29, 1872.—Upon various parts of 
the body she presents scars of the previous skin-disease. The 
angles of the mouth are fissured and puckered. On the left 
cheek is a large rupial crust. The left forearm and back of 
the hand are covered with the crusts and cicatrices of rupia. 
The former are from one inch to two inches in diameter. The 
proximal phalanges of the middle and little fingers of the left 
hand, and the phalangeal articulation of the former, are much 
swollen. This is more manifest upon the dorsal than upon 
the palmar surface, and the former is broader than the latter. 
The skin over the affected parts is tense, the folds in it are 
effaced, and the mobility of these fingers is much impaired. 
The child does not complain of pain in them. They may 
be firmly pressed or moved without objection upon her part. 
There is no crepitation in the movement of the joints. The 
outlines of the phalanges are defined with difficulty, owing 
to the firmness and tenseness of the swelling, but they 
appear to be slightly thickened, though it is evident that the 
increase in the size of the fingers is mainly due to disease of 
the tissues between the skin and the bones. The hand ap- 
plied to these parts detects no elevation of temperature. The 
ring finger is much shortened, so that its distal extremity 
reaches just beyond the proximal phalangeal articulation of 
the middle finger. It is a quarter of an inch shorter than the 
little finger. This deformity is due to destruction of the whole 
of the proximal phalanx. The metacarpal extremity of the 
middle phalanx has been destroyed, as well as a small part 
of the distal end of the metacarpal bone itself. In conse- 
quence, though she retains but little control over it, the mo- 
bility of the member is very great. The nails on all the fingers 
are perfect and healthy. 
The bridge of the nose is not depressed. She has com- 
mencing interstitial keratitis in one eye. Her teeth are 
moderately well formed, but the upper central incisors are 
imperfectly developed and slightly notched. 
The symptoms of this patient are minutely described, 
because the condition of the hand is said to be a rare 19 
one. There can be no doubt that the girl has congen- 
ital syphilis, although the history is not positive in re- 
gard to it. But, without any direct investigation of this 
point, I do not hesitate to accept this view of the case, 
because the teeth are imperfectly developed, and she 
has commencing interstitial keratitis. 
I shall not say anything in regard to the rupial erup- 
tion upon the forearm and dorsal surface of the hand, 
because, striking as this may be, and interesting as it is in 
connection with the congenital disease, my colleagues of 
the surgical staff can show you better examples of it in 
cases of acquired syphilis. But I do direct your espe- 
cial attention to the appearance of the fingers, the de- 
scription of which you now have the opportunity of veri- 
fying for yourselves. This lesion of the hand is known 
as dactylitis syphilitica, and occurs in the later stages 
of both the inherited and the acquired disease. The 
first description of this curious condition was written 
by Chassaignac, in 1859; but the most elaborate ac- 
count of it was published by Ur. R. W. Taylor, of New 
York, in the American Journal of Syphilography and 
Dermatology for January, 1871. Before that time, only 
five cases of the disease had been fully described. To 
this number Dr. Taylor added two others. Since then, 
Dr. Smith, of Ohio,* and Dr. Wigglesworth, of Boston,f 
have each reported a case. Mr. Morgan, of Dublin, 
in his recent work,J describes the affection, and men- 
tions having met with three cases of it. 
This girl presents what seem to be the ordinary 
characters of dactylitis. I call your attention to the 
fact that the swelling involves but a part of the affected 
fingers,—that is, the proximal phalanx and its phalan- 
geal articulation. You notice, too, that the swelling of 
the dorsal is greater than that of the palmar surface 
of these, so that upon transverse section the cut surface 
would present an imperfectly triangular outline. From 
the history which has been read to you, you have learned 
that the disease of the fingers has existed for some time. 
She has been quite six months under observation, and 
we have reason to believe that it had been progressing 
* American Journal ofSyphilography and Dermatology, Jan. 1872. 
f Ibid., April, 1872. 
j Practical Lessons in the Nature and Treatment of Contagious Dis- 
eases, London, 1872, p. 231. 20 
for two months before she entered this hospital. In the 
only other case of syphilitic dactylitis that I have had 
the opportunity of observing, it has run the same 
chronic course; and Dr. Taylor likewise speaks of 
this peculiar chronicity of the disease. Its progress 
seems to be but little influenced by treatment. An- 
other interesting feature of this case is, that the affection 
of the fingers seems to produce but little suffering. You 
see how I handle them, and how little she complains. 
During the whole of the last six months you would 
never have known from the child herself that anything 
was the matter with her hand, though during that time 
some of the bones of the ring finger were destroyed. 
The same peculiarities characterized another case of 
dactylitis, which I shall presently show you. 
Some of you, no doubt, suppose that this condition is 
due to disease of the bones of the fingers, or, in other 
words, that the child has suffered from nodes of the pha- 
langes. Such is by no means the case. In reading the 
history I particularly emphasized the statement, that the 
outlines of the phalanges of the middle and ring fingers 
could be defined with difficulty, but that the swelling did 
not appear to be due to any disease of these bones. 
Dr. Taylor describes two forms of this manifestation of 
syphilis, one of which seems to begin in the bone and 
the other in the connective and fibrous tissues of the 
part. This case appears to belong to the latter class, 
though, if the truth be told, the two varieties are but 
stages of the same condition. It seems to be a form of 
gummy tumor, the morbid material of which is pro- 
duced in the connective and fibrous tissues of the fingers. 
In some instances, as in this one, the swelling involves 
only one phalanx; in others, it affects the whole finger, 
increasing its size uniformly; while in still others, the 
swelling is confined to the joints in the early stages of 
the disease. Nor does dactylitis affect the fingers alone; 
for it sometimes attacks the toes. 
Though the bone may not be involved in the first 
stages of the disease, dactylitis may lead to its destruc- 
tion ; and indeed it has done so in this girl, for you see 
that the ring finger is shorter than the little one, that it 
can be freely moved backwards and forwards, and that 
it presents a peculiar wrinkled appearance, which is due 
to destruction of the whole of the proximal and a por- 21 
tion of the metacarpal extremity of the middle phalanx. 
Precisely the same condition is represented in the next 
patient, whom I show you as an example of recovery 
from dactylitis syphilitica. 
Case VI.—Inherited Syphilis; Dactylitis Syphilitica; 
Hutchinson's Teeth.—W. H. H., aged 10 years, colored, has 
been an inmate of the hospital from infancy. Five years ago 
he suffered severely from nodes on the humerus, ulna, and 
other parts of the body, with dactylitis, which suppurated after 
a long period of inactivity, and destroyed the whole of the 
proximal phalanx of the ring finger on the right hand. The 
disease is now entirely inactive, but the affected finger is a 
mere stump, which scarcely reaches the second joint of the 
little finger. 
In both of these children you see that the dactylitis 
has appeared as one of the late manifestations of in- 
herited syphilis. This is not always true; for Taylor 
quotes the case of Archambault,—an infant in whom 
this was one of the early symptoms of the disease. Dr. 
T. C. Smith since then described a case* in which dac- 
tylitis set in when the infant was only six weeks old. 
These are probably the only examples of the kind upon 
record; for Taylor, when he wrote, in January, 1871, 
believed Archambault’s case to be unique. 
From what I have said, you have been led to infer 
that dactylitis syphilitica is a rare affection. This is the 
opinion of Dr. Taylor; but I may say that my colleague, 
Dr. Maury, tells me that it is his opinion that Taylor has 
exaggerated its rarity. Dr. Maury tells me that he has 
seen a large number of these cases, both among persons 
having acquired and those having congenital syphilis.* 
While I have this patient in the room, I desire to 
direct your attention to another symptom of inherited 
syphilis. It is one which has attracted a good deal of 
attention recently. If you inspect this boy’s mouth, 
you find that the incisor teeth are imperfectly de- 
veloped, and that their free extremities are notched, and 
smaller than the bases of the teeth. To Mr. Hutchin- 
son is due the credit of pointing out the significance of 
this physical sign. Now, these are not typical examples 
of Hutchinson’s teeth, which, when perfect, are smaller, 
* Amer. Jour. Syfthilog. and Dermatology, Jan. 1872, F 33. 22 
more notched, and have more contracted crowns than 
these have. You see, too, that the adjoining teeth of 
the upper, and the middle ones of the lower jaw, present 
the same peculiarities in a slight degree; but you must 
remember that it is not among these that you are to 
seek for these alterations. Mr. Hutchinson has insisted 
upon the fact that the permanent central incisors of the 
upper jaw are the ones which are valuable for diagnosis, 
and you must further remember that he attaches no 
importance whatever to the various other irregularities 
in the position and shape of the teeth, which so often 
occur. The peculiarities to which I have alluded are 
important, viz.: First, instead of the free edge of the 
crown of the tooth being the broader, as it is nor- 
mally, the widest portion is next the gum. Second, 
the free margin is notched or crescentic. These teeth 
are rarely present in more than one of the same family 
of children, and this is usually the one first born with 
congenital syphilis. 
This symptom is wanting in several of the patients 
who have been before you. In this one (Case V.), M. 
W., the teeth are by no means perfect, but the altera- 
tions are not characteristic,—only sufficient to arouse 
suspicion of congenital syphilis. In Case II., E. H., the 
teeth are likewise imperfect. 
While in Case IV., P. K., they are large and well 
developed, his sister (Case III.) has not yet cast her 
milk-teeth. From what I show you this morning, you 
see that there is no uniformity in the presence of Hut- 
chinson’s teeth; and, to state briefly my own convictions 
in regard to the matter, I would say that, so far as my 
present experience shows, these dental changes, when 
they are present, are absolutely pathognomonic of con- 
genital syphilis, but that they are often absent. It is 
another element which will aid you in diagnosis, but 
which, like all other prominent symptoms of disease, is 
sometimes unavailable, because it is not present. This 
last fact is easily accounted for if Mr. Hutchinson’s view 
of its causation is correct. He believes it to be due to in- 
flammation of the alveolar process of the jaw, and, just 
as it is with iritis, keratitis, and various other condi- 
tions, the disease may run its course without the in- 
flammation being developed. 
Before dismissing the consideration of the symptoms 23 
of congenital syphilis, I wish to impress upon your 
minds the fact that the tertiary lesions, of which you 
have seen such striking examples, are by no means 
common. It is exceedingly rare for bone-disease to 
occur during infancy. I have only once met with it in a 
child under two years old; it was in a boy of about 
fifteen months. 
When Diday published his work upon infantile syphilis 
(New. Syd. Soc. ed., London, 1859), stated that there 
were not upon record more than half a dozen authenti- 
cated cases of syphilitic bone-disease in infants. Mr. 
Hutchinson relates another (loc. citat., p. 185). 
There is a question connected with this disease which 
is very interesting, and at the same time very important 
in its practical bearings. The first patient whom I 
showed you undoubtedly inherited syphilis from her 
mother. The same is true of two others; while the histo- 
ries of the remainder are indefinite upon this point. In 
none have we any direct account of the father having 
transmitted the disease. This in hospital practice is the 
ordinary history; but you must not accept this as con- 
clusive, for it must be manifest to you that we have to 
contend with many difficulties in obtaining a correct 
account of the origin and progress of disease in many 
of our little patients. Still, I am inclined to believe that 
the influence of the two parents in the transmission of the 
affection differs, and I am convinced, from the diverse 
statements of authors upon this point, that the subject 
demands reinvestigation. For example, Mr. Hutchin- 
son (loc. citat., p. 208) holds that a child will inherit 
syphilis in as severe a form from the father as from the 
mother, and I believe that I am not misstating the 
truth when I say that this is the opinion of most other 
authorities. On the other hand, Prof. Boeck (Ameri- 
can Journal of Syphilography and Dermatology, Jan. 
1870, p. 16) states that the disease is rarely, and Mr. 
Cullerier (Mem. de la Societe de Chirurgie, tome iv., and 
Archives Generates de Med., Sept. 1854) believes that 
it is never, transmitted from the father to the child. A 
recent and very able writer on this subject, Mr. Mor- 
gan, of Dublin (Contagious Diseases, etc., i2mo, Lon- 
don, 1872), thinks that the influence of the father has 
been much exaggerated. 
I have for some time availed myself of every oppor- 24 
tunity to try to obtain information upon this subject, 
and, while I may subsequently have to modify my 
opinions in regard to it, I cannot but believe that the 
mother is much more likely than the father to trans- 
mit syphilis to the children, and that, as Mr. Morgan 
says, the influence of the father has been exaggerated. 
On the other hand, I do not want you to understand 
me as saying, with M. Cullerier, that syphilis cannot be 
inherited from, the father. I cannot at present commit 
myself to any such doctrine; for I seen more than 
one sad instance in which men seem to have begotten 
syphilitic children. 
It is important that you should inform yourselves 
thoroughly upon this subject, for gentlemen who have 
been relieved of secondary symptoms will hereafter 
consult you in regard to the propriety of marriage. 
Every physician with any experience can point to 
numerous examples of this kind. It becomes you, 
therefore, to be able to give a reliable opinion in regard 
to it; and I beg you, I beseech you, gentlemen, to re- 
member that when a man has once had constitutional 
syphilis, you cannot in the present state of our knowl- 
edge say positively that he will not procreate a dis- 
eased child, no matter if he seems to have fully recov- 
ered. You may feel assured that he probably will not, 
and, more, you may be certain that the probabilities are 
reduced to a minimum, but, as we now understand 
these matters, you are not justified in giving a positive 
opinion in regard to this subject. If a man has once 
had constitutional syphilis, we do not doubt that under 
certain circumstances the poison may be eradicated so 
far as to prevent his begetting a diseased child; but we 
have as yet no reliable means of judging when this is 
the case. 
If your opinion be asked upon this important ques- 
tion, it is your duty to give it clearly and truthfully, with- 
out regard to the feelings of your patient. It is your 
duty to yourselves, to your interrogator, and to his 
prospective children. But when you have told him all 
this, you have only performed a portion of your work. 
You have seen only one side of the dark picture. This 
is a cloud which has no silver lining. Not only is a 
man who is affected with constitutional syphilis to be 
told that he may transmit the disease to his children, 25 
but he is likewise to be informed that his wife may con- 
tract it from him, or from the child in her womb, and 
that he may in the future have to bear the terrible trial of 
seeing her suffer from secondary and tertiary syphilis. 
I know that there is not one of you who will not shrink 
from such a trying position as this is. With a human 
being before you in whose heart burn the same passions, 
the same loves and hates, that move you, you will feel 
tempted to put the case in the most favorable light. 
But, gentlemen, tell the simple truth, remembering the 
delicacy of your position and the dignity of your calling, 
—remembering that in your decision are involved the 
life and comfort of unborn children, the health and 
happiness of a woman who is about to give her heart’s 
best treasures into another’s keeping. 
The study of the etiology, and the laws which govern 
the transmission, of hereditary syphilis is one of the most 
interesting and important subjects in connection with 
the disease. Its elucidation, however, is attended with 
many difficulties. These are increased by the existing 
disagreements among surgeons and physicians in regard 
to the acquired affection. This varies much in different 
cases, both in severity and the order of succession of 
symptoms. The severity and type of the disease in the 
child are no doubt influenced by these circumstances in 
the parent. They are, we have every reason to believe, 
as potently influenced by the time which has elapsed 
after the infection of the parents, or by the treatment to 
which they have been submitted. Where so many ele- 
ments enter into the consideration of a question, and 
where their proper appreciation depends so much upon 
the judgment of the observer, the subject cannot but be 
surrounded with many difficulties. These are increased, 
too, by the moral and social peculiarities of the case. 
Though the disease has set its stigma upon either 
the parent or the child, the former will often hesitate a 
long time before acknowledging the truth in regard 
to it. A man or a woman who would scorn to tell an 
untruth in regard to anything else will persist in the most 
unblushing falsehoods in relation to any sexual disor- 
ders. And again, the physician, when he sees the first 
evidences of syphilis in the child, may sometimes hesi- 
tate about making inquiries about its origin, for so mar- 
vellously perfect is the assumption of ignorance and 26 
innocence in these cases that if he had not known the 
parties before, he might hesitate in questioning either 
parent, for fear of creating domestic difficulty. If any 
of you ever have such doubts as these, if the surround- 
ings of your patient are such that you have misgivings 
as to which may be the guilty party, do you quietly bide 
your time, and satisfy yourselves in the interval with 
properly treating your patient. The chances are that 
in a little time a troubled conscience will bring one of 
the parents to you with some unaccountable story, and 
it is ten to one that this will be the father. 
All of these things, I say, make the subject of the 
transmission of inherited syphilis a very difficult one 
for investigation ; but the interests at stake are so great 
that it must ever possess a deep importance for the in- 
telligent physician. I alluded, a moment since, to the 
influence of the father and the mother in the transmis- 
sion of the disease, and, if you remember, you were 
told it was my own opinion that that of the father 
had been much overrated. At that time I quoted 
the observations of Prof. Boeck and M. Cullerier in 
support of this opinion. I desire to say a little more in 
regard to it before proceeding to the consideration of 
other matters, though I wish you distinctly to under- 
stand that I do not want to lessen the force of the advice 
which I have before given you. The data upon which 
the profession bases the opinion that the father may be 
the source of syphilis in his children do not appear to 
be small, if one peruses the works of the older authors 
upon the subject. Some of these cases are related in 
such a straightforward way that it seems almost im- 
possible to doubt the conclusions which have been 
drawn from them. One thing is noticeable, however, 
that the same illustrations have been used over and over 
again, and the conclusions which have been arrived 
at have been handed down from one author to another, 
while few new facts have been added to support them. 
M. Cullerier’s observations, however, have led to origi- 
nal research upon this point. This author reported 
the cases of two gentlemen who married in the active 
stage of secondary syphilis. They each had one child, 
both of whom were healthy, up to the time when last 
seen, one aged eighteen, and the other fifteen years. M. 
Notta (Archives Generates de Medecine, March, i860) 27 
relates the histories of eleven syphilitic fathers who 
had nineteen children. The wives of three of these 
were likewise affected. Among the nineteen children 
only four had inherited syphilis, and these were all the 
children of the infected mothers. The men whose wives 
were healthy had fifteen children, the youngest of whom 
was seven months and the eldest fifteen and a half 
years old at the time M. Notta wrote. 
M. Charrier (Archives Generates de Medecine, Sept. 
1862) records the histories of fourteen additional 
children, the offspring of seven fathers. In five in- 
stances the father had syphilis and the mother was 
healthy, in one they were both, and in the other the 
mother only, was diseased. Of the fourteen children, 
nine were healthy, and these were the offspring of in- 
fected fathers. Of one of these the age is not given. 
Of the others the youngest was eight months, and the 
eldest six years. Of the five diseased children, three 
were born to the pair both of whom had secondary 
syphilis, while the wife whose husband was healthy 
aborted twice, the foetus being diseased in both cases. 
To these cases may be added two of my own. The 
history of the first of these is as follows : 
Case VII.—A gentleman contracted a chancre six years ago. 
It was cauterized with nitrate of silver within thirty-six hours 
after its appearance, and this cauterization was repeated upon 
two successive occasions, at intervals of twenty-four hours, 
without any medical advice. He then presented himself to 
me, and the sore had all the characters of a true Hunterian 
chancre. It healed soon, and in three months afterwards he 
had copper-colored, slightly scaly spots upon his forehead, 
trunk, and extremities. These symptoms were followed by 
sore throat, when he was at once put upon anti-syphilitic 
remedies. He soon recovered, and married immediately 
afterwards. His wife shortly became pregnant, and within a 
year a child was born, who was healthy until five years of 
age, when I last heard from it. Immediately after his mar- 
riage, this gentleman suffered from a faint eruption upon his 
skin, and from sore throat, which one of the most eminent 
syphilographers of this city pronounced to be specific, and upon 
one occasion since then he was under my care for syphilitic 
maculae and sore throat, which were relieved by specifics. 
This history seems to be a clear one ; but the following 
patient suffered much more severely : 28 
Case VIII.—A gentleman contracted syphilis in 1861. He 
neglected himself, and travelled a long distance before he 
sought medical advice. In the fall of 1862, he was in a most 
deplorable condition, being wasted almost to a skeleton, having 
nodes upon various parts of the body, while the nose and hard 
palate were entirely destroyed. Under the use of specific 
remedies he gradually improved; but he was not entirely well 
until four years later. Six years afterwards he married, and in 
1869 I attended his wife, a perfectly healthy woman, in her 
first and only confinement. This issue, a fine boy, is now 
nearly three years old, and is perfectly healthy. 
To sum up now, gentlemen, we have the histories of 
twenty-eight children, two from Cullerier, fifteen from 
Notta, nine from Charrier, and two cases of my own, all 
of them the offspring of syphilitic men who had married 
healthy women. Not one of these inherited the disease. 
This number might be increased by several others, but 
I forbear, as their histories are not so clear as those 
which have been related; but, in view of these facts, I 
ask you if it is any wonder that I feel inclined to doubt 
the opinions of the eminent authorities who think that 
the father’s influence in the transmission of the disease 
is as strong as that of the mother. 
There is one source of error in estimating the in- 
fluence of the father. It is now generally acknowledged 
by syphilographers, and is, I believe, demonstrated 
beyond possibility of doubt, that secondary syphilis is 
transmissible from one person to another. Zeissl says 
he has noticed that “ as a rule women whose hus- 
bands suffer from latent syphilis lose their blooming 
health, even if they have never been pregnant or had 
any miscarriages,” and Balfour has put upon record a 
series of cases of healthy women, the wives of syphilitic 
husbands, all of whom bore diseased children. All of 
these wives, however, suffered from undoubted symp- 
toms of secondary syphilis, which manifested striking 
peculiarities. It was by no means severe, came on 
shortly after the commencement of pregnancy, and in 
some disappeared without treatment. One of the most 
important points connected with this form of the disease 
is, that it may escape the notice of the physician. Bal- 
four, as you may see by reading his paper in the Edin- 
burgh Medical Journal for 1856, vol. ii., attributes these 
symptoms in the mother to her absorption of the poison 29 
from the foetus; but, so far as I am able to judge, this is 
not yet proved ; and is it not possible that their syphilitic 
husbands gave them the disease at or near the time of 
impregnation ? The intimacy of marital relations must 
certainly subject the wife to dangers which arise under 
no other conditions, and they are so great that I cannot 
but feel that this source of the mother’s contamination 
has to be eliminated before we can implicitly accept 
the doctrine that a syphilitic father can transmit the 
disease to his child. Dr. Van Buren, of New York, has 
recently recorded a case (American fournal of Syphi- 
lography and Dermatology, Jan. 1870) which bears upon 
these observations of Zeissl and Balfour, especially upon 
those of the former. It is so interesting and important 
that I cannot forbear giving you an abstract of it. A man 
had chancres on three separate occasions, the first time 
in the winter of 1854-55, the last time in the spring of 
1857. He never had any secondary symptoms, and 
married a perfectly healthy woman in August, 1858. In 
a little more than nine months, their first, and in June, 
i860, their second child was born, and neither has pre- 
sented any evidences of inherited syphilis. Now comes 
the instructive part of the history. In October, i860, a 
little more than two years after their marriage, Dr. Van 
Buren was consulted on account of certain vague syphi- 
litic symptoms in the wife, while in 1861 the husband 
had syphilitic retinitis, though no mention is made of 
previous constitutional manifestations. A third child, 
born in 1862, showed evidences of inherited syphilis 
in three weeks; while a fourth, born in October, 1867, 
escaped. 
The two facts in this account, to which I wish to 
direct your attention, are, that a husband with latent 
constitutional syphilis of which there had never been 
any obvious signs, not even of cachexia, communicated 
the disease to his wife, and that his children did not 
inherit the disorder until the wife had become diseased. 
These facts certainly give great force to the remark 
which I made a few moments since, that the part which 
the father plays in the transmission of syphilis is very 
uncertain. The matter must remain undecided until 
the subject has been re-investigated, and more facts col- 
lected from which to draw conclusions. 
The cases which I have shown you suggest another question for our consideration. I cannot doubt that the 
stage of the syphilis in the mother influences the pro- 
duction, and modifies the severity, of the disease in 
the child. If you review the histories of two of the 
patients whom I have shown you, and who are again 
before you this morning, you will find that an attempt 
has been made to determine the condition of the mother 
at the time of conception. 
In Case I., J. W., the mother had never had any ter- 
tiary symptoms, though the secondary manifestations 
had been severe. At the time she conceived, the 
disease was perfectly quiescent, so that during and since 
her gestation she has considered herself perfectly well. 
Yet you see that the disease appeared in the child 
within two weeks after his birth; but I would have you 
notice that it is not at all severe. In the second patient, 
E. H., syphilis was inherited from the mother, who at 
the time of conception was probably between the second 
and third stages of the acquired disease. I have spoken 
in these lectures of a child in whom congenital syphilis 
made its appearance after the end of the first year, 
and whose mother, during gestation, and for a con- 
siderable period before it, had had no acute symptoms, 
though she was greatly disfigured by tertiary bone- 
lesions. 
These facts show you that the condition of the mother 
influences the development of syphilis in the child, and, 
more, a fact which has been questioned by some writers 
upon this subject, that a woman who has some time be- 
fore suffered from the last symptoms of the tertiary stage 
may still endanger the life and happiness of her off- 
spring by its transmission. However, I am not inclined 
to think that such children will always be contami- 
nated. Now, nearly two years ago there was a woman 
delivered in the ward who had suffered extremely 
from constitutional syphilis, but who had had no acute 
symptoms for at least five years. So serious had the dis- 
ease been, that her hearing was destroyed, her eyesight 
impaired, her nose much disfigured, and the hard palate 
perforated. During her gestation I watched her with 
much interest, thinking that she would be likely to bear 
a syphilitic child; but it was born healthy, and con- 
tinued so until he was eighteen months old, when he 
died of malignant measles, which was epidemic in the 31 
children’s asylum during last winter. The father in this 
instance was a healthy man. 
There is another question connected with the trans- 
mission of syphilis from the mother to her child which 
we may discuss before considering the treatment. 
The following is the history of the patient who is now 
before you: 
Case IX.—L. A., aged 19, was a perfectly healthy girl until 
two months before her child was born, which was nine 
months ago. At this time she contracted chancres. Four 
months later she had well-developed secondary syphilis. She 
is now covered with copper-colored blotches, a squamous 
eruption, and has a sore throat. She has nursed her child 
until the present time. It was born healthy, and was per- 
fectly well until two weeks ago, when a papular eruption 
appeared upon its belly, back, buttocks, and thighs. This 
was dark-colored,—decidedly coppery,—and was attended by 
a little coryza. There were no other evidences of any disease 
in the child, who is very lively and very strong. 
If you will notice this baby, gentlemen, you will see 
that she is rather remarkable for development and 
strength, and that she presents absolutely no evidences 
of disease besides those which I have mentioned. In 
this the child furnishes a striking contrast to her mo- 
ther, whose pale, cachectic, downcast face would soon 
attract attention, while a very cursory examination 
would reveal the cause of her difficulty. You would 
say that a child thus born could hardly escape having 
syphilis, and possibly some of you feel convinced that 
this is a specific eruption. If you are, I must tell you 
that I do not by any means feel sure that you are cor- 
rect. It is true that this eruption looks as if it were syphi- 
litic. Its color, so far as that is of any value, is suspi- 
cious, and its association with coryza still more so ; but 
it is doubtful whether this will not prove an evanescent 
eruption. This opinion is based upon the fact that the 
mother did not have constitutional syphilis at the time 
she conceived. Writers assert that a woman, who con- 
tracts the primary disease at or after the seventh month 
of utero-gestation, will not transmit it to her offspring. 
Diday (Infantile Syphilis, New Syd. Soc. ed., 1869, pp. 
30, 31) has collected eleven cases in which the mother 
was infected during pregnancy, and from the analysis 
of these he concludes that syphilis contracted by the 32 
mother after the completion of the seventh month, has 
never produced the disease in the child. I am strongly 
inclined to believe, therefore, that this is not the erup- 
tion of congenital syphilis, for, according to the girl’s 
account, pregnancy had advanced fully seven months 
when she contracted the primary disease. 
You see at once the importance of obtaining accurate 
information upon this point, because, if the opinion ex- 
pressed by Diday be true, we can without danger give 
these children to another woman to be wet-nursed,—a 
consideration of no little importance to them. I am 
willing to confess, however, that I should hesitate some 
time before assuming the responsibility of deciding upon 
such a course. 
Another consideration has been pressed upon us by 
this case, and I have several times asked myself whe- 
ther it is proper to allow a woman infected as this one 
was to nurse her own child. Though it escaped un- 
scathed from her womb, I cannot see why she might not 
give her infant constitutional syphilis. You know, how- 
ever, that, upon the other hand, it is asserted, by those 
who hold that the father transmits the disease in the ma- 
jority of cases, that a woman who has borne a syphilitic 
child without herself being diseased may nurse it with 
impunity. This, however, seems to me to go to show 
that she is herself syphilitic, and not to bear at all upon 
the decision of the other question. 
I have felt the same uncertainty about another patient, 
who contracted syphilis at the end of the eighth month 
of her pregnancy. In due season, her child, a healthy 
infant, was born, and was nursed by her. Except that 
she suffered somewhat from fissured nipples, everything 
went well until a month after her confinement, when a 
syphilitic eruption made its appearance upon her. The 
question to be decided now is whether the mother shall 
continue to nurse the child or not. If she does not, it is 
absolutely necessary to procure another nurse. I can- 
not convince myself that this can be done without dan- 
ger to the latter, while I cannot but hope that the child 
has not yet contracted syphilis, and I fear that if allowed 
to continue to nurse from its mother’s breast, she may 
transmit the disease to it. This case illustrates one of 
the most trying circumstances that may arise in connec- tion with infantile syphilis. I do not know how to 
advise you; for I do not know what to do myself.* 
Treatment.—So much time has been spent in dis- 
cussing other questions connected with this subject, 
that we have not much left to devote to the considera- 
tion of the treatment. The first of these cases, the in- 
fant, shall be at once put upon mercury. This may be 
used in one of two ways ; either by the skin or by the 
mouth. If the former be preferred, the ordinary mer- 
curial ointment is the preparation to be used, in the way 
recommended by Sir Benjamin Brodie ; that is, by rub- 
bing a small portion into the skin of the belly, knee, or 
inner side of the thigh. Used in this way, the ointment 
is somewhat offensive; and upon reading a paper by 
Mr. Marshall (La?icet, May, 1872), upon the oleates of 
mercury as external applications in disease, it occurred 
to me that this might prove a very useful method of 
exhibiting the drug in this disease, especially in those 
cases in which it does not seem desirable to administer 
preparations of mercury by the stomach. According 
to Mr. Marshall, the oleate is cleanly and easily ab- 
sorbed, which is not true of the officinal ointment, as 
this is a mere admixture of metallic mercury with lard. 
You will often find local applications of mercury to be 
very efficient, but in most cases you can give the medi- 
cine by the mouth, when you may employ any of the 
mild preparations. One of the best is the hydrarg. cum 
cret., a grain or a grain and a half of which may be 
given once or twice daily. In this case, the medicine 
will be given in this way, and we will begin with a grain 
twice daily. At the same time the child must be care- 
fully watched, and his strength sustained by good food, 
fresh air, tonics, and, if necessary, by cod-liver oil. 
Some authorities oppose the use of mercury in the 
treatment of this disease, and, indeed, there seems to be 
a growing and an influential body of physicians who 
take this ground. On the other hand is an equally 
strong and intelligent body, who look upon it as the 
most efficient agent in the management of syphilis. I 
am perfectly willing to confess that I am old fogy 
* Shortly after the delivery of this lecture, this child began to suffer 
from a sore mouth, and a month later was covered with an undoubted 
syphilitic eruption. In the other infant (Case IX.) the eruption proved 
evanescent, and now, two months later, it remains well. 34 
enough to administer mercury in these cases, that I am 
fully convinced of its utility, and that, having tried both 
methods of treatment, I esteem it more highly than 
any other single drug for the purpose,—nay, more than 
any other set of drugs. Mercury seems to be a tonic 
to these children, and while using it they increase in 
strength and gain in flesh. While I fully recognize the 
fact that the mortality among them is very great, cir- 
cumstances are rarely so desperate that there is not a 
chance that their condition may be improved: so do 
not turn away from these little patients with the con- 
clusion that there is no hope for them. 
In regard to the other children, their treatment must 
be different. They have all passed beyond the first into 
the second stage of hereditary syphilis, and, with a 
single exception, have, at various periods, taken both the 
iodide of potassium and the bichloride of mercury. The 
exception is Case V., M. W., who has been treated with 
cod-liver oil and arsenic without obtaining the slightest 
benefit. Those who have used the specific remedies in 
the ordinary way have always been improved by them, 
and I have no doubt would be again; but, at the sug- 
gestion of my colleague, Dr. Maury, I am going to try 
hypodermic injections of corrosive sublimate in all of 
the cases. Some of you, I have no doubt, know that 
this method of treating constitutional syphilis was pro- 
posed a few years ago, but, so far as I am aware, it has 
been but rarely resorted to in this city. I have had no 
experience with it whatever, never even having seen a 
case so treated. I am, therefore, not capable of judging 
of its merits, but I am somewhat prejudiced against it. 
The most recent writer upon the subject is Dr. Lewin, 
whose work upon the treatment of constitutional syphilis 
is just being republished in this country, and the advance 
proofs of which I have had an opportunity to examine. 
Dr. Lewin employs three solutions of the following 
strength for injections,—three, four, and six grains of the 
corrosive sublimate to the ounce of water,—and states 
that if more concentrated than the strongest of these, 
they often cause intense local inflammation. He gener- 
ally uses the second solution,—four grains to the ounce. 
Lewin seems to be well satisfied with the local effects of 
this injection, for he says, “Out of one thousand of my 
private patients, only one had a small abscess on the 35 
forearm.” In these children we shall use the second 
solution, and shall administer one-twenty-fourth of a 
grain of the bichloride daily, and gradually increase the 
quantity to one-sixteenth, if the children bear it well. 
Lewin prefers the subscapular and sacral regions for 
administering the injection. We shall use the former 
region in all of these cases. 
I stated, a moment since, that I had a prejudice against 
this method of giving corrosive sublimate in congenital 
syphilis. This is not because I am not a firm believer 
in the virtues of the hypodermic syringe. Few persons 
can be more firmly convinced of its great utility. But 
children like these will resist the use of the instrument, 
and I fancy that not many days will have passed before 
they will learn to dread the visits of my resident to the 
wards. No iodide of potassium will be given for the 
present, and the only other remedies which will be 
administered are tonics. This child (Case II., E. H.) 
is, as you notice, very pale, and anaemic. She shall 
have the following: 
1£ Ferri pyrophos., _qss; 
Acid, phosphor, dil., spss; 
Syrupi, 
Aq. aurant. flor., Hjiss. M. 
A teaspoonful in water after each meal. 
The pyrophosphate of iron is given simply because it 
is a pleasant preparation. 
Cases III. and IV. are not anaemic, but are thin and 
not very strong. They shall both have cod-liver oil, 
and, as they have never taken it, we will commence 
with a teaspoonful twice daily,—immediately after break- 
fast and supper. 
The remaining girl (Case V., M. W.) will continue the 
cod-liver oil, which she has been taking for some time.