Two Cases of Syphilis having a Bearing 
on the Question of the Period 
during which the Disease 
is Communicable 
?V 
James Bell, M. D. 
Assistant Professor of 'Surgery and Clinical Surgery, 
McGill University ; Surgeon to the Royal 
Victoria Hospital and Consulting 
Surgeon to the Montreal 
General Hospital 
REPRINTED FROM THE 
Journal of Cutaneous and Genito-Urinary Diseases 
for February, 1895 TWO CASES OF SYPHILIS HAVING A HEARING ON THE 
QUESTION OF THE PERIOD DURING WHICH THE 
DISEASE IS COMMUNICABLE. 
Assistant Professor of Surgery and Clinical Surgery, McGill University ; Surgeon to the Royal 
Victoria Hospital and Consulting Surgeon to the Montreal General Hospital. 
JAMES BELL, M. D., 
THIS communication is merely a report of facts which I have 
had the opportunity of observing under such exceptional cir- 
cumstances as to lead me to the conclusion that they may be 
accepted as absolutely reliable, and of such a nature as to add to our 
knowledge of some of the more obscure problems presented by this 
protean disease. 
They are as follows: 1. A case of transmission of syphilis from 
the male two years after the disappearance of all lesions. 
A gentleman well known to me for years socially as well as pro- 
fessionally, a healthy, strong, active, and athletic man with a good 
family history, aged about thirty years—a club man, and what might 
be called a high liver, although rather abstemious in the matter of 
alcoholic beverages—presented himself on the 3d of March, 188H, with 
a well-marked and characteristic primary sore. I had previously 
treated him occasionally for slight attacks of eczema, sometimes on the 
forearms and sometimes on the legs, but never severe or persistent. I 
frankly stated my diagnosis, told him what he had to expect in the 
way of prolonged treatment, and encouraged him with a favorable 
prognosis. I advised total abstinence from alcohol and tobacco, and 
regular but good living. I gave no medicine, but instructed him to 
present himself once a week for examination. On the 9th of June 
he presented himself with the typical skin, glandular, and throat 
symptoms, and treatment was then begun. The treatment was at first 
hydrargyrum cum creta three times daily, which after about three 
weeks was replaced by protiodide of mercury pills, beginning with a 
quarter of a grain three times a day and increasing it up to half a 
grain within a few weeks. This was continued for some months, then Original Communications. 
a period of mixed treatment—percliloride of mercury and iodide of 
potassium ; then a lull of a month or six weeks and a course of inunc- 
tions to the point of commencing salivation ; then a rest of a month ; 
then some iodide treatment, and finally a return to the protiodide 
pills, half a grain three times daily. This whole course of treatment 
extended over two vears and four months, during which he abstained 
entirely from alcohol and followed out mv instructions to the letter. 
After the first three months of treatment he never had a sign of the 
disease, his general health remained good throughout, and he fre- 
quently declared to me that he never felt better in his life. About 
the time of coming under treatment he was either engaged or about 
to become engaged to be married. As his treatment progressed satis- 
factorily, he became anxious to be married ; but I resolutely refused 
to sanction matrimony within two years and a half of the onset of the 
disease, and then only with the proviso that he should remain perfectly 
free for at least six months prior to making his final arrangements. 
At the end of August, 1888, I fully and unreservedly advised him that 
he might safely arrange to he married. Outside considerations hur- 
ried on the arrangements more rapidly than I had anticipated, and he 
was married on the 24th of November, 1888—two years and eight 
months from the time at which I diagnosed a fully developed chancre and 
two years and six months from the time of commencing the treatment. 
During the month of October he indulged in certain festivities in the 
way of dinners and suppers and champagne, incident to his emancipa- 
tion from treatment and in connection with his forthcoming marriage, 
and (as I believe) in consequence presented himself again with a few 
patches of acute eczema identical in every respect with his presyphi- 
litic attacks. This soon got well, and I saw no more of him until he 
came to consult me about his wife. As I have already said, he was 
married on the 24th of November. On the 25th of January, 1889, he 
came to me to consult me about some swollen and painful condition 
of his wife’s genitals, but as I had gone abroad for a couple of months 
he took her to another medical man, and, filled with remorse as he 
was, told him the history of his own illness. A diagnosis of primary 
syphilis was made, and a month later (so 1 am informed by the gen- 
tleman who treated her) a characteristic rash appeared, and she was 
treated with protiodide pills and suitable local applications. Immedi- 
ately on my return he came to see me, but I could not believe it possi- 
ble that he could have inoculated her. On the 4th of April I saw her 
for the first time. She was a strong and healthy woman, but came of 
a scrofulous family and had had one tonsil removed when a child for 
hypertrophy. The protiodide treatment had been discontinued and Two Cases of Syphilis. 
3 
bhe had about half a dozen raised pustular spots about the neck and 
shoulders and one very suspicious-looking spot as large as a ten-cent 
piece in the fold behind the tragus of the ear. This was moist and 
excoriated and was very suggestive-looking. The superficial cervical 
glands were all enlarged, and the tonsils and pillars of the fauces 
swollen and angry-looking. I declined to make a diagnosis in the 
face of these observations and facts, for the reason that I believed it 
impossible that inoculation could have taken place. I gave a placebo, 
and i-iie went away to the country, but returned in about a fortnight 
with a deeply ulcerated tonsil and a general redness and inflammation 
of the fauces and pharynx. The skin eruption had greatly increased and 
was now multiform, though consisting chiefly of isolated pustular spots. 
I now made the diagnosis of syphilis (in May), and on suitable treat- 
ment all these signs soon disappeared. I may say that in order not to 
excite suspicion no examination of the genital or inguinal regions had 
been suggested, and as 1113 patient had had no sufficient reason given 
her to think it necessary to continue her treatment it was dropped as 
soon as the symptoms disappeared, with the result that in August she 
again appeared with a characteristic iritis. 
1 have given in this narrative the fullest details in order to show 
(1) that the husband was properly treated and was, as far as could be 
seen, free from disease when he married; and (2) that there can be 
no doubt as to the diagnosis in the case of the wife. For the rest, I 
believe the husband to have been perfectly honest in the matter, and 
the wife to have been in every respect above suspicion. In my opin- 
ion, this must have been a case of blood inoculation. 
2. Conception occurring during the period of incubation of the 
chancre in the male parent—the product being a perfectly healthy, 
nonsyphilitic child. 
A. B., a strong, active, and healthy man, thirty years of age, had 
been under my care in the early part of the summer of 1892 for a 
chronic urethritis from which he fully recovered. On the 4th of No- 
vember he came to me in a state of great anxiety. His wedding day 
was fixed for the 7th of November, and he was leaving town that even- 
ing for the city in which he was to be married. The cause of his 
anxiety was, he stated to me, the fact that four days previously (Octo- 
ber 31st), after a prenuptial dinner which had been tendered him, and 
while semi-intoxicated, he had again exposed himself, and was in mortal 
dread lest the urethritis should be revived. This fear completely 
blinded him to the possibility of any other danger. I next saw him on 
the 16th of January, 1893, when he came to me with a fully developed 
secondary syphilis and a large indurated chancre. He had not the 4 
Original Communications. 
slightest suspicion of what was the matter. The sore, which had ap- 
peared two or three weeks after marriage, he attributed to a tear of the 
prepuce, and its subsequent induration to neglect and the irritation of 
repeated coitus. The skin eruption, which had been developing for 
about a week when I saw him (during which he had been away on a 
business trip), was the first thing to excite his apprehension. It is not 
necessary to follow the history of this patient further. The interest of 
the case is centered in his wife and child. 
Careful investigation elicited the following facts concerning his 
wife: (1) That she had ceased to menstruate one week before marriage 
and had not menstruated since; (2) that she was then suffering from 
morning vomiting and other symptoms which led her to believe that 
she was pregnant (about two months). Subsequent events proved 
this to be the case, and her child was born about the middle of August. 
Conception must therefore have occurred during the interval which 
elapsed between the inoculation and the appearance of the chancre. 
It is only necessary to say further that the woman was made aware of 
the grave condition of affairs by the husband, and willingly submitted 
herself to careful examination from time to time during her pregnancy 
(the genitals always excepted), and that at no time up to the present 
has there been any indication of syphilis. From the time of the dis- 
covery of the husband’s disease up to the time of delivery she took 
steadily protiodide of mercury (in pill form), from three quarters of a 
grain to a grain and a hall' daily. She remained in good health, and 
was delivered at full time of a fine,healthy child, which she nursed for 
about six months, when her milk failed and she was obliged to wean it. 
The child (now nine months old) has never shown a sign of syphilis, 
and is a typically healthy, well-nourished baby. 
I regret that I have not had the time nor the opportunity to re- 
view the literature of syphilis—now so very extensive—with a view of 
classifying facts similar to those here recorded, but I trust that these 
cases may be considered of sufficient interest to justify me in bringing 
them before the association.