[Reprinted from Journal of Cutaneous and Genito-Urinary Diseases, May, 1897.] 
NON-VENEREAL SYPHILIS.1 
By HENRY ALFRED ROBBINS, M.D., 
Washington, D. C. 
ON October 5, 1896, a colored girl, aged twenty years, pre- 
sented herself for treatment at the South Washington 
Free Dispensary. A little to the right of the median line 
of the upper lip there was a rounded, tumor-like infiltration, with a 
scarcely appreciable induration. The whole lip was puffed out, 
showing the pink, rose-tinge of the mucous membrane, contrasting 
vividly with the ebony hue of the girl's complexion. The sub- 
lingual, post-cervical, axillary, and epitrochlear glands, were en- 
larged and as hard as pebbles. All over the abdomen there was a 
maculated erythema. She complained of nocturnal headache and 
rheumatic pains. There was no evidence of an initial lesion of syph- 
ilis on the external organs of generation. 
The girl stated that her uncle had a sore mouth and that her lip 
became sore in July, and that she first imagined it was a "fever 
blister," but now she thought it came from drinking from the same 
glass that he used. Dr. James T. Arwine, who is connected with 
our dispensary service, visited the home of the patient and found 
that the uncle of the girl was employed by Dr. Phillip B. Brooks, 
who kindly gave the following notes relating to the uncle, which 
substantiates the truthfulness of the unfortunate girl's statement. 
On the prepuce of the uncle there was a cartilage-like induration 
and situated above Poupart's ligament there was a bubo. There 
was a papulo-pustular syphiloderma over the face, around the 
mouth, and over various parts of the body, and in the mouth were 
mucous patches. On the day of the girl's first visit (October 5th) 
she was placed on % of a grain doses of the proto-iodid of mercury, 
and the lesion was soaked in black wash several times a day. 
The excellent photograph which is now before you for examina- 
tion was taken on October 10th by an amateur artist, a friend of Dr. 
Arwine. It is an exact representation of the lesion as it was on that 
date. One week later there was a most marked improvement in the 
girl's condition. The chancre was very much reduced in size, the 
mucous membrane of the lip not being visible, and the inflamed 
lymphatic glands were smaller and softer. 
1 Read before the Medical Society of the District of Columbia. 2 
Non-Venereal Syphilis. 
A few months ago a young colored girl reported at our dispen- 
sary (South Washington) carrying in her arms a white infant. In 
the girl's mouth were mucous patches. In Vienna she would have 
been arrested and sent to a hospital, where she could be treated by 
competent physicians, and prevented from carrying the disease to 
the family circle where she was employed. We could only threaten 
to inform on her unless she immediately gave up her place. 
Several years ago I called attention to similar facts in The Jour- 
nal of Cutaneous and Genito-Urinary Diseases, in relation to 
colored waiters carrying syphilis in the mucus patches of their 
Fig. 8. 
mouths, who migrate every summer to our mountain and seaside 
resorts. 
On October 22, 1896, a colored child, aged nine years, was 
to the South Washington Free Dispensary by her mother. 
Around the vulva, seated on the labia majora, which was edematous, 
there were a number of condylomata of the moist variety. There 
was a slight oozing of a mucus discharge at the posterior commis- 
sure. There was enlargement of the inguinal and epitrochlear 
glands. Over the abdomen there was a macular erythema, and there 
was a sort of exaggeration of the natural pigmentation of the skin, 
that I have but very seldom observed. There was no evidence of 
either parent ever having had syphilis. The child, as they informed Non- Venereal Syphilis. 
3 
us, was healthy at birth. It never had the "snuffles." There was 
no arrest of development, no evidence of having had "interstitial 
keratitis," no "otorrhea," no "Hutchinson's teeth," and, in my 
opinion, the patient was not suffering from syphilis hereditaria 
tarda. 
No initial lesion was discovered, but when you find an edema of 
the labia majora, you may be almost certain, that there is a hidden 
chancre. The tender age of the child prevented a thorough exami- 
nation. The lesion may have been concealed behind the fourchette. 
The adenitis was well marked-this follows a chancre, as Ricord 
said, " as the trunk follows the root of a tree." As to how the dis- 
ease was imparted we are in doubt. It may have been through the 
medium of a towel or rag, or it may have been caused by dalliance 
with an evil-minded believer of "voodooism." Dr. Arwine, my 
friend and colaborer at the South Washington Dispensary, tells me 
that among certain of the degraded poor it is the belief that if one of 
them gets the pox he can rid himself of it by giving it to a child. 
On the same day, October 22d, a colored female child of the same 
age (nine years) as the one already reported, was brought to our dis- 
pensary (South Washington). At each of the commissures of the 
lips there was a fissure, with enlargement of the sublingual and post- 
cervical glands. Over the pectoral muscles there were patches of 
almost faded-out roseola. As far as Dr. Arwine and I could ascer- 
tain, there was no history of syphilis in either parent, and they 
stated that the child had always enjoyed perfect health. There did 
not exist any evidence of the " triology " of Hutchinson's marks of 
hereditary syphilis, viz., "interstitial keratitis, defective incisors, 
and otorrhea;" nor did there exist the other two which Dr. F. R. 
Sturgis of New York, has proposed to add to the "triology," that 
is, "no general congenital atrophy, and no general arrest of devel- 
opment." It is true that the fissure at the commissures of the lips 
did not present the appearance of the initial lesion of syphilis in re- 
gard to infiltration and induration, but for many years I have given 
more weight, in diagnosing syphilis, to inflamation of the lymphatic 
glands than to the appearance of the primary sclerosis. As to how 
the child acquired the disease, I would answer-just as any mem- 
ber of this society might accidentally acquire it, by drinking from 
the same glass of water, that has been polluted by one who has a 
buccal mucous patch. These syphilitic germ-carriers are not con- 
fined to the lower classes. 
Dr. A. A. Hoelling, Medical Director, U. S. Navy, permits me 4 
No n-Venereal Sy ph ilis. 
to report to the Society two cases of non-venereal syphilis, which 
have come under his observation: 
" I have met with two cases of true chancre, followed by consti- 
tutional symptoms, in which the initial lesion was not the result of 
the sexual act. The first case presented a chancre on his right 
index finger, followed by a bubo in the corresponding axilla, and 
later by a foul ozena. 
"The second patient had a chancre at the lower surface of the 
scrotum, due to wearing a pair of unclean drawers, which he had 
purchased from a sailor infected with the disease. " 
Some few months ago, in getting material for a revised edition 
of "unmerited syphilis," I wrote to my friend, Dr. Irving C. Rosse, 
Member of the Royal Geographical Society, who is so well known as 
an expert authority on mental diseases. The Doctor, most kindly, 
sent me the following, which occurred during his service as a med- 
ical officer of the United States Army: 
"When on duty at Fort Monroe, Virginia, I was consulted one 
morning at sick-call by a Sergeant of Artillery, who showed a sore 
on his wrist, which he said came from a slight scratch that would 
not get well. From its indurated edges, and other characteristic ap- 
pearances, I immediately recognized the sore as syphilitic, but on 
questioning the Sergeant, a man of excellent reputation, he stoutly 
denied ever having had any venereal complaint. The sore remain- 
ing indolent for some time, despite local treatment, I again told the 
Sergeant my suspicions, which were met with the former protesta- 
tions of innocence. Further inquiry into his personal habits showed 
that he and a member of his battery, lately discharged from hospital 
with syphilitic sores on the hands and feet, were in the habit of using 
the same sponge, towels, and wash-bowl. 
" In the course of time, constitutional infection followed the sore, 
for which treatment became necessary. The Sergeant ultimately 
made a good recovery; at last accounts he was Master-at-Arms on 
board a naval flagship."