320 CLINICAL BACTERIOLOGY. 



From all that is known the question as to the direct inheri- 

 tance of syphilis by the child from the father, although this 

 is theoretically quite conceivable, and is accepted by the 

 large majority of clinicians as actually occurring, must yet 

 be considered an open one. 



2. Congenital transmission from the mother -that is, 

 transmission of the disease with the ovum is accepted 

 upon all sides as a possible and frequent mode of con- 

 veyance. As a matter of fact, the offspring of syphilitic 

 women, if the disease has not advanced to the tertiary stage, 

 are almost without exception syphilitic, independently of 

 whether the father is syphilitic or healthy. 



j. Intrauterine Infection. If the mother, healthy at the 

 time of conception, is infected with syphilis during the 

 period of gravidity, the child also becomes syphilitic. Only 

 when the infection of the mother takes place in the last two 

 months of pregnancy are healthy children at times born. 

 The fetus, under these conditions, must acquire the disease- 

 germ from the mother through the placental circulation. 

 Whether a lesion of the placenta is necessary for this to 

 take place, as is assumed for all other forms of intrauterine 

 infection, has not yet been decided. According to some 

 observers, the offspring of a healthy woman may be infected 

 in the uterus through sexual intercourse with a syphilitic 

 man, and the mother, in turn, be infected by the fetus ; but 

 this is as yet undemonstrated. The reverse procedure 

 infection of the woman, who then infects the fetus is the 

 probable one. 



4. Extrauterine infection during parturition or in the first 

 days of life, if the mother be suffering from recent syphilis 

 and the child has remained uninfected until the moment of 

 birth, is altogether conceivable, and probably also occurs. 

 Whether, however, it plays an important part, it is difficult 

 to decide, as probably the majority of such cases, in which 

 a child develops syphilitic general manifestations about six 

 weeks after birth, are designated as hereditary-syphilitic. 

 Extrauterine infection of the new-born can be demonstrated 

 by the presence of a primary lesion, which is wanting in 

 placental (intrauterine) infection. 



