CONGENITAL AND HEREDITARY SYPHILIS. 785 



mother during the period of pregnancy. The manner in which the 

 contagion is transmitted to the embryo from the father or mother is 

 altogether unknown, and we shall, therefore, confine ourselves to a 

 statement of a few known and authentic facts, without attempting any 

 explanation of them. 



If a woman who has secondary syphilis becomes pregnant, the 

 foetus nearly always dies prematurely, and is expelled by an abortion 

 or miscarriage. In such cases, the foetus is generally so much putre- 

 fied that it cannot be determined whether it bears traces of syphilis 

 upon it or not. In like manner, a woman who is healthy at the time 

 of conception, but who subsequently contracts syphilis, usually aborts 

 or miscarries, giving birth to a decomposing foetus. In other cases, the 

 child is carried to term, but dies either at the time of its birth or shortly 

 before. It then either bears distinct evidence of syphilis upon its 

 wasted body, or else there is no anomaly beyond its extreme emacia- 

 tion. In rare instances the child is bora alive, and lives for a longer 

 or shorter period of time. In such cases, the syphilis may appear im- 

 mediately after birth, or else may remain latent, and develop weeks or 

 months afterward. Inasmuch, then, as constitutional syphilis of the 

 mother exerts so pernicious an influence upon her offspring, that it 

 usually perishes either long before or else during birth, it will be 

 readily understood that the majority of cases of congenital syphilis, 

 which become the object of clinical investigation and medical treat- 

 ment, are the progeny of syphilitic fathers. It is an extraordinary but 

 well-established fact that syphilis may be thus transmitted from father 

 to child, without infecting the mother who bears the infected offspring 

 in her womb. Hereditary syphilis, derived from a syphilitic father, 

 sometimes manifests itself immediately after birth, while at other 

 times the characteristic symptoms do not appear until later. 



SYMPTOMS AND COTJESE. The symptoms of congenital syphilis 

 consist principally of affections of the skin and mucous membranes ; 

 and it is only in rare instances, when the disease drags on incurable, 

 out without killing the child, that it causes disease of the bones. 

 When children are born with evidence of the disease upon them, or 

 when it makes its appearance a few days after birth, it usually proves 

 to be of a more malignant nature than when it remains latent for 

 some weeks. 



The former class, in which the malady assumes the character of a 

 bullous or pustulous syphilide, occasionally accompanied by a coryza 

 (see below), was for a long time misunderstood, and used to bear the 

 name of pemphigus neonatorum. When the child does not come into 

 the world with the disease already upon him, it usually commences 

 upon the palms of the hands and soles of the feet, and afterward 



