Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.

  • Mansell-Moullin, C. W. (Charles William), 1851-1940
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    slight attack or from a severe one, but this does not dej^end ii])on the inoculation or the date of infection in the parents, but upon the child. ICarly miscarriages may very probably be accounted for by local affections of the uterus or placenta, the slighter severity in the later children by the improvement in the general health of the parents, and the occasional intensity in one of the last-born by the failing power of the mother, and the consequent feeble development and nutrition of the child. 'I'he child may be affected either through the father or the mother or through both. It is generally believed that when the mother is diseased the child suffers more severely, and, no doubt, death of the f(jetus before birth is commonly due to some affection of the uterus or i)lacenta ; Init, excei)t upon this point, there is no direct evidence one way or the other. The ordinary infection is through the father ; the mother may show no sign of the disease, but, as was first pointed out by Colles, it is impossible to believe that she escapes. An infected child is almost certain to transmit the disease to a wet-nurse, never to its own mother. If the lather's attack is recent, the disease is communicated directly to the mother and the foetus is exceedingly likely to die in utero from some local lesion. If the secondary stage (and with it the ])eriod of direct inoculability) is jjast, the ovum may, or may not, be rendered syphilitic by the spermatozoa. I'he only explanation of the fact that the mother is not infected by the child after birth, is that she has been already rendered syphilitic through the medium of the ftjetus before birth. When this occurs, the mother does not suffer from secondary symptoms : the poi.sori, beyond all doubt, is modified by the conditions under which it is acting (the length of the incubation period in the embryo is proof), and transmitted in this way does not appear to cause them; but tertiary lesions may follow later, for it is not uncommon to meet with them in women in whom the most careful inquiry fails to reveal any evidence of secondaries. The child, there is no doubt, may become infected through the mother alone. If syphilis is acquired during the earlier part of pregnancy, the ftjetus is affected and suffers from the ordinary effects of the congenital disease, just as if the virus had been communicated through the ovum or spermatozoa. In the later months there is a possibility that the child may escape. Congenital Syphilis. The symptoms of congenital syphilis may make their appearance before birth or shortly after it, from three or four weeks to six months. In the former case the child is nearly always born dead. It is quite the exception to find any evidence of the disease upon a child born alive. 1. Before Birth.—It is probable that in a large proportion of the cases the death of the foetus is due to disease of the uterus or placenta, the foetus itself showing no definite sign. In a few, however, suppuration has been found in connection with the viscera; gummata are occasionally present, and certain changes which are admittedly syphilitic have been recorded in the bones. 2. After Birth.—As a rule, the child is born without the least' evidence of any taint, healthy and well-nourished, and no sign of the disease makes its appearance for some weeks. Exceptionally, Pemphigus breaks out within a day or two and nearly always proves fatal. A few weeks after birth the child begins to waste and grow pale. Its nose becomes stuffed up, so that it cannot take the breast for any length of time with- out letting go ; a thin, watery discharge runs from it, the breathing becomes obstructed (whence the popular name, smiffles), and a ?-ash, similar to that which occurs in the secondary stage of the acquired form, makes its appearance more or less all over the body. The favorite situations are the mucous membrane of the nose, mouth, and anus; the skin over the buttocks, owing to the generally moist and heated condition in which that part is kept; and the palms of the hands and the soles of the feet. On exposed surfaces it is for the most part
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