An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. 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.
![Those ((notations indicate what is now the prevailinir view—viz. that tlie period of transniissibility of syphilis is more or less strictly limited even when the disease is allowed to pro<;ress without treatment. As to the fact that it becomes milder with time, so that with each succeeding; year after the termina- tion of the secondary period the chances of escape of the product of c<iiiception increase in a rapidly au<:mcntin^ ratio, there is no difference of opinion whatever. Neither is it seriously disj)iited that the length of time during which the disease remains active, as well as the degree of its activity, may be markedly influ- enced by treatment. Under proper medication patients who have married in the height of the secondary period have had children born healthy who never subse<iuently manifested any symptoms of the disease. We may therefore assume safely that syphilis after a certain period, not extending nmch over four years Avliere the disease is alloAved to run its own course, and probably somewhat reduced by treatment, ceases to be a contagious disease, and at about the same time or somewhat later loses, in the majority of cases, its capability of being transmitted by parent to offspring. As there are ])robably exceptions to the rule that this power of transmission disappears spontaneously within any specified time, it is never safe to trust altogether to nature, but a vigorous and sufficient specific treatment must be employed. Given, however, the lapse of a sufficient time—say from three to four years as a minimum—and the history of a proper and continuous plan of treatment, the risks of marriage are so reduced as to warrant a careful surgeon in permitting it. And, conversely, of course in any doubtful case Avhere such a history can be elicited, and Avhere all these precautions have been observed, it is improba- ble that any taint of syphilis has been transmitted. Beyond this in positive- ness it is not safe to go. There may be exceptions to these as to most other hygienic or therapeutic rules, but they will be of excessive rarity. Before considering the methods by which syphilis can reach the child from one or the other of its parents, it may be well to mention the modes in which the parents can infect each other. The man can derive syphilis from the woman only in the usual way—/. e. by contagion through a breach of surface permitting of the direct absorption of the poison, the development of the disease being attended by the usual phe- nomena—chancre, lymphatic enlargement, skin eruptions, etc. The woman may—and in the majority of cases does—acquire the disease from the man in a similar manner. But the mother may also become infected through the medium of the child, which receives its syphilis directly from the father, the mother up to the time of conception having escaped contagion. More than this, it appears to be highly probable that no woman ever bears a syphilitic child and remains herself absolutely free from the disease. No surgeon of large experience in this class of cases can fail to have seen some in which the husband, having had syphilis and having married after an insufficient interval or an imperfect course of treatment, has infected his wife with the disease, although at the time no discoverable symptom is to be found upon his body. An ecjually careful inspection of the woman will also in such cases be attended by negative results as regards the primary sore, and yet she will be found with immistakable evidences of constitutional syphilis. There is a clue to all such cases which Avill immediately resolve the difficulty. In every instance, provided that no mistake has been made and that both husband and wife are really free, the one from any contagious lesion, the other from any evidence of a present or previous primary sore, it will be found that pregnancy has occurred; that the woman has either been delivered of a syphilitic child or has had an abortion or miscarriage at some time before the outbreak of the](https://iiif.wellcomecollection.org/image/b21217014_0214.jp2/full/800%2C/0/default.jpg)
