ilis (except in the case of a woman who obtains the disease from a fetus) always presents the chancre as an initial lesion; hereditary syphilis never does. Hereditary syphilis may present itself at birth, and usually shows itself within, at most, the first six months of extra-uterine life. In rare cases (tardy hereditary syphilis) the disease does not become manifest until puberty. Rules of Inheritance.-According to Von Zeissl,' the rules of inheritance are as follows: I. If one parent is syphilitic at the time of procreation, the child may be syphilitic. 2. Syphilitic parents may bring forth healthy children. 3. If a mother, healthy at procreation, bears a child syphilitic from the father, the mother must have latent pox or must be immune, having become infected through the placental circulation. She often shows no symptoms, having received the poison gradually in the blood, and having thus received, it may be said, preventive inoculations. Certain it is that mothers are almost never infected by suckling their own syphilitic children (Colles's law). 4. If both parents were healthy at the time of procreation, and the mother afterward contracts syphilis, the child may become syphilitic, and the earlier in the pregnancy the mother is diseased, the more certain is the child to be tainted. This is known as “infection in utero.” 5. The more recent the parental syphilis, the more certain is infection of the offspring. The children are often stillborn. 6. When the disease is latent in the parents it is apt to be tardy in the children. 7. The longer the time which has passed since the disappearance of parental symptoms, the more improbable is infection of the children. 8. In most instances parental syphilis grows weaker, and after the parents beget some tainted children they bring forth healthy ones. Syphilis in the mother is more dangerous to the offspring than syphilis in the father. The frequent immunity of the mother is due to the fact that her tissues produce antitoxins under the influence of the virus. Many women who labor under hereditary syphilis are sterile. Many syphilitic women abort, usually before the eighth month. The fetus very often dies at an early period of gestation. This may be due to a gummatous placenta or to a degeneration of placental follicles. 1 Pathology and Treatment of Syphilis. Evidences of Hereditary Syphilis (manifest at, or oftener soon after, birth).-Hutchinson says that at birth the skin is almost invariably clear. In from six to eight weeks snuffles" begin, which are soon followed by a skin-eruption, by body-wasting, and by a chain of secondary symptoms (iritis, mucous patches, pains, condylomata, etc.). The child looks like a withered-up old man. Eruptions are met with on the palms and soles. Intertrigo is usual. Cracks occur at the angles of the mouth, and leave permanent radiating scars. The abdomen is tumid, and there is apt to be exhausting diarrhea. The secreting and absorbing glands of the intestinal track atrophy. Enlargement of spleen and liver occurs. Sometimes synovitis or arthritis arises. Atrophic lesions may appear in the bones. In the skull the bone may be softened by removal of its salts or be thinned by the pressure of the brain. In the long bones the epiphyseal ends suffer, the attachment of epiphysis to shaft is weak, and separation is easily induced. Epiphysitis is common and rarely causes pain. Epiphysitis rarely suppurates unless in children who are old enough to walk (Coutts). Osteophytic lesions of the skull are shown by symmetrical spots of thickening upon the parietal and frontal bones (natiform skulls). In the long bones osteophytes are frequently formed. A child with precocious hereditary syphilis is apt to die, but if it lives from six months to one year the symptoms for a time disappear and for years the disease may be latent. Diagnosis is difficult after the third or fourth year, especially if the disease be associated with rickets or tuberculosis. When the disease begins again the symptoms are various, namely: noises in the ears, often followed by deafness; interstitial keratitis; dactylitis (specific inflammation of all the structures of a finger); synovitis in any joint; ossifying nodes; developmental osseous defects; suppurative periostitis; ulcerations; death of bone; falling in of nose; nervous maladies; occasionally sarcocele, etc. In hereditary syphilis the eyesymptoms are of great diagnostic importance. In 212 cases of congenital syphilis Fournier found eye-trouble in 101. Keratitis and choroiditis are the most usual forms (Silex). Bone-trouble occurs in almost half of the cases, but is not often severe enough to cause symptoms. The tongue often shows a smooth base (Virchow's sign). Hirschberg believed choroiditis to be pathognomonic. Diagnosis. In the diagnosis of hereditary syphilis the condition of the teeth is of much importance: the temporary 1 Coutts, in Brit. Med. Jour., 1894, No. 1843. FIG. 38.-Hutchinson teeth. teeth decay soon, but present no characteristic defect. If the upper permanent central incisors are examined, they are found defective. Other teeth may show defects, but in these alone are defects almost sure to appear. In hereditary syphilis they present an appearance of marked deviation from health, and are called "Hutchinson teeth" (Fig. 38). If they are dwarfed, too short and too narrow, and if they display a single central cleft in their free edge, then the diagnosis of syphilis is almost certain. If the cleft is present and the dwarfing absent, or if the peculiar form of dwarfing be present without any conspicuous cleft, the diagnosis may still be made with much confidence. In early infancy the diagnosis is made by the snuffles, broad nose, skin-eruptions, wasted look, sores at the mouth-angles, tenderness over bones, condylomata, and history of the parents. The diagnosis at a later period is made by the existence of symmetrical interstitial keratitis, choroiditis, smooth base to tongue, deafness which comes on without pain or running from the ear, ossifying nodes, white radiating scars about the mouth-angles, sunken nose, natiform skull, deformity of long bones, painless inflammation of epiphyses, and Hutchinson teeth. It must be remembered that a child born apparently healthy and presenting no secondary symptoms may show bone-disease, keratitis, or syphilitic deafness at puberty. Treatment.-In infants inunctions are to be used until the symptoms disappear, but mercury must not be forced or continued too long after the symptoms are gone. There must be rubbed into the sole of each foot or the palm of each hand 5 grains of mercurial ointment every morning and night. Brodie advised spreading the ointment (in the strength of 3j to the ounce) upon flannel and fastening it around the child's belly. If the skin is so tender that mercury must be given by the mouth, White and Hearn advise that gr. to gr. of mercury with chalk, with I grain of sugar, be taken three times a day after nursing. If tertiary symptoms appear, or in any case when the secondaries disappear; give gr. ss to gr. j or more of iodid of potassium several times a day in syrup. White advocates the continuance of the mixed treatment intermittently until puberty. Local lesions require local treatment, as in the adult. A syphilitic child must be nursed by its mother, as it will poison a healthy nurse. If the baby has a sore mouth, it must be fed from a bottle; and if the mother cannot nurse the child, it must be brought up on the bottle. For the cachexia use cod-liver oil, iodid of iron, arsenic, and the phosphates. XVII. TUMORS OR MORBID GROWTHS. Division. Morbid growths are divided into (1) neoplasms and (2) cysts. Neoplasms.-A neoplasm is a pathological new growth which tends to persist independently of the structures in which it lies, and which performs no physiological function. A hypertrophy is differentiated from a tumor by the facts that it is a result of increased physiological demands or of local nutritive changes, and that it tends to subside after the withdrawal of the exciting stimulus. Further, a hypertrophy does not destroy the natural contour of a part, while a tumor does. Inflammation has marked symptoms: its swelling does not tend to persist, it terminates in resolution, organization, or suppuration, and the microscope differentiates it from tumor. Inflammation, too, has an assignable exciting cause. A new growth is a mass of new tissue; hence it is improper to designate as tumors those swellings due to extravasation of blood (as in hematocele), or of urine (as in ruptured urethra), to displacement of parts (as in hernia, floating kidney, or dislocation of the liver), or to fluid distention of a natural cavity (as in hydrocele or bursitis). Classes of Tumors.-There are two classes of tumors: the first class includes those derived from or composed of ordinary connective tissue or of higher structures. These all originate from cells which are developed from the mesoblast. There are two groups of connective-tissue tumors: (a) the typical, benign, or innocent, which find their type in the healthy adult human body; and (b) the atypical or malignant, which find no counterpart in the healthy adult human body, but rather in the immature connective tissues of the embryo. The second class of tumors includes those which are derived from or composed of epithelium: (a) the typical, composed of adult epithelium; and (b) the atypical, composed of embryonic epithelium. Müller's Law.-Müller's law is that the constituent elements of neoplasms always have their types, counterparts, or close imitations in the tissues of a normal organism, either embryonic or mature. Virchow's Law.-Virchow's law is that the cells of a tumor spring from pre-existing cells (hence there is no special tumor-cell or cancer-cell). The term "heterologous" is no longer used to signify that the cellular elements of a tumor have no counterpart in the healthy organism, but is employed to signify that a tumor deviates from the type of the structure from which it takes its origin (as a chondroma arising from the parotid gland). Tumors when once formed almost invariably increase and persist, though occasionally warts, exostoses, and fatty tumors disappear spontaneously. Tumors may ulcerate, inflame, slough, be infiltrated with blood, or undergo mucoid, calcareous, or fatty degeneration. Causes. The causes of tumors are not positively recognized, those alleged being but theories varying in probability and ingenuity. The inclusion theory of Cohnheim supposes that more embryonic cells exist than are needful to construct the fetal tissues, that masses of them remain in the tissues, and that these may be stimulated later into active growth. This embryonic hypothesis seems to receive a certain force from the facts that exostoses do sometimes develop from portions of unossified epiphyseal cartilage, and that tumors often arise in regions where there was a suppression of a fetal part, closure of a cleft, or an involution of epithelium (epithelioma is usual at muco-cutaneous junctures). This theory, which does not explain the origin of most neoplasms, cannot successfully be maintained even as a common predisposing cause. Hereditation is extremely doubtful. S. W. Gross found hereditary influence by no means frequent in cancer of the breast. It is affirmed by some, denied by others, and doubted by a number. At most, hereditary influence may only predispose. Nevertheless, cases have occurred which cannot be explained by the term coincidence. In the celebrated "Middlesex Hospital case," a woman and five daughters had cancer of the left breast. A. Pearce Gould had charge of a woman for cancer of the left breast. The mother of this patient, the mother's two sisters, and two of the mother's cousins had died of cancer. Injury and inflammation may undoubtedly prove exciting causes. A blow is not infrequently followed by sarcoma; the irritation of a hot pipe-stem may excite cancer of the lip; the scratching of a jagged tooth may cause cancer of the tongue; chimney-sweeps' cancer arises from the irrita |