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Assistant Professor of Surgery and Clinical Surgery, McGill University ; Surgeoir to the Royal Victoria Hospital and Consulting Surgeon to the Montreal General Hospital reprinvbd from the Journal of Cutaneous and Genito-Urinarv Diseases FOR February, 1895 "^ WEDICAL FAGU./ \k I TWO CASES OF SYPHILIS HAVING A JJEARING ON THE (QUESTION OF THE PERIOD DURING WHICH THE DISEASE IS COMMUNICABLE. By JAMES BKLL, M.I)., Af- iii > final arrangements. At the end of August, 1888, I fully and unreserveilly advised him that he mijjrht safelv arrange to be married. Outside considerations hur- ried on the arrangements more rapidly than T had anticipated, and he was married on the 24th of November, 1888 — two years and eight months from the time at which I diagnosed a fully developed chancre and two years and six months from the time of commencing the treatment. During the month of October he indulged in certain festivities in the way of dinners and su])pers and champagne, incident to his emancipa- tion from treatment and in connection with his forthcoming marriage, and (as I believe) in consequence presented himself again with a few patches of acute eczema identical in every respect with his presyphi- litic attacks. This soon got well, and I saw no more of him until he came to consult me about his wife. As I have already said, he was married on the 2-1-th of Xoveui!)er. On the 25th of January, 1889, he came to me to consult me about some swollen and painful conditi(m of his wife's genitals, but as I had gone abroad for a couple of months he took her to another medical man, and, filled with remorse as he was, told him the history of liis own illness. A diagnosis of primary syphilis was n)ade, and a month later (so I am informed by the gen- tleman who treated her) a characteristic rash appeared, and she was treated with protiodide pills and suitable local applications. Immedi- ately on ni}' return he came to see me, but I could not believe it possi- ble that he could have inoculated her. On the 4th of A[)ril I saw her for the first time. She was a strong and healthy woman, but came of a scrofulous familv and liad had one tonsil removed when a child for hypertrophy. The protiodide treatment had been discontinued and It 1!/ Two CdHt'M (jf Si/p/iifi'n. 8 ^ilc liiid al)oul lialt' a (iuzeii niined purttuhu* ^pots about the iicuk and slionlders and one very RU8jneious-lookin think it necessary to contimie her treatment it was dropped as soon as the symptoms disappeared, with the result that in August she again appeared with a chara(!teristic iritis. I have given in this narrative the fullest details in order to show (1) that the husband was properly treated and was, as far as could be seen, free from disease when he married; and (2) that there can be no donl)t as to the diagnosis in the case of the wife. For the rest, I believe the husband to have been perfectly honest in the nuitter, and the wife to have been in every res|)ect above susi)icion. In my opin- ion, this must have been a case of blood inoculation. 2. Conception occurring during the period of incubation of the chancre in the male parent — the product being a perfectly healthy, nonsyphilitie child. A. B., a strong, active, and healthy man. thirty years of age, had been under mv care in the earlv i)art of the summer of 1892 for a chronic urethritis from which he fully recovered. On the 4th of No- vember he came to me in a state of great anxiety. His wedding day was fixed for the 7th of November, and he was leaving town that even- ing for the city in which he was to be married. The cause of his anxiety was, he stated to me, the fact that four days previously (Octo- ber 31st), after a prenuptial dinner which had been tendered him, and while semi-intoxicated, he had again exposed himself, and was in mortal dread lest the urethritis should be revived. This fear completely blinded him to the possibility of any other danger. I next saw him on the 16th of January, 1898, when he came to me with a fully developed secondary syphilis and a large indurated chancre. He had not the OrKHNAI. CoMMl'NKJATlONrt. slijflitortt HUrtpieiou of wluit wiw tlie matter. The rtoro, wliieli had ap- peared two or three vveekrt at'tt'r inarriai;e, lie attributed to a tear of the prepuce, and its suhsecpicnt induration to neglect and the irritation <>f repeated coitus. 'IMie skin eru|»tinn, whicli had heen developing for about a week when I saw him (during which he had heen away on a business trip), was the first thing to excite his apprehension. It is not necessary to follow the history of this ]>atient further. The interest of the case is centen'd in his wife and child. Careful investitration elicited the followini; facts c(»ncernln had ceased to menstruate one week before marringe and had not menstruated since; (2) that she was then suffering from morning vomiting and other symptoms which led her to believe that she was |)regnant (about two months), Subsequent events proved this to be the ease, and her child was born about the middle of August. Conception must therefore have occurred during the interval which elapsed between the inoculation and the appearance of the chancre. It is only necessary to say further that the woman was nuide aware o\' the grave (rondition of affairs by the husband, and willingly submitted herself to careful examination from time to time daring her pregnancy (the genitals always excepted), and that at no time up to the present has there been any indication of syphilis. From the time of the dis- covery of the husband's disease uj) to the time of delivery she took steadily |)rotiodide of mercury (in pill form), from three quarters of a grain to a grain and a half daily. She remained in good health, and was delivered at full time of a fine, liealthy child, which she nursed f(»r about six months, when her milk failed and she was obliged to wean it. The child (now nine months old) has never shown a sign of syphilis, aiul is a typically healthy, well-nourished baby. I regret that I have not had the time nor the opportunity to re- view the literature of syphilis — now so very extensive — with a view of classifying facts similar to those here recorded, but I trust that these cases may be considered of sufficient interest to justify me in bringing them before the association. •«• ^1 ^ ■