CHAPTER VII.

HEREDITARY SYPHILIS.

IN reviewing the handful of cases collected together in these pages, if there were no other evidence of the fact, we could not do otherwise than come to the conclusion that the poison of syphilis is of a most enduring kind; that, being once received into the blood, it remains there for years, and possibly-indeed, certainly-for the rest of existence.

In juxtaposition with this admitted law of the syphilitic poison, is another equally positive, namely, that a person possessed of this poison is capable of conveying it to another; and if that other be his wife, he may, through her means, convey it also to his child.

Now, if it be true that the syphilitic poison once received into the blood remains there for life, the infected wife must remain infected as long as she continues to live; and, by a parallel reasoning, the infected child must remain infected until death.

The question, then, comes before us-What if an infected child, grown to manhood, should marry? and with still greater force-What if an infected child, grown to manhood, should marry the daughter of an infected wife? There can be no doubt but that some evidence of the latent poison will be exhibited either by themselves or by their offspring. Such evidence is exhibited; and I feel convinced that a considerable proportion of those

diseases which pass under the name of scrofula, are the produce of the syphilitic poison—are, in fact, not scrofulous, but syphilitic.

Had I been furnished with this view of the syphilitic poison at the commencement of my study of the diseases of the skin, I should have been saved much perplexity and much labor in their investigation. But I do not now regret that I did not possess this information, and that I was therefore compelled to unravel for myself the mystery which hung about some of these complaints. In my early studies I met with a number of peculiar affections which I felt at a loss to classify, and was in an equal difficulty to treat. They were of small extent, excessively obstinate, perversely chronic, and when, by good luck, they did get well, they left behind them an indelible trace of their visitation. They belonged to none of the varieties of cutaneous disease, if not to lupus, and yet they differed in several respects from lupus. I could form no other conclusion than that they were scrofulous. I set myself to arrange them, and here also I met with difficulty, on account of the variety of appearance which they presented; a degree of variety which would have scattered them among all the orders of Willan, and destroyed their affinity; I therefore pursued the safer course of keeping them always before my eye, and watching them narrowly.

I am not now speaking of the cutaneous diseases of childhood, in which a syphilitic taint might be traced from the period of birth; but of a form of disease showing itself for the first time after puberty, or even in adult age; modified, if it depend (as I feel satisfied it does) upon the syphilitic virus, by an assimilation in the blood continued for years, and appearing at a distance of time so remote that any connection with an hereditary poison would seem more than unlikely.

I do

not seek to conceal the difficulties of the case, and I do not ask for belief until my views have been carefully and extensively tested upon the patient; but I shall presently have to claim the discovery of a principle of treatment founded on these views, which in my hands has proved most satisfactory and most successful. The laborious exploration of the intricate and obscure passages of truth is for the few; the results of the researches of the few are the share of the many.

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I must now carry my reader's memory back to what I have said of syphilitic tubercles; elevations of the skin of small extent and height, of a dull purplish-red, yellowish-red, or brownish-red color; opaque or transparent, sometimes superficial and sometimes deep; when deep, producing a total disorganization of the structure of the skin, and converting it into a tissue of an inferior type; when superficial, disappearing without leaving any trace behind; when deep, leaving an indelible trace, a deep pit, or a broad cicatrix, in which the deep layer of the corium and its vessels are distinctly seen; sometimes disappearing without any lesion of surface; sometimes ulcerating superficially, sometimes deeply, sometimes vertically, and sometimes creeping along the surface frequently associated with a plexus of large venules; always chronic; persisting for years, and sometimes for life.

Let me adduce an example of the form of syphilitic tubercle to which I am now alluding, that my reader may experience with me the obscurity which envelopes the subject, but which I hope to be the means of removing.

CASE 68.-A healthy-looking man, a valet, thirtyeight years of age, consulted me for two small clusters of tubercles situated, the one on the cheek, the other

over the upper part of the sterno-mastoid muscle; besides these, he had not a spot upon his body, nor a syphilitic symptom of any kind; he seemed to be in perfect health. The tubercles were round, perfectly smooth, and a little softer to the touch than the adjacent skin. Those on the cheek were of a bright-red color, with a tint of purple; those on the neck were of a dusky-red hue, surrounded by a delicate plexus of minute veins, which emptied itself into several large venules. The tubercles had occupied their present location with very little perceptible change for seven years. Occasionally, a tubercle subsided, and left behind it a yellowish-brown stain, but produced no alteration in the level of the skin; the patches, however, did not grow smaller for a new tubercle seemed to be added whenever an old one disappeared.

Now, what were these smooth, polished, seven-yearsenduring tubercles? They were very like the tubercles of lupus, but then they subsided without ulceration, and without a scar; no one in his senses could have called them scrofulous, occurring in a fine healthy man, who had passed the age of thirty when they appeared; if they were syphilitic, where were the concurrent symptoms? There were no concurrent symptoms, but there were signs written on the patches themselves which were unmistakable; let me retrace them;-the size and form of the tubercles; not their color, because that was different from anything of the kind I had seen before; but the plexus of venules and their scattered trunks; and the stains which the tubercles left behind them on their disappearance. I pronounced them to be syphilitic, and obtained the following account of the man's medical history.

He had been married fourteen years, and had had the venereal disease three times, twice before and once