putrid; increased discharge of urine; profuse perspiration; colliquative diarrhoea, all impregnated with an odor of alcohol. Eyes wild and glaring, and the whole features showing the most intense anxiety. Another marked feature in this case was an entire absence of sleep. For four days and nights after coming under my care, there was not a moment's interval of rest, and the attendants were on the constant watch to prevent an escape by the window or door. On the morning of the fifth day he called for food, and after partaking of crackers and a glass of milk, he quieted down and slept several hours, and awoke convalescing. He gradually recovered his mental and physical condition, and I think is in a fair way of entirely overcoming his desire for intoxicants.

There is no doubt but that this case was very much prolonged by the previous administration of large doses of the bromides, as the time was unusually long before the relief came, though the remedy was well selected and clearly indicated. The curative medicine here was Belladonna, of which he received two doses 60th (Swan).

There is a phenomenon connected with the character of every case of mania a potu that has come under my care worth noting, and that is the receptivity of the stomach for small draughts of milk, while it rejects every other kind of food, and sometimes water. Such patients have generally been a long time without eating, hunger being superseded by the cravings for strong drink. And as the system is being rapidly exhausted by the excessive action of all the excretory organs, this becomes an important sustaining aliment at a very critical period, and should be administered in small but oft repeated doses.

. C. S. MIDDLETON, M.D.

HEREDITARY SYPHILIS.

BY T. M. STRONG, M.D.

Definition. Various definitions and divisions have been made to designate syphilis occurring in infants. Thus Bumstead prefers the term congenital, when the disease is acquired from either parent at the time of conception, and also communicated by the mother who may have been infected during the gestation. Boeck makes the following distinctions: "Congenital, received from a mother infected during gestation; hereditary, transmitted from a mother who was syphilitic before impregnation." We, however, prefer to agree with Parrot, who assigns the term hereditary to the condition dating from intra-uterine life, whatever the moment of infection.

Etiology. Hereditary syphilis may be derived from both parents or from either. This question has evoked considerable discussion, and has been ably advocated by the defenders of the various theories, such as (1), that the mother must be suffering from the effects of the disease in some of its forms in order to infect the child; (2), the disease can be transmitted from a father who is diseased, while the mother remains healthy. Dr. Keyes* says that the weight of evidence seems to be in favor of the theories, that when the woman alone is syphilitic the child is quite certain to inherit the disease; when the father alone is diseased and the mother is healthy the child often escapes; but that a healthy woman by a syphilitic man must have a healthy child, is another question and not a fact, since there is abundant evidence that syphilis can be communicated to the child from the father alone, and that, if the mother at the time of conception is healthy, she may remain so, or seem to remain so, indefinitely, the child being born syphilitic. He further adds: "This statement leaves two points unsatisfied; the first is, that there is no case to show that a healthy mother who had produced a syphilitic child diseased from its father, afterwards became her

* Venereal Diseases, 1880.

self poisoned by experimental or accidental inoculation; the second point is, the so-called Colles' law, that a child with inherited disease may poison a healthy stranger whom it suckles, by inoculating the breast, but that the same child cannot poison its mother. From this same fact Zeissl* formulates the belief that a woman may contract manifest syphilis by carrying a foetus from a syphilitic father without her having a primary affection. Kassowizt denies in toto that a woman can be infected through the placental vascular system, or that a mother can transmit the infection to a foetus if she should suffer from a primary lesion during gestation. Prof. Zeissl, in replying to this, relates a case where a man infected his wife, then five months pregnant. In a few weeks, a true Hunterian chancre appeared, followed by constitutional symptoms. The child was seized eleven days after its birth with syphilitic pemphigus and died.

As to the effect upon the foetus according to the time of infection of the mother, the following seem to be established as probable facts unless the mother is poisoned before the seventh month of gestation the child will generally escape; if the mother is poisoned at the moment of conception, or soon after, she is apt to abort; if she is infected later, she may go to term, but the child will be thoroughly poisoned, with few chances of living. The disease may be transmitted from parents in whom all syphilitic manifestations may be latent, and the opposite has been observed in some cases, viz., that the children remained free from disease, after the lapse of years, although one or both parents had secondary manifestations.

Two interesting cases are reported in the current number of the American Journal of Obstetrics which bear testimony in favor of those who claim that the state of the father is of secondary importance so far as syphilis in the child is concerned, and that inherited syphilis cannot occur except as a result of constitutional syphilis in the mother. They are as follows:

Case 1.

A woman contracted syphilis and had various manifestations of it in her 20th year. She married at 21. In the eleventh year of

Amer. Jour. of Obstet., vol. 14, p. 510.

† N. A. J. Hom., 24-576.

Amer. Jour. Obstet. (loco. cit.)