Lettsomian Lectures on Some Moot Points in the Natural History of Syphilis
Authors: J. Hutchinson
Journal: BMJ (1886)

LECTURE III. (Conclduded from paye 2J.2). ,1, tircr ay UShronic Skinl-D~iseases which are dute to the Inher-itance of Syphilis ?-TheNervouts System.-Idiocy in Connection.with Inherited Syphilis.-Conclusion.Are there any Chronic Skin--Diseases which are due to the Inheritance Qf 8Syp hilis ?-The question which I next propose to consider is, as to whether there are any chronic skin-diseases which are caused by the inheritance of a syphilitic taint.We shall pass by those which occur in infancy; with these we are all sufficiently familiar.We know well that an infant born with this taint is very likely to display, during the first six months of life, various forms of eruption.We know also that these are usually transitory, and that, if the child survive, it will in all probability be quite free from rashes before it is a year old.In a large majority of cases, and especially in those treated by mercury, the liability to skin-eruption does not last more than a few months.It may be that condylomatous patches at the anus or on the lips may persist longer, or even originate later, but nothing which can be properly called a skin-disease is commonly seen.In inherited syphilis, we seldom witness the relapses which are common in the eruptions due to the acquired disease.We look at later periods for the results of former skin-affections, for fissures at the angles of the moutli, for little scars or pits on the lace and other parts, and we value these as evidences which help our diagnosis, but we never ex- pect to se any extant eruption.The skin may be pale, thin, abnormally soft;, but it does not show any liability to inflame.I am stating broadly thlie general fact; I purpose now to examine the question in a little detail ; to ask whether this suggested immunity applies to all periods, or only to those immediately following infancy.Before Me proceed further, permit me to remind you that the infant who inherits syphilis gets the disease in a different manner from that which obtained in the case of its parent.I hold that it is almost certain that in each instance a particulate and living virus passes into the victim's fluids.The infant who inherits syphilis does not simply take over fro m its parents tissues which have peculiar proclivities to disease, as in t he case of inheritance of cancer, gout, or scrofula.It takes over, plus th'3 peculiar tissues, a virus which is capable of multiplying in its blood1, and of producing a somewhat acute febrile illness ; a virus which, whilst it is active, makes its bloods and fluids contagious, but wlich after a time ceases to be active, and loses its contagious proprerties.In this important feature, the inherited and the acquired fe ,rms are alike; both pass through a definite stage of secondary symptoms; but, as regards the primary stage, they differ in a very im- portant and possibly a very influential point.In the acquired dis- ease, the virus in the first instance breeds in a group of epithelial or epidermic cells, whereas, in the case of the infant, there is no local breeding; but it exists, it may be in the blood, it may be throughout the body, from the first.I will assume that we are all aware that, in many cases of inheritance-perhaps almost all-there are at.the time of the child's birth no signs of the disease.The virus is latent, and it appears to be necessary that respiratory processes shall have been carried on for a certain time to enable it to assume activity.Most syphilitic infants look quite well when born, and only begin to be ill at the age of a month or six weeks.At the age named, and for a month or two afterwards, they often suffer very severely.To return to my point, it is conceivable that the special nidus of first growth of the virus may have a molifying influence on its later tendencies, and ri o1 lwi Li .)1IJthat which has begun its life in mucous or cutaneous tissue may retain ever afterwards a proneness to attack these.I scarcely think, how- ever, that this hypothesis is the correct one, for I shall have to assert presently that not only is the skin comparatively exempt from attack in the later periods of inherited syphilis, but that the nervous system in a scarcely less degree shares the immunity.'in' the facts to which I hve 'adverted,' we have, to face a ,very obscure. problem.Nor is it easier to explain why one sex should suffer more fre- .11Feb.'Ie.1886.