prematurely born at seven months, scarcely covered by cuticle, affected with dysentery, and it died almost immediately. The fifth was born at eight months, very weakly, and after some days, numerous vesicles, filled with a transparent purulent liquid, appeared on the body and inside the mouth. It died at the end of three weeks; they had placed it under the care of a nurse. This nurse, soon after the child's death, was attacked with ulceration of the nipple, then the glands in the axilla became affected, next a bad sore throat, but without any local lesion, next an eruption on the skin, with desquamation of the cuticle of the hands and fingers, next onychia with loss of the nails of the fingers and toes.

Hunter, in his observation* which I have just analyzed, denies the existence of syphilis in the infant or the nurse. In the latter, he even goes so far as to attribute to mercury, the ulceration of the fingers and the falling off of the nails. But I may observe, that Hunter, whilst denying the existence of syphilis, could not say what the disease was that was under his notice. If it be not syphilis, call it what you will.

Syphilis from the infant to the nurse. Here is another case of Hunter's, which this great surgeon placed under a heading where it was very difficult to discover it, and which is disguised under the title of Diseases which resemble Syphilis. Hunter possessed all the weaknesses of those systematic men who throw aside whatever troubles them. A case is met with which scarcely agrees with their theory, it is the case which is irregular, and is an instance of one of nature's freaks. Thus reason authors on nosology:

Case 7. A lady nursed two children, her own child was suckled at the right breast, the other at the left. At the expiration of six weeks, the left nipple ulcerated, and passed through the different stages of the disease. Cicatrization took place three months after the commencement of the affection. At that time the strange child had impeded respiration, aphthæ in the mouth, and died of consumption, its body covered with ulcers. Shortly after this, the nurse was attacked with lancinating pains in different parts, and had on the arms and thighs an eruption of mucous tubercles, many of which became ulcers. She was placed under a mercurial treatment.

Three years afterwards she became the mother of a child, who had the cuticle detached in several places, and a squamous eruption on its body; it died at the end of nine weeks. It had been placed in charge of a nurse. The nurse a short time afterwards had cephalalgia, sore throat, and ulcers on the breasts. She became an inmate of a hospital, was treated with mercury, and went out at the end of some months not cured. The bones of the nose and palate bones exfoliated, and some months afterwards she died of consumption.

The lady was treated by sea bathing, and Lisbon drink; the ulcers on the arms and nates were cured in a month. A year afterwards she had another very feeble child, it died before the end of the month. Lastly, after ten months, the ulcers broke out afresh, suppurated for a year, and then disappeared permanently.

What is this, then, but a disease transmitted by a child to the breast of a woman, infecting her organism, producing patches on the skin, being the cause of the birth of a child affected with ulcers, which child infects another nurse, in her breasts, throat, bones, and, in fact, every part of her, so as to cause her death? What is it, then, if it be not syphilis, or syphiloid disease?-a word which Hunter has searched for without being able to meet with it, for his opinion was, in speaking of this case, that every day new poisons were produced which greatly resembled the venereal poison, so that it follows that we must judge them not by their points of resemblance, but by their points of dissimilarity.

There is another case of Hunter's, resembling syphilis, and not being syphilis.

Case 8. A child, born of apparently healthy parents, was given in charge to a nurse three weeks after its birth. Its skin was desquamating in some parts, and it had excoriations around the anus. One would have said that the part had been scalded. There was also abrasion of the lips, and aphtha in the mouth. It died at the end of a fortnight, having only sucked from the left breast.

The nurse continued to suckle her own child, and went to the city to look for another nursling. At the end of a fortnight, and five weeks after the death of the first nursling, she had ulceration of the left nipple, and two days after this an eruption, which lasted a fortnight, on the body, the arms, and nates. This eruption was similar to small pox.

At this time a gland in the axilla suppurated, was opened, and rapidly healed. On the other hand, some pustules of the cutaneous eruption became large ulcers and were covered with crusts, next an ulcer appeared on the left tonsil, and she was placed under mercurial treatment for six months. Hunter stopped

it, and the nurse for the time was cured. At a later period she had an abscess of the breast, near the nipple, and a fresh eruption on the face; at last they both disappeared.

The child had been taken away from this nurse five days after the appearance of the eruption, and given to a second nurse. It had, at the end of some days, a pustular eruption on the head, and excoriations in the mouth, which prevented it sucking; it had an eruption on the face, the knees, and feet, during three months. They took it to London, without submitting it to any treatment; it was placed under the care of a third nurse, and rapidly became well.

This nurse had also inflammation of the breast, an ulceration on the nipple, and likewise an eruption on the nates and limbs. She got well without treatment. Her milk failed; but to quiet her own child, she placed in its mouth the nipple of the breast that had been diseased. This child became ill with the same symptoms as the nursling. Both took mercury and were cured.

The third nurse, like the preceding, was in a short time affected, but the spots showed themselves in fewer numbers; it might be said that the disease had lost much of its virulence, for each new infection presented a less malignant character than the preceding. The disease was cured without treatment.

What then, again, is this disease communicated by a child to three nurses successively, and to the child of one of these nurses? What

*Op. cit.; p. 776.

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name is to be given to this new poison, capable of being transmitted in the same manner as syphilis, without being syphilis? Why, one might, after the example of Hunter, acknowledge that the fact puzzled us. Shall we call it syphiloid disease? But this term is nothing more than a mask to conceal ignorance. We prefer, by force of analogy, to see in this case an example of secondary syphilis transmitted by inoculation from the newly-born child to its nurse.

Case 9. Syphilis from a newly-born infant to its nurse.—(Gazette Médicale, 1851.) In March, 1844, a newly-born child, the issue of a mother affected with constitutional syphilis, weak, puny, having ulcers in the mouth and back of the throat, copper-coloured spots on the skin, was brought to M. Petrini of Turin. It became affected with marasmus, and died in three months.

A hired nurse had the charge of suckling it, but observing it grow weaker, she requested two of her friends, sisters, both nurses, to give her nursling the breast.

These had shortly both of them ulcers on the nipples, at a later period, pains in the bones, next, ulcers on the genital organs. They infected their husbands. Their two children had in their turn ulcers of the mouth, or the isthmus faucium, and ultimately sank under these affections.

Simple local treatment restored the husbands to health; they had no sequelæ of a venereal nature.

As to the two mothers who were affected, one recovered her health completely, and the other was cured at the end of several months, after numerous complications, and with the loss of an eye from syphilitic iritis.

What is most astonishing in this case is, that the first nurse escaped the contagion; but it is well known that the mode in which syphilis is transmitted is not necessarily always the same. Again, it is possible that the nurse, taking precautionary measures against the danger, was willing to avoid it, by throwing on her neighbours the duty of suckling her nursling.

But what is quite certain is, that two women, after giving the breast to an infant affected with constitutional syphilis, had-1, ulcers on the nipples; 2, pains in the bones; 3, ulcers on the parts of generation; 4, communicated the same disease to their husbands; 5, infected their children, who died from it.

The obstinate would say that these two women had deceived their husbands, that they had contracted chancres otherwise than from the child intrusted to their care, that they had had constitutional syphilis, subsequently consecutive affections of the nipples, of the bones, of the organs of generation; that the husbands had also acquired their chancres away from home, that they falsely accused their wives, who having secondary symptoms, could not communicate a primary disease; that the children must necessarily inherit this syphilitic taint, and that this is the clearest and simplest manner of explaining the case of M. Petrini, who was mistaken, and unaccustomed to witness cases of this nature.

We do not share this opinion, and we consider this case a very proper one to class with those that we have already reported.

Case 10. (Extracted from the Gazette des Hôpitaux, 1851.) A little girl, covered with an eruption which was considered syphilitic by the surgeons of the Meaux Hospital, was put out to nurse at Ferté-sous-Jouarre, at Madame Follet's.

This woman having had consecutively pains in the breasts, next ulcerations, and at a later period angina with ulceration at the back of the throat, was examined as well as her husband, and no old or recent traces of primary syphilis could be discovered. The surgeons at Meaux concluded that syphilis had been communicated to her by the nursling, and the court having been appealed to to assess the damage done to the nurse, ordered her 2,000 francs damages in spite of an opposite opinion from M. Ricord.

Case 11. (Extract from Bulletin de Thérapeutique, 1851.) A woman at twentytwo, married, the mother of a healthy child, having suckled a strange infant, who remained in perfect health, took another nursling who had a pustulous eruption on the nates and the inside of the thighs. The eruption spread all over the body, and was declared to be of a syphilitic nature, by a surgeon who advised the child to be restored to its parents. This advice was followed and the child soon fell a victim to the disease.

This woman had kept the nursling seven weeks, and ten days after sending it back a small ulcer appeared on the left nipple, next sore throat, and at the same time pimples on the genital organs.

M. Caradec, of Brest, having been called in to the patient, observed an ulcer almost cicatrized, without induration on the nipple of the left breast; syphilitic roseola very plain about the body, mucous patches very abundant on the genital organs, both on the inside and outside of the thigh, on the nates, and the head, slight swelling of the axillary glands; lastly, a deep redness of the back part of the mouth, and a small greyish ulcer on each tonsil.

M. Caradec did not find on the genital organs of this woman any suspicious cicatrix, and it was the same with the husband whose organs were most scrupulously examined.

This woman was submitted to a specific treatment: sarsaparilla and the protoiodide of mercury cured her completely.

Thus, here is a woman, who, after seven weeks of daily contact with a syphilitic child, finds herself attacked with ulceration of the breast, then with angina, then with syphilitic roseola, then with mucous patches, and neither she nor her husband have, on their parts of generation, any suspicious cicatrix of a former chancre.

The nature of the phenomena are not doubtful, their order of succession very well marked; it is constitutional syphilis originating in a constitutional syphilis, and transmitted from the nursling to the

nurse.

[Wiseman (Chirurgical Treatises; book vii, p. 4. London, 1676) has also observed that "nurses may either infect children, or be infected by them. Children that have no ulcers in their mouths or lips, nor any other visible symptom of the lues, have, notwithstanding, betrayed their own infection by transmitting it to the nipples of the nurse; in which case it is frequent to see serpiginous ulcers arise one after another, growing at length into so many round, crusty ulcers: also

nodes thrusting out of the back of the hands, shins," &c. He records two cases "A nurse, by in point, of nurses who had become diseased in this manner. giving suck to a diseased child, was infected with great ulceration and chaps with veruca on the nipples and parts about the breasts, upon which account the child was taken from her, it being suspected that she had infected the child. She had also a node on the right hand, and some breakings out upon the limbs. I, inquiring into the cause, saw this poor woman's child, which was born within the It was, year, very well complexioned and sound."-(Ibid; book vii, p. 29.) therefore, concluded that the disease existed originally in the foster child. A "A nurse was brought to me, who, by similar case occurs in the same volume. giving suck to a diseased infant, had the nipple and parts about the right breast very much excoriated, and four round, hard, crusty ulcers, somewhat more distant. She had a node, with pains on her right leg, also a serpigo on her right hand and fingers. She had not been troubled with a gonorrhoea, nor was the pudendum even diseased, which confirmed to me that she had gotten the infection by suckling the child.—(Ibid; p. 33).

Various ancient authors have alluded to this mode of contamination, and Astruc (De Morbis Veneris; lib. ii, cap. i,) says there can be no doubt as to the frequent occurrence of transmission by means of lactation.

Dr. Barry (Medical Essays and Observations; vol. iii, No. 21) has noticed the rapid and destructive course which the disease thus communicated appears disposed to run, and Vercellon (De Morbis Pudendarum; cap. iv, p. 205) gives an account of a whole village having been more or less infected, from several charitable women, moved with compassion, having given their breasts to two foundling infants infected with venereal disease, and a similar and very remarkable instance is narrated by Portal (On the Nature and Treatment of some Hereditary Diseases; Medical An infant Journal; vol. xxi, p. 251) as having occurred at Montmorency. infected with syphilis, was taken from Paris, to be nursed by a woman of that place. The disease was communicated from the child to its foster-parent, from the latter to her husband, who infected another woman, and in a short time the whole town became more or less infected. Cases related by Mr. Hey (MedicoChirurgical Transactions; vol. vii, 1816), besides illustrating the possibility of syphilitic inoculation by mamillary absorption, tend to demonstrate the elective determination observed in the appearance of some morbid principles; thus the poison of syphilis exhibits a constant tendency towards the genital organs, although introduced into the system by another channel.

"The

Dr. Colles (On the Venereal Disease; p. 272) has recorded an instance in which the disease was communicated by lactation. A woman who had her own infant at the breast, and having an abundance of milk, was induced to suckle another infant, and continued to do so until it died at the end of three weeks. manner of its death, and the state of its body, as related by the woman, leave not a doubt that this infant was affected with syphilis. Previous to her reception of the child, she and her own infant (then four months old) were in perfect health; about the time of the death of the strange infant, a sore appeared on her breast, near the nipple; and not long afterwards an eruption occurred over various parts of the body, preceded by the customary febrile symptoms. Not being aware of the nature of her illness, she did not apply for medical advice; and she has remained up to the present time without treatment; the eruption fading in one place, and then reappearing in another. Her throat, also, has laterally become affected; it presents a deep red appearance, but there is no ulceration to be seen; the angles of her mouth are also affected by fissures; at this period of the complaint, seeing that matters were going on from bad to worse, she determined on coming into the