SYPHILIS HEREDITARIA TARDA.—In a series of lectures at the Hopital Louis, Fournier called especial attention to late hereditary syphilis. He reports some interesting cases in support of his view that the first manifestations of hereditary syphilis may be after the period of infancy, and even during the period of adolescence.
Lesions of Congenital Syphilis. — If not present at birth, lesions of various kinds develop from time to time. The writer has delivered children with a well marked roseola. Chaps and excoriations of the quasimucous surfaces about the genitals, anus, and mouth are apt to develop, and may form true mucous patches or even condylomata. A "scalded" appearance of the anus is quite characteristic. "Snuffles" develop after a time, and the nares become so obstructed that respiration and nursing are interfered with and nutrition still further impaired. Ozmia may develop and lead to necrosis of the nasal carti lages. There is no symptom of itary syphilis so characteristic as snuffles.
Caution is necessary in diagnosis, ever. A great number of young children, especially in such climates as that of our lake-region, are affected with catarrh or coryza that presents an excellent imita tion of syphilitic snuffles.
When atrophic rhinitis attacks a child, and its bilateral appearance cannot be satisfactorily accounted for, a very com plete investigation should be made into the patient's previous illnesses and family history. If the suspicion of in herited syphilis is not then allayed, the child should have the benefit of the doubt by the administration of anti syphilitic treatment. Later on, if the characteristic changes are found in the teeth, the eyes, or the ears, these diffi eulties of diagnosis arc, of course, not encountered. St. Clair Thomson (Jour. of Laryn., etc., Aug., '99).
A livid macular eruption is sometimes seen, and ulcerations may form about the mucous orifices. Popular and pustular lesions are not infrequent, and sometimes quite characteristically affect the palms and soles. Subcutaneous tubercular le
sions may be seen in a few cases.
A very peculiar eruption occasionally occurs in syphilitic children that is iden tical in its physical characteristics with ordinary pemphigus in the adult. This "infantile pemphigus" is an unmistak able evidence of syphilis. It consists of an eruption of bull sparsely distributed over the skin. Sometimes but one or two blebs are present. It is especially apt to affect the palms and soles. The blebs are filled with fluid varying from slightly turbid serum to pus, and is sometimes bloody. When the cuticle ruptures, the fluid dries into a greenish crust and ulceration occurs beneath, as in syph ilitic ecthyma, or rupia.
The epithelial appendages of the body, such as the hair and the nails, are not so likely to become affected in congenital syphilis as in the adult, but a brittle, lustreless condition of the nails is occa sionally noted.
Taylor has called especial attention to lesions of the bones in congenital syph ilis. lie has shown that the most fre quent seat of the osseous lesion is the diaphyso-cpiphyseal junction of the long bones, certain bones being affected with especial frequency. The possible de pendence of certain cases of rickets upon hereditary syphilis is a question which, although as yet sub judice, is of the great est interest and importance.
The most important manifestations of hereditary syphilis are the lesions of the viscera. Any or all of the viscera may be involved, the connective-tissue changes being especially apt to affect the liver, spleen, and kidneys.
The broad features characterizing the syphilitic manifestations in the infant's liver are: 1. Syphilis may lead to the granulomatous deposits in the organ or to interstitial fibroid changes.
2. The specific granulomata may be present either in the form of minute multiple miliary gummata or of isolated larger gummata such as, in general, are regarded as being of tertiary nature.