ACQUIRED SYPHILIS OF CHILDHOOD There is no essential difference between the acquired syphilis of the child and that of the adult. Well developed cases of acquired syphilis in children under observation from the beginning, show a primary lesion at the point of infection, which is followed after the proper interval by the development of indolent buboes and of a universal skin eruption. The majority of these cases, however, do not come under observation at the start, so that there is usually nothing left of the primary lesion. Moreover, the latter does not always appear as a characteristic Hunterian induration, but is frequently a simple papule. It is rare, too, that one sees the first exanthem. In our own ambulatory clinic these children with acquired syphilis present themselves as a rule with condylomata. Since the primary lesion and the skin eruptions are very frequently not well marked in children, they are apt to be overlooked, while the appearance of extensive condylontata causes the parents to seek medical aid. In localities where syphilis is endemic this is not the case, according to the reports of L. Cliick of Sarajewo.
Contagion may take place in children just as in adults, i.e., through venereal contact, through accidental transmission to the surface of the body, and through contact with unclean instruments in the hands of the physician. The following methods of infection must be considered as peculiar to children: (1) transmission at the time of birth from an actively syphilitic mother; (2) transmission through the act of nursing; (3) transmission through various measures employed in the care of children.
A. Fournier denies the possibility of an intrapartum infection, believing in the validity of Profeta's law' with reference to the immunity of a syphilitic mother. Nevertheless, six well authenticated cases of such infection have been described up to the present time.
Of greater importance is the possibility of infection through nurs ing. It is evident that a nurse with virulent syphilitic lesions on the breast can infect the child that nurses her. In that case a primary lesion
forms on the lips, more rarely at the entrance to the nostrils. It is also conceivable that a nurse can transmit syphilis to a child, without her self being syphilitic if she nurses alternately at the same breast a syph ilitic and a nonsyphilitic child. It has happened, for example, that the saliva of a syphilitic child served as the bearer of contagion to a well baby when the latter was given the same breast, without sufficient cleansing, immediately after the former had nursed. The presence of primary lesions simultaneously on the breast of the nurse and in the mouth of the baby can be explained only in this manner.
In those infections occurring as a result of the usual attentions given to infants and children, chance plays a prominent part. The primary lesion may be situated anywhere on the surface of the skin or mucous membranes. By far the most frequent seat in these cases is the mucous membrane of the lips, especially of the lower lip, because of the fact that feeding and caressing are the most prominent causes. Chancre of the eyelids, too, has been seen in children as a result of kissing.
The point of infection is only rarely the genitalia, and then much more frequently in girls than in boys. This method of contagion is sometimes the result of violence on the part of an individual who holds a view that is wide spread, that transmission of his disease to a young virgin will cure his own syphilis (A. Fournier). The finding of a pri mary lesion on the genitalia of a child should always be reported to the police, since it is probably the result of a criminal attack.
As to transmission by the physician in his professional capacity, this had to be considered formerly, as occurring through vaccination. Occasionally, ritualistic circumcision with accompanying sucking of the wound by the operator has led to infection in the child.