In the gluteal region of nonsyphilitic children, an exanthem posed of lenticular spots may occur, the individual lesions of which become eroded in a short time and very closely resemble moist syphilitic papules. These skin eruptions designated by Sevestre and Jacquet "syphiloides posterosives," are due to maceration and are distinguished from syphilitic papules by their brilliant inflammatory red color and by their isolated location on the nates and the posterior surfaces of the thighs. The localization of the eruption is of value in the differential nosis of cutaneous syphilis of infancy. The efflorescence and tions have a predilection for regions of the body that are exposed to chemical and mechanical irritations, therefore the lower half of the body and the face. The color of the skin is a further point in diagnosis. In the majority of cases it is of a light gray, while the efflorescence itself is of a salmon, ham, or copper color. Only for a short time during the period of eruption is there a brighter red color.
The great value of enlargement of the spleen in the newborn and older infants has recently received renewed emphasis by Marfan as a point in the diagnosis of hereditary syphilis and is evident from the following figures established by Parrot : Weight of spleen in children of 5 to 10 days normal...... 7 grams.
syphilitic....38 grams.
Weight of spleen in children of 10 to 20 days normal 0.3 grams.
syphilitic 34 grams.
Weight of spleen in children of 20 to 30 days normal S.3 grams.
syphilitic 1S grams.
According to my observations, about 70 per cent. of all children
that have palpable spleens during the first three months are syphilitic.
From the standpoint of differential diagnosis, several symptoms referable to individual organs should be mentioned. As far as the nose is concerned, there occurs in the newborn a condition in which the nasal mucous membrane becomes swollen, analogous to erythema neonatorum, and is accompanied by a slight snuffle, a condition that is physiological. There may occur likewise influenzal, diphtheritic, and gonorrhoeal corzya of infancy.
The influenzal nasal affection which most frequently has to be con sidered in diagnosis, is always accompanied by catarrhal symptoms of the palate and pharynx that are absent in the syphilitic coryza. Congenital hypertrophy of the tonsils, too, can cause nasal obstruction in babies.
As to the mouth and pharynx, it must be remembered that in infants syphilitic efflorescenees and ulcers are among the rarest lesions in these situations. By keeping in mind the peculiar butterfly shape of the ulcerations of the hard palate that are known as Bednar's aphthw one will never confuse them with syphilis. The constantly changing epithelial defects of the geographical tongue (Landkartenzunge), likewise, have no resemblance to specific lesions.
The diagnosis of late hereditary syphilis must be made from the characteristic symptom-complex above described. The presence of a complete Hutchinson's triad, together with fixed pupils and radial scars on the lips, are weighty diagnostic criteria.