HEREDITARY SYPHILITIC ARTHRITIS As a consequence of hereditary syphilis, arthritis appears as a be lated manifestation in children who have not been specifically treated. The recognition of these cases, for which we are principally indebted to ophthalmologists, is all the more important because antisyphilitic treatment (specifically with iodide) generally results in a complete and rapid cure. Less frequently in children under five (more frequently in those between six and ten years) there arises without any traumatism, either subacutely or chronically an effusion into the joints, which may become very copious, causing at the same time surprisingly little sub jective disturbance. Puncture shows serofibrinous fluid. Tempera ture is normal or subnormal. Cases of severe inflammation, however, accompanied by high fever also accur (Bosse). The knee-joints are most frequently attacked, and the disease almost always affects both of them in the course of time. Therefore, every case of gonitis (in flammation of the knee-joints) beginning in the manner described (and especially if the second knee begins to be involved in the same way), will cause us to suspect secondary syphilis. It will then be necessary to
explore the family history of the child as well as its physical condition.
Should parenchymatous keratitis be present along with the artic ular affection, it will more easily verify the diagnosis, unless the same conclusion has been reached by treatment for syphilis previously em ployed. It is usual for hereditary syphilitic arthritis to be combined with parenchymatous keratitis. The arthritis precedes the eye affec tion almost always by months or years.
Bosse found arthritis of an hereditary syphilitic nature in 37 per cent., von Hippel in 56 per cent. of all cases of parenchymatous keratitis.
The treatment is dependent on the diagnosis. The specific treat ment is generally successful even in cases accompanied with high fever and inflammatory signs which appear to require surgical procedure.