Circumscribed or diffuse swellings arise also on the mucous mem branes of the epiglottis and of the larynx that are of great importance because of their interference with speech and respiration. The late syph ilitic ulcers of the nasopharynx, larynx and trachea. have a. decided ten dency to the formation of scar tissue with contractions. For that reason, very characteristic sequelte of late hereditary syphilis are such lesions as cicatricial adhesions of the velum palati to the posterior pharyngeal wall, contractions and distortions of the epiglottis, stenosis of the larynx and of the trachea, the latter being among the most serious lesions from a therapeutic standpoint.
Among the visceral lesions of late hereditary syphilis, so far as fre quency is concerned, liver affections deserve the first rank, although the lesions differ in no way from those occurring during tertiary acquired syphilis. The large nodular gumnia, the diffuse connective tissue hyper trophic cirrhosis, and the characteristic lobulated liver, resulting from a combination of these two conditions, deserve mention. These liver changes are always associated with hyperplasia of the spleen.
Many cases of contracted kidney and of antyloid degeneration of the kidneys may be a manifestation of late hereditary syphilis. It is certain also that diabetes insipidus in infants is frequently associated with hereditary syphilis.
Lesions of the circulatory apparatus in late hereditary syphilis will be discussed in the chapter on diseases of the circulatory system. It should be mentioned, however, in this connection, that gummata aortitis, as well as arteriosclerosis and phlebosclerosis, occurs in con genitally syphilitic children, and that the presence of the latter condi tions during childhood always justifies the diagnosis of syphilis. cardial and endocardial changes are observed in late hereditary syphilis.
Hyperplasia of the adenoid tissue in the nasopharynx is a very fre quent finding in hereditary syphilis, without however having any pecu liar characteristics that are of diagnostic value. Not alone is Luschka's tonsil hypertrophied, but also the remainder of the adenoid ring of the throat, the tonsils, and the adenoid tissue at the base of the tongue. In the latter position two diametrically opposite conditions can exist: a smooth atrophy, and adenoid hypertrophy.
On account of the great frequency of adenoid vegetations in the nasopharynx in older children with hereditary syphilis, there are nearly always present enlarged submaxillary and cervical lymph-nodes. Natu rally, these must not be looked upon as a specific adenopathy, although such a condition can exist in late hereditary syphilis. There is a certain
tendency to glandular enlargement even in these older syphilitic chil dren, so that lymph-nodes can be felt in places where there are none palpable normally, as for example, in the cubital region [epitrochlear lymph-nodes.1 Besides these simple lymph-node hypertrophies, there occur though not frequently, genuine gummata of the lymph-nodes. This may take one or two forms: either an enlargement of a single node, or group of nodes, that are hard and painless and have but little tendency to softening; or as a generalized lymph-node hypertrophy, very sim liar to the polyadenitis of the secondary stage of acquired syphilis, except that in the late hereditary syphilis of childhood the nodes become larger than in the other condition.
If these are only isolated enlarged lymph-nodes, the differential diagnosis from tuberculous lymphadenitis is not always easy. As a rule stigmata of syphilis are present in the one case, and help in making a diagnosis. The more marked appearance of peiiadenitis in the syphilitic form is of some diagnostic value. The course of suppuration of a gum matous node is wholly different from that of a tuberculous node. In the breaking down of a gummatous node a circumscribed portion of the swelling unites with the skin and the latter breaks down rapidly over a considerable area, giving rise, after the emptying of the characteristic contents of the gumma, to an ulcer with all of the characteristics of the syphilitic type. The gummatous involvement is exceedingly amenable to antisyphilitic treatment, a fact that is of great value from a diagnostic standpoint.
Hereditary syphilis frequently causes general nervous disturbances, even a nervous predisposition. Alany of these children are feeble-minded. Difficulty in learning and in observing, and attacks of night terrors are frequently attributed to adenoids in the nasopharynx, but operation in these cases leads to no improvement and shows that there is some more fundamental cause. Psychoses, too, occur in these children at the time of puberty (Dornblueth). To this period belong infantile tabes and progressive paralysis, while epilepsy of the Jacksonian type is possible at any time during childhood, superimposed upon the same syphilitic foundation. These diseases, together with brain and spinal syphilis of the second period of childhood, and the pseudotabes of hereditary syphilis, are all discussed in their appropriate place in that part of this work that deals with diseases of the nervous system.