S. In the extremities children suffering from hereditary syphilis exhibit a great variety of symptoms. Palsies of a spastic character occur in the form of hemiplegia, paraplegia and cliplegia. A monoplegia of central origin, particularly when involving the arm, is suspicious of syphilis (and brain tumor). Athetosis, tremor and ataxia are often associated with the paralysis.
9. Sensory disturbances are rare, and if the intelligence is preserved, the sphincters of the bladder and rectum usually escape.
10. The deep reflexes in the extremities are frequently exaggerated. Occasionally (tabes) they may be diminished.
The above symptoms have a tendency to combine in various ways and to form more or less sharply circumscribed clinical pictures from which it is sometimes possible to infer the existence of certain definite pathol ogic !lenges.
A. Meningitic Affections.—Hereditory syphilis may produce the picture of acute and chronic meningitis. Acute meningitis in rare cases develops with symptoms similar to those observed in tuberculous men ingitis; in fact it has happened that a ease diagnosed as tuberculous meningitis and given up by several physieians has reeovered tinder treatment with potassium iodide given as a last resort, the effeet of treat ment affording the first indication of the true character of the disease (Fournier, personal observation). Most probably we have to deal in such cases with an uncomplicated serous meningitis, which has been occasionally demonstrated post mortern as an aceompaniment of syphi litic ehanges in the brain (Caro, Cowers). Chronic meningitis of the base of the brain produces rigidity of the neck (opistliotono.s in the meningitis of the posterior fossa of the skull), ocular palsies, etc. Loeal ized meningitis of the convex surfaces of the cerebrum, which is almost always associated with encephalitis, leads to Jacksonian epilepsy and paralysis. Hcemorrhagie pachymeningitis may run a course similar to that of hydroeephalus.
I?. Hydrocepholus.—That simple uneomplieated hydroeephalus may develop after birth on a foundation of hereditary syphilis is an indubitable fact (Elsner. IIeller, Fruinsholz, Ilochsinger, and many others). On the other hand, the relation existing between congenital hydrocephalus and hereditary syphilis is less clear. It has been attributed to intra-uterine disease of the blood vessels or to a parasyphilitie pre disposition, the latter supposition finding support in the association of congenital hydrocephalus with other malformations in ehildren suffering, from hereditary syphilis (Katzenstein) (see eongenital hydrocephalus).
Acquired hydrocephalus when due to hereditary syphilis usually makes its appearanee in the first year, particularly (luring the first six months of the infant's life. The symptoms are extremely variable. In many cases, the only symptoms are enlargement of the skull and bulging of the fontanelle. The intelligene.e is not neeessarily impaired. In other cases hydroeephalus begins like a meningitis with symptoms of brain irritation such as restlessness, insomnia, vomiting, rigidity of the neck and convulsions, and quite frequently leaves a permanent rigidity with contractures of the extremities and marked exaggeration of the reflexes. As a rule, there is imbecility or idiocy. Enlargement of the skull in all these cases is very marked ancl may attain extreme degrees (56.5 eni. Hochsinger); but on the whole acquired syphilitic hydrocephalus does not produce an extreme dilatation of the skull so frequently as the con genital form. When the enlargement is very great, the child is tillable to raise the head. The eyes often exhibit the peeuliar positions already described in connection with congenital hydrocephalus. The remaining symptoms that have been described in connection with cong,enital hydroeephalus inay also be present in the acquired form.
The course of syphilitic hydrocephalus is subject to many varia tions. In rare cases the meningeal symptoms undergo acute exacerba tion and the disease terminates suddenly in death (Fruinsholz); or the course may be subacute, extending over several months, and ultimately ending in death ((l'Astros). Now that the etiologic relation between hereditary syphilis and hydrocephalus has become better known more cases are cured, or at least arrested by antisyphilitic treatment (cases of Hochsinger, Heller, Neumann, Immerwol and others). Unfortunately the cure is not always permanent, and a fresh attack of hydrocephalus or other signs of brain syphilis often develop after an interval of several months. Finally', hydrocephalus in many cases causes a permanent eondition characterized by general convulsions and im becility which leaves the children in ill health or at least very much underdeveloped.