C . Cerebral I nf antile Palsy. —The various clinical pictures of cerebral infantile palsy very frequently rest on a foundation of heredi tary syphilis. I have personally known cases of this kind presenting hemiplegia, paraplegic rigidity and athetosis and Kfinig, who was at first inclined to doubt the influence of hereclitary syphilis in the produc tion of cerebral infantile. palsy was able to demonstrate its presence in seven per cent. of his eases. General rigidity, noted soon after birth and attributed to injuries during labor, is also observed in children affected with hereditary' syphilis (Holly, Vizioli, Gilles de la Tourette and others). These palsies are usually assoeiated with idiocy, epilepsy, and sometimes pupillary rigidity. These forms of cerebral infantile palsy, which rest on a foundation of hereditary syphilis, should be differen tiated from cerebral infantile palsy proper because, as We shall see, the latter is equivalent to a healing process within the brain, whereas those forms of cerebral palsy which rest on a syphilitic basis may at any time undergo a change, and usually a change for the worse.
D. Brain 7' ionor . —The symptoms of brain tumor are sometimes produced by- hereditary syphilis in the form of gumma or encephalo malacia (Cnopf; case of my own in a syphilitic( boy presenting distinct symptoms of a pontine tumor). Antisyphilitic treatment is not always followed by favorable results; both idiocy and death have been observed.
staple Sclerosis. —The familiar symptom-complex of multiple sclerosis—scanning speech, intention tremor, nystagmus, disturbance of gait and mental deficiency—although not characteristic in childhood, is riot infrequently due to hereditary syphilis. In stud' eases we may assume a. multiple focal encephalomyelitis or a diffuse sclerosis (Bechtercw).
F. T abes Dor salis anti Progressive Pa ral ysis. —By i 116 tiding tabes and paralysis in the chapter on diseases of the central nervous system clue to hereditary syphilis We wish to emphasize the fact that, 60 far as the pediatrist is concerned, there is praetically no doubt of the etiologic relationship between syphilis and this condition. This is clearly proven by statistics. Marburg was able to demonstrate the presence of syphilis in 2ii out of :34 juvenile tabetics; Alzheimer found positive, or very suggestive signs of syphilis in 70 per cent. of 11 juvenile paralytics, and these figures assume greater significance from the fact that Hirschl, on. questioning patients with tertiary syphilis in a syphilitic ward, obtained a history of a former attack of syphilis in only 54 per cent. A still more trenchant argument is found in the fact that progre.ssive paralysis and tabes have never been ob.served in any child in which syphilis could be positively excluded after careful observation from Hie first day of life. From this standpoint the frequent association in childhood of two diseases which in themselves are not frequent—hereditary syphilis on the one hand and tabes or paralysis on the other—must be regarded as, something more than a coincidence and the cases, by no means rare, in which the first signs of hereditary syphilis and the initial symptoms of tabes or paralysis have been demonstrated in the same individual when under continuous observatio» (Hochsinger) must be regarded as positive proof of a. causal relationship which is indu
bitably constant. At all events the eonditions found in childhood are of considerable importance in helping to decide this question in adults (K. Mendel).
When it is remembered that in the adult from 15 to 20 years usually elapse between the syphilitic infection and the first signs of the above mentioned nervous affections, there is nothing surprising in the fact that in the child these diseases do not begin to develop until the end of childhood, so that the first obvious signs are often observed during puberty. On the other hand, there is a tendency to a shortening of the interval in children, and paralysis especially' is often seen fully devel oped in children of ten to twelve years of age. The ineidence of tabes or paralysis is the same in boys and girls (Marburg gives the proportion of girls to boys as 4:3; Alzheimer for paralysis as 1:1). This again is in accord with the theory of heredity, whereas in adults, owing to the greater frequency of syphilitic infection in men, the number of male tabeties and paralytics is greater then the number of females afflicted with these diseases.
Tabes and paralysis present characteristic forms in ehildhood and usually occur separately. There are cases, however, which, as in the adult, present common symptoms of the two diseases and whielt may be designated tabo-paralysis. Many cases that would now be regarded as MSC'S of paralysis or tabes were formerly described as forms of cerebro spinal syphilis, which somewhat complicates the task of sifting the material.
(a) Tabes Dorsaltis.—The number of cases of this disease so far described is not large (Marburg has collected 34 cases). This is clue partly to the comparative rarity of the affection and partly to the difficulty of making the diagnosis, chiefly because the disturbance of the gait, which is such a prominent symptom in adults, is rare in the. juvenile form. Among the cardinal symptoms in tabes failure of the pupil to react to light is very frequent, there being no difference in that respect between the infantile and the adult forms. Inequality of the pupils is common. The patella,' reflex is usually abolished, but this symptom is not as constant as in adults. Swaying when the eyes are closed is rarer in juvenile tabes than in the adult form. Ataxia and dis turbances of the gait are much less marked and are observed only in a small minority of the OELSCS of infantile tabes. On the other hand, genuine atrophy of the optic nerve, incontinence of urine—first in the form of nocturnal enuresis—patches of anffisthesia on the trunk and laneinating pains in the legs are not rare in children. Gastric crises, nenralgias, hemicrania and trophic changes (arthropathies, mal perforant) have also been observed both as prodromal phenomena and as sy-mptoms of the disease when fully- established.