The question is still under discussion. A case reported by Zappert, which was unquestionably one of hereditary syphilis with circumscribed. meningitis in the cervical portion of the cord and secondary paralysis of the arms, was regarded by Hochsinger as possibly a birth palsy.
/. In addition to the above-described forms of hereditary syphilis there are a number of other conditions that may, with more or less reason, be attributed to hereditary syphilis. These include observations of symmetrical gangrene (Krisowski), diabetes insipidus (Demme), of trifacial neuralgia tSoltmann), and, finally, a statement by Hoch singer that his myotonia of the newborn shows a special predilection for the subjects of hereditary syphilis.
When we consider the enormous number of different conditions that may develop in the nervous system of children affected with heredi tary syphilis, the diagnostic difficulties are at once apparent. The im portant point for the practical doctor is to remember the possibility of hereditary syphilis in such cases, as the prospect of a cure is so much more certain if that diagnosis can be established. Aside from the history and other signs of syphilis in the child or other members of the same family, any acquired chronic nervous condition with pupillary rigidity, imbecility, ancl cerebral symptoms of difficult localization should excite the suspicion of hereditary syphilis. To make an accurate scientific diagnosis in such eases is far more difficult; for it is sufficiently evident from what has been said that only certain definite pictures, such as hydrocephalus, tabes, progressive paralysis and spastic spinal paralysis are sufficiently characteristic to admit of a precise diagnosis. In very many cases all attempts at an accurate diagnosis must be given up and the practitioner will have to content himself with a general determination of the scat and character of the disease.
The same caution is necessary in giving a prognosis. Although it is quite true that in many conditions simulating a severe meningitis, a brain tumor or a myelitis, the demonstration of hereditary syphilis offers a ray of hope and the possibility of saving the child, it must not be forgotten that many diseases due to hereditary- syphilis continue to progrws steadily in spite of specific treatment, and that even recovery from one syphilitic manifestation in the nervous system does not pre clude the reappearance of the constitutional disease in another form. Nevertheless, it is true, that among diseases of the nervous system of equal severity, those which are due to hereditary syphilis have by far the best prognosis.
In regard to causal treatment directed against the cause of the disease the reacler is referred to the chapter on hereditary syphilis. With the exception of tabes, paralysis and many forms of epilepsy, the effect of antisyphilitic treatment in most of the diseases that have been mentioned is quite prompt, although not always la.sting. In cases in which iodine and mercury prove ineffective, the same therapeutic! prin ciples obtain for diseases of the nervous: system due to hereditary syphilis as for the same diseases when not due to syphilis.
There can be no doubt that syphilis acquired in early life may also produce the above-described symptoms. Observations on this point are not ninnerous, and better proof should be obtained than the mere statement of parents, who frequently attempt to hide the fact that they are themselves syphilitic by attributing the infection to the nurse.