SYPHILIS IN INFANCY Two kinds of organic changes are to be considered: (a) Those that are carried over from the fatal to the extra-uterine period, especially involvement of the viscera, of the osseous system and of the nose.
(b) Those that appear after a period of latency in infants appar ently free from syphilis at birth, especially lesions of the skin and mu cous membranes.
The period of eruption in hereditary syphilis deserves a brief general discussion in cases of the second group. There are children that are born free from syphilis from a clinical standpoint, that develop after several weeks or months an eruption similar to that occurring in acquired syphilis.
The first appearance of this eruption is always during the first three months of life. Most frequently it starts between the second and sixth week after birth.
The first eruption is not always the first. manifestation of the dis ease which may have appeared earlier in the form of specific lesions of the nose, viscera, or bones. In fact, the nose is nearly always involved before the skin eruptions appear. It must be remembered too that syphilis can run its course in infancy without any skin eruption whatever.
The most prominent symptom of infantile syphilis is found in a Millais that consists of an inflammation of the nasal mucous membrane, accompanied by hypertrophy. This very frequently begins during intra uterine life and is accompanied by disturbances of development of the skeleton of the nose.
My own material bearing upon this point comprises 256 cases of hereditary syphilis. I can recall no case in which this hyperplastic rhinitis was absent. Of 173 cases of specific coryza that are accurately described in my records, 65 can be used in determining the time at which this symptom first appeared.
In 3S cases the coryza was present at, or very shortly after birth.
In 5 cases it appeared one week, in 4 cases two weeks, in 4 cases three weeks, and in 2 cases four weeks, after birth. In 53 cases then it appeared during the first month, in the remaining 12 it occurred during the fifth, sixth and seventh weeks.
The affection begins with swelling of the nasal mucous membrane especially of the inferior turbinate bone. At first there is no secre
tion, but later there occurs a tough sanguinopurulent discharge with a tendency to the formation of crusts. There is a very characteristic snuffling sound later accompanied by a moist rattling sound due to mucus. This not infrequently permits the diagnosis of hereditary syphilis at a distance. This impeded nasal respiration makes nursing difficult., and the child frequently turns the head back and holds it in a position of opisthotonos in order to facilitate respiration.
This rhinitis may go no further than the stage of swelling, without any pus formation, or it may lead to ulceration and even to involvement of the cartilaginous and bony skeleton of the nose with resulting changes of shape of the external nose (see figures 120, 122, 132 and 133).
As a result of cicatricial contraction of the cartilaginous and soft portions we have, first of all, the pug nose. If the cartilaginous septum contracts completely a permanent deformity of the nose may result, so that the softer portion may form only a short projection beyond the bony portion with the nostrils directed upwards (bucknose). If the bony septum is made smaller through rarification and ulceration, or through imperfect development, there results the deformity spoken of as saddle nose, characterized by a depression of the ridge of the nose. Perfora tions of both cartilaginous and bony portions of the septum occur in early hereditary syphilis. A certain number of these children are born with deformities of the nose, frequently with abnormally small, or ab normally flat noses. That which characterizes these noses is the fact that the ridge seems peculiarly broad and deeply sunken between the orbits and that the two nasal passages meet under the ridge of the nose at a very obtuse angle. The cause of this congenital nasal deformity lies in an imperfect foetal development of the cartilaginous portion of the septum, analogous to the conditions in myxcedema and mongolian idiocy.