The most important clinical symptom is increase in size. I found this in 31 per cent. of hereditary-syphilitic infants, always in conjunc tion with a varying degree of enlargement of the spleen. It must be admitted that enlargement of the liver can arise also from stasis, fatty infiltration, etc., and that the liver can normally extend more than 1 cm. beyond the costal border in time parasternal and mammillary lines. A comparison however of the frequency of occurrence in nonsyphilitic and syphilitic children showed that in scarcely 3 per cent. of children under six months old in whom there was no suspicion of syphilis was there present a projection of the liver beyond the costal border in the mam millary line while it was present in 31 per cent. of syphilitic children. This alone would seem sufficient to prove that such enlargement of the liver is due to syphilis even if there is no demonstrable hardening of the organ present.
Besides this simple enlargement of the liver in hereditary-syphilitic infants, which promptly retreats under specific treatment, there is still another clinical form, the hyperplastic indurative type, in which the organ in some cases occupies a large part of the abdominal cavity and can be felt as a hard body, frequently with an uneven surface. Children af fected with this form of liver lesion are usually born with it in its fully developed state; they show a distended abdomen with well marked, visible, engorged veins, a hard enlarged spleen, and rarely also icterus. The length of life of infants affected with this form of liver disease is a short one. Whether early hereditary syphilis is capable of producing a hypertropliic biliary cirrhosis has not been decided with certainty. Fre quently congenital icterus due to obliteration and agenesis of the gall passages has been attributed to syphilis, but erroneously, unless there were other manifestations of that disease.
Chiari, Beck and others have described in the newborn a gummatous inflammation of the large bile-passages with termination in contraction, induration and bile stasis; Schiippel has pointed out the occurrence of a contracting peripyophlebitis in syphilitic foetuses.
It is an important. fact that all of these enlargements of the liver accompanied by icterus thought. to be due to syphilis were present at birth; while those cases that occur in hereditary-syphilitic infants after birth run their course as a rule without icterus.
Affections of the is certain that in infants with hereditary syphilis there is seen during the stage of eruption a clinical picture analogous to that of acute nephritis, which disappears under specific treatment. I, myself, then Bradley, Oedmansson, and Finkel
stein have seen cases of that sort. On the other hand albuminuria and casts in congenital syphilis are frequently due to severe, compli cating intestinal disturbances, without having any connection with syphilitic kidney involvement, the existienee of which however, as previously stated, is undoubted (Hecker, Hochsinger, Schlossmann, Karvonen, Stroebe, Stoerk).
From an anatomical standpoint there are found, besides the diffuse interstitial cell proliferation of the connective tissue about the vessels, parenchymatous changes in the renal epithelium and developmental anomalies in the glomeruli of the cortex.
Clinical manifestations on the part of the circulatory system are rare as a result of hereditary syphilis in infancy, although parenchy matous, fibrous, and focal lesions of the heart muscle and endoeardium are observed.
The relations of hereditary syphilis to cardiac and vascular changes will be discussed more fully in the part dealing with diseases of the circulatory apparatus. I will merely mention here that the myocardium of hereditary-syphilitic infants is very frequently occupied by foci of coagulation necrosis which were once erroneously thought to be gum mata, and that, according to Winogradow, there are changes in the automatic ganglia of the heart.
Hemorrhages from the navel in congenitally syphilitic new born infants are much more frequently clue to changes in the walls of the umbilicial vessels which hinder their contraction, than to septic infection.
True syphilitic endoarteritis is usually not fully developed until the second half of the period of infancy and then involves primarily the cranial vessels, giving rise to foci of eneephalomalacia. General involvement of the middle arteries has often been observed (Berghinz).
Children with hereditary syphilis frequently have distended ves sels of the skull (Fig. 132) which are not, however, as E. Fournier thinks, clue to a parasyphilitic dystrophy of these veins, but are caused by hydrocephalic involvement of the inside of the skull. In the same man ner the medusa-like appearance of the veins of the skin of the trunk may be dependent on cirrhotic changes in the liver.
Hereditary syphilis of the lungs occurs occasionally, though rarely, in infants that survive, as a residue from the diseased foetal condition. As a rule, lung infiltrations of syphilitic infants depend upon second ary infections.