Early hereditary syphilitic involvement of the gastro-intest.inal mucous membrane has been mentioned before, but is not. recognizable clinically. Exceptionally it may lead to haemorrhage from the bowel as a result of ulceration of annular infiltrations of the mucosa.
Changes in the Central Nervous are not rare• during the eruptive period of infantile syphilis and manifest themselves. clinically by great restlessness and broken sleep. Increased tension in the fontanelles is very frequently demonstrable during this period in con nection with these symptoms. Involvement of the brain and its men inges is more frequent than that of the cord. The most frequent lesion to be found in this connection is a meningitis serusa interim and externa with involvement of the arachnoid and of the chorioid plexus, appearing in the form of an acute, or chronic. hydrocephalus. This very frequently develops during or at the end of the first eruptive period, or occa sionally in connection with a relapse. More rarely it is present at birth.
The hydrocephalic head of congenital syphilitic origin does not, as a rule, attain the enormous size of the nonspecific form; but at times, baloon-shaped enlargements occur in that form of syphilitic hydro cephalus which is present at birth (Figs. 132 and 133). In the cases that begin after birth, an early hyperostosis of the cranium prevents enor mous enlargement. Here the diagnosis of an increased amount of intra cranial fluid, a miniature hydrocephalus. as it were, must be made from the tense and bulging fontanelle, the moderate enlargement of the head, and the characteristic Hydrocephalic facies. This syphilitic hydroceph alus of infancy may arise very acutely with the picture of meningitis, or it may occur insidiously without marked functional disturbance of the central nervous system. Finkelstein has stated correctly that.
eclampsia and other severe nervous symptoms that occur during the eruptive clays of hereditary syphilis, may be due to a temporary out pouring of hydrocephalic fluid. In favor of this view are, the increased tension in the fontanelle that is out of all harmony with the miserable condition of the child, and the increase of pressure as shown by lumbar puncture. The latter reveals a perfectly clear cerebrospinal fluid.
Besides this internal serous meningitis there occurs in infants with hereditary syphilis a pachymeningitis hwmorrhagica. There are further
inflammatory changes in the brain and meninges, diffuse and circum scribed, and specific vascular lesions with resultant tissue changes, that cannot be discussed at length in this connection. This fact, however, deserves mention, that hydrocephalic enlargements can result in heredi tary syphilis, from these condi tions. If hydrocephalus is accompanied, for a long time, by manifestations of paralysis, or of contractures, then, in all prob ability, there is underlying it a complicating brain lesion.
The experience that a great number of cases of hydrocephalus in childhood are due to syphilis, as a result of true or parasyphil itic changes, makes it a duty to use antisyphilitic treatment in every case. As a matter of fact it is possible, in a great many cases, to cure recent cases of hydro cephalus by this treat 'pent, and t o prevent others from developing.
Neuritis involving the pe ripheral nerves does not seem to occur in early hereditary syphilis.
Clinical manifestations of involvement of the spinal cord in early hereditary syphilis have not been observed hitherto; and yet anatom ical findings are admitted by Gilles de la Tourette and Gasne, who found diseased vessel walls and interstitial cell proliferations, as well as diffuse involvement of the spinal meninges, in both newborn and older infants with hereditary syphilis. The observations by Peters of specific spinal paralysis are more than doubtful. The findings of Sibelius, on the other hand, deserve consideration; lie found developmental disturbanes in the cells of the spinal ganglion in newborn syphilitic children.
Ocular affections of the eyes are observed even in the newborn in the form of a plastic iritis which may run its course within the uterus and may lead to synechia of the iris. Iritis of early hereditary syphilis runs its course without the violent inflamma tory manifestations that ordinarily go with this affection. A diffuse optic neuritis may occur during the first few months; still more fre quently however a chorioiditis with the formation of peculiar spots. On the other hand the parenchymatous keratitis of late hereditary syphilis is very rare in the early form. It must be remembered further that in the newborn, traumatic changes brought about during birth, especially inflammatory processes of the uveal tract:, may occur, which may easily be confused with syphilitic lesions.