The organ of hearing seems to be involved only exceptionally in a specific manner in infantile syphilis, although a discharge from the ear does occur in some of these cases.
Affections of the torpid polyadenitis charac teristic of acquired syphilis has its analogy in early hereditary syphilis in the frequent but by no means constant appearance of general glan dular enlargement during or soon after the period of eruption. If one examines carefully the inguinal and axillary regions of somewhat older infants with hereditary syphilis it is not difficult to make out a definite slight glandular enlargement. It. is fl much more impor tant fact, however, that glandular bodies appear in infants with early congenital syphilis in places in which normally no glands are palpable, as in the cubital region, and in the fourth or fifth intercostal space at the side of the thorax. Regional glandular enlargement that is not de pendent upon 'ulcerated skin lesions, but in extremities that are the seat of bone involvement may also occur. In all of these conditions of glan dular enlargement we have only a very moderate enlargement; rarely do these lymph-nodes become larger than a bean. In the glandular en largement of the relapses of the second to the ,fourth year when they are associated with condylomatous efflorescences there is a very duff erent condition. Here we have, at times, lymph-nodes that attain the size of hazel-nuts with no tendency to suppuration.
Complicating Diseases During Infancy.—Congenitally syphilitic infants have a very marked predisposition to septic infection. The cause of this lies in the many chances for infection clue to the purulent rhinitis and the rhagadic ulcerations at the various openings into the body. It is not necessary, in explaining this tendency, to resort to the of physical inferiority and lack of resistance of the brought about l)v congenital syphilis, when the avenues for infection are so ex traordinarily numerous. It is not difficult to explain the frequent lung affections of the syphilitic newborn as affections due to a purulent nasal secretion that runs downward, or the frequent skin and periarticular suppuration as due to metastases from various primary foci of suppuration.
A frequent complication is found in pseudofurumeldosis to which especial attention must be drawn because of the fact that the flaccid abscesses that occur in this condition are frequently considered gum mata. Besides these erogenic infections of the subcutaneous tissue there occur also in the skin of congenitally syphilitic children true cutaneous furuncular infiltrates and pustules as a part of a severe gen eral pytetnia. Frequently this septic secondary infection in syphilitic children manifests itself as a luemorrhagic disease of the newborn, in which there occur ineltuna, purpura and bleeding from the umbilicus. For a long time a specific vascular lesion was erroneously thought to be the cause of this phenomenon and a special form of syphilis hereditaria ha'marrhagica was thought to exist.
When occasionally the eruptive lesions of early hereditary syphilis show a character this can doubtless be attributed to changes in the vessel walls, but these do not explain foetal internal and exter nal haemorrhages accompanied by general dissolution of the blood. In these cases there is always a secondary septic infection which can pro duce luemorrhagie disease in the syphilitic newborn child as well as in the healthy one. Hess distinguishes three forms of disease in this so-called lunmorrhagic syphilis of the newborn: (1) hamorrhagic disease without evidence of syphilis, but with syphilitic ancestors—an exclusively septic infection; (2) the same, but in children who are manifestly syphilitic; (3) severe, evident, congenital syphilis with severe internal and external haemorrhages.
A very frequent complication of early hereditary syphilis is found in purulent synovitis of the larger joints which is not infrequently associated with periarticular abscess formation.
Parasyphilitic to A. we have here tissue changes whose final cause is to be found in a syphilitic infection but without the real products of syphilis, i.e., real syphilitic lesions.