SYPHILITIC RELAPSES IN EARLIEST CHILDHOOD Inasmuch as the first manifestations of syphilis, in a great many hereditary-syphilitic. children, run their course within the uterus, the whole period of infantile syphilis and the first eruption are a relapse in many cases. It is enough to mention in this connection the visceral, osteochondritic and nasal lesions that start during intrauterine life and are frequently not followed by an eruption until after birth. But even after the first eruption, no matter whether this is part of the first ap pearance of the disease or not, relapses occur during infancy in the most widely different organs. Frequently these manifest themselves as a continuous progressive development, without any periods of la tency, and advance until a large number of organs are affected. We find, for example, that certain affections of the bones are frequently associated with the first period of skin eruption, especially those of the small hollow bones (phalangitis) and the periostitis of the cranial bones with its tendency to hyperostosis. The collection of hydrocephalic fluid often goes hand in hand with these. Not infrequently the first exanthem is followed by an unbroken series of different skin lesions, such as recurring infiltration in the lower half of the body, gamma formation, oozing condylomata, and mucous patches. Involvement of the organs of special sense likewise occurs. In general the following statement is true: the further a child has passed beyond the period of infancy, the less do cutaneous lesions manifest themselves.
Not infrequently congenital syphilis recurs even during the period of infancy in the form of affections of the central nervous system, espe cially as cortical encephalitis the result of specific vascular lesions, and as hydrocephalus. A number of these cases run their course as a cere bral paralysis of childhood with or without epileptic attacks, and are later accompanied by disturbances of intelligence. It is an important fact that syphilitic brain diseases may occur in infancy without evidence of a preceding exanthem; and that the striking result of the use of antisyphilitic treatment in many affections of the brain accompanied by epileptic seizures in earliest childhood, reveals the syphilitic origin of the disease.
Ocular lesions, either independently, or in specific combination with other syphilitic lesions due to relapses arc much more frequent. toward the end of the period of infancy than during the first period of eruption. Above all others in importance in this connection is the focal choreoretinitis of Hirschberg, which is most characteristic of syph ilis present at birth but which also appears during later relapses. Of less significance in the relapses of earliest childhood arc indurative lesions of the palpebral cartilages.
Involvement of the testicle during the period of infancy is another form of relapse in congenital syphilis. There is here. a diffuse inter stitial cell proliferation analogous to the diffuse process in the liver (Hutinel). This manifests itself clinically by enlargement and indo lent hardening of the organ (Henoch). Since this lesion, nearly always bilateral, is accompanied by no particular subjective symptoms it fre quently escapes notice unless it is looked for as a matter of routine in the cases of infantile syphilis. The epididymis always remains free. Syphilitic orchitis of infancy never leads to suppuration and is a pecu liarly favorable lesion from a standpoint of therapeutics. The relapse manifestations of congenital syphilis during infancy are by no means exhausted by those organic changes that have been enumerated so far. Especially frequently are the viscera (liver, kidneys, pancreas) involved. The thymus also may be affected, at times becoming very large and thus producing, as Malian and I have observed, stenosis of the trachea with stridor thymicus; the latter disappearing promptly under anti syphilitic treatment. Paroxysmal hemoglobinuria and hmnatoporphy rinuria, of syphilitic origin, may occur in infancy.