The symptoms are a duplication of those found in the adult types, and the clinical picture is apt to be conglomerate and difficult of analysis. Endarteritis leptomeningitis, pachymeningitis, gummata, diffuse degenerative changes in the cells of the spinal cord, in the basal ganglia, or in the cortex, all are found and in varying combinations. Consideration will be given here to those trends which are sufficiently accentuated tp permit of definite nosological terminology.
Hydrocephalus.— This condition, resultant from congenital syphilis, has been suspected for over two centuries, and was so reported by Haase, Cruveilhier, Von Rosen and Virchow in the last century. In its congenital form, it arises chiefly from syphilitic disease of the cere brospinal fluid producing structures — choroid, ependyma — or from definite obstructive factors in the cerebral foramina, gummata, vascular swelling obstructing the iter, etc. It frequently follows after congenital syphilis, and is without doubt much more frequent than is commonly realized. Hochsinger cites 10 per cent of hydro cephalus in 362 cases of congenital syphilis. In the series recorded by him, and which gives a fairly average review of the whole situation, the hydrocephalus was sometimes feetal, and usually began from the 3d to the filth month after birth. Up to the time that his report was written absence of nervous symptoms were noted in only 11 of the 362 individuals. In the others the phenomena ranged through rest lessness, sleeplessness, chronic vomiting, con vulsions, contractures, nystagmus and feeble mindedness.
The ordinary clinical picture is that of an infant of from three to six months old who, apparently without reason, or it may be from a slight blow on the head, or a trivial gastrointesti nal or bronchial disturbance, develops within a few days grave cerebral disturbances. The child is very irritable and sleepless, screaming and kicking. The head is usually drawn back, the eyes and the fontanelles are apt to bulge. There is frequent vomiting, and there are signs of oculomotor involvement. Internal strabismus resulting from paresis of the external rectos is a usual sign which is frequently preceded by or accompanied by nystagmus and irregular pupils—often not responding to light. The child cries and struggles, and ofttimes with spasmodic or convulsive movements of the arms it seems to try to brush away the source of the pain which is present in the head; pulling the hair, grasping and rolling the head. It is some times possible to demonstrate spasticity, rigid ity and other signs of intracerebral pressure. As a rule there is no heightening of temperature, and such signs of epidemic cerebrospinal menin gitis as herpes and flushed and spotted skin are absent. There is great difficulty in the diagnosis of all these infantile meningeal disturbances.
Feeble-mtindedness.—The very large role played by syphilis in the production of mental defectives has been realized only of late years. Early statistics are comparatively worthless.
Even recent works —particularly English studies, excepting always those of Mott and his coworkers — show a tendency to minimize its importance, showing an unconscious desire to suppress disagreeable truths.
The intimate correlation between syphilis and feeble-mindedness was first definitely brought out by Fournier, the conclusions being forced upon him by his clinical observations on para syphilis. Following him the early English, Ger man and American figures varied from 0.01 to 17 per cent, but since the introduction of exact serological investigation they have gone as high as 40 per cent. Feeble-mindedness is thus shown to be the result of more than one cause, but as we are not here dealing with it in its larger aspects we limit ourselves to that of purely syphilitic origin. This may date from intrauterine life, but rarely. Children who are infected thus early usually die, and Plant (loc. tit.) is authority for the statement that so far as syphilis is concerned, feeble-minded ness may be regarded as the result of extrau terine syphilitic disease, incurred in infancy. In some there are signs of an acute brain disease; some cases of recovered hydrocephalus later show signs of havoc in their inability to develop normally. Many simply fail to develop. There are many recorded observations of mental de fect of very gradual development, without convulsions or fever, or other signs of organic disease, arriving at a definite termination and leaving behind as a result entirely stationary, perhaps even improvable, idiots or imbeciles.
The Wassermann reaction is frequently shown in Fournier's "enfants arrieres," the type of hereditary syphilitic children described as unintelligent, simple, silly, limited children, al ways behind.
Nonne's reported cases of general irritable weakness of the nervous system, and the re searches of others, convince one that a less marked grade of mental defect, along more restricted or special lines, is closely allied with this broad group as a result of congenital syphilis. The patients are highly excitable, show extreme nervousness and moodiness, suffer from headaches, irregularities of appe tite and sudden fits of passion — without other epileptiform analogies. Mercury and the iodides worked wonders for Nonne's cases.
Many so-called psychopathic children are also to be included in this broad group of con genital syphilitics. These children are intel lectually bright, but show marked ethical de fects, and one can conceive of the mental de fect in terms of limited cortical control to the affective response of the sexuality, and to the nutritional instincts. They want, and indulge their wants, without taking the circuitous routes devised by cultural standards. Anatomically one can posit, on the basis of the syphilitic poison ing, a defect or destruction of certain corti cocortical association areas. Consult "Treat ment of Syphilis of the Nervous System" (in White and Jelliffe, (Modern Treatment of Nervous Mental Disease,' Vol. I, Philadelphia and New York 1913).