Morbid Anatomy.—Infantile syphilis, like the other diathetic diseases of childhood, may affect the tissues very widely. The pathological ters may be divided into three classes, according as to whether the part ed is a mucous membrane, a solid organ, or a part of the bony frame-work.
The mucous membrane may be the seat of catarrh, of mucous patches, or of ulcers. All these may be seen on the inside of the cheeks and lips, the fauces, and sometimes the small intestine•; also upon the larynx, the trachea, and even the bronchi.
The inside of the mouth is a common seat for erosions and mucous patches. They do not spread down the gullet, according to Dr. John Mackenzie ; nor are they to be seen on the posterior wall of the pharynx. In rare instances syphilitic ulceration is found in the small intestine. I once saw a little boy—four years of age—the subject of obstinate diar rhoea, in whom the evacuations had all the characters usually found in cases of ulceration of the bowels. His father had had syphilis, and his mother in her next confinement gave birth to a distinctly syphilitic child, and had afterwards several miscarriages. The case resisted all ordinary remedies, but was eventually cured by the continued application of a mercurial oint ment to the abdomen.
Mucous patches and ulcers may be seen on the glottis and epiglottis. The vocal cords may be destroyed by ulceration or may be the seat of warty growths. A case is elsewhere related (see page 417) in which ob struction of the larynx by warty growths occurred in a child who had a past syphilitic history, but'in whom no other constitutional lesion could be discovered. Sometimes great thickening is noticed in the mucous membrane of the glottis. Thus, in a case reported by Er6ss—a syphilitic child aged three and a half years—a laryngoscopic examination showed that the epiglottis was thickened to three or four times its natural size ; the ary-epiglottidean cords were thickened and pale red ; the left vocal cord was more than twice as thick as the right, and bulged out at its edge towards its fellow. The symptoms were aphonia, and frequent convulsive fits of coughing with suffocative attacks. The child was treated with mer curial inunctions, and was well in two months and a half. According to Dr. T. Barlow, the larynx, even after recovery, is left very sensitive and susceptible to fresh catarrh. The mucous membrane of the trachea and bronchi may be affected in a similar way. There may be catarrh, or mu cous patches, or shallow ulcers ; but these lesions are less common here than at the upper part of the respiratory passage. In rare cases the ul
ceration may be extensive. Thus, Woronichin found in a child of fourteen months old ulceration .of the lower part of the trachea, and a similar lesion of the right bronchus which extended as far downwards as the next di, vision of the air-tube.
In solid organs syphilitic lesions assume the form of fibroid growths, which may be either diffused or circumscribed. Whatever organ be af fected, the nature of the lesion is the same. There is hypeiTlasia of the connective tissue of the part. This grows, thickens, and finally contracts, so that the proper parenchyma of the organ is obliterated and replaced by a solid fibroid material. When the lesion is circumscribed it is called " This has essentially the same structure as the diffused form, but tends to soften in the centre by a process of fatty degeneration.
Diffused fibroid change is seen in the lungs, liver, spleen, and pancreas. Gummata have been found in the same organs ; also in the heart and sub cutaneous tissue. Occasionally they are found also in the tongue and soft palate, but not in infants. This is a later symptom and seldom occurs be fore the end of the sixth year.
In a lung the seat of diffused fibroid change, the part is solid and gray in colour, with a smooth shining section traversed by fine fibrous lines. It is very dense and tough. Under the microscope the alveolar walls are seen to be infiltrated with round cells, spindle cells, and fibrous tissue. The round and spindle cells develop into fibrous tissue, which thickens the septa and compresses the alveoli. There is also free production of new vessels, so that the new growth is very vascular. The area of lung thus affected varies. Usually the disease extends over a part of a lobe, or even a whole lobe. Besides the diffused form, are seen sometimes in the lungs. These are rounded well-defined masses, few in number, usually of the size of a nut, and yellowish-white or gray in colour. They are firm at the circumference, but get softer in the centre, and the interior may be reduced by fatty degeneration to a puriform matter. Microscopic ex amination shows the alveolar walls to be infiltrated at the circumference of the tumour with nucleated cells, while nearer the centre round or oval cells are seen in a finely reticulated tissue. These two forms of the same lesion are seldom seen, except in dead-born or very young infants.