The hair and eyebrows sometimes fall out. The nails may also be affected. Inflammation and suppuration occur in the matrix, so that the nutrition of the nail becomes impaired and the nail gets dry and is cast off.
The cry of the infant is a noticeable symptom. It is hoarse and high pitched from laryngeal catarrh or extension of the mucous patches to the larynx. Occasionally the hoarseness is accompanied by attacks of laryn gismus stridulus. In almost every case the ossification of the cranial bones is delayed and the fontanelle is widely open ; but the growth and development of the teeth are not interfered with, for the teeth are cut early, as a rule, and with little inconvenience to the child. Cranio-tabes is present in the large majority of cases, and the posterior cervical glands are often enlarged.
The bone disease presents many very characteristic symptoms. The long bones should be examined for signs of enlargement, especially the humerus, the femur and tibia. If we place the finger and thumb on the anterior and posterior aspect of the humerus at the upper part, and carry the hand downwards along the shaft, we shall often notice that the bone becomes thickened at the lower end, and that the thickening is greatest at the point of junction of the shaft with the epiphysis. In the tibia the thickening can be often detected on the inner surface, in the femur on the outer and inner aspects of the shaft. Besides these, there may be beading of the ribs and thickening of the radius and ulna above the wrist. The osteophytes on the cranial bones have already been described.
When suppuration takes place outside the joint, especially if there be fracture of the neck of the bone, we find peculiar symptoms. The child appears as if paralyzed.. His arms lie pronated by the sides of his body ; his legs are stretched out straight in the cot ; and when the patient is lifted up, they hang loose, like the legs of a doll, swaying from side to side. Crepitation can sometimes be detected between the shaft and the separated epiphysis ; and if an abscess forms, the joint, which had been tender before, becomes bent and stiff and exquisitely painful. Parrot has
called this condition " syphilitic pseudo-paralysis." A form of real paralysis lies been occasionally seen affecting the of the brachial plexus, and causing more or less complete loss of power in the arms. In two cases, described by Dr. Henoch, voluntary movement was almost completely lost in the upper extremities, the flexor muscles of the fingers alone retaining a slight trace of contractility. There were other signs of syphilis, and the paralysis disappeared under the influence of mercury. In some cases a peculiar twisting of the head backwards has been noticed when the child is placed in a sitting position.
The degree to which the child is affected in eases of inherited syphilis varies—partly according to the virulence of the poison, and partly, also, according to the general strength of the infant. In rare cases, where twins are born of parents suffering from this disease, the two children may be affected very unequally. An instance of this came under my own notice.
The children were three months old. One was much emaciated, with a shrivelled, parchment-like skin, covered with pemphigus. She snuffled and cried hoarsely. The other was a healthy-looking child, fat and strong, with a good complexion. She snuffled and showed on her buttocks signs of recent eruption ; but was never thought sufficiently ill to require medical advice.
In practice we see every degree of intensity of the syphilitic cachexia. In one case, like the healthier twin just mentioned, the infant may be plump and strong-looking, with few symptoms and those trifling in char acter. In another the child is wizened and wasted, with a wrinkled, inelastic, blotchy skin. He is peevish and restless, crying hoarsely and whimpering almost constantly. He is always hungry, for the state of his mouth and nasal passages offers a continual impediment to his drawing sufficient nourishment from the breast. He gets weaker and weaker— partly from disease, partly from want of food. Vomiting and diarrhoea perhaps come on, and his miserable little life soon draws to a close.