When the infant survives, he may seem quite to throw off all traces of his illness, and grows up a strong healthy child. But usually, when the symptoms have been severe, more or less permanent impression is pro duced upon the system. The body may be stunted in growth ; the com plexion earthy or unhealthy-looking ; the hair thin and brittle. The brain may be also more or less affected, and epilepsy, deficient memory, loss of perceptive power, and even gradually advancing imbecility are enumerated as consequences of the disease.
.Relapses.—In rare cases the symptoms of inherited syphilis are said to be delayed until the seventh, ninth, tenth years, or even later. Most of these cases are no doubt instances of relapse of the disease, the symptoms which occurred during infancy having been slight and transient. The relapse shows itself in coppery eruptions on the skin with discharges from the nose, ears, etc. The skin often ulcerates, and the nasal bones may be destroyed by gummy ostitis so that the bridge of the nose is depressed. The spongy bones and hard palate may ulcerate away, and the velum and pillars of the fauces may be destroyed so as to throw the nose and mouth into one cavity. The eyes may be affected with interstitial keratitis ; the permanent incisor teeth may be notched and dwarfed ; and deafness may occur. Deafness is the consequence, as a rule, of some morbid condition of the auditory nerve. It is seldom 'accompanied by any disease of the outer or middle ear, for there is tinnitus, and the patient cannot hear a tuning-fork placed on the head. It is most common between the fifth and fifteenth years, and can seldom be improved by treatment.
Epilepsy has been mentioned as sometimes occurring in syphilitic chil dren. It is usually one of the later symptoms, and may exist, as was seen in one of Dr. Hughlings Jackson's cases, without any sign of organic disease being detected in the brain after death. Syphilitic children sometimes die from a basic meningitis with symptoms similar to those produced by the tubercular form of the disease. They may succumb to a cere bral haemorrhage., Dr. Barlow has described a diffused thickening with opacity of the arterial coats in the brain as sometimes occurring in cases of inherited syphilis. This may lead to thrombosis of vessels or rupture of the artery with fatal haemorrhage.
Lastly, in many children who have suffered from the hereditary form of the disease we may find amyloid degeneration of internal organs, espe cially of the liver, the spleen, and the kidneys.
Diagnosis.—When the symptoms are well marked the nature of the disease can scarcely be mistaken. The little, old-looking face, with its dusky complexion, its fissured lips and crusted nostrils; the snuffling, and hoarse cry; the wasted body; the wrinkled and inelastic skin ; the ham like redness of the buttocks and perineum— all these symptoms are suf ficiently characteristic. is only permissible when the symptoms are few and indistinct, when nutrition is unaffected and the child has the appearance of fair health. In such cases there is general pallor of the skin
and careful examination may detect a few coppery spots upon the body ; the spleen may be big, and we may, perhaps, discover some enlargement of the lower end of the humerus or shaft of the tibia. Chronic coryza is sometimes the only sign of the disease. Persistent snuffling in babies is commonly of syphilitic origin. If it be combined with pallor of the skin, specific treatment should always be adopted, especially if a history of pre vious miscarriages can be obtained from the mother.
In older children the signs of past disease are : Flattened bridge of the nose from long-continued swelling of the nasal mucous membrane when the bones are soft ; marking of the skin by little pits or cicatrices from former ulceration, especially when these are seated about the angles of the mouth ; protuberance in the middle line of the forehead between the frontal eminences from specific disease of the frontal bone ; enlarged spleen and marked pallor of the skin. If the permanent teeth have ap peared the incisors should always be examined for signs of the charac teristic malformations.
In cases where there is enlargement of the ends of the long bones, the diagnosis from rickets has to be made. As compared with inherited syph ilis rickets is a late disease. It rarely begins before the ninth month. The lesions of syphilis are seen early, almost always before the sixth month. Again, the bone disease in syphilis is usually evidence of a profound cachec tic state. It is, therefore, in most cases accompanied by other and un mistakable symptoms of the disease. Moreover, it is very partial, seldom affects the ribs, and is not symmetrical. In rickets it is always symmet rical and general and the ribs are the earliest of the bones to be affected. In syphilis separation of the end of the bone and suppuration around the joint are not uncommon. In rickets these lesions are never seen. Again, the preliminary symptoms of rickets are very characteristic, and are quite wanting in an uncomplicated case of inherited syphilis. If, in any case, we find that the bone lesions are symmetrical and involve the ends of all the long bones, if there is an absence of the signs of inherited syphilis but a history of the symptoms characteristic of the early stage of rickets, and if we find that the child's dentition is backward, and that at ten months old he is showing no disposition to " feel his feet "—we shall have little diffi culty in reaching the conclusion that the case is one of rickets. Still, a mild form of rickets is sometimes engrafted upon a syphilitic constitution. Here we shall find symmetrical and general enlargement of the joints and beading of the ribs combined with some of the symptoms of present or past syphilitic disease.