Dactylitis occurring in syphilitic children must be distinguished from the necrosis which sometimes attacks strumous subjects. In syphilis the diseased bone is evenly enlarged, and no inflammation in the integuments occurs unless the size of the lump exposes it to accidental injury. In the fibrous form, also, the swelling is indolent and painless, and although not quite symmetrical, as in the osseous variety, is distinguished by its little tendency to end in suppuration and abscess. In strumous necrosis the bone is enlarged unevenly and generally forms a lump on one side. This lump gets bigger, then softens and suppurates, adhesions take place with the integument, and finally the abscess opens and discharges cheesy pus. On exploring the abscess bare bone is found at the bottom of the cavity. In all these cases careful inquiry should be made for history or sign of syphilis in the patient or other children of the family.
Prognosis.—The prognosis is serious in proportion to the intensity of the cachexia. The general condition is, therefore, of greater importance in counting the chances of a child's recovery than the severity of any par ticular symptom. The degree of intensity of the cachexia may be esti mated by the date of appearance of the first symptoms of the disease, and by the extent to which nutrition is interfered with. If the symptoms ap pear during the first fortnight and the child progressively wastes, death may be anticipated with certainty. All intercurrent derangements which interfere with digestion and assimilation of food sensibly increase the gravity of the case. Thus, vomiting and diarrhoea, which rapidly reduce the strength of even a healthy child, must be looked upon as very serious complications.
Disease of the internal organs or of the bones, as they indicate pro found contamination of the system, make the case a very anxious one. Moreover, the interference with function which results from the visceral disease is another reason for forming a very unfavourable opinion as to the result of the illness.
There is one special symptom which must not be overlooked in forming a prognosis. This is the condition of the nasal passages. When these pas sages are occluded from swelling and incrustation the child is forced to breathe through the mouth. Consequently, he can take but little nourish ment, for while he sinks he cannot breathe, and while he breathes he can not suck. The amount of food he takes is, therefore, very inadequate to the wants of his system, and he is in danger of actual starvation.
If the disease first appears several months after birth, and if the child continues plump, and does not sensibly emaciate, the prognosis is favour able even although particular symptoms may be severe.
In cases of relapse, or of so-called delayed syphilis, when symptoms ap pear after the seventh year, much depends upon the early recognition of the nature of the malady. Syphilitic lesions urgently require specific treat ment, and the so-called tertiary forms of the disease cannot be neglected without serious consequences. Therefore, to look upon such lesions as scrofulous in their nature, to be treated with cod-liver oil and tonics, is to commit an error which may be a very fatal one to the patient.
Treatment.—In every case where a woman gives birth to a syphilitic child the nature of the illness should be explained to the father, so that by suitable treatment of one or both parents their future children may be . enabled to escape the disease. Treatment begun during pregnancy is often successful in preventing the taint from being transmitted to the foetus ; 'but it should be begun early and, if it can be borne for so long a time, should t, be continued for fully three months.
In the child it is important to attack the cachexia at the earliest possi ble moment. Therefore, if previous children have been syphilitic, and the parent in the interval have undergone no treatment, it is well to place the new-born child at once under the influence of remedies, even although he may have a healthy appearance and present no symptoms of the disease. Mercury is indispensable to the successful treatment of infantile syphilis. It may be either given internally or applied externally. In bad cases it is well to combine internal administration with external application, so as to bring the system as quickly as possible under the influence of the drug.
The infant may be given one grain of gray powder twice a day, either alone or combined with a grain of carbonate of potash or a few grains of prepared chalk to prevent irritation of the alimentary canal. After a week the close can be increased by a quarter of a grain every three or four clays until two or three grains are taken twice a clay. If the powders produce irritation of the stomach, they can be omitted for a day or two until the irritation has subsided. If they still disagree, it is better to change the preparation of mercury. In this case perchloride of mercury in doses of twenty or thirty drops of the ordinary Pharmacopceia solution (gr. -A to gr. can be given in a teaspoonful of water sweetened with glycerine two or three times a day. Children take this salt very well, and it will often agree when the gray powder excites irritation and vomiting. Calo mel in doses of one-twelfth of a grain is sometimes preferred, but it is a more irritating preparation than the other.