marked by the former always attacking the palms and soles, by its rarely covering the trunk of the body, and by the presence of other symptoms of syphilis. In ordinary pemphigus the eruption is indiscriminately scattered over the body, the hands and feet escape, and there are, of course, no mucous patches in the mouth or round the anus. Tubercles.-Authors describe subcutaneous nodules as forming in very weakly children. They lie beneath the skin, soften, and ulcerate to the surface, making ragged, spreading sores, liable to be mistaken for chancres. It is a very rare eruption. The Nails may split and fall, and the nail matrix suppurate. They are replaced by new ones, which, so long as the disease in the matrix continues, are also broken and shed from time to time. The nails are but rarely affected in inherited syphilis; few observers have remarked it. Lancereaux1 has collected the observations of Bertin, Doublet, and one or two more, who have mentioned falling of the nail. Hutchinson has described this affection minutely, and gives an excellent drawing of it in his paper on diseases of the nails in syphilis. He found that the various layers of the nail split and grow jagged, from being badly developed in the matrix. Several nails, some on each hand, are always attacked, and the malformation is very obstinate and long continued. Coryza. The lining membrane of the nose in nearly all cases very soon becomes swollen, and secretes a discharge that at first is thin, then gets yellow, and so thick that it blocks up the nasal passages, and compels the child to breathe through his mouth. To this inflammatory action mucous tubercles around the nostrils are added; these chap, 1 Loc. cit., p. 547. 2 Pathological Transactions, vol. xii. p. 259. and sometimes ulcerate deeply. In very feeble children this chronic inflammation of the mucous membrane often extends to the perichondrium and periosteum, and destroys the cartilages and bones of the nose; the bridge flattens, the discharge becomes fœtid, and bits of bone now and then break away from the vomer and spongy bones. The impediments of the passage of the air through the nose produces the snuffling which is so characteristic of the disease, while the necessity to open the mouth to breathe, seriously interferes with the child's sucking, and thus becomes a most unfortunate complication. Laryngitis.-The catarrh of the nose spreads often to the larynx, and the thickening and chronic inflammation of the mucous membrane produce the hoarse cry peculiar to syphilitic infants. In one or two instances the larynx has been found after death to be swollen and congested, but not ulcerated. The Bones are very rarely affected in children, except as just mentioned, in the nose, where the changes they undergo are similar to those developed in acquired syphilis. Lancereaux1 has collected about half-a-dozen unsatisfactory and incomplete observations of disease in the nasal and cranial bones. Bouchut2 attributes a syphilitic origin to a peculiar induration of the shafts of the long bones, and also to a softening process in the epiphysial cartilages, terminating in suppuration under the periosteum, that are met with now and then in syphilitic children. It is not at all clear to what extent these affections of the bones are due to syphilis, or whether they are not rather consequent on imperfect nutrition, which may arise from other causes than syphilis. Testes.-Syphilis attacks the testicle with extreme rarity 1 Loc. cit., p. 550. 2 Maladies des Enfans Nouveau-nés, p. 863. 1861. in children; when it does so, the testicles enlarge and gummy nodules form on them as in the adult organ. Peritoneum.-Sir James Simpson1 has published two observations of peritonitis occurring in children born of syphilitic mothers, which he thinks were possibly due to that disease. Bärensprung describes the peritonæum to be thickened and fastened by adhesions to the viscera in patients whose liver is also attacked by the disease. The Liver.-The affections of the liver, when the disease is inherited, are very similar to those determined by acquired syphilis. Most frequently the liver of children who die from syphilis undergoes no appreciable change; in a small number of cases, however, alterations in the structure of the liver, of two kinds, are observed. The first, and much more frequent, affection consists in enlargement of the liver with lardaceous or waxy infiltration of the parenchyma. The liver is pale yellowish in colour, smooth, and firm, not yielding under pressure until it breaks beneath the finger. Section shows that the alteration extends sometimes only to a part, at others, through the whole of the organ. The brownish, somewhat translucent hue is also more distinct here than on the surface, according to Gubler, who has given a most complete description of the syphilitic liver in young children. The yellow infiltration is arranged in streaks and whitish masses along the the course of the portal veins. Under the microscope this invading substance is seen to consist of nucleated cells, and of amorphous matter, in which the true liver cells are immersed. Trousseau attributes to the compression exerted by this exudation on the portal vessels much of the mortality of inherited syphilis. In the second affection of the liver, which is far rarer than the preceding, 1 Obstetrical Works, vol. ii. pp. 157, 162. distinct hard yellow nodules or roundish masses form. The organ is also enlarged and indurated by general lardaceous degeneration. Lancereaux' relates one observation; Zeissl9 and Wedl also mention instances of gummy masses in children. Zeissl found the masses included in cicatricial seams of a liver, which in every other respect resembled one of an adult when attacked by gummy disease. The Symptoms of disease in the liver, should the child survive its birth, are restlessness, irregularity of the bowels, diarrhoea, gaseous distension of the belly, earthy hue of the skin, and rapid emaciation; jaundice is recorded as occasionally present. The large and smooth liver can generally be felt on the surface of the body. The Spleen is not unfrequently enlarged by albumenoid infiltration; but it has already been described on page 130. The state of the Thymus attracted the attention of Dubois in 1851. He observed in syphilitic children a condition of the thymus that has since been described by Depaul and Wedl, though it is not yet clear how far syphilis is concerned in its production. Collections of diffluent matter, which may be as fluid as pus, or semi-solid, are scattered through the interior of the organ. Hence, probably a process of a gummy kind produces these dense opaque yellow collections. The true nature of the affection is still uncertain; commonly no alteration of any kind is found in the thymus. The Lungs are attacked in various ways; the most common is bronchitis, with plugging and consolidation of the finer tubes and air-cells. Other changes, more identified with syphilis, are sometimes met with, but generally in children who were either born dead, or who died shortly Loc. cit., 3 Path. Histologie, S. 519. 2 Constitut. Syphilis, S. 333. 4 Mémoires de l'Académie de Médecine, t. xvii. p. 563. 1853. 5 Path. Histologie. after birth. One of these is the gummy nodule. Virchow,1 Lebert, and others have described them, and they resemble the gummy nodules in the adult in all respects. Depauls gives the cases of two children with pemphigus, who had very soft puriform nodules or collections scattered through the lungs. Interstitial inflammation along the course of the bronchial tubes and beneath the pleura is found very much more frequently in children than in adults. It renders a lung, or part of it, firm, pale, rosy pink, homogeneous, non-crepitant, sinking at once in water, and the firm parts cannot be artificially inflated with air. The firmness of the indurated tissue, the absence of any softening, and the white colour of it, distinguish this affection from ordinary pneumonic consolidation. The Brain and Nerves in young children are seldom attacked by syphilis. Isolated cases of disease in the brain and spinal cord have been recorded by Virchow which may have been connected with syphilis. He also quotes an observation of Schott, an assistant of Rokitansky; in a child born prematurely with pemphigus on the soles and palms, there was found a gummy nodule in the liver, and what he supposed to be another on the inferior surface of both anterior lobes of the brain. Mr. de Méric is disposed to attribute to syphilis the power of causing hydrocephalus from having found the head much enlarged in syphilitic children. Other observers corroborate him in this remark. Insomnia is related by several authors as being very obstinate in some children; but there is little definitely known of the symptoms of syphilitic affections of the brain in children. 1 Krankhafte Geschwülste, Bd. 2. 2 Anatomie Pathol. Planche, clii. 3 Mémoires de l'Académie de Médecine, t. xvii. p. 135. 1853. 4 Mayr's Zeitschrift für Kinder Heilkunde, Bd. iv. |