CHROXIC INFECTIOUS DISEASES 



spreads to the arms, legs, and body, and sometimes to the face. 

 Roundish spots, as large as a pea or bean, and of a dirty-red color, are 

 first observable. In a short time the cuticle which covers them is 

 elevated into a bleb by the effusion of a turbid liquid. These blebs 

 burst, leaving excoriated, moist spots upon the skin, which show no 

 tendency to heal, and new blebs form upon the toes and fingers. Not 

 unfrequently some of the nails fall off. The later crops of blebs be- 

 have like their predecessors, and, as, day after day, new ones arise, the 

 unhappy child becomes excoriated at innumerable points. I have even 

 seen the blebs form in the mouth and nose. The malady may last 

 from a week to a fortnight ; more rarely three or four weeks, and al- 

 ways terminates fatally. Some of the cases occurring in my private 

 practice, in which the mother, with touching patience, daily cleansed 

 and bound up the fingers and toes of her babe, never suspecting that 

 its dreadful disease was the consequence of the excesses of its father, 

 have made an indelible impression upon my mind. 



When syphilis remains latent for a few weeks, it presents another 

 aspect. (The bullous syphilide never commences latei than the first 

 week of infancy.) The child is often born in apparently good condi- 

 tion, and does not seem to differ in any respect from a healthy child. 

 About a fortnight after birth, and in some instances as late as a month, 

 or even two months after birth, it grows restless and thin, and its sur- 

 face assumes a remarkable dirty color. The skin also becomes ex- 

 tremely dry, rough, and shrivelled ; and, in particular, the hands and feet 

 look as if covered by a delicate husk, like that of an onion. It soon be- 

 comes difficult for the child to nurse, the nasal mucous membrane being 

 swollen, and the nostrils always filled by a thin secretion. This swell- 

 ing of the mucous membrane, and the profusion of the discharge, give 

 rise to a peculiar snorting and snuffling, which is almost pathognomonic 

 of congenital syphilis ; so that, in the absence of other signs, we can 

 hardly err in diagnosticating the disease from this symptom, together 

 with the peculiar condition of the skin. In most cases, the coryza is 

 accompanied by an eruption, which, beginning in the region of the 

 anus, spreads to the genitals, thighs, and loins, as well as to other 

 parts of the body, particularly to the face. This eruption is generally 

 of a character intermediate between that of the maculous, papulous, 

 and squamous forms. The separate maculae are rounded, of the size 

 of a pea or bean. Their color is a coppery or yellowish red, which be- 

 comes actually yellow when pressed upon by the finger. They may 

 be either distinct or confluent. At first they are level with the skin, 

 afterward they project somewhat above it ; then then- surface is not 

 rounded, but flattened, as if the top had been shaved off. As the 

 affection advances, the maculae are often covered with scales of epider- 



