CONGENITAL AND HEREDITARY SYPHILIS. Y8Y 



aris, or with a continuous coating of thin desquamating layers of 

 cuticle, and, where the surface is habitually soiled by urine or the ex- 

 crements, it becomes excoriated. Another constant symptom of con- 

 genital syphilis consists in the formation of rhagades at points where 

 the skin changes into mucous membrane, especially upon the mouth 

 and anus. It can often distinctly be perceived that the lips of the 

 child are incurved and bleed readily upon the slightest movement, and 

 that it dreads to use them either in suckling, laughing, or crying. The 

 act of defecation cannot be accomplished without great suffering, so 

 that the child cries and moans whenever the bowels are moved. The 

 rhagades are often accompanied by condylomata, and in neglected 

 cases large ulcers, of a peculiar irregular, angular figure, form between 

 the nates, and sometimes in the flexures of the thighs, and in other 

 regions where intertrigo is apt to arise in healthy children. The dis- 

 charge from these sores is scanty, and readily dries up into a scab, 

 which is of a blackish color, owing to its containing an admixture of 

 blood. We have already stated that it is rare for congenital syphilis 

 to attack the bones. Cases are reported now and then, however, in 

 which the usually slight ulceration of the nasal mucous membranes 

 causes destruction of the bones of the nose, and depression of that 

 feature in the first year of childhood. In other equally rare instances, 

 congenital syphilis of early infancy either is overlooked or becomes 

 latent in consequence of treatment, and breaks out again at the period 

 of puberty in the pernicious form of syphilitic lupus, or disease of the 

 bones. 



In the autopsies of children who have died of congenital syphilis, 

 or who have been born dead by syphilitic mothers, the characteristic 

 lesions of the disease are sometimes found in the internal organs, 

 especially the liver and lungs, more rarely in the brain. In the former 

 it consists merely of a diffuse, uniform induration, the sequel of a simple 

 non-gummous hepatitis. In the lungs, nodules, with cheesy centres of 

 the size of a pea or walnut, are formed, as well as a form of diffuse 

 condensation, first described by Virchoio, who calls it " white hepatiza- 

 tion," and which consists of a filling up of the air-vesicles with epithelial 

 cells in a state of partial fatty degeneration. In the brain, Schott, in 

 one case, has found gelatinous tumors of the size of a hazel-nut situ- 

 ated beneath the lower surface of the two anterior lobes of the cere- 

 brum. Finally, the thymus gland is sometimes considerably enlarged, 

 and contains abscesses. 



TREATMENT. Hitherto, the treatment of the bullous syphilide has 

 always been in vain. On the other hand, in the second form of con- 

 genital syphilis just described, comparatively good results may be ob- 

 tained by means of appropriate medication. The most common and best 

 method of cure consists in the exhibition of small doses of calomal (gr. J) 



