(3) Chancres. These are partly protopathic, partly consecutive, and, in their form, deviate but little from the known kinds; for here, too, they either occur as simple or as indurated, elevated, and phagedaenic chancres. They occur most frequently at the fraenulum of the tongue, on the velum palati, and in the fauces, in the shape of small, round, somewhat prominent vesicles that soon bursts; whereas, if they occur on the inner surface of the cheeks, they appear in the shape of small cracks, and on the hands and feet in the shape of true rhagades; those that break out on the scalp and in the face are phagedaenic, and soon terminate in fatal gangrene.
(4) Ulcers on the heels. This is a peculiar affection on syphilitic children, commencing with redness and inflammation of the skin of the heel. This redness increases, the skin ulcerates, and whole patches of the cellular tissue under the coverings of the heel-bone become detached, so that the cushion forming the heel finally drops off entirely.
(5) Thickening of the skin of the palms of the hands and soles of the feet. This is a species of psoriasis; the skin becomes rough, thick, shrivelled, like that of washerwomen; the affected parts swell up, assume a red or pale yellow color, the skin hardens, and shows more or less deep, sometimes ulcerated rhagades; at a later period scales form, which fall off, and then form a new, until this process stops entirely, and the whole of the indurated epidermis become detached. After this is accomplished, the affection assumes a different form; the old epidermis is replaced by a new one of the thickness of a thin pellicle; feet and hands assume a dark-blue hue, specially around the finger and toe-nails; the nails soften, and trifling ulcerations sometimes break out all around. Next tot he above- mentioned peculiar color of the skin, the dry coryza and the rhagades of the lips, this induration of the skin, according to Trousseau and Laregue, constitutes one of the most frequent phenomena of infantile syphilis.
(6) Rhagades on the lips and at the anus. These cracks show themselves where the mucous membranes unites with the outer skin. They are located in the folds of the membrane, and are so much deeper and broader the further remote they are from the epidermis; their bright-red and bleeding bottom, and their brown hue, imparts to the lips a very peculiar appearance. If no pustules have as yet formed in the corners of the mouth, they usually break out in the mesial line of the lips, generally in company with these pustules, and simultaneously with the dusky- black color of the skin; and often become the direct cause of a transmission of the syphilitic disease to the nipples of the nurse.
(7) Syphilitic roseola. This exanthem resembles measles, but is much darker and exceedingly fugitive; remains only four or five days, but is always the precursor of much more troublesome phenomena, since the copper spots, after becoming more marked, do not delay changing to pustules and afterwards to ulcers.
(8) Fig-warts. These break out very seldom on infants, and, if at all, generally are found located on the mucous membranes. They are likewise seen around the anus, on the outer surface of the labia majora, or between the sexual organs and the thighs.
(9) Erysipelatous exanthems. The skin is wrinkled, covered with brown-yellow pimples, and erysipelatous spots; here and there the epidermis becomes raised, or it may even become raised over the whole body and suffer destruction at the same time the face and whole body show the emaciated appearance of old age, which is so exceedingly characteristic of the syphilitic affections of children.
Secale 212. – Affections of the Mucous Membranes, and other Complaints.
Under this head we have, in the first place, to notice, as of the highest importance, an affection that is never wanting in any syphilitic infant, namely:
(1) Syphilitic catarrh, or ulceration of the Schneiderian membrane (ozaena syphilitica). – At the commencement, this affection is like the ordinary dry catarrh of infants, from which, during the first period of its existence, it is not distinguished by any special symptoms. Soon, however, the child commences to lose from its nose a few drops of blood, or bloody mucus. This occurs several times during the day, and may increase to true epistaxis. As the disease progresses, the discharge from the nose becomes more ichorous, corrodes the alae nasi and the upper lip, where it may occasion ulcerations that become covered with crusts and rhagades. In most cases, the affection remains confined to the Schneiderian membrane; if the ulceration are not covered with hard crusts, the ichorous secretion is always mixed with blood. This ulceration always commences in the interior of the nostrils, and shows more inclination to spread backwards towards the velum palati and fauces, than forwards towards the outer parts of the nose. If this continues, the nasal bones lose their support, the nose becomes flat and collapses, so that it almost forms a level plane with the cheeks; the breathing become more and more snoring and difficult, so that the child is scarcely able to nurse without danger of suffocation, and the secretion from the nose remains ichorous and bloody. The course of these ulcerations is extremely changeable; sometimes they destroy the bones in a few weeks, sometimes in a few months; whereas, in other cases, they stop of themselves in their course, without destroying the bones. In other cases, this ulceration spreads onward to the fauces, and even tot he larynx; in which case the voice becomes husky, loses all resonance, and may even be lost entirely, the breathing changing to a mere wheezing as in croup. These extensive ulcerations are, however, very rare; in most cases they remain confined to the Schneiderian membrane and the cartilages of the nose; they constitute one of those disorders with which infants are most frequently attacked.
(2) Affections of the lymphatic glands. Upon the whole, buboes are very rare in syphilitic infants. If they do occur, they are more frequently simple glandular swellings than inflamed buboes. After breaking an ichorous matter oozes out like that of consecutive ulcers, in whose company, or subsequently to which, they make their appearance. Sometimes they do not show themselves until long after the disappearance of the other syphilitic symptoms; whereas, in other cases, they occur as protopathic products without being preceded by any other symptoms. Always remaining more or less stationary they frequently disperse spontaneously, and upon the whole, are much more indolent than the genuine primary buboes. In general, they resemble scrofulous glandular swellings, with which they might very readily be confounded, if the whole constitution of the child, the presence of other syphilitic symptoms, and a knowledge of the previous circumstances of the child’s parents and nurse, did not place the diagnosis beyond all doubt.
(3) Affections of the osseous system. – Although this system, in syphilitic children, is very seldom invaded before the end of the first year, yet there are case where periosteal swellings and exostoses occur even during the first months of infantile existence. Bertin relates the case of an infant, 35 days old, whose whole body was covered with pustules and tubercles, and where a periostosis of considerable size was seen on the upper and posterior side of the ulna. In children of five to seven years, I have seen such exostoses on the tibia, as well as on the skull-bones.
(4) Syphilitic cachexia. – This name is applied to the erysipelatous exanthem described in the preceding paragraph, under No.9, with which some children are born, and which is, moreover, distinguished by the above described dusky or yellowish color of the skin, as well as by the most perfect marasmus, and by the appearance of old age, by which this exanthem is always accompanied.
(5) Scrofula. – If Hufeland and other physicians, as well as homoeopathic practitioners who copy them, maintain that hereditary syphilis, in children, often manifests itself under the form of scrofulosis, such a doctrine is based upon nothing else than the most shocking ignorance of sound and definite perception of pathology. Either syphilis and scrofulosis are idiopathic and distinct diseases, or else they are not. If they are distinct diseases, syphilis cannot produce scrofulosis, any more than a plum tree can produce cherries; but if every disposition to glandular swellings and osseous affections is termed scrofulosis, syphilis cannot be anything else than scrofulosis; and what becomes, in such a case, of the diagnostic distinction between the two?
Secale 213. – Diagnosis, Prognosis and Treatment.
In the third division, in No.186-189, we have shown the different ways in which syphilis can be transmitted to children; at the same time, we have stated that congenital syphilis, and the syphilis acquired at birth, generally show their symptoms immediately after birth, and that hereditary or constitutional syphilis does not become manifest until six or eight weeks, and in the larger number of cases, not till months or even years have elapsed. What we desire to add in this place is, that the syphilis adnata of manuals, that is, a kind of syphilis which is transmitted to the child while it passes through the vagina, most likely has no existence. If the mother, at confinement, is affected with venereal symptoms on the sexual organs, in consequence of an infection caught during her pregnancy, the child must have become syphilitic while yet in the womb; this may be considered as perfectly certain, if the child is born with signs of syphilis. However, let us pass this subject over, and let us cast a glance at the diagnosis, prognosis, and treatment of this kind of syphilis.
