Volume 1

The science and practice of medicine / By William Aitken ... From the 4th London ed., with additions, by Meredith Clymer.

William Aitken

Date:: 1866

Credit: The science and practice of medicine / By William Aitken ... From the 4th London ed., with additions, by Meredith Clymer. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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$mucouo membrane, they will be found as whitish patches upon the fau- oeSj uvula, tonsils, and, more rarely, the tongue and buccal membrane. Deep-seated pustular eruptions may appear at a later period, ordinarily upon the face; occasionally upon the neck, ears, and fold of the groin. Ecthyma and pemphigus are occasionally seen in connection with hereditary syphilis, but whether directly due to the virus, or the result of the genera] cachexy is doubtful. The viscera may be affected in the Bame way as in the inherited disorder. A syphilitic infant has commonly a wizened and shrunken countenance, with the skin of a dirty greenish- yellowish hue; there is extreme anaemia; it is puny and often stunted, and presents the aspect of old age on the threshold of life. The face, say- Trousseau, is of a peculiar bistre tint, as if it had been washed with coffee-grounds, or a weak infusion of soot; it is not the pallor, nor yet the icteric or strawy hue, of the other cachexia?; it hardly extends to the rest of the body. The eyelashes are not developed, or have fallen out; the eyelids are often everted, and at the external angle are fissured. In the place of the eyebrows which have fallen out, you see yellowish scaly stains, which are sometimes found about the chin and mouth (Clin. Med., &c, vol. iii, 1865). The child is generally fretful and cryful; sleeps but little; is troubled with vomiting and diarrhoea ; \- very liable to serous inflammations, as pleuritis and arachnitis, which are frequent causes of death. Erysipelas and pneumonia are common intercurrent disorders, and are generally fatal. The child sometimes dies in a state of extreme marasmus. When the syphilitic symptoms are present to any extent at the time of birth, it is rare for the infant to live beyond a few months. In those cases of hereditary syphilis which survive the first year, all traces of the disease disappear about that time, except perhaps unusual paleness, and an expanded nasal bridge, caused by long-continued swell- ing of the parts within. During the period of latency the child usually has excellent health, though Mr. Hutchinson asserts condylomata some- times reappear; but there is scarcely ever a return of the cutaneous rash. The third epoch may begin at any time after the fifth year, but it is commonly delayed until at or near the period of puberty. It is characterized by the lesions known as the tertiary stage in the ac- quired disorder. The diagnosis of inherited syphilis, at or after the age of puberty, may sometimes be made with much certainty, and again it is surrounded with great difficulties. Our most valuable aids, says Mr. Hutchinson, are the evidences of past disease, more especially of the inflammations which may have occurred in infancy. A sunken bridge of nose, caused by the long-continued swelling of the nasal mucous membrane when the bones were soft, a skin marked by little pits and linear scars, especially near the angles of the mouth, the relics of an ulcerating eruption, and a protuberant forehead, consequent upon infantile arachnitis, are amongst the points which go to make up what we recognize as an heredito-syphilitic physiognomy. In a cer- tain number of cases the characteristic dental malformation already mentioned (p. 694) will give valuable aid. It is only in the permanent set that any peculiarity is noticed; the milk teeth are liable to decay,$