—Here the manifestations of syphilis are often serious and widespread. They are produced by the same new tissue to which we have so often alluded, with its tendency at first to degeneration and later to sclerosis. They are always insidious. Gummatous thickening may occur at any point, springing often from the pia of the brain and cord. The arterial walls are frequently so affected, and at many points, that multiple minute aneurysms are produced, any one of which may give way and produce the fatal results of a cerebral hemorrhage. In diffuse gumma of the membranes or cortex the process is slow, and likely to involve areas which may be recognized by cerebral localization. Many cases presenting the features of brain tumor will yield to antisyphilitic treatment, and thus show themselves to be syphilomas.
In the spinal canal implication of the membranes is more likely to occur than in the vessels. In the cord these sclerotic changes are also quite common and produce symptoms strongly suggestive of tabes; in fact, there are those who hold that tabes is of specific origin.
In the motor and sensory nerves much connective tissue is present, and consequently these nerves are not exempt from sclerotic changes with pressure symptoms, which will give the clinical picture of a neuritis.
SYPHILIS IN CHILDREN.
Syphilis appears in young children under the following circumstances:
A. The disease may have been transmitted from the father to the ovum, at the time of conception, by infected spermatozoa.
B. From the mother, who may have acquired it before impregnation or during the early part of her pregnancy. In the latter case the infecting influence is transmitted through the placental circulation.
C. From the mother at the time of its birth, from a recently infected puerperal tract.
D. From some possible extrinsic source, a short time after its birth, as, e. g., through the umbilicus.
The later the mother acquires the disease after conception, the less likelihood that the child will be infected. If infection takes place from the placenta, then it also will be found to be diseased.