180 British Medical Journal, 1867, vol. i. p. 435.
Barlow,181 ten years later, thought Gee had rather understated the proportion of cases in which splenic enlargement occurs, he having found it in 22 out of 28 children with definite hereditary syphilis. Birch-Hirschfeld, Eisenschitz, and Tepel182 corroborate these observations, finding that the enlargement is almost invariable and that the spleen is often double its normal size.
181 Trans. of Path. Soc. of London, Jan. 20, 1877.
182 Quoted by Hill and Cooper, op. cit., pp. 164, 165.
Mr. W. J. Tyson has reported183 a cure of a child born of syphilitic parents, in whom, at two years of age, the spleen extended downward three and a half inches, reaching the crest of the ilium and approaching closely to the umbilicus. The liver was not enlarged; the urine was not albuminous. He ordered mercury with chalk, one grain every morning and evening, and one grain of iodide of potassium, with ten minims of syrup of iodide of iron to an ounce of water, three times a day. Sixteen months later the spleen had become imperceptible, and three years afterward the child was in excellent health.
183 The Lancet, Oct. 23, 1880.
The diminution of the liver under treatment appears to take place before there is any diminution in the size of the spleen.184 This persistence of the latter renders it, as has been stated, a valuable diagnostic sign. In the paper already quoted from,185 Macnamara and Barlow allude to this as follows: Enlargement of the liver, although it ought to be noted because it is often present in hereditary syphilis, has but little value as a confirmatory symptom—first, because the liver is proportionally large in infancy, and it is difficult to state the limit of what is actually normal; and, secondly, because other causes besides congenital syphilis lead to its enlargement.
184 Barlow, British Medical Journal, Jan. 20, 1877.
185 British Medical Journal, Dec. 16, 1882.
With regard to enlargement of the spleen the case is different. Gee's observation, that in the early stage of infantile syphilis some enlargement of the spleen occurs in a large number of cases, has been abundantly confirmed. Although with the subsidence of the other symptoms this enlargement often disappears, so that on post-mortem examination two or three months after there may be no trace of it, yet in a few cases it persists, and indeed sometimes increases, so as to be considerable when the other signs have quite vanished. The importance of this sign is greatest when noted early; as, for example, when the child is from two to three months old, for at that period the enlargement of the spleen due to rickets can hardly come into question.