The practice of pediatrics . sion of dead pieces of bone. Peri-ostitis of the proliferative variety may occur, causing thickening in theshafts of the long bones, and often the formation of nodes on the flatbones, such as the frontal or parietal bones—the so-called cranial may rarely suppurate. On examining the abdomen of infants presenting any or all of theabove signs, we regularly will find the liver and spleen palpable wellbelow their usual location and distinctly enlarged. The edges of bothwill be clean cut and give the impression of hardness. Except in thepresence of some skin
The practice of pediatrics . sion of dead pieces of bone. Peri-ostitis of the proliferative variety may occur, causing thickening in theshafts of the long bones, and often the formation of nodes on the flatbones, such as the frontal or parietal bones—the so-called cranial may rarely suppurate. On examining the abdomen of infants presenting any or all of theabove signs, we regularly will find the liver and spleen palpable wellbelow their usual location and distinctly enlarged. The edges of bothwill be clean cut and give the impression of hardness. Except in thepresence of some skin or bone lesion draining into the neighboringlymph nodes, the nodes will not be found so uniformly and generallyenlarged they are in the acquired disease. Gummata may develop anywhere in the body. In the skin, if un-treated, they break down and form ulcers. In the mucous membranes,as those of the nose and mouth, they regularlv invade the bone, and asthey ulcerate they may perforate the nasal septum or the hard palate,. CONGENITAL SYPHILIS 571 or may cause necrosis of the nasal bones. These perforations of thenasal septum or roof of the mouth are quite typical. When involvingthe nasal bones they lead to the deformity known as saddle-back nose,a distinct depression at the junction of the nasal and cartilaginousportions. Gummata may likewise occur in the viscera, but are ordinarilynot diagnosed in these locations. In some late cases paresis of oneextremity with symptoms simulating lead palsy—e. g., drop-wrist—maydevelop- Anemia and all the evidences of malnutrition gradually increasediiring the course of the development of the symptoms, and from timeto time an irregular fever may be present. The child may die of wasting, or of some intercurrent disease, but ifthe infection is mild, and if proper and energetic treatment is pursued,the evidences of the disease, the secondaries, as they really are, graduallydisappear and the child may completely recover. One of the results
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