In contrast to the acquired form, inherited syphilis is remarkable for the absence of any primary stage, the infection being a general one from the outset.  The spirochaete is demonstrated in incredible numbers in the liver, spleen, lung, and other organs, and in the nasal secretion, and, from any of these, successful inoculations in monkeys can readily be made.  The manifestations differ in degree rather than in kind from those of the acquired disease; the difference is partly due to the fact that the virus is attacking developing instead of fully formed tissues.

The virus exercises an injurious influence on the foetus, which in many cases dies during the early months of intra-uterine life, so that miscarriage results, and this may take place in repeated pregnancies, the date at which the miscarriage occurs becoming later as the virus in the mother becomes attenuated.  Eventually a child is carried to full term, and it may be still-born, or, if born alive, may suffer from syphilitic manifestations.  It is difficult to explain such vagaries of syphilitic inheritance as the infection of one twin and the escape of the other.

Clinical Features.—­We are not here concerned with the severe forms of the disease which prove fatal, but with the milder forms in which the infant is apparently healthy when born, but after from two to six weeks begins to show evidence of the syphilitic taint.

The usual phenomena are that the child ceases to thrive, becomes thin and sallow, and suffers from eruptions on the skin and mucous membranes.  There is frequently a condition known as snuffles, in which the nasal passages are obstructed by an accumulation of thin muco-purulent discharge which causes the breathing to be noisy.  It usually begins within a month after birth and before the eruptions on the skin appear.  When long continued it is liable to interfere with the development of the nasal bones, so that when the child grows up there results a condition known as the “saddle-nose” deformity (Figs. 43 and 44).

[Illustration:  FIG. 43.—­Facies of Inherited Syphilis.

(From Dr. Byrom Bramwell’s Atlas of Clinical Medicine.)]

Affections of the Skin.—­Although all types of skin affection are met with in the inherited disease, the most important is a papular eruption, the papules being of large size, with a smooth shining top and of a reddish-brown colour.  It affects chiefly the buttocks and thighs, the genitals, and other parts which are constantly moist.  It is necessary to distinguish this specific eruption from a form of eczema which occurs in these situations in non-syphilitic children, the points that characterise the syphilitic condition being the infiltration of the skin and the coppery colour of the eruption.  At the anus the papules acquire the characters of condylomata, also at the angles of the mouth, where they often ulcerate and leave radiating scars.