Affections of the Mucous Membranes.—­The inflammation of the nasal mucous membrane that causes snuffles has already been referred to.  There may be mucous patches in the mouth, or a stomatitis which is of importance, because it results in interference with the development of the permanent teeth.  The mucous membrane of the larynx may be the seat of mucous patches or of catarrh, and as a result the child’s cry is hoarse.

Affections of the Bones.—­Swellings at the ends of the long bones, due to inflammation at the epiphysial junctions, are most often observed at the upper end of the humerus and in the bones in the region of the elbow.  Partial displacement and mobility at the ossifying junction may be observed.  The infant cries when the part is touched; and as it does not move the limb voluntarily, the condition is spoken of as the pseudo-paralysis of syphilis.  Recovery takes place under anti-syphilitic treatment and immobilisation of the limb.

Diffuse thickening of the shafts of the long bones, due to a deposit of new bone by the periosteum, is sometimes met with.

[Illustration:  FIG. 44.—­Facies of Inherited Syphilis.]

The conditions of the skull known as Parrot’s nodes or bosses, and craniotabes, were formerly believed to be characteristic of inherited syphilis, but they are now known to occur, particularly in rickety children, from other causes.  The bosses result from the heaping up of new spongy bone beneath the pericranium, and they may be grouped symmetrically around the anterior fontanelle, or may extend along either side of the sagittal suture, which appears as a deep groove—­the “natiform skull.”  The bosses disappear in time, but the skull may remain permanently altered in shape, the frontal and parietal eminences appearing unduly prominent.  The term craniotabes is applied when the bone becomes thin and soft, reverting to its original membranous condition, so that the affected areas dimple under the finger like parchment or thin cardboard; its localisation in the posterior parts of the skull suggests that the disappearance of the osseous tissue is influenced by the pressure of the head on the pillow.  Craniotabes is recovered from as the child improves in health.

Between the ages of three and six months, certain other phenomena may be met with, such as effusion into the joints, especially the knees; iritis, in one or in both eyes, and enlargement of the spleen and liver.

In the majority of cases the child recovers from these early manifestations, especially when efficiently treated, and may enjoy an indefinite period of good health.  On the other hand, when it attains the age of from two to four years, it may begin to manifest lesions which correspond to those of the tertiary period of acquired syphilis.