Diagnosis, prophylaxis, and treatment of congenital syphilis.

The clinical picture of early congenital syphilis is now so often modified that diagnosis must depend on very careful clinical and laboratory examination. The physician should be well acquainted with such attenuated forms of early congenital syphilis to be able to discover and treat them promptly. Osteochondritis of the first degree, if the sole evidence, may not be proof of congenital syphilis, since it is observed in other diseases and even in healthy children. It should be borne in mind that during bismuth therapy the salts of heavy metals circulating in the body may lead to expansion and infiltration of the zone of primary calcification at the boundary between the epiphysis and metaphysis. These metal salts may be introduced not only directly to the child itself, but also through treatment of the mother during the intra-uterine period. The salts of heavy metals may simulate osteochondritis of the first degree. This "bismuth band" resolves only after several months, and at first, with the growth of the bone, it is mechanically shifted towards the metaphysis.