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Discuss paralysis and convulsions separately: both historical labels describe manifestations with several causes. Their occurrence in infancy does not establish one diagnosis, and neither permits invention of examination findings absent from the paper.

For infantile paralysis, distinguish an acute loss of movement after an illness from impaired movement present from birth, delayed motor development and progressive weakness. Note distribution, muscle tone, tendon reflexes, sensation, pain, muscle atrophy, and bulbar or respiratory involvement. The classic acute flaccid, often asymmetric syndrome later identified with poliomyelitis must be distinguished from cerebral injury, cerebral palsy, peripheral nerve injury, spinal disease and painful failure to move a limb. A child who avoids movement because it hurts has pseudoparalysis, not necessarily loss of motor innervation.

An 1866 explanation might attribute some cases to teething, chill or constitutional weakness, and use rubbing, warmth, supports or electrical stimulation. Such attributions need qualification: a preceding event does not prove the mechanism, and electrical contraction does not demonstrate restoration of damaged motor neurons. The clinically useful period aims were preservation of comfort, nutrition and limb position and prevention of deformity while following recovery. No historical stimulant can be assumed to regenerate destroyed neural tissue.

Modern correction: acute weakness requires urgent localization and evaluation of breathing and swallowing. Poliomyelitis results from poliovirus infection and can permanently damage motor function; there is no specific curative treatment for paralytic disease. Supportive care and appropriate rehabilitation address respiratory risk, function and complications; vaccination is preventive rather than a reversal of established paralysis.^[ref] Cerebral palsy describes a different developmental motor disorder associated with disturbances of the developing brain; assessment, investigation when appropriate, physiotherapy, occupational support and treatment of associated problems are individualized. Not every case is attributable to a single event during delivery, and loss of previously attained abilities requires reconsideration of a static diagnosis.^[ref]

For infantile convulsions, consider fever, meningitis, encephalitis, hypoglycaemia, hypocalcaemia and other metabolic disorders, head injury, structural cerebral disease, toxic exposure and epilepsy. Clarify the age, duration, whether movements are focal, recovery between attacks and the child's condition before and afterwards. Neonatal seizures and convulsions in an older febrile infant should not be collapsed into one reassuring category. “Teething” is not a satisfactory explanation for a serious seizure, and a warm bath or gum-lancing must not replace investigation.

During an attack, protect the airway and prevent injury; do not put objects or oral medicines into the mouth. Assess breathing and circulation, time the event, check blood glucose promptly and identify reversible causes. A convulsive seizure lasting five minutes or more is a medical emergency requiring resuscitation and a current status epilepticus pathway, beginning with an appropriate benzodiazepine and escalating if needed. Hypoglycaemia, infection and electrolyte disturbances need direct treatment as well as suppression of movements.^[ref][ref] Following the event, investigate the cause and arrange appropriate follow-up; one provoked convulsion does not by itself establish chronic epilepsy.

Early congenital syphilis can affect the skin, mucosa, bones, viscera and nervous system, yet an infected infant may look well at birth. The symptoms are a variable constellation, not a compulsory sequence seen in every child.

The classical infantile picture includes persistent nasal discharge or “snuffles”, difficulty feeding, poor growth and a rash that can involve the palms and soles. The eruption may be maculopapular or blistering, with desquamation; colour descriptions such as “coppery” are neither universal nor diagnostic alone. Fissures around the mouth and other mucocutaneous lesions may occur. Look also for hepatosplenomegaly, jaundice, anaemia, enlarged lymph nodes and evidence of systemic illness.^[ref]

Bone disease is particularly important when interpreting an apparently motionless limb. Osteochondritis or periostitis can make movement painful, producing pseudoparalysis. This is distinct from the loss of motor function discussed under infantile paralysis. The nervous system can also be involved, including meningitis or seizures. Severe disease can be associated with prematurity, hydrops, stillbirth or neonatal death, although a living infant with mild signs may present much later.^[ref]

The period term “hereditary syphilis” should not be read as a modern account of Mendelian inheritance. Modern science identifies infection by Treponema pallidum, transmitted to the fetus during pregnancy, rather than an inherited constitutional taint. Absence of obvious maternal symptoms does not exclude transmission. Equally, a rash or nasal discharge alone is not enough to prove syphilis or justify an allegation about a parent's behaviour.^[ref]

Later disease is useful for completing the history, but is not the usual neonatal picture. It can include notched permanent incisors or abnormal molars, a saddle-shaped nose, anterior bowing of the shins, interstitial keratitis and sensorineural hearing loss. These permanent dental signs cannot be demanded of a young infant before the relevant teeth have developed.^[ref]

Modern correction: examine and test in the context of maternal infection and treatment, even when the baby has no symptoms. Infant and maternal quantitative nontreponemal results, examination, treatment history and selected direct or additional tests guide assessment. Passive maternal antibodies complicate interpretation of infant serology; a positive test does not have the same meaning in every setting. Appropriate penicillin treatment and follow-up are determined by the clinical scenario, not by waiting for a characteristic rash. Historical mercurial treatment is not its modern substitute.^[ref]