File:The diseases of infancy and childhood (1920) (14765587791).jpg

Identifier: 39002011128551.med.yale.edu
Title: The diseases of infancy and childhood
Year: 1920 (1920s)
Authors: Holt, L. Emmett(Luther Emmett),1855-1924
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Publisher: New York, D. Appleton
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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ent of the liver (seeIcterus of the Newly Born). Late Hereditary Syphilis.—The symptoms may come on at anyperiod during childhood or about the time of puberty, but rarely at alater time than this. They are seen both in those who have had theusual symptoms of hereditary syphilis in early infancy, and in otherswhere the most careful examination into the history fails to disclose anysymptoms whatever of early syphilis. It is fair to assume in such caseseither that early symptoms were absent or that they were of trivialimportance. Late hereditary syphilis shows itself by symptoms which in acquireddisease would be classed as tertiary. The most characteristic are the af-fections of the teeth, the bones, the eyes, gummatous deposits in the solid ITETJEDITARY SYPHILIS 1117 viscera, the skin or mucous membranes, the breaking down of which maylead to ulceration, and, finally, symptoms of disease of the nervous sys-tem. Teeth.—There are no peculiarities in the first teeth of syphilitic chil-
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Fig. 189. Fig. 190. Figs. 189, 190.—Same Hands as Figs. 187, 188. Note that besides the bones shown in theother pictures, two metacarpal bones (C, D) are affected in the left hand and thelower end of the radius (G) in the right hand. dren except their proneness to early decay. They are rather more likelyto appear early than late. The characteristic teeth of syphilis are those of the second set. Inestimating the diagnostic value of these changes, only the upper centralincisors are to be relied upon; these are the test teeth. Although changesare frequently seen in other teeth, they arenot always diagnostic. Typical syphiliticteeth, according to Hutchinson, have each asingle notch in the center of the edge (Fig.191). The notch is usually shallow and moreor less crescentic in shape. The enamel isgenerally deficient in the center of the notch, and the tooth here is apt to be discolored. The teeth in other cases arevariously dwarfed and deformed (Fig. 192). They often taper regu-larly fro

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