Stigmata of Hereditary a great many cases heredi tary syphilis leaves lasting changes by which it can be recognized. These are especially well marked during the second period of childhood, while some of them may disappear during later life. These stigmata , consist of general disturbances of development, of cutaneous scars, of certain skeletal changes, and of the so-called Hutchinson's triad.
1. General disturbances of development arc especially significant at the time of puberty, because infantilism is frequently observed with dwarfism and retarded sexual development. This infantilism occurs as a sequel to severe early hereditary syphilis from which the child recovered in earliest infancy and is distinguished from dwarfism due to other causes by the invariable presence of other unmistakable manifestations of syphilis.
2. Scars.—The ulcerative skin affections of hereditary syphilis leave scars, the location and configuration of which frequently make possible a retrospective diagnosis of hereditary syphilis, without any knowledge of its previous manifestations. The radially arranged cir cumoral, circumnatal and circumanal scars and the scar formations on the mucous membranes of the palate, pharynx, and larynx are very significant. The most important scar symptoms are the radially arranged cicatrices on the lips which give the latter a generally paler and wrinkled appearance.
3. Skeletal Changes.—The hone changes of the first few years, as well as those of later childhood, leave permanent hone deformities. Among these are peculiar deformities of which Parrot's natifornt caput has been mentioned repeatedly. There is present a thickening of the frontal and parietal eminences and a broadening of the transverse diam eter of the skull, so that there is formed a more or less deep furrow, not unlike the intergluteal fold. Frequently, too, there is associated a prom inent bulging forward of the whole abnormally high broad forehead with especially marked projecting and rounded eminences, the so-called "Olympic brow." There are observed also cranial asymmetries, that are not however, always to be attributed to syphilis, but rather to a cranial hyperostosis of syphilitic origin combined with rachitic changes. Hydro cephalic and microcephalic heads, likewise, are found as a result of hered itary syphilis. Permanent deformities of the nasal skeleton arc frequent,
such as pug-nose, saddle-nose and lorgnette nose. The first anomaly is characterized by flattening and broadening of the base of the nose imme diately below the place where it leaves the frontal bone. The second anomaly consists of a sinking in of the nose with a retraction of the end, together with an upward direction, so that the axes of the nos trils extend diagonally forward and upward. In the lorgnette nose (A. Fournier) the lower nasal segment is uniformly depressed and seems to come out of the upper segment, much like the oculars of an opera glass.
Further permanent deformities arc found in the shinbones in the form of thickening and tuberosities of the crest of the tibia, and in the form of the sword-sheath shaped tibia already mentioned.
4. The so-called Hutchinson's Triad is a group of symptoms, com posed of changes in the teeth, eyes, and ears. In the eyes of older chil dren with hereditary syphilis there are frequently found leucoma, spots, and opacities of the cornea, as a sequel to a parenchymatous keratitis; also changes in the iris, such as synechite and irregular pupils; as well as the spots on the chorioid that are characteristic of former hereditary syphilis. The history usually discloses the existence of some ocular trouble dating from earliest childhood. With reference to the ear one frequently obtains the history of an early discharge from the ear or, in some cases, of partial deafness without discharge. Very character istic is a sudden deafness due to neuritis of the auditory nerve. The drum membranes may show a great variety of changes.
It must be remembered that with the exception of sudden deafness, these lesions of the organs of special sense are not pathognomonic of hereditary syphilis. Parenchymatous keratitis, especially, which is usually justly attributed to hereditary syphilis is also found rarely in other than syphilitic children, particularly in those that are debilitated from other causes, such as tuberculosis. No diagnostic value can be attached to those stigmata referable to the organs of special sense, unless there is present other evidence of past hereditary syphilis.