The same is true of Hutchinson's teeth, an anomaly found exclu sively in the upper central incisors of the second dentition. Typical Hutchinson's teeth always show a single, rather superficial, crescenting, broad notch in the middle of the lower border, with rounded corners. In most cases the dentine is laid bare in the centre of this crescentic notch, due to a defect in the enamel; this defect is not, however, by any means, a constant accompaniment. Not rarely one finds these upper central incisors either inclining toward or away from one another; but rarely are they long enough to touch the adjacent teeth. This deformity certainly does occur in children with hereditary syphilis and Hutchin son's explanation for this anomaly, i.e., a nutritional disturbance of the dental germ clue to syphilis, is doubtless correct. But. this same harm ful influence that syphilis has upon the dental germ can be excited by all kinds of acute and chronic infections and constitutional diseases if they appear before the eruption of the permanent teeth. Thus, both Welander and I have seen Hutchinson's teeth in individuals who were positively free from syphilis, and also in children with early acquired syphilis.
With reference to all of these stigmata, it may be said that those alone have indisputable diagnostic value that are the result of actual past specific lesions, such as the scars on the skin and mucous membranes and certain bone and eye anomalies; but that many other alleged stig mata, such as discharge from the ear, partial deafness, corneal opacities, and dental anomalies, occur likewise with other diseases that are accompanied by general weakness and lowered resistance of the youthful organism. An absolutely positive proof of former hereditary syphilis is found in the radial scar formation on the lips.
Hutchinson's triad doubtless occurs frequently in hereditary syphi lis; but it is not a positive proof of the existence of that disease. It must be mentioned, further, that in children who are properly treated in infancy these questionable symptoms, especially that referable to the teeth, only exceptionally occur.