The surgical diseases of the genito-urinary organs including syphilis / by E.L. Keyes ; a revision of Van Buren and Keyes's text-book upon the same subjects.

  • Keyes, E. L. (Edward Lawrence), 1843-1924.
Date:
1889, ©1888
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Licence: Public Domain Mark

Credit: The surgical diseases of the genito-urinary organs including syphilis / by E.L. Keyes ; a revision of Van Buren and Keyes's text-book upon the same subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    esting facts in conncotion with the subject of congenital sypliilis, espe- cially as indelibl}- stamped upon tlie individual after his earlier child- hood. These appearances, until Hutchinson called attention to them, had either been ignored, unobserved, or attributed to scrofula. They are briefly these : A child who has inherited syphilis, who perhaps has never shown marked evidences of the disease in babyhood, becomes somewhat blighted in his development. His skin is coarse, earthy, pallid, per- haps showing cicatrices. He has a squared face, prominent check- bones, overhanging forehead, and a sunken bridge to his nose. He looks prematurely old and grave, and may have chronic catarrh, inter- stitial keratitis, ulceration of the throat, or cicatrices of the mouth or soft palate. The permanent teeth are irregularly set and defective, especially the two middle upper incisors, which Hutchinson calls the *'test-teeth. These are small, often converging, sometimes diverg- ing. The cutting-edge of the teeth is sometimes narrowed, rounded off, whence the name pegged teeth. They are stunted and badly developed, often marked with seams (lines, ridges) in front, and of a dirty-brownish color, but their chief peculiarity is found in their edges, which, being thin when cut, break off centrally, leaving a broad, shallow, vertical notch on the lower border of the tooth. This becomes smoothed down with advancing years, but the size and shape remain to indicate a blighted tooth. Not all children with inherited syphilis have these teeth, but many do, and the sign is well worthy to be carefully watched for. It not infrequently hajD- pens that one child of a family has the notched, pegged teeth, while brothers and sisters born afterward escape, yet still any of these latter may late along in childhood develop some periosteal thicken- ing, some indurated scaly patch on the skin, or mild, raised, excori- ated, insensitive patch of thickening on the mucous membrane of the mouth, which the practiced eye and touch recognize as sy])hi- litic, and which melts away under antisyphilitic treatment, boldly administered. The profession is not entirely in accord upon the question of syjDhi- litic teeth. Clearly syphilis is capable of disfiguring the teeth, and Hutchinson * has clearly shown that the notched central permanent incisors in the upper jaw justly enjoy the distinction of being termed test-teeth. Hutchinson attributes some of the other defects noticed upon the permanent teeth of patients with inherited syphilis to mer- cury, and others to defects in the enamel due to a variety of causes. Parrot,t on the other hand, believes that little rows of circular depres- sions or fissures around the teeth, especially uj^on the canines and first molars, making the crown of the tooth appear as if divided into two * Illustrations of Clinical Surgery, Fasc. Ill, Plate XI, Loudon, 18Y6. f Revue Scicutifiquc, July 22, 1882, p. 111.