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By J. L. C. Martin-Doyle (Auth.)

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T h e following additional stigmata o f syphilis should be looked for : — a. Flatness o f the nose. b. Deafness. c. Hutchinson's teeth. T h e t w o upper central incisors of the permanent dentition are deformed. T h e r e m a y be a central notch and the teeth m a y be pegshaped and unduly small. T h e milk teeth are not affected. d. Glandular enlargement, especially in the posterior triangles o f the neck. e. T h e limbs should be examined for periosteal nodules and synovitis o f joints. T h e Wassermann reaction will settle the diagnosis.

P A T H O L O G Y . — U n c e r t a i n , but there are t w o theories : — a. I t m a y be a virus infection, p r o b a b l y a late stage o f superficial punctate keratitis, or herpes corneae. 6. Some authorities think i t is due t o neuroparalytic changes in the fifth n e r v e . B o t h these theories, h o w e v e r , must b e regarded as unproven. 4. I n t e r s t i t i a l K e r a t i t i s . — T h e name g i v e n t o a deep and vascularizing keratitis due t o congenital syphilis. I t is a disease o f childhood, usually appearing between the ages o f 5 and 15.

M a l i g n a n t P a p i l l o m a of the L i m b u s . — T h i s tumour is 4 sessile and presents a raspberry ' appearance. I t is highly vascular and tends t o i n v a d e the cornea and sclera, and eventually the globe. I n its early stages i t resembles an innocent tumour, but i t soon becomes obviously malignant, i n v a d i n g t h e pre-auricular and submaxillary glands and eventually l e a v i n g secondary deposits in various parts o f the b o d y . 2. E p i t h e l i o m a . — T h e limbus is the usual site for this g r o w t h as i t is the junction b e t w e e n the epithelial surfaces o f the conjunctiva and cornea and these growths show a preference for such junctions.

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