of children in various ways.  Perhaps 5 per cent of children are idiots as a result of syphilis.  Certain forms of epilepsy are due to syphilitic changes in the brain.  On the other hand, syphilitic children may be extraordinarily bright and capable for their years.  Some are stunted in their growth and develop their sexual characteristics very late or imperfectly.  It is one of the wonders of medicine to see a sickly runt of a child at fifteen or sixteen develop in a few months into a very presentable young man or girl under the influence of salvarsan and mercury.  A few syphilitic children seem robust and healthy from the start.  The signs of the disease may be very slight, and pass unrecognized even by the majority of physicians.  Some of them may be splendid specimens of physical and mental development, but they are exceptional.  The majority are apt to be below par, and nothing shows more plainly the insidious injury done by the disease than the way in which they thrive and change under treatment.  Even those who are mentally affected often show surprising benefits.

+Destructive Changes, Bones, Teeth, Etc.+—­Syphilis in children, since it is essentially late syphilis, may produce gummatous changes of the most disfiguring type, fully as extreme as those in acquired syphilis and resulting in the destruction or injury of important organs, and the loss of parts of bones, especially about the mouth and nose.  Certain changes in the teeth, especially the upper incisors in the second set, are frequent in hereditarily syphilitic children, but do not always occur.  These peg-shaped teeth are called Hutchinson’s teeth.  Individuals with hereditary syphilis who survive the early years of life are less likely to develop trouble with the heart, blood vessels, or nervous system than are those with acquired syphilis.

+Eye Trouble—­Interstitial Keratitis.+—­Two manifestations of hereditary syphilis are of obvious social importance.  One of these is the peculiar form of eye trouble which such children may develop.  It is known as interstitial keratitis, and takes the form of a gradual, slow clouding of the clear, transparent convex surface of the eyeball, the cornea, through which the light passes to reach the lens.  While the process is active, the child is made miserable by an extreme sensitiveness to light, the eye is reddened, and there is pain and a burning sensation.  When the condition passes off, the child may scarcely be able to distinguish light from dark, to say nothing of reading, finding its way about, or doing fine work.  A certain amount of the damage, once done, cannot be repaired, although cases improve surprisingly if the process is still active and is properly treated.  The course is slow, often a matter of years, and only too many patients do very poorly on the sort of care they can get at home.  One eye case in every 180 has interstitial keratitis, according to reliable figures.[9] Of 152 with this trouble, only 60 per cent recovered