38i 
patients continue slowly losing tissue for years when untreated, and 
it may heal even after most extensive destruction has taken place. 
There is just as frequent syphilitic ulceration, but of the skin, in other 
places where the rhinopharyngitis is not so common. 
Hutchinson describes the same lesion as being not infrequent in 
the young, and attributes it to inherited taint. It is remarkable, 
however, that he does not usually find the other signs of heredity, 
notched teeth and keratitis, in such cases. In view of the facts which 
1 shall later on present, I have taken the liberty of disagreeing with 
the master’s opinion, and believe that this severe tertiary is usually 
the result of acquired syphilis. 
According to Hutchinson, the tertiaries of inherited syphilis 
commonly seen are interstitial keratitis at about the age of pu ) < 
deafness ; periosteal nodes between the ages of, say, eight to ten y 
sometimes ending in necrosis; lupoid ulceration and ulceration o 
pharynx and palate. I have only seen three instances of deafness m 
juvenile syphilitics in St. Vincent. Interstitial keratitis is rare , 
only remember one case. Perhaps the negro race is not pron 
though iritis and other eye affections are sometimes seen in acq 
syphilis of blacks. Periostitis and synovitis in young persons 
children are common enough, but these belong as muc to 
acquired disease. Lupoid ulcerations and ulceration of the nOS f,^ e 
throat are, as we said before, very common in young persons. ese 
also occur in acquired syphilis. , 
But it is not, I believe, recognised that cutaneous gumma^ ^ 
subcutaneous gumma leading to gummatous ulceis occur or a 
common in the inherited disease. So frequent is the former 
West Indies that it is well known to the natives under t e 
“ blind-boil " and “ blue-blister.” It is just as common in chi ren as 
in adults. 
The terrible and long-lasting ulcers often met with in the young 
peasants are sometimes superficial and lupoid or serpigmou , ^ 
more commonly they are deep subcutaneous gummata. One may ^ 
the early stage when there is a fluctuating tumour so like y o 
mistaken for abscess. I have myself cut into such a gumma 
" f eight years, under the impression that it was a cold a etion 
found the characteristic soft pale tissue exuding a gummy ^ 
lll,,n the cut surface. The frequency of these tertiaries 
Y 
