A system of practical medicine. By American authors. Vol. 2

by Unknown

¹⁵³ "Hutchinson's view, that this form of keratitis is to be regarded as the direct consequence of congenital syphilis, has not been generally accepted in Germany" (Handbook of Ophthalmology, p. 298).

¹⁵⁴ Zeissl's Jahrbuch der Syphilis, 1875, p. 288.

¹⁵⁵ Graefe and S.'s Handbuch d. Augenheilkunde, 1875, vol. iv. p. 264.

¹⁵⁶ Diseases of the Eye, p. 138.

Probably the conclusions of Jullien¹⁵⁷ most nearly express the views of those who do not accept in its entirety the syphilitic theory of the disease. He concludes—(1st) that interstitial keratitis coincides frequently, but not invariably, with syphilitic derangement of the dental apparatus; (2) that it is associated with a feeble constitution and with malnutrition, and is thus produced indirectly by scrofula, rheumatism, or syphilis, each of which by its debilitating influence may give rise to a diathesis which favors such morbid developments.

¹⁵⁷ Op. cit., p. 1013.

As a specimen of the evidence which is produced by observers other than Mr. Hutchinson—who, as he himself observes, may be suspected of "that bias which almost necessarily warps more or less the judgment of one who supposes himself to have noted something new"¹⁵⁸—the statistics of Förster,¹⁵⁹ who apparently takes an unbiassed view of the question, may be noted: In a total of 214 cases of interstitial keratitis evidence of hereditary syphilis other than the corneal disease was noted in 146 (68 per cent.). This number was made up as follows: a, evidence of syphilis in parent, 17; b, evidence of hereditary syphilis in other members of the family, 14; c, evidence in the patient other than keratitis, 115; characteristic teeth, 69; evidences in physiognomy, bones, skin, palate, or choroid, 46. In the remaining 68 cases (32 per cent.), though inheritance of syphilis was not proved, there was, almost without exception, strong suspicion of that disease apart from the keratitis.

¹⁵⁸ Op. cit., Preface, p. x.

¹⁵⁹ Graefe and Sæmisch's Handbuch, vii., Part I.

The condition of the permanent central upper incisors was noted in 138 of the cases; of these they were typical in 73 (53 per cent.); suspicious in 34 (24 per cent.); normal in 31 (23 per cent.). In 15 cases the permanent teeth had not been cut, and in the remaining 61 the state of the teeth was not recorded.¹⁶⁰