alth. On the other hand, when it attains the
age of from two to four years, it may begin to manifest lesions which
correspond to those of the tertiary period of acquired syphilis.

#Later Lesions.#--In the skin and subcutaneous tissue, the later
manifestations may take the form of localised gummata, which tend to
break down and form ulcers, on the leg for example, or of a spreading
gummatous infiltration which is also liable to ulcerate, leaving
disfiguring scars, especially on the face. The palate and fauces may be
destroyed by ulceration. In the nose, especially when the ulcerative
process is associated with a putrid discharge--ozaena--the destruction of
tissue may be considerable and result in unsightly deformity. The entire
palatal portions of the upper jaws, the vomer, turbinate, and other
bones bounding the nasal and oral cavities, may disappear, so that on
looking into the mouth the base of the skull is readily seen. Gummatous
disease is frequently observed also in the flat bones of the skull, in
the bones of the hand, as syphilitic dactylitis, and in the bones of the
forearm and leg. When the tibia is affected the disease is frequently
bilateral, and may assume the form of gummatous ulcers and sinuses. In
later years the tibia may present alterations in shape resulting from
antecedent gummatous disease--for example, nodular thickenings of the
shaft, flattening of the crest, or a more uniform increase in thickness
and length of the shaft of the bone, which, when it is curved in
addition, is described as the "sabre-blade" deformity. Among lesions of
the viscera, mention should be made of gumma of the testis, which causes
the organ to become enlarged, uneven, and indurated. This has even been
observed in infants a few months old.

Occasionally a syphilitic child suffers from a succession of these
gummatous lesions with resulting ill-health, and, it may be, waxy
disease of the internal organs; on the other hand, it may recover and
present no further manifestations of the inherited taint.

_Affections of the Eyes._--At or near puberty there is frequently
observed an affection of the eyes, known as _chronic interstitial
keratitis_, the relationship of which to inherited syphilis was first
established by Hutchinson. It occurs between the ages of six and sixteen
years, and usually affects one eye before the other. It commences as a
diffuse haziness or steaminess near the centre of the cornea, and as it
spreads the ent