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Gaps occur in the elastic membrane which become covered by endothelium. Some cloudiness may be seen in the corneal lamellae adjacent to these fissures, in some cases due evidently to the filtration of aqueous humor through defective endothelium. Prolonged high intra-ocular tension may be accompanied, particularly in cases of secondary glaucoma, by vesicular and bullous keratitis.
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.
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.
While a considerable number of syphilitic children grow up without showing any trace of their syphilitic inheritance, the majority retain throughout life one or more of the following characteristics, which may therefore be described as permanent signs of the inherited disease: Dwarfing of stature from interference with growth at the epiphysial junctions; the forehead low and vertical, and the parietal and frontal eminences unduly prominent; the bridge of the nose sunken and rounded; radiating scars at the angles of the mouth; perforation or destruction of the hard palate; Hutchinson's teeth; opacities of the cornea from antecedent keratitis; alterations in the fundus oculi from choroiditis; deafness; depressed scars or nodes on the bones from previous gummata; "sabre-blade" or other deformity of the tibiæ.
We are profiting by the unhappy experience of Kentucky and other Southern states, and are adopting drastic measures for its prevention. Interstitial keratitis, or inherited syphilis, is a common cause of blindness in children, though, in many cases, the blindness is only partial, and, if taken in time, the remaining eyesight may be saved.
This disease usually appears between the ages of four and twenty, often following some childish malady, and it requires the greatest care and most nourishing food to counteract its pernicious effects. The victim of interstitial keratitis is never strong, and, although a blood test may show a negative condition, any serious illness may cause the constitutional trouble to reappear.
"My dear sir, there is no occasion for us to go into strictly professional details together," said he soothingly. "If, for example, I were to say that you have interstitial keratitis, how would you be the wiser? There are indications of a strumous diathesis. In broad terms, I may say that you have a constitutional and hereditary taint."
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. Of 152 with this trouble, only 60 per cent recovered useful eye-sight and the remaining 40 per cent were disabled partly or completely.
She was the third of a family of 13 children of whom only five survived. Of the children born subsequently to the patient, the first were either premature or died a few days after their births. The seventh was under treatment for interstitial keratitis and tuberculous ulceration of the lips and throat.
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.
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