Among the rarer and more serious lesions of the inherited disease may be
mentioned gummatous disease in the _larynx and trachea_, attended with
ulceration and resulting in stenosis; and lesions of the _nervous
system_ which may result in convulsions, paralysis, or dementia.
In a limited number of cases, about the period of puberty there may
develop _deafness_, which is usually bilateral and may become absolute.
_Changes in the Permanent Teeth._--These affect specially the upper
central incisors, which are dwarfed and stand somewhat apart in the gum,
with their free edges converging towards one another. They are tapering
or peg-shaped, and present at their cutting margin a deep semilunar
notch. These appearances are commonly associated with the name of
Hutchinson, who first described them. Affecting as they do the
permanent teeth, they are not available for diagnosis until the child is
over eight years of age. Henry Moon drew attention to a change in the
first molars; these are reduced in size and dome-shaped through dwarfing
of the central tubercle of each cusp.
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