dle Finger of Adult, the
result of Tuberculous Dactylitis in childhood.]

SYPHILITIC DISEASE

Syphilitic affections of bone may be met with at any period of the
disease, but the graver forms occur in the tertiary stage of acquired
and inherited syphilis. The virus is carried by the blood-stream to all
parts of the skeleton, but the local development of the disease appears
to be influenced by a predisposition on the part of individual bones.

Syphilitic diseases of bone are much less common in practice than those
due to pyogenic and tuberculous infectious, and they show a marked
predilection for the tibia, sternum, and skull. They differ from
tuberculous affections in the frequency with which they attack the
shafts of bones rather than the articular ends, and in the comparative
rarity of joint complications.

_Evanescent periostitis_ is met with in acquired syphilis during the
period of the early skin eruptions. The patient complains, especially at
night, of pains over the frontal bone, ribs, sternum, tibiae, or ulnae.
Localised tenderness is elicited on pressure, and there is slight
swelling, which, however, rarely amounts to what may be described as a
_periosteal node_.

In the later stages of acquired syphilis, _gummatous periostitis and
osteomyelitis_ occur, and are characterised by the formation in the
periosteum and marrow of circumscribed gummata or of a diffuse gummatous
infiltration. The framework of the bone is rarefied in the area
immediately involved, and sclerosed in the parts beyond. If the
gummatous tissue degenerates and breaks down, and especially if the
overlying skin is perforated and septic infection is superadded, the
bone disintegrates and exhibits the condition known as _syphilitic
caries_; sometimes a portion of bone has its blood supply so far
interfered with that it dies--_syphilitic necrosis_. Syphilitic
sequestra are heavier and denser than normal bone, because sclerosis
usually precedes death of the bone. The bones especially affected by
gummatous disease are: the skull, the septum of the nose, the nasal
bones, palate, sternum, femur, tibia, and the bones of the forearm.

_In the bones of the skull_, gummata may form in the peri-cranium,
diploe, or dura mater. An isolated gumma forms a firm elastic swelling,
shading off into the surroundings. In the macerated bone there is a
depression or an actual perforation of the calvaria; multiple gummata
tend to fuse with one another at their m