SYPHILIS OF BONE.
Fig. 229
Syphilitic gummas of head and face. (After Jullien.)
Fig. 230
Syphilitic ostitis and osteosclerosis.
Syphilis of bone may assume the type of gummatous involvement of the periosteum or of the bone itself or of syphilitic caries and necrosis. The former appears usually as a distinct tumor, ordinarily tender and exceedingly painful, especially at night, it being characteristic of almost all cases of bone syphilis that the pain, however great during the day, is exaggerated at night. The true syphilitic gumma, or syphiloma, of bone is but little different from gumma in other tissues, which may become secondarily infected and then suppurate with the formation of sinuses, etc. Suppuration, however, is rare. Central gumma, like central osteosarcoma, is possible, and may lead to expansion of the surrounding bone. Syphilitic necrosis, so far as the bone lesion is concerned, scarcely differs from the other varieties. It is, however, almost always of the slow form, and involves more often the flat than the long bones. It is especially seen in the cranium and the sternum. Syphilis of bone is often mistaken for rheumatism or pseudorheumatism because of the deep-seated and somewhat indolent pain. Syphilitic disease of bone permits occasional spontaneous fracture, the bone affected with this disease being always more friable than natural. There is also another form of bone syphilis—namely, the hereditary. It leads either to bone enlargement or to caries and necrosis, the latter usually upon the cranium, where extensive ulceration and sequestrum formation may be observed, even the dura being exposed by breaking down of the fungous tissue.
Fig. 231
