THE BONES AND JOINTS. 737 



forms of osteitis just described, or gummatous nodules may form. Syph- 

 ilitic osteitis usually commences in the periosteum, which becomes thick- 

 ened and infiltrated with cells, so that there may be a circumscribed 

 thickening of the periosteum, with or without distinct guniniata. The 

 vessels which extend from the periosteum into the bone become sur- 

 rounded by new cellular tissue, which causes an enlargement of the 

 canals. At this stage, if the periosteum be stripped off, it drags with it 

 the vessels surrounded by the new cell growth, leaving the bones beneath 

 with numerous small perforations extending inward. As the disease 

 progresses the channels in the bone enlarge by a rarefying osteitis and 

 coalesce, forming large, irregular defects filled with new fibrous tissue. 

 In these masses of new tissue, cheesy degeneration may occur, so that the 

 new growth has more or less of the character of a gumina. In the vicin- 

 ity of these gumnia-filled spaces a condensing osteitis may occur, both in 

 the substance of the bone and on the surface, in the form of osteophytes, 

 so that the opening in the bone may be surrounded by an elevated, irreg- 

 ular ring of bone tissue. All this may occur beneath the uuinvolved 

 skin, or the skin may participate by a suppurative inflammation, result- 

 ing in ulceration. These processes may be circumscribed or involve a 

 large part of a bone. It is not infrequently associated with necrosis of 

 larger and smaller portions of bone. The syphilitic tissue may be ab- 

 sorbed and its place be more or less filled with fibrous tissue. Syphilitic 

 osteitis is most frequent in the cranial bones, but may occur elsewhere, 

 as in the sternum, clavicle, tibia and fibula, the ribs, etc. 



Congenital Syphilis. The bones of young children in this condition 

 may show increased density or evidences of periostitis, or irregular thick- 

 enings, particularly of the skull. Characteristic lesions are frequently 

 found in the long bones in still-born or young children who are the vic- 

 tims of hereditary syphilis. These lesions are found for the most part 

 along the border zone between the epiphysis and diaphysis. In normal 

 ossification of the long bones, the border line between the calcification 

 and ossification zones is narrow, sharply defined, and straight, or lightly 

 and evenly curved. In the syphilitic bones, on the contrary, this line is 

 broader, uneven, and presents various modifications, which merge into 

 one another, so that all intermediate forms may be seen. In a lesion of 

 moderate grade there may be, between the cartilage and the new-formed 

 spongy bone, a white or reddish-white zone, about 2 mm. in breadth, 

 with very irregular borders, consisting of calcified cartilage, in which the 

 linear groups of cartilage cells are more abundant than normal. In more 

 pronounced lesions the calcified zone, still containing an unusual number 

 of cartilage cells, is broader and still more irregular and less sharply out- 

 lined against the ossification zone. The cartilage just beyond it is softer 

 and almost gelatinous, and may contain numerous blood-vessels, islets of 

 connective tissue or of calcification, or irregular ossification. Finally 

 the bone may be pouched out at the sides around the ossification and 

 calcification zones, and the perichoudrium and periosteum thickened. 

 The whitish, irregular calcified zone is hard and friable. Between this 

 and the new-formed bone there is an irregular, soft, gray or grayish- 

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