CONSTITUTIONAL SYPHILIS. 767 



these membranes such as distortion of the pupil inward and up- 

 ward. Besides the simple syphilitic iritis, there is another form, 

 known as " gummous " iritis. For a description of the very character- 

 istic symptoms and course of this affection, we must refer to the text- 

 books upon ophthalmology. 



VII. Syphilitic Disease of the Periosteum and jBones. One of 

 the common symptoms of syphilis consists in a pain along the bones, 

 unaccompanied by any appreciable objective manifestations. At first 

 these pains are vague and ill-defined. Afterward they are fixed at 

 certain points, particularly in the bones lying close beneath the skin, 

 such as the tibise and the cranial bones. They are increased by pres- 

 sure, and usually remit during the day and recur at night. These 

 osteocopic pains are probably dependent upon a slight disease of the 

 periosteum, capable of complete and speedy recovery, and which prob- 

 ably consists in moderate hyperaemia with an inflammatory oedema. 

 The severe strain which the naturally-unyielding periosteum suffers, 

 even when but slightly infiltrated by serum, fully accounts for the vio- 

 lence of the pain. 



In bad cases of inveterate syphilis, swellings form here and there 

 upon the bones, accompanied by great suffering, which becomes excru- 

 ciating at night. Such swellings, when of a boggy consistence, are 

 called " gummata ; " if their consistence be somewhat hard, they are 

 colled " tophi " (nodes). Like all other syphilitic affections of the 

 periosteum and bones, they are most apt to appear upon the skull, the 

 shins, the sternum, and other bones lying close beneath the skin. 

 Gummata receive their name from the viscid-looking liquid which 

 flows from them when punctured. They consist of cells and nuclei, 

 with very little connective tissue, and a great deal of liquid intercel- 

 lular substance, their elements corresponding closely to those of the 

 recent succulent syphiloma. These tumors may decrease and disap- 

 pear entirely, the liquid and cells both being absorbed, the latter first 

 undergoing fatty degeneration. In other instances pus forms in them, 

 and they turn into abscesses, which, when opened, either naturally or 

 artificially, discharge their contents. 



Tophi, although their consistence is very hard from the outset, so 

 that they are apt to be mistaken by ignorant persons for excrescences 

 from the bone, are circumscribed neoplastic thickenings and elevations 

 of the periosteum by inflammatory exudation. The periosteum whence 

 they spring has but little tendency to suppuration, and by means of 

 an early and appropriate treatment we can often bring about their 

 resolution. When of longer standing, bone forms in the thickened tis- 

 sue ; the tophi are thus converted into exostoses, and are then no longer 

 capable of reabsorption. Besides the form of exostosis just mentioned, 



