CONSTITUTIONAL SYPHILIS. 769 



preceded by syphilitic periostitis, the skin soon becomes reddened, and 

 the face grows oedematous upon the affected side. Sometimes the 

 integuments are perforated by the pus and fragments of bone, and 

 thus a fistulous opening is established in the back of the nose. Syph- 

 ilitic ozaena, often causing a more or less extensive destruction of the 

 bones of the nose, may recover completely. Some time ago, at the 

 autopsy of a syphilitic person, besides an extensive recent anostosis 

 excentrica (see below), I found a complete absence of the bony sep- 

 tum, the turbinated bones of the nose and the inner walls of the antra 

 of the upper jaws. But there was no bare bone to be found, the huge 

 cavity which represented the nose being every where lined by a smooth 

 cicatricial membrane. 



Besides caries and necrosis, a third destructive disease of the bones 

 occurs in syphilis, which was first accurately described by JBruns, 

 although Virchow first pointed out how frequently it originated from a 

 syphilitic taint. Bruns describes this peculiar form of consumption of 

 bone, to which he gives the name anostosis excentrica, as a dissolution 

 and liquefaction of the bone, beginning excentrically, proceeding from 

 the medullary canals and medullary cells, and marked by swelling and 

 redness of the tissues contained in these spaces, but never accompa- 

 nied by suppuration. The calibre of the canals is first enlarged at the 

 expense of their walls, the progressive absorption of which ultimately 

 causes the canals to blend into irregular cavities. The effect of this 

 process is to render the diseased bone porous, and spongy, like carious 

 bone, and in a macerated specimen it is impossible to tell whether the 

 destruction is the result of caries or of anostosis excentrica. When 

 the disease commences upon the exterior of the skull, its surface first 

 assumes the worm-eaten, rough appearance of superficial caries ; but 

 afterward the loss of substance extends more deeply, and here and there 

 may even perforate the cranial wall. The inner surface of the pericra- 

 nium is said to be reddened, swollen, and granulated over the whole 

 diseased region, and the medullary tissue within the diseased bone is 

 converted into a red vascular mass, intimately connected with the peri- 

 cranium. Not a trace of pus is anywhere to be found. The adjacent 

 bone is either unaltered, or else a reproduction of bony matter takes 

 place on the edges of the seat of disease, which is thus surrounded as 

 by a wall. When the process attacks the outer surface of the cranial 

 wall, an extensive growth of new bone may also occur on the interior 

 of the vault of the skull. This description of anostosis excentrica, 

 which has been taken almost word for word from the text-book of 

 Bruns, agrees so closely with Virchoufs account of " caries sicca," 

 or the inflammatory atrophy of the bones of syphilitic persons, that it 

 can hardly be doubted that both observers have described one and the 



