An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.

  • William Williams Keen
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    221/1392 (page 185)
    The symptoms wliicli ohtuin in tliis condition of syphilitic osteochondritis are as follows. There is a swelling at the (lia|)hyso-e])ij)hyseal junction of one of tiie long bones, which in the emaciated subjects of liereditai-y sypliilis is often visible and can always be discovered by ])al|)ation. This consists of a ring or collar which more or less completely surrounds the bone, is apt to be smooth rather than irregular, and, when two bones situated near to each other are simulta- neously affected, may conjoin them. A moderate amount of synovitis is often present. This affects chietly the elbow^ and the knee, but may appear in any joint. It is readily influenced by specific treatment and Avell-regulated pres- sure. When the last stage is reached, or tliat of the formation of granu- lation-tissue, with degenerative changes of the cartilages and of the bones themselves, deformity often becomes more marked. There are unnatural curves or angles in the bones, with more or less complete separation at the point of junction. The most inn)ortant differential diagnosis to be made in these cases is between tlie rhachitis of young children and the form of syphilis in (juestion. The points of resemblance are manifest, just as they are between a syphilitic and a variolous pustule, but they end in both cases when we come to study the evolution of the phenomena either from an anatomical or from a clinical stand- point. They may be expressed as follows in tabular form: Osseous Lesions due to Inherited Syphilis. The swellings, particularly those of the long bones, show themselves at or soon after birth. A history of syphilis or evidence of existing syphilis in one or both parents. Preceded or accompanied by snuffles, coryza, and cutaneous and mucous lesions. No such prodromata in most cases. Cachexia absent or moderate. Physiognomical peculiarities of syphilis pres- ent. Circumscribed tumors on frontal and parietal bones, rarely on occiput. Ribs not markedly affected. Disease of ribs, vrhen existent, not ordinarily coincident with that of other bones. Fontanels close at usual period. Other syphilitic symptoms present—enlarge- ment of phalanges, metatarsal bones, etc. Often accompanied by sinuses, synovitis, ab- scesses, cutaneous ulcers, etc. Generally disappears by resolution, without leaving any permanent change. Mortality among children in whom many bones are involved is very great. Specific treatment useful. In the first stage there is an exuberant cal- cification of the ossifying cartilage, caus- ing necrosis of the new-formed tissue and a consecutive inflammation, which termi- nates in the separation of tlie epiphyses.^ Rickets. Rarely appear before six months, generally still later. No such history necessarily. No such prodromata. Pallor, restlessness, sweating, nausea, diar- rhea, etc. constitute a combination of symptoms which often precede the bone disease. Cachexia marked. Not present as a group. Cranial bones thickened in spots, usually upon the occiput. All or nearly all involved. Nearly always so. Closure delayed. Syphilitic symptoms absent. Little external or surrounding involvement. Usually leaves some bending of shaft and distortion of the neighboring joint. Much less. Of no benefit. This is less marked. There is formed, in- stead, a soft and non-calcified osteoid tissue. ^ This table is founded on one published in the translation of Cornil On Syphilis, by Drs. Simes and White, and is compiled chiefly from the excellent work of Dr. Taylor on thifi subject.