Secale 142.- Inflammation of the Bones and Periosteum.
Although bone-pains very frequently exist without any material changes in the periosteum or bone, yet, as Ricord has satisfactorily demonstrated, they are frequently attended with inflammation, not so much of the periosteum, as of the substance of the bone itself.
Inflammation of the periosteum, if it does at all exist, most likely never occurs independently of the bone. That which has been more recently described, under he names of periostosis and exostosis, as terminations of inflammations-we mean the exudations, want take place beneath the detached periosteum, and form hard swellings-most probably beneath the detached periosteum, and form hard swellings-most probably arises from a superficial inflammation of the bone itself, rather than arises from a superficial inflammation of the bone itself, rather than from inflammation of the periosteum. If the periosteum should be inflamed, more or less circumscribed swellings may arise, more particularly on bones covered with simple integument, which swellings afterwards form the true periostoses, and are seen, for instance, on the tibia, clavicle, radius, ulna, skull-bones, and metacarpal and metatarsal bones. These swellings are sometimes without any sensation; If there is no distinct fluctuation, they at least have a doughy feel, and the integument over them, may remain for a long time movable and without any perceptible alternation. Capable of dispersion in certain cases, these swellings may, under other circumstances, terminate in suppuration, forming true abscesses, which, when opened, may show the bone simply denuded of its periosteum, or a portion of it attacked with caries or necrosis, down to a certain depth, and in fortunate cases, provided already with new granulations.
Otherwise, the more deep-seated inflammation of bones from syphilitic infection is like any other form of ostitis. It may affect the very same parts which we have described a little white ago, at the seat of periostitis. Very often it only attacks the surface of the bones; not unfrequently, however, it penetrates the whole of the body tissue. Generally they run a chronic course, although, exceptionally, they may likewise assume a sub- inflammatory form but for the known bone-pains, it might exist for a long time without betraying itself by any perceptible swelling of the bone; however, should it continue for a long time, it results in the formation of exostoses in either case, it generally terminates in depression, and but very seldom in caries or necrosis. Like simple bone-pains, ostitis has been regarded by many physicians as a mercurial affection, which it undoubtedly is in many cases, however, it may occur in patients who have never made any use of this metal, and where a syphilitic faint is evidenced by the simultaneous manifestation of other syphilitic phenomena upon the skin, or in the throat. If these phenomena are wanting, and the patient has been drugged with Mercury, the diagnosis remains undoubtedly doubtful, inasmuch as not only Hahnemann, but other physicians likewise, have found that Mercury will not only cause inflammation, but a variety have found that Mercury will not only cause inflammation, but a variety of other affections of the bones; any who who doubts this fact, may become convinced of its truth by examining, in the University of Bonn on the Rhine, the half-corroded skull of a man who had died of what is called syphilis of the bones, where he can distinctly perceive the mercurial globules shining in the bony tissue, showing that this metal, in spite of all assertions to the contrary, is capable of causing such frightful disorganizations of the bones.
Secale 143.- Exostoses and Periostoses.
Among the swelling occurring on the bones, we distinguish two kinds with reference to prognosis: (1) slight swellings, which often disappear of themselves, and are occasioned by morbid depositions of the inflamed periosteum, and hence are designed as periostoses; and (2) much more serious swellings, where the substance of the bone itself is inflamed, and furnishes these depositions; these swellings are termed exostoses. Let us endeavor to give a discriminating description of both forms.
(1) Periostoses, which some German authors, among whom Hartmann, falsely describe as gummata (see No. 147), are small, roundish, imperfectly circumscribed, mostly soft, doughy swelling, known a syphilitic nodes, or tophi, arising, as has already been stated, from a previous inflammation of the periosteum, and are principally located on the tibia, clavicle, ulna, radius, skull- bones, and sternum. Although consisting of a swelling of the inflamed periosteum and the subjacent cellular tissue, these swellings frequently show, without any doubt, whether the inflammation is confined to the periosteum, or whether it does not rather emanate from the outer bony laminae. In this later case, it may occasion the effusion of an albuminous fluid between the bones and the periosteum, in consequence of which the former becomes more or less thickened, forming a painless, indolent swelling, which may terminate in dispersion. In other cases, on the contrary, the inflammation of the periosteum may progress and terminate in suppuration, in which case the bone, after the abscess in opened, is found denuded of its periosteum; after which the bone, according to circumstances either exfoliates or becomes necrosed, or else may become attacked with a progressive caries. This lest-mentioned termination occurs more frequently with the broad bones, sternum, etc. whereas the long-bones, tibia, bones of the arm, etc., are more frequently attacked with necrosis. The periosteum may, however, remain inflamed without the substance of the bones becoming involved, and, amid an abatement of the pains, may terminate in chronic thickening and hypertrophy, which, however, does not preclude the possibility of final dispersion.
(2) Exostoses always depend upon inflammation of the bones itself, and, according as the superficial laminae or the whole parenchyma of the bone are inflamed, may assume different forms. If the inflammation is merely superficial the periosteum is always involved, in which case, if nothing but albuminous exudations take place, the disease may be confined to the above- mentioned periostoses; on the contrary, if suppuration of the nose or deposition of inorganic substances takes place, the exudations or simultaneous suppuration of the periosteum are accompanied by semi-globular, conical, flattened or oblong exostoses, which may continue for years in the shape of hard, more or less circumscribed swellings, without dispersing, and which, if occurring on the internal surface of the skull-bones or sternum, may materially interfere with the functions of these organs. If the whole parenchyma of the bone is attacked, the body swelling is uniformly developed in all directions, as may be noticed on the tibia, humerus and femur; such an exostosis or rather hypertrophy of the bone is distinguished with great difficulty form an analogous scrofulous disorganization. Nor is it always easy at the commencement of such swellings do distinguish periostoses, exostoses and hypertrophies from each other; if more advanced, the first-named can always be recognized by their increased softness, the second by their hardness and semi-globular shape, and the last-named by the uniform extension of hard swelling.
Secale 144.- Necrosis and Caries of the Skull, Nose and Palate.
These disorganizations, which, after all, are nothing else than the not very rare termination of a syphilitic inflammation of the bones or their periosteum (ostitis and periostitis), do not exhibit any symptomatic peculiarities that are not likewise seen in non-syphilitic affections of the same kind. In regard to their site they show, however, some peculiar features deserving of a more special notice.
(1) Syphilitic affections of the skull-bones very frequently announce themselves in the shape of simple bone-pains, which, after having lasted for a longer or shorter period of them, give rise to swelling of the bone and sensitiveness of this part to pressure; if the cerebral surface of the skull-bones is the seat of the affection, it manifests itself at most by more or less imparting the cerebral functions; in such a case we have no means of ascertaining whether there is necrosis, caries or a simple exostosis, or whether the duramater is attacked or not. If seated on the outer skull, these affections, like similar affections in other cases, are characterized by tumors or open ulcers; they have been known to cause terrible disorganizations, to corrode the whole outer layer of the skull-bones, and even to penetrate to the inner layer and expose a large portion of the cerebrum.
(2) Equally dangerous are these affections if the bones of the orbits and of the ear are the seat of the disorganizing process. By exercising a pressure upon the optic nerve they may not only cause a considerable diminution of the optic nerve, but likewise complete blindness; or they may cause deafness by attacking the ossicula of the ear. As long as the pains remain internal, and the destruction of the bones is not yet revealed by any external discharge, the diagnosis of these affections remains very obscure, and, even if other syphilitic phenomena should be present, can only be cleared up within the limits of probability.
