A treatise on orthopedic surgery . nt itself may be primarily im-plicated. There is general thickening of the synovial membrane, effu-sion and later destruction of cartilage. Pain is as a rule notsevere.^ The joint manifestations of acquired syphilis are pain, mostmarked at night, during the exanthematous stage. In someinstances effusion may be present which if persistent may beaccompanied by hypertrophy of the synovial membrane. Theknee, shoulder and elbow joints are most often involved. Bona, Berlin, klin. Woch., n. 43 and 44, 1907. NON-TUBERCULOUS DISEASES OF THE JOINTS. 271 The diagnosis o
A treatise on orthopedic surgery . nt itself may be primarily im-plicated. There is general thickening of the synovial membrane, effu-sion and later destruction of cartilage. Pain is as a rule notsevere.^ The joint manifestations of acquired syphilis are pain, mostmarked at night, during the exanthematous stage. In someinstances effusion may be present which if persistent may beaccompanied by hypertrophy of the synovial membrane. Theknee, shoulder and elbow joints are most often involved. Bona, Berlin, klin. Woch., n. 43 and 44, 1907. NON-TUBERCULOUS DISEASES OF THE JOINTS. 271 The diagnosis of syphilitic joint disease is usually suggestedby the history and is confirmed by the other signs of syphiliticdisease. The most important of the confirmatory signs ofhereditary syphilis is keratitis. In a series of 77 cases in whichthis was present there was involvement of the joints in 56 percent., the knee being most often affected.^ Spina ventosa (), which is classed as one of the evidences of syphilis, is far Fig. Syphilitic osteoperiostitis of ttie tibiae resembling anterior bow-leg. This isthe most characteristic manifestation of hereditary syphilis. It induces notonly deformity and hypertrophy, but elongation of the bones as well. more commonly of tuberculous origin^ as is illustrated by thestatistics of Karewski,^ of 157 cases, in. which but three weredue to syphilis. Syphilitic disease of the joints is comparatively rare in ortho-pedic clinics as contrasted with those of tuberculous origin. ^Hippel, Miinch. med. Woch., No. 31, Chir. Krank. dies Kindesalters. 272 OBTHOPEDIC SUEGEBY. This is as migiit be expected, for not only is tuberculosis farmore common than syphilis, but a very large proportion, accord-ing to Fournier, 77 per cent., of the syphilitic children are still-born or die shortly after birth. Even among those that survive, Fig. 188. Fig. 189.
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