A treatise on orthopedic surgery . hyseal enlargements, and by the age of the patient and theabsence of the other symptoms of rhachitis. In the later manifestations of hereditary syphilis, in whichth^ bones in the neighborhood of the joint are involved insyphilitic osteoperiostitis, the joint may be sympatheticallyaffected or the disease may actually perforate the joint. In thisform of disease the synovial membrane is usually hypertrophiedto such degree as to interfere with the function of the fluid is increased in quantity and the affection may resem- 269 270 OBTHOPEDIC SUBGEEY. ble
A treatise on orthopedic surgery . hyseal enlargements, and by the age of the patient and theabsence of the other symptoms of rhachitis. In the later manifestations of hereditary syphilis, in whichth^ bones in the neighborhood of the joint are involved insyphilitic osteoperiostitis, the joint may be sympatheticallyaffected or the disease may actually perforate the joint. In thisform of disease the synovial membrane is usually hypertrophiedto such degree as to interfere with the function of the fluid is increased in quantity and the affection may resem- 269 270 OBTHOPEDIC SUBGEEY. ble synovial tuberculosis. A slow, chronic, infiltrating gum-matous form of disease appearing in later childliood may simu-late very closely the appearances of so-called white swelling. Itis more common at the knee, but other joints are often affectedas well. In other instances one or more of the joints may beinvolved before the enlargement of the neighboring bone is ap-parent, the symptoms being those of chronic synovitis. Fig. Suppurative syphilitic epiphysitis at lower ends of radius and tibia in aninfant aged one month. The child died shortly after the drawings were made,and the epiphyses were found lying loose in purulent cavities. (Tubby.) In tertiary syphilis the joint may be invaded by disease in theneighboring bones, or the joint 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
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