A system of surgery . Fig. 82.—Section through Femur with Gummatous , Raisrd reiosteura; 6, new fibrous deposit; c, edf--e of newbone; d, cavity containing ihick fluid; e, gummatous infiltrationof the cancellous tissue. TERTIARY SYPHILIS. 409 It is especially met with in the palate and nasal bones and those ofthe cranial vault. The bones affected—These various forms—(1) osteo-sclerosis ) (2) nodes, either gummatous or ossifying, or mixed ;. Fig. 83.—CaTvaritim from a Case of Tertiary Syphilis, with very extensive Caries, formationof rough Eidges of Bone, and at one point Perforation of b
A system of surgery . Fig. 82.—Section through Femur with Gummatous , Raisrd reiosteura; 6, new fibrous deposit; c, edf--e of newbone; d, cavity containing ihick fluid; e, gummatous infiltrationof the cancellous tissue. TERTIARY SYPHILIS. 409 It is especially met with in the palate and nasal bones and those ofthe cranial vault. The bones affected—These various forms—(1) osteo-sclerosis ) (2) nodes, either gummatous or ossifying, or mixed ;. Fig. 83.—CaTvaritim from a Case of Tertiary Syphilis, with very extensive Caries, formationof rough Eidges of Bone, and at one point Perforation of both Tables. (3) central gummata ; and (4) osteitis, with necrosis or caries—maybe met with in the same patient, affecting different bones. Thosemost frequently involved in acquired syphilis are :— (a) The nasal bones and the septum, leading to falling in of thebridge, perforation of the septum, and (whilst necrosis is going on)to most offensive ozsena. (6) The hard palate, causing perforation and communicationbetween the nose and mouth. This is to be remedied by the use ofan obturator, a plastic operation being rarely suitable. (c) The frontal and parietal bones, much more rarely theoccipital (Fig. 83). Bony nodes on the frontal, gummatous erosions 410 SYPHILIS. and pits, necrosis of the outer table, and occasionally of the wholethickness of the calvarium are the chief forms met with. Whennecrosis is present, there is grave risk of
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