A system of surgery . vere as tocall for the additionaluse of opium, etc. Inexceptional cases, where the suffering is very great and unrelievedby iodides, mercury or other internal remedies, an incision throughthe periosteum or trephining the bone itself may be required. A second form of tertiary bone-disease is the gummatous,affecting either the periosteum or the medulla. If periosteal, it willprobably soften and break down unless treated, and often producesrounded or oval excavations in the underlying bone. On the skullthese smooth-edged circular depressions are remarkably characteristicof s
A system of surgery . vere as tocall for the additionaluse of opium, etc. Inexceptional cases, where the suffering is very great and unrelievedby iodides, mercury or other internal remedies, an incision throughthe periosteum or trephining the bone itself may be required. A second form of tertiary bone-disease is the gummatous,affecting either the periosteum or the medulla. If periosteal, it willprobably soften and break down unless treated, and often producesrounded or oval excavations in the underlying bone. On the skullthese smooth-edged circular depressions are remarkably characteristicof syphilis (Fig. 84). If central (starting in the medulla) it may leadto considerable expansion, and perhaps to spontaneous fracture. Ifin the neighbourhood of a joint the node, whether gummatous orossifying, may set up synovitis, and is extremely apt to be mistakenfor a sarcoma (Fig. 82). Yet another form of syphilitic osteitis is that causing necrosisof greater or less extent, the process being usually a very slow 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 ;
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