A system of surgery . 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 meningitis or cerebral abscesssupervening, and as soon as the sequestrum becomes loose it shouldbe removed, for fear of its keeping in the pus (Fig. 84). (d) The clavicles, femora,
A system of surgery . 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 meningitis or cerebral abscesssupervening, and as soon as the sequestrum becomes loose it shouldbe removed, for fear of its keeping in the pus (Fig. 84). (d) The clavicles, femora, tibiae, and the bones of the at the joint-ends or elsewhere along the shaft, sclerosis of thegreater part of one of these loug bones, less commonly centralgunimata, are met with in the case of each of them. (e) The sternum. Softening periosteal nodes, usually situatedon the anterior surface, form the chief syphilitic lesion of this bone. We may note with regard to these and other bones that syphilitic. Fig. 84.—Upper Surface of the Frontal Bone of an Adult, showing a rounded, smoothfaced depression, the floor of which was formed hy the inner table. a, This had been produced by a pericranial gumma, and there had been no necrosis or second similar excavation, 6, contained a small sequestrum, c, and the suppuration round thishad led to perforation of the skull and fatal meningitis. nodes are often situated at and involve the attachment of importantmuscles to the bone; thus the insertion of the masseter muscle tothe lower jaw, the origin of the pectoralis major from clavicle,sternum, and ribs, the sterno-mastoid from the clavicle, the gastro-cnemius from the femur, are all rather favourite sites for such nodesor gummata. The frequent strain of these muscles on the periosteumhas very probably something to do with this fact. Few, if any, of the long bones can be said to be exempt fromsyphilitic lesions. One interesting, but rare form of disease of thep
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