A system of surgery : theoretical and practical . enfeebled by alteinationsof debauchery and hardship, as is the case sometimes with sailors, and more fre-quently with prostitutes. The diagnosis of syphilitic affections is usually easy from the history of infectionand the presence of other symptoms; but it may in some cases be obscured by thepatients unwillingness or inability to reveal the history of the original the pains in the bones may be referied to rheumatism; but here the diagnosiscan in most ca,ses be easily established by observing that rheumatic pains in thebones are ge
A system of surgery : theoretical and practical . enfeebled by alteinationsof debauchery and hardship, as is the case sometimes with sailors, and more fre-quently with prostitutes. The diagnosis of syphilitic affections is usually easy from the history of infectionand the presence of other symptoms; but it may in some cases be obscured by thepatients unwillingness or inability to reveal the history of the original the pains in the bones may be referied to rheumatism; but here the diagnosiscan in most ca,ses be easily established by observing that rheumatic pains in thebones are generally accompanied by affections of the thick fibrous structures (musclesor fasciffi) and of the joints ; or, if the rheumatic aflection be more acute, the urineand sweat will probably furnish indications of the nature of the disease. Whennodes have made their appearance, the diagnosis is usually easy, the only question Fig. 50.—Syphilitic Ulceration of the Annular variety. (Museum of the RoyalCollege of Surgeons, No. 635.) \ ^#^- V.\ -^ It T. lying between syphilis and struma, since rheumatic periostitis is, as we shall see,more diffused. In the absence of history, the concomitant symptoms will guide uswhile the skin is unbroken; and after pus has made its way to the surface, someassistance may be derived from the nature of the secretion. Syphilitic caries andnecrosis (as is observed in the essay on Syphilis) are not primary affections ofthe bones, but aie the Iesult and termination of nodes, or of inflammation of thebones, or of ulcerative aflections of the soft parts around the bone, as in the palate,and therefore have been preceded by a long course of symptoms, during which thediagnosis is usually established. If not, it rarely jjiesents any difficulty, since thetraces or the presence of other symptoms of constitutional syphilis can hardly fail tobe recognised. An interesting compaiison has been made between the forms of syphilitic ulcera-tion in bone and those of syphil
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