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In the syphilitic lesion, skiagrams usually show a more abundant formation of new bone, but in many cases the doubt is only cleared up by observing the results of the tuberculin test or the effects of anti-syphilitic treatment. Sarcoma of a phalanx or metacarpal bone may closely resemble a dactylitis both clinically and in skiagrams, but it is rare. Treatment.
The syphilitic lesion belongs to the tertiary period, and although presenting a superficial resemblance to tuberculosis, its progress is more rapid, so that within a few months it may involve an area of skin as wide as would be affected by lupus in as many years. Further, it readily yields to anti-syphilitic treatment.
In its early stages the disease is amenable to anti-syphilitic treatment, and complete recovery is the rule. This rare disease results from the lodgment of the embryos of the tænia echinoccus, which are conveyed to the marrow by the blood-stream. The cysts are small, usually about the size of a pin-head, and they are present in enormous numbers scattered throughout the marrow.
The infant cries when the part is touched; and as it does not move the limb voluntarily, the condition is spoken of as the pseudo-paralysis of syphilis. Recovery takes place under anti-syphilitic treatment and immobilisation of the limb. Diffuse thickening of the shafts of the long bones, due to a deposit of new bone by the periosteum, is sometimes met with.
The affected muscle is larger and firmer than normal, and its electric excitability is diminished. In tertiary syphilis, individual muscles may become the seat of interstitial myositis or of gummata, and these affections readily yield to anti-syphilitic remedies.
It can usually be differentiated by observing that the infiltration is on a larger scale; the progress is much more rapid, involving in the course of months an area which in the case of tuberculosis would require as many years; the scars are sounder and are less liable to break down again; and the disease rapidly yields to anti-syphilitic treatment.
During the secondary period the lesion usually consists in effusion into the sheath; gummata are met with during the tertiary period. Arborescent lipoma has been found in the sheaths of tendons about the wrist and ankle, sometimes in a multiple and symmetrical form, unattended by symptoms and disappearing under anti-syphilitic treatment.
The knees are the joints most frequently affected, and the condition usually yields readily to anti-syphilitic treatment without impairment of function. #Gout.# Arthritis Urica.
The general health is to be improved by open air, by nourishing food, and by the administration of cod-liver oil, iron, and arsenic. Anti-syphilitic remedies should be given, and if they are administered before there is any destruction of tissue, the benefit derived from them is usually marked.
The further progress is complicated by the occurrence of pyogenic infection leading to necrosis of bone, in the knee-joint, for example, the patella or one of the condyles of the femur or tibia, may furnish a sequestrum. In such cases, anti-syphilitic treatment must be supplemented by operation for the removal of the diseased tissues.
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