Diagnosis.—­The conditions most liable to be mistaken for syphilitic disease of bone are chronic staphylococcal osteomyelitis, tuberculosis, and sarcoma; and the diagnosis is to be made by the history and progress of the disease, the result of examination with the X-rays, and the results of specific tests and treatment.

Treatment.—­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.

Radiograms show the rapid absorption of the new bone both on the surface and in the marrow, and are of value in establishing the therapeutic diagnosis.

In certain cases, and particularly when there are destructive changes in the bone complicated with pyogenic infection, specific remedies have little effect.  In cases of persistent or relapsing gummatous disease with ulceration of skin, it is often necessary to remove the diseased soft parts with the sharp spoon and scissors, and to gouge or chisel away the unhealthy bone, on the same lines as in tuberculous disease.  When hyperostosis and sclerosis of the bone is attended with severe pain which does not yield to blistering, the periosteum may be incised and the sclerosed bone perforated with a drill or trephine.

#Lesions of Bone in Inherited Syphilis.#—­Craniotabes, in which the flat bones of the skull undergo absorption in patches, was formerly regarded as syphilitic, but it is now known to result from prolonged malnutrition from any cause. Bossing of the skull resulting in the formation of Parrot’s nodes is also being withdrawn from the category of syphilitic affections.  The lesions in infancy—­epiphysitis, bossing of the skull, and craniotabes—­have been referred to in the chapter on inherited syphilis.

Epiphysitis or Syphilitic Perichondritis.—­The first of these terms is misleading, because the lesion involves the ossifying junction and the shaft of the bone, and the epiphysis only indirectly.  The young bone is replaced by granulation tissue, so that large clear areas are seen with the X-rays.  The symptoms are referred to the joint, because it is there that the muscles are inserted and drag on the perichondrium when movement occurs; swelling is most marked in the vicinity of the joint, and it may be added to by effusion into the synovial cavity.  The baby, usually under six months, is noticed to be feverish and fretful and to cry when touched.  The mother discovers that the pain is caused by moving a particular limb, usually the arm, as the humerus, radius, and ulna are the bones most commonly affected; the limb, moreover, hangs useless at the side as if paralysed, and the condition was formerly described as syphilitic pseudo-paralysis.