Radioscopy is of great importance in hereditary syphilitic lesions of the osseous system.
Syphilitic osteochondritis is demonstrable in X-ray pictures of older foetuses and widening of the zone of calcification with its irregular lagged border can regularly be made out in dead specific foetuses (Figs.
125 and 126). In living infants too, with syphilitic infection, if kept absolutely quiet, the presence of general affections of the osseous system of osteochondral or periosteal nature in the long and short hollow bones, which have not caused clinical symptoms can frequently be discovered. The so-called pseudoparalysis heredosyphilitica (see later) has always shown, in those cases I have examined with the X-ray, recognizable changes in the os seous system, which have consisted in lessening of the dia physeal shadow, or in periosteal hyper ostosis, or in swell ing of the bone (Figs. 127 and 12S). In genuine separation of the epiphysis there is shown a periosteal i nfla mina tory lime deposit at the diaphyseal bor der which extends over to the epiphys'_s and may produce very irregulat shadow effects of the latter.
Affections of the Short Hollow Bones.—The hered itary syphilitic lesions of the bones of the fingers and toes in infants were onlyrarelydeseribed before my own investigations were made. Specific involvement of the phalanges, which occurs much more frequently in infancy in the fingers than in the toes, affects only the bones of the phalanges, never the soft parts and always begins in the proximal phalanges. The latter are also more intensely affected in the further course of the disease than are the distal phalanges.
The X-ray picture of the diseased phalanges shows three degrees of shadow: a moderate lessening of depth of shadow of the epiphyseal borders, a still greater one of the diaphyses and a dark faint shadow; but a sharply defined marginal shadow corresponds to the compact portion of the bones. At the same time the bone seems abnormally swollen both as to width and length (Fig. 12Sa). All of this points unde niably to the fact that in phalangitis there is, from a pathological_ stand point, a diffuse rarefying osteitis of the phalangeal bones, that occurs much more frequently than is usually thought to be the case from mere clinical examination.
From a clinical and diagnostic standpoint the following facts are important: the predominating involvement of the basal phalanx, the absence of suppuration or of external perforation, the tendency to spontaneous restitution and the subacute course of the disease. This painless swelling, involving first the proximal phalanx, and always the bone only, gives to the finger the form of a bottle: with simultaneous involvement of the distal phalanges it takes the form of a tenpin. The finger always appears broader as well as longer. The soft parts do not take part in the disease but the skin, on account of stretching, may be come glossy, tense and peculiarly rosy—sometimes it may even appear thinned. The index finger is most frequently affected. These lesions tend to multiplicity but not to symmetry. A further characteristic lies in the complete absence of involvement of the joints adjacent to the diseased phalanges. This affection belongs to the early manifes tations of hereditary syphilis, and is insidious in its development, with out causing functional disturbances.
Hereditary syphilitic disease of the fingers after the first year of life no longer shows the above characteristic and unvarying type; caries may now appear, as well as involvement of the joints and soft parts.
From a differential diagnostic standpoint spina rentosa scrotulosa needs consideration, especially if only the basal phalanx of one finger is affected. Here there must be considered the history, the age of the child, the possible presence of other symptoms of syphilis, especially the characteristic nasal affection, then various anatomical factors such as absence of suppuration, caries, and necrosis, non-involvement of the skin as well as the shape of the diseased finger, knob-shaped in the scrofulous, olive shaped or conical in the specific disease. Appearance in earliest infancy of the involvement of the phalanges, or of the basal phalanges of all fingers, or of several fingers, would always speak for syphilis.