nd 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formation of Parrot's nodes is also being withdrawn from the category of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-paralys