Congenital Syphilis of the Bones and Joints

Abstract

THIS paper is based upon the examination and treatment of fifty cases of syphilis of the bones and joints and represents about 6 per cent of all cases of congenital syphilis treated by the writer. He does not intend to convey the impression that he has added anything new to either the diagnosis or treatment of these conditions, but he wishes to center attention upon some of the outstanding features that are commonly overlooked or disregarded. (a) Twenty per cent of these cases had a negative serology. Some investigators report as high as 40 per cent. (b) Forty per cent had no sign of congenital syphilis excepting the bone condition and this characteristic finding was made possible only by the use of the X-ray. (c) Of the 60 per cent who had some of the stigmata of congenital syphilis, only ten patients had interstitial keratitis and five had Hutchinsonian teeth, the most constant external finding being the saddle nose. (d) The disease in the long bones was nearly always preceded by a history of trauma. (e) In two cases the bone disease appeared at the termination of typhoid fever. (f) Many of the cases started acutely and had the appearance of an acute osteomyelitis. Since nearly all of these children had a hyperplasia of the lymph and lymphoid tissues, infected tonsils, adenoids and sinuses were the rule; consequently the syphilitic bone manifestations may be and often are infected with pus-forming organisms from the very beginning and the train of signs and symptoms which follow are clinically indistinguishable from ordinary acute infective osteomyelitis. (g) In a large percentage of cases all the other children of the family are apparently free from any signs or symptoms of congenital syphilis. Since these facts are true, the following procedure should be followed in all cases of bone disease in children, excepting in those cases in which the physician feels absolutely sure that the case is one of infection or malignancy. (a) A careful examination of the patient for the stigmata of congenital syphilis. An especially careful examination of all the rest of the family. Thirty per cent of the parents will show active manifestations of syphilis or evidence of its past ravages. The mothers are almost as often affected as the fathers. (b) The serology of the entire family is investigated, and will often confirm a rather shaky diagnosis. (c) Radiographs of the long bones of the other children will often show that the child immediately preceding or following the patient has the characteristic thickened cortices of the tibiæ. (d) Do not accept as conclusive the history of typhoid or any other acute infective disease, since these diseases often precipitate a latent congenital syphilis or activate foci which had already started. In two of this series of cases, bone disease immediately followed an attack of typhoid fever and was diagnosed typhoid osteomyelitis. The bone pictures in both cases were unmistakably those of congenital syphilis.