is usually a disease of adults, while strumdisease of bone, which has an affinity for bones which are rich in cancellous tissue, such as those of the carpus and tarsus, is usually met with in children. The disease, moreover, ig of syphilis, such as generally attended with other indications In the second or there is a clear history of heredity.

Syphilitic dactylitis

ous

nodes,

of syphilitic dactylitis the osseous tissue is the chief of the specific deposit. The inflammatory action may begin either between the periosteum and the bone?syhilitic periostitis; or in the cancellous tissue of the bone?syphilitic

variety

seat

there is often very considerable enlargement that the circumference of the first phalanx of The appearance of the a finger may be five inches (Berg.) affected part is different from that of the first form. The

osteomyelitis:

of the part,

so

skin varies ia colour from a pink to a decided red, and is very tense and glistening, so that it oannot be pinched up between the finger and thumb. As the bones and joint structures are chiefly attacked, the disease does not extend much beyond the bone involved.

Sometimes, the first phalanx only is affected, "the first and second, and all three have suffered at the same time, the first of one finger and the second of another; and all of the last

phalanges.'' Dr. Taylor describes the shrinking finger affected, which looks as though it had been pushed through the Swelling. This variety is sometimes chronic, sometimes acute. There is a tendency to suppuration, syphilitic growths generally being poorly supplied with blood vessels, which the gradual growth of the tissue surely strangle, until the growths undergo disintegration and death by a process of felo de se. Though syphilitic dactylitis is, as I have mentioned, usually met witli as a symptom a disease of adult life, it is sometimes of hereditary syphilis. The late Dr. John Morgan, of the Westmorland Lock Hospital, Dublin, records three such cases (with illustrations) in his Lessons on Contagious Diseases, which occurred in his own practice, in boys of three, seven and eleven years. One of Dr. Morgan's cases?and the one recorded below have a peculiar anatomical interest, the bone chiefly affected in each case being the so-called metacarpal" bone of the thumb?which, while it resembles the phalanges in being developed from two centres of ossification, one for the shaft and loWer end, and one for the upper end, (while the four true metacarpal bones are devoloped from two centres, one for the loiver one for the shaft and upper and end,) still further resembles the phalanges in their pathological affinities, in that it is the seat of dactylitis syphilitica. The diagnosis of syphilitic dactylitis will be aid^d bv the previous history of the patient. Ic is liable to be confounded and retrocession of the

"

SYPHILITIC DACTYLITIS. By Surgeon

Formerly

Shirley Deakin, F.R.O.S., Ensr. (Exnm.), &