[Illustration: FIG. 131.--Syphilitic Hyperostosis and Sclerosis of
Tibia, on section and on surface view.]
_Clinical Features._--There is severe boring pain--as if a gimlet were
being driven into the bone. It is worst at night, preventing sleep, and
has been ascribed to compression of the nerves in the narrowed Haversian
canals.
The _periosteal gumma_ appears as a smooth, circumscribed swelling which
is soft and elastic in the centre and firm at the margins, and shades
off into the surrounding bone. The gumma may be completely absorbed or
it may give place to a hard node. In some cases the gumma softens in the
centre, the skin becomes adherent, thin, and red, and finally gives way.
The opening in the skin persists as a sinus, or develops into a typical
ulcer with irregular, crescentic margins; in either case a probe reveals
the presence of carious bone or of a sequestrum. The health may be
impaired as a result of mixed infection, and the absorption of toxins
and waxy degeneration in the viscera may ultimately be induced.
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