Osteolytic bone syphilis.

Case 1. Indian woman, aged 25 years-Four years before admission noticed swelling over the inner end of the right clavicle extending gradually over the shoulder and upper arm, associated with aching pain made worse by movement. She had one living child ; there had been two miscarriages, one at two months and one at three months. On examination there was generaiised swelling and tenderness over the right upper chest and shoulder. The clavicle was not palpable because of the swelling. Movements of the shoulder were full but painful. The Wassermann and Kahn tests were strongly positive. Radiographs showed gross destruction of the clavicle; faint mottling in the middle third of the bone was all that remained (Fig. 1). Radiographic changes were seen also in the first rib and in the humerus ; the anterior half of the first rib was destroyed ; in the humerus there was destruction of two-thirds of the thickness of the shaft, and this lesion, by itself, resembled a bone tumour. Treatment-The patient was given three and a half million units of penicillin by three-hourly injections over a period of eight days. The pain was relieved, the shoulder felt stronger, and the patient left hospital. Ten months later there were no symptoms. The Kahn test was then negative and radiographs showed that the lesions had healed (Fig. 2). Case 2. Malay man, aged 25 years-Complained of pain and swelling of the left shoulder of three moi’iths’ duration. On examination there was a tender swelling over the inner half of the clavicle. There were two large flat paper-like scars on the forearm, said to be the result of large ulcers which had developed several years earlier and had healed spontaneously. The patient gave no history of chancre or rash. He was familiar with yaws but said that he had never suffered from it. The blood Wassermann and Kahn tests were strongly positive. Radiographs showed erosion of the inner quarter of the left clavicle and destruction of the outer