Dolores Nocturni

DOLORES NOCTURNI (OSTEWCOPY), bone pains appearing at night, "bone-breaker", a term introduced by the earliest syphilologists to designate bone pains in syphilis, whatever bone lesion they might be caused by. Dolores nocturni occupied a prominent place in the symptomatology of syphilis in view of the very frequent involvement of bones and joints in the absence of treatment. At present, owing to more careful treatment of syphilis in general, and possibly also owing to the natural change in the character of the disease, dolores nocturni, like syphilitic osteopathies, are encountered significantly less frequently (according to Jullien, ¹/3 of all patients). Dolores nocturni are characterized by: the appearance of pain at night (especially in the first hours of being in bed), paroxysmal attacks, intensification with warmth, the usual absence of movement disorders, and the rapid effect of specific remedies (especially iodine) when other measures are useless. Patients describe the pains as drilling, boring, breaking, shooting, tearing, etc. Sometimes the pains are alleviated by pressure (in deep osteitis), at times (in periostitis) they are intensified even by the slightest touch. Most often the pains are sharply localized, less often (in compression of nerve trunks by a tumor) they radiate (sometimes over a long distance). They are observed in any period of the disease: in early syphilis—more often along with the first rash, less often—in the period of the second incubation, beginning, according to Mauriac, from the 15th day of the existence of the chancre; most often—in the late periods of the disease and usually as the only symptom of syphilis. Any bones can become diseased, but those that lie directly under the skin (the crest and internal edge of the tibia, flat bones of the skull, ulna, radius, clavicle, sternum, ribs) are more often affected. The basis of the pains is always an organic lesion of the bone, sometimes easily recognized clinically, and sometimes established only by X-ray transillumination. They are caused by 1) periostitis from the deposition in the germinative layer of the periosteum of a specific infiltrate detaching the latter from the bone; 2) osteitis; 3) osteomyelitis; 4) eburnation of the bone. In these processes, the pain is caused by the compression of nerve fibers (bone lesions in syphilis). For the recognition of the cause, it is necessary: careful palpation of the bone, which can reveal the presence of painful periostitis, periostosis, or tophi; percussion with a percussion hammer, giving pain in a limited area of a deep focus in the bone; X-ray transillumination, revealing foci of osteomyelitis or eburnation. The absence of pain does not at all exclude the existence of deep foci of lesions in the bones. Treatment. Early pains and bone lesions quickly respond to standard specific therapy, especially iodine. Late pains and lesions require systematic mixed therapy and thermal and especially mud treatment. Painful foci of eburnation, sometimes of a diffuse type, capable of capturing the entire bone as a whole, especially the tibia, may also require surgical intervention (trepanation).

G. Meshchersky.