on the incubation, the indi. superficial quality of the ulcerat present, and the painless generalnearest group of lymphatic glands. The prognosis is that of syphilis.

CHAPTER IV

AFFECTIONS OF THE.

After the development of the in and glandular enlargement (pri there is another interval before the general or secondary symptom of quiescence is sometimes cal incubation.'

The Period of General Erupti enced by specific treatment, beg ten weeks after contagion, six or tion of the point of inoculation. after the lymphatic glands are enlarged. Malaise, pains in the he and pyrexia, may precede or accor of the rash. The febrile action & times intense, and the former may intermitting course. The fever when the eruption is fully out.

General Remarks on Syph ous aspects of the rashes in syphili

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spreads all over the body. It relapses now and then. The diagnosis depends on the accompanying enlarged inguinal glands, the induration of the point of contagion, the erythematous redness of the fauces, the small amount of irritation and of constitutional disturbance, the rash being always most fully developed on the trunk, and the slow course.

Papular Syphilides.-When the papules are inute they are called miliary; when small, lenticilar; when large, nummular; when desquamating, quamous; when arranged in circles or figures of ght, leprous syphilides. When the palms or soles re attacked, the term psoriasis palmaris or plantaris often used. Miliary and lenticular syphilides are st frequent in the first six months after contan; the scaly form is generally rather later; lepra

papulo-squamous affections of the palms and es are most often seen when the disease is of long ding. The papular syphilide may attack all

of the body, and is the eruption which most rently relapses. The color common to all Pitic papular eruptions is rosy at first, fading to ery or purplish brown. When the papule es full development, the cuticle separates in scales, leaving a characteristic silvery border. usual accompaniments of these eruptions are or papules in the throat, enlarged lymphatic in various parts of the body, and alopecia; quently, periosteal pains, nodes and iritis. ous Patches are merely syphilitic papules by moisture. When large and prominent

Multifarious Character. Syphilitic eruptions are very often present together; thus papules appear among the maculæ, and scaling patches co-exist with mucous patches, or with pustules. 8. Transformation of one form into another is often observed when there is opportunity for watching the progress of the disease; e.g., smooth papules may become scaly, vesicular or pustular, or, if kept moist, develop into mucous tubercles.

The later Syphilides, which appear when the disease is losing its activity, are seldom spread widely over the body. The brown tint is then well marked. Such limited forms are slow in progress: in feeble persons they are prone to ulcerate, and the ulcers leave indelible scars. They are often the only syphilitic symptoms present. They commonly heal readily under proper treatment, but are apt to recur when the treatment is discontinued.

Macular Syphilide.-Roseola is the earliest rash after infection but besides being often overlooked, is not invariably present. It consists of spots, rosy red, and fading under pressure when fresh, often turning to coppery-brown before disappearing. The patches are usually slightly elevated, and sometimes desquamate as the rash subsides. The eruption lasts commonly two or three weeks, but may disappear in a few days, especially under specific treatment. Papules often form among the roseolous spots. There are two varieties of spots, the large and the small. The flanks, abdomen, and chest are the common seats of the eruption, but in rare cases it

spreads all over the body. It relapses now and then. The diagnosis depends on the accompanying enlarged inguinal glands, the induration of the point of contagion, the erythematous redness of the fauces, the small amount of irritation and of constitutional disturbance, the rash being always most fully developed on the trunk, and the slow course.

Papular Syphilides.-When the papules are minute they are called miliary; when small, lenticular; when large, nummular; when desquamating, squamous; when arranged in circles or figures of eight, leprous syphilides. When the palms or soles are attacked, the term psoriasis palmaris or plantaris is often used. Miliary and lenticular syphilides are most frequent in the first six months after contagion; the scaly form is generally rather later; lepra and papulo-squamous affections of the palms and soles are most often seen when the disease is of long standing. The papular syphilide may attack all parts of the body, and is the eruption which most frequently relapses. The color common to all syphilitic papular eruptions is rosy at first, fading to coppery or purplish brown. When the papule reaches full development, the cuticle separates in dry scales, leaving a characteristic silvery border. The usual accompaniments of these eruptions are ulcers or papules in the throat, enlarged lymphatic glands in various parts of the body, and alopecia; less frequently, periosteal pains, nodes and iritis.

Mucous Patches are merely syphilitic papules altered by moisture. When large and prominent

they are called mucous tubercles or condylomata. They form on the mucous surfaces, at the orifices of the body and on the skin where it is kept moist. They secrete a thin, purulent fluid, which is highly contagious. When near to each other they often coalesce into large patches. When developed around the anus, they are frequently subdivided by fissures, called rhagades.

Vesicular and Pustular Syphilides are much rarer than the papular forms. Both are observed in feeble rather than in robust persons. They possess in common a vesicle, varying in size between a pin's head and a bean, forming the summit of an elevated areola (the papule). After a few days the vesicle shrinks to a small scale on the areola and falls off, leaving a coppery-red papule. Sometimes, instead of drying up, the liquid becomes purulent, converting the vesicle into a pustule, and the congestion of the areola increases. Various names (herpetiform, varicelliform, acneiform, impetiginous, etc.), have been given to these syphilides, from their resemblance to the corresponding simple eruptions. They appear usually during the first year after infection; the duration varies from three or four weeks to several months, according to treatment. If the patient be well cared for a serious effect is seldom produced; if he be neglected deep ulcers often form. The diagnosis is rendered positive by the presence of syphilitic lesions elsewhere, and by the characters which this eruption shares with all syphilitic rashes.

Rupia is a form rarely seen till some years have