Suphilis Of The Mucous Membranes

The first visible manifestation of syphilis upon the mucous membranes is the chancre. This we have al-ready considered. Next comes the moist flat papule or "mucous patch." This lesion may appear upon the mucous membranes of the genitals of both sexes, and upon the neighboring integument; upon the lips, tongue, soft palate, tonsils, and pharynx, and in fact any portion of the buccal and nasal cavities. It has also been met with in the external auditory canal, and upon the palpebral conjunctiva. This lesion consists of a flat elevation, varying from the size of a split pea to that of a dime, or even larger. Its elevation is usually from one to five mm. (1/25 - 1/5 inch). Its surface is moist, finely granular, and of a grayish aspect. It is usually one of the first of the earlier manifestations of constitutional disease. Subsequent to the appearance of mucous patches, or sometimes preceding them, we may find diffuse congestions of the mucous membranes of the fauces and neighborhood, accompanied with a certain amount of irritation and uncomfortable sensation. This condition constitutes the early "sore throat " of syphilis. This same diffuse congestion may invade the mucous membranes of the epiglottis, the glottis, and the larynx. When it does so, more or less hoarseness and even complete aphonia may be present. Besides these, and later on in the disease, we are liable to encounter another peculiar lesion. This may be described as a localized opaline or milk-white spot situated upon the tongue or buccal membrane. These milk-spots are barely if at all elevated, and usually not eroded. A single spot may appear, or several may be present at the same time. When one cup d another crops out, and a succession of them not unfrequently show themselves throughout the secondary and intermediate periods, and may constitute the only visible manifestations of the disease. The use of tobacco and negligence in the care of the teeth encourage these lesions. In the later stages still more serious affections of the mucous membranes are liable to appear, such as ulcerations about the genitals, mouth, nose, pha-rvnx, larynx, etc. They will be considered under the head of special organs.

Syphilis Of The Skin

To the cutaneous manifestations of syphilis the names syphilodermata and syphilides have been applied. We prefer the Utter term.

Although the different syphilides vary greatly in their aspect, lesions, and course, they still possess certain common characteristics. These are color, configration, and the absence of local subjective symptoms.

Color

The rotor of the syphilides has been likened to that of copper, or of raw ham, but neither resembles it exactly; it is a color sui gene-ris, and peculiar to syphilis, which must be seen to be exactly appreciated, and is not counterfeited by non-syphilitic affections of the skin, though sometimes closely approached in certain cases of psoriasis, lichen planus, and lupus,

Configuration

The earlier syphilides are usually composed of small lesions widely diffused; the latter, of larger ones, more sparsely distributed. The earlier ones involving the skin but superficially, recover without leaving cicatrices; the later ones invading more deeply often exhibit a tendency to ulceration with consequent scarring, but cicatrices may result even without ulceration. The marks left by the later syphilides are usually brown, but subsequently become white, whiter even than the normal skin. The pigment is first removed from the centre of the spot, and later forms a ring around it just before its final disappearance. The white spot is thinner than the normal skin, is non-adherent and quite smooth, without the irregularities and puckerings met with in scrofulous scars.

The syphilides frequently exhibit a tendency to assume a circular arrangement. If the eruption consists of small lesions, they will often be grouped in round or oval patches, and if of large and isolated lesions, the same tendency will be noticed. A few rounded groups of pustules may be the only manifestation present. The tendency of these, unchecked by treatment, is to extend centrifugally, healing in the centre, and in this way we may have a suppurating, perhaps ulcerating ring inclosing an area of discolored skin on its way to cicatricial degeneration. If the lesion be an isolated ulcer, it is usually round or oval, with perpendicular sides and a grayish base, the margins not irregular and undermined as in some other forms of ulceration. This circular configuration is observed in but few of the non-specific eruptions.

Absence Of Local Subjective Symptoms

The syphilides, both early and late, are characterized by the absence of itching and pain. The most extreme generalized eruptions of early syphilis are, as a rule, free from pruritus and widespread ulceration, and if it involves the skin only, is unattended with pain. The different syphilides present certain special peculiarities which we will now consider.

Macular Syphilide

This is the earliest eruption of syphilis, and usually makes its appearance within the first or second month after the development of the chancre. It consists of small red spots, from 1/16 - 1/4 inch in diameter, scattered over the thorax, abdomen, back, and upper extremities. The macules may be discrete or confluent, and are usually upon a level with the surrounding skin, but are sometimes slightly raised. At first the color is rosy and disappears under pressure, but later becomes somewhat darker and permanent. The eruption usually lasts from four to eight weeks and subsides spontaneously.

Papular Syphilide

This form sometimes occurs by itself, at other times accompanies, or appears just at the decline of the last-mentioned variety. It consists of acuminate or flattened elevations frequently decked with a minute scale. These papules persist for a few weeks, and then disappear, or while still existing, may be complicated with much larger papules, in fact, tubercles. The papules proper exhibit no tendency to ulcerate, but slowly subside, leaving after them a small brownish macule, which soon fades away without leaving any perceptible alteration of the skin.