—Passing now to the lesions of early constitutional syphilis as manifested in particular regions or organs of the body, we take, first, the skin. When syphilis seems to have ended its existence during the primary stage (Fordyce) no further disturbances are expected, and only by waiting can the termination of the disease be determined.
The malignancy of the disease may be estimated by noting the rapidity with which the destructive lesions appear; thus gummas which appear early in the skin or mucous membranes, or elsewhere, indicate a serious type of the disease. So also does profound cachexia, including in this term more than mere anemia. The devastations of the disease in Europe during the fifteenth century show that it presented at that time a severe type.
The eruptions of syphilis have been grouped under distinctive terms, and are usually referred to as syphilides or syphilodermas. It has been already stated that among the new formations of syphilis are those known as syphilodermas; any of the former which are distinctly due to syphilis may be syphilomas. Thus, we may have syphiloma in the skin, in the bones, in the viscera, etc. It has been customary to speak of the syphilides as simulating the non-specific eruptions and identify them by placing before them the adjective syphilitic. Thus writers formerly described syphilitic psoriasis, syphilitic erythema, etc.; but these terms have been abandoned, because it is recognized that the skin lesions of syphilis while imitating most of the features of the non-specific diseases are yet distinctly different from them. We speak, therefore, now of a macular, vesicular, papular, squamous syphilide, etc., implying thereby that it is vesicular, scaly, or otherwise, as the case may be, and at the same time that it is a cutaneous expression of syphilis.
PLATE VIII
Grouped Miliary Papular Syphilide.
PLATE IX
Mixed Papular and Papulopustular Syphilide.
PLATE X