Fig. 26
Tuberculous serpiginous syphilide resembling lupus vulgaris. (Fordyce.)
Fig. 27
An ulcerating gumma of the leg. (Fordyce.)
In many patients, especially of the hospital class, scars, which are strongly suggestive, will be visible upon the legs. It does not follow, however, that an old scar upon the legs, even if surrounded by a pigmented area, is necessarily of syphilitic origin. Old ulcers of the limbs are frequently seen in connection with varicose veins, and may show exceedingly chronic tendencies; moreover, it is possible for chronic and non-specific ulcers to occur in old syphilitic subjects when the course of the local lesions may be influenced by the old affection, although they are not specific ulcers. Benefit, however, will in such cases accrue by the reasonable administration of antispecific treatment, but it should be combined with suitable local measures.
The Vascular System.
—The lesions which are encountered in the bloodvessel walls in chancre and early syphilis have been described. The heart and vessels are liable to suffer, as they contain connective tissue. Gummas have been noted in the heart, while the poison also may produce thickening of the valves, and disease of the coronary arteries, the endocardium and the myocardial structure.
The arteries often suffer from arteriosclerosis, which is either diffuse or nodular. Endarteritis is a common manifestation of syphilis and leads frequently to the formation of aneurysm. Sometimes this appears as a single and large lesion; at other times hundreds of small aneurysms will form in the arterial system of the brain, so that the arteries are studded with them. The explanation of aneurysm under these circumstances is that the arterial walls, being weakened, dilate under the influence of blood pressure. Thus the arteries, from the largest to the smallest, also may suffer. The veins likewise are subject to syphilitic phlebitis, which is frequent in the superficial veins of the extremities.