PHYSICAL CHARACTERS OF THE SYPH ILTDES.—The most important point in the study of the syphilides is their gen eral characteristics. These characteris tics are [Keyes]: (1) polymorphism of all lesions, including the chancre; (2) rounded form of the eruptive lesions and ulcers; (3) lividity or "ham-color," be coming coppery, then grayish, and finally white and shining as cicatrization occurs; (4) absence of pruritus and pain except ing in hairy regions, and, with respect to pain, in the bones; (5) symmetry, gen eralization, and superficial character of the early eruptions in all save precocious or malignant cases; (6) tendency to grouping of the later eruptions, which involve the true skin and tend to scar ring; (7) tendency to circular arrange ment; (S) scales comparatively thin, white, generally superficial, and non adherent; (9) crusts irregular, thick, and adherent, and either of a greenish or black color from admixture of dis organized blood; (10) abrupt edges of both skin and mucous ulcerations, which are not undermined, are sluggish, and bleed easily [the chancrous ulcer, it will be remembered, has sloping edges]; (11) the rounded, depressed appearance of cicatrices, which arc thin, movable upon the sublying tissues, pigmented at first sometimes, but eventually becoming white and shining. These scars are often crescentic or horseshoe-shaped.
In addition to the foregoing special characters of the lesions of syphilis we have attendant symptoms, such as the so-called syphilitic fever in some cases, alopecia, headache, osteocopic pains worse at night, analgesia, anesthesia, in dolent lymphitis, iritis, sore throat, and mucous patches.
The term "polymorphous" is applied to the syphilides because there is no form of skin-lesion that may not occur in syphilis. Indeed, no single form or type of lesion is usually present: e.g., a popular syphilide is rarely purely popular, ves icles, pustules, or erythematous patches being usually found at the same time, the eruption being named from the lesion that predominates.
Prognosis. — According to Baiimler, the infection of syphilis lasts from eight een months to three years, after which it is exhausted. Following the cessation of this active period, the blood and the secretions of open lesions cease to be contagious, and it may also be stated that in by far the greater proportions of cases, especially if they have been properly treated, no further manifesta tions are ever experienced.
The prognosis as regards severity of syphilis varies with the habits and trinsic resistance of the patient, and the ifluity with which treatment is fol lowed up. There is no disease the dura
tion and course of which are so uncertain as those of syphilis. It is impossible to state arbitrarily in any given case that the disease has or has not terminated. This is more especially true when we con sider that it may permanently modify the constitution of the individual, even though no typical manifestations of the disease appear after a certain time. No method of blood-examination thus far suggested to determine the existence of syphilis has proved reliable.
The disease may manifest itself as a series of mild secondary eruptions fol lowed by apparent recovery, or it may afford no evidence of its presence after the initial sore throat until late in life, when suddenly tertiary lesions—i.e., sequehe—crop out.
Curability of Syphilis. — Although it must be acknowledged that syphilis often causes a permanent modification of the patient's constitution, still the evidence shows that syphilis can be cured. The consensus of opinion is that it is a per fectly curable affection in by far the greater proportion of cases. We have proof of its curability in the cases of second attacks, cited by reliable author ities, and in the fact that, whatever the possibilities of tertiary lesions, they are not necessary and are undoubted se (peke. Sequclar syphilitics may pro create healthy children, and the evidence tends to show that the blood and secre tions of tertiary lesions are no longer inoculable. If the microbial character of syphilitic infection be admitted, the spontaneous tendency to cure of syph ilis is almost beyond controversy. It is part of the life-history of the germ. The prognosis of the disease as regards the life of the patient is a matter difficult to determine, as is obvious when the ob scurity and wide variation in type of the more remote conditions produced by syphilis are taken into consideration. Fatal results from syphilis are usually incidental to sequelar lesions of the arte rial or cerebro-spinal systems or the cera. They occur, as a rule, at a period so remote from the original infection, and the symptoms are so obscure as regards the specificity of their origin, that it is practically impossible to determine the primary cause of the condition in a very large proportion of cases. This much may be said, however, namely: syphilis is a disease that is essentially benign so far as danger to life is concerned. It is prob able that in well treated cases the average longevity is not seriously diminished by the disease.