SECOND AEY SYPHILIS. 29 



extent of the skin lesions point to a blood infection, and the 

 slight general enlargement of the lymphatic glands throughout 

 the body as contrasted with the localised glandular swellings 

 dependent upon the primary inoculation is also to be regarded as 

 an indication of systemic infection. 



The occasional manifestations of jaundice, albuminuria, and 

 swelling of the liver and spleen are also evidences of general 

 blood infection, as also are the later affections of the eyes, 

 middle ears, and testicles. In congenital syphilis, large paren- 

 chymatous organs like the liver and spleen, which have a free 

 blood and lymph supply, may suffer severely. 



The characters of the eruptions in the secondary stage are 

 modified by the position of the lesion. On ordinary skin 

 suppuration rarely occurs. Where two skin surfaces come into 

 contact, and there is warmth, dirt, and moisture, condylomata 

 result ; on mucous membranes, which are naturally moist, 

 mucous patches occur. Hence mucous patches may be 

 expected in the mouth or on the fauces, condylomata in the 

 creases below the breasts, in the groins, in the axillae, between 

 the toes, between the auricle and the mastoid, at the anal margin, 

 rarely at the umbilicus and in other positions. 



The tongue, which, from its position and functions, is 

 constantly liable to slight injuries, and is covered by a thick layer 

 of moist epithelium, may become the seat of refractory secondary 

 manifestations. Laryngeal lesions are more protected, and not 

 so liable to ulcerate as are lesions nearer the mouth. 



The involvement of epiphyses and joints admits similar 

 anatomical explanations to those advanced in connection with 

 tuberculosis. 



It is not surprising that the arterial system, which forms the 

 tract by which general distribution occurs, should suffer severely. 

 The actual evidence of vascular disease is rather late in making 

 its appearance. Endarteritis occurs, and may end in thrombosis, 

 which causes irretrievable damage to important nervous struc- 

 tures. The virus, by affecting the vasa vasorum of the larger 

 vessels, may lay the foundation of aneurysm, or give rise to a 



