CONSTITUTIONAL SYPHILIS. 757 



the new coating becomes thinner, the surface shows a peculiar glitter- 

 ing, dirty redness, and, after repeated exfoliations, the epithelial coat 

 is not renewed, but the surface remains raw, and gives off a scanty 

 secretion. In other instances the surface forms a scab, which, after 

 separation, leaves an ulcer with a hard base. The primary syphilitic 

 ulcer may be called the ulcerative induration of syphilis. Its most 

 common situation is upon the genitals ; in men, upon the inner surface 

 of the prepuce, and in the coronary fossa ; in women, between the 

 nymphse, at the posterior commissure, and at the entrance to the 

 vagina. Sometimes, however, it appears upon the nipples, at the 

 angles of the mouth, upon the tongue, and not unfrequently upon the 

 fingers. No part of the body is exempt, and a syphilitic induration 

 will arise wherever the virus touches a spot where the cuticle is thin, 

 or where it has been abraded. The localities above mentioned, how- 

 ever, are the ones most favorable to the occurrence of infection. When 

 but a single follicle is implicated, the induration assumes the form of an 

 upright cylinder, and, if a series of them lying close together be in- 

 volved, the confluence of these indurations forms a hard elevation. 

 When the induration is situated upon the lips of the meatus urinarius, 

 that orifice forms a somewhat gaping, rigid funnel, which feels carti- 

 laginous to the touch. Not unfrequently, when the mouth of the pre- 

 puce is somewhat narrow, its anterior border becomes fissured during 

 coitus. If this point becomes indurated in consequence of syphilitic 

 infection, the prepuce can no longer be drawn back, its outlet having 

 been converted into a hard ring. A phimosis of this kind will subside 

 after the induration has been resolved. 



The bottom of a syphilitic ulcer is not lardaceous, its edges are not 

 eroded, nor does it show any tendency to spread. All these charac- 

 teristics are peculiar to the chancre (chancroid), nor is a syphilitic sore 

 painful, like a chancre, being usually very indolent. It is also soli- 

 tary, as a rule ; and it is only as an exception, when several points are 

 infected simultaneously, that several syphilitic sores are ever seen to- 

 gether. Until the induration ulcerates, it is often overlooked ; and it 

 is not until the sore is established, that the attention of the patient or 

 physician is drawn to it. Sometimes, the induration is so slight, that 

 the sore may be mistaken for a chancre. In such cases all doubt may 

 be dispelled by inoculation. 



The following are the more important forms recognized among 

 syphilitic ulcers : 



The superficial ulcer (Eicord^s chancre parchemin<). In this 

 variety the induration forms a thin cake. An attempt to pinch up a 

 spot of this kind between the fingers imparts a feeling as though a bit 

 of parchment had been slipped beneath the ulcer. Its surface secretes 



