CONSTITUTIONAL SYPHILIS. 759 



almost always gives rise to a painless or else to a very slightly pain- 

 fid enlargement of the inguinal glands to indolent buboes. The 

 number of the glands implicated is always somewhat large, and they 

 are seldom very greatly swollen. Each gland usually attains the size 

 of a bean or almond ; and it is exceptional, and only in scrofulous sub- 

 jects, that it becomes as large as a walnut. The surrounding con- 

 nective tissue is not affected ; the glands remain isolated, and, even 

 when then* number and the degree of tumefaction are such as to pro- 

 duce a large lump, it is always of an irregular nodulated shape, and it 

 can readily be perceived that it consists of a conglomeration of iso- 

 lated glands. Sometimes a thickened and indurated chain of lymphat- 

 ic vessels can be detected between the primary sore and the indolent 

 bubo. In the rare instances in which indolent buboes suppurate, the 

 skin becomes adherent to the glands beneath it, and gradually reddens, 

 and the tumor becomes painful ; some time elapses, however, before 

 fluctuation appears. If, finally, the purulent contents escape, or if they 

 be evacuated artificially, they leave sinuous and tedious fistulous ulcers 

 Behind them. Involution of an indolent bubo proceeds very slowly. 

 Several months always elapse ere the swelling of the glands dimin- 

 ishes, and often the last trace of the enlargement does not disappear 

 for years. Whenever cheesy metamorphosis with calcification has oc- 

 curred, small hard elevations remain for life. The usual seat of pri- 

 mary induration being upon the genitals, indolent buboes are generally 

 found upon the inguinal region ; and it is almost without exception 

 the glands which lie above the fascia lata, on the side corresponding to 

 the seat of the primary sore, which are affected. In primary affections 

 of the mouth and fingers, it is respectively the submaxillary and axil- 

 lary glands which are involved. 



About five or six weeks after the formation of the indolent buboes, 

 upon careful investigation, we shall find numerous enlarged lymphatic 

 glands, lying far away from the point of infection and from the indolent 

 bubo, and situated in various regions of the body. This enlargement 

 is most frequent and conspicuous in the cervical and axillary glands, 

 the inguinal glands of the opposite side, and the cubital and submaxil- 

 lary glands. The size attained by these enlargements varies from that 

 of a pea to that of a bean or hazel-nut. They are quite painless ; and, 

 even when pressed upon, are not more sensitive than other parts of 

 the skin. These diffuse glandular swellings often last for years ; and, 

 as long as they continue to exist, the syphilis is not extinct, even 

 though no other manifestation of lues be discoverable. Inflammation 

 and suppuration of such glandular swellings are quite exceptional, and 

 are then always the consequence of a complication. 



m. Condylomata. The only condylomata which are of syphilitic 

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