CHRONIC INFECTIOUS DISEASES. 



origin are the broad ones covered by a thin coat of epidermis, ^m 

 which, if seated upon the skin, are usually in a state of superficial 

 ulceration, and bathed in a slimy, ill-savored secretion. The dry, 

 pointed condylomata, which are covered by a thick layer of epidermis, 

 are the result of local irritation, and most commonly appear at points 

 moistened by gonorrhceal discharge. The syphilitic condyloma is one 

 of the most frequent symptoms of general infection of the system, 

 and it rarely fails to appear in the series of morbid processes which 

 gradually develop under the influence of the venereal poison. As a 

 rule, too, the condyloma is the first symptom which succeeds the pri- 

 mary affection and the enlargement of the lymphatics. Its external 

 aspect and histological character have already been described. Upon 

 the skin, the most frequent seat of the soft condylomata is between the 

 nates ; in women, between the labia ; and in men, upon the scrotum 

 and outer surface of the penis. Sometimes they spread over the inner 

 surface of the thighs. Their appearance at the angles of the mouth is 

 quite common ; they are more rare at the commissure of the eyelids, 

 between the toes, and under pendulous breasts. They often become 

 fissured, especially when they have coalesced so as to form extensive 

 growths, and in this way painful and obstinate ulcers often form. 

 Fissures and cracks (rhagades) frequently appear in the skin about 

 the condylomata. They are attended by severe pain and heal slowly. 

 We have already treated of the condylomata of the mucous membrane, 

 of the mouth and fauces (plaques muqueuses), and of the condyloma- 

 tous growths which accompany syphilitic laryngeal ulceration. 



IV. Syphilitic Disease of the Skin Syphilides Syphilitic Ex- 

 anthemata, Syphilitic affections of the skin depend partly upon hy- 

 peraemia and exudation, and partly upon the development and meta- 

 morphoses of the " gummy tumor " (tubercular syphiloma) of the skin. 

 In the former class the exudation is sometimes thrown out upon the 

 surface of the skin, sometimes within the tissues, and sometimes in 

 both together. A classification of the syphilides into many species 

 has been based upon the modifications thus induced, and upon the 

 variety in extent and magnitude of the eruption. Since, however, 

 the classification of all other non-specific hyperaemic and inflammatory 

 cutaneous affections is also founded upon similar data, we may be 

 brief in our discussion of the syphilides, and confine ourselves to a 

 description of the differences by which the syphilitic exanthemata may 

 be distinguished from the non-syphilitic ones. 



The general peculiarity of syphilitic eruptions, upon which most 

 weight has always been laid, is their color ; and, indeed, all syphilitic 

 exanthemata, when of somewhat long standing, are of a peculiar 

 coppery-red hue ; and chronic eruptions which do not present this color, 



