CHRONIC INFECTIOUS DISEASES. 



variety, and often drags on with repeated relapses for weeks and 

 months. 



Rupia syphilitica, like ecthyma, originates in a destructive derma- 

 titis. Its mode of development is as follows : Upon a livid, red spot, 

 of the size of a pea or bean, there rises a flabby bleb, containing a 

 dirty, turbid, and sometimes bloody liquid. The contents of the bleb 

 dry up into a scab, which gradually is built higher and higher by the 

 product of the ulceration, which is constantly eating deeper into the 

 skin beneath it, while a ring of new vesicles forms around its border, 

 the drying of whose contents makes the scab wider. If we detach 

 one of these oyster-shell-like crusts, we find beneath it a foul, ulcerated 

 surface, secreting a thin ichor. Sometimes large portions of the body 

 are studded with numerous rupia scabs, which here and there are con- 

 fluent. In other instances, there are only a few, which then are very 

 large. Like ecthyma, rupia belongs to the graver affections, and only 

 appears at an advanced stage of the disease. They heal very slowly. 

 Not unfrequently, only one side of the ulcer beneath the scab heals, 

 while on the other it continues to spread. In this way, horseshoe- 

 shaped, or kidney-shaped ulcers form. The scars, which always result 

 from rupia, are like those of ecthyma, only larger. 



While the syphilitic cutaneous affections hitherto described are the 

 result of irritative and inflammatory processes, syphilitic lupus depends 

 upon the development and degeneration of a neoplasm peculiar to this 

 disease, which arises in the form of nodules (" tubercula syphilitica ") 

 not merely in the skin, but in a variety of other organs. These syphi- 

 litic tubercles (called " gummata," or " gummy tumors," by Virchow, 

 even when they are of a hard consistence, and remain *so while they 

 exist, and which are called " nodular syphiloma " by Wagner) have 

 nothing in common with tubercle in the common sense of the word. 

 Virchow counts them in the class of " granulation tumors," that is, 

 humors which even at then* fullest stage of development contain no 

 mature connective tissue, nor any analogue of it, but consist mainly of 

 elements of a transitory nature, and in which degeneration, death, 

 softening, and ulceration is the regular and necessary consequence of 

 existence. Wherever the syphilitic tubercle appears, it consists of 

 nests of very numerous small cells, with large nuclei, which are lodged 

 in the interstices of the affected tissue, and from which they have sprung 

 through profuse multiplication of its cellular elements. The recent 

 uodules are soft, of a grayish-red color, and infiltrated with a scanty 

 juice. After lasting for some time, they either soften and ulcerate, or 

 else undergo an incomplete cheesy metamorphosis. The most frequent 

 seat of the syphilitic cutaneous tubercle is upon the face, especially 

 upon the forehead (corona veneris), and, next in frequence, upon the 



