CONSTITUTIONAL SYPHILIS. 765 



region of the shouider-blades, and the dorsal surface of the extremities. 

 Some of the nodules are superficial, while others are deeply seated. 

 The more superficial ones are smaller, while the deeper seated ones 

 are larger. At first a small, movable tumor, somewhat sensitive to 

 pressure, appears in the skin, which gradually reddens above it, and 

 rises into a dark-red hemispherical nodule, which rather resembles a 

 boil. Sometimes the covering of the tubercle remains unbroken, and, 

 its contents becoming absorbed, its surface gradually grows paler, 

 sinks in, and a scar forms without there ever having been any ulcera- 

 tion. If the tubercle breaks, a turbid, serous liquid escapes under the 

 cuticle, and, thickening, forms with it a scab. Beneath this scab the 

 ulcer continues to penetrate more and more profoundly. Not unfre- 

 quently one common, broad crust covers a cluster of nodules. The 

 ulcer may retain the circular shape of the tubercle, but it more com- 

 monly happens that the sore extends at one edge, while it granulates 

 and cicatrizes at the other. Thus, like the rupia, the tubercle produces 

 horse-shoe and kidney-shaped ulcers. The scars, which remain after 

 healing of a syphilitic lupus, long retain a brownish-red stain, and, after 

 the disease has subsided, become remarkably white. 



The hair often falls out, in syphilis ; but, as a rule, this is merely a 

 defluvium capillorum, unless the scalp be the seat of an eruption. The 

 hair-bulbs do not perish, and, after the disease has abated, the growth 

 of the hair is as luxuriant as ever. The syphilitic exanthemata, on the 

 other hand, usually destroy the hair-follicles, and cause permanent 

 baldness or alopecia. 



The nails, also, undergo changes from implication of their matrix 

 in the cutaneous disorder. In the simple infiltration of the matrix of 

 the nail, which often accompanies psoriasis syphilitica, the nails de- 

 generate, becoming misshapen, fissured, and horny. In the more rare 

 ulceration of their matrix, they often become detached. 



V. Syphilitic Disease of the Mucous Membranes. Next to the 

 external integument, the mucous membranes are the most common 

 seat of syphilitic disease, although all of them are not affected by con- 

 stitutional syphilis with equal frequence. The lining of the mouth, 

 fauces, nose, and larynx, and, next to these, the mucous surface of the 

 rectum, are the regions upon which the malady is most prone to local- 

 ize itself. 



The mildest form of syphilitic disease of the mucous membrane, 

 and at the same time the one which appears soonest after the primary 

 infection, is syphilitic catarrh. In special instances, it is not always 

 easy to distinguish between a catarrh depending upon syphilis, and 

 one arising from other causes. A remarkably deep, bluish redness, an 

 abruot line of demarcation between the affected spot and the sound 



