766 CHRONIC INFECTIOUS DISEASES. 



parts, and a milky, turbid appearance of its epithelial coating, are sus- 

 picious, but not pathognomonic signs. In most cases the diagnosis 

 depends mainly upon the history of the case, and upon the coexistence 

 of other syphilitic symptoms, particularly enlargement of the lymphatic 

 glands, and maculous or papulous exanthemata, and above all upon 

 the refractoriness of the catarrh to simple treatment, and its speedy 

 disappearance when treated by mercury. 



The appearance of mucous papules, with their transformation into 

 condylomata, erosions, and ulcers, is one of the earlier symptoms of 

 syphilitic infection. Their mode of development is as follows : A spot 

 of mucous membrane of about the size of a pea rises above the sur- 

 rounding level, and seems firmer, and somewhat reddened. If it does 

 not heal after reaching this stage, the epithelium covering the flattened 

 nodule becomes opaque, and assumes a milky, or pearly appearance. 

 After separation of the thickened epithelium, a bright-red erosion re- 

 mains, which bleeds easily. This is followed by a sore, with an un- 

 even, whitish-gray bottom, the product of molecular disintegration, or 

 else plaques muqueuse and mucous condylomata form, from augmented 

 vegetation and development of connective-tissue fibres. We have al- 

 ready treated of the syphilitic mucous papule, and of the ulcers and 

 condylomata of the mouth, fauces, and larynx, to which they give rise. 

 We rarely obtain an opportunity of observing the earlier stages of 

 syphilitic disease of the rectum. The ulcers which arise from mucous 

 papules of the rectum, and the scars which they leave after healing, 

 bear a close resemblance to dysenteric scars. A distinction may be 

 based in some measure upon the seat of the sore, and resulting cicatri- 

 cial stricture, the syphilitic ulcers being situated in the cloaca of the 

 gut, or else close to the anus, while the dysenteric ones are found in 

 the sigmoid flexure. 



The gummata and tubercular syphilomata of the mucous membranes 

 have the same character and mode of development as those of the 

 skin. A nodule of the size of a shot forms in the mucous membrane, 

 and gradually grows until it projects above the surrounding level. 

 If not made to resolve itself by judicious treatment, it softens, bursts 

 its epithelial cover, and turns into a sore. Wide-spread destruction of 

 the nose, palate, fauces, and larynx, may thus occur. Not unfrequently 

 the disease spreads to the submucous tissue, and the cartilage, perios- 

 teum, and bones. The ulcers often produce contractions in healing. 



VL Syphilitic Iritis. The syphilitic contagion not unfrequently 

 gives rise to inflammation of the iris and the choroid coat of the eye. 

 This is a very common complication of the syphilitic exanthemata. 

 Modern ophthalmologists deny the existence of any specific mark of 

 distinction between the syphilitic and non-syphilitic inflammations of 



