THE SECONDARY OR GRANULOMATOUS STAGE 



severe pain along the course of the nerve, and signs of motor and 

 trophic disturbances. 



Hyperidrosis. — -In several of our patients we have noticed 

 hyperidrosis. The phenomenon was limited to the face in some 

 cases, to the hands and soles of the feet in others. It never ex- 

 tended to the whole body, and generally affected symmetrical regions. 

 Hyperidrosis is more frequently observed in children than in adults. 

 In a case at the Colombo Clinic a boy of fourteen, presenting a 

 general eruption of framboesia, the hyperidrosis of the face was so 

 marked that large drops of perspiration were constantly dropping 

 down. He was treated with potassium iodide. After a month the 

 granulomata had disappeared, and the hyperidrosis was no longer 

 noticeable. In some cases the hyperidrosis ceases suddenly with- 

 out any treatment. The condition, however, may last for some 

 weeks or months. 



The Eyes. — -Granulomatous and papular eruptions may develop 

 on the eyelids. A slight periostitis of the orbital margin is not rare, 

 the margin becoming thickened and very painful on pressure. The 

 occurrence of iritis is denied by most authors. In the Colombo 

 Clinic two typical cases were observed during the general granulo- 

 matous eruption. In both cases the affection was of moderate 

 severity. There was photophobia, ciliary congestion, discolora- 

 tion of the iris. Papillary reaction was almost absent. Both cases 

 recovered on large doses of iodides without any local treatment. 



The Genito-urinary System. — -The primary lesion is rarely, if 

 ever, found on the genital organs. In fact, in all the cases we have 

 seen the primary lesion was always extragenital. Eruptions of the 

 secondary stage, papular and granulomatous, frequently involve 

 the skin of the penis and of the labia. Granulomatous ulceration 

 may be found on the vaginal mucosa. The urine, as a rule, does 

 not contain anything abnormal; only when there is fever — as, for 

 instance, when the articulations are acutely involved — then a slight 

 amount of albumen may be present. 



The Blood. — There is often a certain degree of anaemia, never 

 very severe. The number of red blood-corpuscles varied in our 

 cases from 3,000,000 to 4,000,000, the haemoglobin index (Fleischl) 

 from 50 to 75. The red blood-corpuscles did not show anything 

 abnormal in their shape. On several occasions a comparatively 

 large number of polychromatic erythrocytes were noticed, staining 

 blue instead of pink with Leishman's method. Many of these 

 basophile red cells are micro-erythrocytes. The leucocytes varied 

 from 7,000 to 11,000 per cubic millimetre. In the majority of cases 

 an increase was noticeable in the number of the large mononuclears, 

 even when there was no sign and no history of malaria. The number 

 of lymphocytes is generally normal. Clapier and Violle have re- 

 cently emphasized this, and note that it is in contrast to what one 

 sees in syphilis, in which the lymphocytes are increased in number, 

 while the large mononuclears are in normal amount. In many 

 cases the eosinophiles are increased, this being probably due — in 



