SYPHILIS

Synonyms.—Pox; Lues; Lues venerea; Fr., Syphilis; Vérole; Ger., Syphilis; Lust-
seuche.

The syphilitic virus finds its way into the system by inoculation,
usually as a result of impure sexual intercourse or through accidental
contamination, the first evidence of the malady being the so-called
“initial lesion” or chancre. This may present the appearances of a
slightly scaly, flattened papule, a film of infiltration, a surface abrasion
with underlying infiltration, or a variously sized, usually small, crateri-
form ulcer with moderate or marked underlying and surrounding in­
filtration. Still another type is occasionally encountered, consisting
of an abraded surface, with but slight or moderate infiltration, and cov­
ered more or less completely with a somewhat tenacious, firmly adherent,
pseudomembranous film or exudation. The most common site for the
initial lesion in the male, as well known, is some part of the genital region,
usually on the glans, at the corona, on the prepuce, or shaft of the organ;
in the female, on the small or large labia, on the clitoris, or within the
vaginal entrance, or higher up. The lesion as thus met with belongs more
distinctly to the province of the genito­urinary specialists, and for de­
tailed description the reader is referred to works on venereal diseases.

The extragenital or " non-venereal” chancre is a matter of not uncommon
dermatologic observation. It may be seen upon any part of the body,
although by far most frequently about the face, particularly the lips.
The tongue is likewise sometimes the seat of the lesion, and it is occa­
sionally found upon the tonsil. The finger, especially at the lateral
nail-groove, is also a not uncommon situation.¹ On these extragenital
situations chancres do not differ from those seen on the genitalia. On
the lip the superficial flat lesion, with the pseudomembranous coating,
it is not unusual, although in other instances it has the typical subjacent
and surrounding infiltration and the crateriform ulcer. This latter
variety is also generally that seen on the tonsil. Both on the lip and
about the finger-nail the first evidence is often a persistent fissure. In
the latter region sometimes the lesion is exceedingly insignificant.

As a rule, there is rarely much difficulty in the diagnosis of ex-
tragenital chancres, presenting, as they generally do, the slow develop-

¹ D. W. Montgomery, “The Location of Extragenital Chancres,” Jour. Cutan. Dis.,
1905, p. 342, covers the subject well; based upon his own cases and those reported by
others, with bibliography; considers also relative frequency (more than 5 per cent.)
as compared to genital chancres.
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NEW GROWTHS

ment and course and the characteristic induration. A patient coming
with the statement that he has had a “persistent fissure or fever blister
on the lip which will not get well” should always lead to careful inspec­
tion. If such lesion has been of a few weeks’ duration, an examination
will often show a beginning chancre. Any sore on the lip which has
existed several or more weeks must be looked upon with suspicion, as
ordinarily, if not epithelioma, it is the initial induration of syphilis. A
suspicious lesion, of a few weeks’ duration, with enlargement of the near­
est anatomically connected lymphatic glands, is almost invariably found
to be a chancre. A persistent crack at the border of the nail, in those
unaccustomed to fissuring or chapping, should always be carefully
watched; not infrequently induration will be disclosed and beginning
enlargement of the neighboring glands. In fact, a single circumscribed
and hardened lesion or ulcer on any part, whether integument or mucous
membrane, points commonly to either chancre or epithelioma, and if
this is borne in mind, a correct conclusion is generally easily reached.
It is by overlooking the fact that a chancre is not necessarily always
a genital and venereal lesion that mistakes are ordinarily due, for, as
a rule, when this is recognized, the differentiation from other diseases
is rarely difficult.

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