SYPHILIS TERTIARIA

Syphilis ulcerosa.

A syphilitic ulcer is the sequel of a pustulo-
crustaceous, gummatous or tubercular syphilid. It
is found therefore most often upon the favorite sites
of those three lesions, namely the face, especially
about the nose, the forehead, legs and genitalia.
Often the origin of an ulcer cannot be ascertained
from its appearance. The round or irregular more
superficial ulcer met with comparatively early in the
disease and in poorly nourished and anemic indi-
viduals is usually a pustulo-crustaceous lesion from
which the crust has been cast off by increased sup-
puration. The deep ulcers are generally from gum-
matous deposits. The ulcers arising from the tuber-
cular syphiloderm have the same tendency to seg-
mental grouping and circinate configuration that the
tubercular lesions themselves exhibit. When this
feature is marked the lesions are called ulcero-
serpiginous. Ulcers usually travel slowly over the
skin by healing at one side while they advance at
the other. The healing margin is often concave,
the advancing convex and elevated by a ridge of
coalescent tubercles, upon which narrow zone of
infiltration the ulcer constantly encroaches. The
area traversed is marked by soft scar tissue, or when
the ulceration is very superficial, merely by brown-
ish pigmentation. The base of the ulcer is covered
by a grayish yellow, purulent slough which may
dry to form a crust. It is unusual for such a lesion

entirely to heal spontaneously, although almost in-
variably it responds rapidly to specific constitutional
treatment. As a rule syphilitic ulcers are not at all
painful, and only slightly tender. DIAGNOSIS:
Traumatic ulcers have a history of injury and are
acute and highly inflammatory, irregular in shape,
and heal rapidly under simple dressings. A tubercu-
lous ulcer is usually superficial, irregular, sluggish,
with comparatively little, thin discharge under clean
dressings; it arises frequently from caseous glands
or diseased bone, and presents sinuses, milky anemic
granulations, and soft undermined edges. Its scars
are not infrequently keloidal. Lupous ulcers start
earlier in life, are superficial and incomparably slow-
er in development, the edges are brighter red, softer
and often undermined, and apple-jelly nodules
are frequently to be found; the scars are more dif-
fuse, tough and deforming. An epitheliomatous
ulcer starts from a pimple, wart or keratotic patch,
is usually a single lesion on the face, and its sharp
border is almost invariably in some part typically
hard, everted and waxy-looking, with dilated capil-
laries crossing it. TREATMENT: In addition to
the administration of mercury and potassium iodid
local treatment may be employed. Ulcers should
be kept clean and dusted with calomel, or covered
with a five to ten per cent. ammoniated mercury
ointment.