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The syphilitic lesion belongs to the tertiary period, and although presenting a superficial resemblance to tuberculosis, its progress is more rapid, so that within a few months it may involve an area of skin as wide as would be affected by lupus in as many years. Further, it readily yields to anti-syphilitic treatment.
The distinctive diagnostic physical sign of this lesion is the diastolic and perhaps presystolic murmur heard over the left ventricle, accentuated at the apex and transmitted some distance to the left of the heart. There is also an accentuated pulmonary closure. To palpation this lesion often gives a characteristic presystolic thrill at and around the apex.
The first symptoms of lack of compensation with the lesion of mitral stenosis are lung symptoms dyspnea, cough, bronchitis, slight cyanosis, sometimes blood streaks in the expectorated mucus and froth, and, if the congestion is considerable, some edema of the posterior part of the lungs, if the patient is in bed.
In the later stages there may occur a form of creeping or spreading ulceration of the skin of the face, groin, or scrotum, healing at one edge and spreading at another like tuberculous lupus, but distinguished from this by its more rapid progress and by the pigmentation of the scar. Condylomata are more characteristic of syphilis than any other type of skin lesion.
Blair's paper in the Eleventh Annual Report of the New York Zoological Society shows only a very slight lesion, in comparison with those of the mountain sheep. The conclusion is that among the sheep, this disease does not carry off its victims in any short period like 10 days. The animal must survive for some months after it becomes apparent.
But it was exactly because it was important to make the crime high treason that the prisoners were condemned. The offence was considered as a crime not against Leyden, but as an attempt to levy war upon a city which was a member of the States of Holland and of the United States. If the States were sovereign, then this was a lesion of their sovereignty.
If the indulgence be continued, then, either from deranged nutrition or organic lesion, manifestations formerly developed only during a fit of intoxication may become permanent, and terminate in insanity or dypso-mania.
A physiologist would without doubt explain this anomaly by the coexistence of a nervous lesion, light at first, with a muscular, athletic temperament. Whatever the cause, the effect is undeniable. The skilled and dainty pessimism of De Maupassant was accompanied by a vigor and physique very unusual.
"It is strange," said I, thoughtfully; "but your susceptibility to suffering confirms my opinion, which is different from the popular belief, namely, that pain is most acutely felt by those in whom the animal organization being perfect, and the sense of vitality exquisitely keen, every injury or lesion finds the whole system rise, as it were, to repel the mischief and communicate the consciousness of it to all those nerves which are the sentinels to the garrison of life.
The condition is frequently observed to follow, either directly or after an interval, upon a lesion which involves gross injury of the joint or of one of the neighbouring bones. It occurs with greater frequency after repeated minor injuries affecting the joint and its vicinity, such as sprains and contusions, and particularly those sustained in laborious occupations.
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