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The Primary Lesion. The incubation period having elapsed, there appears at the site of inoculation a circumscribed area of infiltration which represents the reaction of the tissues to the entrance of the virus. The first appearance is that of a sharply defined papule, rarely larger than a split pea.
There is no enlargement of adjacent glands, and but little inflammatory reaction in the surrounding tissues; nor is there any marked constitutional disturbance. Recovery is often followed by cicatricial contraction leading to deformity of the face. The treatment consists in destroying the original papule by the actual cautery, acid nitrate of mercury, or pure carbolic acid.
Noguchi has made an emulsion of dead spirochætes which he calls luetin, and which gives a specific reaction resembling that of tuberculin in tuberculosis, a papule or a pustule forming at the site of the intra-dermal injection. It is said to be most efficacious in the tertiary and latent forms of syphilis, which are precisely those forms in which the diagnosis is surrounded with difficulties.
The symptoms are vague, possibly palpitation, vertigo, edema of the limbs and eyelids. The primary stage begins with the initial lesion, which consists of a papule which may be found most anywhere on the body. This papule ulcerates. The secondary stage commences about a fortnight after the papule has healed.
By the seventh day the apex of the papule is of a pale yellow color, and the black skin has the appearance of being dotted over with yellow wax. The papule then develops into nodules of cylindric shape, with a dome-shaped, thick, yellow crust. It is only with the crust off that there is any resemblance to a raspberry.
The infectious material enters the broken surface of either the skin or mucous membrane, called "contact" or "acquired" syphilis. When it is transmitted by the mother to the embryo, it is called "hereditary" or "inherited" syphilis. It may appear as an erosion or as a dry scaling and indurated papule, varying in size from a pin-head to a silver dollar. The base of the ulcer is indurated.
Furunculus orientalis, or its synonyms, Oriental boil, Aleppo boil, Delhi boil, Biskra button, etc., is a local disease occurring chiefly on the face and other uncovered spots, endemic in limited districts in hot climates, characterized by the formation of a papule, a nodule, and a scab, and beneath the last a sharply punched-out ulcer.
In animals the disease has been transmitted by material from all kinds of syphilitic lesions, including even the blood in the secondary and tertiary stages of the disease. The primary lesion is in the form of an indurated papule, in every respect resembling the corresponding lesion in man, and associated with enlargement and induration of the lymph glands.
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