The diagnosis of this form of sjphilide is for the most
part easily made ; varicella and small-pox being the only
diseases characterised by a similar eruption. The syphi- i
litic pustules are more slowly developed, are less numerous, ,
aud their eruption is ordinarily unaccompanied by febrile
symptoms. A papular ernption, which forms the starting
point of the pustules, always coexists. Pain in the back,
vomiting, and other indications of an acute affection are
invariably absent. The history of the case and the {
presence of other symptoms of syphilis will establish the I
diagnosis. f

(3) Syphililic impetigo occurs in the form of small
pustules, sometimes isolated aud sometimes forming
patches of variable size. Tbey begin as circumscribed
darlc-red spots, as large as a lentil or pea. The papules are
soon converted into pnstules which, in turn, rapidly become
dried up, and form yellowish or brown crusts. The erup-
tion often becomes confluent, and is most frequently found
upon the forehead, scalp, and chin, about the mouth
and nose, and in the axillfc. It is less frequently seen on
the trunk and limbs. A coppery-red areola surrounds
each pustule or patch. This form is never seen at an
early period of the disease, i.e. within leas than six months
after the appearance of the primary sore. It belongs
rather to the second or third year, aud this late form oE 1
the eruption is usually confluent and conflned to certain T
parts of the body. In severe aud neglected cases, the j
separation of the crusts sometimes exposes patches o£ ]
ulceration, mostly of a superficial character ; and the I
destructive process occasionally spreads in a serpiginous '
manner. Syphilitic impetigo is a chronic affection, always
lasting for somo months. The confluent form is the more
obstinate ; it occurs in cachectic subjects and indicates gr&vo
disorder of uutrition. Scrofulous impetigo closely resem-
bles the syphilitic eruption. In tbc latter, however, the



AFFErriOXa OF THE SKEN



109



I



coppery-red areola is a distingnishing characteristic.
