-JAHR Georg Heinrich Gottlieb

What we have said at the conclusion of the preceding paragraph, of the circular form as being common to some non-syphilitic eruptions, applies equally to some other symptoms which both syphilitic and non-syphilitic exanthems have in common. In order, therefore, to furnish all the means which may assist in establishing a correct and discriminating diagnosis, we deem it indispensable to present a list of the non-syphilitic cutaneous affections with which the syphiloids are most easily confounded. These are, in general; (1) some exanthematic and epidemic eruptions; (2) certain dermoid affections of the face; (3) various herpetic eruptions; and (4) some forms of mercurial syphiloid eruptions, all of which we will consider more particularly in the following article.
1. Exanthematic and Epidemic forms. Under this head, rubeola, varicella and varioloid deserve our first attention. As regards rubeola (roseola communis), with which, in case the patient should deny the existence of any previous syphilitic infection, syphilitic spots (roseola syphilitica) might be confounded, we have to observe in the first place that the febrile motions with which the breaking out of this last-named exanthem may be attended, are never as violent as the fever accompanying acute exanthems. Moreover, the redness of the common roseola-spots pales off in proportion as the eruption runs its course, and disappears under the pressure of the finger; their final disappearance leaves nothing but a slight desquamation; whereas the spots of the syphilitic roseola are of a coppery-red, deepening and finally changing to a grayish-color as the spots run their course; moreover, they progress slowly, disappear but imperfectly under the pressure of the finger, and,

Varicella

long after their disappearance, leave brown, or dirty yellowish-brown tints which, though not very distinct, become more prominent in the cold or after washing in cold water. As regards varicella and variola, with which some syphiloids are likewise apt to be confounded, the fever accompanying these non-syphilitic eruptions at their first appearance, is likewise much more intense than the febrile motions attending analogous syphiloids; in addition to which, the syphilitic vesicles are always surrounded by a copper colored areola, which is wanting a simple varicella, whose vesicles moreover rapidly incline to suppurate, whereas the syphilitic vesicles remain for a long time in the same condition, and finally become converted into blackish crusts which fall off, leaving dingy-gray spots behind. The absence of acute fever during the prodromic stage of the syphilitic ecthyma, where the febrile motions, as in the case of all other syphilitic eruptions, are much less marked than the fever accompanying the breaking out of an acute exanthem, may be sufficient to distinguish that ecthyma from common variola, though the syphilitic pustules may lead a superficial observer into error, as they indeed have done in many cases, for a few days at least. But even here all uncertainty will undoubtedly disappear after the lapse of a few days, were it only if we consider the slow course and the more circumscribed spreading of syphilitic pustules, not to speak of the different cicatrices and marks which these pustules leave behind.

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