All syphilitic pustules have this in common, that they may break out in all parts of the body, and that they are frequently accompanied by the worst secondary phenomena, such as secondary chancres, exostoses, bone pains etc., or that they have become evolved with other syphilidæ as a final consummation. According to Cazenave, they may break out as a truly protopathic product immediately after infection has taken place. But the case upon which he bases his opinion was an infection, not contracted by sexual connection, but by inoculation. The victim was a physician with a sore finger, who assisted to woman who had a chancre, in confinement. Two or three months after infection, red spots broke out, followed by numerous pustules on the lower and upper extremities, shoulders, and head, which were at first mistaken for varioloid, but afterwards revealed their syphilitic character by chancrous ulcers, whose aspect reminded one of the descriptions of syphilis from the times when syphilis was an epidemic disease. Be this as it may, in our day these pustules, if we except inoculation by the skin, do no longer occur as protopathic products of impure connection. Upon examining such cases as Cazenave’s more closely, we shall see that, where inoculation results in the formation of pustules, the ulcers arising from them, in which the original characteristics of chancre are found slightly altered in form, not in essence, nevertheless exhibit essential differences from the syphilitic pustules, notwithstanding all their apparent similarity with this syphiloid. He who, after the fashion of Willian, deems the anatomical form equivalent to the essence of the eruption, and from analogous form infers an identity of pathological essence, may readily be induced to conclude that protopathic chancres, if occurring in different
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| Syphilitic pustules and papules |
forms, may not only be represented by protopathically appearing pustules as products in all respects identical with chancre, but likewise by any form of syphiloid ulcers. admitting that the ulcers in Cazenave’s case were not a pustulous, syphiloid, but true chancres, we shall insist upon our proportion; that all pustulous, ulcerated eruptions, which have been observed hitherto, never have been protopathic products, but can never have been any thing else than secondary eruptions. In the following paragraphs, we shall see, from a description of each particular form of these syphilitic pustules, in how far they are essentially distinguished from chancres by their course, and even by their frequently spontaneous disappearance, after having run through all their different stages, not to mention other distinctive signs, which every attentive reader can readily discover for himself. The best descriptions of these eruptions has been given by Cazenave. But it is not only by this description that he has facilitated the diagnosis of this syphiloid, and its distinction from other similar non-syphilitic eruptions, but by rigidly arranging this syphiloid in accordance with its external forms, which had hitherto been imperfectly and obscurely described by authors under the common name of syphilitic pustules, under three distinct heads: (a) Acne syphilitica; (b) Impetigo syphilitica; and (c) Ecthyma syphililicum. Let us adopt this arrangement in considering each of these forms.