Diagnosis

To commence at the beginning, the initial lesion or chancre is to be distinguished from the soft venereal ulcer (chancroid) by its long (two or three weeks) incubation, its plastic character, its indurated base and its slight tendency to secretion, and the single or very Limited number of lesions.

The soft chancre, on the other hand, appears a few days after intercourse, presents a necrobiotic or ulcerative character, is not accompanied with the hard,. infiltrated base, and may exist to the number of a dozen or more on the same patient.

In syphilis the initial lesion is usually accompanied with a number of moderately enlarged hard inguinal glands, while the chancroid may be accompanied with one or more very much enlarged and greatly inflamed and painful glands, which not infrequently go on to suppuration. In addition, we have in syphilis the other glandular induration already noticed.


There are very few cases in which the earlier syphilitic eruptions cause any great trouble in diagnosis. Taking the history into consideration, neither the macular nor tubercular eruptions are liable to be mistaken for anything else. The papular eruption of lichen planus, however, may sometimes closely resemble a syphilide. The squamous syphilide may in like manner be mistaken for ordinary psoriasis. In most cases, however, we will learn (if the case is psoriasis) that the patient has had previous attacks of the same form of eruptions, while in syphilis the previous eruptions will have been of a different type.


In late syphilis a patch of tubercular lesions may be mistaken for lupus. The history, however, again helps us, for a lupus patch will have been many months, perhaps, years, in forming, while the syphilitic lesions might have reached the same development in a few weeks. The real difficulties that surround the diagnosis of syphilitic eruption, however, do not so often occur in simple, uncomplicated cases as in those where a syphilide coexists with some other eruptive affection. Thus we have seen at the same time a syphilide and an eczema, a syphilide and a psoriasis, a syphilide and leprosy, a syphilide and scabies, etc., and each of these separate eruptions pursued its own course apparently unmodified by the presence of the other.