EXPERIMENTAL SYPHILIS IN THE RABBIT : IV. CUTANEOUS SYPHILIS. PART 2. CLINICAL ASPECTS OF CUTANEOUS SYPHILIS.

From the study of a large number of rabbits with generalized cutaneous syphilis following local inoculation with Treponema pallidum, lesions were found most often about the hind feet and legs, the head, the front feet and legs, and the tail. There was further evidence of a selective distribution of cutaneous lesions in the fact that, on a given part of the body, the lesions were usually confined to a few restricted areas. About the head, they occurred almost exclusively on the sides and bridge of the nose, the lids, the brows, the lips, and the base and free portions of the ears. On the front feet and legs, the seat of predilection was the extensor and lateral surfaces of the fore arm, the carpus, and the feet, while on the posterior extremities they were situated upon the dorsum and lateral surfaces of the feet and ankles from the level of the tendo achillis to the base of the fifth toe. The positions of greatest frequency were the region of the tarsus and external malleolus, the base of the fifth metatarsal, the lateral and posterior surfaces of the heel and tendo achillis, and the base of the fifth toe. In many instances, the positions of predilection were exposed positions or areas of skin covering bony or tendinous prominences. It was also found that the character of the lesions differed somewhat in the various locations. The lesions of the head were mostly small circumscribed papules or processes of diffuse infiltration; on the fore arms and feet, affections of this type were about equally divided with larger granulomatous masses of a chancre-like character, while on the hind feet and legs, granulomatous lesions were far more numerous than those of any other type and frequently reached a very large size. The cutaneous eruption usually consisted of only a few lesions confined to some one part of the body, but occasionally they were more numerous and more widely distributed. In this connection, it was noted that when multiple lesions appeared in a given area at about the same time, the growth of most of them was abortive, and, as a rule, only one or two developed to any considerable size. Especial emphasis was placed upon this phenomenon of inhibition as a factor of fundamental importance in the experimental infection. From clinical observation, it was found that, as a rule, the first cutaneous eruption occurred at from 2 to 4 months after inoculation but might occur either earlier or later, depending upon the circumstances in the individual case. The earliest eruptions appeared 3 weeks after inoculation and the latest 2 years and 8 months, but, as a rule, the time between inoculation and the appearance of the first eruption did not exceed 4 to 6 months. Successive crops of cutaneous lesions appeared in a number of animals usually within the first 6 months after inoculation. In a few instances, however, there were repeated eruptions extending over a period of 2 years or more, the longest recorded period being 3 years and 7 months. The duration of individual lesions was found to be extremely variable, ranging from a few days in the case of a macular erythema to more than 2 years in the case of a few granulomatous lesions. The average duration of the lesions appeared to vary somewhat with the nature of the lesion but on the whole was not more than 2 to 4 months. No limits could be fixed, however, for the duration of an active skin infection as a whole. Again, it was found that the cutaneous infection tended to pursue a periodic or relapsing course. This was seen in the mode of growth and resolution of individual lesions, the occurrence of successive periods of eruption, and the recurrence of completely healed lesions, all of which was interpreted as evidence of the essential relapsing nature of syphilitic infections.