A system of surgery . acters of these ulcers are of importance in thediagnosis:—(1) History of a swelling or lump preceding the forma-tion of the ulcer; (2) borders of ulcer sharply cut (punched-out)and not much undermined; (3) edge rounded in outline, ofteninfiltrated, hard, and congested ; (4) base covered with whitishslough, secretion thick (unlike the discharge from a tubercular ulcer,which is thin and watery) ; (5) the ulcer yields (if not too long 412 SYPHILIS. neglected) to local and general anti-syphilitic treatment, and if oncesoundly healed shows little tendency to recur; (6) the res
A system of surgery . acters of these ulcers are of importance in thediagnosis:—(1) History of a swelling or lump preceding the forma-tion of the ulcer; (2) borders of ulcer sharply cut (punched-out)and not much undermined; (3) edge rounded in outline, ofteninfiltrated, hard, and congested ; (4) base covered with whitishslough, secretion thick (unlike the discharge from a tubercular ulcer,which is thin and watery) ; (5) the ulcer yields (if not too long 412 SYPHILIS. neglected) to local and general anti-syphilitic treatment, and if oncesoundly healed shows little tendency to recur; (6) the resulting scaris usually thin and supple (like tissue-paper), white in the centre,with often a pigmented margin. The amount of pigment whichremains will vary according to the length of time the ulcer persists,and its situation. All scars, whether syphilitic or not, are mostpigmented on the lower extremities, owing to the venous congestionof those parts. Tertiary ulcers of the legs are sometimes exceedingly difficult to. Fig. 86.—Front of Knees, showing multiple scars due to relapsing gummatous ulcers. diagnose from ordinary inflammatory ones, and there is a form ofscrofulous ulcer (known as Bazins disease) which has most of thecharacters above given. In fact, there is absolutely no conclusivefeature about a syphilitic ulcer. The gummatous slough ofconnective tissue may be exactly imitated in some traumatic ulcers,or in carbuncular ones. A carbuncle is, however, almost invariablyvery painful before the skin gives way, whilst a gumma causes butlittle pain as a rule, and the former is much more acute in itsprogress. The ordinary chronic ulcer met with in subjects with varicoseveins, and liable to long periods of standing at their work, occurschiefly in the lower third of the leg ; syphilitic ulcers may occur inthe upper third, or over the calf. Gummatous ulcers are peculiarlyapt to occur about the knee-joint (especially in women), sometimesover other joints, such as the elbow. Th
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