ccur in the diagnosis of primary syphilis from _herpes_,
as this may appear as late as ten days after connection; it commences as
a group of vesicles which soon burst and leave shallow ulcers with a
yellow floor; these disappear quickly on the use of an antiseptic
dusting powder.

Apprehensive patients who have committed sexual indiscretions are apt to
regard as syphilitic any lesion which happens to be located on the
penis--for example, acne pustules, eczema, psoriasis papules, boils,
balanitis, or venereal warts.

_The local treatment_ of the primary sore consists in attempting to
destroy the organisms _in situ_. An ointment made up of calomel 33
parts, lanoline 67 parts, and vaseline 10 parts (Metchnikoff's cream) is
rubbed into the sore several times a day. If the surface is unbroken, it
may be dusted lightly with a powder composed of equal parts of calomel
and carbonate of zinc. A gauze dressing is applied, and the penis and
scrotum should be supported against the abdominal wall by a triangular
handkerchief or bathing-drawers; if there is inflammatory oedema the
patient should be confined to bed.

In _concealed chancres_ with phimosis, the sac of the prepuce should be
slit up along the dorsum to admit of the ointment being applied. If
phagedaena occurs, the prepuce must be slit open along the dorsum, or if
sloughing, cut away, and the patient should have frequent sitz baths of
weak sublimate lotion. When the chancre is within the meatus, iodoform
bougies are inserted into the urethra, and the urine should be rendered
bland by drinking large quantities of fluid.

General treatment is considered on p. 149.

#Secondary Syphilis.#--The following description of secondary syphilis
is based on the average course of the disease in untreated cases. The
onset of constitutional symptoms occurs from six to twelve weeks after
infection, and the manifestations are the result of the entrance of the
virus into the general circulation, and its being carried to all parts
of the body. The period during which the patient is liable to suffer
from secondary symptoms ranges from six months to two years.

In some cases the general health is not disturbed; in others the patient
is feverish and out of sorts, losing appetite, becoming pale and anaemic,
complaining of lassitude, incapacity for exertion, headache, and pains
of a rheumatic type referred to the bones. There is a moderate degree of
leucocytosis, but the increase is due not