to the polymorpho-nuclear
leucocytes but to lymphocytes. In isolated cases the temperature rises
to 101 or 102 F. and the patient loses flesh. The lymph glands,
particularly those along the posterior border of the sterno-mastoid,
become enlarged and slightly tender. The hair comes out, eruptions
appear on the skin and mucous membranes, and the patient may suffer from
sore throat and affections of the eyes. The local lesions are to be
regarded as being of the nature of reactions against accumulations of
the parasite, lymphocytes and plasma cells being the elements chiefly
concerned in the reactive process.

_Affections of the Skin_ are among the most constant manifestations. An
evanescent macular rash, not unlike that of measles--_roseola_--is the
first to appear, usually in from six to eight weeks from the date of
infection; it is widely diffused over the trunk, and the original dull
rose-colour soon fades, leaving brownish stains, which in time
disappear. It is usually followed by a _papular eruption_, the
individual papules being raised above the surface of the skin, smooth or
scaly, and as they are due to infiltration of the skin they are more
persistent than the roseoles. They vary in size and distribution, being
sometimes small, hard, polished, and closely aggregated like lichen,
sometimes as large as a shilling-piece, with an accumulation of scales
on the surface like that seen in psoriasis. The co-existence of scaly
papules and faded roseoles is very suggestive of syphilis.

Other types of eruption are less common, and are met with from the third
month onwards. A _pustular_ eruption, not unlike that of acne, is
sometimes a prominent feature, but is not characteristic of syphilis
unless it affects the scalp and forehead and is associated with the
remains of the papular eruption. The term _ecthyma_ is applied when the
pustules are of large size, and, after breaking on the surface, give
rise to superficial ulcers; the discharge from the ulcer often dries up
and forms a scab or crust which is continually added to from below as
the ulcer extends in area and depth. The term _rupia_ is applied when
the crusts are prominent, dark in colour, and conical in shape, roughly
resembling the shell of a limpet. If the crust is detached, a sharply
defined ulcer is exposed, and when this heals it leaves a scar which is
usually circular, thin, white, shining like satin, and the surrounding
skin is darkly pigmented; in the case of