Another type of pustular syphilide is that known as _rupia_, where the ulcers are larger and are covered with concentric layers of crust resembling an oyster-shell. These lesions begin as papules and undergo changes which make them bullæ or pustules and then open ulcers. The peculiar scabs are somewhat conical in shape when not disturbed, and are greenish or brownish in color. If they are dislodged, irregular, indolent, and often sensitive ulcerated areas will be found beneath them. Even when these ulcers heal they are irregular in outline and show a white scar often surrounded by an areola of pigment. This rupia is the most visible lesion of syphilis, as no other skin disease assumes any such type. In the last-described and ulcerative forms of syphilide there is a possibility of septic infection, or at least of septic intoxication by absorption; hence the need for care in this direction. In fact, into the treatment of every pustular indication of syphilis the elements of local protection and local antisepsis should enter. =The Mucous Membranes.=--Here the manifestations of syphilis are of great importance because of their extreme infectiousness. The earlier manifestations are seen mainly about the mouth. When an eruption appears upon the skin a condition corresponding to it may often be recognized in the pharynx and upon the uvula and soft palate. This will be accompanied by discomfort, and the patient complains of “soreness of the throat.” These throat lesions are chronic, liable to recur, and disappear slowly, unless the patient is vigorously treated; they sometimes cause dryness of the fauces, followed by a free flow of mucus. The dusky discoloration of the rash is quite distinctive. The congested areas have a dusky hue on the skin and are spoken of as “coppery” or “raw-ham” in tint. They are usually well outlined; should the disease progress they become eroded. “Syphilitic sore throat,” as this condition is often called, may be aggravated by the use of tobacco and by unclean mouths. The involvement of the cervical lymphatics will be proportionate to the vividness of the lesion. TERTIARY OR CONSTITUTIONAL SYPHILIS.