(3) Besides these two kinds of chancre of the throat, some authors range in this class the annular herpetic ulcer, of which mention has been made in the former paragraph. It is distinguished by its faintish-white circular patches, on the surface of the tonsils, velum palati, columns of the palate, tongue, and even cheeks and lips, and is always accompanied by a scaly eruption on the skin, of which it may be regarded as a continuation. Many pathologists deny its syphilitic nature, and only view it as a mercurial affection; this opinion, however, may be erroneous; at any rate, it is not substantiated.
(4) Among other affections of the mouth and throat, the balances of which have already been described in the last paragraph, we only mention mucous tubercle and figwarts, which, though rarely, yet sometimes show themselves at the root of the tongue, where they are sometimes mistaken for cancer of the tongue, on the velum palati and in the neighborhood of the posterior molars.
Secale 134.– Continuations of the preceding subject.
DISTINCTIVE DIAGNOSIS OF SYPHILITIC AND NON-SYPHILITIC AFFECTIONS OF THE MOUTH AND THROAT. We have shown that the secondary syphilitic products on the mucous membrane of the throat and mouth may appear: (1) as superficial, whitish, tettery ulcerations; (2) as simple chancres of the tonsils; (3) as phagedaenic chancres of the fauces; (4) as spots of papules that soon disappear again: (5) as mucous tubercles, and (6) as circular herpetic ulcers accompanied by a squamous exanthem on the skin; and that these ulcers may not only be attended with condylomatous growths, but may likewise cause the most fearful destructions; may eat away the palatine and nasal bones, and may result in caries of the cervical vertebrae. Usually, at least very frequently, these phenomena set in with a simple redness and puffiness of the mucus membrane, which is nowhere ulcerated, but very frequently streaked with varicose vessels, and sometimes here and there covered with a layer of tenacious mucus; this condition, which is known under the name of angina syphilitica, may continue for a long time without showing any sings of ulceration.
As a general rule, these ulcers of the mouth and throat are readily distinguished from non-syphilitic ulcers, although it may happen in a few rare cases that the former are mistaken for mercurial scorbutic and even simple ulcers. To enable the reader to avoid such mistakes, we will subjoin the following remarks;
(1) Mercurial ulcers are generally seated on the inside of the cheeks, near the gums and on the borders of the tongue, do not, like syphilitic ulcers, spread from behind forwards, but from before backwards, and usually spread more rapidly than syphilitic ulcers; they have no grayish or lardaceous, but a milky-white base, are never surrounded by an erysipelatous redness, and may in some cases occasion very dangerous rhagades.
(2) Scorbutic ulcers exhibit a dark-red, bluish and blackish base with similarly-looking edges, are of a relaxed consistence, of fungoid appearance, have an irregular form, bleed readily, and are generally seen on the gums and around the roots of the teeth.
(3). Simple ulcers, specially when arising after an ordinary inflammation of the throat, always have a simple, distinctly inflammatory character, run a proportionately rapid course, and are generally consequent upon the small abscesses in the tonsils.
(4) Simple aphthae, which some might possibly mistake for syphilitic ulcers, break out, specially in children and when attended with fever, in greater number than syphilitic ulcers; they are of a milky-white or yellowish color; it is only in the case of full-grown persons, when they break out in consequence of using heating food or beverages, at most one or two at a time, on the inside of the lips or cheeks, that they readily be confounded with syphilitic ulcers, so much more easily since these so-called gastric aphthae have sometimes a whitish, lardaceous, mother-of-pearl base, are always surrounded by a more or less inflamed areola, and not unfrequently are more or less deep and painful. However, they disappeared in all cases of themselves in five days, or, at the latest, in a fortnight.
(5) With carcinomatous ulcers they might possibly be confounded in cases where fungoid chancres or numerous fungoid condylomata have broken out on the tongue; in such a case, however, the balance of the symptoms will soon shed light on the true nature of the case.
Secale 135.– Secondary phenomena in the Larynx and Nose.
Although in most cases the symptoms in these organs are caused by the spreading of the disease from the fauces, yet they may likewise be attacked by themselves, and, inasmuch as in such cases the true nature of the malady may easily be overlooked, it seems indispensable that these forms should be considered more in detail.
(1) Syphilitic affection of the Larynx.- Syphilitic ulceration of the larynx, if occurring by itself, generally sets in a long time after (the disappearance of the primary symptoms, in which case it is accompanied by all the symptoms of ordinary affections of the larynx, such as : certain uneasy feeling and a seated painfulness in the region of the larynx, alteration or even loss of voice, difficulty of breathing, short cough, with a desire to hawk up the stuff which obstructs the larynx, and expectoration of purulent substance streaked with blood. If the affection progresses, fever may supervene, with night-sweats and all the other signs of laryngeal phthisis. Sometimes the cartilages of the vocal organs become involved., In such a case of the prognosis becomes much more unfavorable, since, even after the ulcers are completely healed, aphonia, or at least an incurable hoarseness, many remain behind. I have seen this disease develop itself in the case of a young, vigorous German, who had been treated for laryngeal phthisis by the greatest physicians in Paris, and whose affection I likewise mistook for this disease until syphilitic pustules broke out on the forehead, when he placed himself in the hands of some other homoeopathic physician of the Specific School, under whose treatment he died in six months.
(2) Syphilitic affection of the Schneiderian membrane (ozaena syphilitica).– Like laryngeal affections, these may likewise break out by themselves, without any previous ulceration of the fauces; they manifest themselves sooner or later, subsequent to the disappearance of the primary symptoms, in the form of a dry coryza; indeed, the patient fancies he has taken cold. Soon, however, he commences to blow out of his nose a thick, yellowish, purulent matter, which is often mixed with thin, blackish crusts; at the same time he becomes aware of a diminution of the sense of the smell; after which a more careful examination of the nasal cavity reveal a fungoid swelling of the Schneiderian membrane, extending in both nostrils as far as the eye can reach. At the same time, or soon after, on the inner walls of the alae nasi, or higher up, ulcerations break out which, like those in the throat, are phagedaenic, and may affect the nasal bones. If these become destroyed by the ulcerative process, the patient, l when blowing his nose, generally blows out pieces of these bones, until the nose caves in, without the outer skin having become injured. This is the ozaena syphilitica of older authors, during which condylomatous growths in the nostrils may supervene which have often been confounded with polypi. In other respects this affection is one of those that may break out sooner than any other after the disappearance of the primary phenomena, but which at the commencement is heeded no more than so many other apparently trifling syphilitic symptoms, which may continue unnoticed for years, until the disorder suddenly becomes more manifest, five, six or eleven years after the chancre had been healed, and is then regarded to a recent affection.
Secale 136.– Affections of the Ears and Eyes.
CONJUNCTIVITIS AND IRITIS. Although, not very frequent, yet both these affections are not so very rare either, provided we choose to heed them.
Beside the secondary ulcers that here break out syphilitic affections of the ears consist in a syphilitic derangement of the mucous membrane of the meatus auditorius, characterized by a yellowish-green, viscid, thin, and more or less copious discharge from the ears, which, like all the constitutional syphilitic discharges, are generally painless, and attended with more or less difficulty of hearing. Sometimes we notice, at the same time, syphilitic ulcerations of the outer ear, or at the entrance of the meatus; if located more interiorly, they can be discovered by means of the speculum. Soft, cauliflower excrescences and other figwarts, as well as mucous tubercle have been seen in the meatus.
SYPHILITIC AFFECTIONS OF THE EYES. –Here we distinguish two kinds of affections: 1. Conjunctivitis Syphilitica, which is a disease of the mucous membrane; and, (2) Iritis Syphilitica, which has nothing to do with the mucous membrane, and is entirely confined to the iris.
