444 DISEASES OF THE MOUTH. 



CHAPTER V. 



SYPHILITIC AFFECTIONS OF THE MOUTH. 



ETIOLOGY. Primary ulcers and condylomata that is, those de- 

 veloping at the point where the transfer of the syphilitic poison has 

 taken place occur, according to my observation during the last few 

 years, much more frequently than I had formerly supposed. In some 

 cases the contagion passes from the nipple of a syphilitic nurse to the 

 mouth of the nursling. Occasionally the infection is caused by un- 

 natural debauchery; most frequently through so-called sugar-teats, 

 which pass from the mouth of a syphilitic to that of a non-syphilitic 

 person. From one town in the vicinity of Tubingen^ I have treated, 

 and shown in the clinic, a family of ten persons, children, parents, and 

 grandparents, who all had syphilitic ulcers and condylomata of the 

 oral mucous membrane from this cause. 



Among the secondary syphilitic affections (by which term we mean 

 those that occur in the early stages of the disease only, not at the 

 point of infection, but at other parts of the body), condylomata and 

 ulcers often occur together in the mouth. Among the tertiary forms 

 (those which occur in the later periods), we have the gummy tumors, 

 or nodular syphilomata ( Wagner] of the tongue, which are often mis- 

 taken for cancer of the tongue. 



ANATOMICAL APPEAKANCES. Both the primary and secondary 

 syphilitic ulcers and condylomata spring from circumscribed indura- 

 tions, or from syphilitic papules of the mucous membrane. Then an 

 excessive collection and milky cloudiness of the epithelium give a pe- 

 culiar white appearance (as if it had been touched with nitrate of 

 silver) to the surface of the affected part. Subsequently the papules 

 of the mucous membrane form syphilitic erosions or ulcerations by 

 molecular disintegration, or condylomata by papillary proliferation, or 

 both together. The ulcers occur most frequently at the corners of the 

 mouth ; here they are usually superficial, and it looks as if the com- 

 misure of the lips were torn. On the edges of these ulcers there are 

 almost always small condylomata. The ulcers occurring on the tongue, 

 especially on its upper surface or sides, which are exposed to many 

 sources of injury, form more or less deep fissures, or extensive losses 

 of substance, whose uneven base is covered with a whitish-gray de- 

 tritus. On the lateral edges of the tongue, the condylomata usually 

 form elongated, shallow excrescences ; on the dorsum of the tongue, 

 on the contrary, they form round or oval warty vegetations, with broad 

 bases, often separated by fissures. Not unfrequently, patients who 

 have a bad conscience, and occasionally, also, inexperienced physicians 



