SCORBUTIC AFFECTIONS OF THE MOUTH. 44.5 



mistake the circumvallate papillae at the base of the tongue for syphi 

 litic condylomata. 



Gummy tumors, or nodular syphilomata of the tongue, usually 

 come on the anterior third. At first only an indurated spot is noticed ; 

 this soon swells to the size of a bean or hazel-nut, and subsequently 

 softens and ruptures. After the rupture of the nodule there is left a 

 deep, sharply-bounded ulcer, with inverted, thickened borders. 



SYMPTOMS AND COURSE. The primary and secondary ulcers in the 

 mouth cause pain in chewing and speaking, and are accompanied by 

 the symptoms of chronic oral catarrh, described in the first chapter. 

 The diagnosis rests partly on the history, partly on the objective symp- 

 toms above given. 



When condylomata occur at the edges of the tongue, they cause 

 little annoyance, and would be easily overlooked, if patients who have 

 long suffered from syphilis did not pay such attention to themselves. 

 They often recede at one place, while new ones come at another. In 

 other cases, without any treatment, they disappear for a longer or 

 shorter time, but come back again, and, with any treatment, show great 

 tendency to relapse. Condylomata on the dorsum of the tongue impede 

 its movements, and thus become annoying. Inspection of the mouth 

 renders the diagnosis certain, as the affection is not easily mistaken. 



The nodular syphilomata of the tongue develop without pain, 

 and even their ulceration does not cause much, but they render the 

 tongue unwieldy and rigid, and thus interfere with speaking and 

 chewing. But the ulcers left, after their breaking down, are very sen- 

 sitive to the touch of the teeth, and to hard articles of food. 



TREATMENT. The principles for treating syphilitic affections of 

 the mouth will be given hereafter. 



The effect of preparations of mercury on primary and secondary 

 ulcers and condylomata of the mouth is, as a rule, very striking. We 

 may, almost with certainty, reckon that, under mercurial treatment 

 they will very shortly improve, and entirely disappear. Nevertheless 

 we must guard against the misuse of mercurials, especially in repeated 

 relapses of syphilitic papules of the mouth, when they are the sole 

 symptoms of syphilis. Even the nodular syphilomata of the tongue 

 may disappear at any stage, under proper treatment. 



CHAPTER VI. 



SCORBUTIC AFFECTIONS OF THE MOUTH. 



ETIOLOGY. The affection of the gums is among the most constant 

 and among the first symptoms of scorbutis. The changes in the gums 

 are exactly analogous to those caused by the disease in other tissues. 



