SYPHILITIC AFFECTIONS OP THE PHARYNX. 4.75 



boundary of the redness, at the line where the soft palate becomes the 

 hard, is as little characteristic of this disease as is a bluish-red (copper) 

 color of the mucous membrane; we find both of these appearances in 

 non-syphilitic cases of catarrhal angina. 



Syphilitic mucous papules also come chiefly on the arches of the 

 palate and the tonsils, which are sometimes extensively covered with 

 them. In such cases, if the epithelial covering be milky, on superficial 

 observation it looks as if the mucous membrane were covered with a 

 croup membrane, and, if the white coating be present only in the space 

 between the half arches of the palate, it seems as if there were an 

 ulcer covered with a fatty base. The ulcers caused by the breaking 

 down of syphilitic papules present losses of substance, reddened or 

 covered with gray detritus, and bleeding easily, which gradually 

 spread, by the breaking down of more recent papules that come 

 around the edges, but show no tendency to become deeper. Condylo- 

 mata form, small pedunculated excrescences, particularly on the uvula. 



Gummy tumors occur in all parts of the pharynx. If they develop 

 on the tonsils, these at first appear decidedly swollen, with smooth red 

 surfaces. The breaking down of the nodules causes deep ulcers, of the 

 size of a pea or a bean, with fatty floors. Not unfrequently gummy 

 tumors form on the posterior wall of the velum, and then sometime:? 

 cause perforation before they are recognized. Gummy nodules, and 

 the ulcers caused by then- breaking down, occur most frequently on 

 the uvula and the parts of the soft palate bordering it. At first the 

 uvula looks as if gnawed, later it only hangs by a small pedicle, finally 

 it and a large part of the soft palate may be destroyed. Under prop- 

 er treatment, gummy tumors may be resolved. In such cases there 

 is proliferation of connective tissue at the former seat of the nodule ; 

 this subsequently shrinks, and there is a cicatricial contraction. If ex- 

 tensive ulcers heal, there remain radiated, firm, white cicatrices occa- 

 sionally also adhesions of the soft palate to neighboring parts, con- 

 strictions and distortions of the pharynx, or closure of the Eustachian 

 tube. 



SYMPTOMS AND COURSE. Syphilitic catarrh of the pharynx can- 

 not at first be distinguished from other pharyngeal catarrhs ; diagnosis 

 is only possible later in the disease. If a patient has had difficulty of 

 swallowing for weeks, if this difficulty has come on gradually, not sud- 

 denly, and if it obstinately resists all treatment, we may strongly 

 suspect that the existing catarrh is of syphilitic nature. If these 

 difficulties are found in a person who had a chancre a few weeks pre- 

 viously, and if they improve rapidly under the use of mercurials, the 

 diagnosis may be considered as certain. 



Syphilitic mucous papules often develop without pain or othei 



