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: a 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 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.
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| Syphillitic ulcers on throat |
(2) Syphilitic affection of the Schneiderian membrane (ozoena 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 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 alæ nasi, or higher up, ulcerations break out which, like those in the throat, are phagedænic, and may affect the nasal bones. If these become destroyed by the ulcerative process, the patient, 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 ozoena 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 seven years after the chancre had been healed, and is then regarded as a recent affection.