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 phagedænic chancres of the fauces; (4) as spots or 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 vertebræ Usually, at least very frequently, these phenomena set in with a simple redness and puffiness of the mucous 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 signs 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 always 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.
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(3) Simple ulcers, especially 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 small abscesses in the tonsils.
(4) Simple aphthæ, which some might possibly mistake for syphilitic ulcers, break out, especially 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 may readily be cofounded with syphilitic ulcers, so much more easily since these so-called gastric aphthæ 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 disappear 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 shead light on the true nature of the case.