The Oropharynx.
—The tongue may be the site of intermediate and late syphilitic lesions. Men suffer more than women, apparently because of their use of tobacco. Mucous patches, deep ulcers, and even gummas, single or multiple, are seen here. Gummas in the tongue are inclined to undergo superficial ulcerative infection and become abscesses. In these lesions there will be notable involvement of the adjoining lymphatics. The appearance of smooth, bluish-gray patches upon the mucous membrane of the tongue and cheeks is known as leukoplakia or leukokeratosis. These lesions do not respond readily to treatment; they give rise to little or no complaint, and are often followed by malignant disease.
It is difficult to distinguish between gumma of the tongue and epithelioma. Usually the latter is a single lesion; the former often multiple. In epithelioma the ulcer is superficially painful, with more elevated and indurated edges, while the pain is sometimes intense and radiates toward the ears.
Interstitial glossitis is a late manifestation of a sclerosis beginning in the connective tissue and involving the muscle fibers, leading to enlargement of the tongue and later to atrophy and inflexibility.
The Larynx.
—Syphilis of the larynx appears either as one or more ulcers, as gumma, or as chondritis or perichondritis, often with necrosis of cartilage. When ulcers form they are deep and destructive, involving even the intrinsic muscles of the larynx, and causing harshness or loss of voice, with dyspnea. Subsequently they lead to cicatrization, often leaving a stricture which may call for tracheotomy. The epiglottis is also liable to ulceration and gummatous lesions.
In these cases, aside from the general treatment, there is need also for local applications of combined antiseptic and anodyne character. Cocaine or one of its less toxic substitutes may be used in spray or by insufflation, in connection with an antiseptic powder, morphine or heroine. Edema of the glottis may be subdued by the local use of adrenalin.
The Alimentary Tract.
—Between the mouth and the rectum the intestinal canal is rarely involved in syphilitic disease. In the rectum, however, ulcers, as well as gummatous infiltrations, are frequently encountered. If the ulcers are low, within two inches of the anus, they will cause great pain. Higher up the rectum is not so well supplied with sensory nerves. Ulceration may involve the entire circumference of the anus.
In the rectum chronic ulcers are liable to be followed by stricture, which will call for surgical relief. (See chapter on the [Rectum].)