Syphilis of the larynx, trachea, and bronchi / by J. Solis Cohen.

  • Solis-Cohen, Jacob da Silva, 1838-1927.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Syphilis of the larynx, trachea, and bronchi / by J. Solis Cohen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The liistory of the case, and the previous or actual presence of mani- festations of syphilis elsewhere, are the main positive factors in the diagnosis of specificity, especially in the early stages of either variety. The later lesions of tertiary syphilis are often sufficiently characteristic; sometimes not at all so. In cases of doubt, antisyphilitic treatment will almost always detect a lesion of syphilitic origin, but not invari- ably. Hence, in instances of strong suspicion, the various methods of antisyphilitic medication should be thoroughly tried before that test is abandoned. This suspicion is justifiable in cases of obstinate chronic laryngitis, whether ulcerative or not, in individuals in whom no other appreciable local or constitutional cause can be detected. Laryngoscopic inspection is an invaluable aid in diagnosis; though practically indispensable, it is inadequate for fully appreciating the extent of deeply seated lesions; and its revelations are not always suffi- cient to establish the diagnosis in the absence of corroborative lesions elsewhere. Erythematous and catarrhal inflammation of secondary syphilis, when diffuse, are not to the ordinary eye distinguisliable from similar non-specific conditions. Circumscribed erythema, though usual in syphilis, occurs in non-specific laryngitis also; consequently, that conditign alone is insufficient for discrimination. Patchy erythema on the vocal bands, and elsewhere, may be regarded as characteristic. Not so, however, the shaded pigmentations at the extremities of the vocal bands. Symmetric bilateral localization of erythematous and other patches is highly characteristic of secondary syphilis; but a contrary condi- tion by no means excludes the diagnosis. Isolated bilateral conges- tions of the supra-arytenoid structures and of the Wrisbergii have been cited as pathognomonic. Nothing can be more fallacious or mislead- ing. Enlarged inguinal' and post-cervical glands furnish excellent cor- roborative testimony of syphilis. Papules, or condylomata, upon an erythematous mucous membrane, are to be considered pathognomonic. Their recognition may require an exceptionally good light on the one hand, or repeated examinations on the other. They must be carefully discriminated from minute collections of mucus or of saliva. Diffuse gummous infiltration is to be distinguished first from inflam- matory syphilitic infiltration by the coexistence of gummous proces.ses elsewhere, its more circumscribed contour, and its sharper definition. Differential diagnosis is much easier after it has reached t]t(> stages of liquefaction and ulceration. Syphilitic ulceration usually proceeds from above downward, rarely