INTERESTING MANIFESTATIONS OF SYPHILIS 
IN THE EYE AND THROAT: 
Ulcers of the Epiglottis, Strabismus, and Paralysis of 
■ Ocular Muscles. 
BY 
EDWARD F. PARKER/M.D., 
' OF CHARLESTON, S. C., 
DEMONSTRATOR OF ANATOMY, AND ASSISTANT TO CLINICAL LECTURER ON DISEASES 
OF THE EYE AND EAR, MEDICAL COLLEGE OF THE STATE OF 
SOUTH CAROLINA. 
FROM 
THE MEDICAL NEWS, 
1 April 29, 1893. [ Reprinted from The Medical News, Apri)*^, 1893. 
INTERESTING MANIFESTATIONS OF SYPHILIS 
IN THE EYE AND THROAT: ULCERS OF 
THE EPIGLOTTIS, STRABISMUS, 
ANO PARALYSIS OF OCULAR 
MUSCLES. 
BY EDWARD F. PARKER, M.D , 
OF CHARLESTON, S. C., 
DEMONSTRATOR OF ANATOMY, AND ASSISTANT TO CLINICAL LECTURER 
ON DISEASES OF THE EYE AND EAR, MEDICAL COLLEGE 
OF THE STATE OF SOUTH CAROLINA. 
Manifestations of tertiary syphilis, as distinguished 
from those of primary and secondary syphilis, have two 
important characteristics : they usually attack the patient 
long after the primary inoculation, when the lapse of 
years seems to give promise of future immunity, and 
has lulled all anxieties to sleep; while they are also 
characterized by the destructive tendency of the lesions, 
which leads to extensive and rapid alteration of shape 
and to a corresponding interference with normal func- 
tional perfection. 
The eye and throat, because, perhaps, they are more 
exposed, and in almost constant activity, are unusually 
common and popular sites for the exhibition of syphi- 
litic symptoms. 
On November 21, 1891, H. J., aged fifty years, was 
referred to me for throat-symptoms of an alarming 
nature. He had been suffering for some days with dysp- 
nea and dysphagia, which had rapidly increased, until 
swallowing was almost impossible. Being unable to 
swallow, he had lost flesh rapidly, and his breathi ng was 2 
so labored and noisy that it could be heard at some dis- 
tance. 
On examining his throat a most peculiar condition 
was found, the whole pharynx being covered with 
numerous deep, circular cicatrices, with considerable loss 
of tissue. The laryngoscope showed the epiglottis to be 
much enlarged, and on its lingual surface was a deep, 
circular, jagged ulceration. The epiglottis was doubled 
on itself in so peculiar a way as to resemble two large 
tumors of the vocal bands. The laryngeal opening was 
thus constricted to such an extent that a space not more 
than one-quarter of an inch in diameter was left for 
respiration. 
The swelling was intensely red, but easily distinguished 
from that of edema by its lack of transparency. The 
dysphagia and dyspnea had come on suddenly, and the 
condition of the parts below the epiglottis could not be 
determined. 
The diagnosis of syphilitic laryngitis with ulceration 
was made and subsequently confirmed by the history. 
Fifteen years previously the man had had a chancre and 
bubo, with mild secondary symptoms. Since that time, 
though suffering from occasional attacks of sore-throat, 
he had been in perfect health. His wife had aborted 
three times. 
So urgent were the symptoms that preparations were 
made for tracheotomy, should it become necessary. In 
the meantime the parts were daily sprayed with a solu- 
tion of borax, and afterward with carbolic acid and gly- 
cerin, alternating with an application of silver nitrate 
(gr. xx to gj). 
The general treatment given was mercury by inunc- 
tion and large doses of potassium iodid. 
The patient rapidly recovered as soon as the symp- 
toms of ptyalism appeared, and a seemingly desperate 
case progressed quickly to recovery. 
Another case, of a similar nature, presented on March 3 
20, 1893. James G., aged thirty-three years, consulted 
me, complaining of difficulty in swallowing and dyspnea, 
which had come on rather suddenly. On March 17th his 
throat felt sore, and three days later he was unable to 
swallow solid food. 
Laryngoscopic examination disclosed a thickened epi- 
glottis, and just at the line of junction with the tongue 
was a large, deep, circular ulcer on the left side, which 
gradually grew larger. The swelling was characterized 
by a hyperemia of intense crimson color, not uniform, 
however. The man admitted having had a chancre 
and bubo with secondary eruption ten years previously, 
but had been in perfect health since that time until the 
present attack. 
The treatment was the same as that detailed in the 
preceding case, and in a few days the swelling began to 
subside, the ulcer to heal, and recovery was rapid. 
The foregoing cases are interesting, not as rare in- 
stances of syphilitic infection, but as showing all of the 
diagnostic points of syphilitic laryngitis. The lesions 
may sometimes be taken for the ulcers of laryngeal 
tuberculosis, or for malignant grows, but the diagnosis 
can usually be made by the laryngoscopic appearances 
alone. 
The epiglottis is the most frequent site of ulceration 
in syphilis of the larynx, whereas in laryngeal tubercu- 
losis the ary-epiglottic folds are first attacked and present 
characteristic tumefaction. Multiple ulcers occur in 
tuberculosis, while the single ulcer is the rule in syphilis. 
The larynx in syphilis presents a most peculiar and 
almost pathognomonic redness, seldom seen in any 
other affection, while in tuberculosis of the larynx the 
opposite condition prevails; though the parts are 
swollen, they are unusually pale in color. 
The syphilitic laryngeal ulcer is acute in development 
and accompanied with no pain, except on swallowing; 
it may even remain unnoticed by the patient until ex- 4 
tensive changes, with subsequent contractions, have 
impaired the usefulness of the part. The ulcers of laryn- 
geal tuberculosis are usually quite painful, are of slow 
growth, and are aggravated by cough, with a large 
amount of mucous secretion. 
In the two cases reported there were single ulcers 
occurring on the lingual surface of the epiglottis ; tuber- 
culous ulceration usually involves the laryngeal surface. 
Malignant ulcers of the larynx are generally the seat 
of great pain, the neighboring lymphatics enlarge, and 
the surface soon assumes a fungous character. They, 
too, are of slow growth, and are preceded by a tumor of 
varying size. 
The peculiar features, then, of syphilitic ulceration of 
the larynx which would be sufficiently diagnostic, even 
in the absence of a definite injury, are : ulceration of the 
lingual surface of the epiglottis, appearing suddenly 
and characterized by active hyperemia, causing a crim- 
son, glassy look, and with little or no pain, except on 
swallowing. 
The importance of getting the patient rapidly under 
the influence of anti-syphilitic remedies cannot be over- 
estimated. The ulcers are likely to lead to great de- 
struction of the parts, to adhesions and cicatricial con- 
tractions, which cause permanent and dangerous changes 
in delicately-constructed organs. 
When the patient is able to swallow, the plan I pursue 
is to give hydrargyri chloridum mite, gr. j; pulvis ipe- 
cacuanhae, gr. % ; pulvis opii, gr. %, three times a day, 
in conjunction with twenty drops of a saturated solution 
of potassium iodid, gradually increased to fifty or sixty 
drops. As soon as symptoms of ptyalism appear, the 
mercury is stopped and the iodid continued. If the 
patient is unable to swallow the pill, I practise inunction. 
By these means, at the end of three or four days the 
system is thoroughly anti-syphilized, and improvement 
is rapidly noted. Local treatment, by means of cleansing 5 
sprays and the application of stimulating caustics di- 
rectly to the ulcer, is of great assistance in hastening the 
reparative process. 
The following are two rather rare examples of syphilis 
of the eye: 
Josh G., aged forty-six years, consulted me in Feb- 
ruary, 1893, for strabismus and failing vision. He had 
been confined to bed for some time previously with an 
attack of paralysis of the left arm and leg. The right eye 
was turned to the nasal side and almost fixed in this un- 
natural position by a paralysis of some of the ocular 
muscles. Vision was much impaired, but was not tested 
accurately, owing to the ignorance of the patient. The 
eye was movable to the left and downward, but immov- 
able upward and to the right. The man denied any 
syphilitic history, but several stigmata were found upon 
his legs, which confirmed a diagnosis of probable 
gumma of the brain. Under treatment improvement set 
in, the movement of the eye becoming more natural, 
when the right side of the face became paralyzed. In 
consequence of this, a large corneal ulcer formed and 
gradually spread. The contents of the globe became 
purulent, and were discharged through the perforating 
ulcer; the globe was destroyed and the patient died soon 
afterward. 
On March I, 1893, George A., aged thirty years, was 
referred to me for strabismus convergens of both eyes. 
V.: R. E., 12/xx; L. E., 12/XL. There was an old 
leukoma in the left eye. 
The man was a constant sufferer from severe head- 
ache, which was referred to the occipital region and con- 
fined him to bed at intervals. Tinnitus aurium existed 
to a depressing degree. No history of syphilis was ob- 
tained, nor were there any scars or cicatrices on the 
penis ; yet upon his body stigmata betrayed the previous 
existence of the disease. 
The man was put upon anti-syphilitic treatment, with 6 
the result that the strabismus was rapidly corrected, 
vision improved (R. E., 12/xn ; L. E., 12/xxx), head- 
ache disappeared, and the tinnitus was much relieved. 
Dr. Hyde, of Chicago, in an admirable article in The 
Medical News, March 18, 1893, p. 281, calls attention 
to the importance of studying the ravages of former dis- 
ease, as shown in scars or stigmata on various portions 
of the body. Those of syphilis are almost pathogno- 
monic, and should always be looked for in obscure cases 
of disease. He also calls attention to a very important 
fact, namely, that these syphilitic stigmata are less fre- 
quently found on the penis than upon other less accessible 
regions of the body, and that failing to find them on this 
organ they should be sought for carefully elsewhere. 
These stigmata become, then, not only important links 
for diagnosis, but positive therapeutic indications. The Medical News. 
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