Clinical notes on chancre of the tonsil, with analysis of fifteen cases / by L. Duncan Bulkley.

  • Bulkley, Lucius Duncan, 1845-1928.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Clinical notes on chancre of the tonsil, with analysis of fifteen cases / by L. Duncan Bulkley. 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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    most carefully studied, the history and train of symptoms, with the condition of the patient then present, were such as to make the diagnosis absolute. In all the cases there had been no diagnosis of tonsillar chancre previously. Many of them had been treated as tonsillitis, one as diphtheria, one as grippe. It is fair, therefore, to suppose that the general profession, and even those engaged in throat practice, are not very familiar with the primary lesion of syphilis in this locality, and are not on the lookout for it. One of my most marked cases, in a young man, was sent to a throat clinic by one of my assistants before I saw the case, and was there treated for tonsillitis with iron and chlorate of potash. In one of my cases, in private practice, a lovely married lady, whose husband I saw, and who was certainly free from syphilis, had what was supposed to be tonsillitis, but which she herself recognized to be something different, owing to the stony hardness of the tonsil. In a month or thereabouts, while she had great malaise, supposed to be due to the tonsillitis, an eruption broke out, which was then called measles, and when the hair fell out, it was thouglit to follow that exanthem. When she came to me with a palmar and plantar syphilide, a month later, there was still the hardness of the tonsil, the greatly enlarged sub-maxillary glands of that side, and other manifestations of constitutional syphilis. We may now briefly consider the symptoms commonly presented by these cases. In most of my patients there has occurred, as the first symptom, a stinging pain in the tonsil to be affected, with a moderate pain on swallowing. The tonsil then swells pretty rapidly, so that at the height of the trouble it may project fully to the median line of the throat, and in some cases I have seen it enlarged vertically so as to reach above and behind the velum palati and below the ordinary visual line behind the tongue; iu rare instances the enlargement is not very great. The surface of the tonsil is always very red, but commonly, as in the primary lesion of syphilis of the penis and elsewhere, the ulceration is not a striking feature, indeed, in some instances there is very little loss of substance. But with care there can always be made out some erosion of surface, and the margin of this, as in chancre elsewhere, will be well defined and sharply cut, although seldom much elevated. The base of the sore will generally be