Syphillitic tubercles Diagnosis:

D-JAHR Georg Heinrich Gottlieb

This is a generally not very difficult, especially if other syphilitic symptoms are present on the sexual organs. The only appearances with which they might possibly be confounded, are the elevated chancre, figwarts, mercurial ulcers, and at the anus, with ulcerated hæmorrhoids, or hæmorrhoidal rhagades. From the elevated chancre, and from figwarts, they will readily be distinguished by any one who has read our description of both these appearances in §§ 37, 68, and 73. It is likewise impossible to confound them with mercurial ulcers, even when these are seated in the mouth and fauces; for these ulcers are never raised, but always flat, generally spreading over an extensive surface, and always of a milky-white appearance. As regards hæmorrhoidal ulcers or rhagades, they are always of a more or less violet-red color, never flattened, but always globular, elastic and not resisting to the feel. But it is more difficult to distinguish these tubercles from an old, neglected or mismanaged, ordinary, simple chancre, for the reason that a mucous tubercle, if it occurs singly,

Condylomata accuminata

 very frequently resembles a chancre in the stage of fungous growth. It is true that, in most of these cases, the remnants of the sharply-circumscribed edges of the chancre can be readily distinguished from the less sharply-circumscribed border and base of these tubercles; but chancres which, like syphilitic erosions, have remained superficial, and which afterwards become suddenly raised, or exhibit marked granulations, very frequently bear a very close external resemblance to these tubercles. Ricord's assertion that we may always be sure of having to deal with an old chancre, if a patient who had no previous syphilitic symptoms about him, presents himself for treatment after having become infected with one or two such tubercles that had broken out at the spot where chancres are in the habit of making their appearance, may be perfectly correct in most instances, but not by any means in all. I have seen two such tubercles on a young mechanic-one on the frænulum, the other on the inner surface of the prepuce-three days after they had broken out all at once, which I certainly should have mistaken for old chancres in the period of fungous reproduction, if I had not been well acquainted with the patient, who was in the habit of consulting me for the smallest trifles, and would not have allowed a chancre to reach this period without coming to me for treatment. No other symptoms of either primary or secondary syphilis could be discovered in this case; but the girl who had infected him, and who did not keep herself very clean, had a number of such tubercles on the inside of the labia majora and at the anus. On the other hand, it is undoubtedly correct that these mucous tubercles generally break out on different parts at once, in greater or less quantity; in a case of chancre this never takes place in the same manner.