This section is from the book "Diseases Of The Intestines", by Max Einhorn. Also available from Amazon: Diseases Of The Intestines A Text-Book For Practitioners And Students Of Medicine.
Syphilitic ulcers of the intestines are quite rare. In the small intestine they are mostly met with in the new-born. Here the ulcers are found either singly or in great numbers over the entire small intestine. They originate in the lymphatic apparatus of the mucosa and submucosa, first forming gummata within the intestinal walls, which afterward undergo rupture. Syphilitic ulcers of the small intestine have also been observed in adult life (Klebs,1 Birch-Hirschfeld2).
Of greater clinical importance are the acquired syphilitic ulcers which often occur principally in the lower part of the colon and the rectum, including the anus (most frequently the lower part of the rectum a few centimetres above the anus is affected). We may have primary ulcers of the rectum through direct infection after a preternatural coitus. These are observed principally in men and are located in the median line of the anus. They are characterized by a hard base, sharp margins, and bacon-like appearance. We may also have secondary ulcers due to constitutional syphilis. Condylomata and gummata may undergo degenerative changes and form ulcers, which by their cicatrization very often give rise to the development of strictures of the rectum. The latter variety is much more frequently found in women than in men. Among two hundred and nineteen patients with constricting rectal ulcers Poelchen 1 found one hundred and ninety women. This author, however, correctly remarks that not all these ulcers resulting in stricture are due to syphilis. In a great many instances their origin is attributable to a gonorrhoeal affection of the Bartholinian glands which ultimately through infection leads to destructive processes within the rectum.
Some of these ulcers may also result from traumatic causes, such as the frequent use of clysters or hard fecal matter irritating the mucous membrane.
1 Klebs: "Handbuch der pathologischen Anatomie," Berlin, 1868. 2 Birch-Hirschfeld: "Lehrbuch der pathologischen Anatomie, " Leipzig, 1887.