Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.
- Mansell-Moullin, C. W. (Charles William), 1851-1940
- Date:
- 1893
Licence: Public Domain Mark
Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![sliyhtly raised ajul hardened spot, pi^nieiUed for a time. This, however, is ex- ceptional. More fre(|uently the epidermis scales off, exposing the subjacent ti.ssue, which undergoes necrosis and melts away ; but whether this is due to the effect of the poison, or simply to i)ressure, is not known. When this happens it leaves a suiierficial sore, which may or may not suppurate ; in many cases the only dis- charge is a thin watery serum with a few ei)ithelial scales, or a little tissue debris without true i)us from first to last. If a soft chancre is present already, the appearance and the discharge are naturally dependent upon this ; the only change at the end of the incubation jjcriod is a sudden hardening at the base. Chancres in the finger usually take the form of a ])atch of small and rather Horid granula- tions, with little discharge, and without any evidence of cicatrization at the edge. The margin is raised above the level of the skin, and appears steep and thick from the exudation it contains. On the lips it is much the same, only in some ca.ses the infiltration at the base and edges is so great that it is slightly cup-shaped. The duration of the hardening and rapidity of cicatrization are no less variable. If untreated, the sore is said to last six or nine months, and leave a cicatrix depressed according to the amount of tissue lost. Very often, however, under the influence of mercury it vanishes altogether in a few weeks, and it is ex- ce])tional for it to continue more than three months. Its disappearance is not complete until all hardness is gone from the cicatrix ; sometimes when a hard sore complicates a soft one, healing takes place very soon after commencing mercurial treatment; but in spite of this the induration of the base persists for a considerable period. When the infection is mixed, the extent of the suppuration is sometimes pro- fuse, but there is no evidence that it is ever sufficient to prevent the development of constitutional symptoms. The same may be said of phagedsena. Relapsing chancres are occasionally met with. It is not uncommon to find, if the treatment is interrupted too soon, that the induration, which was beginning to subside, extends again ; but, independently of this, true relapses occur, sometimes a year afterward, the seat of the original infection becoming indurated again and slowly subsiding under treatment without there having been a sign of its existence in the meanwhile ; and this may hapi)en more than once. 2. The Secondary Symptoms.—The secondary stage includes the infec- tion of the lymphatic glands, and the general symptoms that follow the entry of the poison into the circulation. Glandular eiilargonent usually shows itself ten days or a fortnight after the appearance of the primary sore. The local ones are affected first, the inguinal, for example, when the chancre is on the penis, the submaxillary when it is on the lip; but it never remains limited to them. From the beginning the enlargement is multiple, and it soon becomes general, not as in the case of the uncomplicated soft chancre, limited to one locality and often to one gland. The character of the swelling is also quite different. Unless the infecting chancre is inflamed, or a soft one is present as well, there is little or no infiltration of the periglandular tissue; the enlargement is confined to the glands themselves ; they swell up, become hard, and slightly tender, but they remain perfectly isolated and distinct, and they are as freely movable as they are in health. The inflammation is specific, not simply due to absorption of septic or suppurative products. Whether suppuration occurs in the first set of glands involved depends entirely upon the character of the .sore ; if it is foul and sloughing, the pyogenic organisms will, in all probability, gain access through the lymphatics, and, finding a genial soil, excite suppuration, whether syphilis is present or not, and without having any influence upon it. The same thing is true of phagedena ; an ulcer left by a sup- jnirating bubo, occasionally under the combined effect of syphilis, a broken-down constitution and other injurious influences, becomes itself phagedenic ; but at the present day it is decidedly rare. The glands once removed, too far distant to be affected by local causes of this character, sometimes attain a very considerable size, but never form abscesses. As a rule the enlargement subsides quickly at](https://iiif.wellcomecollection.org/image/b21213744_0107.jp2/full/800%2C/0/default.jpg)
